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Barriers to talking about air pollution

In our RCPCH &Us roadshows we spoke to hundreds of CYP across the UK. They told us that whilst some had learnt about air pollution in school, fewer than 50% had been told about it by a healthcare professional.

found that UK health professionals are not taking action (which includes simply talking to patients) because they ‘underestimate the presence and urgency of air pollution’. This is due to:

• an incomplete understanding of the health impacts 
• a feeling of insufficient evidence 
• a rosy view of the air quality situation in the UK - it is subtle and hidden
• air pollution being perceived as an environmental problem.

Air pollution workshop attendees at the RCPCH Conference 2024 also cited lack of knowledge as a key barrier to action on air pollution. In addition, they mentioned lack of time and resources.

We hope that through the information created and curated in this Air Pollution Companion we can give child health professionals the confidence they need to take action on air pollution. If you have ideas for further resources which would help you, contact us at cleanair@rcpch.ac.uk.

The ethical dilemma: is it right to talk to patients about air pollution?

Paediatricians may feel uncomfortable initiating conversations with patients and their families about air pollution due to its complex nature, the perceived limits of their expertise and the lack of straightforward solutions. But the complexity of the topic doesn’t mean it shouldn’t be addressed. 

UNICEF defines air pollution as a child rights issue:

In 2022 the UN Human Rights Council officially recognized the right to access a clean, healthy and sustainable environment. Articles 24 and 29 of the Convention on the Rights of the Child include specific protections related to the environment. Article 24 states that every child has the right to the best possible health, including the right to safe drinking water and protection from environmental pollution.

summarises the position of paediatricians who want to do no harm, but who must also abide by the UN Convention on the Rights of the Child. They conclude that:

As there is now strong evidence of harm from even low levels of air pollution, failure to disclose this knowledge to families is paternalistic and arguably makes paediatricians complicit in an ongoing mass breach of children's rights.

In the UK, the into the death of Ella Adoo Kissi-Debrah concluded that ‘The adverse effects of air pollution on health are not being sufficiently communicated to patients and their carers by medical and nursing professionals.’  

Ella’s mother, Rosamund Adoo Kissi-Debrah, has shared that had she been made aware of the dangers of air pollution, she would have taken measures to protect her child. This is echoed by Jemima Hartshorn, founder of who was aghast that after multiple hospital visits for her child’s respiratory problems, no-one mentioned air pollution as a possible contributory factor. 

Paediatricians are known for their strong communication skills and collaborative approach to patient management. Providing children, young people and their families with up-to-date information about air pollution aligns with this and can be viewed as an ethical responsibility, allowing them to make informed decisions.

Preparing to talk about air pollution

1. Build your knowledge

Use our Build Your Knowledge section to learn more about air pollution and its health impacts. Remember: 

• You probably already know quite a lot 
• The research has already been done and summarised 
• You don’t need to know everything; awareness of the range of evidence is helpful 
• Everyone learns in different ways: choose from global and UK reports, academic studies, videos or podcasts  

2. Have confidence in your skills

There can be a reticence amongst doctors to broach a topic unless we are an ‘expert’. But actually, there are lots of areas of medicine where we communicate a topic without in-depth knowledge, for example, the exact genetic code for a condition.

You have many transferable skills in communication and education – don’t be afraid to apply them. 

3. Air pollution is 'business as usual'

Along with smoking, alcohol, housing, finance etc, air pollution is a core determinant of health. It should be included in all history taking.

It may take practice to become comfortable talking about air pollution – but you have to start somewhere.

For junior child health professionals, seeing these conversations role modelled by more senior colleagues will make a real difference.

4. Make every contact count

The obvious time to talk about air pollution is when a child presents with a respiratory condition (such as asthma exacerbated by bad traffic pollution), but air pollution could be talked about in a variety of settings.

Examples:

• antenatal appointment advice about air pollution exposure
• outpatient diabetes clinic about links between air pollution and other health conditions
• physio appointment with advice about exercising on high air pollution days

5. Amplify your message with resources

Patients are unlikely to remember everything you’ve said, but if they’ve seen the same information on a poster in the waiting room and in a clinic letter afterwards, it is more likely to sink in.

Having useful trustworthy sources will also give you confidence to talk about the topic and can make it more collaborative (see section below).

UK resources: Global Action Plan and Clean Air Fund toolkits

is 'an environmental charity working towards a green and thriving planet, where everyone can enjoy happy and healthy lives within Earth’s limits'. Their evidence hub for healthcare professionals, , contains lots of useful training and resources, in particular their checklists which can be worked through with CYP and families. Look at the  or download from the bottom of this page.

is a 'global philanthropic organisation working with governments, funders, businesses and campaigners to create a future where everyone breathes clean air.'  They have produced a toolkit - it is not specific to conversations with patients, but the messaging is still helpful.

Global resources: WHO and UNICEF

WHO has lots of up-to-date information and guidance about air pollution and climate change. Their toolkit is highly recommended. This easy-to-read guide talks through the principles of good communication and is directly applicable to air pollution.

UNICEF Children’s Environmental Health Collaborative is a font of useful information. Particularly relating to communication, their includes a module on taking a Paediatric Environmental History

If you know of any other resources you think should be mentioned here, contact us at cleanair@rcpch.ac.uk.

Poster: Exploring air pollution with CYP and families in clinic

This poster is in the RCPCH Milestones magazine for members (winter 2024 edition). You can also download it at the bottom of this page.

Coming soon: Videos of simulated air pollution conversations

To be released on RCPCH Learning in early 2025.  

Want to learn more about talking to patients? Explore how to engage children, young people and families.