Book review: An Air That Kills

Alan Ramage
On behalf of Plymouth Green Book Club

At the invitation of Professor Iain Stewart, I am opening this blog on behalf of Plymouth Green Book Club, which read Dr John Rieuwerts’s book “An Air That Kills” earlier this year. It is an important contribution to the public’s understanding of an issue which has rightly gained a high profile in Britain’s media.

Dr John Rieuwerts lectures at the University of Plymouth and has very kindly agreed to contribute to the blog. This will ensure that questions and statements will be responded to with the full depth of Dr Rieuwerts’s extensive knowledge of the subject and current research.

Chapter 1

An Air That Kills” opens with a chapter titled “A Breath of Fresh Air” and states emphatically that air pollution is an invisible killer, which is far more severe than most people realise and the main sources are all around us. The British government’s Advisory Committee on the Medical Effects of Air Pollution states that the average reduction in the life expectancy of a British citizen caused by unavoidable exposure to air pollution “is larger than that of several other established mortality risks”, including car accidents and passive smoking.

Chapter 2

The second chapter, “Air and Smoke, a Foggy History” is a salutary reminder of the grim reality of Victorian Britain when, In industrial areas, the well-off sited their house to the west of their wealth-making enterprises, while the poorer people’s homes were downwind of the prevailing south-westerlies. Coincidence? We are reminded of London’s “Great Smog” of December 1952 when thousands of Londoners of all ages died during the smog and subsequently a further 8,000 from fatalities that were originally attributed to influenza. This and previous smogs led to the Clean Air Act of 1956 and subsequent acts empowering local authorities to designate smoke control areas, more commonly referred to as smokeless zones.

Chapter 3

The third chapter explains the various forms of air pollution and their effects. With the offshoring of the source of much of Britain’s manufactured goods to Newly Industrialised Countries, road vehicles are the main source of today’s air pollution, which is all the more insidious for being largely invisible but nevertheless toxic. At the moment EU legislation sets limits for some pollutants, while others remain as only having target values.

PM ( particulate matter) 10 and PM 2.5 particles are invisible to the eye. The latter can travel to the tiny sacs in the lungs where oxygen is transferred into the bloodstream, leading, in time, to a range of pulmonary and cardiovascular diseases e.g. emphysema, bronchitis, stroke and heart attack. There is also a link with lung cancer. Long term exposure to nitrogen dioxide, produced wherever fossil fuels are burned, can severely inflame the airways causing breathing difficulties. Over periods longer than a year, research tentatively suggests an association with certain concentrations leading to a reduction in the growth of lung function in children. Ground-level ozone interacts with other pollutants such as nitrogen dioxide to create a photochemical smog in sunny weather. A consequence is severe inflammation to the lining of lungs with reduced lung function. Long term exposure scars the lungs.

Chapter 4

The fourth chapter, “The Scale of the Problem” opens with a quote from Simon Upton of the OECD (Organisation for Economic Co-operation and Development): “the number of lives cut short by air pollution is already terrible and the potential rise in the next few decades is terrifying.”

Locations exposing inhabitants, workers and regular visitors to particular risk are congested urban areas, industrial areas and main roads. An unexpected inclusion is rural main roads and rural areas. Dr Rieuwerts explains later in the book that rural area pollution is partly a consequence of synthetic urea fertilisers, which are widely used, producing ammonia, which combines with oxides of nitrogen and sulphur from urban and industrial areas and forms fine PMs, significantly decreasing air quality. The most vulnerable in all these areas are the very young, frail, elderly people and those of any age who already have cardiovascular and respiratory conditions such as asthma, bronchitis and emphysema.

Chapter 5

Chapter five is titled “Current Challenges”. It explains the limitations of the current monitoring of the AURN ( Automatic Urban and Rural Network ) and LAQM ( Local Air Quality Management ). This chapter makes specific reference to pollution in Plymouth. Drawing upon the contents of this chapter a submission has been sent to Environment Plymouth by Plymouth Green Book Club in response to the request made to Environment Plymouth and other organisations by Plymouth City Council as part of its Budget Scrutiny Consultation. This submission is at the end of the blog.

The Supreme Court has ruled in favour of Client Earth, a non-profit organisation of lawyers, which has launched legal challenges against the UK government, claiming it had not considered or put in place all practical measures to ensure compliance with E.U. air quality standards.

