China leads the world in many things, and AstraZeneca China was thinking ahead when it started work on YHP China to protect young people from air pollution back in 2013. This was five years before air quality was formally acknowledged by the WHO as the ‘fifth risk factor’ for non-communicable diseases (NCDs) in 2018; putting it alongside tobacco smoking, alcohol misuse, poor diet and underactivity1.
The close association between air pollution and premature death and ill health has, of course, been known for many years. The famous Six Cities study2 demonstrated the strong link between particulate air pollution and mortality back in 1994. This influential study has been cited over eight thousand times - an indication of the huge interest and further research that it generated.
Since then the focus has been increasingly on fine particulate known as PM2.5 – the sort of minute particles that can be breathed into the lungs and may even pass into the circulatory system3 - among other pollutants. The WHO guidelines recommend an average maximum ambient PM2.5 concentration of 10 μg/m3 or less. The challenge is that exposure in many cities is way above this. In China alone at least six cities are estimated to have fine particulate levels over ten times higher4.
This has major consequences for young people, and especially those aged under five, as the WHO has summarised in its recent ‘Air Pollution and Child Health’5. This noted that 93% of children are exposed to PM2.5 in excess of the WHO guidance and that in 2016 almost 300,000 children under the age of five died due to ambient air pollution.
Children are especially vulnerable as they breathe faster than adults, taking in more air and, with it, more pollutants. Children live closer to the ground, where some pollutants reach peak concentrations. They may spend much time outside, playing and engaging in physical activity in potentially polluted air.
The links between early exposure and NCDs is becoming ever clearer with the WHO publication reporting ‘robust’ evidence of links to respiratory disease, ‘substantial’ evidence of a link with childhood leukaemia, and a ‘potential association’ with childhood obesity6. A recent study shone some light on its behavioural effects too, demonstrating that ambient PM2.5 air pollution significantly discouraged physical activity among freshmen students living in Beijing7.
Reducing ambient air pollution is clearly a public health necessity – but individuals can also act, which is where the work of the YHP and its volunteers from AstraZeneca comes in.
In China there is a pressing need for help not just because of the pollution levels but also because many of the young people are the children of migrant workers coming from the countryside to the great cities, and neither the parents nor the children often know much about pollution and environmental protection. This puts them at great risk.
To combat this, AstraZeneca volunteers have conducted courses on air quality, its importance to health, and how to protect against pollution, in schools across the country - from Beijing to Shanghai and Guangzhou. They bring a focus and expertise to the subject that hard-pressed teachers really appreciate.
‘The volunteers bring our students a colourful lesson, inspiring them to think, learn what smog is, understand the importance of environmental protection and how to protect from it through masks’, said Ms Gao a primary school teacher from Taiyuan. ‘It is a profound lesson for us and our students’.
One student from Jinan Jinxiuchuan Southwest Primary School described what she learned: ‘through this lesson, I now know that I can help to reduce air pollution by avoiding firecrackers, riding bikes more and using more public transport. I also know the harm smog does to my body, so I look forward to their next visit. We don’t get extracurricular content like this normally.’
The classes are also very practical ‘We show students different materials and types of masks to help them learn how to protect themselves against air pollution and we will add some experiments on air purification to show other ways improve air quality’ said Amy Wen, Associate Director, Government Affairs & Corporate Social Responsibility at AZ China.
The AZ China volunteers also feel that they benefit from working with the children - enhancing professional skills ‘it helps me understand others’ needs and respond better’ according to Miss Bian from Wuhan; but perhaps the last word should go to Miss Gao, a volunteer from AstraZeneca (Shanghai ) ‘I hope that I can give back to the society, help more people in need, let them feel good things and feel positive energy’.
Understanding about air quality and taking simple actions will not remove this public health menace, but at least it will help these children to grow up healthier and stronger.
 BMJ, 2018, Air pollution moves up the global health agenda, BMJ 2018; 363. Available at https://www.bmj.com/content/363/bmj.k4933.full accessed 29 April 2019
 Dockerty DW, Pope CA, Xu X et al, 1993, An Association between Air Pollution and Mortality in Six U.S. Cities, New England Journal of Medicine 1993; 329:1753-1759. Available at https://www.nejm.org/doi/full/10.1056/NEJM199312093292401 accessed 29 April 2019
 Marshal J, 2013, PM2.5, Proceedings of the National Academy of Sciences of the USA. PNAS May 28, 2013 110 (22) 8756. Available at https://www.pnas.org/content/110/22/8756 accessed 29 April 2019
 WHO, 2018, Global Ambient Air Quality Database. Available at https://www.who.int/airpollution/data/cities/en/ accessed 29 April 2019
 WHO, 2018, Air Pollution and Child Health – Prescribing Clean Air. Available at https://apps.who.int/iris/bitstream/handle/10665/275545/WHO-CED-PHE-18.01-eng.pdf?ua=1 accessed 29 April 2019
 Yu H, Yu M, Gordon P et al, The association between ambient fine particulate air pollution and physical activity: a cohort study of university students living in Beijing, International Journal of Behavioral Nutrition and Physical Activity201714:136. Available at https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0592-x accessed 28 April 2019