InSPIRE: Innovating UK clean air policies to prevent cognitive disorders across the lifespan, particularly for vulnerable urban populations

Lead Research Organisation: Durham University
Department Name: Sociology

Abstract

THE PROBLEM
Public health prevention today faces a serious challenge: new research suggests that breathing high levels of air pollutants at critical points in our lives, particularly in early life, can lead to significant cognitive disorders, including dementia. This causal link, however, from a public health standpoint, is not the primary challenge. Instead, the challenge is in figuring out how best to prevent it. What new research tentatively suggests, and here is the real public health challenge, is that the factors that account for which populations are most likely to develop air-pollution-based cognitive disorders has less to do with 'how' they live and more to do with 'where' they live. In other words, it appears that, from a prevention standpoint, the complex social and environmental systems in which certain populations live makes air pollution a health vulnerability for them. Air pollution is a form of cognitive health inequality.

What is not clear, however, is specifically 'how' these complex systems make air pollution a cognitive health vulnerability? From policies for traffic management and urban congestion to the un-equitable sharing of benefits derived from clean air strategies, we do not entirely understand the pathways by which the social and environmental determinants of air pollution lead to cognitive disorders. In turn, therefore, we do not entirely know how to effectively intervene into these complex systems. In other words, from a primary prevention standpoint it is not clear which air policies or interventions best mitigate against the negative impact these determinants have on cognitive health, particularly for the most socioeconomically vulnerable populations in the UK's major conurbations.

Hence the purpose of InSPIRE.

OUR COMPLEXITY APPROACH
InSPIRE will develop innovative primary prevention strategies for improving air quality, so that where one lives in the UK is no longer a cognitive health vulnerability. InSPIRE (which is comprised of 22 academics working across 9 universities with a network of partnerships) will engage in a highly ambitious research programme using the latest developments in systems science methods for public health to do the following:

1.Develop a cutting-edge UK air pollution model (1970-2020) of what is known as PM2.5. These air pollutants are hazardous because they enter the bloodstream and travel to the brain to cause cognitive impairment.
2.Work with the Dementias Platform to link our air pollution model to the cognitive health outcomes of three different highly regard UK cohorts.
3.Work with regional and national partners to evaluate previous and current clean air strategies (1970 - 2020) to identify the most successful (for our cohorts) at mitigating the negative impact place has on cognitive health.
4.Create a catalogue of these policy strategies and evaluate them further for 4 conurbations: London, Birmingham, Tyne-Wear and greater Manchester.
5.Use these results to produce high quality policy information and strategies to inform end-users on preventing air-pollution-based cognitive disorders and health inequalities.

OUR TOOLKIT/SIMULATION PLATFORM
InSPIRE will also launch an online evaluation toolkit and scenario simulation platform similar to the UK Multiple Deprivation Index and 2050 DECC Energy Calculator. With impact at the forefront of our partnership with the public and stakeholders, our simulation platform and toolkit will be immediately fit for purpose. Additionally, central and local end-users will be able to fine tune their platform as the world changes around them. Linking with national or local data and regional services, they will also be empowered to determine what will work and what is cost effective in the short and long term. Together, InSPIRE will help mitigate the effect of air pollution on cognitive health, both opening prospects and closing pathways to this cognitive barrier for the good of our population.

Technical Summary

Public health does not yet understand the complex pathways by which the social and environmental determinants of air pollution lead to health and cognitive disorders; therefore, we do not entirely know yet how to effectively intervene into these complex systems.

InSPIRE will use computational modelling, environmental epidemiology, atmospheric modelling, and policy evaluation for interventions in complex systems to understand how the socio-environmental determinants of PM2.5 and related air pollutants impact cognitive health to provide cost effective, scalable interventions and guidelines.

InSPIRE's highly ambitious research agenda is organised around three synergistic work programmes: Programme A: (WP1) engage in participatory action research with partners to (WP2) develop a theory of change model (WP3) for novel, actionable guidelines that plug into the UKPRP Impact and Evaluation Framework. Programme B: (WP4) develop a complex systems theory of the socio-environmental determinants of PM2.5 exposure and their downstream associations with cognitive disorders; (WP5) create a UK model of PM2.5 for 1970-2020; (WP6) link this model to cognitive outcomes (including severity and type) for three birth cohorts (1946, 1970, millennium). Programme C: (WP7) advance a cutting-edge evaluation approach (WP8) to engage in UK-wide and conurbation-specific evaluation of a catalogue of innovative strategies (1970-2020), including future economic/health benefits (up to 2050), to identify scalable, cost-effective air pollution-based prevention knowledge for cognitive health.

InSPIRE will drive forward new research and methods; leverage its partnerships to create a challenge-focused consortium; and inform the 2019 Clean Air Strategy. InSPIRE will also create a public evaluation toolkit/scenario simulation platform for exploring novel UK-wide or region-specific strategies and public health co-benefits; as well as motivate prevention among public and policy stakeholders.

This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP's 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.

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