Helena Clements: ULEZs and clean air zones

I have been asked to reflect on the controversy around ULEZs and clean air zones. Paediatricians are acutely aware of the impact of air pollution after the tragic death of Ella Kissi-Debrah over 10 years ago. The coroner ruled that air pollution caused her death after her patterns of severe acute asthma exacerbations and ultimately her death correlated closely with peaks in air pollution. The impact of this event has had a profound impact on paediatricians, particularly those that were unable to save her and has resulted in movements such as Ride for their Lives and a general focus from the RCPCH on the impacts of air pollution on child health. We are currently recruiting to 2 fellowships in conjunction with the Clean Air Fund which is very exciting.

Last week I spent time with colleagues in our adult respiratory team talking about optimising asthma care and weaning patients and clinicians away from SABAs particularly in MDIs which is good for our patients, good for the NHS and good for the planet. The SENTINEL PROJECT led by Michael Brooks in Hull is leading the way and I understand that new asthma guidance form BRS/NICE will also be encouraging this. We need to change behaviour fast; we have the evidence. Good maintenance treatment is a no brainer in terms of better outcomes, winter pressures, health inequalities, cost and carbon impact giving us the magic triple bottom line!

So this brings me to cars! A colleague asked me about replacing his old family diesel workhorse for an electric car. There was a long answer! It is difficult. There are lots of variables. If the average car carbon footprint is 50% manufacture and 50% use, you can reduce the relative emissions by keeping it a long time. But it is not just CO2; particulates are also important especially if diesel. So keeping the engine in good nick is important, and keeping types pumped up to increase miles per gallon and reduce particulates from tyres (true for EVs too).

We have a VW Touran and are expecting it to die soon but keep it on the road for now. It has done 258,000 miles. We have “replaced” it in advance with an electric Vivaro van which we have converted to a camper. Typical retiree! But it had to be a 5-seater and long distance “car” first and camper second. The range is said to be 206 miles but that depends on how you drive it. We have learnt to slow down and enjoy the ride. Again, a luxury of being older maybe. I chatted to a young couple with 3 small kids, and they were very disappointed with theirs. Hadn’t understood that we can’t just buy our way out of climate crisis - we need to change our behaviour.

Walk and cycle more, use public transport, replace old and unmendable with low energy replacements and travel less in general and more slowly. My son and his family are moving back to our neighbourhood, and we will share our Leaf and Van with them which will encourage us to share trips and pause before getting behind the wheel.

That is the personal bit, but we are health professionals and need to be advocates for safe active transport and good public transport and clean air as a basic right for all children. So yes, I support low emissions zones and speed restrictions but only accompanied by improvements in pavements, cycle routes and public transport. I freely admit to enjoying driving and have been known to drive 2-3 mph over the limit. But driving at speed is not a divine right and I would welcome the addition of cycle routes, traffic calming and speed restrictions on country routes as well as urban ones so that I can walk and cycle safely for the good of my health and encourage my grandson to cycle to school or into town and maybe breathe more easily too!

It is deeply concerning to hear our prime minister rowing back on commitments to address climate change in favour of short-term economic gains prior to a general election. The personal and economic cost of delay in terms of our health and our children’s health and wellbeing is massive. But air pollution is not all about transport; we need to look at the impact of industry, farming and domestic heating. As health professionals we need to care enough to stand up and advocate for policies which benefit the poorest and most vulnerable in society even it means we slow down a bit and make changes in our own lives.