Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

So welcome everyone to this online webinar by the International Child Health Group. And so this evening, we're delighted to have Malcolm White speak to us about his work in sort of air pollution and climate change. So he's going to be talking about essentially the impact of air pollution on health and ways that we can actually introduce that topic in our clinics and our clinical work to our patients and how we can sort of advocate advocate for climate change topics in actual sort of day to day work. And so let's Malcolm sort of share his slides and take it there. Great. Thank you Gemma and thanks very much for the International Child Health Group for having me to speak tonight. Very happy with it. And I assume for some people it's tonight, some people, it's maybe this morning and some people, it's some other point of the day, but uh welcome everyone and for those watching the recording. Uh delighted to have you watching this as well. Um So yes, uh bring the slides there and as Gemma kindly introduced, my name is Doctor Malcolm White. Um I live in Glasgow in Scotland and I work for the charity Global Action plan and that aims to mobilize action on the systems that harm us and the planet. So that's a nice catchy headline. But the areas that I work in most commonly is relating to air pollution and how the health sector can be doing more to bring this information to our patients and tackle it in its own. Right. Um My background is in hospital medicine. Um So I worked for over 10 years as a sort of adult physician medic and that was in the hospitals of the Glasgow area. Um So again, that's the major background for me, but that's lots of acute medicine, lots of respiratory gastro rheumatology, et cetera. And I've also done a bit of pediatrics in my time as well, but I certainly would defer to others on the call for their expertise and, and just even to say that, you know, some of these slides are maybe slightly more focused on adult medicine. Um or at least, you know, I've done a lot of this teaching for adult medicine, but we've also done quite a lot of it for pediatrics and other health groups as well. And um yeah, so, um it's definitely going to be applicable across these specialties. Um and also being someone who does a lot of education in the UK health space, um that is to some degree where the focus of the slides are, but um I'll explain where, where there are um crossovers and areas where um yeah, there are particularly relevant parts across the world as well and I do very much speak to the international perspective too, but I think a very key message to take home is that air pollution really does impact us all. And that's if you work and live in the global north or the global south east or west. And whether you, whether you are a healthcare provider or a patient or indeed, everyone of course, is a patient in their own right. Um Air pollution unfortunately affects us from before. We are even born in the sense of it impacts the mother's health and it impacts the developing baby. Um It has been shown to cross the placenta and it impacts from when we were born all the way through until the end of life as well. Um In old age. So yes, it, it really is a lifelong insult, so to speak and we'll go into the ways in which that is the case. Um Just for anyone in the UK. Um And I guess just for an awareness for anyone outside um a bit of a plug in that global action plan run Clean Air Day, which is the, the U K's largest air pollution campaign. Um It's a great celebration in which we bring lots of communities, branches of the health sector, schools, local authorities, branches of government, et cetera. Um All celebrates Clean Air Day and that's usually the third Thursday in June and there are other national days and there is indeed the US um clean air day for blue skies, which is the sort of day in September. So as long as everyone is pushing the boat in the same direction towards, um you know, reducing air pollution and helping our populations, then I'm happy. Um So speaking about the sort of the global significance and the international context of air pollution. Um First of all, it is, as we've said, a massive issue, it really is a massive issue in terms of the impacts on mortality. And there are, it's thought to be about 8 million or so. People die each year early as a consequence of air pollution related illness. And this sort of statistic from the air quality life index looks to see, it essentially says that on average, if you take the amount of impact that air pollution has on average across the whole world population, then the average person in the world loses over two years and four months of their life as a consequence of air pollution. Now, because that's an average, there are some parts of the world or even some areas within a country where people will lose more of their life and some areas where they will lose less. Um So that's the impact of the average and that's also one thing that I'm going to try and keep on coming back to in this presentation is talking about the way that air pollution's impact on societies are, it's, it's an unequal impact. So therefore, it's a significant health care inequality. Um, so, um, one area to combine to compare as well is that even just one type of air pollution, particulate matter, which I'll come on to more later, has a greater impact in total across the world than that of smoking, which is a sort of bizarre statistic when we think about how central, you know, our consideration of smoking is to healthcare around the world. Um But on average, because a lot of people around the world don't smoke or are less impacted by smoking, therefore, in total air pollution has a greater effect. Now, for people who do smoke, they on average will lose more of their life than the impact simply of air pollution. But it's the fact that air pollution impacts everyone around the world is why it's got such a significant impact globally. Um And although this number I believe has increased since the creation of this slide and it is gradually increasing in terms of the amount of funding that we are seeing related to air pollution. It's very fair to say that it is dwarfed in comparison to the amount of money funneled towards very serious and very worthwhile conditions such as HIV aids and malaria. You know, again, I wouldn't, you wouldn't hear me saying that H I and AIDS doesn't deserve every single penny in cent of that. Money. But at the same time, I think health and public health figures around the world would