Indoor air pollution kills 4.3 million people globally every year, according to the World Health Organization (WHO). The main causes are heating and cooking practices that produce high levels of toxic substances, such as fine particles and carbon monoxide.

Doctor Alessandro Miani, heads-up the non-profit Italian Society for Environmental Medicine (SIMA), which recently drew up a set of rules to preserve the air we breathe in our homes and offices. Miani, who is also professor of hygiene and environmental prevention at the University of Milan, discusses environmental medicine and the need for public health strategies to tackle indoor air pollution.

Professor Miani, the last WHO report shows that indoor air may be more harmful to health than outdoor air. Can you explain how this happens?
Indoor air is basically the same as outdoor air, but the difference lies in the amounts and types of contaminants. Indeed, besides the contaminants we find outside, we also have indoor contaminants. There are pollutants typical of homes such as dust, spores, moulds, and those produced by human activities like cooking and house-cleaning, which contribute to the release of additional damaging substances.

What’s the aim of the rules laid out in the SIMA Indoor Air Quality document?
In Italy, while for outdoor air there are laws that regulate the subject matter, there is no comprehensive set of rules that govern indoor pollution. Of course individual citizens should also convincingly adopt their own virtuous behaviours because the environment does not belong to states and governments, but to each one of us.

One way to improve indoor air quality is using biobased construction materials. For example, the European Isobio project is studying natural materials, like hemp and straw. By “breathing”, they offer better ventilation and help reduce damp. What benefits could this field of research provide?
There are no doubts that bioarchitecture and bioconstructions can contribute to improving the overall well-being of those who spend a lot of time indoors, and can offer practical help to improving the energy efficiency of buildings.

All this has a positive effect on the amount of harmful emissions from the heating systems of our homes, which are the biggest source of thin particulates in large towns. Moreover, there are many other entrepreneurial initiatives that, thanks to new compounds, are seeking to improve air quality. New green roof tiles and a new antismog paint are some examples.

What is meant by environmental medicine?
Environmental medicine deals with prevention, diagnosis and treatment of disorders that may be related to “environmental factors”. This is a sector that encompasses various disciplines such as biomedical sciences, environmental sciences, legal sciences, economic science, social and political science, material sciences, and construction science.

Environmental medicine may be considered to be the medical branch of the much broader field of environmental health, which, in turn, is a part of public health. It is not very well known in Italy, but it has been explored by WHO and is a common concern in the US.

Even though it is a fundamental issue for our health, it seems there is not enough attention to environmental medicine in the media of your country, Italy. Are there sensitivities around these issues?
The media need information that has been verified and certified, and this type of information can be provided only by associations and bodies that have strong ties with research and science. Releasing information through the media about initiatives aimed at informing the people or that intend to be a stimulus for politicians and institutions, requires players who are credible and well-known.

So I don’t think it is about hurting “sensitivities” but rather about the fact that so far the few people who have dealt with this issue before us, have restricted themselves to a specialised medical approach. Environmental medicine is instead a multidisciplinary field, aimed at preserving human health and at avoiding that our surroundings may become an environmental factor that causes diseases, injuries and premature death.