Written questions by Farron.

Which public health factors created the 10 largest direct cost impacts on the NHS in 2024; and how much the NHS spent in 2024 on tackling the health impacts of the following public health factors: (a) air pollution, (b) alcoholism, (c) obesity, (d) excessive salt consumption and (e) smoking.

Global Burden of Disease data considers the top ten public health factors in the United Kingdom in 2023 in order of importance to be: tobacco, high body mass index, dietary risks, high fasting plasma glucose, high blood pressure, high alcohol use, high cholesterol, occupational risks, kidney dysfunction, and drug use. Further information on the Global Burden of Disease data is available at the following link:https://vizhub.healthdata.org/gbd-compare/The following table shows the various estimates of the cost to the National Health Service of the five factors specified:Risk factorEstimated NHS costSource of EstimateAir Pollution£1.6 billion for fine particulate matter and nitrogen dioxide combined between 2017 and 2025.Public Health England Agency, 2018Alcohol£4.9 billion annuallyInstitute of Alcohol Studies, 2021/22Obesity£9.3 billion annuallyFrontier Economics & NESTA, 2025Hypertension (excessive salt consumption is linked to an increased risk of hypertension)£2.1 billion annuallyOptimity Matrix (commissioned by Public Health England), 2014Smoking£1.8 billion annuallyAction on Smoking and Health, 2025 Comparisons of costs should not be made between these estimates because of the different methodologies used in their construction.

How many people died from alcoholism in England in each year since 2021.

The information requested falls under the remit of the UK Statistics Authority. A response to the Hon gentleman’s Parliamentary Questions of 6th January is attached.

How many people died from conditions related to obesity in England in each year since 2021.

The information requested falls under the remit of the UK Statistics Authority. A response to the Hon gentleman’s Parliamentary Questions of 6th January is attached.

Food and Rural Affairs, what assessment she has made of the effectiveness of the Clean Air Act 1956, the Clean Air Act 1968 and the Clean Air Act 1993.

The Clean Air Act is kept under continuous review to ensure it remains fit for purpose. A number of amendments have been made since its introduction in 1956. The most recent changes were introduced under the Environment Act 2021, which included the strengthening of existing enforcement powers for local authorities in smoke control areas and the introduction of new legally binding targets for fine particulate matter.

Food and Rural Affairs, which areas in the following zones her Department assesses may delay compliance with the nitrogen dioxide annual limit value beyond 2024 and until when in (i) West Midlands Urban Area; (ii) Greater Manchester Urban Area; (iii) Liverpool Urban Area; (iv) Bristol Urban Area; and (v) Coventry/Bedworth.

The results of the UK’s air quality assessment for 2024 are published online on the UK-Air website (https://uk-air.defra.gov.uk/). Projections of future compliance for locations in exceedance of the nitrogen dioxide annual mean limit value in 2024 are being developed as part of updates to the national model.

Communities and Local Government, what Government guidance there is on technical standards to be applied in dwellings and other buildings to improve indoor air quality.

The government sets standards for indoor air quality mainly through Parts F (Ventilation) and L (Conservation of fuel and power) of the Building Regulations which apply primarily to new buildings with detailed guidance provided in Approved Documents. Approved Document F sets minimum ventilation requirements to provide fresh air and reduce risks from pollutants, moisture, condensation and mould. These standards were strengthened in 2021 and took effect in June 2022. Indoor air quality in existing properties is addressed separately, including through Awaab’s Law which requires social landlords to investigate and remedy damp and mould hazards within set timescales. Government policy is also informed by the Committee on the Medical Effects of Air Pollution (COMEAP) which provides independent advice on air quality and health.

Food and Rural Affairs, what the largest environmental risks are to public health in the UK.

There are a number of environmental risks to public health in the UK, including air pollution, noise pollution, climate change and extreme weather, emerging chemical and biological risks and water quality.

Food and Rural Affairs, whether any hotspots in zones other than the five zones identified in the Compliance Assessment Summary 2024 exceeded the nitrogen dioxide annual limit value in calendar 2024.

The localised hotspots identified through Defra’s national modelling and monitoring networks are published annually on UK Air (https://uk-air.defra.gov.uk/) as part of the national compliance assessment under the Air Quality Standards Regulations 2010. Localised hotspots that have been identified by local authority-owned monitoring are published in their respective annual status reports.

