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Air_pollution_main report_WEB

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Introduction With increasing concerns over the adverse health effects of air pollution on human health, the primary aim of this enquiry by the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) was to raise awareness of new issues affecting health, across the lifecourse, from indoor and outdoor air pollution and in relation to a changing environment. Recognising that there was already a strong evidence base for the health effects of acute air pollution episodes, on the basis of new evidence, we decided to focus our enquiry on the health impacts of continuous exposure to chronic air pollution over a lifetime, with specific reference to: • pregnancy and children as well as adults • indoor as well as outdoor air pollution exposure • the influence of local, regional and national policy relating to pollution control measures • examining the influences of climate change. In addition, during our enquiry we recognised the importance of socio-economic impacts of air pollution and so we added this dimension to our terms of reference. More specifically, the scope of this report covers: • the effects of prenatal and childhood exposure to air pollution on susceptibility to chronic disease over the lifecourse; this covers respiratory disease, cardiovascular disease, systemic effects such as diabetes, obesity, central nervous disease and cancer, as well as effects that maternal exposure to air pollution has on the developing fetus, such as miscarriage, stillbirth, premature delivery and low birth weight • the impact of outdoor pollutants from vehicle exhaust, as well as indoor pollutants (including carbon monoxide (CO), volatile organic compounds (VOCs) and emissions from fossil fuel fires and stoves) on health; the recently introduced tobacco smoking legislation in public places is used as an example of health gains that can be made through exposure reduction • a predominantly UK focus, but drawing information from research conducted in other countries and, where appropriate, comparisons with rapidly and slowly developing nations • special attention being paid to vulnerable groups, including deprivation, poor housing and other socio-economic factors, and the overall cost of air pollution to society • the influence of changing age demographics, urbanisation and climate change on air pollution and associated health risks. While there is abundant literature on the adverse health effects of air pollution, this report specifically concentrates on the newly recognised, insidious effects of chronic and persistent pollution exposure from conception to old age. It takes account of total pollution exposure sources, both outdoors and indoors, as well as the influence of combinations of pollutants acting together and, finally, viewing air pollution as a stressor that interacts with many other stressors such as diet, socio-economic deprivation and climatic conditions to create reduced health and increased susceptibility to disease. In taking a holistic and multidisciplinary view of the current air pollution problems and trends over time, we have identified this as a major public health problem, which we address in a series of recommendations that mandate urgent and definitive interventions to protect the public, especially those people in society who are most vulnerable. © Royal College of Physicians 2016 1

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