like to see a greater equity in terms of the amount of money being spent towards this really serious issue, which is actually the greatest population health risk from the environment that we have in the world. And as I said, it is the vast majority of the world's population which is 98% who live in areas where just even this one type of air pollution exceeds the World Health Organization guidelines. Now, these guidelines were made more stringent in 2021. And that was with the aim of recognizing that there is no safe level of air pollution. So therefore, we need to aim aggressively to zero if we are to, you know, reduce the amount of impact that this is having on the population. And so it is an ambitious target. I will definitely agree. But at the same time, I think it is a correct target and we should continue to aim down towards zero again, just thinking of the international picture. And unfortunately, if this list here is the top or worst six in terms of the amount of air pollution and the impact that that has on the population. And if we look to Bangladesh, then that's nearly seven years of life lost per person on average because of air pollution, which is an absolutely astounding horrifying figure. Um You know, so, you know, it's a absolutely serious problem in a lot of countries um in what might be considered developing nations or the global South. Um And that to some degree is related to the amount of funding and finance available uh to tackling these issues. It's also sometimes to do with how stringent um the the ambitions are of the governments in terms of um say standards of vehicle emissions, for example, or the amount of coal burning that is happening in the countries, the population density, there are a lot of factors. So I'm not pointing the finger at these countries in order to say, you know, this is completely your fault and you're failing. There is a great climate and ecological justice issue that comes in a lot of these countries who for a long time, have you essentially suffered under the, the unequal distribution of wealth that is seen around the world? And this is one way in which that is felt um just because I have done quite a lot of work in the UK relating to this, looking at that picture in a typical westernized country, you can see that the impact from air pollution is still significant, but it is much less than some of those countries around the world. So it's somewhere in the middle in terms of the air pollution rankings overall. And if we just think of say Wales and England, which are relatively densely populated, then that's somewhere between four months and six months of life lost on average. Um And if you go to Scotland, which is really not a densely populated country at all, then that level of air pollution is comparatively quite low. However, you will still find in Scotland and other cities around the UK, that air station levels are, are quite high. Um And that really does have a significant impact on the population and it causes up to 43,000 deaths each year in the UK. That's thought to possibly be a conservative estimate, to be honest, but it's based on the best available data and it has a really big impact on the economy and you would see this in countries around the world as well. So it causes, you know, well over 6 million sick days each year. So that has a really big impact on the economy and it costs the Uk's National Health Service as with associated care. Well, over 20 billion lbs per year, which is a really, really large amount of money. And it really supports the argument that spending more money on prevention and reduction of air pollution at scale in a systemic way is going to have massive impacts in the economy of the UK as it would around the world in terms of the different countries. Um thinking about how that impacts hospitals and the front line so to speak, is that air pollution related illness causes over 20,000 hospital admissions just for lung and heart problems in itself which again is a massive, you know, burden on the NHS. So it's worth recognizing that. Um, so this, er, graphic was taken from Public Health, England. Um, and essentially it's just looking at some of the different types of air pollution. Now, this is based on the UK. But I think you would see, even if the proportions would be different in different countries around the world, it would tend to be similar um pollutants that we would be seeing. And I apologize that the image is a bit complex, but um hopefully we can go through it to explain. So first of all, I've mentioned particulate matter and so that that one is tiny, tiny little particles or droplets of liquid and they're invisible to the naked eye. I'll go into a bit more detail about them in a minute. But essentially that's one of the major types and the biggest sources of that, particularly in the UK. Actually, considering we don't have as much coal burning for electricity generation and vehicle standards have been made to be relatively good, so to speak. Um The actual biggest source of that in the UK is the burning of wood and other solid fuels for residential or small, small scale commercial combustion. And so what that really equates to in the UK is a lot of wood burning stoves, coal and other open fires. And yeah, it's a sensitive issue. So it's not one that I would necessarily start wagging a finger at all of my patients relating to. But it is surprising to a lot of people and they don't necessarily know that wood burning stoves are actually really quite harmful for your health, both for the people in the room sitting there. But also that the air pollution is unfortunately just blowing up the chimney and then, um, affecting people in that local area as well. So that, that is actually the biggest driver of this really, really important type of air pollution in the UK. Um The, the next group is called nitrogen oxides or oxes. Um So that's nitrogen oxide, nitrogen dioxide, et cetera. Um And that essentially is most commonly found when you burn the things in particular that's related to road transport, which is the biggest source of that in the UK causing about a third of all emissions. But then non road transport such as trains and planes and then there are say the energy industry and manufacturing. So there is a more a greater spread across the country, so to speak in terms of the different industries. But the biggest source indeed is road transport. Um So sulfur dioxides. Um So that's commonly found again when you burn things, it's the actual constituent that causes acid rain, in fact as well. Um