Air quality in Assessing the impact of poor air quality on our residents’ health

Southwark’s Joint Strategic Needs Assessment

Health Improvement & Place Southwark Public Health March 2018 GATEWAY INFORMATION

Report title: Air Quality in Southwark Status: Public Prepared by: S Baird Contributors: D Divajeva, B Legassick, S Unger, C Williamson, S Newman, M Piasentin, T Weaver, S Robinson-Marshall Approved by: Jin Lim Suggested citation: Air Quality in Southwark. Southwark’s JSNA. Southwark Council: . 2017. Contact details: [email protected] Date of publication: December 2017

Slide 2 Health Needs Assessments form part of Southwark’s Joint Strategic Needs Assessment process BACKGROUND

The Joint Strategic Needs Assessment (JSNA) is the ongoing process through which we seek to identify the current and future health and wellbeing needs of our local population. . The purpose of the JSNA is to inform and underpin the Joint Health and Wellbeing Strategy and other local plans that seek to improve the health of our residents.

. The JSNA is built from a range of resources that contribute to our understanding of need. In Southwark we have structured these resources around 4 tiers:

Tier I: The Annual Public Health Report provides an APHR overview of health and wellbeing in the borough.

JSNA Factsheets Tier II: JSNA Factsheets provide a short overview of health issues in the borough.

Tier III: Health Needs Assessments provide an in- Health Needs Assessments depth review of specific issues.

Tier IV: Other sources of intelligence include Local Other Intelligence Sources Health Profiles and national Outcome Frameworks.

. This document forms part of those resources. . All our resources are available via: www.southwark.gov.uk/JSNA

Slide 3 This Health Needs Assessment aims to develop a holistic understanding of air quality and health in Southwark AIM & SCOPE

The aim of this document is to develop a holistic understanding of air quality in the borough and its impact on the health of local people.

This is a high level summary of air quality in Southwark, that is specific to human health, and signposts further relevant information where possible.

The scope includes: . The legislation and policy context of air quality in relation to health

. Outdoor air quality across the borough, specifically nitrogen dioxide (NO2) and particulate matter (PM)*

This document will inform future local plans and any proposed actions to address the health impact of air quality. It will identify gaps in provision and list areas for improvement to reduce harm.

Indoor air quality, other air pollutants and environmental and other legislation are outside the scope of this document.

*Only these pollutants are included in this work because these are the only pollutants with Slide 4 national/international targets with which Southwark is non-compliant CONTENTS

Introduction

Policy Context

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 5 Air quality is a high priority due to its impact on a range of policy areas, including health INTRODUCTION

Air quality has become a high priority across the world . A wealth of new evidence in recent years has shown that poor air quality affects a wide range of policy areas, including health, putting air quality on the agenda globally

The impact of air pollution on health costs* the UK more than £20bn every year1 . This is just under 16% of the current annual NHS budget

Air pollution affects everyone who lives and works in London . The majority of pollutants within London are now at concentrations below national air

quality standards however, levels of nitrogen dioxide (NO2) and particulate matter (PM10) continue to exceed these standards in some areas and locations

Tackling air quality contributes to a wide range of outcomes . Measures to improve air quality not only improve health and reduce health inequalities, they also bring benefits for the economy, wider environment and assist with climate change adaptation & mitigation

*This includes costs to society and business, health services, illness and premature death

References Slide 6 1. RCPCH. Every breath we take: the lifelong impact of air pollution 2016 People’s health may be affected by poor air quality even if they never experience any noticeable effects INTRODUCTION

Exposure to poor air quality is associated with both ill health and premature death1 . Numerous studies, replicated across the Death world, agree that breathing air of poor quality impacts on people’s health Hospital admissions . Air pollution can cause short-term symptoms and long-term effects Emergency . Many people will not notice the effects of air department visits pollution on their health, however, long-term exposure can contribute to the development Doctor visits of chronic diseases and can increase the risk of respiratory illness . Children, older people and those with heart Asthma attacks, medication use, and respiratory conditions are most affected symptoms and are considered vulnerable groups . Any improvement in air quality will have Unnoticed physiological changes positive health consequences, however, it is recognised that there is no absolutely ‘safe’ level of particulates2

References 1. WHO. Quantification of the Health Effects of Exposure to Air Pollution 2000 Slide 7 2. WHO. Review of evidence on health aspects of air pollution – REVIHAAP Project: technical report 2013 Air pollution is a mixture of particles and gases that can have adverse effects on human health INTRODUCTION

Pollutant Sources Health effects

Road transport (especially diesel vehicle Nitrogen dioxide emissions), domestic & commercial Lung irritation and damage (NO ) 2 boilers, power stations and industry

Road transport (mainly diesel vehicle Increased chances of respiratory Particulate matter emissions and tyre & brake wear), disease, lung damage, cancer and (PM and PM ) domestic & commercial boilers, power 10 2.5 premature death stations, industry & construction

