Ulez key to tackling ‘unacceptably high’ child illness and death, doctors say

Leading doctors and scientists have warned politicians against watering down plans to expand city-wide schemes aimed at reducing traffic pollution levels linked to thousands of deaths each year.

They urged politicians not to lose their nerve over plans to improve poor air quality, such as the expansion of the ultra low emission zone (Ulez) in London, which they said were central to tackling “unacceptably high” levels of illness and child deaths, and called for more ambitious policies to reduce toxic air.

The Conservative party in London has promised to scrap the Ulez expansion, despite a judge on Friday dismissing a legal bid by five Tory-controlled councils to overturn the scheme’s enlargement. There are concerns Labour’s national leadership may water down its support for clean air programmes for fear of a backlash from motorists and businesses hit by charges for driving polluting vehicles.

Dr Camilla Kingdon, the president of the Royal Society of Paediatrics and Child Health, said: “Action is needed in the form of clean air schemes as seen in some UK cities and nationwide, as well as clear air quality targets. At the end of the day, this is a child’s rights issue, and our children need to remain at the heart of these policies.”

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Kingdon said she was unable to comment on the Ulez expansion scheme specifically but added: “As paediatricians, we see the impact of poor air quality on our patients every day. Clinically, there is no escaping this harsh truth: the UK has one of the highest prevalence of asthma in Europe and tragically unacceptably high rates of emergency admission and death in childhood.”

Mark Hayden, a London-based paediatric hospital consultant and a spokesperson for the health climate campaign group Ride for Their Lives, said: “Some of the children [I treat] would not be coming into the hospital at all if they didn’t live in a polluted city. I patch up those children and send them back to the ‘war zone’.”

He said the Ulez extension did not go far enough and urged politicians not to turn clean air initiatives, including low-traffic neighbourhoods and bans on wood-burning stoves, into political dividing lines. “I don’t think breathing clean air is a political issue, but making it into one is harming people. We need to stop politicising pollution,” he said.

Long-term exposure to air pollution is associated with chronic conditions such as heart disease, asthma and lung cancer, reducing life expectancy. Short-term exposure to high pollution levels can cause coughing, wheezing and asthma attacks, leading to increased hospital and GP attendances.

According to data published by Public Health England, air pollution is the single largest environmental risk to public health, and is linked to between 28,000 and 36,000 UK deaths a year. The estimated cost to the NHS and social care of air pollutants is estimated to be £1.6bn between 2017 and 2025.

Despite the clear effects on health, air pollution has been formally listed as a cause of death in just a single case, that of nine-year-old Ella Kissi-Debrah, who died in 2013 after an acute asthma attack. In 2020 a coroner ruled she died of asthma “contributed to by exposure to excessive air pollution”.

Dr Suzanne Bartington, a public and environmental health specialist at the University of Birmingham, said traffic pollution schemes such as those in London, Birmingham and Bradford had made gains but needed to be bolder. “We would not accept these levels of harm from our drinking water, so why accept it from our air?” she said.

The Tories believe public opposition to the expansion of Ulez later this summer, which will introduce a £12.50 a day charge for drivers of the most polluting vehicles in the capital’s outer boroughs, was key to its narrow victory in the Uxbridge and Ruislip byelection earlier this month, which it won by a 495-vote margin.

Sadiq Khan, the Labour mayor of London, is committed to enlarging Ulez on 29 August to all of Greater London. He said the existing Ulez scheme had already reduced toxic nitrogen dioxide air pollution levels in central and inner London by nearly half and a fifth respectively.

Map of Ulez and councils challenging expansion

The Conservatives’ mayoral candidate, Susan Hall, has promised to scrap the expansion “on day one” if she is elected next May, arguing it would devastate local businesses and households who could not afford to upgrade their vehicles. The Tories believe Ulez expansion would have only a negligible effect on air quality.

Prof Frank Kelly, chair of community health and policy at Imperial College London, said rowing back on clean-air schemes such as Ulez expansion would be “problematic” for the NHS: “The health service is on its knees. Yet had we better air quality over the last 50 years, those NHS beds would not be so full.”

Dr John Wright, the director of the Bradford Institute for Health Research, co-authored a study published earlier this month that showed exposure to acute levels of air pollution in the city – this occurred 157 days a year in Bradford on average – was linked to nearly 50% of A&E visits and a third of GP attendances for patients with breathing difficulties.

“The evidence is incontrovertible,” Wright said. “Air pollution is poisoning our bodies and our planet. People understand this. When you talk to patients with asthma or breathing problems they know; they can feel the pollution. For them, it’s scary, it’s tangible.”

Despite media controversy, polling in Bradford had revealed most people locally were in favour of the city’s clean air zone, he said. “Politicians should be careful about treating the electorate as fools,” he added. “If politicians start to wobble [on air quality improvement schemes] they will get it wrong. My advice is: do the right thing.”