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Every breath you take…but where is the action on air pollution?

In his latest Out of the Box column, emergency medicine specialist Dr Simon Judkins investigates the many ways that Australia is failing to address the health risks of air pollution.


Simon Judkins writes:

On a cold afternoon, I walk past ambulances ramped out the front of the Emergency Department. Some patients are waiting in the back of the vehicles until a space can be found for them in the hospital. Others line the hallways, some are on oxygen, and some have asthma and emphysema, or cardiac conditions.

The undercover ambulance bay reeks of exhaust fumes, despite ventilation systems. It is distressing to think that we are making people, patients, ambulance staff and hospital workers sicker as they breathe in these pollutants. Hospitals are meant to be a place of health and healing; we should be doing a lot better.

I am encouraged by the position of Ambulance Victoria’s CEO, Tony Walker, who has supported his organisation’s commitment to a greener path and the actions of ACT Health in adopting a “green fleet” of vehicles and building its new hospital expansion to be sourced from all renewable power.

But many other jurisdictions have some way to go to “first do no harm”.

If hospitals are to be places of healing, all new builds need to adopt a “zero emissions” goal, to be carbon- neutral. Hospitals and health services have no reasonable excuse for failing to implement sustainable building practices, renewable energy sources, green procurement, and electric vehicle fleets.

Air pollution is everywhere, especially in our built-up urban environments. There is no safe level of air pollution.

Yet, our society seems to somehow tolerate the status quo. Compare this with the outcry about the health concerns of passive smoking that led to legislative and policy reforms, since emulated in many other countries. We were unafraid of the backlash and we banned smoking indoors, even in pubs, because of the health risks and never looked back.

Children’s health on the line

Contrast this with the insipid approach from our State and Federal Governments today. Where is the political leadership as our children breathe in the exhaust from diesel-powered buses and trucks belching smoke as they pass our primary schools, kindergartens, and homes? The health risks of air pollution for our children are clear and have been known for decades.

Extraordinarily, we see childcare centres built in cities, along main roads. Aged care facilities are right alongside main polluting throughfares. Primary schools sit next to peak hour traffic areas and the high rates of car use ensure pick-up zones are highly polluted as cars idle with engines running.

More medical experts are calling for change. A recent Coroners report in the UK recognised the impact of worsening air pollution in directly contributing to the death of a nine-year-old girl, Ella Kissi-Debrah. The Coroner recommended reviewing the UK air pollution legislation and providing more information to the public and health professionals about the impacts of air pollution.

Just as we provide warnings regarding potential “high pollen days” and “thunderstorm asthma” events, we should also consider acute health plans for those who are at high risk of suffering during high pollution days – those with asthma, chronic obstructive pulmonary disease (COPD), and other respiratory disorders, and cardiac conditions. The information is available, we need to use it and ensure the public is aware of the risks.

We create cycling lanes on our busy roads but ask cyclists to ride alongside trucks and buses spewing out noxious exhaust. An individual’s desire to improve their own health (and lessen their carbon footprint) is, ironically, undermined by governments’ failures to support/promote a transition to electric vehicles (EVs). The technology is here, but the political will isn’t.

Political hypocrisy

I remain flabbergasted and confused by the hypocrisy of political leaders, who promote a “technology not taxes” approach to climate action, but willingly refuse to adopt electric vehicle technology, refusing to support a tax incentive for EVs, in fact doing the opposite, while allowing tax write-offs for diesel-fuelled utes.

Air pollution kills. The World Health Organization estimates air pollution prematurely kills an estimated seven million people annually worldwide. It has both acute impacts, with spikes in deaths in surge events, such as the recent bushfires, and its chronic exposures significantly contribute to ill-health and mortality across the globe, impacting pregnancies, childhood development, older people, and those with respiratory illness.

Hazardous air quality has disproportionate impact on those in lower socioeconomic groups. They are more likely to be exposed to poor air quality, including through occupational exposures, and are less able to implement protections, particularly due to poor housing quality. We also know that improvements in air quality can see improvements in those damaged lungs.

The bushfires of 2019 and 2020 were a catastrophic event on many levels, but really highlighted the impacts of the air we breathe. They resulted in many hospital admissions and deaths across Australia, with an 86 percent increase in emergency visits for respiratory illness in the NSW Riverina district.

That fire season increased our awareness of the detrimental impacts on health of air pollution. These prolonged smoke events affecting mass populations have a gripping visibility, with acute negative physical and mental health effects.

Winter burnoffs, another source of air pollution. Photo by Melissa Sweet

We must obviously act urgently to prevent further climate change driven bushfires, but policy makers must also adapt resilience strategies to protect populations, recognising these disasters are predicted to increase in frequency and severity. If we consider hazardous air quality as both a cumulative and acute exposure risk, we need to think seriously about reducing our daily exposures as a resilience strategy.

But, what about when we are living our “normal” existence? If climate change is going to see our exposure to poor air quality increased by more destructive events, we should be driven to act more urgently on areas where we have some control and reduce our “routine” exposures.

The major sources for routine air pollution are industrial processes, vehicle emissions, home woodfires and open burning. Major indoor air pollutants, where most Australians spend the bulk of their time, include woodfire smoke, gas cookers and heaters, fungi, microbial contamination, house dust mites, particulate matter and air toxics such as formaldehyde.

