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Level of need in the population

Background papers: Lifestyle and wider determinants :: Air Quality [Update in progress] :: Level of need in the population

Medway's position between London, Kent and continental Europe brings health challenges associated with its unique pollution profile.

Medway's extensive transport network carries a disproportionate number of HGVs, with their associated carcinogenic diesel emissions. Around the coast, shipping also brings an impact from marine diesel. Easterly winds can bring pollution, from continental Europe, which affect the whole of Medway, raising levels of particulate matter and/or ozone. Winds from the opposite westerly direction can bring London's urban pollution plume drifting across the area.

The Environment Act 1995 places a statutory duty on local authorities to monitor air quality across their area. This duty is informed by an European-wide commitment to reduce air pollution. These are transposed into English policy by the Air Quality Standards Regulations 2010.[1]

These Regulations include criteria for determining how achievement of the limit values should be assessed, including consideration of locations and length of exposure in relation to the averaging period of the limit values. Details of these obligations are available on the DEFRA website.

In areas where air quality objectives are not likely to be met by the relevant target date, local authorities are required to declare an Air Quality Management Area (AQMA) and develop an action plan in pursuit of the air quality objectives. In other words, these are areas where there are consistent exceptions to meeting the objectives. There are currently three AQMAs in Medway. They are Central Medway, High Street, Rainham, and Pier Road, Gillingham.

Medway has three continuous automatic air quality stations; one at an urban roadside location in Chatham, one at an urban background site at Luton and one at a rural location in Lower Stoke. Monitoring of NO2 and PM10 is undertaken at all three sites. Monitoring of PM2.5 is also carried out at the Chatham and Lower Stoke sites. The Lower Stoke and Luton sites also monitor sulphur dioxide. The latter site also monitors carbon monoxide. Alongside these 'automatic' monitoring areas, there is also a network of 23 NO2 diffusion tubes sites across Medway. The following graph shows the levels of NO2 in the three automatic monitoring sites, against the regulatory objectives, and pollution levels against Medway-wide levels.

Figure 1: Trends in annual mean nitrogen dioxide concentration measured at diffusion tube monitoring sites
Figure 1: Trends in annual mean nitrogen dioxide concentration measured at diffusion tube monitoring sites

More detailed analysis of air quality has been produced by Environmental Health at Medway Council and the most recent progress report (June 2013, data from 2012), is available here. This latest progress report concludes that “exceedences continue to occur in each of the three AQMAs [whilst] there were no exceedences of the annual mean NO2 objective outside of areas declared as AQMAs."[2]

Alongside these Regulations, the impact of air pollution on health in upper tier and unitary local authority areas is measured as part of the Public Health Outcomes Framework. Indicator 3.01 is "Fraction of mortality attributable to particulate air pollution” and Medway's rate is slightly higher than that of the English average, and its neighbouring local authority Kent, although caution is advised in comparing regions, the data being based upon estimates by COMEAP calculated from background levels of PM2.5. As mentioned above, local monitoring of PM2.5 is limited by cost which makes it currently impossible to produce accurate local data.

Figure 2: Mortality attributable to particulate air pollution
Figure 2: Mortality attributable to particulate air pollution

Kent and Medway Public Health Observatory have additionally carried out some more detailed analysis of mortality attributable to particulate matter across the Kent and Medway region, as well as background levels of PM2.5.

Figure 3: Number of deaths per 100,000 population attributed to pollution, 2011
Figure 3: Number of deaths per 100,000 population attributed to pollution, 2011

Data collected via the primary care Quality and Outcomes Framework (QOF) also provides information on COPD and asthma prevalence in Medway.

There are 5,026 patients registered with a COPD condition, and this represents 1.8% of Medway patients (practice range 0.59%–3.14%). The following table illustrates mortality from COPD conditions over a four year period by ward. Again, it is striking that the wards within whose boundaries the AQMAs lie have the highest mortality over this period.

Figure 4: COPD mortality by ward
Figure 4: COPD mortality by ward

There are 15,800 patients with asthma registered at GP practices in Medway, which represents 5.6% of the population (practice range 3.54% – 7.15%).


References

[1]   The Air Quality Standards Regulations 2010;
[2]   Medway Council. Air Quality Progress Report for Medway Council 2012 2013; Medway Council.