NO2 is a gas which is produced in combustion processes with other oxides of nitrogen (NOx) . Of all oxides of nitrogen, NO2 has the largest impact on health . NOx emissions are often used as a proxy for NO2 emissions

Particulate matter (PM) is a complex mixture of small particles . PM10 is the size of particle that is breathable and can lodge in the lungs

. PM2.5 is the size of particle most evidently linked to poorer health outcomes – this is because it is so small that it can pass through lungs into the bloodstream and on to any other part of the body . Some particles are long-lived in the atmosphere and can be transported great distances

References Slide 8 1. Southwark Council. Air Quality Strategy & Action Plan 2017 CONTENTS

Introduction

Policy Context . International; National; Regional; Local

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 9 There are legal limits for key pollutants that are regulated by international and national legislation POLICY CONTEXT

International . WHO guidelines1 - Designed to offer expert guidance of the health impacts of air pollution . EU Directive2 - Sets legally binding limits for key pollutants National . Air Quality Standards Regulations3 - Puts the EU limits into national UK law (see table on next page) - Determines how achievement of the objective values should be assessed . National Air Quality Strategy4 - A UK government policy framework identifying air quality standards and objectives for key pollutants

References 1. WHO. Air quality guidelines: Global update 2005 2. EU. Directive 2008/50/EC: Cleaner air for Europe 2008 3. The Stationery Office Limited. Air Quality Standards Regulations 2010 Slide 10 4. Defra. The air quality strategy for , Scotland, Wales and Northern Ireland: Vol. 1 & Vol. 2 2007 UK legislation objectives are not always as low as WHO guidelines POLICY CONTEXT

Concentration Date to be achieved in the UK Pollutant WHO guideline1 UK objective2 measured as (by and maintained thereafter)2

40 μg/m3 40 μg/m3 Annual mean 31 December 2005 NO 2 200 μg/m3 not to be exceeded 200 μg/m3 1-hour mean 31 December 2005 more than 18 times a year

20 μg/m3 40 μg/m3 Annual mean 31 December 2004 PM 10 50 μg/m3 not to be exceeded 50 μg/m3 24-hour mean 31 December 2004 more than 35 times a year

10 μg/m3 25 μg/m3 2020 Annual mean 15% reduction in concentrations PM N/A Between 2010 and 2020 2.5 at urban background

25 μg/m3 N/A 24-hour mean N/A

. UK legislation for air pollution includes a number of objectives, taking into consideration the change of air pollution levels throughout the day . WHO stresses that the objectives cannot fully protect human health as there are no ‘safe’ levels of particulate air pollution

References 1. WHO. Air quality guidelines: Global update 2005 Slide 11 2. Defra. National air quality objectives 2010 Pollution is a national public health priority which should be supported by local areas POLICY CONTEXT

National . Public Health Outcomes Framework1 - Sets out the vision for public health – it includes the desired outcomes and the key indicators that help us understand how well public health is being improved and protected, including the number of deaths attributable to air pollution

. Annual Report of the Chief Medical Officer 20172 - A statutory report on the state of the public’s health, with this edition focusing on the health impacts of all pollution on human health – it includes outdoor air pollution as an example of where we must act to roll out and embed into routine use actions that we know will improve health, and to evaluate and explore new ways to act - Sets out two recommendations for local authorities: 1) broaden current environment strategies to be cognisant of all forms of pollution and to consider risk at all levels of exposure; 2) consider at all stages of local authority planning the potential impact of all relevant forms of pollution upon human health

References 1. PHE. Public Health Outcomes Framework Ongoing Slide 12 2. CMO. Annual Report of the Chief Medical Officer 2017, Health Impacts of All Pollution – what do we know? Air quality is a priority for London and requires commitment from local areas POLICY CONTEXT

Regional . The London Plan1 - Air Quality is one of the six Mayoral objectives for London

. Mayor’s Air Quality Strategy: ‘Clearing the Air’2 - Outlines measures aimed at enabling achieve the UK & EU objective limit values for pollutants

. Mayor’s Transport Strategy3 - Statutory document setting out ’s vision and how it will be delivered

. Draft Mayor’s Environment Strategy4 - Brings together approaches to every aspect of London’s environment

References 1. GLA. The : The spatial development strategy for London 2016 2. GLA. Clearing the air: The Mayor’s air quality strategy 2010 – to be updated in 2017 3. GLA. Draft Mayor’s Transport Strategy 2017 Slide 13 4. GLA. Draft London Environment Strategy 2017 – in consultation at the time of writing Interventions to reduce air pollution are already in place in London, and more are planned POLICY CONTEXT

Regional . Congestion Charge (2003)* - Charges motorists to drive into on weekdays - Designed to encourage motorists to use other modes of transport