Pursuant to the Answer of 10 May 2023 to Question 183643 on Public Health, what methodologies were used to estimate the costs to the NHS for each of the five risk factors specified.

The applicable methodologies for the National Health Service cost attributed to each of the risk factors outlined are explained in the following reports.The estimated air pollution related costs to the NHS can be found in the Public Health England report ‘Estimation of costs to the NHS and social care due to the health impacts of air pollution: summary report’ , from 2018, which is available at the following link:https://www.gov.uk/government/publications/air-pollution-a-tool-to-estimate-healthcare-costsAn estimate of the NHS and healthcare costs of alcohol from 2021/22, produced by the Institute of Alcohol Studies, can be found at the following link:https://www.ias.org.uk/factsheet/economy/Estimated obesity related costs to the NHS can be found in the Frontier Economics report for NESTA, published in July 2025, ‘The Economic and Productivity Costs of Obesity and Overweight in the UK’, which is available at the following link:https://media.nesta.org.uk/documents/The_economic_and_productivity_costs_of_obesity_and_overweight_in_the_UK_.pdfEstimated Hypertension related costs to the NHS can be found in the Optimity Matrix Cost-effectiveness review of blood pressure interventions, ‘A Report to the Blood Pressure System Leadership Board’, published November 2014, available at the following link:https://cleanair.london/app/uploads/vdocuments.site_cost-effectiveness-review-of-blood-pressure-cost-effectiveness-review-of-blood.pdfThe most recent estimated smoking related costs to the NHS can be found in the press release, ‘New figures show cost of smoking to society in England dwarfs tobacco tax revenue’. This is available at the following link:https://ash.org.uk/media-centre/news/press-releases/new-figures-show-cost-of-smoking-to-society-in-england-dwarfs-tobacco-tax-revenue

How many attributable deaths there were from fine particulate matter, PM2.5, were there in (a) East Midlands, (b) East of England, (c) Greater London, (d) North East, (e) North West, (f) South East, (g) South West, (h) West Midlands, (i) Yorkshire and the Humber, and (j) England in each year since 2018 using COMEAP's latest methodology.

The number of deaths attributable to fine particulate air pollution (PM2.5) is not annually calculated for each region. The current estimate of attributable deaths in the United Kingdom for 2019 was 29,000 to 43,000 deaths for adults aged 30 years old and over.The fraction of mortality attributable to particulate air pollution is annually calculated for each region and represents the percentage of annual deaths from all causes in those aged 30 years old and over, attributed to PM2.5. This indicator is calculated using the Committee on the Medical Effects of Air Pollutants’ updated concentration-response-function, and figures for the years 2018 to 2023 are available at the following link:https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/4/gid/1000043/pat/15/par/E92000001/ati/6/are/E12000004/iid/93861/age/230/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/ovw-do-0_car-do-0Estimates for 2024 will be available later in 2026.

When he will update the Health and Technical Memorandum 03-01 for the latest technical standards.

Published guidance on ventilation in healthcare settings includes the Health Technical Memorandum 03-01: Specialised ventilation for healthcare premises. It gives comprehensive advice and guidance on the legal requirements, design implications, maintenance, and operation of specialised ventilation in healthcare premises providing acute care. Further information is available at the following link:https://www.england.nhs.uk/publication/specialised-ventilation-for-healthcare-buildings/NHS England will update Health Technical Memorandums, including HTM 03-01, when necessary.

Food and Rural Affairs, pursuant to the Answer of 26 March 2025 to Question 39815 on Nitrogen Dioxide: Pollution Control, which of the exceedances mentioned complied with the annual limit for nitrogen dioxide in 2024.

The results of the UK’s air quality assessment for 2024 are published online on the UK-Air website (https://uk-air.defra.gov.uk/). Local authorities are expected to publish the data from their locally managed nitrogen dioxide measurement networks on their websites.

Food and Rural Affairs, pursuant to the Answer of 17 April 2025 to Question 45555 on Nitrogen Dioxide: Pollution Control, which road links within 10 miles of Heathrow airport exceeded 20 micrograms per cubic metre in 2024.

The results of the UK’s air quality assessment for 2024 are published online on the UK-Air website (https://uk-air.defra.gov.uk/). Local authorities are expected to publish the data from their locally managed nitrogen dioxide measurement networks on their websites.

