The Big Interview: Dr Gary Fuller
Gary Fuller is one of the UK’s three Clean Air Champions and a member of Defra’s Air Quality Expert Group. He led the development of the London Air Quality Network to become the largest in Europe and has written his own book: ‘The Invisible Killer – the rising global threat of air pollution and how we can fight back’
What did you study at university, that led to what you do now?
Physics. I’m not sure I remember that much of it but when it comes to measuring air pollution it does come in handy because most of the instruments we use, use spectroscopy or other physical processes. But my pathway through to a role in an academic institution, isn’t really the pathway that most academics follow.
I spent some time in a research institute that was set up as part of the NHS and then moved into academia. Many of the colleagues I work with now were originally there and have also moved into academia. So, although I’ve got ‘Dr’ in front of my name, that’s actually relatively new. I only got my PhD when I was in my 40s, so I suppose I followed an unconventional route.
Also, most of the work that I’ve done over time has been what you would probably call applied research for different parts of government: Defra, the Environment Agency, the GLA and others, rather than working on the sort of big research grants that most academics do.
Gary addressing last year’s National Air Quality Conference at Lord’s Cricket Ground, London
What was the first significant work you undertook in the air quality field?
A lot our group at ERG [Imperial College’s Environmental Research Group], people like Sean Beevers and David Carslaw, all started together and some of our first significant work involved nitrogen dioxide and diesel engines.
Around 2001, we were doing work for London government and realised that there was something not quite right about the levels of nitrogen dioxide from traffic. Through the measurements that I made and through the modelling and other work David and Sean did, we were able to observe that there was more NO2 than there should be. We speculated that it might be for a variety of reasons, but we didn’t have an answer at the time.
It turned out that the diesel vehicles on our roads, were using all sorts of different clean-up technologies, some of which were leading to greater production of NO2, but we didn’t know that at the time. So our very early papers include all these curves and question marks that just said: ‘nitrogen dioxide, there’s too much of it.’
Around that time the UK wanted to hit what we now think of as limit values for NO2 by about 2005. We were concerned that that might not happen, but we were pretty confident that it would happen soon afterwards. And here we are, what, 20-odd years later? Still trying to achieve it in some parts of our cities.
At the last AQN conference you, said that you’ve been working less on your own science and more ‘representing and supporting other people’s science.’ How did that come about?
I suppose over time I’ve become increasingly aware that the situation we have with air pollution and its health burden in the UK is not due to a lack of evidence. It’s due to that evidence not being acted on by government and other stakeholders. So I started to work more and more in the translation of that evidence towards policy. And, about three or four years ago, I become connected with the Clean Air Champions programme, when one of the original champions, Martin Williams, sadly died, and I took his role within the programme.
The Clean Air Champions support a big research portfolio in the UK. There’s £42.5m worth of research projects funded by a variety of organisations – UKRI, the government, the Met Office, National Physical Laboratory and others They’ve all put money into the pot and there’s a large portfolio of projects. One of those projects – the Clean Air Champions – was set up to ensure that the rest of the research achieved its impact. So our role as champions is not to run the programme, but bring together the scientists, so that they work more closely together, talking to each other and interfacing with other air pollution research that’s not inside the programme. And then to take this air pollution community and to try to connect more widely with NGOs, the government and the public.
So I spend a lot of my time now talking about other people’s science rather than talking about my own. It’s quite a privilege but it’s also really interesting as well.
To an extent, the Clean Air Champions are the glue holding the community together?
Exactly. We’ve just organised a brilliant conference in Birmingham for the Clean Air programme. We had over 200 people, a lot of them researchers who are actually working hard on the science questions, but also people from government, people from industry as well that were all bought together. It really shows the mass of activity and the strength of this community.
But the challenge is, how do we keep this going? How do we keep this momentum up? Because research activities are funded for short periods. We need ways to go forward so that the air pollution research community in the UK doesn’t fragment after this current round of funding but actually joins together with other people who are doing applied work.
So we’re talking to people like the Institute for Air Quality Management and the IES to think about ways in which we can make a bigger air pollution community in the UK and keep that going in the longer term.
If you went back 20-odd years, people working in air pollution had loads of ways in which they could get together and work as a community. The 1956 Clean Air Act actually set up regular meetings for local authorities funded by Defra and there were a couple of those every year, up until about 10 or 15 years ago.
So I think it’s increasingly difficult for people that are facing challenges on the ground, let’s say in local authorities, to keep up with, not only the evidence, but the best practices that their colleagues are learning and discovering.
Have we got enough science now? We seem to be almost saturated with it, so is it time to see things actually happening as a result of it?
Completely. The weight of evidence in the air pollution and health area is really overwhelming. If you do a search on PubMed, you’ll find around 64,000 papers that have looked at air pollution and health, and thousands continue to be published each year. Not all of them point to the same things and not all of them give a cohesive story, but if you stand back and look at it, the evidence is overwhelming.
