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COMMITTEE ON THE MEDICAL EFFECTS OF AIR POLLUTANTS MINUTES - 18 June 1999 COMEAP/MIN/99/2

Present:
Chairman:	Professor S T Holgate

ITEM 1.APOLOGIES FOR ABSENCE AND ANNOUNCEMENTS

1.Apologies for absence had been received from Lord Harris, Professor Tattersfield, Mr Hurley, Dr Venitt, Professor Blain, Professor Richards, Dr Harrison (IEH), Mr McAllister (DHNI) and Mr Morris (SCIEH).

2.The Chairman welcomed Dr Hemantha Wickramatillake to the meeting. Dr Wickramatillake had recently been appointed to the vacancy left at the Institute for Environment and Health (IEH). The Chairman also welcomed Professor Philip Poole-Wilson. It was noted that Mr Alan Hedges would be joining the meeting for the discussion of Item 6 of the agenda.

3.The minutes were reviewed page by page and agreed as an accurate record of the meeting.

4.It was noted that since the minutes would now be released into the public domain via the Internet, the Chairman would sign a copy of the minutes in order to indicate that they had been formally agreed by the Committee. There was also some discussion as to whether the minutes should be released in their entirety. It was agreed that only a record of Committee business that had been completed would be released.

5.Some changes to the procedural workings of the Committee were also noted. Members were reminded to make a declaration of relevant interests before the consideration of each agenda item

6.Finally, there was discussion with regard to the release of individual papers Committee papers, for example, papers provided for previous meetings Members agreed that it might not be appropriate to release papers that referred to work in progress or that contained information on unpublished work of other organisations. After some further discussion, it was agreed that Members and the Secretariat should mark papers as appropriate for release or not, and that the decision to make these available to members of the public, if requested, would be made at the subsequent meeting of the Committee.

7.It was agreed that the action accepted by the Chairman, to write to CMO expressing concern about the retrospective release of minutes, should be delayed until the details of the Freedom of Information Act had been made clear. Attention was drawn to COMEAP/99/11: Freedom of Information: Consultation on Draft Legislation, which had been circulated for Members' information and it was pointed out that the draft consultation paper did not currently include plans for retrospective release of minutes.

8.Members were informed that the Code of Practice (circulated after the February meeting) had now been formally adopted by the Committee.

9.The Secretariat commented that work to develop further guidelines for the investigation of the health effects of local industrial emissions was continuing and that these issues would be discussed further at the next meeting

 ITEM 4.INDEMNITY FOR MEMBERS. COMEAP/99/7

10.The Committee was reminded that, at the last meeting in February, during the discussion of greater openness of COMEAP's proceedings, some Members expressed concerns about their personal liability as a result of being Members of an Advisory Committee that provides advice. The Secretariat suggested that Members would be reassured to know that all members of Department of Health Advisory Committees were currently covered by a standard indemnity underwritten by the Treasury, a copy of which was at Annex A of COMEAP//99/7.

11.The Secretariat went on to comment that the Report of the Neill Committee on "Public Liability In Public Service Organisations" had been published in the summer of 1998. This had included a recommendation that the Treasury should undertake a review of the means of legal protection available to appointees in Non-Departmental Public Bodies, and that it should ensure that, if such protection continued to be provided in the form of a standard indemnity, its terms should accord with the protection which would be afforded under a commercial insurance policy. The Treasury undertook this review in consultation with the Cabinet Office and Ministers agreed that a wider indemnity should now be offered. It was noted that DH was currently reviewing the position of indemnities for all its Advisory Committees in the light of the Treasury review and that Members would be informed of the outcome. In the meantime, the Secretariat said that Members might wish to note the draft indemnity at Annex B of COMEAP/99/7. This was based on an indemnity provided by the Minister of Agriculture to members of the Veterinary Products Committee following the Treasury review, and was felt to be clearer than the current indemnity outlined at Annex A.

12.Some Members felt that paragraph 3a of Annex A might have implications for the type of cover individuals applied for from bodies such as the Medical Defence Union (MDU) and the Medical Protection Society (MPS). Members were concerned that DH (as a part of Her Majesty's Government) might not feel able to act on behalf of members who had arranged a professional cover insurance with these organisations. It was pointed out that the cover provided by the MDU and the MPS varied depending on the work undertaken by those applying for such cover. The question of cover provided by employers was also raised: it was wondered whether such cover would extend to work for committees such as COMEAP and, if so, whether DH would regard the provision of such cover as the responsibility of the employer. It was agreed that the Secretariat would look into these issues and report back.