. Low Emission Zone (2008)† - Charges the most polluting heavy diesel vehicles to drive into Greater London - Designed to encourage use of ‘cleaner’ vehicles

. T-Charge (to be introduced in October 2017) - Aims to discourage use of older, more polluting vehicles in central London (the first step towards the introduction of the ULEZ)

. Ultra Low Emission Zone (to be introduced in 2019/20) - Will charge vehicles to drive into zone if they don’t meet the ULEZ exhaust emission standards - Initially planned to cover the Congestion Charge zone but may, as a result of the consultation, be extended to the North and South Circular roads

* Congestion Charge zone covers central London and includes north west Southwark Slide 14 † Low Emission Zone covers majority of Greater London and includes the whole of Southwark Southwark has declared an Air Quality Management Area and has updated its Air Quality Strategy and Action Plan POLICY CONTEXT

Local Air quality management areas in Southwark . London Local Air Quality Management Framework (LLAQMF) - Local authorities have a statutory responsibility to review & assess air quality on a regular basis - Southwark is a Cleaner Air Borough – this does not relate to pollution levels but acknowledges that Southwark works effectively to improve local air quality - The GLA has designated seven Air Quality Focus Areas in Southwark

. Southwark Air Quality Strategy & Action Plan1 States Southwark’s intentions and planned actions to work towards improving local air quality

. Local Implementation Plan2 - Sets out how the borough will deliver the Mayor’s Transport Strategy in their area

References 1. Southwark Council. Air Quality Strategy & Action Plan 2017 Slide 15 2. Available after the Mayor’s Transport Strategy which is currently in consultation CONTENTS

Introduction

Policy Context

The Local Picture . Pollution levels

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 16 Emissions of key air pollutants in Southwark are decreasing and are projected to decrease still further THE LOCAL PICTURE 1,639 1,452 1,200 Air pollution data show a decrease in total emissions for

nitrogen oxides (NOx) and particulate matter (PM) in 641 27% 544 529 Southwark

NOx (tonnes/year) NOx . NOx is the largest pollutant in Southwark with around 1,200 tonnes emitted in 2013 alone 2008 2010 2013 2020 2025 2030 . This is over a quarter less than in 2008 136 126 110 . Around 110 tonnes of PM10 were emitted in Southwark in 96 96 95 2013 – a decrease of a fifth since 2008 19% . Around 56 tonnes of PM2.5 were emitted in 2013 – a

PM10(tonnes/year) decrease of over a quarter since 2008 . These reductions in air pollution have been achieved 2008 2010 2013 2020 2025 2030 through legislative standards and improved technology, as 77 69 well as London-wide and local initiatives 56 . All emissions are predicted to continue decreasing until the 42 40 41 27% year 2020. After that it is difficult to predict due to, as yet unplanned interventions and other actions both nationally

PM2.5(tonnes/year) and locally. 2008 2010 2013 2020 2025 2030

Data source Slide 17 GLA. London Atmospheric Emissions Inventory (LAEI) 2013 Road transport is the main source of air pollution in Southwark THE LOCAL PICTURE

Total emissions by pollutant type The largest source of air pollution in Southwark is road in Southwark in 2013 transport, contributing to over half of the annual NOx and

5% PM emissions 8% . Road transport is the main source of air pollution, accounting

for over half of NOx and PM emissions combined NOx 1,200 tonnes 31% 56% . Domestic and commercial fuels, which come mostly from cooking and heating, are another significant pollutant,

accounting for about a third of annual NOx emissions 16% 17% . Physical disturbance of previously emitted and deposited

pollutants (resuspension) accounts for a quarter of all PM10 PM PM 10 2.5 emissions; this type of pollution is heavily influenced by the 110 tonnes 50% 16% 56 tonnes 25% 56% weather, however, reductions in emissions will reduce

11% deposits 9% . Non-road mobile machinery is mostly used in construction, such as bulldozers, pumps, industrial trucks, fork lifts, mobile cranes and generators . ‘Other’ sources of emissions include aviation, river, rail, industry and dust from construction and demolition

Data source Slide 18 GLA. London Atmospheric Emissions Inventory (LAEI) 2013 Buses are the largest contributor to road transport emissions in Southwark THE LOCAL PICTURE

Road traffic emissions by pollutant type Of all road traffic in Southwark, buses emitted the largest in Southwark in 2013 amount of air pollution in 2013 1% 11% . Buses and taxis account for nearly half of the 1,200 tonnes of

NOx emissions and around a fifth of PM emissions 20% 42% NOx . Transport for London (TfL) buses contribute the most to this, 680 tonnes accounting for a third of total transport-related NOx emissions . Cars are another large source of road traffic emissions,

