Born in Bradford: using evidence to influence policy, improve health and reduce inequality

Professor Rosie McEachan, Director of the Born in Bradford Research Programme and applied health researcher describes their ‘city Collaboratory’ approach to reducing pollution and improving the city’s health.

Nestled in the Yorkshire dales in the North of England is the City of Bradford. With over half a million residents, it is one of the largest districts in England. It is a young city, with more than one than one quarter of its population aged under 20.  A third are from ethnic minority groups. It is a vibrant city in which to live and work. But like many other cities it does have challenges, including areas of very high deprivation. A third of the population live in the most deprived decile compared with England and Wales averages and in tandem with high levels of deprivation are high levels of ill-health. In Bradford people living in the poorest areas will die ten years earlier than those in the wealthiest areas.  This isn’t fair.

Based within Bradford Teaching Hospitals NHS Foundation Trust, The Born in Bradford (BiB) project was set up by clinicians, researchers and education practitioners in the city in 2006 to explore the reasons behind ill-health in the city, and most importantly, what we could do about it. To do this we set up a birth cohort. Birth cohort studies are one of the most powerful epidemiological research methods that can explore the factors which influence our health and development over time. As the name suggests, parents (and their babies) are recruited to these studies during pregnancy, and the health and wellbeing of families tracked as they grow up. Families complete regular measurements of health, their life circumstances, behaviours and attitudes, and scientists can measure the quality of the environments in which they live. The richness of the data collected in this way can help to disentangle exactly which are the crucial aspects of our lives which impact on our health. Importantly, they can also help us to identify the factors which cause health related inequalities.

Between 2007-2011 BiB recruited over 12,500 families with over 13,700 babies to the study and have been following these families ever since. Our oldest BiB children are now reaching their 16^th Birthday.  And the BiB project has grown too: over 50,000 Bradfordians are actively involved in our research, and we host the Connected Bradford database which links up routine health, care and education data for the entire population. BiB works closely with communities and stakeholders to co-produce research priorities and provide a model for the translation of research into practice. This, combined with our research infrastructure makes Bradford a very good place to come if you want to understand the impact of policies to improve health.

Born in Bradford City Collaboratory

We have spearheaded the concept of a City Collaboratory.¹ This is an environment where the public, scientists, the local authority, policy leaders and practitioners work with each other. The City Collaboratory co-production model consists of a multistep interactive cycle that places local communities at the heart of decision making (Figure 1). There is active participation in both shaping and using the research, and this also connects academic expertise with policymakers.¹

Figure 1. The Born in Bradford City Collaboratory approach

The Collaboratory in action: Reducing pollution and the Bradford Clean Air Plan

Over the past 10 years we have been working closely with our partners in the city using our Collaboratory approach to drive down levels of pollution.

Bradford has illegal levels of pollution, centred around the inner city, deprived areas. Rates of respiratory disease are high. The most recent figures in Bradford suggest that 500 people die from respiratory disease each year; here are over 13,000 diagnosed cases of COPD and more than 41,000 people diagnosed with asthma.² It is estimated that a third of asthma cases in the city are as a result of air pollution.³

BiB Evidence

BiB research has been crucial in highlighting the importance of pollution on health in the city. Our early research found links between pollution and low birth weight of babies in Bradford.⁴ As children grow up we found exposure to air pollution during early life to be related to higher blood pressure,⁵ and poorer brain development ⁶ at ages 4-5 and indoor air quality to be related to childhood obesity at ages 6-11.⁷ At a molecular level BiB found exposure to pollution relates to shorter telomere length (an indicator of biological aging).⁸ We recently looked at healthcare attendances for respiratory health across the city and estimate that 1 in 2 visits to accident and emergency as a result of breathing difficulties could be due to high pollution levels. ⁹

We have demonstrated the stark inequalities experienced by families living in deprived areas which are not only blighted by pollution, but by other environmental hazards such as noise and lack of green space, exacerbating health inequalities.¹⁰

The Bradford Clean Air Zone

In 2018 Bradford was one of 28 local authorities to receive a ministerial direction to explore ways of improving air quality as quickly as possible, including implementation of a charging clean air zone. The Bradford Clean Air Programme board was formed comprising representatives from health, planning, transport, and researchers. With a clear focus on health and the reduction of inequalities, the board worked with communities and stakeholders to develop the Bradford Clean Air Plan. Plans were developed based on science and evidence recognising that everything is connected in a whole city approach to tackle the clustering of environmental risk factors.

BiB research from seldom heard communities informed the development of the plans. Communities reported that they were worried about the health impacts of pollution but also worried about the impact that charging the taxi-trade would have on families already on low incomes.¹¹ As a result of this, appropriate mitigation strategies were planned including over £30 million funding to support taxis, buses, lorries and vans to upgrade their vehicles to compliant standards.