But in terms of air pollution, the biggest sources of that is the energy industry and manufacturing. And then the last couple to talk about, we've got ammonia or NH three. And by far, in a way, the biggest source of that in, as you would see in many countries around the world is agriculture. And that essentially is because of pesticides, but also particularly from animal urine and feces and then also manure and other fertilizers which are put on. So, artificial fertilizers also, in particular, the way that they are put onto the soil in order to enrich it, so to speak for farming. But unfortunately, it causes quite a lot of water pollution as we will have heard before, but quite a lot of air pollution which I think people aren't particularly aware of. So even if the cities are often places where air pollution tends to congregate and concentrate because of dense road transport and dense populations in the countryside. You will find that agriculture and ammonia are actually big culprits of air pollution. And then the last type of ment I'll talk about um in this sort of outdoor section, so to speak, is looking at volatile organic compounds as they're called. And the NM stands for non methane related. But essentially vocs is a collection of about 10,000 or so chemicals which are known by industry and health and they are known to be harmful and they are often found in industrial processes, pharmaceuticals, sprays, cleaning, you know, things that stop things from burning all sorts of chemicals which unfortunately are harmful to human health and are considered pollutants. Therefore, And so as I say, the biggest, the biggest source of that is from industrial processes, but actually from fugitive emissions which can include things like say waste as well. Fine. So briefly as well, I'll talk about um, indoor air pollution. Um, it is certainly a massive topic in its own, right? But mostly to say that actually a lot of the pollutants of, in question are, are, are similar. Um, so that particular matter is also produced when we burn the things and the same with nitrogen oxides. And in particular actually say I've mentioned burning at home because of say a wood burning stove or such. But if, say, if we've got a gas cooking or a gas, central heating, now that is a relatively clean um fuel in terms of carbon monoxide and other things like that. And particularly if we're thinking about the global perspective, with a lot of people still cooking at home on open fires or in concentrated spaces like outdoor kitchens with lots of um open flame, then gas and things like that are comparatively much cleaner. But if we are driving towards having no air pollution to the greatest extent that we can manage, then we do have to recognize that gas, central heating and gas cooking are other sources of burning in the home. Essentially. And unfortunately, do produce amounts of air pollution, which we know are harmful and do contribute to childhood asthma rates and the development of asthma more generally as well, just as one example condition. Um So another few things to mention, of course, uh things like VO CS are often found in furniture, paints, varnishes, um and say bathroom cleaning, all sorts of things like that. But one area that I haven't mentioned compared to the others and the more outdoor space is um mold and other organic type um air pollutants which are produced in particularly in damp, cold settings. So there might be people who can't particularly afford to heat their homes. Um And people who live in rented accommodation where they don't have the actual power to change their situation. Um So I think this once again comes around to the um the argument of inequality here. So if someone lives right beside a main road because they're in rented or government owned um property, then it might be that they don't necessarily have that power to change their situation. They don't necessarily have the money or finances to be able to do it either. Um, and they might not be able to move because of work or their schools or their kids and all sorts of reasons. Um So it does, unfortunately, therefore impact people who are immigrants newly to a country, people without, with a lower social and economic status, essentially. So it means that the health outcomes for these people are worse even within more developed countries. And this is also seen around the world essentially too. And so yes, I've mentioned about particulate matter a couple of times. Um And essentially, this slide just helps demonstrate the sort of size that we're talking about invisible to the naked eye and much smaller, in fact, than grains of sand or the size of a human hair. Now PM 2.5 is the one most commonly talked about by governments or by um academia, but there is also PM 10, which is essentially just bigger um 10 micro micrometers in diameter or 2.5 for PM 2.5. And there is also steadily increasing evidence about what you could almost call nanoparticles or ultra fine particles, which would be less than one micrometer in diameter. And the thought is potentially the smaller they get, the more harmful they get because the easier, the more easily they get into the body essentially but will come on to more of that too. So we've talked about a particular matter in some detail, but also just to look at nitrogen dioxide here, which as we know is in the UK, at least mostly produced by the burning of fossil fuels in internal combustion engines or cars and vans and lorries, etc. In this example, here is a map of Hackney which is in London as the capital of England. And um essentially you can see that you take the air pollution levels from these areas across, across the city and then you map put that onto the map and then you can see that these dark dark lines show the very high levels of air pollution and that follows the major roads. Um So this down here is more central in London. So as you can see, unfortunately, even the background levels away from the main streets are quite high here, dangerously high. Um And as you get further out of the center of the city, then the air pollution levels start to drop but are still in the dangerous category. And even though there has been lots of really, really good work happening in London, like it is genuinely a world leading city in some respects for air pollution and there's still clearly a lot more work to do. Cool. So I've been talking about the wider picture quite a lot here. But I'm wanting now to think and focus a bit about how it impacts the body. And this indeed, you know, is looking throughout the whole life