26% accounting for a quarter of NOx emissions and nearly half of all 2% 2% PM emissions 18% 21% 20% 22% . Diesel cars account for twice the amount of NOx emissions PM compared to petrol cars PM 2.5 10 32 tonnes 12% 55 tonnes 11% . Commercial vehicles contribute to a fifth of NOx emissions and over a tenth of PM emissions 45% 47% . Vans & mini buses account for a tenth of NOx emissions and a fifth of PM emissions . ‘Other’ sources of road traffic emissions include electric vehicles and motorcycles – these contributions are negligible compared to the total

Data source Slide 19 GLA. London Atmospheric Emissions Inventory (LAEI) 2013 Concentrations of key pollutants are decreasing in

Southwark but NO2 continues to be of concern THE LOCAL PICTURE Average annual concentration of air pollution 46.5 Trends over time show a downward trend in NO2 and PM emissions,

54 however there is a year-on-year variation

40 µg/m3 . There are two NO2 and PM10 monitoring sites in Southwark: one at , measuring background levels of pollution, and one

NO2 (µg/m3) NO2 along Old Kent Road, measuring roadside levels

. PM2.5 emissions in Southwark are modelled using overall PM trends 2000 2005 2010 2015 . NO2 in Southwark is showing a gradual decrease towards the legal 40 μg/m3

objective 30 23 . Concentrations of both PM2.5 and PM10 are showing a clearer downward trend with both being well below the legal UK objective

3 1

PM10(µg/m3) 20 μg/m . Atmospheric pollutants remain above the WHO recommended levels . While these downward trends are due, in part, to initiatives that have 2000 2005 2010 2015 been implemented, it is important to note that the concentrations of air 25 μg/m3

pollution presented here are also heavily influenced by weather and movement of air from other countries or other parts of the region2 14.1 10.9 . This means that emissions from Southwark are not the only contributor to air pollution in the borough and that we cannot control all elements PM2.5(µg/m3) 10 μg/m3 causing poor air quality locally 2010 2015

Southwark UK legislation WHO guidance Data source References

1. Southwark monitoring sites (NO2 & PM10) 1. WHO. Air quality guidelines: Global update 2005 Slide 20 2. PHE profiles (PM2.5) 2. DEFRA. Air Quality: A Briefing for Directors of Public Health 2017 The highest concentrations of air pollution are in the north west of the borough and along major roads THE LOCAL PICTURE

Concentrations of NO2 and PM also vary across the borough

. NO2 concentrations are above the legal objective limit in the north west of the borough (part of the Congestion Charge zone) and well above the legal objective along most main roads

. PM concentrations are generally low in Southwark, however PM10 exceeds the legal objective on the main roads around Elephant & Castle . Air quality is broadly compliant in the south of the borough other than on some major routes

Maps of mean concentration levels of key pollutants across Southwark (2013) References Slide 21 1. GLA. London Atmospheric Emissions Inventory (LAEI) 2013 While annual levels of PM10 are below national objectives, this pollutant is still of concern THE LOCAL PICTURE

Some main roads in the borough have high

levels of PM10 more often than is legally permitted . The number of objectives in the legislation for air pollution demonstrates that air pollution levels vary throughout the day

. Legal objectives state that PM10 must not exceed 50 μg/m3 on more than 35 days each year2 – Southwark is above this objective around some of the main road corridors in the Congestion Charge zone . During 2013 areas around Elephant and

Castle had high levels of PM10 for more than 60 days1

References 1. GLA. London Atmospheric Emissions Inventory (LAEI) 2013 Slide 22 2. Defra. National air quality objectives 2010 Nearly half of people in Southwark live in areas with NO2 levels above the legal objective THE LOCAL PICTURE

Proportion of the population living in areas Estimates show that 45% of people living in Southwark are with NO2 above the legal objective regularly exposed to high NO2 levels Kensington & Chelsea . Compared to other , Southwark has one of the highest proportions of residents living in areas of high Camden NO2 Southwark 45% Tower Hamlets . Air pollution is typically highest near to emission sources & - There are a number of arterial roads in Southwark, Hackney many of which are key bus routes and thus key Richmond upon Thames locations for NO2 emissions Newham Haringey . These roads include the roads around Borough, London Kingston upon Thames Bridge and the Elephant and Castle junction, as well as Waltham Forest High Street, Road, Road Barnet and Old Kent Road . Southwark residents living along or near to these roads are Redbridge Brent regularly exposed to levels of NO2 higher than the national standard Sutton Harrow . Poor air quality can contribute to local health inequalities as Enfield there is a social gradient associated with housing on busy 1 Barking & main roads Havering References Data source 1. DEFRA. Air Quality and Social Deprivation in the Slide 23 Borough Population - GLA Borough Projections UK: an environmental inequalities analysis 2006 NO2 concentrations in Southwark are projected to decrease, with the ULEZ having an immediate impact THE LOCAL PICTURE

