Environmental Audit Committee
Oral evidence: Air Pollution in England, HC 21
Monday 14 September 2026
Ordered by the House of Commons to be published on 14 September 2026.
Members present: Mr Toby Perkins (Chair); Julia Buckley; Jonathan Davies; Barry Gardiner; Sojan Joseph; Manuela Perteghella; Adrian Ramsay; Martin Rhodes; John Whitby.
Questions 192 - 220
Witnesses
I: Right Hon. Dame Diana Johnson MP, Minister of State for Public Health and Patient Safety, DHSC; Professor Sir Chris Whitty KCB, Chief Medical Officer for England; and Simon Reeve, Deputy Director for Public Health Systems and Workforce, DHSC.
Written evidence from witnesses:
- Written submission from the Department for Environment, Food & Rural Affairs, Department for Health and Social Care and Department for Transport (AIR0144)
Witnesses: Dame Diana Johnson MP, Simon Reeve and Professor Sir Chris Whitty KCB.
Q192 Chair: Welcome, everybody, to the latest meeting of the Environmental Audit Committee as part of our look into air quality. I am delighted to say that today’s two panels are based on the Government response to this very important and cross-Government issue. We will be hearing shortly from the Department of Health and Social Care—Dame Diana Johnson and her colleague. We will also be hearing from the Chief Medical Officer, Professor Sir Chris Whitty. Welcome to the three of you. We will later be hearing from the Department for Transport and the Department for Environment, Food and Rural Affairs.
We have been attempting for the last month and more to get a representative here from the Ministry of Housing, Communities and Local Government, but we have been unsuccessful. Initially we were told that they did not consider this a key area of responsibility for them, and subsequently that they did not have anyone available to attend. Given the issues of planning and local government monitoring, and the evidence we heard that construction is a significant cause of air pollution, we felt that they should have been here, so I am putting on the record this Committee’s disappointment with that decision.
Notwithstanding that, we are delighted to have with us this excellent panel today. Dame Diana, could I invite you and the colleagues joining you to introduce yourselves and describe your responsibilities in this area?
Dame Diana Johnson: My name is Diana Johnson. I am the Minister for Public Health and Patient Safety in the Department of Health and Social Care.
Professor Sir Chris Whitty: I am Chris Whitty and I am the Chief Medical Officer, so I am responsible for public health in the broader sense across the whole of Government. I wrote an annual report on this in 2022. It was quite a long but, I hope, helpful technical report.
Simon Reeve: I am Simon Reeve, deputy director for public health systems in DHSC. My team has policy responsibility within the Department for our interest in air pollution.
Q193 Chair: Excellent, thank you very much. Diana, could I start with you? Obviously, your Department has responsibility for the results of air pollution. We know the very substantial health impacts of air pollution. Can you give us a sense of how easy you find it to get other Departments to take seriously the health concerns caused by air pollution? Obviously, we will be hearing from the Department for Environment and the Department for Transport, and we have already spoken about the construction contribution. How easy do you as a Department find it to get other Departments to understand how serious this issue is?
Dame Diana Johnson: First, thank you very much for the opportunity to appear before the Committee this afternoon. I have only been a Minister in the Department for a few short weeks, but I have certainly made inquiries as to the relationships that have gone before, particularly between Ministers. I know that there were good relations and meetings with DHSC Ministers and DEFRA Ministers in particular. I certainly take the view that this is obviously a cross-Government issue. We cannot leave it to the Department of Health and Social Care to sort out air pollution, nor can we leave it to DEFRA; every Government Department has to be involved.
The role that I see for my Department is that we are providing the strong public health case on our need to get air pollution down and why we need good-quality air, for all the reasons that the Committee already know. We have evidence of the health impacts, particularly for chronic ill health; we know that it is linked to between 26,000 and 38,000 deaths a year and that it costs the NHS a great deal of money. For all those reasons, we are providing the scientific evidence data to DEFRA and other Government Departments so that they can make the right decisions about the policies that they take forward and we are making sure that health is part of that.
As the new Minister, my intention is to build on those existing relationships. Officials meet all the time, so that is very ingrained. I was previously a Minister in the DWP. We published the child poverty strategy, and I was clear that dealing with child poverty was not DWP-only, but had to be across Government. With the review of the air quality strategy that DEFRA has announced, there is an opportunity to look again at working across Government. Perhaps the Committee may also reflect on that in its report.
Q194 Chair: I am sure that we will. Professor Whitty, building on that answer, can you take the Committee through the key impacts of the current levels of air pollution, along with the key causes that you have discovered from your work?
Professor Sir Chris Whitty: I massively welcome the Committee’s work on air pollution because it is such a big driver of ill health, as the Minister said. I agree with the Royal College of Physicians’ central estimate of 30,000 deaths. Just to give a sense of scale, that is not an exact figure; it is a kind of ranging shot.
