Stronger and concerted action is required across all areas of public policy to reduce air pollution and its impacts, England’s Chief Medical Officer has urged.

In his annual report Chris Whitty said that while outdoor air pollution in England has reduced significantly since the 1980s it still poses significant health threats including increasing heart disease, stroke, lung disease, cancer, child lung development, and asthma, and kills an estimated 26 000 to 38 000 people a year in England.

The report said that indoor air pollution is becoming an increasing proportion of the overall problem as outdoor air pollution improves, and called for more focus on tackling it.

According to the report people spend around 80% of their time indoors, whether for work, study or leisure. Many indoor spaces are public, and people do not have a choice about spending time in them. Despite this, indoor air pollution has been studied less than outdoors.

The report said: “Solid fuels are by far the most polluting method of domestic heating, and wood burning has increased in popularity over recent years. Reasons for burning wood and other solid fuels vary, and include aesthetic as well as practical, ecological or economic reasons. For air pollution emissions, there is substantial difference between the different open fire and stove designs, the age of the appliance and how well maintained it is, and the moisture content of the wood, for those who want to burn wood. In urban areas, burning wood has the potential to worsen local air quality significantly”

The report makes 15 recommendations across a range of sectors:

Outdoor air pollution

1. Outdoor air pollution is falling and will fall further, provided we continue and accelerate the things we know work. This requires action in many sectors, but the interventions are all realistic. We need to focus on areas where people live, study, work and have leisure.

Indoor air pollution

2. As outdoor air pollution falls, indoor air pollution becomes a greater proportion of the problem. Ventilation and reducing emissions are important. Several interventions are highlighted in the report. However, the path to improvement is not as clear as for outdoors, and further research will be needed.

Specific recommendations


  1. The electrification of light vehicles and public transport is important for reducing air pollution from vehicle tailpipes – momentum must be maintained, and accelerated wherever possible. Emissions from tyres and road wear will not be improved by electrification, and this is a key research and innovation need.
  2. A greater range of options for reducing air pollution emissions from heavy vehicles is needed. Some specialised vehicles such as refrigerated units need to be addressed, especially in urban areas.
  3. The electrification of railways can significantly reduce air pollution emissions from trains and improve air quality for travellers, staff and those living nearby. Where this is not possible, bi-mode or other low-pollution technologies should be used. Closed spaces are important, for example we should look to end diesel trains being left running in enclosed stations.

Urban planning

6. With national government, local authorities are central in the response to air pollution. Urban planning should support reducing air pollution concentrations locally – such as reducing air pollution near schools and healthcare settings. Shifting to active travel where possible has direct health wins as well as reducing air pollution from vehicles – planning should support this.


7. The substantial improvements from industrial processes over recent years are impressive. Wherever possible remaining industries that emit pollution should be sited away from densely populated areas. Where they cannot, such as construction, mitigations can significantly reduce the impact and they should be adhered to.


8. Ammonia emissions from agriculture contributes to secondary particulate matter air pollution, which can travel large distances and affect populated areas. Significant reductions in ammonia air pollution could be achieved by precision application of slurry to, or into soil, and covering slurry-stores. There would be capital costs, but these changes could be self-sustaining afterwards.


  1. The NHS is committing to halving its contribution to poor air quality within a decade while reducing health inequalities.
  2. The training of healthcare staff should include the health effects of air pollution and how to minimise these, including communication with patients.

Indoor air pollution

  1. People spend large periods of time indoors and many indoor places are public, where individuals have little control over the quality of air they breathe. These two factors should be recognised in the planning and development of public indoor spaces.
  2. Effective ventilation, while minimising energy use and heat loss, is a priority for reducing air pollution, respiratory infections and achieving net zero. This is a major engineering challenge which needs solving.
  3. While there is co-ordination across government, the ownership of indoor air quality policy within government needs to be clarified.

Wood stoves and other solid fuel heating

14. The use of wood stoves is increasing and can impact air quality significantly in urban areas. Air pollution emissions can be reduced, but not fully eliminated, by using modern, less polluting stoves and burning wood that is dry. In smoke control areas, the rules should be adhered to.


15. Research priorities are highlighted in the research section. Indoor air pollution in particular needs greater research interest. Policies should be evaluated once implemented.

Professor Chris Whitty, Chief Medical Officer, said:

“Everyone is affected by air pollution, and it is everyone’s problem.

Air pollution has improved and will continue improving provided we are active in tackling it. We can and should go further – and it is technically possible to do so.”