People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Planning


Include air pollution in 'plan making' by all tiers of local government, in line with the Department for Communities and Local Government's National Planning Policy Framework. This includes county, district and unitary authorities, as well as regional bodies and transport authorities. The Local Plan and other strategic planning processes (such as the core strategy, local transport plan, environment and health and wellbeing strategies) should include zero- and low-emission travel, for example cycling and walking (see the section on walking and cycling and NICE's guideline on physical activity: walking and cycling). Other strategies for zero- and low-emission travel could include:

  • Providing charge points for electric vehicles in workplaces, commercial developments and residential areas.

  • Supporting car sharing schemes or car clubs.


When 'plan making' consider:

  • siting and designing new buildings, facilities and estates to reduce the need for motorised travel

  • minimising the exposure of vulnerable groups to air pollution by not siting buildings (such as schools, nurseries and care homes) in areas where pollution levels will be high

  • siting living accommodation away from roadsides

  • avoiding the creation of street and building configurations (such as deep street canyons) that encourage pollution to build up where people spend time

  • including landscape features such as trees and vegetation in open spaces or as 'green' walls or roofs where this does not restrict ventilation

  • including information in the plan about how structures such as buildings and other physical barriers will affect the distribution of air pollutants.

See how the committee made recommendations 1.1.1 to 1.1.3.

1.2 Development management


Consider ways to mitigate road-traffic-related air pollution. This could include:

  • Taking action to reduce the number of motorised trips. For instance, by:

  • Supporting the use of zero- and low-emission vehicles for instance, by providing charging facilities for electric vehicles.

  • Managing street trees and vegetation to reduce the risk of restricting street ventilation, where this may contribute to poor air quality (for instance, by the choice of species, siting and pruning regimes).

See how the committee made recommendations 1.2.1 and 1.2.2.

1.3 Clean air zones


Consider introducing a clean air zone that:

  • includes restrictions or charges on certain classes of vehicle

  • supports zero- and low-emission travel (including active travel)

  • includes targets to progressively reduce pollutant levels below EU limits and aim to meet World Health Organization air quality guidelines

  • aims to reduce exposure to air pollution across the whole zone rather than focusing on air pollution hotspots.


Identify which classes of vehicles to restrict or charge in a clean air zone (see recommendation 1.3.1) based on an understanding of local conditions (such as local sources of road-traffic-related pollution and factors influencing dispersion). Use nationally recognised vehicle types (such as the Euro classification for diesel and petrol vehicles).


Work across local authority boundaries to address regional air pollution and prevent migration of traffic and emissions to other communities, resulting in areas of poor air quality.


Consider support for zero- and low-emission travel. This could include:

  • Encouraging walking and cycling (see NICE's guideline on physical activity: walking and cycling).

  • Encouraging uptake of zero- and low-emission vehicles, for instance:

    • Providing electric charging points.

    • Encouraging public and private sector organisations to use zero- or low-emission vehicles for deliveries to retail, office, residential or other sites in the zone, particularly for the last mile of deliveries in city centres.

  • Developing integrated public transport networks (including park and ride schemes) based on low-emission vehicles.


Consider taking action to reduce emissions within the clean air zone. For instance:

  • Introducing fuel-efficient driving initiatives including:

  • Action to minimise congestion caused by delivery schedules.

  • Using a fleet recognition scheme (such schemes help fleet operators improve efficiency by reducing fuel consumption and emissions: the system recognises operators who meet best operational standards).

  • Addressing emissions from public sector transport activities (see the section on reducing emissions from public sector transport services and vehicle fleets).

  • Specifying emission standards for private hire and other licensed vehicles.


Where traffic congestion is contributing to poor air quality, consider incorporating a congestion charging zone within the clean air zone.


Consider monitoring outside the zone to identify whether its implementation is causing problems in terms of traffic composition and flow. If so, address any issues identified. For instance, by changing the boundaries to address increased pollution at the margins of the zone or problems caused by diversion of traffic.


Assess the impact of any proposed charges (including exemptions for zero- and low-emission vehicles) on vulnerable groups.

See how the committee made recommendations 1.3.1 to 1.3.8.

1.4 Reducing emissions from public sector transport services and vehicle fleets

Driver training


Consider introducing fuel-efficient driving as part of any test carried out when appointing or re-appraising staff who drive as part of their work.


Consider training staff drivers to reduce their vehicle emissions. This could include:

  • reducing rapid accelerations and decelerations, and correct gear selection to improve fuel consumption

  • switching off engines, if practical and safe, when parked by the roadside and when dropping off people or deliveries

  • vehicle maintenance, including pumping up tyres to the recommended pressure

  • emphasising that lower vehicle emissions will reduce both fuel costs and air pollution.


Consider using:

  • 'in-vehicle' elements, for instance to ensure vehicles display real-time information about current fuel efficiency, appropriate gear selection and speed

  • telematics technology to provide next-day information about driving style.