To the first part of your question, it is very clear that air pollution has effects all the way through the life course, from causing premature births, which can cause significant problems in childhood, through to effects in adulthood. Problems in childhood include things such as very severe asthma attacks and effects on lung development. Then, in adulthood, there are big impacts on cardiovascular disease, which I think most people do not recognise. It is a major driver of heart disease and stroke. There is also increasing evidence that it has an impact on dementia along with several cancers, including lung cancer, and long-term lung disease.
Put the other way round, we have a real generational opportunity to make an enormous impact on this. If you put that together with the Tobacco and Vapes Act, which this Parliament passed, children today should have a much better reduction in the things that assault them through their lungs—essentially air pollution and smoking—than any previous generation for a very long time, probably over two centuries. That is an enormous step forward if we can achieve it.
You will know what causes air pollution from hearing previous witnesses, but I will summarise. There have been big impacts from transport, and although major steps forward have been taken, so that vehicle emissions are much lower than they were, there is further to go. Moving to an electrified fleet will take us a further step in the right direction. Construction has always been important. In the agricultural industry, ammonia is very important and is really the only pollutant that has not really gone down over a long period. There are perfectly good ways we can deal with that, and I am sure you will be dealing with that in the next panel, although I could go into it in more detail if you wanted. Space heating is also very important in the winter months, and some forms of heating are much more polluting than others.
Q195 Chair: Such as?
Professor Sir Chris Whitty: Anything that burns is going to be more polluting. That means that you get no air pollution from any form of electrical heating. Then you have mid-burning things, like oil, and slightly more than that, the DEFRA-exempt wood burners; then you have old wood burners and open fires right at the top end. There is a gradation between those, and that is laid out in some detail in the report, if people are interested in the details.
These are areas where we can make progress. It is important to reflect that, in virtually every sector, we have had substantial progress. It is notable that the Royal College of Physicians report I referred to, which I know you have all read, now has a central estimate of 30,000 deaths. Ten years previously, it said 40,000. That is due to improvements we have made. Air pollution is not only an issue that causes huge problems; it is also an issue we can do a lot about.
Q196 Chair: Great. Can you talk us through the key interventions that the Government could propose that would make the biggest difference?
Professor Sir Chris Whitty: I would start off with what we can do internationally, because many of the things we can do most effectively are done on an international basis. Part of that is because many pollutants, like PM2.5, are transboundary; we get things from France and France gets things from us, depending on which way the wind blows. The European vehicle standards are incredibly powerful at driving down particulate matter—PM2.5—and nitrogen oxides in both light and heavy vehicles. That was done on a whole-continent basis, and the advantage is that no country’s industry is disadvantaged. There is a lot we can do internationally.
In a sense, the others follow from the previous answer. Industry has done a remarkable job in most areas, but some residual areas are still tricky, including construction, which you mentioned. There have been remarkable improvements in many areas of transport, but there are some niche areas that stand out. I will give one example, which demonstrates that you can do quite simple things—I know that the Minister firmly agrees with me on this one, as I hope she does other things as well. I cannot understand why we still allow diesel engines to idle in stations in this country just to keep the lights on, when there is a power source 3 metres away. It is ridiculous. Old diesel engines in enclosed spaces with large numbers of people working, commuting and going on leisure trips is an example of how to increase air pollution. We could turn that off remarkably quickly. There are quite a lot of small things that you could add together.
It is worth having a serious look at how it is that some countries, such as Holland, have managed to reduce ammonia from agriculture, which combines over cities and causes secondary pollutants—secondary particulate matter—while we have not been so effective. It is very important to look at the economics of this. For the farming industry, this could be made to be self-sustaining, because it can mean the farms use less fertiliser. We need to make that transition. Those are just examples. I have also mentioned space heating, which is an important area.
Q197 Chair: We know that the UK’s targets are less ambitious than the WHO guidelines. We have heard evidence that we could achieve the UK targets and still have quite substantial negative impacts on public health, particularly in areas of greater deprivation. Should policy be moving faster towards WHO guidelines, or are the UK targets sufficiently ambitious?
Professor Sir Chris Whitty: I note in passing that the WHO tightened its targets quite significantly in 2021, because of new evidence. My view is that we should aim to push down all the forms of pollution we can to the lowest level compatible with a functioning economy and with making sure that things work societally. We can go a long way without having a negative impact on the economy. The targets are useful as a prompt, but even if we met the UK targets, we should keep going in the areas where we can, because of the very large impact on chronic diseases, acute diseases and child development, as I talked about at the beginning.
I do not think that that is a particularly controversial stance. If you talked to people in the street, there would be very wide support for that position. People know that someone polluting upwind of them can affect them and their children, the elderly and people who have chronic diseases. This is something we can make a very big impact on. Once we have done it, it seldom goes backwards.
