Speaking out about the health impacts of air pollution

In her first blog, Dr Emily Parker takes us through her journey leading to her new role at RCPCH as a Clinical Fellow with the Clean Air Fund Partnership.
Photo of Emily Parker in a woodland area

Reflecting on my medical training and career as a doctor, it is understandable that it took me so long to recognise air pollution as a health issue. During medical school, air pollution was occasionally mentioned – perhaps in a long list of risk factors for respiratory disease, or in a global health lecture about the health impacts of solid fuel cooking stoves. In clinical training, asking patients about their smoking history was standard, and respiratory histories included pets and occupation if you were being diligent. However, considering exposure to outdoor air pollution was absent from the medical school model of ‘how to be a good doctor’. Air pollution was conceptualised by the medical curriculum as a problem that was ‘over there’, or as a causal factor in respiratory pathophysiology that clinicians couldn’t do much about.

Last year I was lucky enough to undertake a one-off role as a Sustainability Fellow in Paediatric Medicine, initiated by RCPCH’s VP for Policy, Dr Mike McKean, funded by the Newcastle Hospitals Charity, and supported by the Centre for Sustainable Healthcare. This was the first time that I had connected my personal commitment to reducing my environmental impact with my professional role as a doctor. During my fellowship I conducted research into the carbon footprint of pills versus liquid medicines, led a greenspace co-design project involving 100 children and young people, and delivered education on sustainable healthcare to medical students, doctors, nurses and allied health professionals.

Through the Centre for Sustainable Healthcare’s seminars, I became aware of the huge contribution pressurized metered-dose inhalers make to the carbon footprint of the NHS in England (3%), and the drive to change practice to reduce this as part of the Greener NHS Net Zero strategy. There are many useful resources available to those who want to reduce the carbon footprint of inhaler prescribing, but these strategies rarely focus on prevention. This might be explained by how medical education shaped our conceptualisation of our roles as doctors. Our training focused mainly on understanding health at an individual level and responding to disease through individual patient management. In this framework, preventative medicine was envisaged as advising patients to adopt healthier lifestyle changes. Working towards broader social and political change was seen as a public health role.

However, the frame is shifting. Two key documents underscore this: firstly, the 2016 ‘Every breath we take’ Report outlines the significant impact of chronic exposure to air pollution, emphasising the duty of doctors to act on this. Secondly, the coroner’s Report to Prevent Future Deaths, after his investigation into the tragic death of Ella Adoo Kissi-Debrah, clearly recommends that doctors must learn about the health impacts of air pollution and inform their patients. Medical Colleges, the RCPCH among them, as well as RCP and RCOG, are beginning to take this directive seriously, and I am excited to join the team at the RCPCH working on this.

Supported by a grant from the Clean Air Fund, I am one of three Clinical Fellows starting at the college this month. The other fellows start later in the year, and we are working alongside Zara Raffeeq, Georgia Bickerton and the RCPCH &Us team, led by Dr Helena Clements and Alison Firth. Our work focuses on developing educational materials for healthcare professionals, establishing an RCPCH policy on air pollution, evaluating novel clean air clinics in London and Liverpool, and creating an advocacy toolkit for healthcare professionals to engage in conversations encouraging system-level change. I am most excited about the final one of these, because it feels brave and radical to me as a doctor based on what I was taught about healthcare in medical school.

I am looking forward to encouraging you all to speak up and out on air pollution – a critical concern for everybody’s health, but especially impactful for children. More on this in my next blog, but for now, I hope to hear from any members who have a particular interest in supporting this work: email me at emily.parker@rcpch.ac.uk.