New working party being set up to establish how indoor environments are impacting on children's health

The Royal College of Paediatrics and Child Health (RCPCH) is proposing to undertake a 17 month project to produce an evidence based report on the impact of indoor air pollution on children’s health in the UK which will include much needed open access systematic reviews of evidence. I've been working voluntarily with them to help set up the working party and set out the context below. I urge those of you with CSR and charity budgets, to consider supporting the RCPCH's efforts on this through a charitable donation -the fundraising leaflet in PDF form can be downloaded here.

Poor outdoor air quality is gaining traction as a global public health concern. According to research published in The Lancet (2017) exposure to ambient air pollution increases morbidity and mortality, is deemed a leading contributor to global disease burden and exposure to ambient PM2.5 has now made it into the top 5 mortality risk factors (ranked as number 5 in 2015). The authors analysed spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015, finding that exposure to PM2.5, in 2015 alone, was responsible for 4.2 million deaths and 103.1 million disability-adjusted life-years.

There is well documented public concern over outdoor air pollution yet, given the average adult in the UK spends 92% of their time indoors on a weekly basis, just 2 hours a day outdoors (Ribble Cycles, 2017), should concern about air quality end at the front door?

Air quality (indoors as well as outdoors) concern for public health

In the UK, in 2016 the medical community, represented by a partnership between the Royal College of Physicians (RCP) & Royal College of Paediatrics and Child Health (RCPCH) set out their concerns publicly, with the publication of a joint report Every breath we take: the lifelong impact of air pollution which examined the impact of exposure to air pollution across the course of a lifetime. The report set out the now much used figure of 40,000 deaths annually attributed to exposure to outdoor air pollution in the UK.

The report also highlighted that indoor air pollution is often overlooked. Factors such as location of buildings in areas of poor outdoor air quality, building design, the building itself, its ventilation, the materials from which it is built and those with which it is decorated, faulty boilers, open fires as well as fittings, furnishings, cleaning and personal care products can cause poor air quality in our homes, workspaces and schools. The possible health consequences of exposure to poor indoor air quality include but are not limited to: asthma, respiratory irritation, effects on the heart, and cancer, as well as headache, tiredness and loss of concentration.   

Indoor air pollution in the nation's homes has received considerable attention over the past two years:

• the Bonfield Review Each home counts was published in 2016, which included recommendations for action to tackle poor indoor air quality;
• earlier this year the National Institute for Health and Care Excellence (NICE) established a committee to devise guidelines for 'Indoor air quality at home';
• the All Party Parliamentary Group for Healthy Homes and Buildings has been actively working to raise standards and improve building regulations for homes; and
• the UK Indoor Environments Group recently published a report on a workshop held with government departments and agencies on the challenges of delivering healthy indoor environments.

Consistent across all recommendations is the need to address knowledge gaps. To date there has been no work to systematically review the evidence of medical impacts of poor indoor air quality exposure across the life-course of children in relation to how these risks could be mitigated across the variety of indoor environments children are exposed within, in the UK. In order for those devising solutions to move forwards, we need to bring together the often localised/building typology and, or, health condition specific evidence to provide a comprehensive state of knowledge, open access, to help those working in an evidence based manner to devise solutions that mitigate this health risk and produce safe indoor environments.

Air quality indoors and child health

The quality of the air indoors in our homes, workspaces and schools is important because it is here that our children, from foetus through childhood, spend the majority of their time. Air pollution is considered one of the leading dangers to children's health - when combined with the impacts of outdoor pollution, air pollution has been directly linked with pneumonia and other respiratory diseases, accounting for nearly one in ten under-five deaths (UNICEF, 2016).

In April 2017, whilst I was still working for the EPSRC funded ARCC network, we were asked by the medical community to bring together the medical and built environment communities to explore what was known about indoor air pollution and what could be done to tackle it across the variety of UK housing stock. The workshop, “Better homes, better air, better health” hosted by the RCPCH brought together professionals across research, industry and the third sector. It highlighted the need to strengthen understanding of the relationship between indoor air pollution exposure and health impacts, identify solutions to help tackle and reduce indoor generated air pollution and communicate this information clearly to the public (full event report available here). Many attendees felt that poor indoor air quality in UK homes was at a scale and magnitude that warranted national-level attention and action and were supportive of an interdisciplinary working party on indoor air quality with a life-course focus being set up, with particular consideration given to the impact of poor indoor air quality on children’s health and wellbeing.

What next

In light of this, the RCPCH is proposing to undertake a 17 month project to produce an evidence based report on the impact of indoor air pollution on children’s health in the UK.

Subject to the necessary funds being raised, the project aims to start in January 2018, a working group will be established to commission systematic evidence reviews and drive the development of the report with the ultimate aim to raise awareness of the issues affecting the health of children exposed to indoor air pollution generated outdoors and indoors and develop evidence based solutions. Whilst the working party itself will narrow the scope and focus, it is being set up with the ambition that it will review evidence and make recommendations to influence professional practice and measures the public can take, not just policy and legislative changes, for the renovation of current housing, workplaces and school stock, and the planning and building of new buildings in order to mitigate health risk. The working party will explore solutions focused on:

• improving the health of children
• attenuating the consequences of exposure in childhood on health effects across the lifecourse.

The Working Party will also seek to highlight the effects of climate change on this problem.

The fundraising leaflet with contact details for the RCPCH is available for download in PDF form here.

I'm working in a voluntary capacity to help set this working party up. This article is a personal opinion article.