Q198 Jonathan Davies: We have just discussed the WHO guidelines, and it is good to hear the commitment to cross-governmental collaboration, Minister. If the Government’s legal air-quality limits permit levels of pollution that are still associated with premature mortality, chronic illness and ecological harm, what is the justification for maintaining those limits?
Dame Diana Johnson: As the Chief Medical Officer set out so eloquently, we are clear that there are no safe targets that would not impact on population health, so clearly we want to get the air pollution down and the air quality better. DEFRA is responsible for setting the targets in this country, and you will hear from the DEFRA Minister next.
On the WHO guidelines, when I was looking at them, they were very clear that each nation has different things to take into account and consider. It is absolutely right that we do as the Chief Medical Officer says. We work as hard as we can to get the air pollution levels down, but as I referred to earlier, the review that will take place in DEFRA of the air quality strategy will allow us and DEFRA Ministers to look at the latest health and scientific evidence when deciding what to do with the strategy.
Q199 Martin Rhodes: Air pollution disproportionately impacts children, those in deprived communities, ethnic minority populations and those with pre-existing health conditions. What progress has been made in reducing those inequalities, and how are we measuring that?
Dame Diana Johnson: First of all, this Government are very aware of the problem of health inequalities, and we want to do something about it. In the 10-year health plan, we set out very clearly that we want to halve the gap in healthy life expectancy between the richest and poorest in this country. That is absolutely the right thing to do, and it fits alongside the environmental improvement plan that was produced by DEFRA. You are absolutely right; we all know that the most vulnerable people, often in the most deprived areas, are the most affected.
We are doing various things at the moment, and perhaps at the end I want to say something about how we are going to measure this, because our aim is over the 10 years of the health plan. The UKHSA has an air quality and health dashboard for England, and that is important because it gives local authority areas’ directors of public health the opportunity not only to drill down into their local areas about what the levels of air pollution are, but to look at the demographic and socioeconomic information. If the residents of an area are predominantly families or elderly people, for example, the authorities can target any policies they want to bring forward on those particular areas. That is really important. The other thing that we have done in the recent devolution Act is to put a duty on mayoral combined authorities and strategic authorities to have to look at health determinants, because again that will help us to start to tackle some of the health inequalities.
I am sure that the Committee has looked at the evidence from the CHILL study, which looked particularly at children in Luton and London and at the impact of decisions that the Mayor of London, Sadiq Khan, took when he extended the ULEZ policy. The fact that I was quite taken aback by is that children’s lungs can recover and grow if they get cleaner air. I thought that that was very important. Again, this is looking at the kind of policies that mayors particularly might be able to use in their local areas to deal with specific issues.
Within MHCLG—I am sorry you have not got a Minister to talk about this—there is the local outcomes framework, which includes an indicator about mortality attributable to air pollution. Again, I think that that will help to concentrate the minds of local authorities when they design policies, because of course they will be looking at planning policies, what industries they are bringing into areas, the housing and a whole range of things there that will start to tackle some of the inequalities that we see in different parts of the country.
You are probably going to ask me, “Well, how are we going to measure this and what is actually working already?” There is work to do on that because, while we have got this big aim over 10 years, to actually know that we are making progress in the right way is important. I am sure that the Chief Medical Officer will have something to say about how we are going to measure that success over the years to come.
Q200 Martin Rhodes: We will come to that in a minute, but to be clear, do you see the responsibility for monitoring this as being with local authorities?
Dame Diana Johnson: Sorry, I probably did not make myself as clear as I should have. I think they have a huge role to play and, of course, the Government’s agenda around devolution—pushing decision making down and using mayors and local authorities—is really important. As the Chief Medical Officer said, we have responsibilities at a national and international level as well, but if we are dealing with the health inequalities of certain communities, there is a really strong role for elected politicians and officers at the regional and local level.
Q201 Martin Rhodes: The concern would not be about the devolving of responsibility; it is about what resources are going in for them to deliver on those responsibilities.
Dame Diana Johnson: I am not an MHCLG Minister, but I know that additional money has gone into local government in the last two years and that many local authorities are looking carefully at how they can improve the health of their communities. Of course, the local NHS does joint strategic needs assessments to identify the health needs in those areas. That combination is important for tackling health inequalities at a local level. Of course, we also have responsibilities nationally to make sure that happens.
Q202 Martin Rhodes: We may want to follow up by letter to the MHCLG about the issue of funding. Chief Medical Officer, did you have something to add about measurement?
Professor Sir Chris Whitty: To build on all the points that the Minister made, the thing about people living in areas of deprivation is that they tend to get a double hit. They both start off with less good health—of course, that is an average—and they have worse air pollution. If you put those two together, you get a significant impact, which is differentiated across society, unfortunately. It is important to say that because air pollution spreads so widely, the best way to deal with it is to reduce it for absolutely everybody. That has the biggest impact, including in areas of deprivation.
