Manchester is winning awards for its smoke-free agenda but toxic air still plagues the city
Car emissions still make Manchester one of the UK's most polluted cities – are Clean Air Zones the answer?
Greater Manchester recently received an award for its work in making outdoor spaces smoke-free to improve Mancunians’ health, but as one of the worst UK cities for air pollution, city residents are still being exposed to debilitating health conditions.
Greater Manchester is home to 2.8 million people where an estimated 5,700 die each year of smoking-related illnesses, such as lung cancer, asthma and heart disease. A further 24,000 are hospitalised with these illnesses annually. 2022 data put the city among the UK’s worst for smoking with 15.4 per cent of adults smoking in the city, exceeding the English average of 13 per cent. England and Wales aim to reduce that number to 5 per cent by 2030 and Manchester is on the way to doing that, having driven its 2018 figure down from 18 per cent.
The UK government dictates smoking legislation but gives local authorities a budget to use how it sees fit on tobacco control. Manchester has taken one of the more comprehensive approaches, said John Waldron, policy and public affairs manager at advocacy group, Action on Smoking and Health.
While working towards national targets, the city also aims to ensure every child is born smoke-free and that no woman smokes during pregnancy by 2030. This “would be out with anything that has ever been achieved anywhere in relation to reducing smoking prevalence,” says David Boulger, associate director of population health at NHS Greater Manchester.
To do this, Greater Manchester’s NHS offers support to those who want to quit and launched the Make Smoking History campaign in 2016, which aims to change the way people perceive smoking and implements smoke-free spaces.
The government banned smoking in enclosed public spaces in 2007, but Manchester has extended that to outdoor spaces, including hospital grounds, transport hubs and parks such as the 6.5 acre Mayfield Park.
Costing approximately £50,000 over three years, these measures, said Boulger, are a “cost-effective” way of deterring smoking whilst protecting non-smokers from second-hand smoke. Other cities such as Bristol, Bradford and Durham have done similar, but not to the same extent as Manchester.
“Our work on smoke-free spaces and smoke-free hospitals is a sector-first, creating an environment where smoking is no longer the norm. This isn’t just about reducing smoking rates — it’s about transforming lives, communities, and the entire city-region,” Andy Burnham, Mayor of Greater Manchester, said in a statement.
It’s for this work that the city received a 2025 Partnerships for Healthy Cities award in March. The Partnerships is a network of 74 cities run by Bloomberg Philanthropies, Vital Strategies, and the WHO that promotes the reduction of injuries and diseases, such as cancers, diabetes and lung disease. It gives each city in the network $100,000 to kickstart such initiatives and honours a few each year pioneering efforts to improve health.
That Manchester worked in consultation with communities most impacted by smoking makes it unique, said Ariella Rojhani, director of the Partnership for Healthy Cities at Vital Strategies. The city conducted a series of community workshops to ensure locals understand the risks associated with smoking and launched toolkits for organizations to create smoke-free spaces.
“That's a tough nut to crack for a lot of cities in getting the right balance of community engagement and understanding how to meaningfully integrate that community engagement into the work,” Rojhani adds.
As a result, over 126,000 people have quit smoking since 2018, and the percentage of pregnant women smoking has halved from 12 per cent to 6 per cent, revealed Boulger. That is 6,000 babies that have been born smoke free, who wouldn't have been otherwise, he said.
Manchester’s efforts are inspiring cities like Melbourne, Paris and Rio De Janeiro, said Rojhani, to do the same while in the UK, “the northeast and parts of Yorkshire [are] steaming ahead, showing a lot of leadership, being really innovative and sharing best practices,” said Waldron.
“There are other areas where you don't see quite the same level of progress.” Westminster, Barrow and Furness and Lincoln are among the places with the highest number of smokers and venues that permit smoking.
The disparity in city action is because outdoor smoke free spaces aren’t mandated by the government, according to the interviewees. That could change, however, as Prime Minister Keir Starmer considers a ban on smoking in pub gardens, outdoor sports stadiums and children's parks.
Smoke-free but still toxic
While the work Manchester is doing in reducing smoking rates among its population is admirable, citizens are still exposed to toxic air via air pollution. The city’s nitrogen dioxide levels – mainly caused by vehicle emissions – often make it the most polluted city in the UK. But unlike London, Manchester hasn’t implemented any Clean Air Zones (CAZ).
