Do we all breathe the same air?

It's also been scientifically proven that there are no safe levels of air pollution. Even low levels can cause long-term damage to our health. We're all exposed every day.

The sky and the light were blotted out, and London coughed and crawled almost to a standstill in murky yellow gloom. And, as if this wasn't bad enough, there was more. [eerie music] Mixed with the filthy smog was a high proportion of another substance—sulphur dioxide—and this was the killer. As the days passed, doctors realized that something drastic was happening. Deaths were increasing at a frightening rate. The mortality rate for babies under a year old doubled.

Hospitals overflowed with chest cases. Deaths from pneumonia increased four times. And, for those with bronchitis, it was the worst killer of all. The mortality rate rose by nine times and nobody could do anything about it. Smash-and-grab raiders had a field day, and though there weren't many cars on the roads, there were hundreds of accidents. [train chugs] On the railways, it was chaos.

Those trains which did get through were packed and, at the stations, crowds queued, in many cases, all night. Thousands were stranded. It was impossible to see the signals and drivers had to work by ear. [train thuds] [eerie music continues] As the five days passed, the emergency built up. Ice and frost joined in to make matters even worse, and while people coughed and choked, the smog got thicker and darker.

[music intensifies] At the airport, traffic came to a standstill and it was the same in the docks. Ships and aircraft stopped where they were and waited. As a direct result of those five days of smog, 4,000 people died.

And, just as in 1956, London is yet again leading the charge against air pollution, ensuring all residents are breathing safer, cleaner air through a variety of measures. [upbeat, energetic music] Under the leadership of Mayor Sadiq Khan, the Ultra Low Emission Zone, or ULEZ—an area of London where the most polluting vehicles are restricted or a charge must be paid—was expanded to cover all boroughs of the city.

The Clean Air Wins campaign is focused on building a network of advocates committed to social and environmental justice and was a vital tool in building public support for the ULEZ expansion and other clean air policies. Thus far, ULEZ is estimated to have contributed to a 4.5% reduction in long-term health problems and an 8% decrease in respiratory issues like asthma and bronchitis.

It is expected to bring cleaner air to an additional 5 million people while reducing carbon emissions in outer London by a further 27,000 tons. Being able to breathe clean air should be a human right but here are some statistics that might surprise you. According to the World Health Organization, only 1% of the global population can take that right for granted. 99% of the world's population does not experience clean air because they live in areas that exceed safe pollution limits.

6.7 million premature deaths per year are due to exposure to poor air quality and 91% of those premature deaths occur in low- and middle-income countries. But, on a brighter note, there are 50 like-minded cities around the world, committed to ambitious targets that take direct and decisive action against air pollution. Cities are taking urgent action on air pollution to tackle climate breakdown, improve air quality, and create healthier, more resilient cities.

But, what does that action look like in practice? [music ends] [light, gentle music] Today, we'll hear from two amazing clean air advocates who are empowering cities to raise up the voices of those who are most affected. These leaders are ensuring that the most vulnerable and impacted city residents are better protected from the health impacts and inequities of the climate crisis.

One of those guests is C40's own Senior Manager for Air Quality, who helps cities to collaborate and share best practices and solutions for improving air quality to meet their public health, climate, and equity goals. But first, let's meet a community leader who's committed to placing research and agency back into the hands of Black communities as advocates for change in their own health narratives. [music ends]

To overcome these injustices, it's vital for cities to listen to, and be champions of, the important work that Agnes and her organizations are doing. [music ends] Agnes, welcome to Cities, 1.5.

So, I just kind of fell into this space of, "How can I keep my daughter safe?" In parallel to that, I'm a maternal health advocate, and so when I was looking at all of the conversations around maternal health, maternal mental health, but particularly Black maternal health in the UK at the time, so looking at 2019, Black women were five times more likely to die in pregnancy than white women, and similar stats that we see also in the US and around the world, none of

the conversations were around these environmental factors that contribute towards adverse health outcomes. I'm thinking, "Hold on. Why are we not talking about, [chuckles wryly] you know, the environmental factors in all these different conversations?" and then they all kind of met together in the middle and that started my journey.