In terms of the measurement, you have to extrapolate—because of this/that, you have two different things. You can measure the pollutants and measure them locally, and then you can work out where the most vulnerable populations are, but it is a calculated figure rather than a directly measured one. Therefore, it is much more difficult to say with absolute certainty, unless you have a particular thing—going back to the Minister’s point about the CHILL study—where you can say, “Right, here’s where a change happened, it’s really clear in time, and here’s what happened to the health outcome as a result.”
We should be intervening more in things that we know will reduce air pollution and then measuring before and after. We may find, as with CHILL, that the effects are bigger than we were expecting rather than smaller. That really is the best way to do policy.
Q203 Sojan Joseph: Professor Sir Chris Whitty, I will start with an example. Last week, I met a nurse in my constituency. She was diagnosed with tuberculosis, and when she had a meeting with her respiratory consultant, there were no conversations about air quality and how it can impact tuberculosis.
I chair the all-party parliamentary group for global tuberculosis, and we recently carried out an inquiry that showed rising rates in the UK. We had 5,490 cases notified in 2024, which is a 13.6% increase. London accounted for 20.6% of tuberculosis notifications, and one in five people in the UK have at least one TB social risk factor. Do clinicians currently have adequate guidance to communicate air pollution risks to patients, particularly those with cardiovascular, respiratory or pregnancy-related vulnerabilities?
Professor Sir Chris Whitty: First, I am sorry to hear about your constituent. You are absolutely right that tuberculosis is a significant issue—doubly so if someone is a healthcare worker because it has big implications for them more widely. To reaffirm for the record, you are also completely right that air pollution is a risk for tuberculosis, as it is for many other respiratory infections. The link is very clear.
In terms of whether people have the available information, most clinicians will have a clear understanding that air pollution is a risk factor for these diseases. Very often where they stumble and find it more difficult is working out what they can advise an individual in terms of reducing their risk. Because the risk is so generalised across society, they can certainly point people towards the very good things that most people do without necessarily knowing it. For example, weather apps have things that say whether pollution is high or low, and people who are at particularly high risk may want to pay attention to that to reduce their risk on high-pollution days.
In contrast to something like stopping smoking, where you say, “Well, smoking is your big risk, so just stop smoking,” and it is very clear what you should do, with air pollution it is harder, but there is very good guidance out there. I have discussed this with the Academy of Medical Royal Colleges, and with the Chief Medical Officers of the other three nations, to make sure that the evidence is out there; indeed, there is some specifically on healthcare workers in the annual report I did on air pollution, which is on this. There are vehicles, but the difficulty is: what do you do now? This really gets back to the fundamental point, which is that the best thing we can do societally is to reduce air pollution in the round. That would benefit absolutely everybody, including someone like your constituent.
Sojan Joseph: Minister, do you have anything to add?
Dame Diana Johnson: No, I think the Chief Medical Officer has set that out.
Q204 Sojan Joseph: Just to follow up with Professor Whitty, is current health surveillance and pollutant monitoring sufficient to detect and track air pollution-related illnesses? What clinical indicators or datasets are missing?
Professor Sir Chris Whitty: I think the air quality monitoring is not bad, but it has a number of technical limitations—which I am not going to go into for this Committee, because giving you a proper answer would take 15 minutes. I will point you towards the chapter in the report, which goes into this in a lot of detail, but I think we all agree that there should ideally be a denser network, and the most important thing is to do that in urban settings. I am very conscious of the risks to rural health in many other areas, but for air pollution, the great majority of the risk is in urban areas; indeed, that is where many of the interventions have to happen. You would want to have very good monitoring, and nobody would say that what we have at the moment is ideal. I think we would all like to see more and denser monitoring, particularly around areas with vulnerable groups. I would want to see close monitoring around schools, around care homes for the elderly and around hospitals, for example, to ensure that in those places, where there is a high concentration of very vulnerable people, we are aware of what is going on and can see the changes.
Q205 Chair: Professor Whitty, expanding on what you were saying about the way that Government Departments work together, I absolutely accept that the greatest good we can do is to reduce air pollution for everybody, but we know that if you are living in a house that is very close to a busy main road, your vulnerability is going to be far greater. Many of us have areas in our communities where there is real pressure on housing. I very much doubt that when authorities allocate housing, they think, “This house is very close to the road, so we’ll be conscious of whether there is a child with asthma in the household before we allocate it,” or anything like that. To what extent do you think Government is working together in those areas that have the greatest risk in order to identify how we reduce this number of 30,000, rather than using the broad policy levers that, as you say, are already making some progress?
Professor Sir Chris Whitty: Starting with your example of someone living near a road—we are tiptoeing cautiously into the complex area of housing allocation, which is definitely not my area—you are absolutely right, of course. If you look at the map of air pollution in any major city in the UK—Birmingham or London; it does not matter—you can see the major roads picked out really clearly, because they are the ones where you have high levels of nitrogen dioxide and particulate matter.
