Coroner urges government to set legally-binding pollution targets

A coroner has today urged the government to change the law after a nine-year-old girl was killed by air pollution. 

In a landmark inquest last year, coroner Philip Barlow ruled that toxic air contributed to the death of Ella Kissi-Debrah. 

The nine-year-old, who lived near a notorious pollution hotspot in south London, died after suffering three years of seizures and nearly 30 visits to hospital for treatment to breathing problems.

The council admitted pollution levels were a ‘public health emergency’ at the time of the schoolgirl’s death but it failed to act on it. 

Mr Barlow said Ella’s mother, Rosamund, had not been given information which could have led to her take steps which might have prevented her daughter’s death.  

Today, the coroner said legally binding targets for particulate matter in line with World Health Organisation (WHO) guidelines would reduce the number of deaths from air pollution in the UK and urged the Government to take action.

The WHO guidelines suggest keeping an average concentration of PM2.5 under 10 micrograms per cubic metre of air (µg/m3), to prevent increased deaths.

The UK limit, based on European Union (EU) recommendations, is a yearly average of 25 µg/m3.

Ella’s bereft mother, who spent more than five years campaigning for justice, said she would have moved home if she had known polluted air was killing her nine-year-old daughter. 

She said today: ‘Because of a lack of information I did not take the steps to reduce Ella’s exposure to air pollution that might have saved her life. 

‘I will always live with this regret. 

‘People are dying from air pollution each year. Action needs to be taken now or more people will simply continue to die.’

Ella Kissi-Debrah, nine, died in 2013, after three years of seizures and 27 visits to hospital for treatment to breathing problems

Ella Kissi-Debrah, nine, died in 2013, after three years of seizures and 27 visits to hospital for treatment to breathing problems

Ella Kissi-Debrah, nine, died in 2013, after three years of seizures and 27 visits to hospital for treatment to breathing problems

Rosamund Kissi-Debrah, Ella's mother

Rosamund Kissi-Debrah, Ella's mother

A handout photo showing Ella at the front, middle, with her siblings

A handout photo showing Ella at the front, middle, with her siblings

Rosamund Kissi-Debrah, Ella’s mother, (left) and a handout photo showing Ella at the front, middle, with her siblings 

The nine-year-old lived just 80ft from a notorious pollution 'hotspot' on the busy south circular road in Lewisham, south-east London - one of the capital's busiest roads

The nine-year-old lived just 80ft from a notorious pollution 'hotspot' on the busy south circular road in Lewisham, south-east London - one of the capital's busiest roads

The nine-year-old lived just 80ft from a notorious pollution ‘hotspot’ on the busy south circular road in Lewisham, south-east London – one of the capital’s busiest roads

How air pollution causes a catalogue of health problems 

Pollutants, including nitrogen dioxide and small particles known as particulate matter, or PMs, play a role in the equivalent of 40,000 early deaths a year in the UK, experts have said.

Air pollution can create a catalogue of health problems; it triggers strokes, heart and asthma attacks, increasing the risk of hospitalisation or death, causes cancer and can stunt lung growth in children.

It has been linked to premature births, damage to children’s learning and even dementia.

Older people, the young and those with chronic illnesses are more vulnerable to air pollution and those on low incomes and from ethnic minorities are disproportionately affected by it.

Legal limits for pollution to protect people’s health should have been met by 2010.

But across the UK levels of nitrogen dioxide still breach the rules today, and while particulate matter pollution is within legal limits, it is still above World Health Organisation guidelines.

The Government has lost three court actions in the last decade brought by environmental law charity ClientEarth, over its failure to tackle the problem of illegally dirty air.

The court cases have prompted requirements for action by local, regional and devolved governments – and a new clean air strategy last year to tackle the problem.

In 2019, 33 of the UK’s 43 air quality zones were still above the legal limit for nitrogen dioxide, analysis of government figures by ClientEarth has revealed, including London, Manchester, Sheffield, Glasgow, Belfast and Bristol.