cycle. But of course, a lot of this has impacts on Children and indeed developing an unborn Children too. So thinking in that way, thinking from the youngest to the oldest. Um first of all, it unfortunately does have impacts on the developing child which can lead to a premature birth or even miscarriage. Unfortunately, um it will, you know, you can easily show in studies that the birth weight in areas of high air pollution is lower than that in areas of lower air pollution. And actually, I think relatively recently, there were studies that came out talking about the levels of air pollution during the Beijing Olympics because the city did. It had a really, really big air pollution problem. It still does unfortunately, but they went into overdrive trying to tackle this in before the air, before the Olympic Games happened. And Children born within that period had a higher birth weight by about 23 g compared to other people, um, who were born in subsequent years or years before. Um because unfortunately, the levels crept up again. II don't know if they've continued to go down over time, but you can really see that that's a massive impact in terms of the development of Children. Um and in terms of fertility itself, the decreased sperm quality. And as I said in um at the beginning, it has a big impact in um maternal illness as well, including preeclampsia, gestational diabetes, et cetera, et cetera. Um As we start thinking into childhood, it has a big impact in terms of asthma which I think most people would know in advance and recognize. But um this unfortunately translates as well. Um air pollution later on in life in terms of lung cancer risk. It is the most common source, you know, cause of lung cancer outside of smoking, essentially. Um and indeed other illnesses throughout life as well like infections and stuff like that. But particularly thinking for Children is that it has a big impact on their lung development. And that's both in utero while the child is developing, but also throughout childhood. So there's a big impact on lung development and brain development and also like mental acuity, like the ability to think and solve problems, etc. So to the point that you can see that in a study in Barcelona, Children who lived in a central more polluted area had lower attainment. Um even after um you know, controlling for other factors, they had a lower grade attainment, they had poorer. Um They, yeah, they, they have poor achievements in their education because of air pollution as well. So yeah, these are really significant issues and we can also just see that this goes around the body. Um and it causes essentially air pollution. Then this is the gasses and the particulate matter. It causes a generalized inflammation, a general irritation throughout the body, which means that many of the blood vessels and blood cells around the body are impacted. And that's why we see such a wide variety of health conditions which are worsened by air pollution. Um I'll just glance through a couple of the other ones, but in particular, it's worth saying that the biggest cause of mortality related to air pollution is actually heart disease, not lung disease. And um approximately a quarter of all um deaths related to heart disease and a quarter of all deaths related to stroke are caused by air pollution, which to me is like really significant fact as well. And it sort of drives at home that this is a thing that we should be talking about with our patients. And it's a thing that is not necessarily taught that well in a lot of parts of the UK. And I'm assuming indeed the rest of the world too. So that's partly why we drive forward this agenda. Ok. So we can safely say that we understand air pollution has a big impact on the body. Um And this definitely, you know, equates to different um health services around the world as well. But we argue that the NHS does have a role to play um very much in educating staff so that they are then able to speak to other staff about it and then so that they can inform their patients and the patients families too. Um It's recognized that health professionals are generally trusted to develop the to deliver this health information to patients. Um But we have to recognize that patients should not be made to feel wholly responsible for the changes required. There are some things that the individuals can do in order to reduce their exposure and contributions to air pollution. But ultimately, it's going to take wide scale like big scale, widely applied systemic changes in order to tackle air pollution to the level that we need. Um And actually I'll just speak for one second because I think it's a case which does have international significance um about the, the really tragic case, which is quite a famous case in the UK of a young girl called Ella Adu Kissy Debra, um who unfortunately died um as a result of quite a severe form of asthma. But um she lived right beside a major road in London called the South Circular. And over the course of um 2 to 3 years while she developed this serious form of asthma, um she was admitted to hospital over 25 times with serious asthma attacks and unfortunately, she died of her asthma. Um And after a lot of campaigning, um there was an inquest into her death which allowed the coroner. So, you know, the person responsible for making judgments on the cause of death was able to, for the first time, as far as we understand, anywhere in the world, they were able to put air pollution as a contributing cause of death on the death certificate. Um So I think this, you know, is such an important case in the UK, it's really helped um push forward organizations such as the royal colleges, the government, um and other medical and other healthcare education systems um to really bring this information to staff and patients and it's really been a big driver behind the work that we've done as well. Um, a global action plan and um Ella's mum Roberta actually continues to campaign to this day and is a really, really excellent speaker regarding air pollution as well. Fine. And so we now understand that air pollution is a big issue, it impacts our patients. And now we want to be able to bring this information to our patients. Um And it's very much worth saying that the way in which we do this will very much, it will differ depending on the circumstances of your work, um the circumstances of your role, but there are some central tenants, some central um ideals that we can use in order to bring this information to our patients. And so I would argue in general that trying