The first thing to say—sorry, I am a cracked record on this—is that reducing the risk from air pollution for everybody is the biggest thing you can achieve. But you are certainly right that some areas of every city, particularly near major roads and things such as major airports, are places where you would ideally not have people who have the greatest vulnerability, because the effects of air pollution on them will be quicker and more severe than they would be for the general population.
Q206 Chair: If we think about all the things we have been talking about in respect of the Government working together, such as housing allocations, how local health services provide specific support to individuals, or health education for people living in the affected communities—for example, they might want to think more carefully than others about whether their children play in the front garden—to what extent are the Government working together in the light of the medical knowledge we have? If we put to one side the fact that it is obviously a good idea for everyone and think about the 30,000 people out of our population of 70-odd million who die every year, and all the additional health benefits, are we doing enough to spread your health expertise across Government, so that it actually makes a difference to those who are most likely to die or to have serious health impacts?
Professor Sir Chris Whitty: I will divide the answer into outdoor air pollution and indoor air pollution, and then I am going to subdivide indoor air pollution, because the answer is different for each.
I think there is genuine co-ordination across Government on outdoor air pollution. While I as a public health person, and the Minister as a Public Health Minister, are obviously going to want things to go faster across a whole lot of areas, I do not think that is for lack of co-ordination across Government. Most Government Departments that can act are fully seized of this. I think DEFRA is taking this very seriously, and the Department for Transport is taking it very seriously. You can draw your own conclusions in other areas, but those two certainly are—I can be absolutely clear on that.
When it comes to indoor air pollution, that is much less true. We have started to understand the importance of indoor air pollution only recently, because outdoor air pollution so dominated the conversation until recently. As outdoor air pollution has come down, so the relative importance of indoor pollution has got greater and our scientific understanding has improved, and I think we should be giving it a lot more thought. The evidence base is much weaker. If you gave me enough time—although it would take up the whole session—I could go through all the things we do for outdoor; we know what they are. Indoor is a lot harder, and there are a lot more things we do not know.
If I was going to choose, I would really concentrate on indoor pollution in public buildings, because public buildings are essentially like the outdoors. You have no choice about going into a hospital, a library, a supermarket, the mosque or whatever. Understanding those environments and making sure that we reduce the risks there for all of society seems to me entirely in line with what we are trying to do on outdoor pollution.
The more we get into private spaces, the more questions there are about, “We should be providing information. We shouldn’t be telling people what to do.” That balance gets more complicated. But if we are talking about an indoor space that everyone has to use, and you cannot tell whether it is polluted, I think that is an area where we really ought to be doing a lot more. I therefore think that is an area where Government could be better co-ordinated.
Q207 Adrian Ramsay: Professor Whitty, we have talked a lot in this session about the fact that air pollution is a big threat to public health—we know that—but what specific action is being taken to ensure that doctors are equipped to advise patients on the risks, and by when will that be standard practice across the NHS?
Professor Sir Chris Whitty: You are absolutely right. This very much follows on from the previous question, so I will build on what I said previously. We clearly need to be informing people of this from the earliest stage. It ought to be covered in medical school, so that all doctors get it irrespective of their area of professional practice. There are clearly some professional practices—for example, general practice, physicians, paediatricians, and obstetrics and gynaecology, because of the risks in pregnancy—where you need even more information that is relevant to your particular client group, if I can put it that way, or patient group. I think we have got some of the way down that path.
The individual royal colleges, which tend to lead on postgraduate education, have done a good job on this in some areas, but I think we would all agree that they could go further. I pay particular tribute to the Royal College of Physicians, which did the excellent report that I think you referred to in some of your earlier evidence sessions. Again, though, I do not think any of us feels that we could not do more on this, because it is a risk. But I go back to my previous point: the difficulty is not in saying, “There’s a risk”; it is in saying, “And now this is what you should do about it.” Telling someone they have a risk but we do not know what to do about it is obviously not a very satisfactory situation.
Q208 Adrian Ramsay: I appreciate that it is only part of the picture, but how far would you say we are along the road towards it being rolled out to the extent that it should be?
Professor Sir Chris Whitty: To make a number up, let’s say 50% for the sake of argument. We have gone quite a long way, but I think the distance to go is quite a bit further.
Dame Diana Johnson: Could I say something at this point? Obviously, doctors are very important, but I am interested in what role other healthcare professionals have to play in getting information out to patients. There is some work going on with health visitors, who can be a useful source to get information to families and children where there might be risks that need to be identified and mitigated. So, there are other healthcare professionals as well.
Q209 Adrian Ramsay: I fully take that point. Looking at the obligations on integrated care systems, are they required to identify and act on air pollution risks, or is that discretionary?
Dame Diana Johnson: I referred earlier to their integrated health plans and how they have to identify health needs in communities. Integrated care includes commissioners, providers, the Department of Health and UKHSA. There is a very big group there. You need to think about how you get information out, and about how they work together at the local level and bring together the local commissioners and providers with the local councils and public health to do the integrated health assessment of what the needs are in that area and how you get information out.