So, with myself, with the network that I had been able to build, I kind of pulled the whole team together and said, "Look, we're not waiting around. If not us, then who?" And that's how Global Black Maternal Health came about.

And, our mission is to really put research back into the hands of Black communities as leaders and change agents, because we fundamentally believe that actually, when we're looking at research that's evidence-based, and when we look at how funding is allocated, you need to have the evidence.

You need to have research, rounded in the community but, if it's not there, then actually the situation becomes very anecdotal, so we felt that actually, if we want to readdress structural inequalities, we needed to be the ones to drive home that research, and that's what we're doing at the moment.

I'm having that conversation so that policymakers, government, but also the community can understand what does air pollution, what does clean air look like to the very communities who are disproportionately impacted? So, that was kind of what we thought our role was because we couldn't even delve into any further area because there just hadn't been a baseline study. A lot of things were being done to communities as opposed to with communities.

It's to say that, actually, where these communities disproportionately live means that they're, to a higher degree, more likely to be exposed to environmental hazards, you know? [music fades out] And so, for us, if these very communities then are not aware that they're more likely to be exposed or it's the only area that you you breathe, then that's where the social justice issue comes about.

And, when you're talking about how has our work now kind of impacted the research world, for myself personally, just within the past, I would say seven, eight months, it's been a really busy time. I actually thought we were going to release our report, we were going to have our conference, and I was going to be able to rest. That was what I thought.

[laughs] But actually, since our conference and since releasing the report, you know, we've been having conversations in Ghana with anyone from the World Health Organization to the United Nations around our work and how there's kind of similar correlations in a different context. I was just at COP 28, speaking about maternal health to a global audience, so you can see that there is a massive appetite to actually understand the human impact.

Even though we've only focused on London, so many different kind of cities and communities around the world are identifying that actually, yes, you know, where people live, where they grow up, where they school does have an impact on their health. Definitely, it has an impact on our health as adults. What's the impact on us, on our children, and also our unborn babies? So, that conversation and that research is starting to happen. But, not enough.

I feel like there should be more, but at the end of the day we are starting to have those conversations.

And, it looks to me like, in London at least, you've been able to move past that and try to speak to results, as well.

So, being part of the Clean Air Wins campaign was good because we were able to speak to communities in a very culturally sensitive way. For me, now moving forward, it's about getting involved in these kind of campaigns, but much earlier on now. You know, we want to be able to be involved and be on the driving seat before a campaign is even a campaign so that, when there are policies coming out, it's not just, "Now, let's get involved."

It's actually that communities well-informed about the issues, and therefore they're actually the ones even asking for these changes. But Clean Air Wins was really, really important. I thought that it helped to drive, you know, a conversation in a very kind of nuanced way and I and I was really honoured to be a part of it.

And, it might be well-meaning but actually, let's give communities the agency to be able to let policymakers really understand what matters to them and work together in a relational way. And, I think, when we do policy that way, we can't help but make our world a more, healthier, better place. [music fades out]

And, what they had said to me was that actually, because of climate change, you know, particularly in the north of Ghana, it means that crops are not growing in the same kind of way, and it means that there's a massive migration from the north to the south, which is bringing instability, which is increasing violence, and we know disproportionately then it's women and children who are impacted.

So again, it's about really understanding when we're talking about the environment and we're talking about climate change, what's the real-life impact on human beings on the ground? You know, what does that now look like? Does it look like instability? Does it look like more crowded cities? Does it look like then lack of economic opportunity?

If I hadn't been in Ghana, I would never have thought that, so it's all about the importance of actually being on the ground and speaking to communities, individuals, about what does climate change actually look like for them on a day-to-day basis? And I think, if we're not having those conversations and we're being presumptuous and we're also extrapolating a Western mindset-- you know, I'm born and raised in an urban city in London, right? So yes, I'm a Black woman.

My heritage is Ghanaian, but I'm not born and raised in Ghana, so I still have to, even when I'm in Ghana, be in a continuous state of learning and understanding, and so speaking to communities and understanding the nuance of what that looks like from their cultural standpoint, again, you get that thing cascading effect, where then communities will start actually doing the work that they need to do and policymakers can then see, "Where can I fit in to support

you on doing the work within that way?" But also, again, policymakers from a kind of a macro level has a big role to play. When we're talking about climate change, we know that for communities that are disproportionately impacted, they're not the biggest contributors to climate change. Right?