Nitrogen dioxide and PMs come from sources such as road traffic and domestic heating systems including boilers and wood burners, with vehicles – particularly diesel vehicles – a key part of the problem.

In the long-term, the shift to electric vehicles and heating systems will help, though particle pollution is still caused by tyres and brakes, but those improvements are still many years off.

Traffic’s role in nitrogen dioxide emissions was highlighted earlier this year when levels of the pollutant fell in many cities and towns as people stayed home and roads emptied of vehicles in lockdown.

But the benefits were short-lived, as pollution has already returned to pre-pandemic levels or even higher in the majority of towns and cities.

And evidence suggests that air pollution could play a role in at least some of the deaths from Covid-19, compounding its other health impacts.

As people continue to stay away from public transport, efforts to encourage active travel such as walking and cycling in towns and cities – which would also benefit health and reduce the pollution that drives climate change – have been mixed.

Low traffic neighbourhoods and cycle lanes have been installed, but a backlash from some motorists has seen them removed in places such as Kensington High Street.

Campaigners want to see measures to speed up the use of electric vehicles, including e-bikes, and the introduction of clean air zones, which charge drivers of the most polluting vehicles in certain areas.

But efforts to bring in clean air zones have been delayed by the pandemic in some areas.

Part of the lack of urgency on the issue may be because, unlike the old pea-souper smog events that prompted the UK’s first Clean Air Act to clean up pollution in the 1950s, today’s pollutants are an invisible killer.

But now the fatal impact of pollution has a human face – an active nine-year-old girl who died because of the toxic air she was surrounded by.

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Today Mr Barlow, the assistant coroner for Inner South London, said greater public awareness of air pollution information would help individuals reduce their personal exposure.

And he warned the adverse effects of pollutants were not being sufficiently communicated to patients and their carers by medical staff.

In his report published today, Mr Barlow said national limits for particulate matter – a dangerous form of air pollutant – were set far higher than WHO guidelines. 

The coroner said: ‘The evidence at the inquest was that there is no safe level for particulate matter and that the WHO guidelines should be seen as minimum requirements.

‘Legally binding targets based on WHO guidelines would reduce the number of deaths from air pollution in the UK.’ 

Ella’s mother Rosamund spent more than five years battling for a second probe into her daughter’s death.  

A previous inquest ruling from 2014, which concluded Ella died of acute respiratory failure, was quashed by the High Court following new evidence about the dangerous levels of air pollution close to her home. 

The nine-year-old lived just 80ft from the south circular road in Lewisham, one of the capital’s busiest roads.

Ella was rushed to hospital following a 2am coughing fit but repeatedly lost consciousness and eventually died February 2013.

The inquest heard how levels of nitrogen dioxide where she lived had been over the limit for three years.

Representatives from the local council admitted it had moved at a ‘glacial’ pace after identifying concerns in 2007 but not bringing in an action plan for seven years. 

At a second inquest last year, the schoolgirl was the first person in the UK to have air pollution listed as the cause of death on their death certificate. 

Mr Barlow said: ‘Ella’s mother was not given information about the health risks of air pollution and its potential to exacerbate asthma. 

‘If she had been given this information she would have taken steps which might have prevented Ella’s death.’ 

Mr Barlow said Government departments for environment, health and transport should address the issue, while local and national governments should address the lack of public awareness about pollution information.

Health bodies and professional organisations needed to tackle the failure by doctors and nurses to communicate the adverse effects of air pollution on health to patients, he said.

Ella’s mother Rosamund Kissi-Debrah called on the Government to act on the recommendations, warning people were dying needlessly because of a lack of public information about the levels of pollution and the health risks.

She said: ‘As the parent of a child suffering from severe asthma, I should have been given this information but this did not happen.

‘Because of a lack of information I did not take the steps to reduce Ella’s exposure to air pollution that might have saved her life. I will always live with this regret.

‘But it is not too late for other children.’ 

Ms Kissi-Debrah said she would be contacting Environment Secretary George Eustice to urge him to put the WHO pollution guidelines into law in the Environment Bill and achieve them in the shortest possible time. 