Q210 Chair: If the Government recognise air pollution as a major public health risk—we have heard today that it is—do you feel that they should have launched a specific national awareness campaign so that people can take actions themselves to try to improve or reduce their exposure? Also, we could have a national conversation about this silent killer in our midst.
Dame Diana Johnson: As the Chief Medical Officer has set out, you have to be very careful about how you communicate with the public. You want it to be meaningful and give people actions that they can take and the information that they need. There has already been work on improving the health advice around the daily air quality index, which has been updated. DEFRA has led on the alerts that people can sign up to, to be told if there are high pollution levels in the area where they live; they can be given information about that. I was looking on my own telephone because, on the weather app, you can see what the pollution level is each day. I looked at what it was yesterday. That information is more readily available, and of course we have the Air Pollution Awareness Coalition, which is DEFRA-convened. I am sure that Minister Hardy will talk to you about this, but that brings together academics, health professionals and charitable groups to talk about how we best communicate. So a range of things are happening already. That is always kept under review. Whether we need to go further and do things in a different way, I am sure will be considered, alongside the air quality strategy review that DEFRA is undertaking.
Q211 Chair: We heard from Professor Whitty earlier that there is obviously a desire to reduce air pollution as much as possible, but there are also conflicting factors such as the need for us to use ammonia in agriculture or whatever else it might be. You are the Public Health Minister. You want to see the Government doing everything they can, but you are conscious of the other pressures. You say we have to be careful about public health messaging. Given the health inequalities that exist when it comes to issues like air pollution, and given that the poor and people from ethnic minorities are more likely to be affected, do you feel under pressure to not get that message out there because it might pose questions that the Government find impossible to answer, such as, “Why am I living in this house very close to a busy main road?”, or, “Why am I living right next to a factory that is burning pollutants?”, or for which they do not have a useful answer? Do you feel there are limitations on what you can say because it poses uncomfortable questions for other Government Departments?
Dame Diana Johnson: No, I don’t feel that at all. I am very conscious of what the Chief Medical Officer said about the advice that you give through public communications. That is why it is about the use of trusted healthcare professionals, ensuring they have the training and the information they can then impart to their patients to say, “If you do live near a busy road, these are the things you need to think about.” Particularly in the very hot weather we had, we were getting messages out about what you should try not to do in the middle of the hot weather. So it is about being clear about messaging that will help people make good choices. But I go back to that issue of ensuring that, particularly for vulnerable groups, there are trusted healthcare professionals from whom they can get good advice; that is very important.
I am not opposed to a more public awareness campaign, if that is what we decide needs to happen. We must review what we are trying to do. We want to provide good-quality information, advice and guidance to the public—obviously, in a cost-effective way, and we must be mindful of that—while using the other avenues that are open to us to get that information to the targeted people who perhaps are not looking at their phones or on social media. They need to feel that there is a healthcare professional—a doctor or a nurse—who they can talk to about their particular circumstances.
Q212 Chair: That is really important. You raise an interesting example because, when it comes to smoking, healthy eating, the hot weather that we have seen or covid, Government did not leave it to health professionals. They decided that they were going to get out there and do public health messaging. Yet here we have this thing that is killing 30,000 people a year and causing huge impacts, particularly in the young and the old, and we are leaving it to local doctors to communicate that message. We are hearing, through this whole process, that we already know the communities most affected, and we can show you on a map. Yet, I suspect, from the evidence we have heard, that they are not being told—through no fault of their own—that they are facing greater risks than you and I are. They are not being given any greater support to protect themselves, and in many cases cannot do so because they are simply victims of where they live. What consideration is being given to stronger public messaging on that key public health issue?
Dame Diana Johnson: We would always keep that under review. I do not think we are saying, “Absolutely no. We are not having a mass public campaign.”
Q213 Chair: You are not saying that, but you are not saying the opposite—“Yes, we are.” Do you think you should be doing more?
Dame Diana Johnson: I don’t think it is in my gift, this afternoon, to announce that that is what we will do. Obviously, you will write your report and make your recommendations, and we will want to look at what you have to say. I would be guided by the Chief Medical Officer and his advice on how you communicate. As I said, there is the Air Pollution Awareness Coalition that the Chief Medical Officer is involved in. I know there is a particular strand around healthcare professionals and how you ensure that messaging works there. We need to do more there. That is important. Whether we need something more public-facing as well is certainly something we keep under review.
Chair: I appreciate that; thank you.
Q214 Martin Rhodes: We have been asking questions, and you have been answering, on the co-ordination between Government Departments. What about co-ordination with other parts of the United Kingdom, such as the collaboration across Scotland and elsewhere? In terms of learning from different approaches, including internationally, are there examples of actions taken elsewhere that we could learn from?
