Enhancing local air quality management in Wales to maximise public health awareness, integration, collaboration and impact

Brunt, Huw A

Abstract

Air pollution is a significant public health concern. The UK Local Air Quality Management (LAQM) regime mandates collaborative action to reduce air pollution to protect health. Despite having this aim, LAQM is disconnected from broader public health policy and practice. Several LAQM ‘structure’ and ‘process’ limitations have likely contributed to this unsatisfactory situation and LAQM’s failure to deliver effective ‘outcomes’. Two main shortfalls are to blame: prescribed risk assessment and management processes that are too narrow in public health scope, and a poor recognition of the value contribution that public health bodies and specialists could and should make to support LAQM.

With Wales selected as the research study area, this research explored LAQM shortfalls through complementary research strands, framed by a mixed-methods approach and a convergent parallel study design. The first of these research strands – an ecological study – linked air pollution, deprivation and health data to assess associations and determine the merits of broadening the public health scope of LAQM. The second – a Delphi study – formed expert consensus on the role of public health in LAQM, and defined the value added by, and opportunities, barriers and solutions to, increasing public health awareness, integration and collaboration in LAQM. Research outcomes were subsequently mixed, validated and evolved to develop a suite of drivers (and linked recommended enabling actions) to support new public health-driven ways of working in LAQM in Wales.

The ecological study found that interactions between air pollution and socio-economic stressors modified and compounded associations with important health outcomes. Thus, there is merit in considering air pollution problems and solutions in the context of broader public health priorities. Further, aligning risk reduction actions with principles of proportionate universalism could achieve greater health gain.

Through the Delphi study, experts agreed that public health bodies and specialists could and should do more to support LAQM, and proposed enhanced ways of working around assessing risks, integrating LAQM action with the ‘day job’ (and vice versa), appraising and interpreting evidence, and undertaking research and evaluation. These, together with a better application of core public health skills such as authoritative communications, policy development advocacy, and change leadership, could add value to LAQM.

Integrating, validating and evolving this evidence – the latter achieved through a workshop and case study interviews with experts – informed proposals for new public health-driven ways of working in LAQM in Wales. These are underpinned by the primary drivers of risk assessment and management approaches of broader public health scope, stronger public health support, and full integration of LAQM with wider public health policy and practice.

In conclusion, this research makes a compelling case for LAQM enhancement through better public health awareness, integration and collaboration. While evidence-based drivers for change can help guide LAQM evolution, stakeholders must still commit to enable and achieve them. The positive impacts resulting from fully connected LAQM and public health policy and practice have the potential to ripple way beyond the LAQM arena to help tackle wider linked public health and wellbeing priorities.

• Thesis Type: Thesis
• Publicly Available Date: Jun 7, 2019
• Keywords: local air quality management, public health, integration, collaboration, delphi
• Public URL: https://uwe-repository.worktribe.com/output/860302
• Award Date: Sep 24, 2018