13.Members learnt that earlier this year, a decision on the content of an EU research programme on pollution-related diseases had been reached between the Parliament and the Council of Ministers. A copy of this decision was attached at Annex A of COMEAP/99/8. It was noted that the budget for the programme would be 3.9 m ECU over 3 years beginning this financial year. It was further noted that in May of this year, the European Commission had called a meeting of Member States to discuss both the content of a call for proposals and the criteria for selection. Details of these, currently both still in draft form, were attached at Annexes B and Annex C of COMEAP/99/8. With regard to the timetable of call for proposals, Members were informed that whilst at one stage, a limited call for proposals was being considered, it had eventually been decided to publish the call as widely as possible in the Official Journal early in August, with final proposals to reach the Commission by September 15. The Secretariat felt that, given the lack of time to prepare proposals, it seemed sensible to forewarn interested parties about the bidding process in advance of the call. The Secretariat noted that Members would wish to consider whether they wanted to make a bid for funding under the programme and consider the advantages of the formation of a network as envisaged by the Commission. It was also thought that it might be helpful if Members could pass details of the programme to others outside the Committee who might also be interested in submitting a bid for aspects of this work. It was pointed out that the programme covered a wide area of environmental epidemiology, toxicology and communications, and that a copy of the Commission's "Vade-Mecum" on grant management was available from the Secretariat on request. Members' comments were welcomed.

14.Members felt that the approach taken by the EU to set up this research programme was inappropriate, and that it demonstrated that the several directorates involved were not communicating with each other sufficiently to identify the problems adequately. Members further commented that the time-scale within in which to submit research proposals was wholly unrealistic. They noted that 3.9 m ECU was not a huge amount of money, and that it might be useful to clarify whether matching funding was involved. The suggestion was made that further dissemination of this call for research proposals could be undertaken by the IEH.

 ITEM 6.COMMUNICATING WITH THE PUBLIC - INITIAL RESULTS OF RESEARCH. COMEAP/99/6

15.Members were reminded that this was an issue that the Committee had looked at on previous occasions. However, the opportunity to carry out some qualitative research had presented itself earlier this year, the focus being vulnerable groups, for whom information about the effects of air pollution on health, was likely to have some practical relevance in relation to their conditions. Research was carried out by Mr Alan Hedges during March 1999 at four locations which were felt to be fairly representative of air quality across the country: West London, Birmingham, Lincoln and Bournemouth. The sources of information which were tested out included: information on air pollution provided through the Freephone line, Ceefax and Teletext, the internet and print and broadcast media; the DETR leaflet "Air Pollution - what it means for your health"; and the DETR leaflet "Winter Smog Summer Smog".

16.The main findings were as follows. There was widespread concern about air pollution, amongst members of the public but the concerns tended to be unfocused and poorly informed; knowledge and understanding did not seem to have moved on much since 1993 when an initial survey had been undertaken. Air pollution was seen to affect people in various ways, with health effects being a key concern, although there was more interest in long-term than short-term health effects. Air pollution was often identified as a trigger for the symptoms of asthma and lung disease, but less often of heart disease. However, it was acknowledged to be only one contender among a large and complex web of possible triggers. It was found that very few people had thought of seeking air pollution bulletin information. When this idea was suggested, there was usually little or no spontaneous interest, since most people could not visualise any great benefit from knowing current air pollution levels: approaches to disease management were usually more reactive than proactive and the scope for action appeared limited. Exposure to samples of official bulletin services did not generally encourage the idea of future use. However, it was noted that most people did want to know more the nature and effects of air pollution, and that most people responded well to the government leaflets about air pollution. People felt that the health advice on the phone line was only mildly interesting, whereas the health advice in the leaflets was fuller. However, again, the suggestions for action usually seemed of limited practical value. Finally, people felt that important information should come to them rather than them seeking it out, and that a campaign to educate the public about air pollution might be helpful. However, there were also signs that government information was sometimes mistrusted.

17.It was concluded that the most important objective was to educate the public about the basic facts relating to air pollution and health. Air pollution needed a more significant publicity campaign, and ways of delivering the leaflets more effectively needed to be considered. Government bulletin messages needed to be better publicised, and shortened and simplified, as did the telephone messages and access to them. With regard to health advice, it was concluded that most people seemed to take a broadly reactive approach to the management of their ailments. One problem was that the scope for action seemed to be rather limited, and that it did not make a compelling case for investing time in watching pollution levels or taking a more proactive approach to the management of disease in relation to air pollution. It was further concluded that there seemed to be a case for collecting together disease-specific health messages in one place in the leaflet. Members' comments on these initial results were welcomed, particularly in view of the original intention to follow this initial study with as quantification stage.

