skip to content

Cambridge Institute for Sustainability Leadership

Air quality and NCDs

Air pollution is the leading environmental risk factor for non-communicable diseases (NCDs) and responsible for an estimated seven million 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 adopting 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, 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

  • Future risk and opportunity
  • Measures, targets and disclosure
  • Culture, capacity and leadership


Contribution to CISL’s core research themes

Zero carbon


Protection of nature


Inclusive and resilient societies




About the project

Building on existing work within the field of air pollution epidemiology, air quality management strategies used by other African cities, and engagement of community, commercial and policy actors, this Fellowship is exploring interventions to reduce outdoor air pollution in Kampala and Jinja cities, in Uganda. Through the application of transdisciplinary research methods, the project will identify, understand, and integrate stakeholder perspectives into the co-design of strategies for both cities, thereby fostering healthier and safer communities in Uganda through evidence-based policies and citizen science.

To achieve this, the project aims to:  

  1. 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 of strategies.
  2. Assess knowledge and perspective of actors whose roles influence air quality and/or related health outcomes
  3. Map of air pollution and explore association with healthcare visits and admissions.
  4. Explore clinician perspectives on feasibility of and strategies for integrating air quality data into patient care/management of respiratory diseases.
  5. Re-convene stakeholders/actors to share findings and co-design strategies to address air pollution and build capacity for public advocacy.

Sustainability Impact and relevance

Through a comprehensive, intersectoral collaboration with policy, community, and commercial actors whose roles influence air quality and/or the related health outcomes, the project will provide a platform for the co-design of strategies to combat air pollution within the context of urban settings in LMICs. 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) play an increasingly pivotal role in the health and wellbeing of people.


1. Scoping review

In the face of rapid urbanisation, many African countries are vying with the complexity and cost of understanding and controlling air pollution. The situation has been further exacerbated by insufficient monitoring, the absence (or limited nature) of national policies on air pollution, and a lack of technical capacity, all of which have contributed to a shortage of guidance.

The review will provide a repository of information for stakeholders/actors to reference when considering which strategies might be suitable for their local context, which partners could become potential collaborators, and the pitfalls which should be avoided during implementation of these strategies.

2. Mapping stakeholder perspectives

The comprehensive approach required for the prevention of diseases associated with poor air quality (NCDs) necessitates intersectoral collaboration, as the actors that influence air quality lie largely outside the healthcare sector and include the likes of industry, urban development, transport, household energy and waste management. Mapping stakeholder perspectives will provide a comprehensive overview of who are the main actors that play influential and increasingly larger roles in shaping the air quality landscape within the urban settings of LMICs. This will further support the identification and development of necessary communication and management strategies needed to tackle air pollution in LMICs.

3. Air pollution epidemiology

The burden of air pollution is increasing in LMICs with rapid economic development and urbanization, due a proliferation of emissions from industry, open trash burning, household fuels and motorized transport . The global air pollution crisis is closely linked to rapidly worsening impacts on health, economy and climate change. Evidence from this objective will enable us to identify the air pollution “hot spots” in the two cities and explore how the air quality is associated with health centre visits and admissions due to respiratory illness/symptoms.

4. Explore perspectives on feasibility and strategies on how air quality data can be integrated into the management of respiratory diseases.

Different forms of day-to-day exposure patterns (duration and concentrations) of air pollutants, are associated with different pathologies namely myocardial infarction (MI), respiratory tract disease, asthma, increased COPD exacerbations etc. Ambient air pollutant exposure has been linked to asthma exacerbation and other respiratory symptoms. A recent landmark court ruling in the UK recorded exposure to air pollution as a medical cause of death of a nine-year-old girl who died following a fatal asthma attack. This objective will enable us, together with the primary healthcare clinicians, explore the use of air quality data in the (self) management of patients with respiratory disease and multimorbidity (RD+MM) by better understanding (and avoiding) potential triggers (temporal changes in air pollution) to symptoms within their daily lives.

5. Co-designing strategies to address air pollution and build capacity for public advocacy.

Strategies to address air pollution have been largely developed by the healthcare and academic sector, without the society-wide engagement required to comprehensively understand the complex social-environmental systems, changing circumstances and the inherent trade-offs. Our approach to craft usable knowledge will involve a wide and inclusive range of actors’ collaboration. This objective will be centred on involvement of actors within and outside academia (community, commercial and policy) into the research process (co-production and co-design process) in order to integrate the best available knowledge, reconcile values and preferences, as well as create ownership for problems and solution options. 


Babatunde I. Awokola, Gabriel Okello, Kevin J. Mortimer, Christopher P. Jewell, Annette Erhart and Sean Semple. 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 2020, 17(19), 7243;

Okello, G. (2021) Could electric motorcycles (e-bodas) reduce air pollution in Kampala and other rapidly growing African cities? UrbanBetter.

Webinar: Air Quality, Urban Mobility and Governance in Kampala 

Collaborators and funding

This work is supported by a philanthropic gift from AstraZeneca.


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 (

Dr. Rebecca Nantanda, Makerere University Lung Health Institute, Makerere College of Health Sciences, Uganda. Dr. Rebecca Nantanda | Makerere University Lung Institute


Paul Green and Engineer Bainomugisha - Makerere University AirQo, Uganda.  

Professor Rhoderic Jones, Dr. Lia Chatzidiakou and Dr. Lekan Popoola - Yusuf Hamied Department of Chemistry, University of Cambridge, UK.

Jennifer Kutesakwe - National Environment Management Authority, Uganda.

William Avis - University of Birmingham, UK.

Kampala Capital City Authority, Uganda.

Immaculate Nyamaizi - Ministry of Works and Transport, Uganda.

Christopher Lubega – United States Embassy Kampala, Uganda.


Dr Gabriel Okello

Dr Gabriel Okello

The Prince of Wales Global Sustainability Fellow in Air Quality and NCDS, supported by AstraZeneca



“Enhancing population awareness of the health effects of breathing polluted air at home, work and outdoors is key to driving behavioural and policy changes at individual, community, national and international level. This will in turn foster air quality improvements and consequent health benefits for various communities.”

Dr Gabriel Okello

“AstraZeneca’s strong partnership with CISL is based on a shared drive to advance science-based approaches to address sustainability issues. The Fellow for the programme, studying the health-related impacts of air quality,  is rooted in a region of the world of critical interest to AstraZeneca. He has been integrated into the best of Cambridge related research and the programme has a specific aim to carry its results into practice – in this case addressing air quality management in African cities.”

Professor Jason Snape, AstraZeneca