Clean Air South | An evidence-based exploration of air quality in the Central South

CLEAN AIR SOUTH

An evidence-based exploration of air quality in the Central South and how we might improve it

“There is no safe level of air pollution.”1

This stark message from Professor, Sir Stephen Holgate is alone a compelling reason to establish Clean Air South.

An equally powerful motivation is the recognition that individual organisations working and investing time and resources alone in an effort to reduce air pollution will not succeed. The solution requires a team effort. Clean Air South is a team.

Convened originally by the University of Southampton, Wessex Health Partners and Local Authorities across Hampshire, Clean Air South brings together a growing consortium of academics, health leaders, local government and industry. We are pooling ideas, resources and expertise to step up to a health challenge that is costing lives and livelihoods across our region.

Clean Air South is focused on action and results. The ambition is simple: to improve the quality of air we breathe across the Central South. The route there is highly complex, but a collaboration of public, private and other organisations demonstrates recognition

SIGNATORIES

Professor William Rosenberg Chair, Wessex Health Partners;

Sue Littlemore Director, Civic University of Southampton

that challenges, and their solutions, are embedded in ecosystems. Clean Air South is a consortium that will integrate, social, economic, cultural, health, environmental and policy understanding. The partnership approach of Clean Air South improves our chances of success.

This report is one of Clean Air South’s first actions. Mountains of evidence exist about the adverse health impacts of air pollution, for example, the World Health Organisation has reported that outdoor air pollution contributes as much to poor health and increased deaths worldwide as active and passive smoking put together.2

But what do we know about air quality in the South? Who is most affected? What more do we need to know and what actions might make a difference? This report begins to tackle those questions, collating the reliable evidence we have and identifying the knowledge gaps we must fill.

This is not a report about blaming polluters, anyone who drives a car with a petrol or diesel engine is compromising air quality. It is about setting out robust evidence to understand the causes, impact, potential health mitigations and preventions of air pollution.

As the founding partners of Clean Air South, we invite you to read our report and join us to help improve the safety of the air we breathe.

Professor Craig Hutton Director, Sustainability & Resilience Institute, University of Southampton

David Ingram Service Lead Public Protection, Winchester City Council

Sir Stephen Holgate

Executive Summary

The report consolidates the evidence from research, policy and practice on air quality in the Central South region. Key insights include:

– We have a poor air quality problem in our region – evidence points to urban pockets of pollution that are worse than comparators elsewhere.

– Data on air quality in the region is not readily available and usable for policymakers at the granular level they need.

– There is a huge international evidence base that conclusively shows general associations between air pollution, increased morbidity and socioeconomic deprivation. From this evidence base we can infer that:

- Poor air quality contributes significantly to the strain on local health services, with wideranging and long-term health ill-effects from exposure to dangerous pollutants;

- Poor air quality in our region contributes significantly to local health inequalities –those who contribute least to the problem are also the most exposed and the most vulnerable to health ill-effects;

- Poor indoor air quality, linked closely to substandard housing, is emerging as a critical area for attention but is less well studied and understood.

– Local authorities currently have limited levers to address the root causes of poor air quality, and face challenging political trade-offs in doing so.

These worrying insights give rise to a clear need for action to address poor air quality. Key avenues to explore include:

– Drawing on examples of good practice locally and further afield to inform promising interventions in policy, planning and practice;

– Directing attention at urgent clinical needs and planning ‘quick wins’ in ways that can build the case for more fundamental preventive policy interventions;

– Taking a more nuanced approach to ‘behaviour change’ in recognition of the complexities of poor air quality in the region;

– Working collaboratively across government and – where useful – with regional industry to more effectively tackle the specific constellation of factors that contribute to air pollution in our region;

– Developing a much stronger and more bespoke evidence base on air quality to better reflect the diversity of the region and track the efficacy of interventions in this context.

Introduction

This report aims to provide a foundational evidence base for local and national stakeholders working to improve the quality of the air we breathe in the Central South region of Dorset, Hampshire and the Isle of Wight. Though an area widely known for its abundance of blue and green spaces, this report shows that our region faces significant challenges in addressing air pollution. The features of our geographical, demographic and economic profile mean that many residents are exposed to fine particulate matter both in and outside of their homes. Exposure to fine particulate matter at any level is ‘unsafe’ - exposure at the high levels found in parts of our region is known to contribute not just to high levels of respiratory illness, but to a wide range of chronic health problems.