to inspire behavior change successfully is going to be more successful if we can reinforce the message. And so that might mean that the patient sees a message multiple times. And if they're coming in to see the doctor or something like that, then it might be that there is a poster in the waiting area or if they're using a phone service or a website in order to make the appointment, then, you know, they might be able to see some information about that while they're visiting during the consultation with a healthcare staff member, then it might well be that the healthcare staff member has been trained and feels more confident in order to pass this information on to patients. And even if they don't feel super confident, then we would hope and argue that they should be able to point people in the right direction, especially if the patient brings it up themselves, which you, you may well find in your practice. And then lastly, um but by no means, an exhaustive list is that we could give a leaflet or sort of a follow up text, email, et cetera many different ways in which we can give this information to our patients. And I'll show you some examples that we have a global action plan which are freely available to download from our website. Um So yeah, there are many ways in which we can bring this information to our patients. And this leaflet here is um I think it's actually, I wouldn't call it out of date, but we've slightly changed the design on it, in fact. So you might find um subtly different ones if you go on the Global Action plan website, but the information is very much the same and so on this first page, it really talks about a lot of these health impacts that we've already heard of here. But I think an important thing in terms of giving patients actions that they can take in order to reduce their exposure to air pollution and their contributions, they need to have those actions. They need to see that there is something that they can do about it. Otherwise people will just be scared and you know, feel defeated before they even start. So for that reason, we have what we call the clean air hub, which I think people could find around the world but is particularly relevant in the UK. And this is a patient focused website where we can send patients to learn a bit more about air pollution. They can even calculate their own levels of air pollution that they produce themselves by their activities in their daily life. Um So yeah, lots of information on the first side, but in particular, I bring it up um the second side because it looks at actions that people can take in order to reduce that exposure and contributions. And it's split into outdoor and indoor air pollution and for the outdoor air pollution um particularly in the UK setting that really focuses on improving um people's use and you know, ability to do active travel. Um So when people can being able to walk scoot cycle or wheel um to school or work and whenever they can, um you know, that's a really, really important step and for people who say, do walk or use these modes of transport if you can do so avoiding the main streets. And as we saw on the map, the highest levels of air pollution, particularly related to road transport. Of course, we're nearest the greatest concentration of cars and vans on the road. So by walking away from the side streets, even by just a number of meters, you do have a a lesser reduction. Um Sorry, you have a reduction in the amount of air pollution that you're exposed to. I'm recognizing that some people do have to drive and I'll speak more on that in a minute. But if you do have to drive, turning off the engine, not idling, the engine reduces the amount of fuel being burnt. So therefore, it just reduces the amount of air pollution. And it's definitely worth saying that particularly if you're in a really, really busy road or if you're in nose to tail, sort of traffic jams, then the amount of air pollution inside the vehicle can easily be worse than outside the vehicle. For people just walking along the side of the road. And people sort of imagine that they're safe in their like glass box, so to speak, but unfortunately, that's not always the case. Um And yeah, I think that this um is an important area to consider as well when we think of the unequal impacts across society again. And that's because um you might have some people who have kids who are in two different schools and then they need to go work and they live in a slightly more countryside area and they have to drive into the city to do it or something like that. So this person has to drive their car, like there's kind of no two ways about that. They might not have the sort of money it takes to change to an electric vehicle, even though that over time, these will become cheaper than new internal combustion engine vehicles at the moment, that's certainly not the case. And the reason I bring that up again is because if you just go into every consultation, saying to every patient, well, obviously you're going to stop driving your car. Now, then you've lost that patient. That patient is not really on your side because they, they don't think that you have the capability of understanding their circumstances. And so therefore, it is really, really important to understand the circumstances of the patients that you're speaking to. So an important point very quickly, just thinking of some things that we can do inside the home in order to um reduce the impact of air pollution too, um, that can be using fragrance, free milder cleaning products, um avoiding things like plug in fragrances and other heavily scented things because if you can smell it and it's strong, then unfortunately, it's probably got air pollution linked to it. Um, when you're doing painting or varnishing, then you can buy products at least commonly in the UK, now labeled low voc, um, asking people not to smoke or burn things in the home as much as possible. And although, you know, this is something which requires sensitivity in an international context but trying to reduce home burning as much as possible, um, such as log burners, et cetera will reduce the amount of air pollution quite significantly, excuse me. And then having done as much of this as possible because it is very much better to reduce the amount of air pollution we are producing rather than simply blow it away, so to speak. So once we've reduced as much as possible, then ventilating while you're cooking and cleaning as much as possible, so to speak, by opening the windows or using extractor fans or other things like that