The King's Global Sustainability Fellowship in Air Quality and NCDs, supported by AstraZeneca
Air pollution is the leading environmental risk factor for non-communicable diseases (NCDs) and responsible for an estimated seven million premature deaths worldwide every year. The fine particles in polluted air that penetrate deep into the lungs and cardiovascular system can lead to many diseases and medical conditions, including lung cancer, chronic obstructive pulmonary diseases (COPD), pneumonia, stroke and heart disease. Air pollution-related diseases place a significant burden on public health systems, whilst also damaging the economy by reducing human performance and increasing sick days. NCDs kill 41 million people each year, equivalent to 71% of all deaths globally, and disproportionately affect people in low- and middle-income countries (LMICs) where more than three quarters (32 million) of global NCD deaths occur. NCDs pose a major health challenge for global development, particularly for LMICS, and threaten both economic and social advances. This ambitious study is applying a transdisciplinary approach to address the risks of NCD by focusing on air quality within the urban settings of LMICs. The project aims to generate evidence to conceptualise and co-design strategies to address air pollution in the Ugandan cities of Kampala and Jinja, and to replicate these strategies in other urban settings in LMICs. Applications in practice
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About the project
Building on ongoing work and collaborations, this project aims to co-design strategies to address air pollution in the Ugandan cities of Kampala and Jinja. The collaborative engagement with policy makers, businesses and academic stakeholders which has characterised this project to date is continuously providing better understanding of the interactions and cross-cutting interests among stakeholders and collaborators. The benefits of this approach are being further reinforced as the project progresses, leveraging on each collaborators’ strengths and allowing “cross pollination” of ideas.
Initial evidence has underscored the severity of air pollution in Kampala and Jinja, including the spatial and temporal distribution. This evidence is enabling collaborators to collectively decipher, prioritise, and co-design strategies to tackle air pollution. Examples include the piloting of retrofitting petrol-powered 2-wheel motorbikes (boda bodas) to electric vehicles in Kampala, the co-creation of air management policies, and the exploration of how air quality data could be used in respiratory disease management.
To achieve this, the project aims to:
- Synthesise evidence associated with air quality management strategies in African cities, with a focus on who is involved, what works, why, and the potential unintended consequences.
- Assess the knowledge and perspective of actors whose roles influence air quality and/or related health outcomes.
- Explore perspectives on feasibility and strategies for how air quality data can be used to generate evidence which informs mitigation actions for individuals and policymakers.
- Assess the potential impact of the transition to electric mobility.
- Re-convene stakeholders to share findings and co-design strategies to address air pollution and build capacity for public advocacy.
Impact and relevance
Through a comprehensive, intersectoral collaboration with various stakeholders, the project is working to provide a platform for the co-design of strategies to combat air pollution within the context of urban settings in LMICs and a knowledge sharing platform to stakeholders. In turn, this will aid in the prevention of diseases (NCDs) associated with poor air quality and exhibit how actors outside the healthcare and environment sector (e.g., the transport sector and the transition to e-mobility) can play an increasingly pivotal role in the health and wellbeing of people.
Workstreams
1. Scoping review
Current work on the review has provided critical insights on which strategies have been implemented in Africa, which ones have worked, who is/was involved, and unintended consequences (both positive and negative) caused by the implementation of these strategies. This evidence is vital to various stakeholders across different sectors, regions and/or countries who are involved in tackling air pollution. Providing information about successful strategies and their implementors has facilitated cross pollination of ideas, allowing participants to leverage the learnings of other stakeholders when using similar strategies. This review is crucial due to insufficient continuous air quality monitoring, the absence (or limited nature) of national policies on air pollution, and a lack of technical capacity to address air pollution in many African countries.
2. Mapping stakeholder perspectives
Mapping stakeholder perspectives has provided a comprehensive overview of the main stakeholders that are playing influential and increasingly larger roles in shaping the air quality landscape within Kampala and Jinja. Efforts to conceptualise and explore pathways through which air quality strategies in Kampala and Jinja can be shaped and adapting them to local contexts are currently ongoing.
3. Air pollution epidemiology
The burden of air pollution is increasing in LMICs with rapid economic development and urbanisation, due to a proliferation of emissions from industry, open trash burning, household fuels, and motorised transport. Mapping the variations in air pollution (PM2.5 levels) and meteorological conditions in Kampala has provided evidence on the severity of air pollution in Kampala; annual averages for fine particulate matter (PM2.5) currently exceed the World Health Organisation recommended annual limits by approximately 12 times. Air pollution “hotspots” have also been identified. Assessment of the association between air pollution (PM2.5 levels) and incidence of short-term respiratory illness/symptoms in Kampala is ongoing, with the project aiming to explore how air quality data can be integrated into the management of respiratory diseases.