Parallel work has been conducted investigating the evidence base and datasets that can inform and contribute to developing and helping to answer more specific research questions. This evaluation has used a framework to cover the domains related to air quality and health (human and environment). The Drivers, Pressures, State, Impacts and Response (DPSIR) framework allows us to identify data associated with

activities, emissions, air pollution levels, exposure and sensitivity of receptors and impacts as well as consider the interventions and policy responses. This audit allows us to look at data availability against potential needs, for example whether data are available over the right geospatial and temporal scales and frequency and whether there is historic data from which to help us to measure change and identify trends

This report discusses the quality of the air we breathe across the region, focusing in particular on air pollution hot spots in the urban areas of Southampton and Portsmouth. It outlines the policy framework through which air pollution can be addressed. It reveals the burdens of poor air quality to health, as well as differences in emissions, vulnerability and exposure amongst populations within our region. The report then highlights some successful interventions both locally, nationally, and internationally, and points to some key principles that need to underpin progressive policy change in this area. It concludes with knowledges gaps that need to be addressed to improve our understanding of air quality in the Central South.

Figure 1. DPSIR framework for considering the datasets that help provide data inputs to help answer research and policy questions (Hill 2024)

What do we already know about the quality of the air we breathe in the Central South,

both currently and historically?

The local picture

In this section we will provide a picture of the air quality in the Central South. For the discussion below, we draw on two key sources of data.

– The first is the Department for Environment, Food and Rural Affairs’ (DEFRA) UK Air Information Resource. DEFRA provides a map of the United Kingdom’s Air Quality Management Areas (AQMAs) (DEFRA, n.d.). The existence of an AQMA indicates a locality in which air quality has been predicted to breach relevant targets, providing a clear sense of air pollution ‘hot spots’ in the region.

– The second is reports from local authorities, who are required to monitor and report on air quality (DEFRA, 2023, p. 7).

These data sources help to paint a picture of the region in relation to existing government guidelines. However, we note an important caveat here that we will return to later in the report – that the broad scientific consensus suggests the government limits are inappropriately permissive and can risk conferring a false sense of ‘safety’ in areas which still have damaging levels of pollution.

The quality of the air across Central South exhibits a disparity between the rural and urban areas. DEFRA’s map indicates that local authorities have established many more AQMAs in urban areas in our region than in rural areas, and local policy documents confirm that picture via an emphasis on urban contexts.

– Dorset Council state that air quality in its region is “broadly very good”, due to the largely rural environment, with only two AQMAs in the county (the first established in 2007 and the second in 2009). As of 2023, air quality had improved and pollutant levels at both sites met the Government’s air quality objectives (Dorset County Council, 2023, pp. iii-iv). The Bournemouth, Christchurch, and Poole region has no AQMAs, and concentrations of pollutants there are generally declining (BCP Council, 2023, pp. 33-37).

– Hampshire County Council notes that Hampshire’s air quality has improved over the last 10 years and 14 AQMAs were revoked between 2010 and 2020 (Hampshire County Council, 2021, p. 9).

However, air quality can still be poor in parts of rural areas, despite meeting the Government’s standards. Bournemouth, Christchurch, and Poole Council have noted that non-urban regions can have a lack of joined up travel infrastructure that necessitates high road vehicle usage and causes congestion (BCP Council, 2023, pp. i). In Dorset, some locations have levels of pollutants close to the Government’s objectives (Dorset Council, 2023, p. i).

The two major urban areas in Central South, Southampton and Portsmouth, are more polluted than the rural areas.

– Portsmouth established 13 AQMAs in 2005 and revoked 8 in 2009, leaving 5 AQMAs in place (Portsmouth City Council, 2017, p. 11).

– Southampton has 10 AQMAs, typically in areas where road vehicles are congested (Southampton City Council, 2022, p. 24).

An academic study compared Southampton with comparator cities in England (including, Liverpool, Oxford, Derby, Nottingham) and Poland (including Warsaw and Poznan) and found that many of Southampton’s air pollution concentrations were worse than its comparator cities (Williams et al., 2019).

Evidence shows that the air quality of Southampton and Portsmouth is affected by the ports (Portsmouth City Council, 2017, Owusu-Mfum et al., 2023).

Southampton’s port is the United Kingdom’s busiest cruise terminal and the second largest container port (Southampton City Council, n.d, pp. 2-3). The extent of the impact on air quality in the region is a matter of some contention – with high-profile controversy over the claims made about the negative environmental impacts of Southampton’s port in a recent report from Transport and Environment (2024). Nevertheless, there is consensus that the marine and maritime industries of the city contribute important externalities. Likewise, compelling evidence points to the polluting impact of

the intensive traffic generated through its international airport and transport links to London, and its football team, two universities, and major shopping centres (McLaren and Williams, 2015, p. 481). Portsmouth, on the other hand, faces unique challenges in improving its air quality as the city is densely populated and only has three roads linking Portsea Island to the mainland, which can cause significant traffic congestion (Portsmouth City Council, 2017, p. 10).

The flow-on effects for local population health are also well-established (e.g. Gan Ming De, Vanderwel and Loxham, 2022, p. 6). For example, Portsmouth City Council estimates that 6.2% of deaths in 2022 in the city were attributable to long-term exposure to particulate air pollution (Office for Health Improvement and Disparities, 2024). Likewise, research shows that cutting air pollution in Southampton by one fifth may result in 150 fewer children with low lung function each year (Williams et al., 2019, pp. 82-99).