will do what you can to reduce the amount of air pollution and allow it to blow outside to. But it is worth saying again, for that person who lives beside a major road that maybe they don't want to open the windows, particularly the ones beside the road. So maybe they can open the ones on the other side of the building if possible. Fine. So I'm just gonna glance past this leaflet very, very similar except for um, more related to pediatrics and child health. Um, it's a newer design than actually, I think even a couple of colleagues might have seen on the call, but, um developed quite recently, but with the same messaging and what's good about this type of leaflet is that it has, um, sort of almost checklist like an, a, an activity that the family can do with the child in order to understand together the ways in which they can help, um, air pollution or rather help tackle it. Of course, um, this is just part of a sort of anti idling campaign that we, um, put together with Barts Hospital Trust in London. Um, so I thought a really great design. And one worth just noting, I'm fine in the interest of time. I'll just sort of glance on, but now that you hopefully understand more about the impact of air pollution, you understand more about the sources of air pollution and we can start to think about how to bring this into our consultations. And the idea really is that, you know, there are resources, leaflets, materials and other things like that available, especially if you have access, say to a printer in order to um print them out yourselves. Um And then from that point, we can start speaking to our patients about it. Now it's going to take time and it's going to take um effort and it's going to take practice essentially um in order to bring that into the normal consultations that we have with patients. But for myself, I would say that it's um the sort of questions that we should be automatically asking on hospital Clarins or something like that in, in the same way as we always ask about smoking and we always ask about drinking um alcohol. So, you know, I think it would be quite common to say something like um can you tell me what home is like? Um Do you have any concerns about air pollution? Um Do you live beside a major road? And what's the air quality like where you live or something like that? Because I think people would be surprised at how often that will start to generate conversations where you can really understand things which might be driving the health impacts of patients essentially. And over time, you'll find that it develops into your routine and you can find the words and phrases that work for you. Um Even actually, just for example, in some GP practices, which is like community doctors based in the UK, we found that some of them might cycle to work and then have their bicycle in the consultation room. And they found that that was a great way in order to sort of spark spark the conversation about air pollution. And so like I say, you develop your routine. And so that in that sense, that's what we really talk about embodying as a clean air champion. And the second way in which we really think about that is spreading the message. And so having introduced that to your consultations, we really hope that you'd be able to share this with colleagues. And it might well be that as part of this, we'll be able to share around slides such as these, for example, so that you can take these, edit them, make, make them your own because we're not precious about that. We just want the message to get out there. So you can speak at local education meetings, you can share with colleagues. It might even be that you want to speak at a wider more regional meeting about this because it is a regional and national international issue. And I really want to hammer home the importance as well of, you know, if you feel able, if you have capacity and capability, writing with your health care hat on to local government or national government representatives in order to ask what they are doing about your pollution. And more importantly, asking them to do more about it because as we hear healthcare professionals and staff are trusted in this space when we're talking about this really, really important health issue and it might be that you don't always get the best traction that you would like. But at the same time, if you don't hear the right words from them, you can try again or you can write to someone else, you know, I think that that's a really important message I would bring forward. Um So yeah, just as an example, um we're very pleased to say that um although this website might go under a bit of redevelopment soon um at the action for Clean Air website or what we call the Clean Air knowledge hub. Um We've got loads of training videos, there are loads of downloadable resources such as the leaflets that I showed earlier and loads of other things like posters too. So yeah, this is just one example. There are um lots of resources um available from other charities in the UK and in particular, actually, now we notice that a lot of the Royal Colleges are starting to use our resources but also develop their own, including videos and things like that too, which brilliant to see. And then um we've now quite recently seen that the who has really launched quite a comprehensive education piece on this too, um a series of modules that take about four hours in total, but at the same time, are really, really in depth about the topic and therefore we think really valuable. Um So I will even say that gap ourselves are um bringing out some modules which are going to be launching, I think next week or so. But um a more concise version of modules to with equal mobility, I think so, yeah, just as a few other examples, you might find posters there. Um the sort of things that it might be possible to stick up in the waiting room of your healthcare organization. Um So many, many other ways in which to spread this message to our patients. And here again, looking at the NHS, but very much recognizing that other healthcare systems around the world can also yes, have a role to play. And if people are not aware of, then the NHS in the UK is essentially 11 really big organization and it's a sort of fully funded service. So it's, it's a massive employer, it is the biggest employer in the UK. Um It creates a lot of air pollution itself because of the actions that it takes. Um it has about 5% of the total road miles in the UK just as an example, so that obviously contributes to air pollution. So it really needs to tackle its own air