On his way to work every morning, consultant geriatrician Colm Byrne has a fair idea how busy his day will be at the Mater hospital on the northside of Dublin just by breathing the air.
Byrne had long suspected a link between days of particularly poor air quality in Dublin and a spike in stroke or suspected stroke admissions, so two years ago he and a team from the Royal College of Surgeons began to investigate.
The RCSI team looked at data gathered from patients admitted to hospitals between January 2013 and December 2017 for stroke or ischaemic attacks – sometimes referred to as mini-stroke.
More than 10,000 people suffer strokes in Ireland every year. In Dublin alone, hospitals take in six stroke patients and four with ischaemic attacks every day. And the numbers are higher during colder winter months.
The RCSI team then mapped out air quality records for the same dates from monitoring stations around the city that report to the Environmental Protection Agency (EPA).
Factors such as temperature, humidity, date and time were taken into account. What they found was simple and clear: a statistically significant rise in stroke hospitalisations in Dublin within two days of bad air pollution.
“The research we did showed about a 9 per cent increase in stroke admissions linked to days of poor air quality,” says Byrne. “It is significant. It is a life-or-death situation. It is a major public health issue that has been ignored.”
His remarks come amid much debate around the Government’s attempt to ban retail sales of turf, but not the cutting of turf by those who have cutting rights on their own bogs.
Coincidentally, around the same time the RCSI team were carrying out their research, a group of academics at NUI Galway’s School of Physics were examining the chemical composition of air pollutants in Ireland.
Despite a 30-year-old ban on smoky coal, homes setting solid fuel fires in Dublin and Birr, Co Offaly – two urban centres of vastly differing population scales – were found to be the main offenders.
Air pollution in both Dublin and Birr – which has about 1 per cent of the population of the capital – had a similar chemical composition. Turf, on average, was to blame for 27-30 per cent of the carbon pollution, rising to as high as 63 per cent on occasions.
According to Dr Byrne, it is only a small proportion of households in Dublin causing the majority of the air pollution. The CSO has suggested as low as 5 per cent
In both city and town, coal was responsible for less pollution (24 per cent and 17 per cent respectively) than turf, the study published in the Atmospheric Chemistry and Physics journal reported.
“Therefore, in order to reduce wintertime particulate air pollution, primary emissions from solid fuel burning, especially peat, should be the primary target of policy regulations,” the researchers stated.
According to Dr Byrne, it is only a small proportion of households in Dublin causing the majority of the air pollution. The Central Statistics Office (CSO) has suggested as low as 5 per cent.
“It may be only a small number of people but it is having a significant public health effect,” says Dr Byrne.
High air quality
Nationally, 1,300 deaths a year are attributed to air pollutants. This is despite Ireland's air quality being among the best in Europe and globally.
While traffic has a role to play, “most are caused by solid fuel burning”, says Dr Byrne.
But turf burning – as well as coal, and unseasoned wood to a lesser extent – is not just causing more strokes. Heart disease, respiratory illness, diabetes, dementia, Parkinson’s disease and worse outcomes from Covid-19 have all been shown to be associated with poor air quality.
It is also linked to exacerbating asthma. Latest official figures show 88 people died from asthma attacks in Ireland in 2018. Then there is the terrifying impact of the condition itself for many day-to-day sufferers.
According to the Asthma Society of Ireland, there are currently 380,000 people with the condition.
“It is a huge percentage of the population,” says Eilís Ní Chaithnía, research manager for the society. “A few years ago we were the fourth worst in the world for it. We have very high levels compared with internationally.”
The result is 8,000 hospital admissions every year, with one person dying every six days.
The correlation between poor air quality and the worsening of asthma is incontrovertible, says Ní Chaithnía.
Sufferers contacting the society report having to leave cities and towns on days of bad air pollution to take exercise.
“They report increased coughing, wheezing and struggling to breathe. It is very serious,” she says.
“Another worry is that, despite a hereditary link to the condition not being clinically established, it does tend to run in families. We don’t have the answer to why that is. Neither do clinicians. But we constantly hear personal testimonies from mums who have asthma bringing their young children out for a walk in the buggy, acutely aware of smoke billowing from chimneys around them.