Figure 2. Air quality Domain Score (LSOA) based on the Access to Healthy Assets index & Hazards (2022) (Source: CDRC)

Is our air safe?

Southampton and Portsmouth’s Councils have made progress to improving air quality and comply with the Government’s air quality objectives (Portsmouth City Council, 2017, p. 14, Southampton City Council, 2022, p. 4). However, the designation of areas that comply with the Government’s objectives having ‘safe’ air may be misleading.

A major study has stated that the required air quality levels for fine particulate matter (PM2.5 - airborne particles under 2.5 microns in diameter) are still harmful to health. Research suggest that no safe lower threshold exists for the chronic effect of PM2.5 on overall cardiovascular health. Substantial harm could be prevented by governments adhering to the World Health Organisation’s (WHO) air quality guidelines (Wei et al., 2024). Notably, the United Kingdom’s air quality requirements are significantly more permissive than those recommend by WHO. WHO recommend an annual average level not exceeding 5 µg/m3, which is substantially lower than the Government’s 20 µg/m3 threshold (Wei and Schwartz, 2024). Additionally, research has shown that people exposed to levels of air pollution well within the United Kingdom’s guidelines experience changes in the structure of the heart, similar to changes in the early stages of heart failure (Aung et al., 2018, p. 2179). Achieving the Government’s objectives is an important step in preventing harm to the public health, but local authorities should aspire to reach the WHO guidelines.

The national picture

The challenges of poor air quality in Central South are not unique to the region. It is well established that air pollution is a serious harm to the public health across the country. Generally, long-term improvements have been made to air quality in the UK (DEFRA, 2023), especially if we consider the scale of improvements over the last hundred years (Exley et al., 2022, p. 3). One notable recent improvement is that childhood asthma admissions due to air pollution in London have reduced by 30% since 2016 (Public Health England, 2018).

However, significant health gains can still be made, and many people suffer avoidable chronic ill health due to air pollution (Witty, 2022, p. ii). Across the UK, long-term exposure to air pollution has an annual effect equivalent to 29,000-43,000 deaths for adults aged 30 and over (DEFRA, 2023, p. 34). This figure may actually be higher as the estimate does not consider all outdoor pollutants or indoor pollutants (Exley et al., 2022, p. 2). So, whilst improvements are being made, much work is still needed until the air we breathe is safe.

What is the policy framework in which air quality is addressed?

Local policy framework

Air pollution has been a challenge for policymakers since at least 1285, when King Edward I possibly created the world’s first air pollution commission and banned the burning of sea coal (Brimblecombe, 1975). The current policy framework is divided into a regional and national sphere.

The local policy framework is largely shaped by the national government. The national government sets the powers that local authorities have to control air pollution in their region, as well as setting the objectives that local authorities must meet (DEFRA, 2023). Every local authority is required to assess and report on air quality in its region. If the required air quality objectives are not met, or are unlikely to be met, the authority must create a management plan, known as an Air Quality Management Area (AQMA), as outlined in Section One. Once an AQMA is established, the authority must create and update an Air Quality Action Plan (AQAP) to ensure compliance with the AQMAs. The authority must then report on progress through an Annual Status Report (ASR) (DEFRA, 2023, p. 17).

The effectiveness of this system has been questioned. It is hard to establish whether the designation of an AQMA improves the air quality in an area, or whether the improvement in air quality is caused by other factors (Air Quality Expert Group, 2020). One empirical study found that establishing an AQMA did successfully reduce emergency hospitalisations for respiratory conditions (Rose et al., 2021). Recently, Fareham revoked its clean air zones successfully reducing its pollution levels within the AQMA (Waple, 2024). Other regions in Central South have also successfully revoked AQMAs after putting appropriate measures in place. However, research conduct for DEFRA on behalf of its independent Air Quality Expert Group found that an AQMA in Newcastle produced little, if any, reduction in NO2 concentrations (Air Quality Expert Group, 2020, p. 36). Whilst empirical research is limited, it seems these the success of these regulations is mixed.

Beyond their statutory requirements, the county and unitary authorities in the region also have dedicated strategies to address poor air quality, signalling its importance as a policy priority for joined-up policymaking. Currently, most district authorities do not have dedicated strategies of this sort.

Local governments have a limited range of powers and policy levers to improve air quality, but they are not powerless (DEFRA, 2023, pp. 26-34).

The most significant power that local authorities have may be to restrict transport in their region. Authorities have a range of coercive power over road vehicles, including implementing traffic management schemes and issuing drivers with fixed penalty notices for idling. Councils can also use non-coercive measures to reduce driving, such as establishing cycle lanes. Authorities also have the power to introduce Port Air Quality Strategies to reduce emissions from ships, but this power is very limited (Department for Transport, 2019). Local authorities also have powers to control domestic burning. Authorities can implement local smoke control areas and are responsible for enforcing restrictions on fuel sales. Additionally, councils have powers in the agricultural sphere and must consider ammonia emissions in planning decisions. Authorities also can monitor and regulate industrial sites. For addressing indoor air quality, authorities can only play an advisory role. This role can involve providing public health information about the dangers of indoor pollution and recommending behaviour changes.

