IHWG/IZCWG Joint Meeting – Blog
Six per cent of mortality in the West Midlands is due to poor ambient air quality. We know that air pollution is the greatest risk to health; the clinical evidence for this is long established and robust. However, this is not a problem which begins and ends in the health sector. Its roots can be found in transport, industrial, waste and other practices, and its solutions must therefore also include those areas. It is a problem which is also growing in complexity – while we know much about the links between outdoor air quality and health, we know far less about the role of indoor air quality in health outcomes. Indoor air quality is complex because there is so much variation in indoor (and domestic) environments, and yet anecdotal evidence and recent stories such as the death of two-year old Awaab Ishak from mould in the home tell us that this is an urgent problem.
As always thinking innovatively and comprehensively about big social problems, the West Midlands Innovation Programme saw two of its Working Groups come together to discuss the interaction between health and the co-benefits of the zero carbon agenda on the issue of air quality. The Innovative Health Working Group and Innovative Zero Carbon Working Group hosted two panel discussions; one on indoor air quality and one on outdoor air quality, to explore the antecedents and possible places to address these wicked problems, and to start collaborating to do so across sectors.
Indoor Air Quality
The first panel on indoor air quality brought together Hem Patel, MD of ActivePure Technologies; Dr Louis Gyoh, Head of the Department of Built Environment at the University of Wolverhampton; Anna Edwards of Health Innovation West Midlands and Dr Suzanne Bartington, Clinical Associate Professor at University of Birmingham and UKRI Clean Air Champion.
Dr Bartington explained the robust evidence for the risk of poor outdoor air quality and health but highlighted that the link between indoor air quality and poor health was less well evidenced as this was really difficult to study. This is because there are so many factors that contribute to air quality; cooking methods and ingredients, cleaning products, air fresheners/candles, pets, microbes, smoking, volatile organic compounds (VOCs, often found in paint, solvents and cleaning compounds) and the build quality of the home. Exposure is thus extremely variable. However the panel was clear that we do know there are links, and so anything reducing exposure in the home will be beneficial, particularly for vulnerable groups such as children, pregnant women and elderly people.
Dr Gyoh set out the University of Wolverhampton’s plans to find funding to do research to improve indoor air quality and measure this. In the face of the aforementioned multiple factors which can contribute to poor air quality, buildings must be properly ventilated. Building regulations for ventilation standards were made more robust in 2022, and as such going forwards many of these problems can be designed out. However most homes were built before 2022 and many are not sufficiently well ventilated, leading to a build up of condensation (which encourages mould), and other harmful compounds.
Technology does have a role to play in alleviating some of these challenges. ActivePure Technologies have produced a technology which eradicates microbes – including the Sars Cov 2 virus – in under 60 seconds. It can also contribute to combating the mould crisis (a victim of which was Awaab Ishak as previously mentioned). It can be retrofitted into indoor air ventilation units, or hardwired as a small unit. It could also be used in the transport sector to reduce the spread of illness. Hem Patel talked about their experience of testing their technologies in Birmingham City Council homes; this reduced tenants’ asthma levels as the mould aggravating their condition did not come back.
Other helpful technologies can work to reinforce behaviour change, for example, apps that communicate to people the improvements to their health (and their wallet!) once they have given up smoking. Many people are not fully aware of the risks of poor indoor air quality and how it can lead to poor cognitive function as well as poor physical health – technology can be used to facilitate that understanding. More broadly, technology is important for monitoring air quality in the workplace, both in clinical and non-clinical settings. Technology can also be used to build up the evidence base where it is lacking in indoor air quality and be used to communicate the less understood risks of poor indoor air quality to clinicians through online learning modules.