Dame Diana Johnson: Perhaps I could ask my official to comment on what has gone on before. As I said, I have only been in the job a few weeks and have not had the opportunity to meet any Ministers from the devolved Governments. I am sure there were meetings going on before, and we were learning from what was happening in the other areas.
Simon Reeve: I can start, and then the CMO can answer. In terms of the UK dimension, the DHSC of course has responsibility for England, but our expert advisory mechanisms hosted by the UK Health Security Agency and COMEAP, the expert committee, engage across the UK. We are connected on the evidence, and that is the core DHSC brief, so it is wired into the science that we build this understanding on a UK basis. In terms of international examples of practice, the CMO mentioned ammonia; I don’t know if there are others he would like to add.
Professor Sir Chris Whitty: I will add a few things to that. I discussed this with the other Chief Medical Officers because we all see this as a major problem, but we should recognise that England has the biggest problem in the United Kingdom by quite some distance. Although there is pollution in some of the bigger cities in Scotland, England—and southern England in particular—has the largest burden of disease as a result of air pollution, for a variety of reasons. Some of that is to do with transboundary—what comes over from continental Europe—but quite a lot is just because of the concentration of people and particular forms of farming.
In terms of the international, as I said at the beginning, international action is really critical. There is a lot we can learn from other countries, and every country has done some things that we have not. I will expand a bit on agriculture, because it is really important that Holland or Canada, for example, have managed to reduce their ammonia emissions by up to half through changes in farming, which are, importantly, economically self-sustaining once they are done. The transition is the difficulty, but it really does things once it is achieved. That is an area where we have a lot to learn.
Other countries have been very imaginative about how they have done rapid transition to an electrified fleet in high-risk areas. Leaving aside carbon questions, on air pollution, the places you really care about are where you have lots of cars and people, which is in cities. One of the reasons we should discuss this internationally is that there is a lot to learn, as well as a lot of things we can do that are mutually helpful for one another.
Q215 Jonathan Davies: It has been good to hear about the collaboration that goes on in Government. We have specifically talked about DEFRA, DFT and DHSC. Thinking about some other Government Departments, particularly the Cabinet Office, the Treasury and the Business Department, I am interested to know, Minister, how well you feel they get these issues.
There is often a tension economically when we try to do something for air quality, as we have in Bradford, and there is pushback. We tried in Manchester as well, and the person who was closest to that is now much more—well, he is the Prime Minister. That is something he will be thinking about. That clean air zone did not go ahead, and they say that they made the difference by electrifying the bus fleet, but there is probably more we could do in Manchester on that.
As the Government approach some key decisions—they are consulting on the ZEV mandate and will make a decision on Jackdaw and Rosebank in the not-too-distant future—how well do you feel that those Departments, which are perhaps more on the periphery of this but quite often make the weather in terms of policy, get this? If we deal with air quality, that is obviously a huge saving to the NHS.
Dame Diana Johnson: As we have been saying, this cannot be left to one, two or three Departments; it has to be across Government. All Government Departments signed up to the 10-year health plan, and there is a section in that about air pollution and what we need to do about it. DEFRA obviously leads on setting targets, and you will hear from Minister Hardy shortly, but there is a commitment across Government overall. I am certainly keen as the new Public Health Minister to be involved in redoubling our efforts and making the public health case, and that fits with the review that will take place around the air quality strategy.
I want to pick up on what you said about Manchester. There was obviously a decision there not to proceed with the plan for a ULEZ-type model. The mayor then, who you rightly say is now our Prime Minister, decided that his investment would go into low-emission buses and electric buses. That goes to the heart of what I was saying earlier about devolution in terms of making decisions locally that best fit the needs of your community and taking into account all the economic issues your community is facing. That has to be built into this; we may find different solutions or means in different parts of the country, but at the end of the day we are all after reducing air pollution. We will have to accept that devolution will deliver different things in different areas, but the outcome is what we should all be focused on.
Q216 Manuela Perteghella: Should regional public health bodies or local public health bodies be statutory consultees on planning applications? I have a bypass in my constituency, and houses and family homes have been allowed to be built very close to it. When the bypass is opened, it will have heavy traffic and all the HGVs will be redirected through an area where children live. However, there was no discussion of pollution levels, so those houses were allowed to be built. I know that we do not have MHCLG colleagues here, but in your view, should public health play a more fundamental role in development, especially given the Government’s mission to build 1.5 million houses?
Dame Diana Johnson: All I would say is that our public health directors in all our communities and constituencies do an excellent job, and I certainly want to do everything I can to support them. On whether your suggestion is the right thing to do, I am happy to take that away and look at it. As I said earlier, the local authorities and the public health directors have an important role to play in making sure that they are reducing air pollution and improving the health of their local populations. I do not know whether the Chief Medical Officer wants to say anything.
