TY - JOUR
AU - Richardson,, Judith
AB - Abstract This article covers recent National Institute for Health and Care Excellence (NICE) guidance relevant to public health, with a focus on indoor air quality. It introduces the evidence behind this guideline, and the actions that need to be taken by a wide range of stakeholders to implement the guidance and help people to achieve good air quality in their homes. It also highlights the inequalities in exposure to poor quality indoor air and identifies groups that are more vulnerable to health impacts. indoor air quality, indoor air pollution, housing, public health, guidelines What’s new? In January 2020, the National Institute for Health and Care Excellence (NICE) published a guideline on indoor air quality at home. This guideline was supported and co-badged by Public Health England. It aims to raise awareness of the importance of good air quality in people’s homes and how to achieve this. NICE is producing a quality standard on this topic for publication in October 2020 and has previously published Air pollution: outdoor air quality and health (June 2017). Spotlight on improving indoor air quality at home to prevent ill health Indoor air pollution from flueless solid fuel stoves has long been a priority in global health.1 Within the UK, increasing attention has been given to outdoor air pollution, considering both industrial and transport-related sources;2,3 but rather less attention has been given to indoor air quality, despite most of the population spending ~90% of their time indoors, and 60–70% of their time at home.4 Source, pathway, receptor The indoor air quality at home guidance employs a source–pathway–receptor model and makes use of logic models to understand the health impacts from pollutants. It considers sources of pollutants inside the home—of particulate matter, damp and excessive humidity. The pathway is the enclosed area of a home—and particularly the poorly ventilated spaces that may be created by insulating homes without maintaining sufficient ventilation to prevent condensation and to disperse pollutants. Smaller homes provide less dispersal. In areas with poor quality outdoor air, opening a window to increase ventilation might let more pollutants enter the home. Indoor and outdoor air qualities are therefore linked, creating a further disadvantage that particularly affects people living in inner-city areas. The receptor is a person and individual vulnerability is affected by both pre-existing conditions and social determinants, which include the tenure of housing, as a key determinant of a person’s ability to reduce their exposure to poor quality indoor air. Lower socioeconomic status is also likely to be associated with poor quality housing and spending more time in the home. Health impact NICE committee members reviewed evidence suggesting that the health impacts of poor indoor air include respiratory conditions and a range of allergies. Evidence on the health effects of poor indoor air quality came primarily from observational studies of people drawn from populations with pre-existing conditions—particularly asthma and allergies—or who were otherwise vulnerable. Evidence was used to triangulate housing conditions, pollutant levels and health outcomes. One of the challenges in formulating recommendations for this guidance was in assessing the extent to which this was generalisable to the whole population. One key study5 assessed the health impact of changes to indoor air quality and temperature when refurbishing homes to meet 2030 carbon reduction targets. This study modelled different ventilation scenarios alongside fabric refurbishment: regulation compliant ventilation for all properties, additional ventilation only for properties exhibiting visible mould or other issues, or no additional ventilation. Regulation-compliant ventilation resulted in a net gain of 2241 QALYs per 10 000 persons over 50 years whereas the other scenarios resulted in a net loss of 539 and 726 QALYS respectively. Implementation The recommendations from this guidance are reassuringly simple; (i) limit sources of pollutants and (ii) ensure good ventilation in all homes—whether new or existing. The challenges in implementation are that while the recommendations might sound simple, the specific measures required will vary between properties, and require professional judgement, as well as consideration of the environmental context of the home. Homeowners, tenants and landlords might be unwilling or unable to carry out their responsibility, meaning that a wide range of stakeholders may need to act together through a multidisciplinary approach to resolve issues affecting occupiers and tenants. The primary audiences for this guidance are, therefore, the professional groups responsible for planning, developing and maintaining housing, as well as those who have a relevant regulatory role. These include Housing, planning, building control and environmental health teams. Private and public sector property managers, landlords and maintenance staff. Architects, designers and builders. As such, this guidance speaks to new and non-traditional audiences for NICE, and we need to ask for help from you, the public health community, to find ways of bringing this to their attention. Other NICE guidelines relevant to this guideline are: NICE Guideline (NG70) Air pollution: outdoor air quality and health.3 NICE Guideline (NG6) Excess winter deaths and illness and the health risks associated with cold homes.6 Ben Fryer, Speciality Registrar in Public Health Hugh McGuire, Technical Adviser, Public Health Guidelines Lise Elliott, Programme Manager, Public Health Guidelines Monica Desai, Consultant Public Health Advisor Judith Richardson, Programme Director—Quality and Leadership References 1 World Health Organisation . WHO guidelines for indoor air quality: household fuel combustion . Geneva : World Health Organisation , 2014 . https://www.who.int/airpollution/publications/household-fuel-combustion/en/ (17 February 2020, date last accessed) . Google Scholar PubMed OpenURL Placeholder Text Google Preview WorldCat COPAC 2 Public Health England . Health matters: air pollution , 2018 . https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution (17 February 2020, date last accessed) . 3 National Institute for Health and Care Excellence . Air pollution: outdoor air quality and health , 2017 . https://www.nice.org.uk/guidance/ng70 (17 February 2020, date last accessed) . 4 Klepsis N , Nelson W, Ott W et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants . J Expo Sci Environ Epidemiol 2001 ; 11 : 231 – 52 . doi: 10.1038/sj.jea.7500165 Google Scholar Crossref Search ADS WorldCat 5 Hamilton I , Milner J, Chalabi Z et al. Health effects of home energy efficiency interventions in England: a modelling study . BMJ Open 2015 ; 5 : e007298 . doi: 10.1136/bmjopen-2014-007298 Google Scholar Crossref Search ADS PubMed WorldCat 6 National Institute for Health and Care Excellence . Excess winter deaths and illness and the health risks associated with cold homes . NICE , 2015 . https://www.nice.org.uk/guidance/ng6 (17 February 2020, date last accessed) . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC © The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - NICE public health guidance update
JF - Journal of Public Health
DO - 10.1093/pubmed/fdaa045
DA - 2020-11-23
UR - https://www.deepdyve.com/lp/oxford-university-press/nice-public-health-guidance-update-3BZ0XRr744
SP - 799
EP - 800
VL - 42
IS - 4
DP - DeepDyve
ER -