So, there's a whole role that policymakers, the government, individuals that have decision-making authority need to be involved in order to really change that balance of power so that we don't have the biggest players creating the most towards pollution, to climate change, and having the option to then kind of move out of that city or move out of that area and leave the most vulnerable at the mercies of the environment when they didn't cause those damages.

And oftentimes, in rooms I walk in, I'm the only person from-- I don't even want to say a Black background – from a minoritized background, walking in the room. So, there is a lot that the environmental sector needs to do. I think, secondly, I will put my hands up in the air and say I elbowed my way into all of this. I don't take no for an answer, but not everybody has the agency to be able to do that.

I think because of the work I was doing on the maternal health side, I was able to translate that into the environmental sector. When you do have people around the table, how many of them are around the table with an equal voice and what I mean is how many of them are there at senior decision-making levels? And, if you're working within the environmental sector and you know, "Actually yes, it's true.

Every meeting I go into, actually, there's not really a representation of the communities that we serve in a decision-making level," then there needs to be something done about that.

Different people from different communities are going to experience the environment in different ways, so it is really important that we're not just looking at this from a kind of race aspect, but also poverty and race and how that intersects and make sure that, when we are having meetings, just like I said with the way I fell into the maternity or through service-user voice, that actually, within the environmental sector, we're including service-user voice of voice around that table.

So, they're kind of our four key areas of actions. And, we also have a particular kind of area of action for policymakers. We want to raise awareness of air pollution amongst Black families.

For me, one of the biggest social justice issues around the kind of environmental sector, around air quality, that the people who are most disproportionately impacted do not even know that they're being harmed, so they're more likely to have strokes, more likely to have high blood pressure, more likely to have diabetes, all these kind of different aspects, and they don't actually know they're actually living in areas with high levels of air pollution.

You can't even help to empower these communities if they're unaware, and so I think the main thing at this level, at the moment, is really raising that awareness around the impact of air pollution on maternal health outcomes.

In the UK, for example, at the moment, Black women are over three times more likely now, in 2024, to die in pregnancy, twice as likely to experience a stillbirth, more likely to experience miscarriages, and it's interesting that women who live in areas with high levels of air pollution are also twice as likely to experience a stillbirth. At the first level for policymakers is how do we engage the community to make them aware, and then equally then, women are looking at policy making.

If the communities are aware, policymakers and the community can now work together to look at, "Okay, what are some of those solutions?" because even when we're talking about air pollution, we're talking about outdoor but there's also indoor air pollution. You know, there are so many other different factors.

And, I think, really, you need to watch this space. I mean, we've got a lot in store, we're doing work around looking at the impact of air quality on neurodiversity, so there's a lot on the horizon and, with all of your support, please keep downloading the report, [pensive music] please keep spreading the word in terms of the work that we're doing, and hopefully we are able to move some of these kind of tangible research into action because that's really the next stage.

It's to not just produce reports for reports' sake, but actually to listen to the community and then get on with the job of actually solving some of these really pressing issues.

The Journal serves as a platform for dynamic content that highlights ambitious, near-term climate action, focusing on human-centred solutions to today's most pressing climate challenges. To read the latest issue, visit JCCPE.utpjournals.press or find the link in the show notes.

[rotary dial telephone rings] [clicks] [receiver chimes, replaced in cradle] [light, gentle music] Dolly's priority at C40 is to support cities in designing healthier, inclusive, and resilient societies across the transport, buildings and energy, and waste management sectors.

Air is intrinsically tied to each of these sectors, both because they have substantial impacts on polluting emissions and because air health needs to be considered in every arena, because having clean air to breathe is a concern that affects all of us. [music fades out] Dolly, welcome to Cities, 1.5.

Prior to joining C40's Air Quality Team, I was also based at the Mayor of London's office, but within the realms of my current work, the broader air quality program also offers technical assistance at a global level and regional initiatives across various African countries. The ultimate goal for our cities is to rapidly reduce air pollution so they can now improve the health, well-being, and social equity for their residents.