She added: ‘I invite the Government to act now to reduce air pollution. Immediately. Not in eighteen months, not in five years – that’s not fast enough.

‘People are dying from air pollution each year. Action needs to be taken now or more people will simply continue to die.’

A Government spokesperson said: ‘Our thoughts continue to be with Ella’s family and friends.

‘We are delivering a £3.8 billion plan to clean up transport and tackle NO2 (nitrogen dioxide) pollution.

‘Through our landmark Environment Bill, we are also setting ambitious new air quality targets, with a focus on reducing public health impacts. 

‘We will carefully consider the recommendations in the report and respond in due course. ‘

Dirty air was responsible for one in eight (12 per cent) of all global deaths in 2019, with half of these related to cardiovascular disease (file photo)

Dirty air was responsible for one in eight (12 per cent) of all global deaths in 2019, with half of these related to cardiovascular disease (file photo)

Dirty air was responsible for one in eight (12 per cent) of all global deaths in 2019, with half of these related to cardiovascular disease (file photo)

Ella Kissi-Debrah (pictured left with mum Rosamund), from Lewisham, was the first case of a person in the UK to have air pollution listed as the cause of death

Ella Kissi-Debrah (pictured left with mum Rosamund), from Lewisham, was the first case of a person in the UK to have air pollution listed as the cause of death

Ella Kissi-Debrah (pictured left with mum Rosamund), from Lewisham, was the first case of a person in the UK to have air pollution listed as the cause of death

The difference between nitrogen dioxide and particulate matter

NITROGEN DIOXIDE (NO2)

  • Gas is produced along with nitric oxide (NO) by combustion, which are together referred to as NOx
  • 80% of NOx emissions in areas where the UK is exceeding NO2 limits are due to transport
  • Largest source is from diesel light duty vehicles – cars and vans
  • Others include power generation, industrial processes and heating
  • Short-term exposure to high NO2 levels that can cause inflammation of the airways leading to coughs
  • It is also linked to reduced lung development and respiratory infections in early childhood 
  • Studies associate it with reduced life expectancy, although it is unclear whether this is caused by NO2 or other pollutants at the same time 

PARTICULATE MATTER (PM)

  • Generic term refers to mixture of solid and liquid particles 
  • Some are emitted directly (primary PM), while others are formed in the atmosphere through chemical reactions (secondary PM)
  • Composition depends on geographical location, emission sources and weather
  • Main sources of man-made PM are the combustion of fuels by vehicles, industry and domestic properties
  • Natural sources include wind-blown soil and dust, sea spray particles, and fires involving burning vegetation
  • Particles larger than 10µm are mainly deposited in the nose or throat, but those smaller than 10µm pose the greatest risk because they can be drawn deeper into the lung
  • Long-term exposure to PM increases mortality from cardiovascular and respiratory diseases 
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Responding to the report, Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, said: ‘The death of nine-year-old Ella Kissi-Debrah from a fatal asthma attack, triggered by air pollution, has shone a bright light on the need for the Government to urgently tackle toxic air.’

She said children, older people and the 6.5 million people in the UK living with respiratory disease were all at risk from poisonous air.

‘If the Government follows the recommendations in this report, and commits to much bolder clean air laws in line with World Health Organisation guidelines, this would be a game-changer, potentially preventing thousands more families facing the death of a loved one because of air pollution.

‘We are urging the Government to produce a health protection plan for England to safeguard everyone from the effects of air pollution overseen by a newly created cross-government air quality minister.

‘This should include proposals to train up health professionals to understand how dirty air impacts our health and ensure people are getting the health information they need about air pollution to protect themselves.’

Environmental law charity ClientEarth has won a number of legal fights against the Government over its failure to meet legal limits for another air pollutant, nitrogen dioxide (NO2).

Katie Nield, lawyer for ClientEarth, said: ‘The coroner’s report highlights that air pollution is still putting people’s lives at risk in the UK – eight years after Ella’s death and over a decade after legal limits should have been met.’

She said pollution was often touted as an ‘invisible killer’ but public bodies are well aware of where harmful emissions are coming from and their impact on people’s health.

