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Foreword I am very pleased to introduce this report from the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH), which takes a 'cradle to grave' approach to considering the impact of air pollution on our health. Air pollution, to which we are all exposed to a lesser or greater extent, has a significant public health burden. In 2010, the Department of Health's Committee on the Medical Effects of Air Pollutants (COMEAP) reported that long-term exposure to outdoor air pollution caused the equivalent of approximately 29,000 deaths in 2008 in the UK. Current work by the committee suggests that the effect might be even greater. Some health effects associated with air pollution are well recognised, such as increases in hospital admissions and deaths from cardiovascular diseases, respiratory diseases and lung cancer. We know that those with pre-existing cardiovascular and respiratory diseases and older people are particularly at risk. However, researchers are finding that air pollution may be associated with a much wider range of health conditions. For example, the report considers the evidence for effects of air pollution on diabetes and neurological disease, as well as how exposure during pregnancy may be associated with low birth weight and pre-term births. More research is needed to characterise the impacts, but there is no doubt that the health effects of air pollution are significant. The report also explores how the sources of air pollution have changed and that it is not just an outdoor problem; we spend much of our time indoors, where we can be exposed to numerous pollutants from a variety of sources. It considers what we can expect in the future with an increasing and ageing population and climate change, and the pressures that these put on our changing society. While air quality improvements have been made since the early 20th century, it is clear that we must address the ongoing problem of air pollution and we all have a role to play, however big or small. Individuals can take steps to reduce their exposure to air pollution and reduce their impact on air quality and the environment, for example by considering the transport they use and the routes they travel. This type of action alone is not sufficient to help those living in the most deprived areas, where levels of air pollution may be greater and where the death rates from cancer and cardiovascular diseases can be higher. If we are to make significant progress, collective action at population level is needed. Such action will not just reduce air pollution, but can also help to address other important public health and environmental issues such as health inequalities, physical activity levels and climate change mitigation. Professor Dame Sally Davies Chief medical officer for England iv © Royal College of Physicians 2016

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