We know that air pollution is shortening people’s lives. What does that look like? Well, it’s about 4,000 early deaths per year in London. It’s about 40,000 in the UK and it’s about 400,000 – from particle pollution – across Europe. And globally, certainly from outdoor air pollution, you’re looking at about four million. And that’s really just the tip of the iceberg.
We are learning that air pollution is affecting us through the course of our life, even before conception, through the development of children in the womb and then – especially – their development through childhood, when they’re really exposed to polluted outdoor air, and through to adulthood and into the later stages of life.
For instance, we find children are growing smaller lungs. That was work we did in in London about 10 years ago. Because of the air pollution they’re exposed to, their lungs aren’t as big as you would expect them to be.
Some of the really interesting areas now that are coming out are not only around childhood development but in brain health. We’re seeing the effects on attentiveness and performance in tests while they’re young, all the way through to depression and psychosis in adults. And at the end of life, there have now been some pretty firm linkages between air pollution exposure and certain types of dementia.
The evidence stacks up more and, importantly, the costs stack up. Not just financially, but in terms of the way it impinges on people’s lives. But are we really taking that much more action on air pollution than we were 20 years ago? I don’t think so.
But there’s good evidence that clearing up air pollution really does work. There was a study, just over a year ago, on a completely outdated industrial unit in Pennsylvania. When it was eventually closed there was a 42% reduction in hospital admissions for heart attacks almost overnight. And those figures continued to improve over time.
And we talk about London’s ULEZ often and, if you look at the way it’s reported in the media, you’d think it was the only such scheme in the world, but there’s hundreds of them and the studies around them point to improvements in people’s cardiovascular health, or at least the number of people that are attending the hospital for strokes and for heart attacks. And some of the studies point to improvements in the numbers of people attending for respiratory problems as well. So there is lots of evidence that if we do sort this out, then people will be healthier and lead better lives.
There are around 40 projects supported by the strategic priorities fund that are looking at different aspects of indoor and outdoor air pollution. Are there any of those that you think ‘I’m looking forward to seeing how that develops’?
There’s a few. They’ve been funded at different stages, so we have much more out of the ones that have been running longest. As a measurement scientist, I suppose I have biases in that direction but it’s funding three super sites in London, Birmingham and Manchester. You just have to sit alongside the scientists in these field laboratories and see the data pouring in, to be able to see the insight that they’re providing. They’re able to detect, for instance, the wood burning that’s going on in our urban areas every winter. They’re now finding things like arsenic in urban air in winter from the burning of scrap wood. And they’re starting to learn a lot more about ammonia in urban areas as well.
In terms of the work the Met Office is doing, there are some really good tools around air pollution emissions that are much more agile and better for modelling than the conventional ones that are used. And on the industry side, there’s a really nice project called Auto Align that looks at the very difficult area of tyre wear.
The newer research looking at indoor air is also really exciting. We’re looking at homes in Bradford and in London, and researchers in Cardiff are focusing on air pollution early on in life, to do with childhood development. And up in Manchester, we’re looking more at different sources that might affect brain health later on in life. All of those ones are ones to really watch out for.
Do you think air pollution is high up on their agenda of the British public at all?
No, I don’t think so, I think it’s quite low. Partly because its invisible. I often think that if people died from air pollution covered in green spots and were lying in the streets, then we would take a lot more action, but they don’t. People may die early with respiratory problems or heart attacks, so it adds to the health burden that is already there and is therefore quite invisible.
I also think the way in which we tackle it doesn’t particularly help. We only frame and focus on one part of the problem at a time. If you went back to the 1950s it was home fires, in the 1970s it was power stations, industry and acid rain, and we’ve moved forward into traffic pollution, particularly that from diesel. We need to look at it much more holistically.
Conversely, while I’m saying there’s low awareness of the problem, I’ve gone out and talked to community groups through our WellHome project and there are so many people that really care about the quality of their local environment, but they don’t focus it entirely around air pollution. They might think about the impacts of traffic in terms of road accidents, noise and air pollution. They might think about the quality of their streets, not just the amount of traffic and the road space and the intrusion that it has, but the lack of green space.
So on one hand, you could say people aren’t aware of air pollution in its own right that much, but people are aware of the quality of their environment and the way it impacts on their daily lives. And they see air pollution as part of that.
I’m guessing these people are mostly parents?
In the winter, two groups of people make up the majority of my inbox and the common thing is that they’re all carers. There are people that are looking after their children and they either have asthma or they want just them to grow up as healthy as possible, but I also get written to by quite a few people who are looking after the elderly, be it in their own homes or supporting their elderly parents, and they see the state of their lung health and get concerned about that. That one comes a lot from when neighbours are burning solid fuel, they worry that their elderly person’s bedroom is full of smells and their COPD or their asthma is being aggravated.