NO2 levels in Southwark are projected to decrease . It is planned that from 2020 a new Ultra Low Emissions Zone (ULEZ) will come into force in Projections of annual mean roadside NO2 London concentrations in Southwark . ULEZ will cover the current Congestion Charging 50 42 zone, which includes the north west of Southwark, but 40 may cover all areas within the North and South 31 Circular roads, subject to further consultation by the 30 London Mayor in 2017 21 µg/m3 20 23 . It is projected that, with the implementation of the 19 ULEZ, levels of NO2 will drop dramatically within the 10 space of a year, from 33µg/m3 in 2019 to 23µg/m3 in 0 2020 2015 2020 2025 2030 . These reductions are likely to have an immediate With ULEZ Without ULEZ positive impact on the health of the population

. Without implementation of the ULEZ, levels of NO2 would continue to decrease due to existing initiatives, but this would be at a much slower rate and would have a less immediate impact on health

Data source Slide 24 Calculated from DEFRA’s Roadside NO2 Projection Factors CONTENTS

Introduction

Policy Context

The Local Picture . Health impact

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 25 Air pollution is a significant risk factor for mortality and ill-health in Southwark THE LOCAL PICTURE

Proportion of deaths linked to PM2.5 City of London There is a strong body of evidence showing that exposure to Westminster Kensington and Chelsea high levels of air pollution can have a range of adverse health Islington effects Tower Hamlets Hackney Camden . Air pollution can exacerbate respiratory conditions, such as Southwark asthma and chronic respiratory disease, and increase the risk Hammersmith and Fulham Newham of cardiovascular events like heart attacks and stroke Lambeth Waltham Forest Haringey . Long-term exposure can also increase the risk of premature Brent mortality and PM is thought to have an effect equivalent to Redbridge 2.5 Wandsworth over 80 deaths per year in Southwark, comparable to the Barking and Dagenham Lewisham number of deaths caused by lung cancer Greenwich Trend in proportion of deaths Ealing . The effect of PM 10% Barnet 2.5 linked to PM2.5 Enfield on mortality is higher in 8% Hounslow Merton Southwark than in London 6% Bexley or England, but is on the Havering 4% Richmond upon Thames Kingston upon Thames decrease 2% Croydon England Hillingdon . There is no other health Harrow 0% London Sutton data available locally 2010 2011 2012 2013 2014 2015 Bromley Southwark London England 0% 5% 10% Data source Slide 26 PHE Public Health Outcomes Framework 2015 More than 1 in 4 people in Southwark are at an age that makes them more vulnerable to poor air quality THE LOCAL PICTURE

Children . There are 55,500 children in Southwark aged 0-14 and this is projected to increase to 62,000 by the year 2026 . Children are more vulnerable to air pollution because their lungs are still developing and, for their size, they breathe more air each minute than an adult . There are relatively high numbers of children living in some of our air quality focus areas, namely around Peckham, Old Kent Road and Camberwell Road

Older people . There are 25,000 older people in Southwark aged 65+ and this is projected to increase to 33,000 by the year 2026, an increase of a third . Older people are more vulnerable to air pollution because their lungs are less elastic and therefore less able to filter out polluted air . Older people are also more likely to have a long term condition that can be exacerbated by air pollution . While older people tend to live in less polluted areas of the borough, some do live on or close to main roads and air quality focus areas, particularly around Elephant & Castle and Peckham

Data source ONS mid-year population estimates 2016 Slide 27 ONS population projections 2016 Some of Southwark’s groups that are vulnerable to air pollution live in and around air quality focus areas

THE LOCAL PICTURE

15

-

Children aged 0 aged Children Older people aged 65+ aged people Older

Data source Slide 28 ONS mid-year population estimates 2015 Air quality focus areas also have high numbers of population groups with generally poorer health outcomes

THE LOCAL PICTURE

Ethnic minority groups minority Ethnic communities Deprived

Data source 1. ONS Census 2011 Slide 29 2. DCLG Indices of Deprivation 2015 1 in 25 people in Southwark have asthma, making them more vulnerable to poor air quality THE LOCAL PICTURE

Over 4% of people registered with a GP in Southwark have diagnosed asthma . 13,600 patients in Southwark have an asthma diagnosis and 4,400 patients have a diagnosis of chronic obstructive pulmonary disorder . People with long term conditions are vulnerable to air pollution because their conditions are likely to be exacerbated by the air pollutants entering their bodies . We know which GP practices these people are registered with but we don’t know where they live, or if they are Southwark residents . Some of these people could also be in a vulnerable age group

Data source Slide 30 NHS Quality and Outcomes Framework 2015/16 CONTENTS

Introduction

Policy Context

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 31 Air quality is a Council priority and is included in the New Southwark Plan THE LOCAL RESPONSE

At the time of writing a new development management policy on air quality is under consultation as part of the emerging New Southwark Plan1 and Old Kent Road Area Action Plan2 . This policy outlines the requirements for developers to meet air quality neutral standards, contribute to air quality monitoring, reduce human exposure and mitigate the effects of poor external air quality on occupiers and users through design solutions . This addresses the CMO recommendation3 to consider the potential impact of air pollution at all stages of local authority planning

