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Executive summary Why the RCP and the RCPCH are tackling this issue Each year in the UK, around 40,000 deaths are attributable to exposure to outdoor air pollution, with more linked also to exposure to indoor pollutants. Air pollution plays a role in many of the major health challenges of our day, and has been linked to cancer, asthma, stroke and heart disease, diabetes, obesity, and changes linked to dementia. Neither the concentration limits set by government, nor the World Health Organization's air quality guidelines, define levels of exposure that are entirely safe for the whole population. When our patients are exposed to such a clear and avoidable cause of death, illness and disability, it is our duty as doctors to speak out. How we approached the task This report is a joint effort by the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Physicians (RCP). The two colleges assembled experts in medicine and environmental sciences to discuss the evidence and draw up recommendations. We searched the literature and heard detailed evidence from experts and key organisations. A draft of the report was circulated to a wide range of stakeholders for comment. Full details of the scientific references, evidence heard and stakeholders consulted are available on the RCP website. 1 Effects across a lifetime This damage occurs across a lifetime, from a baby's first weeks in the womb all the way through to the years of older age. Gestation, infancy and early childhood are vulnerable times because the young body is growing and developing rapidly. We know that the heart, brain, hormone systems and immunity can all be harmed by air pollution. Research is beginning to point towards effects on growth, intelligence, and development of the brain and coordination. Harm to babies and children will have an impact that lasts far into the future. For the same reason, any air quality improvements we make now will have long-lasting benefits. Older people, and adults with long-term conditions, are also vulnerable to the effects of air pollution. Improving air quality will help them to stay independent and well, benefiting individuals and easing the pressure on our NHS and social services. xii © Royal College of Physicians 2016

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