Did COVID change anything, in terms of people’s awareness of air quality?
I don’t know whether it had any effects at all. There were quite a few people that felt that somehow we could come back better, but I’m not convinced that things have really changed since that time. There were a lot more people cycling and there was a lot less traffic and we all really appreciated those things, but I think people have reverted to the lives they had before COVID rather than using it to think differently about how life could be.
In terms of domestic wood burning, do you think it should be tackled through enforcement, in a similar way that polluting cars have been tackled?
I don’t think air pollution from traffic has really been tackled through enforcement at all. It’s been tackled mainly through technology. The diesel or petrol vehicle that you will buy today, in terms of its exhaust cleanup system, is beyond anything engineers could have created 20 years ago. And it’s those technological advances that have really brought about the greatest change. And of course, this has been accelerated by things like London’s ultra-low emission zone. They’ve accelerated that change and brought about cleaner air far faster.
In terms of solid fuel burning, I don’t know. I suppose I struggle a bit with the whole idea that low pollution behaviour should be only brought about by enforcement. It needs to be brought about in ways that people are encouraged, informed or even empowered to be able to have a less polluting lifestyle.
For instance, in the traffic area, goodness knows how many talks I’ve done to community groups over the years where the best solutions are to think about leaving the car at home, taking active travel, walking, cycling, public transport or something like that. That’s fine for me to say as a scientist but for many people, the reality is that they don’t have those choices. And we need to think a lot more about who’s being polluted, who’s being impacted, and about the agency that people have to affect change.
So I don’t think we should always be looking at this through an enforcement lens. We should be looking at it in ways in which we change everybody’s attitudes or change what is considered to be acceptable.
Drunk driving is the paradigm that’s often put forward, or indoor smoking bans. Not many people are fined for indoor smoking but yet the levels of compliance are really high, because people understand the need for it. So I think we need to get away from thinking about it in terms of enforcement and we need to think about normalising less polluting behaviour.
You mentioned the fact that air pollution is invisible, would putting it on more death certificates raise the profile of the problem?
There’s so many underlying causes that don’t appear on death certificates. My Clean Air Champion colleague Stephen Holgate does a lot of work on allergies and it’s likely that many deaths caused through allergy are just written down as being caused by, say asthma or something like that. So you’ve then got to ask yourself is that really the best intervention possible, that it becomes recognised on death certificates?
Probably the most powerful thing from Ella’s death was the Coroner’s Prevention of Future Deaths report. One of the things that asked for was for clinicians to be much more active in this, so they can recognise the people that are being affected from air pollution and think about the interventions that could then come forward. We don’t want to wait until someone dies from air pollution. It needs to be further forward in that process.
We’ve discussed the UK, how worried are you about the rest of the planet in terms of air quality? We don’t have it too bad here, but there are some areas of the planet where it’s just atrocious.
It really is. It’s a global problem that we need to be paying much more attention to. The dubious title of the world’s most polluted city seems to move round over time. If you went back to the 1950s you would say it was London due to coal burning. There were times when we focused on city places like Mexico City and Los Angeles because of ozone and photochemistry and then we moved on to Beijing. And now the focus, quite rightly, should be in India because the burden from air pollution there is just enormous. And the priority given to it is really not enough.
It’s almost as though countries are thought to be on a development pathway, whereby you introduce more and more pollution sources until, at some point later, you decide to clean them up. But by that time a whole generation has been consigned to ill health.
I think China shows what can be done. China’s made great steps in cleaning up its air pollution. I was involved in a really nice project with Jim McQuaid at the University of Leeds, where they’ve created air pollution stripes, a bit like Ed Hawkins’ climate stripes, for all of the major cities of the world. If you explore that website, you can see the different trajectories that the various parts of the world are on and the awful deterioration that’s happening.
There’s data – from the UK mostly, but also some European cities – that give an insight into the air pollution that people experienced in the late Victorian times and into the early 20th century, and that was terrible. But it was ‘only’ being experienced by several tens of millions of people. Now we have equal concentrations in places like India and the countries around it, which is being experienced by hundreds of millions, if not billions of people.
So in terms of looking at it as a humanity-wide problem I think air pollution and its impacts is probably now worse than it’s ever been.
A younger Gary Fuller in a previous role, measuring air pollution at the Marylebone Road supersite
Are thresholds and limit values the best way to approach the problem?
Well, the WHO provides guidelines that give us some sort of international comparator and benchmarks as well, but they’re not saying that everybody has to get PM 2.5 down to five micrograms straight away. Part of the way that the guidelines are structured is with interim targets that help you track your progress along the way. And they’re really important for those countries to focus upon.