References 1. Southwark Council. New Southwark Plan Preferred Option 2017 2. Southwark Council. Old Kent Road Area Action Plan 2017 Slide 32 3. CMO. Annual Report of the Chief Medical Officer 2017, Health Impacts of All Pollution – what do we know? A range of Council strategies addressing physical activity and green space also address air quality THE LOCAL RESPONSE

The range of Council documents that address air quality demonstrates Southwark’s holistic approach to the issue . Many Southwark initiatives to address air quality are synonymous with increasing physical activity and active travel: - Active Travel JSNA: recommending work to increase active travel - Cycling Strategy: making 10% of all journeys in the borough by bicycle - Kerbside Strategy: reallocating road space to prioritise sustainable travel and make ‘necessary’ journeys greener - Transport Plan: encourages the take up of sustainable travel and reduces reliance on private vehicles - Open Space Strategy: providing open space and green chains, networks and corridors to improve air quality . Some initiatives address green infrastructure: - Open Space Strategy: providing open space and green chains, networks and corridors to improve air quality - Tree Management Strategy: acknowledges that trees are essential for improving air quality and how deficiencies will be addressed . These documents meet the CMO recommendation1 for environment strategies to be cognisant of air pollution while the Air Quality Strategy and Action Plan considers risk at varying levels of exposure to pollution

References Slide 33 1. CMO. Annual Report of the Chief Medical Officer 2017, Health Impacts of All Pollution – what do we know? Southwark’s Air Quality Action Plan requires input from a range of policy areas THE LOCAL RESPONSE

Southwark has an Air Quality Strategy and Action Plan1 with eight strategic aims: . Monitor and report on local air quality

. Reduce emissions from buildings using the planning process and awareness raising

. Increase public awareness through communications, campaigns and engagement

. Reduce emissions from road traffic, particularly diesel vehicles

. Reduce carbon emissions*, including for new developments, and ensuring energy efficiency in Council properties

. Regulate and control emissions from commercial and domestic sources

. Support the GLA’s actions and policies, including extension of the ULEZ

. Maintain air quality as a local public health priority

*carbon emission are produced by the same sources as the pollutants assessed in this document, therefore reducing carbon emissions will have an effect on other key pollutants

References Slide 34 1. Southwark Council. Air Quality Strategy & Action Plan 2017 A number of actions are included to support vulnerable groups THE LOCAL RESPONSE

Reducing school traffic . Encouraging children to walk or cycle to school by promoting school travel plans and increasing the number of schools with TfL STARS accreditation . Improving air quality around schools by piloting School Streets and facilitating the GLA’s Air Quality Audits in some of our primary schools . Providing advice to schools and nurseries and embedding air quality into the local curriculum

Poor air quality alert cascade . Provides alerts about poor air quality to staff and contracted services, particularly those in schools and care homes, so they can provide information and advice to those with specific health issues that might put them more at risk

GP access to appropriate prompts, advice and information . To develop resources that enable GPs to provide vulnerable individuals with advice on reducing personal exposure to air pollution

Slide 35 Actions meet many of the identified needs in Southwark

THE LOCAL RESPONSE

A number of actions in the Air Quality Action Plan address the main source of emissions – road transport . About a quarter of the actions in the AQAP aim to reduce emissions from road transport. While local actions cannot address the largest proportion of road transport emissions (TfL buses), these actions allow some level of local improvement.

. Resuspension of dust particulates accounts for a quarter of PM10 emissions. Most dust in urban areas is generated by construction and waste management sites which Southwark is addressing through working with the Environment Agency and enforcing regulations and conditions on permits.

Actions to mitigate exposure of those in vulnerable groups . Poor air quality affects all, as do all improvements . Vulnerable individuals who sign up to AirText will receive air quality forecasts to help them better manage their condition or illness . Vulnerable groups cared for by the Council will find their carers receive poor air quality alerts and can modify their activities and care packages appropriately . Those with higher exposures who live close to main roads will benefit from all the actions being taken to reduce emissions from vehicles as set out in the Air Quality Action Plan

Slide 36 Southwark’s AQAP is realistic when considering ease of delivery and magnitude of benefits THE LOCAL RESPONSE Southwark’s AQAP aligns well to the GLA’s Borough Air Quality Action Matrix1 and NICE recommendations2 Easier but Easier & larger . The AQAP includes many of the local smaller benefits actions recommended by the GLA benefits Emissions from and NICE Public health & developments & awareness raising buildings . The GLA note that some actions are easier to implement than others and some yield more benefits than others – this helps determine the priority level of each action locally1 Less easy & smaller Less easy but Southwark’s AQAP improves on action benefits larger benefits plans prepared by other local Delivery servicing & Localised solutions authorities freight Cleaner transport . AQAPs from other authorities that are Borough fleet actions considered to be leaders in the field were considered as a baseline in developing Southwark’s action plan