I'm particularly interested in providing cities with a space where they can build long-lasting, trust relationships as this creates an environment in which they can be honest about their barriers. But, it also allows them to inspire and motivate each other to try new ideas and be much more ambitious. And, the cities I support are taking a range of steps to improve air quality. They are, for example, monitoring air pollution to identify the key sources in their city.

They're also enabling the transition to cleaner household fuels, introducing vehicle emission standards, as well as building safe and affordable public transport networks and pedestrian- and cycle-friendly networks. These are just a couple of examples, but cities are doing so much more to reduce pollution from a broader variety of sources.

There are two pollutants in particular—black carbon and ozone—which aren't just air pollutants harming our health, but they are also short-lived climate pollutants, as they are powerful climate forces that remain in the atmosphere for a much shorter period of time than carbon dioxide, and yet their potential to warm the atmosphere can be many times greater.

So, burning wood, charcoal, and kerosene release black carbon, and one way these fuels are used are within households that, unfortunately, cannot afford cleaner forms of energy. Ozone, however, is formed by interacting with vehicle and industrial emissions, as well as sunlight and methane. Methane is another short-lived climate pollutant and, together, these short-lived climate pollutants are responsible for up to 45% of current global warming.

[light, driving music] From that perspective of air quality and emissions, is transitioning away from fossil fuels important to improving air quality and protecting public health? How does transitioning from fossil fuels to clean energy help?

We recognize that, for many residents within cities, especially within the context of this global cost-of-living crisis, they may not have the financial resources or the capacity to transition towards cleaner sources of energy, and when we think about cities' capacity and what we would consider to be a first step to taking action, air quality monitoring is an incredibly useful tool for simply establishing the baseline pollution levels and identifying where air pollution is highest in the city.

The data can then be used for informing how and where cities target, design, implement, and evaluate their air quality and their climate policies, but also framing their policies as a health issue, so really making climate a health issue.

From a health inequity or social justice perspective, air quality monitoring can also help cities to measure pollution levels and impacts on marginalized and clinically vulnerable communities, and these communities are typically women, children, Indigenous communities, low-income groups, and informal workers, so it's important to prioritize health assessments in the areas where these communities live, work, and play. [music fades out]

As you know, they are disproportionately exposed to air pollution, most impacted by climate breakdown, and in some cases may also be very much economically impacted by the transition to cleaner sources of energy. And, those three challenges that I just described, this is due to deep historic and systemic inequities.

So, for example, in my hometown, London, the city's most-deprived residents are living in neighbourhoods with an annual average PM2.5 concentration that is 6% higher than the least-deprived areas. Further research on air pollution exposure shows that Black communities, diaspora immigrant communities are the worst affected by air pollution. However, this gap is thankfully closing due to measures implemented to improve air quality, such as the Ultra Low Emission Zone.

There is also emerging evidence that particulate matter also impacts the brain, which can cause neurological and psychological damage. So, the consequences of inhaling PM2.5 are truly severe.

really great opportunity to support cities, not just collaborate with each other, city-to-city, but also working and engaging vertically, so engaging with their regional counterparts, their state, and their federal counterparts, so they're now collaborating with each other to really tackle air pollution within that broader region.

For the World Health Organization, they've done a fantastic job in setting these really clear health-based guidelines to support countries around the world to understand what they consider to be relatively safe air pollution concentration levels, and at the heart of air quality and climate action is health – social and economic justice.

So, I'm currently working with a few cities to specifically address the health and equities of air pollution to make sure that the residents that are most affected by air pollution, which, as I mentioned, are marginalized in clinically vulnerable residents, that they are prioritized in the design of clean air and climate solutions.

And, this approach is a step towards ensuring equitable outcomes, so it is really essential to remember that clean air is a human right, defined by the UN as these same residents have seen their human rights violated in the past. So, let's not allow toxic air to compound these existing inequities.

Reducing the health inequities associated with air pollution can be achieved through policy design, but first, cities should identify what are the environmental, social, and economic factors that influence localized exposure and vulnerability to air pollution, and then take an integrated approach to addressing these factors.

