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The most vulnerable suffer the most harm Air pollution is harmful to everyone. However, some people suffer more than others because they: • live in deprived areas, which often have higher levels of air pollution • live, learn or work near busy roads • are more vulnerable because of their age or existing medical conditions. Some chemicals in air pollution may be implicated in the development of obesity. It may be a vicious circle, because we also know that obese people are more sensitive to air pollution. These vulnerabilities are heightened among those living in the most deprived communities. This is due to poor housing and indoor air quality, the stress of living on a low income, and limited access to healthy food and/or green spaces. Moving away from an area of high outdoor air pollution may be unaffordable for local residents. Some people may not want to leave their homes – and they should not have to. Costs of air pollution The annual mortality burden in the UK from exposure to outdoor air pollution is equivalent to around 40,000 deaths. To this can be added further impacts from exposure to indoor air pollutants such as radon and second-hand smoke. The health problems resulting from exposure to air pollution also have a high cost to society and business, our health services, and people who suffer from illness and premature death. In the UK, these costs add up to more than £20 billion every year. Vulnerable people are prisoners of air pollution, having to stay indoors and limit their activity when pollution levels are high. This is not only unjust; it carries a cost to these individuals and the community from missed work and school, from more health problems due to lack of exercise, and from social isolation. Taking action will reduce pain, suffering and demands on the NHS, while getting people back to work, learning, and an active life. The value of these benefits far exceeds the cost of reducing emissions. Air pollution and climate change Air pollution plays a key role in the process of climate change, which places our food, air and water supplies at risk, and poses a major threat to our health. Several pollutants that cause this environmental damage are also toxic to our bodies. Therefore, many of the changes that would decrease air pollution to protect our health – especially using energy more efficiently and burning less solid fuel and oil – would also help to slow down the overheating of our planet. © Royal College of Physicians 2016 xiii Executive summary

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