Enhancing Local Air Quality Management to maximise public health integration, collaboration and impact in Wales, UK: A Delphi study

Background: Outdoor air pollution is a significant public health problem. The UK Local Air Quality Management (LAQM) regime is intended to protect public health through a prescribed process of assessment and collaborative action. Despite its intention and underpinning principles, public health bodies and specialists do not interact with or support LAQM as much as they could or should. This study aimed to explore and understand this disconnect, to inform action that can resolve problems and maximise public health integration, collaboration and impact in this important public health work. Methods: The Delphi technique was used to elicit multiple viewpoints from a range of experts on this complex problem in Wales, UK. Over three iterative feedback-interspersed survey rounds, 86 expert panellists generated opinions and formed consensus on the role of public health bodies and specialists in LAQM and the added value that might be achieved as a result of increased integration and collaboration. Linked opportunities, barriers and solutions were also described. Qualitative data were subject to thematic analysis; quantitative data were analysed using descriptive statistics to assess consensus, and the Wilcoxon matched-pairs signed-ranks test to assess response stability. Results: Consensus opinion confirmed the public health role in LAQM should support both broader mainstream risk assessment and management, and also enabling functions such as communications, research and evidence appraisal, advocacy and leadership. Linked opportunities, barriers and solutions were described so as to facilitate change. Panellists suggested that the added value of increasing integration and collaboration would be more efficient, creative and, productive collaboration, meaningful risk assessments and effective action. Conclusions: The significant role of public health in LAQM is rarely recognised or realised. The findings of this study present a convincing evidence-based case for directing and supporting much-needed change to LAQM sous to increase public health integration, collaboration and impact. Not only has this study generated new evidence to enhance LAQM policy and practice, it has also confirmed the applicability of the Delphi method in investigating complex environmental public health problems. While some opinions generated relat to Wales' unique circumstances, most were general in context and will have relevance and importance across the UK and in countries beyond where air quality management and public health policy and practice are disconnected.