The solution has been available to public bodies in the form of clean air zones, which remove the most polluting vehicles from the roads.

Ms Nield added: ‘The coroner himself has highlighted that legally binding targets based on stricter WHO guideline levels for harmful particulate matter would prevent future deaths.

‘Toxic air is clearly not going to disappear on its own. The Government needs to get its act together and explain what more it is going to do to prevent lives like Ella’s being cut short.’

In December London recorded the biggest annual reduction in air pollution last year of any area of Britain – but it is still at illegal levels and the worst air quality in the country.

Ella's mother Rosamund Adoo-Kissi-Debra, pictured in 2018 at the south circular road in Catford, south London

Ella's mother Rosamund Adoo-Kissi-Debra, pictured in 2018 at the south circular road in Catford, south London

Ella’s mother Rosamund Adoo-Kissi-Debra, pictured in 2018 at the south circular road in Catford, south London

What are the World Health Organisation guidelines on particulate matter? 

According to a WHO assessment of the burden of disease due to air pollution, more than 2 million premature deaths each year can be attributed to the effects of urban outdoor air pollution and indoor air pollution (caused by the burning of solid fuels). 

The WHO guidelines suggest keeping an average concentration of PM2.5 under 10 micrograms per cubic metre of air (µg/m3), to prevent increased deaths.

The UK limit, based on European Union (EU) recommendations, is a yearly average of 25 µg/m3.

Across the UK levels of nitrogen dioxide still breach the rules today. 

And while particulate matter pollution is within legal limits, it is still above World Health Organisation guidelines and there is concern that it is not being brought below this. 

The WHO says that at eight-hour concentrations exceeding 240 µg/m3 , significant health effects are considered likely. Both healthy adults and asthmatics would be expected to experience significant reductions in lung function, as well as airway inflammation that would cause symptoms and alter performance. 

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The capital, whose Mayor Sadiq Khan introduced an Ultra Low Emission Zone in April last year, saw a 13 per cent fall in nitrogen dioxide levels in 2019 from 2018.

The analysis by ClientEarth emerged after the second inquest into Ella’s death.  

Key pollutants in the air are from vehicles are nitrogen dioxide and particulate matter (PMs). 

While pollutant levels have fallen in recent years, ClientEarth found 33 out of 43 UK air quality zones still have levels of nitrogen dioxide that are above legal limits.

While particulate matter pollution is within legal limits, it is still above World Health Organisation guidelines and there is concern that it is not being brought below this.

The research was carried out in October, seven years after Ella passed away.

ClientEarth said the data from 2019 came before a temporary decrease in nitrogen dioxide levels in some areas due to the coronavirus lockdown in March.

However it added that traffic and pollution levels had since been back on the rise in many towns and cities, and the temporary dip should not be an excuse for inaction.

ClientEarth said the UK is not meeting legal limits of nitrogen dioxide pollution, where the annual average cannot exceed 40µg/m3 (micrograms per cubic metre of air).

And there are concerns over clean air zones which deter the most polluting vehicles from entering the most polluted parts of towns being pushed back due to the crisis. 

Legal limits for pollution to protect people’s health should have been met by 2010.

But across the UK levels of nitrogen dioxide still breach the rules today, and while particulate matter pollution is within legal limits, it is still above World Health Organisation guidelines.

The Government has lost three court actions in the last decade brought by ClientEarth, over its failure to tackle the problem of illegally dirty air.

The court cases have prompted requirements for action by local, regional and devolved governments – and a new clean air strategy last year to tackle the problem.

Mr Khan claims that since he took office in 2016, nitrogen dioxide levels have reduced in Central London by a rate five times greater than the national average.

In 2016, London’s air exceeded the hourly legal limit for nitrogen dioxide for more than 4,000 hours – but last year this fell to just over 100 hours.

In 2019, 33 of the UK’s 43 air quality zones were still above the legal limit for nitrogen dioxide, analysis of government figures by ClientEarth revealed, including London, Manchester, Sheffield, Glasgow, Belfast and Bristol.