References 1. GLA. LLAQM Borough Air Quality Action Matrix Slide 37 2. NICE. Air pollution: outdoor quality and health (NG70) 2017 CONTENTS

Introduction

Policy Context

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 38 Southwark’s Air Quality Strategy and Action Plan was generally well received COMMUNITY & STAKEHOLDER VIEWS

Southwark’s draft AQAP underwent both statutory and public consultation1 from December 2016 to January 2017 . This process demonstrated that air quality is important to both residents and partners in Southwark, as well as confirming the need for certain messages through local campaigns and communications . To address issues raised during the consultation, a number of modifications and additions were made to the AQAP

Feedback on the draft AQAP was largely positive, but some felt we could do more . The GLA supported the level of Public Health involvement and commented on the comprehensive nature of air quality improvement actions proposed . The Environment Agency wanted to see more emphasis on spatial planning and regeneration, as well as addressing particle resuspension specifically . Both Better Bankside and Team felt that there was insufficient air quality monitoring in the borough and a third continuous air quality monitoring station is now planned . All key stakeholders and delivery partners supported the actions listed in the AQAP, offering support and collaboration where needed

References Slide 39 1. Southwark Council. Air quality strategy & action plan consultation responses 2017 CONTENTS

Introduction

Policy Context

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 40 Southwark does not meet the legal objectives for air pollution, but emissions are decreasing SUMMARY & KEY FINDINGS

There are legal limits for key air pollutants that are regulated by European and national legislation. Southwark does not meet all the objectives for NO2 or PM10. . While these legal objectives exist, there are no absolutely safe levels of air pollution . Air pollution has a wide range of health effects that are particularly harmful to children, older people and those with existing long-term health conditions

. Levels of NO2 and PM vary across the borough, with high levels in the north west and along main roads, and lower levels in the south

Emissions of NO2 and PM are decreasing in Southwark and are projected to decrease still further . The primary source of emissions is road transport, particularly TfL buses . Decreases in emissions are largely due to London-wide initiatives like the Low Emission Zone, the Congestion Charge zone, the ULEZ, and the introduction of cleaner, greener buses and electric/dual fuel taxis . Whilst locally we can have little influence over TfL buses, our local actions build on and support these wider regional initiatives by encouraging active travel and replacing diesel vehicle fleets

Slide 41 Exposure to air pollution is high in Southwark but there is insufficient knowledge about its impact on health SUMMARY & KEY FINDINGS

Almost half of people living in Southwark are regularly exposed to high NO2 levels . This is higher than most London boroughs and contributes to local health inequalities

. With the implementation of existing and planned initiatives, particularly the ULEZ, NO2 levels in Southwark are projected to decrease – this will have a positive impact on health . A number of our residents in vulnerable groups live in and around our air quality focus areas . While many initiatives aim to reduce emissions, helping local people to mitigate their exposure to air pollution should also be key to our local actions

Mortality linked to air pollution is higher in Southwark than in London or England, accounting for 6% of all deaths . There is no data available to assess the direct health impact of air pollution locally, but with some of our vulnerable groups living around our air quality focus areas, evidence shows that they will be disproportionately affected by poor air quality . Southwark’s AQAP includes actions to mitigate the health effects on vulnerable groups, but these are limited

Slide 42 Air quality is a local priority and addressing it will have significant co-benefits for the environment and health SUMMARY & KEY FINDINGS

Improving local air quality is a Council priority in Southwark . Air quality is addressed in several Council strategies, including the New Southwark Plan and Old Kent Road Area Action Plan . Southwark’s Air Quality Action Plan requires input from a range of policy areas . The listed actions in the AQAP meet many of the identified needs in Southwark but more could be done with health and care providers to mitigate exposure and support older people

Some of the actions in the AQAP are likely to have significant co-benefits . Measures that encourage people to use sustainable transport, such as walking and cycling, also improve the environment and their personal health outcomes due to increased physical activity

Slide 43 CONTENTS

Introduction

Policy Context

The Local Picture

The Local Response

Community & Stakeholder Views

Summary & Key Findings

Recommendations

Slide 44 Engaging and working with partners is vital to improving air quality RECOMMENDATIONS

Engage with NHS partners to help support vulnerable groups in mitigating their exposure to air pollution . Raise awareness in GPs and other health professionals to incorporate air quality into supported care plans  Lead: Public Health, Environmental Health and Clinical Commissioning Group

Continue to support health-related air quality grant applications . Provide local health and air quality monitoring data and information on the Council webpages . Identify projects suitable for air quality funding applications and apply where possible after reviewing the funding guidance  Lead: Public Health and Environmental Health

