The Conservatives and Labour remain split over London’s Ultra Low Emission Zone (Ulez). But Sarah Woolnough, the chief executive of Asthma + Lung UK, says the government urgently needs to prioritise tackling air pollution, smoking rates and poor-quality homes, to reduce the prevalence of respiratory conditions.
In the UK, people in the poorest communities are seven times more likely to die of a lung condition than those in the richest areas, due to higher exposure to air pollution, damp, mould, and cigarette smoke.
Woolnough told Spotlight that the “social determinants of health inequalities” need to be addressed, and this could be achieved by introducing clean air zones, smoking cessation services and better housing standards. The charity is “very supportive” of London mayor Sadiq Khan’s expansion of the Ulez scheme. The programme has proved divisive with the capital’s residents, and likely influenced the recent Conservative win in the by-election in Uxbridge and South Ruislip, a constituency in north-west London.
“We know it’s controversial but clean air zones work,” said Woolnough. “[Air pollution] impacts people living with asthma and chronic obstructive pulmonary disease (COPD) and other lung conditions, but it also impacts cardiac health, dementia, and cancers. There is such a strong body of evidence that if you clean up the air, it’s better for health.”
The charity is also calling on the government to introduce more targeted measures for those with lung conditions, such as a review of the exemption list for prescription charges. The list was established in 1968 and means that individuals with certain long-term conditions do not have to pay for their prescriptions. This includes cancer, diabetes and epilepsy, but not respiratory diseases such as asthma or COPD. In the UK, only England still has a charge – it has been abolished in Wales, Northern Ireland and Scotland.
Asthma + Lung UK recently released a report showcasing the links between poverty and severity of respiratory diseases. It surveyed 14,000 people with lung conditions.
Looking at the poorest 20 per cent of respondents, nearly three quarters – 70 per cent – live with uncontrolled asthma and one in four are breathless every day. Nearly three quarters – 70 per cent – struggle to afford essentials such as rent or mortgage, heating, food and prescriptions, and 70 per cent said their lung condition has worsened in the past year. Nearly half – 46 per cent – of those who pay for prescriptions said they couldn’t afford them, compared to only 6 per cent of the highest income group.
Woolnough says that it is “totally unacceptable” that people are being forced to choose between “eating, heating and breathing”, and that prescription charges are exacerbating this problem.
“It’s long been an anomaly that people with lung conditions – and often they are chronic, long-term conditions – have to pay for their prescriptions,” she said. “They’re over the threshold, whereas other long-term conditions are exempt. We really would like the government to look at that again.”
The charity is also calling for additional financial support, such as help with energy bills as winter approaches, and reimbursements or grants towards machinery that help people breathe. Electricity refunds are currently provided for those using oxygen machines at home, but not for other machinery such as ventilators or continuous positive airway pressure (CPAP) machines, which are used by people with sleep apnea. Campaigners have previously called for an energy grant for disabled people, to cover the higher costs associated with running such equipment. So far, the government has only offered an one-off cost-of-living payment of £150 for recipients of disability benefits (Disability Living Allowance and Personal Independence Payment).
The government’s upcoming Major Conditions Strategy will look at ways to prevent, diagnose, treat, and manage the six main groups of health conditions in England, including: cancer, cardiovascular disease, chronic respiratory diseases, dementia, mental ill-health and musculoskeletal diseases. It will replace several former strategies and plans, including a ten-year mental health plan, a ten-year cancer plan, and a health disparities white paper, which was meant to address health inequalities and lay out a prevention strategy.
Woolnough says she is “very pleased” that chronic respiratory diseases are included within the Major Conditions Strategy, as they have “too often been neglected and deprioritised”, despite being the third biggest cause of death globally.
“I understand the rationale for why they’re doing it this way,” she said, on whether she would have preferred to see a separate strategy for lung diseases. “I think what is most important for us is that we see enough attention, focus and resource dedicated to tackling lung conditions, which must include significant attention around prevention, early diagnosis and helping people live well [with lung conditions].”
Asthma + Lung UK also wants simple prevention methods to be standardised, such as inhaler checks, annual reviews, and ensuring people are up to date with vaccinations and that they have access to same-day GP appointments so they can get on top of viruses quickly. Doing so would improve people’s quality of life and reduce hospital admissions.
“It’s not rocket science,” she says. “So many people… struggle to access primary care… therefore they end up in hospital, contributing to winter pressures when if only we placed more emphasis on keeping people well and out of hospital, it [would be] better for them and better for the system.”