National policy framework

The national government has a greater range of powers than local governments. The national Air Quality Strategy aims to work with three other UK Government strategies: the Industrial Strategy, the Clean Growth Strategy, and the 25-Year Environment Plan (DEFRA, 2019, p. 6). The national government imposes legislation to address air polluting activity, which is underpinned by England-wide powers to control major sources of air pollution (DEFRA, 2019, p. 6). Westminster also enacts non-legislative policy levers, such as providing funds to local authorities. The Department for Transport’s Clean Bus Technology Fund allowed local councils to apply for grants of up £500,000 to upgrade buses (DEFRA et al., 2019). The Department for Energy Security and Net Zero (DESNZ) has an Industrial Energy Transformation Fund that allows businesses to apply for grants for improving industrial energy efficiency measures and deep decarbonisation (Department for Energy Security and Net Zero, 2024). DESNZ also offers energy audits for small and medium enterprises to identify areas to improve energy efficiency (Department for Energy Security and Net Zero, 2023). These measures can all help reduce emissions.

The national policy framework was driven by international agreements and EU legislation. Former EU agreements have been retained, in accordance with the EU withdrawal act (Smith and Bolton, 2024, p. 13). The United Kingdom is also part of the UN Economic Commission for Europe Convention on transboundary air pollution (Smith and Bolton, 2024, p. 16).

What do we know about air quality inside buildings and air quality in the “fresh” air?

The detrimental effects of outdoor air pollution are well-documented in scientific literature. Recently, however, there has been a growing focus on the adverse impacts of indoor air pollution on individual health (Lenox, 2021). Improving poor indoor air quality is vital to protecting public health, given that many individuals spend most of their time indoors in various settings such as homes, workplaces, and educational institutions (Saini, Dutta and Marques, 2020). Indoor air pollution arises from multiple sources, including human activities, like cooking, and the building’s location and condition. Moreover, outdoor air pollutants can infiltrate indoor environments (Exley et al., 2022, p. 13). Unfortunately, very little is known about indoor air quality at the local level.

Indoor air quality is particularly difficult for policymakers to address, especially within the home. Nonetheless, local authorities can still play an important advisory role to prevent indoor air pollution (DEFRA, 2023, p. 42). For example, authorities can advise people to avoid cleaning products with high levels of volatile organic compounds (VOCs) and

to encourage people to open windows to provide ventilation. There is also an important role the state can play in helping to ensure citizens can access housing free of damp and mould – albeit policy interventions here are known to be difficult in the context of the UK’s available housing stock. This issue is particularly pertinent after the tragic death of Awaab Ishak, a two-year-old who was killed by mould in a social housing flat. “Awaab’s law” was created to require landlords to investigate and fix reported health hazards within specified timeframes (Booth, 2023).

How does air quality differ in different parts of the region?

Limited data is available at the local level. However, the national perspective provides valuable insights. One available source of local data is DEFRA’s UK Air Information Resource, which provides a map of the AQMAs (DEFRA, n.d.). The interactive map shows areas where local authorities have designated areas that require air quality management. This data illustrates the parts of the region where local authorities have identified air quality that does not meet the Government’s Air Quality Objectives. There are at least 30 AQMAs in the Central South region.

Generally, the more rural areas of Dorset and Hampshire have better air quality than the urban areas, like the cities of Southampton and Portsmouth. In Hampshire, air quality has generally been improving over the last ten years and 14 AQMAs were revoked between 2010 and 2020. The improvement is partly due the effectiveness of the local authority policy and cleaner vehicles being the norm. However, some AQMAs have increased in size (Hampshire County Council, 2021, p. 9).

The national picture provides a clearer indication of the difference in air quality by region. Generally, urban areas have poorer air quality, and this is more pronounced in deprived neighbourhoods (Blake and Wentworth, 2023). Another study found that, though generally cleaner than urban areas, deprived rural areas also face more pollution than non-deprived rural areas (Gray, Lewis and Moller, 2023). The authors of this paper point out that policymakers should consider region-specific emissions reduction strategies to improve air quality. Policies must focus on the range of emissions sources most damaging in the region (not just road transport) to improve air quality.

Which groups of the population are most vulnerable or most resilient

and what do we learn from this?

People can have different levels of personal exposure dependent on individual factors such as their occupation or lifestyle habits (Exley et al., 2022, p. 14), but it is clear that certain population groups are more vulnerable than others. The inequality of this outcome can partly be explained by two factors; differences in exposure, and differences in vulnerability to exposure.