Outdoor air pollution contributes to up to 43,000 deaths in the UK every year and triggers the same kinds of diseases as smoking, such as lung disease and cancers. In Manchester, the number of children admitted to hospital with pollution-related illnesses last year was 520 higher than the year prior.
CAZ are areas of a city where vehicles that exceed certain emission standards must pay in order to access. Ultra low emission zones (ULEZ) are a more stringent form of these. “You bring about cleaner technology vehicles and effectively ban older vehicles that have higher polluting behaviours,” explained David Carslaw, a researcher of urban air pollution at the University of York.
Since the implementation of the ULEZ in London in 2019, pollution has dramatically reduced and several other UK cities, including Bristol, Birmingham and Bath, have adopted them. But Manchester hasn’t followed suit.
One barrier, said Ben Pearce, head of health of effects of air pollution programme at Impact on Urban Health, is that such zones are often controversial. When a CAZ was proposed for 2022, Manchester residents petitioned against it, claiming the fee would disproportionately impact working people and small businesses.
“The mayor in London was braver and stuck with the ULEZ. That hasn't happened in Greater Manchester or other cities,” said Pete Abel, a campaigner with Manchester Friends of the Earth.
An additional challenge is that motorways run through Manchester yet the city has no authority over the motorway network, Abel said. “A huge chunk of the air pollution that affects people in Greater Manchester is outside the control of the Greater Manchester authority.”
The city is, however, investing in free public transport and more bike and pedestrian paths while the government considers its broader clean air plan. Air pollution is a focus within the mayoral combined authority, said Bougal, explaining that in 2017 Manchester was the first UK city to sign up to the BreatheLife 2030 campaign, which aims to make air quality levels safe by 2030 and has pledged to be carbon neutral by 2038; 12 years earlier than the UK’s overall goal.
The issue, said Liz Godfrey, the Manchester coordinator for grassroots organisation Mums for Lungs, is that there isn’t the same level of awareness of the impact of air pollution.
“It's invisible. We wouldn't drink dirty water, but we are breathing dirty air,” she says, adding that she would like to see a larger health message being shared, like there is for smoking. “It would be great if we could have these messages plastered across the back of buses saying that [it is] causing health issues.”
While both toxic air and smoking are harmful to Mancunians, these issues are distinct and don’t need to be mutually exclusive, said Waldron. “Just because you're trying to reduce one of them and not the other one doesn’t mean it's pointless. You're still reducing some of the harm and some of the exposure,” he said.
In fact, for non-smokers living with a smoker, second-hand smoke exposure is much worse for their health than traffic pollution, said Sean Semple, a professor at the Institute for Social Marketing and Health at the University of Stirling, who has researched the effectiveness of smoke-free spaces.
“We’ve measured PM2.5 [toxic, inhalable particles] in hundreds of smoking homes and the levels of pollution indoors can reach many, many times the concentrations that you’d find outdoors – even if you were standing on the busiest streets,” he said.
Pollution and smoking are both critical public health issues that continue to disproportionately impact the most vulnerable people in Manchester and beyond. A joined-up approach that focuses on prevention and additional layers of protection for children and the elderly is crucial, as well as bravery from politicians to implement measures that may not be universally popular.■
About the author: Rebecca. L. Root is a multimedia journalist from the UK based in Bangkok. She covers humanitarian aid, human rights, global health, development and climate, among other things. Her work has featured in The Guardian, The Telegraph, The New Humanitarian, Devex, and others.
At The Lead we believe in cleaner air for all, especially minorities communities and vulnerable sections of society who are more likely to be impacted by pollution and poor health. Our senior editor Natalie Morris has reported on the disproportionate burden of toxic air in our cities and how Black children are more likely to be hospitalised with pollution-related illnesses. Rosamund Adoo-Kissi-Debrah, the mother of Ella, the only person in the world to have air pollution listed as a cause of death on her death certificate, has also written for us on the success of ULEZ and why the Clean Air Bill is so important. Help support our independent rigorous journalism by taking a paid subscription to The Lead.
I read ‘The Link’ because it’s not London-centric or biased towards Southern England. But, all your stories are bloody miserable. Any chance of something on positive changes taking place?
This piece powerfully captures the paradox: we’ve normalized breathing what we’d never drink. The effort to make smoking visible and unacceptable has worked—imagine if we treated toxic air the same way. Both forms of harm deserve equal clarity and courage.