“They are painfully aware of the potential impact for their children. Some struggle to sleep. It is a worry for parents. It should be worrying us all.”
One in five children in Ireland will have asthma at some stage, the society found in a study on the economic cost to the State of the high rates of the condition – €472 million every year.
Asthma sufferers have been “waiting a long time” for a clampdown on turf, wood and coal burning, says Ní Chaithnía.
“With each passing year, more people are developing chronic diseases and dying as a result of burning solid fuels. We can’t wait any longer. Public health has to take priority.”
Patchwork approach
The society admits it does not have all the answers to urgent arguments about a ban sharpening fuel poverty in a time of soaring oil and gas costs. But it points out a higher prevalence of asthma among lower-income households.
“We are not in position to present all of the solutions, that is up to the Government,” says Ní Chaithnía.
“People from rural Ireland have experienced a lot of change, and they are genuinely concerned about losing rural Ireland, about it disappearing, and a turf ban is one way people see that happening.
“They are rightly very protective and it does add a real complexity to the discussion. But we are concerned with making sure people remain as healthy as possible, protecting them from pollutants that can trigger asthma, cause asthma and which can be fatal.”
"There is already a patchwork approach to prohibiting smoky coal. It is very difficult to enforce"
Ní Chaithnía is sceptical of Government plans to exempt communities of under 500 people from a ban.
“There is already a patchwork approach to prohibiting smoky coal. It is very difficult to enforce. Anyone can jump in a car and go to the next town where it is permitted to sell smoky coal and bring it home. We can assume that same problem with exemptions on a turf ban.”
Any prohibition must be nationwide, she insists.
During his time in office as minister for environment, Richard Bruton "cited threats of legal action by commercial actors" for not extending the 1990 ban on smoky coal.
The Irish Times has seen legal correspondence from three coal importers – Enerco, Hayes Fuels and LCC (the latter two based in the North) – objecting in the “strongest possible terms” to the existing ban on smoky coal as well as any extension.
The Government has previously acknowledged the partial prohibition is “unlawful insofar as it does not treat fuel products which emit similar (and in some cases greater) quantities of pollutants equally,” it states.
The ban of one solid fuel “and not another fuel product that is a greater polluter (ie peat and wood) raises serious concerns under Irish and EU law and could be overturned if challenged in the courts,” lawyers for the importers argue.
“Any extension to the existing ban, which is not product-neutral, will be subject to the same serious concerns and risk of challenge.”
Extended ban ‘justified’
The importers cite an EPA study, published in June 2020, known as the Sapphire report (Source Apportionment of Particulate Matter in Urban and Rural Residential Areas of Ireland) which showed "the burning of peat for home heating in the towns of Killarney, Enniscorthy and Birr ... was the largest source of air pollution in these locations."
Coal was the least polluting of all three solid fuels, according to the research.
Given the Government’s own advice, the importers have implored it to “reform” the existing ban to include all solid fuels before any move to extend it, at that stage, to 12 towns nationally.
In response, the Department of the Environment said an extended ban “is fully justified by and proportionate to the aim of preserving public health and saving lives”.
“The evidence shows that the proposed extension will save lives in the towns concerned,” an official states, before dismissing the suggestion that the Government acknowledged as “unlawful” the existing ban.
Indeed, it has been “unquestionably highly effective”, and in Dublin alone has resulted in about 350 fewer deaths a year, by “reducing cardiovascular, cerebrovascular and respiratory mortality in the general population.”
The Government said the Sapphire study was “expanding our knowledge” on other solid fuels and would inform future decisions.
"No one likes change. But it is change that needs to happen. Air pollution is a serious public health issue"
Dr Byrne believes “an element of populism and cultural association” is driving the reticence of vocal opponents to the expanded ban.
“No one likes change,” he says. “But it is change that needs to happen. Air pollution is a serious public health issue. Leaving out the biodiversity crisis, the climate change effect of digging up bogs, it is a public health issue.
“By continuing to allow turf burning, it is not going to improve people’s homes, improve fuel poverty. We should be looking at measures that improve both air quality and fuel poverty.
“There was also a cultural attachment to smoking indoors at one time. That ban was brought in and it had significant public health benefits. We need to grasp the nettle.”