In 1990 Mary Harney, then a junior environment Minister, banned the sale and use of smoky coal in Dublin, a ban that has since been gradually extended to most parts of the country. When the ban was proposed, people complained. Some people even continued to use illegal Polish smuggled coal for a while. But the vast majority of people were compliant and grateful for the ban. Toxic air pollutants in cities due to domestic coal burning had taken lives and ruined quality of life for decades. Alternative cleaner fuels were found and most importantly, lives were saved. The ban on domestic smoky coal was a success.

In 2011, the Air Quality Standards Regulations brought the EU Directive on Ambient Air Quality and Cleaner Air into Irish law. These regulations introduced a limit value to concentrations of nitrogen dioxide, carbon monoxide and benzene as well as lead, ozone and sulphur dioxide, and on particulate matter.

As GPs we experience first-hand the serious effects of poor air quality on patient health. However it is difficult to know how to advise patients to avoid poor quality air, especially for those who live in the inner cities, cycle in congested areas or walk to work. Cycling brings many health benefits yet cyclists have not only an increased risk of road traffic deaths but also of asthma and bronchopulmonary disease due to environmental pollutants and toxic levels of nitrogen dioxide gas.

In 2015 the World Health Organization (WHO) published a report highlighting the need to reduce emissions of short-lived climate pollutants black carbon, ozone and carbon dioxide which contribute to more than seven million deaths globally each year. WHO has rated more than 20 affordable measures to mitigate short-lived climate pollutants including reducing carbon emissions and implementing policies and investments that prioritise dedicated rapid transit such as buses and trains, and foster safe pedestrian and cycle networks.¹

The Environmental Protection Agency publishes a map and hour-by-hour report on its website where you can check the Air Quality Index for Health (AQIH) for your area at any time. In Ireland, air quality varies from fair to very poor on at least 20-30 days in every AQIH area of the country.²

There is a growing voice among young and old that we can no longer tolerate an environment that is causing such devastating harm to health, simply for the sake of the ongoing convenience of the petrol and diesel car.

At a political level, using budgetary measures to affect mass public health behaviour change through creeping carbon taxes and tiny governmental incentives to reduce carbon emissions in homes, while absolutely necessary, can seem excruciatingly slow. As GPs, our very real experience in the prescribing of inhalers and steroids is an invaluable evidential tool pointing to the meaningful action that needs to take place in reducing carbon emissions in Ireland. GPs can become a powerful voice in public health campaigns, and as family doctors we are key stakeholders in the growing campaign for cleaner streets and breathable air.

Thanks in great part to the tenacity of medical voices, we were the first country in the world to do implement a workplace smoking ban. We have challenged popular misconception and political opinion to ensure that science and healthcare will prevail so that lives can be saved. Doctors can support government initiatives to reduce carbon pollutants, and we can use our influence to strive for cities where we can breathe.  

References on request