However, we need to go further, both with technology and beyond. The discussion following the panel highlighted that despite the myriad of opportunities currently provided by technology, people’s homes – where they spend most of their time and are responsible for their greatest outgoings – do not give us any information at all (unlike our phones). Dr Gyoh explored the idea of having ‘dashboards’ in homes as standards to provide air quality (and other sorts) of information. Yet information is not enough – not everyone is equally able to use the information to improve their homes in order to remove the risks of poor air quality. Technologies like ActivePure can be a very useful tool to address the symptoms of poor quality housing, but thermally inefficient, poorly ventilated homes are the cause of many of these problems and their associated health outcomes. It is the socioeconomically disadvantaged groups who most often live in these homes and who need regulation to protect them. This takes us into the fraught world of thermal efficiency ‘retrofit’ of homes – an area which has suffered from a lack of consistent policy direction and support for well over a decade. Here we have flawed information about the building stock (the discussion touched on the unreliability of Energy Performance Certificates to give an idea of how thermally efficient a house is and how to improve it, and moves to correct this), an insufficiently skilled workforce to provide the high quality retrofit design and delivery in order to avoid making health problem worse, and a lack of understanding of the link between the two in that workforce. The panel and discussion certainly highlighted the need to work across health, construction and innovation to address this particularly knotty problem.
Outdoor Air Quality
For the second panel, Dr Suzanne Bartington was this time joined by Dr Mohammad Nazir of Nazir Associates, Daniel Johns of Vaisala and Sally James, Air Quality Policy Manager for Birmingham City Council.
As explained in the first panel, outdoor air quality receives a great deal of coverage, and its links to poor health are clear. Dr Bartington pointed out that addressing outdoor air quality is very much part of the transition to a net zero future, which must include a transition in housing quality (as discussed) and transport. Much work is being done to reduce tailpipe emissions (for example through electric cars), but so far, the issue of non-exhaust emissions (for example from tyres) has not received equal attention. Dr Bartington is evaluating the impacts of Birmingham’s Clean Air Zone (CAZ) in real time, working in partnership with local government; an exciting opportunity to see how much difference can be made to people’s health by such a policy.
Sally James talked about the CAZ in more detail – she described how it has indeed reduced the impact of highly polluting vehicles, but Birmingham City Council wants to go beyond this and facilitate a modal shift. This is a real challenge for a city which has such a big population and is a nationally important motorway connection point, and where people often highlight how perceptions of safety act as a barrier to that modal shift. Sally James explained that myth busting was important to address this challenge – pointing out that people are still at risk from pollution when inside vehicles, and are not more at risk on a scooter, bike or on foot. Additionally, individual behaviours to keep children safe (for example by driving them to school), can lead to a greater build up of air pollution around schools – and children are at greater risk of lung damage from such air pollution.
This was followed by an in-depth discussion of the issue of monitoring air pollution, to try and understand where the most effective action can be taken. It was pointed out that monitoring systems themselves need to be monitored, calibrated and maintained, but if they are, they can give a general idea of the geospatial changes in air quality. Dr Nazir has taken all data of this publicly available type, combined it with weather and traffic data, and carried out predictive analysis using AI to give a more accurate idea of pollution levels across a more granular scale, which can be checked through an app. This can help people make better choices to protect their health, but only if they have a range of choices available to them about when, where and how to travel. Daniel Johns is exploring how you can create a predictive model at really high resolution (15 meters), and how you can get that information to the health sector in a way that they can use it, perhaps by making more staff available to deal with a predicted influx of patients.
This led to a discussion of monitors and their limits in general. Monitors need to be in the right place to give good quality data, but there are trade-offs to avoid vandalism, and increase accessibility for reading, which can reduce the quality of data they are able to give. Low cost sensors have been considered a ‘silver bullet’ for the last two decades, but their use has not led to an increase in positive health outcomes. There are indeed desires for more accurate data collection, at higher levels of resolution. There again, the point was made that if we spent as much time focusing on action to reduce air pollution, as we do focusing on how well we are measuring it, we would have gone some distance to addressing this problem already! We must beware of fetishizing data, and the technology that provides it, and rather take action – often in the policy and regulatory sphere, such as with CAZs, to address the £3.2bn health impact of poor air quality in our region.
Closing Note
This joint meeting of the Innovative Zero Carbon Working Group and Innovative Health Working Group is an excellent example of the ability of the West Midlands Innovation Programme to work across sectors, and across the public and private divide, to bring together the greatest expertise with technology and policy innovation, to drive forward collaboration. As the secretariats for these two working groups, Emma Yeap and I, Beck Collins, were proud to see our region blazing a trail in addressing such an important social issue.