pollution and lead the way for society. And as I've said, the NHS staff are powerful voices for change um in terms of the UK picture, although we do see this um echoed around the world in different ways. Um Our chief medical officer who is essentially the top doctor in, in the, in England, so to speak, um said that we would have contribution to poor air quality within 10 years while reducing the impact of air pollution on health inequalities. Like I've said throughout this talk, the way that air pollution impacts society is unequal. So by improving air pollution, we will improve the health inequalities that we see within our country. Um And they also called on lots of healthcare staff training to include um about air pollution essentially. So I'm delighted to be giving this presentation today. Um And I, I think I'll maybe not talk about this too much, but essentially in the UK, we're trying to do a big drive towards reducing carbon emissions. So different health services will produce what they call green plans. And we really feel that air pollution is something that should be also addressed within that space. That is my slide. Oh, yes, here we go. Um So yes, again, something I'll just speak to for a few seconds. But this is in some ways, it's like the utopia that we would like to see um in which the NHS and other healthcare institutions around the world are reducing the amount of air pollution that they produce. And they are inspired other organizations within their community and the wider community and the public themselves by having all of the sorts of things that you would want to see which I won't list here. But there are many, many ways in which health care services can reduce their impacts on air pollution and global action plan have what we call the clean Air hospital framework, which is a a system essentially where hospitals and other healthcare institutions can try and reduce the amount of air pollution that they are producing. And it's just a lot of ways in which we advise them to do it. Um So like I've also said, is one of the key sort of take homes in the wider um space of air pollution is that there are some changes that individuals can make and we should definitely be telling our patients and colleagues about this. But ultimately, it will take wider changes in society in and also the legislation within countries such as the UK Europe and beyond in order to reduce the amount of air pollution that we see. And for anyone not familiar, this is the Houses of Parliament in London. Fine. I'll glance past this because in the interest of time and essentially just say thank you. And this is the clean air website that I mentioned, which is a patient focused website where we can take patients and to learn more about air pollution because we have to recognize that a lot of healthcare professionals certainly don't have time to talk to every single patient about air pollution. Um So there, there are plenty of websites where we can send people to find out more information, particularly if you're time poor as a healthcare professional. And my final final take home message is I promise is that air pollution seriously impacts our health. There are things that we can do to reduce air pollution and we should not underestimate the power of the voice of the healthcare professional in calling for change. And I think I will stop sharing, but thank you very much. Great, great. That was excellent. Thank you very much. Um Yeah, it was so lots of points that I didn't realize and it's really important. Thank you and health and lessons. Just simple ideas, practical ideas that we can do and tell our patients about changes and reduce that impact of that evolution, especially on Children instead of walking down roads. That's such a simple thing just to avoid the main roads and go on smaller roads. So it's really listen to hear those thoughts. So thank you. Thank you for your time this evening. And I just before we open this sort of webinar to any questions or a bit of discussion. I just wanted to quickly talk through a few things that the Royal College of Pediatrics and Child Health in the UK is doing. So I've got just a couple of quick slides that I'll just bring up. I need to pass. That's good to know. Um ok, so I just have to, so can I can you see that? Ok, so we can see that coming up? OK, good. Um Perfect. So this um sorry. Um So I just wanted to highlight um the fact that so International Child Health is a group that has links to the Royal College of Pedia in Child Health in the UK. And the college is doing a lot of work at present and looking ahead into the future due to a Clean Air Fund project that they've created. So the college is partnering with the Clean Air Fund to try and essentially start to tackle air pollution with the aim to protect children's health in our country. So there's some really great work going on and this is a slide that I been sharing with me about the Clean Air project that is currently taking place. Um So um there's some really good resources that I'd just like to sign past people to. So this is a resource that's been created by that partnership team. Um Looking at ways we can upskill ourselves and our colleagues in terms of talking about air pollution specifically for child health professionals. Um So that's the link there if anyone's interested. Similarly, there's been quite a recent report about the impact of climate change on child health across the world, not just based in the UK, but across other parts of the world, which is relevant to our particular membership. So again, there's a link if anyone's interested. And there's also been some recent work with the Royal College and US group, which is basically a group of Children and young people and their families that do lots of advocacy work through the college. And they've actually done a report about sort of what the Children and young people in our country feel about climate change and their about ways we can try and preserve the world for future generations. And that report has come out of various educational roads that they can be created by the Royal College of N and those roads have gone across the four countries of the UK. So again, that's quite an interesting report that people want to read further about it. Um And there's some really exciting future plans arranged by the college. So at the moment, there's a website that is currently being created which will essentially um end up being a one stop shop for all the resources linked to the college in terms of air pollution and the child health. So I think