There are major disparities in the impacts of air pollution, with low-income communities facing greater health risks due to higher exposure to air pollutants. In this blog, Professor Sheena Cruickshank, an immunologist and Academic Lead for Public Engagement with Research at The University of Manchester, outlines the disproportionate health effects of air pollution on marginalised communities, proposing a community-centric, place-based approach to tackle the root causes of air pollution.

• Low-income communities bear disproportionate health burdens as they experience higher exposure to air pollutants which negatively impacts immunity and increases the transmission of air-borne respiratory infections.
• Effective and meaningful engagement with marginalised communities can mitigate social inequalities while also informing research on the risk of individual air pollutants.
• Funding for long-term initiatives that build meaningful partnerships with communities is needed to solve air pollution-related problems.

Air pollution is increasingly acknowledged as a major risk for human health. While its effects on the severity and incidence of lung conditions such as asthma have been widely recognised, the impact of air pollution on respiratory infections is often less appreciated. Research shows this has disproportionate effects on different areas of society: low-income communities face increased exposure to air pollutants and increased health risks. In this article, we outline what is currently understood about the health impacts of air pollutants on respiratory infections and propose how we can engage at-risk communities to develop our understanding and build a resilient solution to the air pollution problem, reducing risks and outcomes on health and the economy.

Air pollution is a healthcare problem

Exposure to air pollutants can cause damage to the body’s cells, generating harmful free radicals that can in turn impair or alter the function of the lungs and immune cells within the lungs. This decreases our body’s ability to fend off respiratory infections such as cold viruses, influenza and SARS-CoV-2 (COVID-19). Fine particulates, or particulate matter (PM), are associated with significant health risks. Studies in China have shown that at least 10% of influenza-related hospitalisations were due to exposure of PM2.5 pollutants (particulate matter smaller than 2.5 microns i.e. over 40 times smaller than the width of a human hair). Similar trends have been seen in England, where exposure to PM2.5 pollutants is associated with a 12% increased risk of severe complications in COVID-19. As well as particulate matter, exposure to NO2 and ozone have demonstrated a negative effect on immunity to respiratory infections. In addition to the direct effects on our bodies, studies indicate that air pollutant particulates can act as a “highway” promoting the transmission of viruses such as SARs CoV-2. Such observations highlight the urgent need to reduce the incidence of air pollution that heightens both the severity and transmission of respiratory infection. Research is ongoing to grow our understanding of this link, however to successfully understand and combat the air pollution problem, we must meaningfully engage the communities that face the greatest pollution exposure and resulting health impacts.

The disproportionate effect of air pollution on low income communities

Reports tend to focus on the harmful impacts of air pollution on the elderly and very young, however, it is increasingly evident that there are major disparities in which groups of the population have the highest exposure to the worst pollution. Communities with lower socioeconomic status tend to exhibit the most risk factors for health which collectively impact on life expectancy. These communities also often experience much higher exposure to air pollutants. As a result, low-income communities experience major health disparities driven by these and other mutually reinforcing socioeconomic and environmental factors.

Despite this unevenness in exposure and risk, we still don’t fully understand what pollutants communities are exposed to and the individual factors underlying susceptibility to health problems. Projects such as the Manchester Urban Observatory and citizen science-based projects such as Britain Breathing that map respiratory symptoms to time and geolocation, are tools that can be employed to start bridging such gaps in our understanding. These initiatives should be expanded and championed as useful tools that provide accurate on-the-ground information, while engaging and educating the affected communities.

Researchers should also seek to utilise members of these communities to help inform and guide their research into the sources and effects of air pollution. The University of Manchester project Researching Age-friendly Neighbourhoods is an excellent example of effective community engagement in research. Community members were trained as co-researchers and played leading roles in the key sections of the research project – helping to design, deliver and disseminate the research. Employing members of the communities in this function helped develop tangible outcomes rooted firmly in the needs of the community: applying this methodology to research surrounding the air pollution problem is likely to yield similar benefits.

Additionally, a co-benefit of establishing these meaningful partnerships in research and in developing solutions, is building trust within often marginalised communities. This can help promote future healthcare initiatives as well as help address root causes of pollution in the neighbourhoods.

Engaging local communities to promote successful health initiatives

While community engagement has many benefits, the worst-affected communities are often not involved in attempts to address the social inequalities linked to poorer health outcomes. This can lead to a perception that interventions at a community level are ‘done to’ communities, often resulting in mistrust from the same communities that the interventions are seeking to help. The severe and unequal impact of COVID-19 is a pertinent example of this. Areas of lower socioeconomic status have death rates that are doubled compared to areas of higher socioeconomic status, yet residents in these areas are less likely to take up protective vaccination. A poll conducted by the Royal Society for Public Health showed that just 70% of the lowest earners were likely to say yes to a vaccine for COVID-19.

Place-based, community-centric projects are critical to work with and within communities to investigate root causes of pollution-related issues and co-create solutions. Although recent steps to fund such partnerships have been made by UKRI and more recently the Welcome Trust, these tend to be short term. Moreover, they don’t provide adequate funding for community engagement and thus are limited in their impact – it can take years to build the trust necessary for an effective partnership. Short-term initiatives don’t always create the legacy needed to affect long-term change further amplifying mistrust. Our work funded by ESRC in the LOOPER project and now UKRI via the pilot place-based research initiative in Brunswick has revealed major concerns about air inequality and health alongside mistrust of institutional motives within the community.

Supporting, developing and enabling community-based champions who have the social networks and reach to exert change is one way to help bridge the gap. Giving such voices a meaningful role within decision-making processes can help keep community needs at the centre of proposed interventions, thus helping to build trust and improve engagement. Unfortunately, current funding models rarely allow for this to any longer-term extent. The British Science Association Community Leaders Programme – which trains individuals to become science ambassadors in their communities and supports them in developing long-term science engagement projects – has been effective in building engagement with communities that historically have been hard to reach. However, the programme does suffer the drawback of finite funding.

An alternative model for meaningful partnerships between local government and marginalised communities could come from The Camden Citizens’ Assembly on the Climate Crisis. The Assembly, led by the Camden Council, brought together over 50 randomly selected residents of Camden to develop an approach for how Camden can best tackle the climate crisis. It should be a policy priority of local authorities to expand and replicate such programmes that empower residents of marginalised communities to help guide positive change, developing solutions to problems such as air pollution and building community trust.

With COVID-19 accelerating the social-economic divide, there has never been a more critical time to support community-centred research that upskills, empowers and listens to the residents to drive policy changes and affect positive action. Community champion roles and long-term funded partnerships between communities and local authorities can help to involve members of the communities facing the highest exposure and health impacts from air pollution. This meaningful engagement can help build trust with marginalised communities and is essential to allow us to fully understand and solve the problem of dangerous air pollution.

This article was originally published in On Air Quality, a collection of thought leadership pieces and expert analysis on how to tackle air pollution, published by Policy@Manchester.

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