Dr Rieuwerts states that local air quality management is an admirable system with air quality officers across the country working hard to to figure out the best ways to reduce air pollution in their local areas. However, the actions they identify generally require resources and support from central government. Traffic congestion is typically the source of the worst problems but local authorities do not have the means to reduce the sheer amount of traffic on Britain’s roads; it requires broader solutions that can only come from central government. It is at this point I feel impelled to make a personal observation. I have visited several cities in England where there are several Park and Ride sites around each place. Plymouth has its existing and planned Deep Lane P&R sites. I would like to see a feasibility study done in association with Cornwall and Devon to see if more could be done through additional P&R sites to reduce traffic flows into the city’s arterial routes and its very congested city centre. I do wonder about the air quality at Prince Rock Primary School with busy roads passing by each side. Has this been monitored for all relevant pollutants?

Chapter 6

Chapter six, “Clearing the Air”, recommends two key approaches, which require central government support and co-ordination, underpinned by national policies.

  • The first is the widespread adoption of proven and affordable technologies that are already available to us.
  • The second is for a fully-informed public to engage in a perceptible cultural shift in attitudes and behaviour facilitating a move to more sustainable lifestyles that acknowledge the environmental and financial costs of business as usual and the fundamental benefits of a cleaner and healthier environment.

An extensive list of areas for action follows: “cleaner” vehicles – the impact of catalytic converters; the use of diesel particulate filters; hybrid vehicles; financial incentives for the “cleanest” vehicles; reduction of speed limits on busy roads; cleaner fuels; electric vehicles; hydrogen fuel cells; fewer vehicles; considering whether we always need to travel, which may be fundamentally about sense of entitlement to visit far-flung areas and the modern expectation that any of us should be able to go wherever we choose as long as we can afford the trip; public transport; economic tools to effect change e.g. vehicle taxation, tax on fuels; low emission zones; car rationing; freight and haulage; reducing pollution from power generation; renewable energy; nuclear power; energy efficiency.

The submission to Environment Plymouth

The submission to Environment Plymouth, using information from “An Air That Kills” with particular reference to chapter five, “Current Challenges”, is below.

One of the books we recently read was “An Air That Kills” by Dr John Rieuwerts of Plymouth University. Dr Rieuwerts’ book has several paragraphs devoted to Plymouth.

He expresses concern that the current level of monitoring nationally may not be continued post-Brexit. He says that concerned citizens need to be vigilant, and possibly outspoken, to ensure that environmental protections are not watered down.

With regard to Plymouth, he asks if the current monitors are in the right places and fully representative of likely human exposure.

He specifically instances the AURN (Automatic Rural and Urban Network ) monitoring site in the middle of a large pedestrian precinct some 140 metres away from any vehicular traffic, which is realistically the only source of serious air pollution in the city.

He goes on to mention the busy thoroughfares for both pedestrians and vehicles, instancing Royal Parade a busy highway with lines of city traffic, separate bus lanes and numerous bus stops with idling, diesel-fuelled buses, all bounded by wide pavements that are always full of shoppers and commuters. By the time their pollution reaches the monitoring site in the pedestrian precinct, it will have been diluted, if it arrives there at all.

Local authorities do make measurements of air pollution in their area, including at roadsides, and are required to draw up action plans if concentrations breach the official AQS (Air Quality Standards. However, such LA measurements nation-wide, unlike those derived from the AURN, are not as intensively collected, do not have the same coverage of air pollutants, and, more to the point, are not as readily available to the public

AURN monitoring stations are typically set at the height of four metres above the ground. This is generally done for entirely practical reasons, such as keeping the inlet out of the reach of interference by curious or mischievous members of the public. It does mean, however, that officially declared pollution concentrations may not always be fully representative of the situation nearer to the ground, where most of the exhaust emissions occur and where pedestrians, small children in particular, are predominantly exposed.

Even the current E.U. standards have their limitations. For the three main pollutants, nitrous oxide, ozone and PM10, the current rules on what constitutes ‘meeting air quality objectives” may regularly expose residents to potentially hazardous levels of air pollution.

Nitrous oxide measurements are permitted 18 exceedances per year; ozone is permitted 10 exceedances by the UK government; PM10 35 exceedances per year.
As Dr Rieuwerts says, action is needed not just at local level but at governmental level. Adding people power to this drive can only be to the good.


Plymouth Green Book Club holds several meetings a year. Details can be found on the University’s events calendar or by signing up to receive the Sustainable Earth Institute’s monthly e-bulletin.

1 response to Book review: An Air That Kills

  1. Janet Green says:

    I would be very interested in reading this book. I have had concerns about particulates since my Environmental science degree 20 years ago. Since that time I have avoided, as far as possible, encounters with traffic pollutants in the belief that it was exacerbating my asthma attacks. This didn’t seem to be recognised by any GP I have consulted, yet there must have been medical evidence of this. I want to know more about this subject.

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