In September 2022 Bradford switched on a ‘class C’ clean air zone (CAZ) which charge non-compliant buses, coaches, heavy goods vehicles, vans, minibuses and taxis a daily fee to enter the zone. Private vehicles are not charged.  The CAZ includes exemptions and support packages for locally registered vehicles and those that are regularly in the zone. These include financial support for upgrade or retrofit, and the provision of infrastructure for low emission technologies. The proposed CAZ is the third largest in the country and encompasses an area of 22.4km². Around 20% of the Bradford population live within the zone.¹²

These types of policies are increasing momentum. There are currently seven charging Clean Air Zones in England, an expanded ultra-low emission zone in London, and plans for a range of Low Emission Zones in Scotland. But these policies can be divisive and unpopular, and, as many of the policies are new, UK based evidence on their effectiveness is still in its infancy. Robust research is needed to evaluate the health and economic impacts of these policies.

In Bradford we will use our City Collaboratory to evaluate the impact of the Bradford CAZ on health in the city as well as unintended consequences.¹² The impact on lung, heart health and birth weight will be measured by comparing the health of over 500,000 Bradford residents in the three years before and three years after the Clean Air Zone is in place. The research will examine whether the impact is different for people from more deprived areas or different ethnic groups. We will look at whether the policy changes the way people choose to travel using surveys, and we will also conduct group discussions and interviews with key groups of people including businesses, transport companies, families, and pedestrians. These discussions will explore what may have helped or hindered the success of the policy and any unexpected effects. We will explore if the Clean Air Zone is good value for money, for example, do any improvements in health justify the costs.

Our findings, which will complement those of colleagues evaluating the London Ultra Low Emission Zone¹³,  will allow us to judge the impact of these policies both in terms of health, but also how they interact with the social, economic and political contexts in which they operate.

There is a moral imperative to reduce levels of pollution to improve the health of city dwellers. There is also an imperative for researchers to work together with policy makers to build in rigorous and transparent evaluations of policies aimed at reducing pollution. We need to be open to learning what works and what doesn’t work, and to encourage ambition and innovation. By working together, we can create a whole that is greater than the sum of its parts.

1. Wright, J. et al. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing. Wellcome Open Res. 4, 156 (2019).
2. City of Bradford Metropolitan District Council; Joint Strategic Needs Assessment: The Population of Bradford District. https://jsna.bradford.gov.uk/documents/The population of Bradford District/1.2 Health Inequalities and Life Expectancy/Health Inequalities and life expectancy.pdf (2020).
3. Khreis, H. et al. Traffic-related air pollution and the local burden of childhood asthma in Bradford, UK. Int. J. Transp. Sci. Technol. 8, 116–128 (2019).
4. Pedersen, M. et al. Ambient air pollution and low birthweight: a European cohort study (ESCAPE). Lancet Respir. Med. 1, 695–704 (2013).
5. Warembourg, C. et al. Urban environment during early-life and blood pressure in young children. Environ. Int. 146, (2021).
6. Binter, A. C. et al. Urban environment and cognitive and motor function in children from four European birth cohorts. Environ. Int. 158, (2022).
7. Vrijheid, M. et al. Early-Life Environmental Exposures and Childhood Obesity: An Exposome-Wide Approach. Environ. Health Perspect. (2020) doi:10.1289/ehp5975.
8. Clemente, D. B. P. et al. Prenatal and childhood traffic-related air pollution exposure and telomere length in european children: The HELIX project. Environ. Health Perspect. 127, (2019).
9. Mebrahtu, T. F. et al. The effects of exposure to NO2, PM2.5 and PM10 on health service attendances with respiratory illnesses: A time-series analysis. Environ. Pollut. 333, 122123 (2023).
10. Mueller, N. et al. Socioeconomic inequalities in urban and transport planning related exposures and mortality: A health impact assessment study for Bradford, UK. Environ. Int. (2018) doi:10.1016/j.envint.2018.10.017.
11. Rashid, R., Chong, F., Islam, S., Bryant, M. & McEachan, R. R. C. Taking a deep breath: a qualitative study exploring acceptability and perceived unintended consequences of charging clean air zones and air quality improvement initiatives amongst low-income, multi-ethnic communities in Bradford, UK. BMC Public Health 21, (2021).
12. McEachan, R. R. C. et al. Study Protocol. Evaluating the life-course health impact of a city-wide system approach to improve air quality in Bradford, UK: A quasi-experimental study with implementation and process evaluation. PREPRINT, (2022).
13. Mudway, I. S. et al. Impact of London’s low emission zone on air quality and children’s respiratory health: a sequential annual cross-sectional study. LANCET PUBLIC Heal. 4, E28–E40 (2019).