Issue link: https://hi.iaq.net/i/670243
Foreword – European perspective It is now hard to imagine that, when I started my career in environmental health some 35 years ago, air pollution in western Europe was not seen as much of a public health problem. The great sulphurous smogs of the 1950s and 1960s were a thing of the past, and our summer weather was considered too lousy to produce much in the way of ozone, which was wreaking havoc in the Los Angeles basin at the time. As the Every breath we take report testifies, this has changed enormously over the past decades. It is a bit of a paradox – most air pollutants have been strongly reduced over time, and health benefits of these downward changes have been convincingly shown in quite a few studies. So why are we still (or again) concerned? Partly, this stems from the fact that, when concentrations are high, the research effort naturally focuses on what's going on at these high exposures. So, without the success of the air pollution abatement programmes, studies of effects at low or lower levels were simply not possible. The many studies now available at lower concentrations document serious effects on population health, which, as this report forcefully argues, cannot be ignored. Partly, it is also a matter of improved research methodology: the application of time-series analyses (developed in econometrics) in air pollution studies has enabled very detailed ascertainment of shapes of acute concentration–response relationships down to very low levels of pollution, seen on the cleanest days only; advances in air pollution exposure modelling have made it possible to study effects of long-term air pollution exposure in large cohort studies, often designed for other purposes; and related to this, studies have now demonstrated that air pollution is involved in much more than symptom exacerbation and early death in older and frail bronchitis patients. Air pollution affects us at just about every stage of life, starting in the womb, continuing through childhood, adolescence and young adulthood into old age. We now see a 'lifecourse' epidemiology of air pollution effects on population health emerging, and this Every breath we take report is perhaps the first one to emphasise this perspective in a concise and easy-to-follow format. It often quotes results from the European Study of Cohorts for Air Pollution Effects (ESCAPE), a recent pan-European effort to use data from over 30 different cohorts, spanning all ages and a multitude of diseases. I had the great privilege of serving as the coordinator of an incredibly dedicated group of talented colleagues in this project, and it is rewarding to see the results being put to some good use in this report. Although air pollution abatement really has been an environmental and public health success story, this and other reports show that there is still a lot to be gained. Even major additional clean-up efforts cost far less than the monetarised health benefits that they produce. This report, by emphasising that air pollution harms us in all phases of life, provides powerful arguments to support cleaning up the air we breathe every minute, day, year and decade of our lives. Professor Bert Brunekreef Chair of the European Respiratory Society Task Force on Air Pollution © Royal College of Physicians 2016 v