First, socio-economically disadvantaged groups are more exposed to poor air quality and high levels of pollutants. The higher levels of exposure result from the fact that socioeconomically disadvantaged groups are more likely to live near major roads, have less access to green spaces, and live in more densely populated areas (DEFRA 2019, p. 23, Blake and Wentworth, 2023, p. 5). They are also more likely to live in housing with inadequate ventilation and poor indoor air quality. This inequality also operates on racial lines, as Pakistani, Bangladeshi, Indian, African, and Caribbean populations are more exposed to pollutants than the majority population in England (Al Ahad et al., 2022). Young families and children are also disproportionately represented in areas with highest concentrations of NO2 (Mitchell and Dorling, 2003, p. 64). Recent research found that every new school being built in Britain is in an area with unsafe levels of air pollution (Mahfouz, Tydeman and Robertson, 2024).

As well as being more exposed to air pollution, socioeconomically disadvantaged groups are also more vulnerable to the effects of exposure to air pollution. The increase in vulnerability is explained by the fact that

“Children are especially vulnerable to air pollution but contribute the fewest emissions and have the least ability to reduce their exposure.”

these groups are more likely to have preexisting medical conditions, which are often exacerbated by pollutants. Socioeconomically disadvantaged groups are more likely to have higher underlying baseline disease rates. They are also more vulnerable to so-called ‘lifestyle’ factors – such as poor diet, psychosocial stress, smoking, and obesity - which predispose to greater effects of air pollution. This increase in vulnerability leads to higher rates of respiratory irritation, cardiovascular disease and even premature death (Dimitroulopoulou et al., 2022, p. 26).

Children are disproportionately harmed by air pollution as their lungs and other organs are still developing, and they inhale more air relative to body weight than adults (Dimitroulopoulou et al., 2022, p. 26). For children, poor air quality risks poor early life organ development, asthma, breathing issues, and development problems. In utero, air pollution contributes to adverse birth outcomes and low birth weight. Reductions over long periods in PM and NO2 levels are associated with improvements in the development of lung function in children (Exley et al., 2022, pp. 1-3).

The fact that socioeconomically disadvantaged groups are more exposed and vulnerable to air pollution is particularly troubling as these groups often contribute fewer emissions than socioeconomically advantaged groups (Barnes, Chatterton and Longhurst, 2019). In simple terms, they are less likely to own and use private vehicles, or to travel as far for work, education and leisure. Likewise, children are especially vulnerable to air pollution but contribute the fewest emissions and have the least ability to reduce their exposure. The issue here is one of social justice – those who contribute least to the problem in their day-to-day activities bear the greatest burdens.

What are the main factors determining air quality?

“There is an overwhelming body of research evidence that, regardless of all current efforts, an air quality problem persists in our region.”

The rate of air pollutants can be affected by sources of emissions and can increase at busy periods of human activity. The overall air quality is further affected by many other factors, like the atmospheric chemistry of pollutants and meteorological elements such as wind, sunlight and air pressure (Mouatt, Ghalaieny and Martell, 2022, p. 41). There is also a growing body of evidence that climate change and its myriad causes and effects are closely linked to worsening air quality – with more wildfires, altered aeroallergen release, increased airborne dust and ‘urban heat islands’ all contributing to problematic air pollution (see Pinho-Gomes et al. 2023; Hu et al. 2022; Piracha and Chaudary 2022).

As awareness of the serious and sometimes lifethreatening effects of polluted air has grown, many organisations have instigated plans aimed at limiting their own direct and/or indirect toxic emissions in their locality. As examples, Southampton Football Club introduced a park and ride scheme to reduce the number of cars congesting the city on match days; Southampton Airport says it has offset the emissions created by passengers and staff travelling to and from the airport; and Southampton Port has produced and updated an air quality strategy featuring a range of strategic and practical initiatives aimed at supporting cleaner air.

It is reasonable to assume that none of these organisations would claim there is no more they might do; and, as this report demonstrates, there is an overwhelming body of research evidence that, regardless of all current efforts, an air quality problem persists in our region.

However, a positive next step would be to work in partnerships to identify the research questions and policy interventions that would be embraced by these organisations and other private sector partners committed to cleaner air enabling them to go further and maximise their impact on the region’s clean air.

Human activity

The factors that determine air quality that policymakers have capacity over are largely related to human activity. Different areas have distinct pollutant profiles that can vary in accordance with population density, transport infrastructure and predominant regional industry (Mouatt, Ghalaieny and Martell, 2022, p. 42). Day-to-day variations in human behaviour also affect air quality. The typical peak of certain pollutants occurs during the morning and evening 'rush hour', as more vehicles are on the road in busy areas (Agnew, Clewlow and Hort, 2022, p. 240). Additionally, large-scale sporting events contribute to poorer air quality in specific areas due to the increased use of road vehicles by visitors (Watanabe, Yan and McLeod, 2023).

Transport, in general, affects air quality. Air quality near airports can be affected, by aircraft engines, equipment, operational vehicles, and airport traffic (Martinez-Botas and Cumpsty, 2022, pp. 112-114). For example, Southampton Airport has the 3rd biggest carbon footprint of UK airports (measured by carbon emissions per passenger per km) (Longley, 2023).