In terms of limit values, I ask the question, ‘is it time to get away from them?’ The scientific evidence for limit values, in that there is some sort of a safe threshold, is no longer sustainable. It was very much the thinking of the late 1990s and it’s not supported by evidence now. We find in studies that there are health impacts from air pollution for as low as you go.
The WHO is giving us guidelines, the limit values is how they’re incorporated into law and within the UK there are many instances where they’re counterproductive. For instance, planning-wise, if you want to build something that creates a lot of pollution, it’s hard to do it in an air quality management area, but it’s much more easy to do in a place that’s clean. So we’re not keeping our clean areas clean. It also means that local authorities and others just focus on big junctions or major roads rather than focusing on the rest of the population where the total gain might be better.
But I think one of the worst impacts of limit values has been here in the UK, in the setting of the targets that are in the Environment Act. The target for 2040 was set according to the progress that could be made in the most polluted places, which constrains our ambition in lesser polluted places. Should we always be focusing in the most polluted locations? Or should we be focusing in the locations where vulnerable people are, where children are, where elderly people are?
I think the focus on limit values means that we sometimes put our efforts into the wrong places. UKHSA have been trying to work on a pilot indicator of air pollution vulnerability. And if you look at this on a map, it doesn’t always focus on the air quality management areas, It focus on different places where there’s a combination of vulnerable people and let’s say moderately high air pollution. So maybe that’s a better way of doing it.
Do you have a position on LTNS?
LTNS are a really difficult thing to address because it’s so hard to be able to see through the entrenched and noisy views that people have about them.
If we look at some of the evidence base – and most systematic studies come from London – what they find is that people that live in low traffic neighbourhoods tend to take more active travel and people that live around low traffic neighbourhoods also tend to do so.
In terms of the health benefits – from less air pollution, – but principally from the greater amounts of active travel, they’re just huge. The rate of return for investment in low traffic neighbourhoods in terms of the bricks and mortars, the bollards and the greening of spaces, is just huge in terms of public health later. But they need to be well designed.
There’s an argument that traffic is diverted from rich areas to poorer areas but a lot of the evidence on where the LTNS are says that they’re not exclusively in wealthy areas. And there’s been a lot of traffic counts all pulled together in one study and what they find is that yes, within the LTN areas, there is less traffic, but the notion that the area around them worsens is not borne out by any evidence at all.
Some places around LTNS have a worsening, some places have improvements, so much of this comes from people’s personal experience, their lived experience.
Most of the LTNS were put in during COVID and I was out of action at the time, having been hit by car while cycling, so I wasn’t able to visit these them as they were installed, to see this for myself. The one I did see was the one where my parents – who were then in their mid-80s – lived, and it meant that they could cross their road a bit easier. They also found it easier to cross the boundary road as well, simply because there were fewer junctions and it simplified the traffic flow. So it certainly seemed to work in their area, not only inside but on the edge of the zone as well.
If you could do one thing to improve our air quality, what would that be?
I’ll go for two: Stop focusing on individual pollutants and look at all of the sources of air pollution and look for ways to deal with them. The other one probably would be to start to move away from limit values, take a Vision Zero approach. Vision Zero started when someone in Sweden said ‘why should we carry on building road junctions where we know there will be a fatality rate of 10 a decade? Let’s go for zero.’
Can we bring the same learning into air pollution? Can we look at every development, every road change? Can we look at redesigning our urban areas to try to get air pollution impacts down to zero, rather than focusing our efforts mainly in the most polluted places?
I do think a lot of the solutions lie in urban design, not just in public transport. It’s no use me saying, ‘you should cycle and walk a lot more’ if you know your area just isn’t safe to do so, or you don’t have a route by which you can walk to school.
Wouldn’t that be difficult to implement?
No, I don’t think so. The whole concept behind the 15-minute city is that all the things you need to do in your daily life, be it go to school, go to the shops, go to the doctors, the library, the pub, all of those things, are within a 15 minute journey by walking, cycling or possibly by public transport. And if you look at most of the areas where we live, they were actually designed like this.
I live in an area (outside London) that was mostly built around 1900. It was built with shops on street corners. We have buses, for instance. There are parks nearby. For many of the things you actually have to do, you don’t have to travel that far. So strengthening that is what’s required, rather than just ripping up our cities and starting again. Most of them were built this way in the first place.
To end on an enigmatic point, at a recent AQN conference, you quoted Professor Alastair Lewis, saying: ‘As air pollution is getting better, the problem seems to be getting worse.’ Can you expand on that?
This points to the fact that yes, air pollution is a lot better in the UK than it was in the 1950s, for instance. But at the same time, we are learning more and more about the impacts of air pollution on health. As I said at the start, in just the last in five or six years we’ve learnt new things about air pollution and brain health, both in terms of children’s development and their learning at school, all the way through psychosis and depression, adulthood and dementia. And they’re things that we didn’t know about. So, although air pollution gets better, we are learning that its impacts are even greater than we thought.