However, the data that is needed to develop an integrated approach is often collected and held by multiple city, regional and national agencies and this is why inter-agency or regional collaboration and multidisciplinary teams are extremely important to build.

One truly great example of that is Bogotá, where they considered community participation in that process of their recently launched clean air zone, better known as the ZUMA, but also really prioritized specific low-income districts for the location of their first ZUMA so, in the long term, the city is hoping to implement several of these. And, the way they did this wasn't by accident. It was by design.

They were firstly fully aware of these existing silos and institutional barriers within the city, and they broke them down by bringing together professionals across air quality, health, and mobility, but also key stakeholders such as academic institutions. [music fades out] So, together, they developed this shared vision which allowed them to provide critical data inputs, engage with communities and implement the ZUMA so it can primarily benefit the low-income residents.

And, as a result of that collaboration, they developed a new socioeconomic equity index. And so, it is their flagship air quality policy. The socioeconomic equity index included a few metrics which I think would be really exciting for other cities to learn.

They included citywide population density, the density of marginalized residents, loss of life associated with air pollution, per capita income, land and house value, the facilities where clinically vulnerable residents are/reside, such as schools, nursing homes, and hospitals. And then, they overlaid this analysis with a map of their existing and planned mobility programs, and then that went on to identify these key priority areas for their ZUMA.

We're also seeing really great work happening within non-profit organizations, but also private sector corporations, and I think we can do so much more to make sure that these solutions or innovative work receive media attention as this will help us all gain broader support from the public and politicians.

And, what we're seeing when cities talk about communicating a positive vision is their interest in also working directly with the broader health community, such as medical practitioners and their public health agencies, and they're doing this to find creative ways of communicating air quality and the associated public health risks, but they're partnering with the broader health community to also educate the health community and use that as an opportunity to inform clinical practice and provide

a better service to their patients.

But also, framing has been a real lesson learned in the past couple of years, for example, in Phoenix, Arizona, they've been thinking about how to frame air quality within the context of extreme heat. So, for Phoenix clean air, heat, and social equity are the city's main holistic priorities, but this is actually tied to resilience and economic development.

I think that type of framing is something that cities are really interested to learn as we continue to face and tackle misinformation and the manipulation of air quality and climate evidence. [pensive music] So, because it is often politicized, framing the challenges that we face as a resiliency solution can be one way of securing broader political support for many cities.

Cities should reach out to, support, and platform organizations like Global Black Maternal Health who are placing information and agency into the hands of those facing the health impacts caused by air pollution and climate change. Their future depends on decisive and critical actions from cities, and it's action that must happen now. [music continues then ends] [Cities 1.5 main theme music plays]

On the next episode of Cities 1.5, we have a fascinating conversation about climate disinformation and how it threatens climate action—and potentially democracy itself—with Jennie King, the Director of Climate Research and Policy at the Institute for Strategic Dialogue and Co-Founder of the Climate Action Against Disinformation Coalition.

We will also hear from C40's Director of Urban Planning and Design, Hélène Chartier, who speaks to the concept of the 15-minute city, an urban planning policy that allows everyone in every neighbourhood to meet most of their daily needs within a short walk or bike ride from their home. This policy has been adopted by many mayors and cities, but has also been the target of climate conspiracists and disinformation attacks. You won't want to miss it.

[music continues] This has been Cities 1.5, leading global change through local climate action. I'm David Miller. I was the Mayor of Toronto, Canada, and I know, firsthand, the role cities can play in solving the climate crisis. I'm the Editor in Chief of the Journal of City Climate Policy and Economy, published by the University of Toronto Press in collaboration with the C40 Centre for City Climate Policy and Economy, where I'm also the Managing Director.

C40's mission is to help our member cities halve their emissions within a decade, while improving equity, building resilience, and creating the conditions for everyone, everywhere to thrive. [music continues] Cities 1.5 is produced by University of Toronto Press in association with the Journal of City Climate Policy and Economy and C40 Cities. This podcast is produced by Jessica Schmidt, and our executive producers are Peggy Whitfield and Dali Carmichael. Our music is by Lorna Gilfedder.

The fight for an equitable and resilient world is closer than you think. To learn more, visit the show's website, linked in the episode notes. See you next time. [main theme music continues then ends]