Ports are significant sources of air pollution, from ships entering and docking, the use of diesel port machinery, and vehicles that serve the port (Martinez-Botas and Rajoo, 2022, p. 115). The ports in Southampton and Portsmouth are a vital part of the local economy, and it is important to acknowledge that both have sought to improve their emissions through designated air quality strategies – a point we return to in the discussion of solutions below.

Non-human activity

There is also a relationship between the seasons and air quality. The effects of seasonal variation can interact to determine air quality, for example traffic volume and meteorological conditions affect airborne concentrations of pollutants (Fraser and Sapsford, 2022, p. 72). Colder winter temperatures lead to more people driving and higher use of domestic heating, both of which result in higher production of pollutants. Lower winds in the winter are often associated with poorer air quality. In the summer, hot, sunny days contribute to higher pollution levels. In the spring and autumn, light south and southeasterly winds over Southern England bring in pollutants from continental Europe (Agnew, Clewlow and Hort, 2022, p. 238). Stable weather conditions can hinder the dispersion of pollutants such as PM (Mouatt, Ghalaieny and Martell, 2022, p. 41).

What is the cost of poor air quality in the region and on future generations?

While there is a large and settled body of evidence on the negative impacts of poor air quality generally, there is little research on the costs of poor air quality to population health, the economy, housing, and health services in the Central South region specifically.

Local authorities do note that there is a cost to local economies and that protecting the public health from air pollution will have economic benefits (Portsmouth City Council, 2017, p. 15 Southampton City Council, 2022). However, there are few details on exact costs. We can extrapolate from the national and international picture to build an understanding of the costs of air pollution to Central South.

Costs to the economy and health services

The costs to the economy and health services are well established in the public health literature. We know that poor air quality worsens health, which reduces productivity and increases societal medical and social costs (DEFRA, 2023). In the United Kingdom, air pollution is estimated to have caused productivity losses of up to £2.7 billion in 2012, as poor air quality leads to illness, reducing work efficiency and increasing sick leave (Birchby et al., 2014, p. 55). Relatedly, air pollution places a large cost on the NHS. A study estimated that over 18 years, the total cost of air pollution to the NHS and social care system was £5.37 billion for PM2.5 and NO2 combined. The study suggested that the figure could rise to £18.57 billion when costs for diseases for which there is less robust evidence are included (Pimpin et al., 2018, p. 1).

Research on the relationship between productivity and air pollution in Europe has shown that reducing PM2.5 concentration by 1µg/m3 boosts GDP by 0.8%. Generally, air pollution causes economy-wide reductions in market economic activity. Still, the costs of reducing air pollution are smaller than the economic benefits gained. Therefore, policymakers have an economic incentive to reduce pollution (Dechezleprêtre, Rivers and Stadler, 2020, pp. 7-8). However, this might be complicated at the local level

as polluting industries contribute to the local economy. Southampton City Council has stated the continued success of the port is “vital” to the city’s economy (Southampton City Council, n.d, p. 3). Policymakers face a difficult challenge between protecting public health and local economies.

Other costs

It is well established that air pollution in urban areas harms humans. Animals may well be similarly affected, but research is lacking in this area (Work, 2022, p. 179). Some work has been done to establish that air pollution damages animals, crops, soil and water (Feng, Liu and Zhang, 2015). Sulphate pollution is also known to damage forests (Work, 2022, p. 179). Poor air quality also risks reducing population density, species diversity, and species richness in birds as the animals suffer respiratory disease and illness (Sanderfoot and Holloway, 2017).

“The long-term threat of air pollution risks an unsafe future for the next generations”

Costs to future generations

Future generations are threatened by poor air quality. Section Five outlined how foetuses and children are harmed by air pollution – these impacts continue throughout the life-course, impacting on health and well-being for the long term. There is also evidence to suggest that air pollution has epigenetic effects, i.e., pollution modifies DNA and genetic mutations are passed onto future generations (Yauk et al., 2008). There may be very long-lasting effects of traffic-related air pollution that affects sperm DNA (Ji et al., 2016). Generally, if children grow up to be healthy and not harmed by air pollution, they are more likely to become healthy parents. The long-term threat of air pollution risks an unsafe future for the next generations. As noted above, air pollution can be harmful to food production by damaging animals, crops, and soil. (Feng, Liu and Zhang, 2015). Reducing pollution is vital to protecting future generations.

What interventions work to improve air quality work?

As explained, the most important levers to set appropriate safety limits and tackle the root causes of air quality lie with national government. However, there are actions that local policy actors can take within this constrained environment. We look to promising examples of good practice from around the region and beyond.

