Enhancing local air quality management in Wales to maximise public health awareness, integration, collaboration and impact

Air pollution is a significant public health concern. The UK Local Air Quality Management (LAQM) regime mandates collaborative action to reduce air pollution to protect health. Despite having this aim, LAQM is disconnected from broader public health policy and practice. Several LAQM ‘structure’ and ‘process’ limitations have likely contributed to this unsatisfactory situation and LAQM’s failure to deliver effective ‘outcomes’. Two main shortfalls are to blame: prescribed risk assessment and management processes that are too narrow in public health scope, and a poor recognition of the value contribution that public health bodies and specialists could and should make to support LAQM.With Wales selected as the research study area, this research explored LAQM shortfalls through complementary research strands, framed by a mixed-methods approach and a convergent parallel study design. The first of these research strands – an ecological study – linked air pollution, deprivation and health data to assess associations and determine the merits of broadening the public health scope of LAQM. The second – a Delphi study – formed expert consensus on the role of public health in LAQM, and defined the value added by, and opportunities, barriers and solutions to, increasing public health awareness, integration and collaboration in LAQM. Research outcomes were subsequently mixed, validated and evolved to develop a suite of drivers (and linked recommended enabling actions) to support new public health-driven ways of working in LAQM in Wales.The ecological study found that interactions between air pollution and socio-economic stressors modified and compounded associations with important health outcomes. Thus, there is merit in considering air pollution problems and solutions in the context of broader public health priorities. Further, aligning risk reduction actions with principles of proportionate universalism could achieve greater health gain.Through the Delphi study, experts agreed that public health bodies and specialists could and should do more to support LAQM, and proposed enhanced ways of working around assessing risks, integrating LAQM action with the ‘day job’ (and vice versa), appraising and interpreting evidence, and undertaking research and evaluation. These, together with a better application of core public health skills such as authoritative communications, policy development advocacy, and change leadership, could add value to LAQM.Integrating, validating and evolving this evidence – the latter achieved through a workshop and case study interviews with experts – informed proposals for new public health-driven ways of working in LAQM in Wales. These are underpinned by the primary drivers of risk assessment and management approaches of broader public health scope, stronger public health support, and full integration of LAQM with wider public health policy and practice.In conclusion, this research makes a compelling case for LAQM enhancement through better public health awareness, integration and collaboration. While evidence-based drivers for change can help guide LAQM evolution, stakeholders must still commit to enable and achieve them. The positive impacts resulting from fully connected LAQM and public health policy and practice have the potential to ripple way beyond the LAQM arena to help tackle wider linked public health and wellbeing priorities

Air pollution, deprivation and health: Understanding relationships to add value to local air quality management policy and practice in Wales, UK

© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. Background Air pollution exposure reduces life expectancy. Air pollution, deprivation and poor-health status combinations can create increased and disproportionate disease burdens. Problems and solutions are rarely considered in a broad public health context, but doing so can add value to air quality management efforts by reducing air pollution risks, impacts and inequalities. Methods An ecological study assessed small-area associations between air pollution (nitrogen dioxide and particulate matter), deprivation status and health outcomes in Wales, UK. Results Air pollution concentrations were highest in 'most' deprived areas. When considered separately, deprivation-health associations were stronger than air pollution-health associations. Considered simultaneously, air pollution added to deprivation-health associations; interactions between air pollution and deprivation modified and strengthened associations with all-cause and respiratory disease mortality, especially in 'most' deprived areas where most-vulnerable people lived and where health needs were greatest. Conclusion There is a need to reduce air pollution-related risks for all. However, it is also the case that greater health gains can result from considering local air pollution problems and solutions in the context of wider health-determinants and acting on a better understanding of relationships. Informed and co-ordinated air pollution mitigation and public health action in high deprivation and pollution areas can reduce risks and inequalities. To achieve this, greater public health integration and collaboration in local air quality management policy and practice is needed

Impacts of the Covid-19 pandemic on air quality in Wales: March to October 2020

The report covers the WAQF's activity in 2020 and important policy developments since the last report was published in 2020. As usual we review the latest trends in air pollution measurements and implications for policy compliance as well as maps of Air Quality for NO2, O3, PM10 and PM2.5 in 2020. The area of special interest this year looks at the Landmark Second Inquest Rules that Air Pollution Contributed to the Death in London of 9-Year Old, Ella Adoo-Kissi-Debrah. The health chapter provides a review of Air Quality and Public Health in 2020

Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study

Background Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health. Methods/Design EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes. Discussion The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes

Local Modelling Techniques for Assessing Micro-Level Impacts of Risk Factors in Complex Data: Understanding Health and Socioeconomic Inequalities in Childhood Educational Attainments

Although inequalities in health and socioeconomic status have an important influence on childhood educational performance, the interactions between these multiple factors relating to variation in educational outcomes at micro-level is unknown, and how to evaluate the many possible interactions of these factors is not well established. This paper aims to examine multi-dimensional deprivation factors and their impact on childhood educational outcomes at micro-level, focusing on geographic areas having widely different disparity patterns, in which each area is characterised by six deprivation domains (Income, Health, Geographical Access to Services, Housing, Physical Environment, and Community Safety). Traditional health statistical studies tend to use one global model to describe the whole population for macro-analysis. In this paper, we combine linked educational and deprivation data across small areas (median population of 1500), then use a local modelling technique, the Takagi-Sugeno fuzzy system, to predict area educational outcomes at ages 7 and 11. We define two new metrics, “Micro-impact of Domain” and “Contribution of Domain”, to quantify the variations of local impacts of multidimensional factors on educational outcomes across small areas. The two metrics highlight differing priorities. Our study reveals complex multi-way interactions between the deprivation domains, which could not be provided by traditional health statistical methods based on single global model. We demonstrate that although Income has an expected central role, all domains contribute, and in some areas Health, Environment, Access to Services, Housing and Community Safety each could be the dominant factor. Thus the relative importance of health and socioeconomic factors varies considerably for different areas, depending on the levels of each of the other factors, and therefore each component of deprivation must be considered as part of a wider system. Childhood educational achievement could benefit from policies and intervention strategies that are tailored to the local geographic areas' profiles

Cluster of atypical adult Guillain-Barré syndrome temporally associated with neurological illness due to EV-D68 in children, South Wales, United Kingdom, October 2015 to January 2016

We report a cluster of atypical Guillain-Barré syndrome in 10 adults temporally related to a cluster of four children with acute flaccid paralysis, over a 3-month period in South Wales, United Kingdom. All adult cases were male, aged between 24 and 77 years. Seven had prominent facial diplegia at onset. Available electrophysiological studies showed axonal involvement in five adults. Seven reported various forms of respiratory disease before onset of neurological symptoms. The ages of children ranged from one to 13 years, three of the four were two years old or younger. Enterovirus testing is available for three children; two had evidence of enterovirus D68 infection in stool or respiratory samples. We describe the clinical features, epidemiology and state of current investigations for these unusual clusters of illness

Variations in Micro-impact of Domain (MiD).

<p>Overall rates and directions of expected changes in education under attainment rate, for unit change in domain deprivation score.</p

Variations in Contribution of Domain (CoD).

<p>These values represent a product of the observed WCIMD deprivation scores, and the domain coefficient scores (MiD values) in each LSOA, and represents the contribution of each type of deprivation domain to the expected education under-attainment rate in each LSOA.</p

Educational under-attainment rates (EUR) in each LSOA across Wales.

<p>Educational under-attainment rates (EUR) in each LSOA across Wales.</p