Medical professionals have a role to play as advocates for public health, but “system change” is necessary, says MedAct Bristol.
At a full council meeting on the 19th March, Bristol’s Labour mayor, Marvin Rees, made the unusual move of sticking it to the NHS – or more specifically – two local doctors who raised the issue of the council’s delayed action on air pollution and its enormous health impacts.
“The NHS generates five percent of all road journeys in this country,” Rees said. “They contribute 735 deaths through air pollution, causing 85 deaths and 772 major injuries through traffic, and they create £650 million-worth of demand on NHS services. I’ll be interested to know what the NHS is doing around transport plans to take the burden you bring off our roads.”
The mayor’s defensive outburst was prompted by a petition from Dr Ellen Wood and Dr Victoria Stanford from MedAct Bristol, the local arm of a nationwide campaign group of medical professionals working to tackle social inequalities. The group is urging the mayor to take action now on the air pollution crisis.
The Cable caught up with MedAct Bristol members to hear about why education around air quality is so essential in healthcare, and what they are doing about it.
“It sounded like he was scraping the barrel,” Stanford says, when asked about Rees’ response to her question. “It was a knee-jerk reaction: it’s not something he’s mentioned before or since. And there’s no real data to support his accusation. After all, there’s no alternative to healthcare, but there are alternatives to private transport.”
You buy in
So we can't sell out
Become a memberJoin the Cable
Since forming last year, MedAct Bristol has been focusing on air pollution, holding public events and penning an open letter to the council. The March statement to council came after news broke that the already delayed Clean Air Plan wasn’t going to be ready until the end of the year.
Activism from the medical profession around air pollution isn’t new. Doctors against Diesel, a spin off campaign from MedAct formed in 2016, have vociferously spoken out against the use of diesel vehicles in inner-city locations, and want them to be completely phased out.
There is still concerning ignorance about the dangers of air pollution among healthcare professionals
Dr Guddi Singh, a Doctors against Diesel representative, told the Guardian: “As our knowledge of the link between air pollution and ill health grows, so does the weight of our responsibility towards those affected by it, especially the next generation. We won’t be able to tell them that we didn’t know, or that we didn’t have a solution. If we fail, it’ll be because we didn’t want to succeed.”
Doctors as advocates
Stanford believes there is an urgent need for Bristol’s medics to stand up and be counted in the campaign to clean up the city’s toxic air: “Doctors have an advocacy role. We have an important voice in the debate. Advice coming from a trusted profession can have a huge impact. It can change behaviour.”
Parents could stagger their school runs, for instance, to avoid idling vehicles outside schools. Or they could walk or cycle with their children to school. Research has shown that car users are exposed to twice the pollution than pedestrians are, and nine times the amount cyclists breath in.
Stanford practices as a GP and she notes that, while progress is being made, there is still concerning ignorance about the dangers of air pollution among healthcare professionals.
“Understanding of the scope of the problem is poor,” she explains. “[Air pollution] is just not known about. It’s not on our curriculum, nor in our training. Environmental health is not on the agenda at all for medics.”
She gives the example of a patient coming into her practice with asthma. Standard practice is to ask about triggers for attacks: does the patient smoke? Do they have a history of respiratory disease? But now, she has also taken to asking also whether the patient lives by a busy road or whether their asthma gets worse as they move about the city.
“Currently, air pollution isn’t included on the list of possible triggers,” she notes. “Exposure to car fumes isn’t even on the radar. It’s not proactively known about, so people don’t tend to modify their behaviour to avoid it. But [as doctors] if we’re ignorant, then it leaves absolutely no chance for patients to protect themselves.”
To raise greater awareness among medical professions, MedAct have, alongside their campaign work, published a checklist for frontline doctors to check patients against air pollution exposure. They are also working with NICE and Public Health England to highlight the issue among patients and doctors.
Links between poverty and pollution
At the full council meeting where he was challenged by MedAct representatives, the mayor alluded to the conflict he sees between taking action on air quality and delivering economic growth for the city: “We’re not [going] to trade off economic growth against the environment. Sometimes they clash but we have to deliver on both at the same time.”
But the doctors speaking to the Cable think this is a false dichotomy. Dr Emma Coombes, a MedAct member and paediatric specialist, believes that Bristol City Council has failed to fully appreciate that air pollution doesn’t exist separately to socio-economic concerns – the two are closely interlinked.
“The more emphasis we put on patients and risk-avoidance behaviour, the more we let authorities and local councils off the hook – they’re the ones who can effect widespread change”
She explains: “Poverty is as much a public health issue as air pollution. Children in [some] lower-income families suffer the most from the effect of poor air quality because of Bristol’s geography, among other factors. Inner-city areas have the busier roads and are at lower altitudes than more affluent areas.”
Furthermore, air pollution itself feeds in to future economic disparities and has an economic impact. “The council seems behind the curve in recognising there’s an economic impact to air pollution,” she notes. “Our children are our future workforce who’ll be paying taxes, paying people’s pensions. We need to see tackling air pollution as an investment in children.”
When asked about the work the council has done to tackle air pollution, Coombes says it is inadequate. In particular, she considers the council’s fixation with not slowing economic growth to be a significant obstacle to improving a public health.
“I don’t think the council is taking things seriously enough,” she admits. “I think what Marvin Rees is doing is pitting causes of ill-health against each other. Air pollution is a socio-economic driver of ill-health – it makes people poorer. He’s failing to recognise that these things are interconnected.”
As well as campaigning for increased awareness of air pollution among front line medical professionals, MedAct delivered an open letter to the council setting out a list of recommendations. These include the adoption of the most comprehensive Clean Air Zone (CAZ) plan available, which would have the widest geographic reach and charge all vehicles entering it. (The council, it appears, has already dismissed this version of a CAZ though.)
But the letter also warns that a CAZ must be supplemented with comprehensive strategies to move people away from private car use, and towards public transport and healthier transport options. The emphasis, it says: “Should be on improved and reduced cost public transport, great access to cycling and walking routes, as well as subsided travel for lower-income workers.”
Having a joined-up approach to city planning which encourages greener, more active lifestyles is vital for Bristol’s public health, says Stanford. “The more emphasis we put on patients and risk-avoidance behaviour, the more we let authorities and local councils off the hook – they’re the ones who can effect widespread change.”
“I hope the mayor is proactive about it,” Stanford concludes. “Because if we wait another year, that’s another 300 people who are going to die in Bristol due to poor air quality. I want to see progress being made.”