Examples of interventions in the Central South

– A notable ‘best practice’ case in the literature is the improvements made at Fawley oil refinery. New Forest District Council worked with the oil refinery to improve its procedures when Fawley village was downwind of the refinery. The cooperation successfully improving air quality. The refinery operator and Environment Agency collaborated to reduce emissions by implementing an emissions management procedure. The Environment Agency reduced the emissions limits and imposed requirements of technological improvements to key emissions sources. The process was successful and air quality in the region improved (Marner, Clegg and Williamson, 2022, p. 151).

– Portsmouth Port has also been recognised for its work in reducing emissions. The port is developing a system for docked ships to connect to the National Grid to provide power and reduce air pollution from idling engines on ships (Paine, 2023). The energy will be partly powered by 2,600 solar panels and a megawatt sized battery (Portsmouth Port, n.d.) However, it must be noted that shoreside energy is not a magic bullet solution – there can be high costs for users and there are significant feasibility restrictions for the regional infrastructure given the power draw involved. At Southampton Port, for example, only one in ten cruise ships have plugged into the shoreside power since 2022, due to the high cost of energy (Webster and Amin, 2023).

National Examples

– Perhaps the highest-profile interventions in recent years have been the Ultra Low Emissions Zones (ULEZ) introduced throughout London’s boroughs. The policy has been subject to media controversy because of a small but vocal political opposition in a context of widespread local support (see Mabbett 2023). Similar proposals in the Central South region have met with controversy as well – with, for example, Southampton City Council rowing back on its plans to charge high-polluting vehicles in a Clean Air Zone.

– Islington Council worked with DEFRA to train health professionals to become Air Quality Champions. GPs provided advice to patients and 52% of patients said they wanted to understand more about air pollution and changed their behaviour. Using ventilation whilst cooking and walking more were the most popular changes. A community communication campaign was also launched and patients who had seen this information were twice as likely to act compared to those who only received advice from their health professional (DEFRA, 2023, p. 13).

– Voluntary agreements between polluting industries and councils can be an effective way to reduce pollution. Horn Lane in London is an industrial site. Here, voluntary agreements between industries and the local authority led to a combined effort to improve practices. The agreements successfully and improved air quality (Marner, Clegg and Williamson, 2022, p. 152). Given that local authorities have limited powers, voluntary agreements can be an effective option to improve air quality. However, regulation and enforcement are often required to ensure compliance.

International Examples

– The port authorities in Belgium undertake remote emission measurements from ships to single out ships for on-board inspections in ports. The inspections aim to ensure that ships coming into port comply with their regulations and to deter rulebreaking (Van Roy et al., 2024).

– Norway imposes a tax on nitrogen oxide emissions from ships in its ports. The tax raises revenue that can be spent on improving air quality and deters ships from polluting (Transport & Environment, 2024, p. 12). However, this tax would require primary legislation from the national government. Local authorities could make the case for the tax to the national government.

– Cities in France and Germany have strict traffic management areas that aim to reduce pollution. The German scheme can outright ban on vehicles that fail to meet pollution standards (Gehrsitz, 2017). Paris’ Crit’Air scheme uses stickers to mark cars with different grades of emissions. On days of high pollution, certain grades of cars can be banned from the city centre (Benard et al., 2020). Targeting road vehicles is a relatively easy and effective way for authorities to improve air quality. However, London's low emissions zones demonstrates that such schemes are currently political contentious in England.

How might we address poor air quality in the region?

Poor air quality is a notoriously difficult policy problem to address in practice – it is what policy scholars call a ‘wicked’ problem with multiple, intersecting and complex causes, and solutions that require difficult political trade-offs and contestation (see discussion in Boswell 2023, Ch7). The evidence from the study of tackling air quality as a wicked problem offers no easy and ready solutions, but points instead to three important avenues for further exploration.

The need for ‘split-screen thinking’ for both short-term and long-term action

The first key point is that preventive policymaking requires persistence and creativity. The theory of addressing a problem like poor air quality ‘upstream’ is compelling. But that goal proves difficult to realise in practice – commitments to take action are often vague, the actions required are at odds with policymaking routines, and authorities usually lack capacity to follow through on monitoring and enforcement in the face of political opposition (Cairney et al. 2023).

In the Central South, for instance, the marine and maritime industries contribute significantly to the local economy. Likewise, many local households in our

region commute across neighbouring cities, towns and villages for work, education and leisure in ways that make them dependent on private vehicles (Sarri et al. 2024). Making progress to address poor air quality in this context will require persistence, resilience and savvy. There will be a necessity for ‘split screen thinking’ that targets urgent needs and ‘quick wins’ that can help build the case incrementally for more fundamental changes to tackle the root causes of poor air quality in the region (see Cairney et al. 2024). For example, urgent measures can be taken to educate health professionals about the adverse effects of poor air quality – given evidence suggests that nearly 4/5ths are currently unaware (Holtgrewe et al., 2024). But those individual interventions need to help document and build the longer-term case for systemic interventions in, for instance, local housing and transport policy.

