The chief medical officer for England, Professor Chris Whitty, has called for schools, workplaces, transport hubs, hospitals and supermarkets to be monitored for indoor air pollutants.
Concerns have been growing about the links between air pollution and health, not least because of the case of nine-year-old Ella Kissi-Debrah, whose death in 2013 was ruled by a coroner in 2020 to have been caused by air pollution.
Research has linked air pollution to an increased risk of long-term illness and mental ill health. There is also increasing recognition of the harmful pollution impact of long-burning stoves and domestic open fires.
Then, of course, there is the fact that Covid-19 is an airborne virus and so air filtration and circulation measures can help to mitigate its spread.
Professor Whitty, writing in the journal Nature, with Professor Alastair Lewis, a professor of atmospheric chemistry at the University of York, and Dr Deborah Jenkins, a specialist registrar in public health at the Department of Health and Social Care, has called for more research into indoor air pollution to be carried out to create a “road map” to how we achieve cleaner indoor air.
Indoor air pollution can be dust, dirt, or gases in the air inside buildings that are harmful to breathe in and can be linked to lung diseases such as asthma, COPD and lung cancer. These can include particulate matter, or tiny particles of dust and dirt in the air, such as soot and dust mites, and gases, for example carbon monoxide, nitrogen oxide, and sulphur dioxide.
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“A scientific road map to cleaner indoor air will need to work through many challenges. Who is most exposed and where? What are the key sources of pollution?” they point out.
“What beneficial actions (technical, behavioural and regulatory) would have the greatest impacts? The scientific community must provide evidence to make these decisions and encourage action. Whereas scientific efforts must be global if they are to capture the ranges of buildings, behaviours and weather, science-based advice for cleaner indoor air will inevitably be country- and region-specific,” they argue.
Indoor pollution overlooked
Professor Whitty and his co-authors highlighted that, in industrialised nations, most people spend 80%–90% of their time indoors – in private homes as well as in public spaces such as schools, workplaces, transport hubs, hospitals and supermarkets.
Yet, they add: “Indoor air pollution hasn’t received the same attention, even though it might cause almost as many deaths globally – 3.2 million in 2020, according to the World Health Organization (WHO), compared with around 3.5 million linked to polluted outdoor air.”
To that end, they argue that monitoring the indoor environment for pollution should become standard practice in public spaces. “Indoor emission inventories need urgent investment. Better advice on reducing indoor exposure without reducing energy efficiency will need to lean heavily on measurements. Long time series must be established in representative public buildings and homes to inform future building standards,” they argue.
This will need to include better ventilation and innovations involving filtration and ultraviolet light. “As with most public-health interventions, many incremental improvements leading to wholesale change are more likely to be effective than is waiting for a small number of transformational improvements,” they write.
“It is essential that decarbonization, building improvement and gains in indoor air quality are, as much as possible, delivered equitably across society. Strategies that rely on householders investing in, for example, installing heat pumps, air filters and ventilation systems will skew benefits towards those who can afford to pay.
“People most affected by poor indoor air quality, and who are in poor health to begin with, tend to be those on lower incomes, living in homes that rely on older gas or solid-fuel heating, homes with damp and those situated in areas of high outdoor pollution. Supporting these people is essential. Low- and middle-income countries face extra challenges, for example where solid fuel such as wood, charcoal or coal remains a major part of indoor cooking and heating,” they add.
Role of employers and government
Local and national governments needed to take a lead on ensure that good indoor air quality is delivered for those in shared, social or rented accommodation, and for public indoor spaces, Professor Whitty and his co-authors argue.
They cited the example of France, where monitoring of a range of pollutants is mandatory in schools. “Beyond state intervention, employers must ensure safe, healthy workplaces, including good-quality air.
“Just as for outdoors, improving air quality indoors globally requires sustained investment in scientific and engineering research and international collaborations that share best practice in measurement, modelling and abatement.
“It is time for researchers to develop the evidence that will allow governments, businesses and individuals to take up the baton and devise science-based global standards for indoor air quality, to reduce emissions, exposure and harms,” they add.
Separately, a report by the Royal Academy of Engineering has found that improving ventilation in public and commercial buildings can be cost-effective through reducing infections alone.
The report outlined eight recommendations to embed “infection resilience” into the commissioning, design, management, and operational stages of the construction of buildings and transport infrastructure.