Air pollution: The invisible health threat – World Health Organization (WHO)
“In the realm of public health, the detrimental effects of air pollution have long been a cause for concern. A disconcerting reality persists: the issue of air pollution remains inadequately integrated into the educational curricula of health professionals. By equipping health professionals with comprehensive knowledge and practical skills to understand, assess, and mitigate the health risks associated with air pollution, we can empower them to take proactive measures that protect people’s health.”
Maria Neira, Director Department Environment, Climate Change and Health, WHO
Air pollution is a public health emergency
Each day, as we take a breath, an invisible storm of particles and molecules infiltrates our bodies, posing a threat not only to our lungs. Yet, have you ever truly pondered the significance of clean air as an important determinant of your health and wellbeing? Yet, it is a question that warrants your consideration, for you likely find yourself among the vast majority – 99% of people exposed to air pollution levels that exceed those recommended by WHO in their latest guidelines published in 2021.
Air pollution is a major environmental threat and one of the main cases of death among all risk factors, ranking just below hypertension, tobacco smoking and high glucose. WHO estimates that, globally, air pollution is responsible for about 7 million premature deaths per year from ischemic heart disease, stroke, chronic obstructive pulmonary disease and lung cancer, but also from acute respiratory infections such as pneumonia which mainly affects children in low- and middle-income countries. Being recognized as one of the main risk factors for Non-Communicable Diseases, a growing and consistent body of evidence shows that air pollution health effects also include preterm and low-birthweight, asthma as well as cognitive and neurological impairment basically having the potential to impact our whole body, way beyond our lungs.Air pollution is a threat also for public health economy as it imposes enormous global health costs representing 6.1% of the global gross domestic product (more than US$ 8 trillion in 2019).
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Breathing for tomorrow: training the next generation of health workers
Put yourself in the shoes of a family doctor, faced with a young girl who frequently suffers from asthma attacks. As you embark on the journey of gathering her medical history, you realize that there might be more to the story than meets the eye. Could air pollution be an underlying risk factor worth considering in your patient’s assessment? What additional questions would you pose? How would you advise her to reduce her risk?
At present, health workers are often not aware of the health impacts of air pollution. This risk factor is not sufficiently addressed in the curricula of health professionals, with only 12% of medical schools world- wide including it as part of for- mal education, a study from the International Association of Medical Students’ Associations reports. As research is showing that a strong incorporation of air pollution and health as part of clinical disease guidelines is missing, the results from a World Heart Federation members survey indicates that while air pollution is recognized as one of the major risk factors for cardiovascular diseases, less than 50% of the responders felt that they have access to any tools and resources they need to better educate themselves and others.
Yet, the international community recently recognized that the health workforce should play a more prominent role in the battle for clean air. The World Health Assembly resolutions WHA68.8,9 “Health and the environment: addressing the health impact of air pollution”, and A69/18,10 “Road map for an enhanced global response to the adverse health effects of air pollution” request WHO to strengthen the capacity of the health sector to address the adverse health effects of air pollution.
In a landmark collaboration with more than 30 international experts, the World Health Organization has developed the first WHO Air Pollution and Health Training toolkit targeting health workers (APHT) set to be unveiled at the end of 2023. The toolkit will be made of download- able and interactive resources to train health care workers, and beyond. In preparation for the toolkit launch, a freely accessible OpenWHO online training will be released on the occasion of the UN International Day for Clean Air and Blue Sky on 7 September 2023.
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Training the trainers: a pilot workshop in Ghana
“If health workers are aware, they can train their peers and advise people in their neighborhoods and communities on how to reduce their risk”, said Edward Owusu, District Control Officer at the Regional Health Directorate, Central Ghana. Edward is one of the almost fifty health professionals that gathered in Kumasi, Ghana, in June 2022 during a one-week pilot workshop of the APHT toolkit led by WHO in collaboration with Ghana Health Service. WHO also invited experts from the Global Family Doctors (WONCA) and University of Ghana.
Participants were exposed to a set of training modules and multiple interactive sessions, tackling introductory modules about air pollution and health as well as specific modules for clinicians and care-givers addressing cardiovascular and respiratory diseases as well as the health effects of air pollution on newborns, children and pregnant women. Using a train-the-trainer approach, the pilot workshop allowed health professionals to gain appropriate skills and knowledge to act as trainers with peer colleagues in the health sector and in the communities they serve. The development of a clinical approach to air pollution was enhanced using clinical case scenarios specifically designed to improve the clinical reason- ing of health professionals, taking environmental risk factors into proper consideration when assessing the health status of a patient, and providing guidance for exposure reduction. A field visit to hot spot air pollution sites was also organized. Piloting directly with the target audience ensure relevance and provide invaluable feedback for future adaptation and implementation on the ground.
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Clean air interventions as a win-win-opportunity
A reduction in air pollution emissions is a “win–win” opportunity to simultaneously protect human health and the environment and to address climate change mitigation, as the combustion of fossil fuels contributes to increasing the levels of some air pollutants.
In addition to interventions that can take place in sectors like household energy, transportation, power generation and industry, agriculture, and housing, building the capacity of the health sector on air pollution and health is essential to reduce the burden of disease. Health workers have a central role to play in this effort while engaging in multi-sectoral action and advocate for clean air interventions that aim at lowering emissions of pollutants – and promote the collaboration between all civil society relevant actors, political parties, and institutions for policy implementation. Their action is an unprecedented opportunity to protect and pro- mote both people’s health and wellbeing as well as the planet.
While health care workers cannot reduce the emissions of air pollution alone, the constant trust being given to them and being at the front line of prevention and care, is a strong basis for providing guidance to individuals, patients and communities. Primary prevention and addressing root causes of ill-health remains crucial and needs to be strengthened, as it is cost-effective but often under-funded and over- looked. The health argument needs to be central to policy making in various sectors for a healthy planet with healthy people. WHO leadership is now needed more than ever.
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