Tag Archives: social determinants of health

Tunnels, traffic and toxic air

Over the last few years I have become increasingly concerned about preventable death and disease from air pollution. As a Respiratory doctor, I worry for my patients living with asthma and COPD, but air pollution affects everyone of every age in London, and every organ of the body. Of course it doesn’t affect us all equally, as the poorest in the city contribute least but are affected most by the toxic air they are forced to breahe. Air pollution is a stark example of the social and health inequalities exacerbated by Climate change. Before the Mayoral elections, I and friends from MedAct made short films, showing the air pollution on our commutes from home to work.

I had hoped that Sadiq Khan, a mayoral candidate at the time, would be a strong advocate for Clean Air, and he has been, at least in words. But actions speak far louder, and disappointingly he has not cancelled the Silvertown Tunnel which will bring more toxic fumes to some of the most polluted communities in London. What follows is a copy of a letter I recently sent to Sadiq Khan. I am yet to receive a response.

Dear Sadiq Khan,

I am writing to ask you to cancel the Silvertown Tunnel. I am a South London resident and Respiratory Specialist doctor, working at Kings College Hospital. I see the effects of air pollution on a daily basis, not only exacerbations of asthma and COPD in my Respiratory patients, but an excess of heart attacks, strokes, diabetes, cancer and dementia. Air pollution has profound effects across the life course and is an entirely preventable cause of premature death. There is no place for the Silvertown Tunnel in a time of climate emergency when there is overwhelming evidence of the dangers of traffic related air pollution.

When I voted for you as Mayor of London, I believed I was voting for a Mayor who would prioritise the health of Londoners above other interests. I had seen you work to implement the ULEZ, introduce low emission buses, end the licencing of new diesel taxis and invest in cycling infrastructure. You have shown that major reductions in toxic pollutants can be achieved and that businesses and the public are willing to make the necessary changes to deliver this. But the Silvertown Tunnel risks undermining all this progress.

As you have said, air pollution is a social justice issue. “It’s the poorest people, least likely to own a car, least likely to cause the toxic air problems, who are most likely to suffer the consequences.” These words ring hollow when you know that the Silvertown Tunnel will increase air pollution for some of the city’s poorest people in Newham, and will disproportionately affect communities of colour. Children in Newham already have lungs that are 10% smaller than lungs of children in richer, less polluted areas. It is unjustifiable to allow this tunnel to go ahead, funneling traffic, including heavy freight vehicles, into Newham. It is in direct opposition to your stated aims, and undermines all of the work you have previously done on improving air quality.

As you know, because the proposed Silvertown Tunnel has HGV landers, and is bigger than the Blackwall tunnel, it will be used by larger HGVs and this new traffic will use existing already saturated approach roads, causing yet more congestion and air pollution near over 160,000 children on each side of the river and local schools within 500m of feeder and approach roads, many of which are already suffering illegal or damaging levels of dirty air. HGV logistics centres are planned near the tunnel mouths on both sides of the river.

The tunnel is opposed by the adjacent boroughs of Lewisham, Southwark, Newham, Hackney and some Greenwich councilors. It is also opposed by environmental health, transport and climate policy experts, air quality campaigners, active travel NGOs, climate activists, politicians from all parties across East and South East London, local residents, local headteachers, cycling campaigners and cycle logistics companies.

You, as Mayor of London, have the power to cancel the Silvertown tunnel. I urge you to reassess the economic, environmental and public health viability of the project in light of: the carbon emission reductions that London must make to meet the Paris Agreement compliant carbon budget; evidence on serious health impacts of air pollution including harmful particulates from ‘zero emission’ vehicles; the implications of COVID19 on the financial viability and future of transport for London.

At the recent summit you held, Rosamund Adoo-Kissi-Debrah said “It’s going to cost money but it will save lives, so this is all about saving lives. We need to be very bold, and we need to be very loud”. Rosamund knows better than any of us the devastating health consequences of air pollution. Please don’t let her, and all Londoners down, by allowing this tunnel to go ahead.

The Silvertown Tunnel scheme will lock East and South East London into high levels of heavy motor traffic, air pollution and carbon emissions for decades, and make already illegal air quality worse for many. Environmental justice demands that the health of those in Newham, a borough with a high BAME population, must not be sacrificed for the benefit of ‘growth’ for other Londoners. We have a fantastic opportunity to divert the estimated £2 billion cost to alternative projects which would help us meet World Health Organisation Air Quality Guidelines for particulate matter, nitrogen dioxide, ozone, and sulphur dioxide and make London a modern Clean Air city.

Don’t let your Mayoral legacy be more preventable deaths from air pollution.

I ask you to cancel the project immediately.
Best wishes,

You can learn more about the Silvertown Tunnel at the campaign website.

You can write to your MP or Mayor Sadiq Khan through writetothem.

Mutual aid

A view across Greenland Dock, London in teh early morning when is is dark, looking across at a misty view of Canary Wharf.

Joy is elusive this month. I leave home early and return after a long day in darkness. My sleep is broken and unrefreshing. My dreams are invaded by oxygen flow meters, masks, monitors, and breathless patients. I am tired, but that word is inadequate to describe the omnipresent fatigue that seeps into every cell of my body through the day, and which sleep fails to banish.


But there is hope. There is always hope. And right now it’s name is mutual aid.

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My health, my choice?

I spent this Christmas, as I’m sure many others did, over-indulging in rich foods and alcohol, and barely moving from the sofa. I made choices that were far from healthy, and take full responsibility for the resulting lethargy, bad skin and headache.

But on a larger scale, to what degree is an individual responsible for their health? It is all too easy to label the smoker with lung cancer, the alcoholic with liver failure or the obese patient with heart disease as culpable and look no further. And of course it is true that no-one held a gun to their head and made them smoke, drink, or eat to excess. But this view is dangerously narrow and simplistic. The actions of individuals and their health-related actions must be viewed within a broader social context. We act as individuals but we do not live in a vacuum.

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