Continue to develop the air quality communications campaign . Spread messages to bust air quality myths . Further promote the use of AirText among our vulnerable groups . Maintain and strengthen the poor air quality alert cascade . Organise an air quality conference in Southwark  Lead: Environmental Health, External Affairs and Clinical Commissioning Group

Slide 45 We need to continue and build on the work that we are already doing RECOMMENDATIONS

Continue to advocate for wider, regional action to address air quality . Support wider initiatives and challenge proposals and decisions as appropriate  Lead: Environmental Health, Transport Policy, External Affairs and Clinical Commissioning Group

Build on existing Council work to further address air quality locally . Explore possibilities for more extensive wet road cleaning techniques to reduce re- suspension in the borough  Lead: Environmental Health and Street Cleaning . Continue to develop and adopt robust planning policies that require high standards from new development proposals, particularly in identified areas such as Opportunity Areas or Air Quality Focus Areas  Lead: Planning

Maintain our multi-agency approach to air quality . Air quality will continue to be addressed and monitored through a range of actions and strategies across the Council and its partners . Continue to review and update the AQAP as objectives are achieved and as new evidence emerges  Lead: Environmental Health Slide 46 More information is needed to truly understand the health effects of poor air quality locally RECOMMENDATIONS

Work with local research partners to get a better picture of the health effects of air quality in Southwark . Identify and engage local research partners who could assist us in investigating air quality and health locally . Identify potential sources of data that could contribute to modelling the health effects of air pollution in Southwark  Lead: Environmental Health and Public Health

Commission an air quality study for the Old Kent Road Opportunity Area . Model pollutant dispersion to inform the design of housing and infrastructure development proposals in the Opportunity Area and identify necessary measures and best practice to reducing exposure to, and mitigating the impacts of poor air quality . Use the study to inform and support the air quality policy in the Old Kent Road Area Action Plan  Lead: Planning

Slide 47 Actions to address outdoor air quality also address other key health issues TAKE HOME MESSAGE

Air quality improvement measures positively contribute to over a third of the Public Health Outcomes Framework indicators1 . Generally reducing emissions contributes to improving health, increasing healthy life expectancy and reducing early death from cardio-respiratory diseases . Reducing traffic reduces the risk of injury and death from road traffic collisions . Creating environments that are more pleasant for walking and cycling reduces traffic and increases physical activity levels, improves mental health and wellbeing and resilience to climate change . Green infrastructure helps to absorb air pollution while giving people the opportunity to get outside, be physically active and improve mental health and wellbeing . Improving the energy efficiency of homes reduces fuel bills and therefore fuel poverty

No other area of intervention could impact on so many key aspects of population health

References Slide 48 1. GLA. Air quality in Southwark: A guide for public health professionals Air pollution in Southwark: a summary

Air pollution is the biggest environmental risk factor for premature death. Nitrogen oxides (NOx) and particulate matter (PM) are the two air pollutant types which are known to have a detrimental effect on human health. Sources of air pollution and emissions Health impact of air pollution

Road transport is the main Affects the brain and the source of air pollution in central nervous system High levels of PM Southwark causing strokes and NOx pollution irritate eyes, nose and throat Domestic & commercial fuels, mostly from cooking and Increases the risk of heating lung cancer and reduced lung function Both causes and long-term; exacerbates exacerbates existing heart disease by Non-road mobile machinery, existing respiratory conditions hardening the such as industrial trucks, arteries cranes and generators

A total of 1,300 tonnes of nitrogen oxides (NOx) and Particulate air pollution is thought to have an effect equivalent to over particular matter (PM) were emitted in Southwark in 2013. 80 deaths per year in Southwark.

Air pollution trends in Southwark Who is at risk in Southwark UK legislation and WHO guidance provide limits, above which air Air pollution has a negative impact on everyone but a disproportionate pollution is likely to harm human health. However, there are no impact on vulnerable groups, including children, older people and those absolutely safe levels of PM and evidence suggests that health with long-term conditions. effects can still occur well below these limits. By the year 2026 the number of residents aged 65+ is predicted 13,600 patients in to reach 33,000: an increase of Southwark have an asthma diagnosis 32% compared to 2016

A number of people in Southwark 55,500 children aged 0- who are more vulnerable to air 14 live in Southwark and this NO and PM concentrations in Southwark have reduced since 2000, x pollution live in and around air is projected to increase to however NO concentrations are still above UK legal limits and PM x quality focus areas 62,000 by 2026 concentrations are above WHO guidance.

Sources: GLA, London Atmospheric Emissions Inventory 2013; DEFRA, Air Quality: A Briefing for Directors of Public Health 2017; COMEAP, Long-term exposure to air pollution: effect on mortality 2009; ONS, Mid-year population estimates 2016; DCLG, English indices of deprivation 2015; ONS, Annual Population Survey; DfE, School Census 2017.

Find out more at southwark.gov.uk/JSNA

People & Health Intelligence Section Southwark Public Health