Professor Sir Chris Whitty: You will be unsurprised to know that I would be keen to have as many opportunities as possible for educated public health inputs in planning decisions, including these ones, because I think it helps make sure that local decision makers have the full range of views available. The decision on whether it should be statutory is obviously not for me, as that is a political question. If you were a local leader, would you want to have that as part of the input that allowed you to make an informed decision? I am sure the answer would be yes.
Q217 Adrian Ramsay: Professor Whitty, what is your view of the proposed Clean Air (Human Rights) Bill, and particularly its impact on the issues we are talking about today? That Bill is otherwise known as Ella’s law—for the benefit of people listening, it was named after a nine-year-old girl, Ella Adoo-Kissi-Debrah, who tragically died in London in 2013. She was the first person to have air pollution named as the cause of death on her death certificate. The Bill seeks to establish that the right to clean air is a human right, wherever people live, given the inequalities that we have heard about. I should say that it has had wide cross-party support, but it is still on the books as a proposal. After the discussion we have had today, what do you think the impact of something like that would be on advancing the goals you have outlined that we need to see?
Professor Sir Chris Whitty: First, the tragic death of Ella has been an enormous spur to action. Ella’s mother is actually in the audience, and she has been a tireless campaigner and very effective in changing things. However, I am going to do what I very rarely do and dodge this, only because questions of what should be Bills are for political leaders, not me. The general principle that we should be driving change as a result of the experience of Ella, her family and others is clearly right, but as to whether a Bill is the right way to do it, it is not my position to say.
Q218 Barry Gardiner: Apologies for arriving late to this session; I was chairing another meeting. Can I press you on why the Government have not followed the EU in updating the limit values to reflect the WHO guidelines? In 2008, we did that following the change to the guidelines in 2005, but at the moment we are lagging sorely behind. The Northern Ireland Executive have been looking at this over the summer, and I think they have put forward proposals to halve their limit values of PM10 to match the EU, and PM2.5 will be cut from 25 to 10 micrograms per cubic metre, again matching the EU’s standards. Will it not be rather strange to have citizens in one part of our country protected to a higher standard than those in the rest of the country and, of course, those in the European Union? Why should people in England, Wales and Scotland lag behind?
Dame Diana Johnson: Perhaps I could start by saying that you will probably want to put that question to Minister Hardy in the next session, because DEFRA is responsible for the targets that we have. I do not know whether you were in the room when I said—I think I have said it several times—that the air quality strategy review will look at all of that. I do not know whether the Chief Medical Officer wants to say something particularly about that.
Professor Sir Chris Whitty: No. My job is to make the case, from a purely medical point of view, that going further than we do in many sectors and industries is essential. We had a long discussion about that when you were chairing your other meeting. The question about what the guidance should be for the Government is one for Ministers, and for DEFRA Ministers specifically, so I am not going to give a view on that, but I certainly think we should keep on going quite a long way from where we are across multiple different sectors.
Q219 Barry Gardiner: Can you confirm the range of excess deaths that are in some way attributable to air pollution in the UK at the moment?
Professor Sir Chris Whitty: The Minister laid out the range at the beginning, but the central estimate from the Royal College of Physicians, which is probably reasonable, is around 30,000 deaths a year. It is important to say that that is an extrapolated number, not a measured number, but most people would accept that it is a reasonable ranging shot. However, there is also the burden of ill health below that, which is not deaths, but anything ranging from premature birth at one end of life through to dementia at the other end, with really strong evidence on cardiovascular and lung disease and some cancers, particularly lung cancer. That is the reason why we all want to see major changes, in addition to on the deaths. The deaths are part of the health burden but definitely not all of it.
Q220 Barry Gardiner: Indeed. As parliamentarians, we extensively debate the 250 deaths a year from knife crime and the 2,500 from road traffic accidents, yet when we are talking about 30,000 deaths from air pollution, we have not moved, have we?
Professor Sir Chris Whitty: I will give a technical answer, but the Minister might want to answer on the political side and talk about what is debated in Parliament. We have moved in the sense that, in the last Royal College of Physicians report done by a similar group of people, which is a very good expert report done about a decade previously, the number was 40,000. That is because air pollution has improved in a large number of areas, although not in all, as we discussed at an earlier stage. What I would certainly be clear about, as would anyone who has read about this, is that taking air pollution further down, which we can do easily—that does not mean it would be straightforward in every area or sector, but it would be easy technically—would definitely lead to reductions in ill health in adults and better development in children, and delay a large amount of chronic disease that burdens people and reduces their independence.
The arguments for why we should do it are very clear, but I do not want anyone to leave feeling that we have not had progress—we definitely have. The whole point is that we can keep going down the slope, but it does not happen on its own. It happens because Parliament puts pressure on it and the law changes. It happens because engineers do better engineering. A variety of things can happen, but they need to be pushed. They do not just happen by magic.
Chair: Thank you very much, Minister, Professor Whitty and Mr Reeve, for the evidence we have heard today. I am very grateful for your appearance and for the quality of your responses. We will bring the first panel to a close.