Nitrogen dioxide and PMs come from sources such as road traffic and domestic heating systems including boilers and wood burners, with vehicles – particularly diesel vehicles – a key part of the problem.

Air pollution increases the risk of several conditions, including heart attack, stroke and diabetes. Covid-19 is thought to be more deadly in people with cardiovascular disease

Air pollution increases the risk of several conditions, including heart attack, stroke and diabetes. Covid-19 is thought to be more deadly in people with cardiovascular disease

Air pollution increases the risk of several conditions, including heart attack, stroke and diabetes. Covid-19 is thought to be more deadly in people with cardiovascular disease

ANNUAL AVERAGE CONCENTRATIONS OF NITROGEN DIOXIDE IN UK AREAS 
YEAR  URBAN (GENERAL) URBAN (ROADSIDE)  RURAL 
1997 46.04 59.72 17.69
1998 40.67 59.02 14.48
1999 39.70 61.81 15.95
2000 35.87 57.26 13.97
2001 35.67 54.31 15.47
2002 32.91 49.40 12.93
2003 35.28 54.82 14.94
2004 32.43 52.18 11.21
2005 32.43 53.62 10.36
2006 31.93 54.21 10.45
2007 28.45 52.74 10.45
2008 28.24 49.88 8.95
2009 29.15 45.80 8.99
2010 31.32 46.23 9.37
2011 26.94 41.17 9.23
2012 26.75 41.44 9.73
2013 25.39 38.88 8.68
2014 25.21 38.36 7.98
2015 22.83 36.08 7.04
2016 23.28 37.55 8.65
2017 21.74 33.68 7.58
2018 20.00 32.80 7.14
2019 19.57 31.14 7.17

Revealed: MailOnline dissects the impact greenhouse gases have on the planet – and what is being done to stop air pollution

Emissions

Carbon dioxide

Carbon dioxide (CO2) is one of the biggest contributors to global warming. After the gas is released into the atmosphere it stays there, making it difficult for heat to escape – and warming up the planet in the process. 

It is primarily released from burning fossil fuels such as coal, oil and gas, as well as cement production. 

The average monthly concentration of CO2 in the Earth’s atmosphere, as of April 2019, is 413 parts per million (ppm). Before the Industrial Revolution, the concentration was just 280 ppm. 

CO2 concentration has fluctuated over the last 800,000 years between 180 to 280ppm, but has been vastly accelerated by pollution caused by humans. 

Nitrogen dioxide 

The gas nitrogen dioxide (NO2) comes from burning fossil fuels, car exhaust emissions and the use of nitrogen-based fertilisers used in agriculture.

Although there is far less NO2 in the atmosphere than CO2, it is between 200 and 300 times more effective at trapping heat.

Sulfur dioxide 

Sulfur dioxide (SO2) also primarily comes from fossil fuel burning, but can also be released from car exhausts.

SO2 can react with water, oxygen and other chemicals in the atmosphere to cause acid rain. 

Carbon monoxide 

Carbon monoxide (CO) is an indirect greenhouse gas as it reacts with hydroxyl radicals, removing them. Hydroxyl radicals reduce the lifetime of carbon dioxide and other greenhouse gases. 

Particulates

What is particulate matter?

Particulate matter refers to tiny parts of solids or liquid materials in the air. 

Some are visible, such as dust, whereas others cannot be seen by the naked eye. 

Materials such as metals, microplastics, soil and chemicals can be in particulate matter.

Particulate matter (or PM) is described in micrometres. The two main ones mentioned in reports and studies are PM10 (less than 10 micrometres) and PM2.5 (less than 2.5 micrometres).

Air pollution comes from burning fossil fuels, cars, cement making and agriculture

Air pollution comes from burning fossil fuels, cars, cement making and agriculture

Air pollution comes from burning fossil fuels, cars, cement making and agriculture 

Scientists measure the rate of particulates in the air by cubic metre.

Particulate matter is sent into the air by a number of processes including burning fossil fuels, driving cars and steel making.