4. Explore perspectives on feasibility and strategies on how air quality data can be integrated into the management of respiratory diseases.
Like much of Africa, Uganda's fast population growth and rapid urbanisation has led to a rapid increase in mobility demand to move people and goods. Motorcycle taxis (commonly known as boda bodas) form a major part of the solution. However, these motorcycles are major contributors to air pollution in cities and are expensive to maintain as a result of the need to frequently change engine oils and clutches. This project is currently piloting the retrofitting of existing petrol-powered motorcycles in Kampala to electric vehicles. An electric transition of boda bodas has the potential to reduce local air pollution and the related burden of disease, mitigating climate change, increasing the income of motorcycle riders, and creating tens of thousands of jobs in a new green economy for Kampala and other similar cities.
5. Co-designing strategies to address air pollution and build capacity for public advocacy.
The collaborative approach centres on involving stakeholders from business, policy and academia in the research. This co-production and co-design process aims integrate the best available knowledge, reconcile values and preferences, as well as it creates ownership for problems and solution options.
Selected outputs
Okello, G. and Tatah, L. (2025). Exploring the potential health impacts of electrifying two-wheelers in Kampala, Uganda. Cambridge: Cambridge Institute for Sustainability Leadership.
Okello, G., and Reynolds, J. (2022). Pathways to e-mobility transitions in Uganda: Policy brief on transition to electric mobility. University of Cambridge Institute for Sustainability Leadership.
Okello, G. (2021). Effective collaboration is a crucial pathway to tackling air pollution, climate change. New Vision, 8 November [Online article].
Interviewed for Cambridge Zero film, entitled 'Careers to Solve the Climate Crisis: The Built Environment' - YouTube
Interviewed for RE:TV documentary film, entitled ‘Recirculating Plastic' - re-tv.org
Semple, S., Dobson, R., O'Donnell., R., Abidin, E.Z., Tigova, O., Okello. G. & Fernández .E. (2022). Smoke-free spaces: a decade of progress, a need for more?, Tobacco Control.
Awokola. B.I., Okello. G., Mortimer. K., Jewell. C.P., Erhart. A. & Semple. S. (2020). Measuring Air Quality for Advocacy in Africa (MA3): Feasibility and Practicality of Longitudinal Ambient PM2.5 Measurement Using Low-Cost Sensors. Int. J. Environ. Res. Public Health.
Okello, G. (2021) Could electric motorcycles (e-bodas) reduce air pollution in Kampala and other rapidly growing African cities?. UrbanBetter, 17 May [Blog].
Woolley, K.E, Thomas, G.N., Kirenga, B., Okello, G. et al (2022). Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys. Atmospheric Environment.
Collaborators and funding
This work is supported by a philanthropic gift from AstraZeneca.
Advisors
Dr. Tolullah Oni, Clinical Senior Research Associate & Joint Lead, Global Diet and Activity Research Group and Network, MRC Epidemiology Unit, University of Cambridge. Dr Tolullah Oni - MRC Epidemiology Unit (cam.ac.uk)
Dr. Rebecca Nantanda, Makerere University Lung Health Institute, Makerere College of Health Sciences, Uganda. Dr. Rebecca Nantanda | Makerere University Lung Institute
Collaborators
Deo Okure and Engineer Bainomugisha - Makerere University AirQo, Uganda https://www.airqo.net/
Badru Ntege - NFT Mobility, Uganda: Home - NFT MOBILITY
Usamah Kaggwa Luutu – Ministry of Energy and Mineral Development
Jennifer Kutesakwe - National Environment Management Authority, Uganda
Richard Mikisa: Modjo Energies, Uganda https://www.modjoenergies.com/
William Avis - University of Birmingham, UK.
Immaculate Nyamaizi - Ministry of Works and Transport, Uganda.
Professor Rhoderic Jones, Dr. Lia Chatzidiakou and Dr. Lekan Popoola - Yusuf Hamied Department of Chemistry, University of Cambridge, UK
Additional sources of funding
Further funding to support current workstreams has been provided by:
The National Environment Research Council (NERC) impact grant in partnership with Cambridge Zero: Discipline Hopping for Environmental Solutions initiative (2022)