that's imminent in the next month or so. So that's worth looking out for and there's also plans to potentially for them to write a toolkit for child health professionals to help us actually discuss these issues with our patients. And there's also a couple of clinics that have been set up to try and actually combat clean air and the impacts. For example, for Children with asthma and other respiratory illnesses, which can be related to problems with clean, with air pollution. And so there's one being set up recently in Liverpool and there's one in being set up in London. And the college is sort of helping create those clinics will also evaluate these clinics and see if that can be an idea that can be shared forever. And then finally, um the the college and looking at planning a website, a webinar with hope for future, which is due to take place in in about November. So again, that's worth just keeping an eye out for. And then just before I finish, I've just got a few slides about the International Child Health Group. So I'm not sure whether everyone on this course is actually a member of, you've just come across this webinar on me, but the International Child Health Group is quite an active group with three main streams. There's an education and training school which this webinar is linked to, but there's also a research stream and an efficacy stream that's doing incredible work. Um And we have various awards for people with an interest in International Child health specifically to help them and develop research and adverse case skills and also to help fund medical electors in child health. And so it's got big membership across the world and it's open to both pediatricians, but also other child health professionals and wider Modiin team. So these are kind of main social media handles and then a QR code if you actually want to join the organization, and these are the sort of events that are planned over the next month or so. So there's actually an advocacy webinar tomorrow about conflict and displacement and vulnerable populations. Then at the end of the month, there's a research webinar about writing abstracts and that's essentially designed to help people um write abstracts in advance of the Royal College of Pediatrics annual conference, sort of abstract deadline, which is on the third of October. So if you're thinking of writing abstract, that's quite a good session to go to just to help you write that abstract before you submit it. And then from our perspective, um we've, we're organizing an International Child Health Careers evening in October. And um we also have a session in November where our two elective award winners from 2023 and 2024 are actually going to present their award and their project that they did as a result of that award. Um So these will be publicized through those social media channels and also online. Um And then finally, we always have a, a meeting at the World College Conference in the spring, but we also have a winter meeting every year and this is online, um which basically means that anyone across the world can join. Um So that's going to take place on Thursday the fifth of December. And that is um so at the moment, we've got the save the date, but that's um just to the point where tickets will start to be released over the next month or so. Um And these are just other things. So it's a time for abstract submission for the college conference in 2025. And then also at present, the award that's open is the advocacy award which is going to place on the 28th of September. If anyone's interested in finding out more about that, and we have various walls on our committee which are open. So if people are interested in actually linking in and joining in with uh the International Child Health Group, there is opportunities for you to join us and we have lots of resources. Um So these are a few of the resources that we've created in the past. Um That is all on the website. And we also have quite close links with an organization called A which is basically Global Health information sort of discussion forum, which is a huge organization. And again, they do some really great work. And if you're interested in global Child Health it's a really great organization to, to join and it is free. So that's just my contribution this evening. So I'll just stop sharing and we will see if anyone's got any questions or any thoughts about this evening. Anything that Marin said or any other things that you'd like to contribute from your experiences and your backgrounds. Yeah. And just to say, very happy to answer questions. But also if people do want to reach out to me afterwards, um I put my email address in the chat there so people can feel free to um ask for resources or just um you know, have a chat and, and ask some questions about um how to bring this to your practice or anything to very happy to speak in the future. So thank you very much for your time, everyone this evening and I hope everyone found that useful and yeah, thank you very much Malcolm for giving a really fascinating talk, really inspiring. We've got lots of things we can go away and do. Yeah. And just thanks very much once again to the International Child Health Group and the Royal College for having me to speak. And you know, I'm not just saying, I am impressed by the work that they're doing and it's really great, at least in the UK to see that a lot of the Royal Colleges are starting to take the issue seriously and are actually starting to push it forward because in some senses, I would love to not have to be doing this and, you know, I'm very happy to do it. It's the job that I wish to bring this knowledge to my colleagues across the country. But at the same time, this is something that we should really all be teaching in medical school, nursing college, all sorts of places like that. So that it's actually just an inherently known part of our education. Yeah, definitely. Yeah, I think I can't remember any lectures or any discussion about climate change when I was at medical school. I think I came across it in terms of the International Medical Student Association, but I didn't think it was part of the main curriculum. It was very much an extracurricular thing that I kind of stumbled across through sort of global health organizations. Yeah. And I do think that this is changing, but at the same time recognizing air pollution as part of this climate change um and sustainability agenda is brilliant. So, anyway, thank you very much. Ok. Well, have a lovely evening everyone and thank you for your time. Bye bye.