Consider monitoring fuel efficiency and providing feedback to drivers after training. This could include providing support from colleagues or 'buddies' to improve their driving style and rewards for those who drive efficiently (see NICE's guideline on behaviour change: individual approaches).


Consider monitoring the fleet's fuel consumption and evaluating the local effect on air pollutant emissions to demonstrate the benefits of training on fuel use and air quality.

Procuring public sector vehicles


Consider making low vehicle emissions (nitrogen oxides and particles) one of the criteria when making routine procurement decisions. This could include selecting low-emission vehicles, including electric vehicles.

See how the committee made recommendations 1.4.1 to 1.4.6.

1.5 Smooth driving and speed reduction


Consider promoting a smooth driving style by using:

  • speed limits and average speed technology on the roadside

  • real-time information to tell drivers what the current optimum driving speed is

  • 20 mph limits without physical measures to reduce speeds in urban areas where average speeds are already low (below around 24 mph) to avoid unnecessary accelerations and decelerations

  • signs that display a driver's current speed to reduce unnecessary accelerations.

    See also recommendations 1.4.1 and 1.4.2.


Where physical speed reduction measures are used to reduce road danger and injuries (20 mph zones – see NICE's guideline on unintentional injuries on the road), consider using them to encourage drivers to maintain a reduced, steady pace along the whole stretch of road, rather than road humps that may increase acceleration- and braking-related emissions.

See how the committee made recommendations 1.5.1 to 1.5.2.

1.6 Walking and cycling


Provide a choice of cycle routes, including routes that avoid highly polluted roads. Ideally use quiet streets or segregated routes.


Where busy roads are used consider:

  • Providing as much space as possible between the cyclist and motorised vehicles.

  • Using dense foliage to screen cyclists from motor vehicles, without stopping air pollution from dispersing or reducing the visibility or safety of cyclists near junctions. Also take into account concerns about personal safety.

  • Reducing the time cyclists spend at highly polluted sites, including some junctions, where this can be done without increasing the time that other groups spend exposed to poor air quality.

See how the committee made recommendations 1.6.1 to 1.6.3.

1.7 Awareness raising


Ensure healthcare professionals are aware that information on air quality is available, what it means for patients and what actions are recommended.


Consider providing information on:

  • How health is affected by exposure to air pollutants in the long term as well as during specific periods of poor air quality.

  • The impact of local pollution on air quality inside, as well as outside, a vehicle (levels of pollution are not always lower inside).

  • How to reduce air pollutants and people's exposure, including the need to:

    • Reduce the number of motor vehicle journeys, if possible.

    • Drive in a style that minimises emissions by: avoiding rapid accelerations and decelerations, restricting the time spent with an engine 'idling' and ensuring the vehicle is correctly maintained (see the Energy Saving Trust's driving advice).

    • Change routes to avoid highly polluted areas and adding to traffic congestion.


Consider public awareness initiatives such as car-free days or National Clean Air Day to raise awareness of air pollution.

Vulnerable groups


Healthcare professionals should be aware of vulnerable groups who are particularly affected by poor outdoor air quality. When notified of poor outdoor air quality, during any contact with vulnerable groups healthcare professionals should give general advice on how to avoid contributing to levels of air pollution and raise awareness of how to minimise exposure. This could include advice to:

  • Avoid or reduce strenuous activity outside, especially in highly polluted locations such as busy streets, and particularly if experiencing symptoms such as sore eyes, a cough or sore throat.

  • Use an asthma reliever inhaler more often, as necessary.

  • Close external doors and windows facing a busy street at times when traffic is heavy or congested to help stop highly polluted air getting in.

    (See also the Department for Environment, Food and Rural Affairs' information about the Daily Air Quality Index.)

See how the committee made recommendations 1.7.1 to 1.7.7.

Terms used in this guideline

This section defines terms that have been used in a specific way for this guideline. For general definitions, please see the glossary.

Electric vehicles

Any vehicle that uses 1 or more electric motors for propulsion. It includes electric bikes and electrically assisted pedal cycles (see the Highway Code information on electric bikes: licensing, tax and insurance).

Smooth driving

Driving in a way that assesses the road ahead to avoid unnecessary braking and acceleration, which increase the amount of fuel used and emissions.

Street canyons

Streets flanked by buildings on both sides. They can be categorised using the ratio of the height of the buildings to the width of the road, with a deep canyon having taller buildings relative to the width. The geometry of the canyon and its orientation to the prevailing wind influence the flow of air. This can lead to the formation of vortices and the recirculation of air that trap pollutants emitted within the canyon. It can also restrict dispersion, potentially leading to areas of high air pollution.

Vulnerable groups

Children, older people and people with chronic health problems are among the most vulnerable to air pollution. Short-term (for example day-to-day) peaks of elevated air pollution are linked with increased hospital admissions for people with respiratory and cardiovascular conditions. The Royal College of Physician's report on air pollution (Every breath we take: the lifelong impact of air pollution) noted that it can affect the growth of an unborn baby and may be linked to premature birth.