Local action on outdoor air pollution to improve public health
Received: 4 December 2017 / Accepted: 9 April 2018 / Published online: 20 April 2018
Ó Swiss School of Public Health (SSPH+) 2018
Objectives The National Institute for Health and Care Excellence, jointly with Public Health England, have developed a
guideline on outdoor air pollution and its links to health. The guideline makes recommendations on local interventions that
can help improve air quality and prevent a range of adverse health outcomes associated with road-trafﬁc-related air
Methods The guideline was based on a rigorous assessment of the scientiﬁc evidence by an independent advisory com-
mittee, with input from public health professionals and other professional groups. The process included systematics
reviews of the literature, expert testimonies and stakeholder consultation.
Results The guideline includes recommendations for local planning, clean air zones, measures to reduce emissions from
public sector transport services, smooth driving and speed reduction, active travel, and awareness raising.
Conclusions The guideline recommends taking a number of actions in combination, because multiple interventions, each
producing a small beneﬁt, are likely to act cumulatively to produce signiﬁcant change. These actions are likely to bring
multiple public health beneﬁts, in addition to air quality improvements.
Keywords Air pollution Á Air quality Á Road trafﬁc Á Emissions Á Interventions Á Public health
Air pollution has a very signiﬁcant impact on the public’s
health, globally accounting for about 4.2 million deaths in
2015 and ranking 5th worldwide among all risks including
high blood pressure, smoking, and diet (HEI 2017). In
England, 4.7% of adult mortality from all causes in 2015
was attributable to outdoor air pollution measured as
human-made particulate matter (PM
) (PHOF 2017).
Although a lot of progress has been made in controlling
emissions from industry, power generation and domestic
sources in high income countries over the decades fol-
lowing the Great London Smog of 1952, air pollution
stubbornly remains one of the main public health problems
of the 21st century (Landrigan et al. 2018).
Exposure to air pollution over several years has been
found to reduce life-expectancy, mainly due to an
increased risk of cardiovascular and respiratory illness and
lung cancer, while short-term (day-to-day) exposure can
aggravate respiratory and cardiovascular conditions, and
trigger asthma attacks and premature deaths (RCP 2016;Di
et al. 2017). The World Health Organization’s (WHO)
International Agency for Research on Cancer (IARC) has
classiﬁed outdoor air pollution, and diesel engine exhaust
in particular, as carcinogenic to humans (Loomis et al.
2013; Benbrahim-Tallaa et al. 2012). There is also
emerging evidence of possible links with diabetes, obesity,
This Review is part of the section ‘‘Knowledge Synthesis, Translation
SV was Topic Expert Member, RK Public Health Technical Adviser,
and PL Chair of the NICE Public Health Advisory Committee on
Outdoor Air Pollution; PC is Medical Director of Public Health
England, an Executive Agency of the Department of Health; SH was
Chair and JG vice-Chair of the working party on air pollution of the
Royal College of Physicians and the Royal College of Paediatrics and
Child Health; FK is Chair and JG a Member of the Committee on the
Medical Effects of Air Pollutants; SV, SH and FK are Members of a
Dyson advisory board; SV is co-Chair of Healthy-Polis (International
Consortium for Urban Environmental Health and Sustainability) and
has honorary academic appointments with Exeter University Medical
School and the London School of Hygiene and Tropical Medicine.
& Sotiris Vardoulakis
Extended author information available on the last page of the article
International Journal of Public Health (2018) 63:557–565