Drivers of air quality are the range and intensity of activities within the area that generate emissions (pressures). An important emitter activity is the level of transport which may be measured in many ways. Figure 3 illustrates one indicator of the scale of the driver based on Census records the percentage of the population travelling between 5-10 kilometres to work based on the national 2021 Census returns.

Figure 3: Percentage of the population travelling to work (5-10 km) (Census, 2021) (Source: Nomis)

The need for a more nuanced understanding of ‘behaviour change’ to address air quality

The second key point speaks to the limitations of the ‘behaviour change’ framing that typically informs health promotion efforts. The lived experience of poor air quality in our region – as evidenced above – is one of inequality: the local residents that suffer most from poor air quality are those that contribute least to the problem. There is some enthusiasm in the most recent behavioural public administration literature about so-called Nudge 3.0, in which interventions to drive behaviour change are infused with an ethos promoting democratic empowerment and social justice (see Batterjee and John 2019). Concrete examples might include activities like citizen science that engage residents actively in monitoring air quality and contributing to interventions (eg , or participatory innovations such as citizen assemblies in which a cross-section of the population generates buy-in for local policy solutions to enhance air quality (eg Boswell 2021). However, evidence of their efficacy in driving meaningful change is limited. The reality is that these represent usually small, one-off inputs to a complex and iterative policymaking process, vulnerable to being cherry-picked or sidelined altogether. Any attempts towards behaviour change therefore need to be attuned to the subtleties and challenges surfaced in the dedicated literature on how ‘policy-relevant knowledge’ is used and interpreted in policy work (see Tenbensel 2006; Sanderson 2009).

The need for collaboration action to mitigate the causes of air pollution

Addressing air pollution will need collaborative action involving multiple levels (eg. national and local) and traditional ‘silos’ of government (eg. health, planning, transport and so on). But it will also require working with actors outside government, including industry. To address the bespoke constellation of factors that contribute to air pollution across our region, many of the levers to drive meaningful change lie within the private sector. Indeed, international evidence shows that productive collaboration among stakeholders is a key cornerstone for port-cities like Southampton and Portsmouth especially (see Roberts et al. 2023). It is important to acknowledge that key stakeholders such as regional ports and airports have already recognised their role in proactively reducing air pollution, through designated strategies and concrete measures (eg Associated British Ports 2023). These are promising developments. However, there is no independent evidence of the effectiveness of these actions as yet. Decades of research on public health interventions indicate that industry initiatives alone are seldom sufficient to address the negative externalities of their activities (Moodie et al. 2011), and that national and local governments have an important convening role to play in driving standards, monitoring effectiveness and ensuring accountability (see Sullivan 2022).

“Our ambition must be to create a future with safe air in Central South”

What we need to know

1. More usable data.

There is a huge amount of data on the sources of air pollution and their general negative impacts across the national and international literature. However, data is not readily available at the granular level local policymakers need in their everyday work. Indeed, one local policymaker reported that DEFRA’s air quality modelling is not accurate for all parts of our region –the unique geography of the Central South, with urban and peri-urban areas clustered in ways that produce a wide commuter belt, is not captured adequately. This poses a significant challenge to policymakers who rely on this modelling in a context of urgent capacity challenges.

2. The harms of indoor air pollution.

Indoor air quality is an emerging field of research. We need to develop a stronger understanding of the dangers of poor indoor air quality. There are also uncertainties about what can feasibly be done to address poor indoor air quality, as well as potential trade-offs with, for instance, energy security and Net Zero goals around housing policy.

3. Health inequalities.

We can infer from the national and international literature that air quality impacts on local health inequalities. However, we need to know more about what can feasibly be done to achieve ‘behaviour change’ in the context of injustice and inequality that characterises the impacts of local air quality.

4. The cost to the economy and health services.

We know that air pollution imposes costs on the economy and health services nationally, but little data exists at the local level. Stronger capacity to drill down in this fashion can help to build the case for stronger, systemic action to address the root causes of poor air quality.

5. Best practice.

Some information exists to inform our understanding of which interventions work and why. However, further evidence here could guide better policy – there is an opportunity to work with and through the new governance architecture of integrated care systems (and potentially, in future, locally devolved powers) to ensure this sort of learning is enabled and embedded in practice.

6. Future states.

Our ambition must be to create a future with safe air in Central South. Considering long-term future planning and the threats to this can help us achieve this goal. There is a need to systematically illustrate and evaluate the trade-offs and consequences of action/inaction to address the issue.

7. The barriers to effective policymaking.

The powers of local authorities to address air pollution are limited. Furthering our understanding of the barriers to effective policymaking on air pollution can identify solutions.

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SUSTAINABILITY & RESILIENCE INSTITUTE

Acknowledgement

This report is designed to consolidate the emerging work of the Clean Air South network. It has been funded by the Civic directorate at the University of Southampton. The report has been conducted in collaboration with the Sustainable and Resilience Institute, Wessex Health Partners, and the Centre for the South.