Despite great improvements in air quality in the UK since the Clean Air Act of 1956, current background levels of air pollution still pose a significant risk to health.

Long term exposure to air pollution at the levels experienced in many urban centres in the UK is now known to cause respiratory and cardiovascular disease and lung cancer. Short term exposure to episodes of elevated air pollution also leads to a worsening of symptoms for those with existing asthma, respiratory or cardiovascular disease, and can trigger acute events such as heart attacks in vulnerable individuals.

Air pollution can also be seen as a matter of social injustice. The most deprived 20 % of neighbourhoods in England have higher air pollution levels than the least deprived neighbourhoods. Those communities that are most polluted and which also emit the least pollution tend to be amongst the poorest in Britain

Human-made air pollution comes from a number of different sources, but the leading contributor in urban centres is road traffic emissions.

There are cost-effective, achievable local actions that can be taken to address air quality.  These involve a shift towards greater use of active travel (walking and cycling), public transport and cleaner low emission vehicles. These actions also produce benefits across local priorities, including reduction in hospital admissions, increase in physical activity and healthy weight and tackling climate change. Addressing air pollution has been shown to achieve a high return on investment.

In Nottinghamshire County 5.7% of all adult mortality (430 deaths), and in Nottingham City 6.4% of all adult mortality (150 deaths) was attributable to long term exposure to human-made particulate air pollution in 2010.  

There are 8 air quality management areas in Nottinghamshire County and Nottingham City, where levels of nitrogen dioxide (NO₂) exceed nationally set air quality objectives. Key drivers of high NO₂ levels include use of diesel engines, particularly in public transport fleets.  In addition, background (ambient) particulate matter (PM2.5) levels exceed World Health Organisation guidelines across the majority of Nottinghamshire County and Nottingham City.  Further reductions in levels of PM2.5 and NO₂ are required to protect human health.

Gaps include:

• Evaluation and update of the existing Nottinghamshire Air Quality Strategy (which was published in 2008 and due to be reviewed in 2011)
• Evidence of cost effectiveness, impact and local applicability of proposed actions on air quality
• Clarity on the existing powers and mechanisms for local authorities to prioritise actions which protect and improve air quality.
• Regional collaboration and sharing of best practice
• Quantification of the impact of NHS employment, transport and facilities on local air quality

Identification of the role which NHS commissioners can play in tackling air quality

• Review and update the Nottinghamshire Air Quality Strategy, including consideration of evidence of effectiveness and cost effectiveness of various interventions, and linking with partners in health, environment, planning, transport and sustainability.
• Consider inclusion of air quality as a priority within the Health and Wellbeing Strategy.
• Continue to strengthen the joint working across planning, transport and environmental health to identify shared opportunities to improve air quality.
• Develop a communication strategy to provide key messages on air quality to the public.
• Recommendations are provided in full in Section 10 of this chapter.