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The burden of diseases attributable to air pollution is comparable to those of global health risks such as unhealthy diets and tobacco smoking, with many air pollution sources also emitting climate heating gases. In this UK study we estimated the co-benefits of Net Zero (NZ) climate policy on the health benefits of air pollution reduction, increased active travel, outdoor exposure inequalities and indoor air pollution changes. The study focused on two of the largest UK sources, road transport and building heating, with comparisons made between NZ and UK existing policy, referred to as Business as Usual (BAU). Particulate matter (PM 2.5 ), Nitrogen Dioxide (NO 2 ) and Ozone (O 3 ) projections were made between 2019 and 2050, with emphasis placed upon the NZ co-benefits in 2030 and 2040. We compared the UK BAU scenarios with the Climate Change Committee's (CCC) Balanced Net Zero Pathway (BNZP) and Widespread Innovation (WI) pathway. Compared to BAU predictions, BNZP assumptions lead to more electric vehicles, reduced vehicle km, more low carbon building heating, and reduced emissions of NO 2 and PM 2.5 . By 2040 under BNZP, relative to BAU, the buildings sector was predicted to be three times more effective at reducing PM 2.5 than road transport. To help reduce the inequality gap the NZ building transition was tailored toward those most in need. Outdoor air pollution exposure inequalities prevailed across the socioeconomic spectrum, especially for NO 2 , but were less pronounced due in part to NZ policies. Core air quality health benefits for the BNZP buildings sector were £21.3 billion (16.4 to 26.2) by 2050 and £98.4 billion (75.7 to 121.1) by 2154. For the transport sector the health benefits were £9.1 billion (7.0 to 11.2) by 2050 and £36.5 billion (28.1 to 44.9) by 2154. NZ building sector operating costs did not achieve break-even via efficiency savings, but with Greenhouse Gas (GHG) (lower benefits) break-even was achieved in 2052. With additional air pollution health benefits, building-sector time to break-even improved by between 3.1 (2.5 to 4.7) and 6.3 (4.7 to 7.6) years to between 2046 and 2049. Analysis found that removing gas cooking at home, for NZ, may result in greater concentration reductions than outdoor air pollution for NO 2 . Net Zero health and economic co-benefits are large, as are the changes needed, requiring political leadership and public engagement. Our findings are relevant to other countries facing the NZ transition., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The UK is committed to achieve net zero greenhouse gas emissions by 2050. The suite of policies needed to reach net zero will lead to improvements in air quality and, consequently, could lessen air pollution inequalities. We assessed air pollution inequalities across different sociodemographic groups in England and Wales and explored how these might be differentially impacted by future air pollution projections in 2030 and 2040 under net zero policies., Methods: We employed a geodemographic classification approach to categorise neighbourhoods into five distinct clusters based on 2021 UK Census sociodemographic variables. We modelled fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) concentrations for the year 2019, and predicted concentrations in 2030 and 2040. We compared a business-as-usual (BAU) scenario and two policy pathways to achieve net zero currently considered by the UK government. We aggregated air pollution concentrations to the neighbourhood level and assessed differential neighbourhood-level concentrations across the geodemographic groups using descriptive statistics and box plots., Results: The Urban Central Professionals group experienced 14 µg/m 3 higher average NO 2 concentrations compared with the Rural Elderly group in 2019. Despite substantial improvements to air quality in 2030 and 2040 of up to 6.3 µg/m 3 for NO 2 based on BAU, and further reductions of up to 2.4 µg/m 3 NO 2 under net zero policies, the overall pattern of inequality persists, but is predicted to be less pronounced., Conclusions: Our findings demonstrate the effectiveness of targeted policies and innovations in reducing both air quality and greenhouse gas emissions and in bridging the environmental inequality gap. Our findings are essential to develop targeted communication campaigns to secure acceptance and willingness across the sociodemographic spectrum to support the significant behavioural changes needed to achieve net zero, by highlighting the wider co-benefits to the environment and health of such policies., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Co-authors Heather Walton and Mike Holland declare membership of the Committee on the Medical Effects of Air Pollutants reporting to the UK Department for Health and Social Care. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper]., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The recent United Kingdom (UK) Environment Act consultation had the intention of setting two targets for PM 2.5 (particles with an aerodynamic diameter less than 2.5 μm), one related to meeting an annual average concentration and the second to reducing population exposure. As part of the consultation, predictions of PM 2.5 concentrations in 2030 were made by combining European Union (EU) and UK government's emissions forecasts, with the Climate Change Committee's (CCC) Net Zero vehicle forecasts, and in London with the addition of local policies based on the London Environment Strategy (LES). Predictions in 2018 showed 6.4% of the UK's area and 82.6% of London's area had PM 2.5 concentrations above the World Health Organization (WHO) interim target of 10 μg m -3 , but by 2030, over 99% of the UK's area was predicted to be below it. However, kerbside concentrations in London and other major cities were still at risk of exceeding 10 μg m -3 . With local action on PM 2.5 in London, population weighted concentrations showed full compliance with the WHO interim target of 10 μg m -3 in 2030. However, predicting future PM 2.5 concentrations and interpreting the results will always be difficult and uncertain for many reasons, such as imperfect models and the difficulty in estimating future emissions. To help understand the sensitivity of the model's PM 2.5 predictions in 2030, current uncertainty was quantified using PM 2.5 measurements and showed large areas in the UK that were still at risk of exceeding the WHO interim target despite the model predictions being below 10 μg m -3 . Our results do however point to the benefits that policy at EU, UK and city level can have on achieving the WHO interim target of 10 μg m -3 . These results were submitted to the UK Environment Act consultation. Nevertheless, the issues addressed here could be applicable to other European cities., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Background: Evidence for associations between ambient air pollution and preterm birth and stillbirth is inconsistent. Road traffic produces both air pollutants and noise, but few studies have examined these co-exposures together and none to date with all-cause or cause-specific stillbirths., Objectives: To analyse the relationship between long-term exposure to air pollution and noise at address level during pregnancy and risk of preterm birth and stillbirth., Methods: The study population comprised 581,774 live and still births in the Greater London area, 2006-2010. Outcomes were preterm birth (<37 completed weeks gestation), all-cause stillbirth and cause-specific stillbirth. Exposures during pregnancy to particulate matter with diameter <2.5 μm (PM 2.5 ) and <10 μm (PM 10 ), ozone (O 3 ), primary traffic air pollutants (nitrogen dioxide, nitrogen oxides, PM 2.5 from traffic exhaust and traffic non-exhaust), and road traffic noise were estimated based on maternal address at birth., Results: An interquartile range increase in O 3 exposure was associated with elevated risk of preterm birth (OR 1.15 95% CI: 1.11, 1.18, for both Trimester 1 and 2), all-cause stillbirth (Trimester 1 OR 1.17 95% CI: 1.07, 1.27; Trimester 2 OR 1.20 95% CI: 1.09, 1.32) and asphyxia-related stillbirth (Trimester 1 OR 1.22 95% CI: 1.01, 1.49). Odds ratios with the other air pollutant exposures examined were null or <1, except for primary traffic non-exhaust related PM 2.5 , which was associated with 3% increased odds of preterm birth (Trimester 1) and 7% increased odds stillbirth (Trimester 1 and 2) when adjusted for O 3 . Elevated risk of preterm birth was associated with increasing road traffic noise, but only after adjustment for certain air pollutant exposures., Discussion: Our findings suggest that exposure to higher levels of O 3 and primary traffic non-exhaust related PM 2.5 during pregnancy may increase risk of preterm birth and stillbirth; and a possible relationship between long-term traffic-related noise and risk of preterm birth. These findings extend and strengthen the evidence base for important public health impacts of ambient ozone, particulate matter and noise in early life., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Short telomeres are associated with chronic disease and early mortality. Recent studies in adults suggest an association between telomere length and exposure to particulate matter, and that ethnicity may modify the relationship. However associations in children are unknown., Objectives: We examined associations between air pollution and telomere length in an ethnically diverse group of children exposed to high levels of traffic derived pollutants, particularly diesel exhaust, and to environmental tobacco smoke., Methods: Oral DNA from 333 children (8-9years) participating in a study on air quality and respiratory health in 23 inner city London schools was analysed for relative telomere length using monochrome multiplex qPCR. Annual, weekly and daily exposures to nitrogen oxides and particulate matter were obtained from urban dispersion models (2008-10) and tobacco smoke by urinary cotinine. Ethnicity was assessed by self-report and continental ancestry by analysis of 28 random genomic markers. We used linear mixed effects models to examine associations with telomere length., Results: Telomere length increased with increasing annual exposure to NO x (model coefficient 0.003, [0.001, 0.005], p<0.001), NO 2 (0.009 [0.004, 0.015], p<0.001), PM 2.5 (0.041, [0.020, 0.063], p<0.001) and PM 10 (0.096, [0.044, 0.149], p<0.001). There was no association with environmental tobacco smoke. Telomere length was increased in children reporting black ethnicity (22% [95% CI 10%, 36%], p<0.001) CONCLUSIONS: Pollution exposure is associated with longer telomeres in children and genetic ancestry is an important determinant of telomere length. Further studies should investigate both short and long-term associations between pollutant exposure and telomeres in childhood and assess underlying mechanisms., (Copyright © 2016. Published by Elsevier Ltd.)

Road traffic gives rise to noise and air pollution exposures, both of which are associated with adverse health effects especially for cardiovascular disease, but mechanisms may differ. Understanding the variability in correlations between these pollutants is essential to understand better their separate and joint effects on human health. We explored associations between modelled noise and air pollutants using different spatial units and area characteristics in London in 2003-2010. We modelled annual average exposures to road traffic noise (LAeq,24h, Lden, LAeq,16h, Lnight) for ~190,000 postcode centroids in London using the UK Calculation of Road Traffic Noise (CRTN) method. We used a dispersion model (KCLurban) to model nitrogen dioxide, nitrogen oxide, ozone, total and the traffic-only component of particulate matter ≤2.5μm and ≤10μm. We analysed noise and air pollution correlations at the postcode level (~50 people), postcodes stratified by London Boroughs (~240,000 people), neighbourhoods (Lower layer Super Output Areas) (~1600 people), 1km grid squares, air pollution tertiles, 50m, 100m and 200m in distance from major roads and by deprivation tertiles. Across all London postcodes, we observed overall moderate correlations between modelled noise and air pollution that were stable over time (Spearman's rho range: |0.34-0.55|). Correlations, however, varied considerably depending on the spatial unit: largest ranges were seen in neighbourhoods and 1km grid squares (both Spearman's rho range: |0.01-0.87|) and was less for Boroughs (Spearman's rho range: |0.21-0.78|). There was little difference in correlations between exposure tertiles, distance from road or deprivation tertiles. Associations between noise and air pollution at the relevant geographical unit of analysis need to be carefully considered in any epidemiological analysis, in particular in complex urban areas. Low correlations near roads, however, suggest that independent effects of road noise and traffic-related air pollution can be reliably determined within London., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)