Draft Freedom of Information to Great Ormond Street Hospital

Paul Scott and I have have written the draft in the hope of others will also sign  and offer amendments during April, The idea is to submit the request in May and see what comes back. Great Ormond Street have been been pro-active in linking air pollution to child health. I cut and paste the Hospital press release of 16th February 2023 below:

Air pollution levels added to patient's postcodes

16 Feb 2023, 6:15 a.m.

Air pollution levels for patient’s postcodes have been added to their medical records to help families understand the risk in their local area. 

Great Ormond Street Hospital for Children (GOSH) has teamed up with Imperial College London, which collected the data from across Great Britain, to make the average annual pollution rates for each of the patient’s postcode easily available.

Clinicians can compare the patient’s postcode levels to those recommended by the World Health Organisation (WHO), to explore any risk this may pose.

Why is this happening?

In December 2020, Ella Adoo Kissi Debrah, became the first person in the UK to have air pollution listed as a cause of death on her death certificate. This was a result of years of campaigning by her mum Rosamund to have a new inquest, following the nine-year-old's death in 2013.

In a report to prevent future deaths, the coroner said that clinicians must do more to warn families of the dangers of air pollution.

Last year, the chief medical officer Christopher Whitty, also made recommendations on air pollution.

For the NHS he said: “The training of healthcare staff should include the health effects of air pollution and how to minimise these, including communication with patients.”

How does this help clinical teams work with patients and families?

The clinical team will be able to see air pollution data for PM2.5 (fine particulate matter) and nitrogen dioxide on each patient’s electronic medical record, as well as the World Health Organisation guidelines for these particles, and the rates at GOSH.

There are also links to further information, training and advice on how our clinicians can speak to families about the issues.

The training and the data will help our clinicians consider whether air pollution is a factor in their child’s illness, how it affects them, and if there are steps that can be taken to help.

What else is GOSH doing?

In 2019 GOSH launched the first ever Clean Air Hospital Framework to improve air quality in and around the hospital. It also launched Play Street, as part of this goal. In 2021, we became the first London hospital to declare a Climate and Health Emergency and have set ourselves challenging Net Zero targets to drive us forward. Over 30 members of GOSH staff also cycled to Glasgow to coincide with the COP26 climate meeting as part of Ride for Their Lives.

What happens next?

Now that the air pollution data has been added to the medical records, training will be rolled out across GOSH.

Mark Hayden, Nicola Wilson and Johanna Andersson, who led the project at GOSH to add the air pollution data to medical records, hope to work with other hospitals to add air pollution to more patients’ records. END OF PRESS RELEASE


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The draft Freedom of Information request to the hospital is below. 

Dear Great Ormond Street Hospital Freedom of Information Department,

We are concerned about High Rise residential being planned across by busy roads in London. Sometimes developments are also in between busy roads and railway tracks. Both air and noise pollution are linked to serious illness. Sometimes these developments are designed with affordable housing in mind which suggests the families living in them have low incomes and as a consequence may suffer from poor diet. There is research which suggests poor diet makes children more vulnerable to diseases.

So although the information we request may be more expensive that that usually allowed we argue that is in the public interest for it be released to an academic.

An example of medical information being given to an academic is when the Fire Brigades Union have sent medical information to an academic on behalf of their members. The study was dated January 2023, the press was titled “Firefighters far more likely to die from cancer and heart attacks than public” and is available at https://www.fbu.org.uk/news/2023/01/10/firefighters-far-more-likely-die-cancer-and-heart-attacks-public The study found fire fighters more likely to die of serious diseases than the general population. 

Our expectation is that the illness and mortality data you hold will show worse health for children located close to roads which will inform public debate and policy making.

We can find no studies linking the impact of noise, air, magnetic field and inadequate diet on child health. The data Great Ormond Hospital holds could prove useful in discovering whether worse health child health outcomes are correlated to areas 

The Goldacre review at https://www.gov.uk/government/news/goldacre-recommendations-to-improve-care-through-use-of-data aims to drive innovation and improve healthcare through safer use of health data. We argue that the data Great Ormond Street holds is likely to influence planning policy, in particular pollution hotspots where a number of pollution factors are located in one location making the health risk of building there measurably worse than elsewhere.

The Mayor of London’s office uses modelled mortality rates for policy making purposes, we say the real data you hold will test how accurate the Mayor’s modelling is and will be more comprehensive covering other risk factors such as EMF, noise and poverty as well as air pollution.

We seek the following information.

1) The full postcodes of patients, both in patients and out patients aged under 18 who have been are/receiving treatment for the following conditions living within a London Borough

a) Cancer with a breakdown of types, for example
Leukaemia
Brain and spinal cord tumour
Neuroblastoma
Wilms tumour
Lymphoma (including both Hodgkin and non-Hodgkin)
Rhabdomyosarcoma
Retinoblastoma
Bone cancer 
b) Otitis media
c) All Acute lower respiratory infections, such as pneumonia and bronchiolitis.
d) Meningitis

e) Asthma

For the following periods:
23rd March 2020 to 22nd March 2021
23rd March 2019 to 22nd March 2020
These dates tie in with the lockdown period.
2) Children who have died in your care either in hospital or at home as out-patients aged under 18 for the same time periods and same conditions with the full postcodes set out in 1 above. It is accepted there are confidentiality issues here, but when Councils are planning substantial housing developments close to roads it must be right to discover if there is a health risk to building homes in these locations.

3) Dates of admission and deaths in (1) and (2) to discover if there is correlation to high pollution days.

This information may be over the usual cost limits, but it is the public interest for the it to be published. Information relating to the slight risk of blood clots from the astrazeneca vaccine has led to changes in the use of the vaccine.

