Improving indoor air quality for children and young people’s health

Co-authored by Catherine Max

How can we reduce the harm of poor indoor air quality at home for children and young people? Find out how two London boroughs are using an integrated “population health” approach to tackle the problem.

The second workshop of this year’s Health and Housing Impact Network viewed housing and integrated care through the lens of “population health” and indoor air quality (AQ) related initiatives to address the health of children and young people.

Through case studies (below) and interactive discussion, we shared good practice and explored opportunities and challenges for working with and influencing Integrated Care Systems (ICSs).

Why population health?

Population health is an ICS priority approach which acts on the wider determinants of health alongside service design and delivery. It emphasises prevention and reducing health inequalities and considers what is most needed, and most effective, for particular segments of the population and/or groups with particular health issues.

Our workshop focused on the health of children and young people, as there is a need for more system-wide data on their needs.

Read more about population health on our resources page.

Why indoor air pollution?

Air pollution is a major health risk and one way in which housing can affect health.  Outdoor and indoor air pollution alike have short- and longer-term health effects over a person’s lifetime. While outdoor AQ has been improving, evidence is emerging of the, possibly greater, impacts of indoor pollution. This includes associations with other factors such as fuel poverty; climate change and extreme weather (e.g. heatwaves); housing conditions including overcrowding; and location. There is an imperative to think more about indoor AQ and how it can be managed or improved – and by whom.

Illustration of a home and the sources of pollution that can impact indoor air quality for children and young people. This includes, cooing, smoking, furniture, candles, sprays and mould
Sources of indoor air pollution. Image credit: North Central London Integrated Care System

We heard from two examples of successful local partnerships between different teams and organisations, with potential to achieve further impact if more formally and strategically adopted and scaled up across the ICS.

Camden’s indoor air quality research and community engagement project – a summary

  • What: academic research and place-based community engagement
  • Why: aims to help households understand what AQ-related factors are within their control and equip them with the confidence and ability to take action
  • How: distributing AQ sensors to households to find out whether and how access to indoor air quality data would impact people’s behaviour and their receptiveness to this, compared with a control group (who received sensors but could not view the data)
  • Who: London School of Economics, the University of Southern California, Camden’s Air Quality team

Case study: Read more about the project, its findings and next steps here

The NHS and Environmental Health in Southwark working together to improve the health of children with asthma – a summary

  • What: a clear example of harnessing complementary expertise and reach to tackle a shared priority, in this case from a “bottom up” rather than strategic starting point
  • Why: to help deliver LB Southwark’s Air Quality Action Plan and address housing issues affecting children’s health
  • How: a co-produced template letter which the Evelina Hospital’s medical team uses when they identify demonstrable housing-related factors contributing to children’s asthma in relevant cases
  • Who: collaboration between environmental protection team and with paediatric respiratory consultant at Evelina children’s hospital

Case Study: Read more about the project, its findings and next steps here

Achieving an integrated approach: Some cross-cutting themes

Who is thinking about indoor air quality?

Among workshop participants, more people from Housing and associated sectors were already considering indoor AQ than from Public Health.

Generating evidence and innovation

There is some indication that the negative effects of indoor air pollution can outweigh the effects of outdoor air pollution even when there is a major external event. More evidence is needed regarding the interplay between indoor and outdoor pollution.

More innovation and testing are needed to design and build homes which enable energy efficiency and carbon reduction alongside ventilation and adaptation to climate change. For example, more energy efficient mechanical ventilation where natural or passive ventilation is not appropriate.

Using a population health approach to achieve equity

An indoor air quality sensor highlighting measurements of PM, Temperature and humidity. All of these can affect indoor air quality and the health of children and young people
Indoor AQ sensor. Image credit: LB Camden

A population health approach to tackling indoor AQ requires a system-wide commitment to address individual patient need alongside global imperatives. For example, dry powder inhalers have a lower carbon footprint than other devices but options must be discussed with patients and only prescribed when clinically-appropriate. See NHS England guidance.

One suggestion made was to extrapolate evidence gathered from homes issued with sensors to make the case for improvements on similar neighbouring properties. While this could not take into account household behaviours, it is likely that housing conditions and appropriate improvements could be identified for a wider group.

The importance of relationships

There are many formal networks, including within ICSs, which can and should be utilised. However, these are subject to repeated change and personal relationships should also be fostered. Often, the individuals remain the same even when structures are altered.

Informal and formal relationships both enable co-production of projects and products which draw on different expertise. The Evelina and Southwark referral letter evolved from an individual’s idea into an informally produced joint effort to a fully co-produced initiative.

Public Health teams are essential allies and best placed to facilitate connections across the council and with ICS partners. Southwark’s Director of Public Health chairs the steering group overseeing their Air Quality Action Plan and it is their job to drive council-wide implementation.

Getting the messaging right

In Camden, effort was made to avoid causing alarm with emphasis placed on risks which can be managed. It was noted that there are negative mental health effects of highlighting dangers where people do not feel empowered to reduce them.

To influence policy and decision-makers, as well as harness public support, stark facts alongside more emotive messages may be necessary.  In the UK, there is a need to convey that asthma can be fatal, but that this is avoidable. UK’s statistics are high (up to 30% of children experience asthma at some stage) but there are some very effective medications and it can be eradicated (as in some other European countries).

Experience shows that presenting a solution rather than a problem to ICSs is more effective, particularly if this can be aligned with priority deliverables such as those in the National Bundle of Care for Children and Young People with Asthma.

Influencing planning and standards

There are local and national level opportunities to influence building standards and planning policies. For example, embedding in policy the Well Building Standard which recommends installing indoor AQ sensors (which are relatively cheap).

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