The UK's Clean Air Hospital Framework: The Role of Hospitals as Anchor Institutions in Achieving Improved Air Quality Within the Communities They Serv

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Air pollution has been associated with an increase in the number of health cases such as asthma, stroke, cardiovascular diseases, lung cancer, and others, in hospitals (Kampa and Castanas 2008, Great Ormond Street Hospital and Plan 2021). The UK government acknowledges poor air quality as the largest environmental risk to public health and gave a lower limit financial estimate of £8 billion as the cost of its impact on the UK economy in 2010 (Brunekreef and Holgate 2002, House of Commons Environmental Audit Committee 2010). The healthcare system, which is responsible for catering to the health care needs within society, is itself responsible for about 4-5% of global Greenhouse Gas emissions and associated ambient air pollutants (Watts, Amann et al. 2019). The situation is made worse with over 2000 health centres and 200 hospitals are in areas with average fine particulate matter (PM2.5) levels above World Health Organisation recommended annual average of 10ug/m3(British Lung Foundation 2018). Consequently, the NHS has seen a need to look inwards to reduce air pollution and carbon emissions, and in 2019 Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) declared a Climate Emergency becoming the first healthcare institution in the world to make such commitment. This declaration commits the NuTH to actively reducing their carbon footprint and improving on air quality towards a sustainable healthcare system.As part of NuTH Climate Emergency Strategy and in compliance with UK government regulatory requirements (e.g Health and Care Act 2010), the NuTH is implementing the Clean Air Hospital Framework (CAHF) to effectively address its indoor and ambient air pollution. This project, therefore, seeks to monitor implementation and evaluate the effectiveness of CAHF as a tool towards achievement of clean air within two member hospitals of the NuTH, the Royal Victoria Hospital and the Freeman.This project will seek to answer the following questions.1.What are the strengths and weaknesses of the CAHF as an effective and sustainable model for air pollution and carbon reduction within the NHS and other high human resource organizations using the participating hospitals as case studies?2.What is the impact of CAHF implementation on air quality at the NuTH hospital sites and in the wider locality?3.What are the health improvement opportunities for hospital staff, patients, visitors, and the wider community that is provided by the CAHF implementation?The overall aim of this project is to study, for the first time, how an integrated net-zero carbon, and clean air strategy, based on the CAHF, can improve ambient and indoor air quality at major urban hospital sites, whilst at the same time contributing to achievement of the hospitals' net-zero carbon targets. Further, it will investigate the role of hospitals as anchor institutions in improving air quality within the communities that they serve, and the health benefits this will bring. This project will draw on computational analysis of data from activities that are informed by the seven focus areas of the CAHF guideline: Travel, Procurement & Supply, Design & Construction, Energy Generation, Local Air Quality, Communication & Training, and Outreach & Leadership. Methodologies based on air quality modelling and monitoring will be developed to evaluate the impact of CAHF implementation on air quality in the local and wider areas. Overall, the work will allow the estimation of health improvements (in terms of Daily Adjusted Life Years) to staff, patients, and the wider community. The project will also consider opportunities and challenges of integrating the CAHF strategies into the wider NHS and Newcastle city strategies for improving air quality.This study is aligned with the EPSRC's transforming health and healthcare strategic priority through its contribution to the development of a sustainable healthcare future,a clean air environment,and achievement of the UK's net-zero target