Many developments are close to busy roads, some between railways and busy roads. Some of these developments are designed for low income residents. Research suggests a poor diet is likely to make children more vulnerable to disease linked to air pollution. There is also evidence that suggests EMF is linked to child cancer. This means some sites planned for development will have all four risk factors: traffic pollution, noise pollution, EMF and poor diet. The data Great Ormond Street Hospital holds has the potential to inform public debate about whether it is responsible to build developments in such apparently toxic locations.

They are many articles linking child illness pollution one at

https://www.nature.com/articles/s41416-0...

says

“A meta-analysis by Boothe et al.31 assessing childhood leukaemia in relation to multiple pollutants found an increased risk for post-natal exposure but no association with pre-natal exposure. Most studies found an association with childhood leukaemia overall, but the association tended to be stronger when examining just acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) for specific pollutants32. “

 

 

Yours faithfully,

Paul Scott

Andy Walker

 – supporting literature

 

1)” Childhood cancer and traffic-related air pollution in Switzerland: A nationwide census-based cohort study” Environment International published in Volume 166, August 2022, 107380

2) “More than 90% of the world’s children breathe toxic air every day “Published by World Health Organisation 29 October 2018. We quite “Air pollution also impacts neurodevelopment and cognitive ability and can trigger asthma, and childhood cancer.”

3) Air Pollution and Otitis Media in Children: A Systematic Review of Literature Published online 2018 Feb  downloaded from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858326/#:~:text=There%20is%20an%20increasing%20body,risk%20of%20OM%20in%20children. The quote we rely is “There is an increasing body of evidence supporting an association between higher ambient air pollution exposure and a higher risk of OM in children”

4 Noise Effects on Health in the Context of Air Pollution Exposure Stephen A. Stansfeld. Int J Environ Res Public Health. 2015 Oct; 12(10): 12735–12760. Published online 2015 Oct 14.Published online 2015 Oct 14. The quote is:

“There is good evidence from large population studies that environmental noise from road traffic and aircraft is associated with cardiovascular morbidity and mortality independent of the association with air pollution. There may be both independent mechanisms and common mechanisms involving methylation for these associations of environmental exposures with health. Environmental planning and policy should take both exposures into account when assessing environmental impacts.”

4) Road proximity, air pollution, noise, green space and neurologic disease incidence: a population-based cohort study. Weiran Yuchi, Hind Sbihi, Hugh Davies, Lillian Tamburic & Michael Brauer Environmental Health volume 19, Article number: 8 (2020

“Emerging evidence links road proximity and air pollution with cognitive impairment”

5) Impact of nutrition on pollutant toxicity: an update with new insights into epigenetic regulation Jessie B Hoffman, Michael C Petriello, Bernhard Hennig Rev Environ Health. 2017 Mar

Ann N Y Acad Sci

6)  2017 Jun;1398(1):99-107. doi: 10.1111/nyas.13365. Epub 2017 Jun 2.

Protective influence of healthful nutrition on mechanisms of environmental pollutant toxicity and disease risks

Jessie B Hoffman 1 2, Bernhard Hennig 1

Our work has shown that diets high in anti-inflammatory bioactive food components (e.g., phytochemicals or polyphenols) are possible strategies for modulating and reducing the disease risks associated with exposure to toxic pollutants in the environment. Thus, consuming healthy diets rich in plant-derived bioactive nutrients may reduce the vulnerability to diseases linked to environmental toxic insults.

7) Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis X. WU, R. C. NETHERY M. B, D. BRAUN

SCIENCE ADVANCES

4 Nov 2020

Vol 6, Issue 45

The Harvard study is one of several that suggest air pollution is affecting COVID-19 mortality.

8) US government research on EMF and cancer at

 https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/electromagnetic-fields-fact-sheet

The quote is:

“ In 2015, the European Commission Scientific Committee on Emerging and Newly Identified Health Risks reviewed electromagnetic fieldsExit Disclaimer in general, as well as cell phones in particular. It found that, overall, epidemiologic studies of extremely low frequency fields show an increased risk of childhood leukemia with estimated daily average exposures above 0.3 to 0.4 μT, although no mechanisms have been identified and there is no support from experimental studies that explains these findings”

9) “Impact of air pollution on children’s health” 7th December 2021 by Sarah Woolnough, Chief Executive of Asthma UK and the British Lung Foundation, and Andy Ratcliffe, Executive Director of Programmes at Impact on Urban Health at

 

 https://www.openaccessgovernment.org/childrens-health/125608/

The quote is:

“Our newly published joint report, Clear the Air: Improving air quality to protect future generations and level up our communities highlights that 85% of people living in areas with illegal levels of pollution make up the poorest 20% of the UK population.”

10) Air pollution and neurological development in children 9th December 2020 by

Sandie Ha at

https://pubmed.ncbi.nlm.nih.gov/33300118/

The quote is “Mounting evidence suggests that exposure to air pollution, both during pregnancy and childhood, is associated with childhood developmental outcomes ranging from changes in brain structures to subclinical deficits in developmental test scores, and, ultimately, developmental disorders such as attention-deficit/hyperactivity disorders or autism spectrum disorders.”

 

11) Air pollution and children by Larissa Lockwood

Head of Health and Air Quality, Global Action Plan & Jemima Hartshorn

Campaigner and founder, Mums for Lungs

 

https://urbanhealth.org.uk/insights/reports/air-pollution-and-children

 

The quote is:

Air pollution can impact on children before birth – research has found that pregnant women exposed to PM2.5 and NO2 air pollutants are more likely to have smaller, low birth weight children.

 

 

 

 

 

 

 

 

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