Stories from “the big smoke”

Jane is a work colleague. I arranged to meet with her and her partner, Geoff, to discuss their concerns and plans to move out of the city. They live in a flat in inner Melbourne, just off one of its busiest roads, Hoddle Street. Every day, about 350,000 people use this busy arterial road. Concerningly, the traffic levels are higher now than pre-COVID (in Sydney also )and public transport use has dropped, increasing the traffic congestion and pollution.

Geoff has asthma. He can walk to work, as he works in the CBD. During COVID lockdown, his asthma was very well controlled. “In fact,” he says, “ I could get out and exercise without having to use my inhaler. The air was cleaner. There was no traffic. But now, I’m back to using my Ventolin before I go out. I know that, on busy mornings, I start to feel tight again. I have no doubt the increase in traffic is impacting my health. I have to be careful when and where I exercise.”

Geoff and Jane are planning to start a family. But they plan to move first. “I worry about the impact of living so close to this busy road would have on my pregnancy, the health of my child,” says Jane. So, they are looking for a home away from “the big smoke”.

A not-so Fun Fact: The term” the big smoke”, coined in the 1950s to describe the pollution in London at the time, causing skin irritation and respiratory illness, is a term used to describe our polluted cities. One just has to look at the brown haze floating over Melbourne and Sydney on still weekdays to understand that we are surrounded, enveloped by “big smoke” on many days. The problem is rapidly worsening. In 2019 Sydney experienced 81 days of poor, very poor or hazardous air quality – more than the combined total for the previous 10 years. Melbourne has experienced the same trends.

Jane has good reason to be concerned. An article released this year supports the ongoing and building knowledge base regarding the impacts of poor air quality on pregnancy and foetal health. The concern is that this knowledge has been available for years, has been confirmed in the Australian context, and yet Australians continue to tolerate the dangers of living in high-pollution corridors, in built up industrial areas and next to coal mines.

Well, it’s not necessarily “tolerated”, it’s more about a community being able to impact policymakers. And it’s about “toothless” environmental protection agencies being unable to implement and enforce standards, monitor the environment, and enforce the rules.

COVID lessons

During the COVID lockdowns, particularly Melbourne’s 2020 long closure, our air quality was better. Admissions for respiratory complaints of all sorts dropped. Cardiac events dropped. It is well known that small particulate matter (PM 2.5) is associated with increased risk of myocardial infarction (MI), stroke, arrhythmia, and heart failure exacerbations within hours or days of exposure in susceptible individuals.

Improved air quality may be a significant contributor to the decrease in hospital presentations we have seen, not only locally, but across the globe when cities are in COVID lockdown.

Will our change in lifestyles though COVID see a change in the air quality as we evolve to a new-normal? Will working from home balance the decrease in public transport? Will our lack of government policy and support for hybrids and EVs have an increased impact on air pollution as more people choose to drive rather than share buses, trains, and trams?

Regardless of the combinations and permutations, we know that our CO2 emissions continue to rise, and transport continues to be a huge contributor.

The issue of increasing vehicle use and emissions in Australia is and will be a triple-whammy to our health. The exhaust spews noxious, harmful pollutants into the air we breathe. In those highly impacted communities, people will be less likely to participate in outdoor activities due to the health concerns.

The decrease in public transport use, potential impact on outdoor activities and commutes to work, school etc by cycling, walking will all contribute to a decrease in the overall health of communities. The added impacts of not accessing neighbourhoods, communities and any green spaces within communities, all impact mental health and wellbeing. And, the vehicle emissions, of course, have obvious impact on our health as a hugely significant contributor to climate change and all of the devastation that will inevitably bring.

Solutions focus

The answers are clear. For the health of individuals, our communities and our planet, we must transition from carbon fuels with urgency to electric vehicles and/or “green” hydrogen vehicles. This is a race. We must encourage the use of public transport, but with an understanding of people’s hesitancy to do so due to COVID.

The electric buses being developed and built by Australian companies must replace the toxic diesel polluters in all cities and towns. We must encourage the use of cycling, working from home to reduce the reliance on cars. And we should attempt to decentralise living and work, so people can live near their work, their school, healthcare, and community hubs they need. We must emphasise the co-benefits of climate action – that these measures will create greener, healthier, and happier communities.

We are at a point where the majority of Australians want action on climate change, want to align with other countries and set a target of net zero by 2050. But we are still in a state of delusion and our political leaders are contributing to the delusion. We are using our polluting resources (coal and gas), to destroy our environmental and ecological natural resources, with immediate and future health implications for the whole population.

I am reminded that, in July, NAIDOC week will be celebrated with a theme of “Heal Country”. This is the right time to reflect that, as Aboriginal and Torres Strait Islanders have done for 60,000 years, caring for country will guide our future, our health and our prosperity.

It’s time we faced the obvious reality and embrace our natural, renewable energy resources, sun, wind, and water, to clean up our economy, our industry, our transport, and our air for the sake of our health, our economy, our environment and our children, now and into the future.

Thank you to Dr Kimberly Humphrey and Dr Laksmi Govindasamy for reviewing and contributing to this article.

• Follow Dr Simon Judkins on Twitter: @JudkinsSimon

Also follow this Twitter list of climate and health leaders 


See previous columns by Dr Simon Judkins.

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