Wednesday, 21 September 2011

Air pollution and the public health agenda

You will have seen discussion boards where somebody points out that exhaust emissions are worse for you than passive smoking, and someone else says 'ah, but we need cars'! as if this were a good enough reason to ban something that we supposedly don't need, without any proof that it's damaging.

When I was growing up in the 1970s word had reached us in East Yorkshire that Glasgow had a poor health record. We were told that much of this was because of poverty, substandard housing and a damp climate. No one in those days told us that drinking and smoking was the cause or gave us that pearl of twenty-first century wisdom – that smoking causes health inequalities.

But in the corridors of power there is evidence of change going back twenty more years. (H/tip to Rose for the link.) Published in 2002, this link reports attempts to disguise the impact of air pollution on the London smog of 1952:
Delegates attending an international conference in London today to commemorate the 50th anniversary of the Great London Smog of 1952, which caused an estimated 12,000 deaths, will hear how governments from the late 50s onwards deliberately downplayed the huge threat to public health caused by air pollution, and sought to shift the blame firmly onto cigarette smoking instead.  
In 1953, Dr Guy Scadding, speaking on the television programme Matters of Medicine, had expressed a belief that air pollution was as much a factor in whether someone developed lung cancer as smoking, citing the significantly higher number of deaths from the disease among those living in polluted cities, as opposed to the countryside, and assuming that rates of smoking were likely to be similar in both populations. 
A few years later, in 1957, the Medical Research Council was planning to issue a statement saying although smoking was a significant cause of lung cancer, up to 30% of cases might be caused by air pollution. But the Cabinet committee on cancer of the lung, fearful of another political embarrassment which could be caused by stressing the air pollution connection, asked the MRC to reconsider its statement. On 31 May 1957 a modified version was published, which asserted that although it was likely that atmospheric pollution did play a role in lung cancer, it was 'a relatively minor one in comparison with cigarette smoking'.
 The clear conclusion?
'What was happening in this committee was a shift away from a concept of health and wellbeing related to an individual¹s environment, occupation, class or work, towards one focused strongly on that individual's responsibility for his or her health, which smoking came to symbolise. After the 1962 report, it was smoking and the type of public health which it epitomised which was to become the central public health issue. Smoking was something which the individual could do something about; air pollution was not,' explains Professor Berridge.
Public health, as far back as 1957, was to become judgemental. The medical establishment was already prepared to take an attitude on the issue, and suppress data that would inconvenience the public health message: 'take responsibility'. (Was this an early revolt against universal health provision free at the point of need?)

The medical establishment has appealed to corporations to take note that poor employee health is costing money. Hell, someone has to support them, and why not have a crack at those who support smokers, drinkers and the obese by offering them a livelihood?

Sometimes this smacks less of altruism than of a deliberate attempt to disenfranchise people. Usually, in fact.  Any health problem can be resolved by addressing personal issues (smoking, drinking ...). People are not expected to protest about the extent of air pollution (or any other health issue) because health politics is no longer the domain of those most affected by health inequalities. Their duty is to look after themselves so that their employers can make more money from them.


George Speller said...

It doesn't take much imagination to trump up a case for "passive driving" or even "passive aviation" - the injury and death to people who don't indulge in these activities. I've always thought this would be a good way to scupper "passive smoking" but then again it would propably only provoke the bansturbators.

Anonymous said...

Mortality in the London Boroughs, 1950—52, with Special Reference to Respiratory Disease - 1956

“The greatest proportionate departure from expectation occurred in the respiratory section of the I.C.D.” (International classes of disease WHO 1949)

“Thus bronchitis and pneumonia produced well over 4,000 excess deaths in London during 1950-52.
But this was by no means the whole of the excess attributed to diseases of the respiratory system, for more than half of the excess deaths in the malignant section of the I.C.D. were caused by cancer of the trachea, bronchus, and lung.
In addition there was an excess of more than 500 deaths from respiratory tuberculosis.

Taken together these four diseases of the respiratory system yielded 6,513 more deaths than would have occurred at the rates ruling in England and Wales generally, an excess of 37.3 percent.”

“It is interesting to note the parallel between these figures and those of a recent study of cancer among British immigrants in New Zealand ( Eastcott, 1956)

Compared with the native born population, British immigrants had an excessive risk of death from cancer of the lung (but no other site),and this excess was sufficiently greater for persons who had lived in Britain until they were 30 years old than for those who migrated at an earlier age.

Thus emerges from both studies a consistent relationship between duration of exposure to the putatively noxious environment and risk of later death from respiratory disease.”

“The worst affected area of London was the East End, which had the highest density of factory smokestacks and domestic chimney pots. The low-lying geography of the area encouraged the smog to settle.

To a large extent, Londoners tolerated the unpleasant effects of the smog as the cost of the city’s economic growth, but conditions became intolerable in the 1950s.”

Smoking and the sea change in public health, 1945-2007

"Today's alliance between doctors and the government to influence individual lifestyles is a relatively recent phenomenon.
First, it required the medical profession to abandon its culture of secrecy, based on patient confidentiality: this began with the use of television in the late 1950s.

Second, it required the introduction into public policy of studies linking lifestyles and health risks: this began with a change in leadership at the Royal College of Physicians in the early 1960s.

Third, it required a shift in the nature of public health from local information giving to central publicity campaigning: this began with the Cohen Report on health education in 1964, advocating a rethinking of the profession of health educators as persuaders, even salesmen.

Finally, it required politicians to modify their early dislike of the 'nanny state', opened up by Labour politicians' willingness to be more interventionist in the 1960s."

It was James Repace who put me onto this.

"More people died in 2002 from passive smoking at work in the UK than were killed by the Great London smog of 1952"

James Repace

Though I remember the industrial smogs of the 60's, the Great London Smog was before I was born.


Anonymous said...

Formula 1 is not a necessity. Should those cars be banned, since they serve no useful purpose? I think not.