Air pollution has long been seen as a fact of city life. You might, for example, shrug off the discovery of black particles in your nostrils after a day pounding the streets. But as soot particles collect unpleasantly in our noses, what is happening as they travel down to our lungs? For people whose job it is to work outside, all day or for all their life, it is a more serious concern.
Street cleaners, refuse workers, community police support officers, cycle couriers and others are all at increased risk, according to scientists. And as research is building a more concrete picture of the health dangers, we ask who is protecting these workers from air pollution? If not, what should we look to change?
Each year inhaling particulates found in outdoor air pollution causes around 29,000 deaths in the UK. On recent evidence, this may rise to around 40,000 when considering nitrogen dioxide exposure, the Royal College of Physicians (RCP) said in their 2016 report Every Breath We Take: the Lifelong Impact of Air Pollution. Debate has centred on diesel exhaust emissions. Since the International Agency for Research on Cancer (IARC) classified these as carcinogenic in 2012, momentum on the case against them has been building, despite fierce opposition from the car companies and lobbyists. The news stories have come thick
Heart attack risks
In June 2017, the University of Edinburgh released results of its groundbreaking 10-year study to show how tiny particulate matter in vehicle emissions are able to “cross the barrier” from the lungs into blood vessels. Using gold nanoparticles they showed how toxic particulates could get inside fatty areas of the blood vessels that are responsible for heart attack and strokes. Dr Mark Miller, who led the study, said: “If reactive particles like those in air pollution reach susceptible areas of the body then, even in a small number, they might have serious consequences.”
Heart attack patients are even being told in hospital that pollution might be a root cause. Bill Peters interviewed for Channel 4’s Dispatches programme, Dirty Secrets: What’s Really in Our Air?, described his surprise at being told by surgeons his coronary could have been from air pollution, because he neither drinks nor smokes. “They talk about obesity, smokers, but you never hear anybody say about pollution – if this is the case that more and more people are having heart attacks because of pollution, then people need to be aware.”
Particulate matter makes up 60% to 80% of emissions from diesel exhaust. Researchers at Queen Mary, University of London studied the effects of the tiniest particulate matter, PM.25, which is 2.5 micrometers or less in diameter. They found that as PM2.5 exposure rises, the larger the heart gets and the worse it performs. “Both of these measures are associated with increased morbidity and mortality from heart disease,” said Dr Nay Aung, cardiologist of the study released in May this year.
One of the long-known worst enemies to human health in diesel engine exhaust emissions are the Polycyclic Aromatic Hydrocarbons, or PAHs. These are carcinogens that bind with the particulates and are taken down deep into the lungs when breathing occurs. In May 2017, Imperial College London produced the first ever study which demonstrates how PAHs stimulate nerves in the lungs, producing coughing and tightness of the chest particularly in vulnerable groups such as asthmatics.
Finally, high levels of exposure to nitrogen dioxides (NO2) in diesel emissions can damage the lungs and/or heart, says the RCP report. It’s a problem in cities including Birmingham, Glasgow and London, where NO2 annual limits are regularly breached. This year, parts of London exceeded the annual limit just five days into January.
Doctors trace risks to outdoor workers
The new evidence also tells us something useful and important for health and safety practioners – air pollution affects workers in some occupations. The RCP’s report listed people who work alongside busy roads as one of just three groups they see as most vulnerable to air pollution, together with the people who live in deprived areas, which often have higher levels of air pollution and those more vulnerable because of their age or existing medical conditions.
Subheaded ‘The lifelong impact of air pollution’, the study shows how damage occurs across a lifetime, from the baby’s first weeks in the womb through to old age. “We know that the heart, brain, hormone systems and immunity can all be harmed by air pollution. Research is beginning to point towards effects on growth, intelligence, and development of the brain and coordination,” it says.
Dave Smith, the blacklisted construction union activist, has always known this. Speaking passionately on the issue at this year’s annual general meeting at London Hazards Centre, he said: “Everyone’s got bronchitis, everyone’s got asthma when you lived our ways [in Barking and Dagenham]. I don’t see environmental activism as a middle class thing, I see it as a working class thing – that we should unite around.”
It is important to add it is not possible to say that people who work and live in dirty air all their life will definitely suffer from health issues. This is because it is thought currently that the risks vary from person to person. “A person is exposed to air pollution if they work outside. Vulnerability is more difficult as the data is on populations and groups of people not individuals. One asthmatic may be very sensitive to air pollution and another may not be,” cautions Frank Kelly, Professor of environmental health at King’s College.
Higher sickness absence
However, anecdotally it is safe to say there are big problems. Dan Shears, GMB’s national health, safety and environment director says: “We’ve had longstanding concerns for the members that we have that work primarily outside – refuse workers, roadsweepers, people who work for local authorities doing parks (aboroculture) – and you do see higher sickness absence records for those individuals.
“We suspect there’s an elevated risk for lung cancer as well but it’s very difficult to tell because you haven’t got a classic workplace so it’s difficult to look at an exposure.” Dan says self-employed drivers are also reporting higher levels of lung cancer than in the wider GMB membership population.
At Unite the union, a diesel fume exposure register is tracking the impacts and experiences of workers across all industries. A spokesperson told us that: “In the first few weeks we have already had several very alarming cases of people suffering health problems due to diesel fume exposure.”