Food and Rural Affairs, what the difference is in legal duties and obligations between limit values under the Air Quality Standards Regulations and air quality targets for PM2.5 concentrations set in the Environmental Improvement Plan 2025.

The Air Quality Standards Regulations (AQSR) 2010 establish legally binding standards across the UK, for numerous air pollutants, including PM2.5. The AQSR limit value for PM2.5 concentrations is 20 micrograms per cubic meter in England and responsibility for meeting the target lies with the Secretary of State. Targets established through the Environment Act 2021 (The Environmental Targets (Fine Particulate Matter) (England) Regulations 2023) set legally binding targets of annual mean concentration of 10 micrograms per cubic meter or lower by 2040, and a 35% reduction in population exposure by 2040 (compared to 2018 levels). These apply to England only and responsibility for meeting the targets lies with the Secretary of State. The Environmental Improvement Plan also sets out non-legally binding interim targets. Some AQSR standards are mirrored in the Local Air Quality Management framework. This is not the case for the Environment Act 2021 targets, although local authorities are required through the Air Quality Strategy to contribute to targets being met.

Communities and Local Government, with reference to paragraph TR7 of the proposed revised version of the National Planning and Policy Framework, what criteria he is using to determine an acceptable environmental effect.

The reference to acceptable environmental effects in proposed policy TR7 is couched in general terms, but the consultation is clear that when using the Framework, the draft policies need to be read as a whole, including in this instance the more specific policies found elsewhere in the Framework for assessing certain environmental impacts. The consultation will remain open for responses until 10 March 2026, and all responses received will be considered before finalising our policy proposals.

Food and Rural Affairs, pursuant to the Answer of 25 November 2025 to Question 91935 on Air Pollution: International Cooperation, whether she is seeking to agree (a) reductions or (b) increases for each of the national emission reduction commitments (ceilings) listed in Annex IX of the Gothenburg Protocol.

The United Kingdom of Great Britain and Northern Ireland continues to engage with other Parties to the United Nations Economic Commission for Europe’s Convention on Long‑Range Transboundary Air Pollution on the ongoing revision of the 2012 amended Gothenburg Protocol, including obligations regarding ammonia emissions. The United Kingdom is committed to supporting effective action on transboundary air pollution across the region, while ensuring the Protocol is fit for the future and can be ratified and implemented by more Parties to the Convention.

Food and Rural Affairs, pursuant to the Answer of 25 November 2025 to Question 91935, what she is seeking to achieve from revisions to the Gothenburg Protocol including Annex IX.

The United Kingdom of Great Britain and Northern Ireland continues to engage with other Parties to the United Nations Economic Commission for Europe’s Convention on Long‑Range Transboundary Air Pollution on the ongoing revision of the 2012 amended Gothenburg Protocol, including obligations regarding ammonia emissions. The United Kingdom is committed to supporting effective action on transboundary air pollution across the region, while ensuring the Protocol is fit for the future and can be ratified and implemented by more Parties to the Convention.

Food and Rural Affairs, whether Commitment 19 in the Environmental Improvement Plan 2025 should refer to emissions of oxides of nitrogen rather than nitrogen dioxide.

Commitment 19 of the Environmental Improvement Plan (EIP25) relates to The National Emission Ceilings Regulations 2018 national reduction commitments for 2030 and should correctly be referenced as oxides of nitrogen.

What estimate his Department has made of the number of premature deaths in (i) England and (ii) the UK attributable to (a) smoking, (b) air pollution, (c) alcoholism and (d) obesity in the last 12 months.

The information requested falls under the remit of the UK Statistics Authority. A response to the Hon gentleman’s Parliamentary Question of 5th of January is attached.

If he will make an assessment of the potential implications for his policies of the press notice by the Royal College of Physician of 13 November 2025, which called for a UK-wide public health campaign on air pollution.

Clean air is a key part of our shift from ‘sickness to prevention’ as per the 10-Year Health Plan for England, which sets out action to further improve the quality of the air we breathe.Alongside the 10-Year Health Plan, the Department for Environment, Food and Rural Affairs’ Environmental Improvement Plan, published in December 2025, outlines commitments to improve the communication of air quality information.Government action is being informed by the recommendations from the Air Quality Information System review report published in 2025, which specifically considered ways to increase public awareness about air pollution.We will continue to work closely with the Department for Environment, Food and Rural Affairs to reduce the health harms of air pollution and to help make air quality part of everyday conversations.