18.Members were of the view that the public reaction to the information available to them was generally about right. The Committee thought that there was little need for most people to know information in more detail since most of the public was unaffected by the effects of air pollution, or, with the exception of asthmatics, had no means of reducing effects even if they did. The Committee was interested to learn that the public were of the opinion that chronic effects were more important than day to day symptoms, and agreed that any new leaflet might cover this in more detail.

19.The Committee was reassured with the findings that the public found the air pollution leaflets interesting and helpful and acknowledged that there was a need to address how the effects of air pollution fitted in with other risk factors. Members agreed that disease specific information was a good idea, but expressed some doubts about what could or should be said to patients with heart disease. Any advice needed a strong scientific basis and some idea of the importance of risk. There was some discussion about the air pollution bulletin systems. The need for Government to produce such information was acknowledged and supported, but the Committee was not convinced that this should be given too much attention for fear of creating concerns uncessarily. After some further discussion of these and other points, it was agreed that DH and DETR would write a short paper for the next COMEAP meeting on how this matter should be taken forward, and that Mr Hedges should be invited to attend and participate in this discussion.

19.The Secretariat reported that the section of the COMEAP Update Report on mechanisms of action of individual pollutants was now virtually completed and being reviewed by Professor Richards and the Chairman. It was felt that once complete it might be appropriate to publish this as a separate report to avoid dating of information, but a final decision had not yet been made on this issue.

20.The Secretariat was currently engaged in writing the section on volunteer studies. Dr Mannered had completed this section for ozone, and this was currently being considered by Professor Tattersfield and the Chairman. This section on particles was now being tackled by Dr Mannered and Dr Walton had agreed to write a section on volunteer studies for nitrogen dioxide.

21.In relation to the epidemiological section of the update report, Professor Burney had undertaken to write a section on chronic studies. The time-series/panel studies were being considered by Professor Anderson who now had a contract with DH to produce an interrogative matrix, as discussed at the February meeting. Professor Anderson had produced a series of letters outlining his proposals in detail, and it was agreed that these should be circulated to Members for information. It was also agreed that a meeting should be convened in August/September at which the Members designated to write sections on individual pollutants should discuss how to take matters forward. Professor Poole-Wilson agreed to participate in this meeting in his capacity as a cardiologist.

22.The Secretariat noted that this was not yet finalised. A submission was shortly to be presented to Ministers for their consideration.

23.Members were told that ozone would be discussed further at a future meeting of the COC. This was part of a general review of mouse-specific carcinogens of which ozone is an example. Human data had not been considered. Examination of lung tumours in mice had suggested that there was a specific pattern of genetic changes induced by ozone. This could indicate that ozone was genotoxic although further research would be needed to confirm this. The COC would consider further the most likely mechanism (genotoxic or nongenotoxic) of tumour formation.

24.It was noted that the EPAQS report on PAHs was at the printers and that it was intended that the report would be published in the first 2 weeks of July.

25.The Secretariat drew attention to the draft note of a meeting that had been held on March 4 1999 in order to discuss the chronic effects of particles on health and asked for any comments on this issue to be submitted to the Secretariat in writing.

26.The following members declared interests in this item: Dr Gibbs (shares, BP/shell); Professor Seaton (Aeroengines). The following members declared non-personal interests (research grants): Professor Ayres (Perkins); Professor Harrison (Perkins, Rover); Professor Holgate (US Health Effects Institute).

27.Members' attention was drawn to COMEAP/99/10 which had been updated in light of comments submitted to the Secretariat by correspondence. Members agreed the statement, and the Secretariat undertook to place this on the COMEAP website as soon as possible.

28.This consultation paper was circulated for Members' information. Attention was drawn in particular to paragraphs 33-37 on pages 10 and 11 as these made specific mention of matters relating to the release of information in minutes and papers to the public domain.

29.The Press Release issued by DETR on 16 June 1999, marking the start of the summer smog season, was circulated for information. Members were informed that it was DETR policy to issue a statement when the first summer air pollution episode occurred, but that press releases were not issued on every subsequent occasion.

30.Attention was drawn to a recent newspaper item outlining details of a WHO report that had claimed that air pollution was responsible for more deaths than road accidents. Members were informed that further details of the report and how to obtain it were available from the Secretariat.

31.The following date was noted:

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