However, despite these worrying cases, the public health warnings and the studies, there is still no legal obligation for employers to protect workers from air pollution. The founding principle of the Health and Safety at Work Act 1974 is that employers have a duty to control risks stemming from work activities, which does not include air pollution. HSE’s remit also explicitly excludes public highways under the HSWA.
Yet, in purely occupational terms, some believe HSE has been slow to grasp the diesel issue for workers, even where they do have remit. Dan Shears says that: “Diesel’s been classified as carcinogenic for five years now – there’s been very little coming out from HSE in terms of guidance or updating existing guides around that.” Frank Kelly even thinks that workplace exposure limits for workers lag behind those set by the EU for public health: “Occupational health-based standards for particulate matter for example tend to be weaker than ambient pollution guidelines or limit values – so with the new health based evidence there are reasons to look at these again.”
HSE told Safety Management: “There is no occupational exposure limit for diesel engine exhaust emissions. The Control of Substances Hazardous to Health (COSHH) regulations outline the steps employers need to take to ensure that the risks of exposure to DEEEs in the workplace are controlled appropriately.”
They said they were not able to comment on general ‘environmental pollution’ guidelines: “Our area of responsibility is for work-related health, safety and illness; acting in the public interest to reduce work-related death and serious injury across Great Britain’s workplaces.”
First Clean Air Day
There may be no legal obligation for employers when it comes to pollution risks, but change is occurring. The first Clean Air Day, a campaign run by over 70 organisations, took place on 15 June. It has been established to bring academic-approved advice to the public. Engaging posters and leaflets summarise the health dangers to the heart and lungs through air pollution and gives advice on what can be done. Advice comes under three headings: reduce, talk, avoid. For example, employees are encouraged to take back street routes if walking or cycling to work to reduce their exposure. They are also urged to cut down on Amazon deliveries to the workplace, instead picking up parcels from collection points, which such firms offer, to avoid clogging up the city streets.
Chris Large, senior partner of Global Action Plan is upbeat: “Two factors that are incredibly encouraging in the fight against air pollution are that the problem disappears very quickly when we stop polluting, and that many of the solutions that we need already exist. Organisations can act now to reduce
the pollution that they cause or expose their employees, residents, patients, pupils or customers to.”
One company which has taken a lead on the issue, is Addison Lee. Although the taxi company as an employer is in a different position in that, the air pollution is caused by the work activity (driving), this is not how Stephen Wilkinson, head of risk and compliance, sees it. He was shorlisted for the Health and Safety Champion award at this year’s British Safety Council’s International Safety Awards for his work in initiatives in health, safety and the environment.
His current plans include measuring pollution exposure to drivers by installing air monitors in their cars. “It is not necessarily the driving, (all drivers are advised to keep windows closed to minimise exposure to dirty air), but it’s when he opens his door. If someone opens the door and closes it, they’ve let out filtered air and then what they are doing is re-polluting their vehicle.” Stephen says it isn’t about legal responsibilities: “It’s being a good employer. It goes back to awareness of the health impacts, 40,000 people dying each year. It’s difficult to work around a lot of the issues at the moment because there’s no electrical charging infrastructure in London [just a few being now installed]. All we can do is get the cleanest vehicles possible to reduce emissions and give advice to drivers to reduce their exposure. It boils down to social responsibility.”
Employers can only do so much. Government action on diesel has been widely accepted as appalling. Plans to tackle the UK’s illegal levels of air pollution have twice been found in court to be so poor as to be unlawful. New plans are expected to be published on 31 July, but ClientEarth, the law firm that has won two cases against the government for its failure to tackle air pollution, in 2015 and 2016, is not holding its breath and will push to take the government back to court if improvements are not made. Its CEO, James Thornton, said: “We have found some major flaws.”
The new draft plans have also been fiercely criticised for abrogating responsibility onto cash-strapped local authorities. This is because local councils are expected to help introduce plans for clean air zones in 27 of the worst affected towns and cities, making the most polluting vehicles pay to enter. But the measure will only be allowed, say the government, if they have invested in other ways to mitigate pollution through traffic control first. One suggestion is for local councils to remove speed bumps in order to reduce the stop starting that increases vehicle emissions; a proposal roundly condemned by Road safety charity Brake.
On a positive note, London Mayor Sadiq Khan confirmed plans to introduce the ultra-low emissions zone (Ulez) in central London from April 2019, six months earlier than expected, and in April launched a consultation to expand it across the capital.
Brexit, post-election uncertainty and Trump’s tearing up of the US signatory to the Paris Agreement on Climate Change all cast a gloomier outlook for focus on air pollution, already long put on the backburner by a government with other priorities. But with the science on air pollution’s health risks gathering apace, it is an issue that is not going to go away. With more self-employed and gig workers working on the streets as couriers, or drivers, or just traveling to jobs, it also warrants the question whether HSE’s remit and HSWA law should exclude the roads. Others say that we need to take our cue from the scientists and look at exposure and impacts on workers, in the same way we do in any other work activity where there is exposure risk to carcinogens.
“It’s hard to know what degree lung cancer to our members is being caused by environmental exposure. But I’m certainly not aware of any research that’s looking into this in any great detail. There’d certainly be a need for that,” summarises Dan Shears, from GMB.
By Chris Keen, BOHS on 22 December 2020
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