Why are particulates dangerous?

Particulates are dangerous because those less than 10 micrometres in diameter can get deep into your lungs, or even pass into your bloodstream. Particulates are found in higher concentrations in urban areas, particularly along main roads. 

Health impact

What sort of health problems can pollution cause?

According to the World Health Organization, a third of deaths from stroke, lung cancer and heart disease can be linked to air pollution. 

Some of the effects of air pollution on the body are not understood, but pollution may increase inflammation which narrows the arteries leading to heart attacks or strokes. 

As well as this, almost one in 10 lung cancer cases in the UK are caused by air pollution. 

Particulates find their way into the lungs and get lodged there, causing inflammation and damage. As well as this, some chemicals in particulates that make their way into the body can cause cancer. 

Deaths from pollution 

Around seven million people die prematurely because of air pollution every year. Pollution can cause a number of issues including asthma attacks, strokes, various cancers and cardiovascular problems. 

 

Asthma triggers

Air pollution can cause problems for asthma sufferers for a number of reasons. Pollutants in traffic fumes can irritate the airways, and particulates can get into your lungs and throat and make these areas inflamed. 

Problems in pregnancy 

Women exposed to air pollution before getting pregnant are nearly 20 per cent more likely to have babies with birth defects, research suggested in January 2018.

Living within 3.1 miles (5km) of a highly-polluted area one month before conceiving makes women more likely to give birth to babies with defects such as cleft palates or lips, a study by University of Cincinnati found.

For every 0.01mg/m3 increase in fine air particles, birth defects rise by 19 per cent, the research adds. 

Previous research suggests this causes birth defects as a result of women suffering inflammation and ‘internal stress’. 

What is being done to tackle air pollution? 

Paris agreement on climate change

The Paris Agreement, which was first signed in 2015, is an international agreement to control and limit climate change. 

It hopes to hold the increase in the global average temperature to below 2°C (3.6ºF) ‘and to pursue efforts to limit the temperature increase to 1.5°C (2.7°F)’.

Carbon neutral by 2050 

The UK government has announced plans to make the country carbon neutral by 2050. 

They plan to do this by planting more trees and by installing ‘carbon capture’ technology at the source of the pollution.

Some critics are worried that this first option will be used by the government to export its carbon offsetting to other countries.

International carbon credits let nations continue emitting carbon while paying for trees to be planted elsewhere, balancing out their emissions.

No new petrol or diesel vehicles by 2040

In 2017, the UK government announced the sale of new petrol and diesel cars would be banned by 2040.  

However,  MPs on the climate change committee have urged the government to bring the ban forward to 2030, as by then they will have an equivalent range and price.

The Paris Agreement, which was first signed in 2015, is an international agreement to control and limit climate change. Pictured: air pollution over Paris in 2019.

The Paris Agreement, which was first signed in 2015, is an international agreement to control and limit climate change. Pictured: air pollution over Paris in 2019.

The Paris Agreement, which was first signed in 2015, is an international agreement to control and limit climate change. Pictured: air pollution over Paris in 2019.

Norway’s electric car subsidies

The speedy electrification of Norway’s automotive fleet is attributed mainly to generous state subsidies. Electric cars are almost entirely exempt from the heavy taxes imposed on petrol and diesel cars, which makes them competitively priced.

A VW Golf with a standard combustion engine costs nearly 334,000 kroner (34,500 euros, $38,600), while its electric cousin the e-Golf costs 326,000 kroner thanks to a lower tax quotient. 

Criticisms of inaction on climate change

The Committee on Climate Change (CCC) has said there is a ‘shocking’ lack of Government preparation for the risks to the country from climate change. 

The committee assessed 33 areas where the risks of climate change had to be addressed – from flood resilience of properties to impacts on farmland and supply chains – and found no real progress in any of them.

The UK is not prepared for 2°C of warming, the level at which countries have pledged to curb temperature rises, let alone a 4°C rise, which is possible if greenhouse gases are not cut globally, the committee said.

It added that cities need more green spaces to stop the urban ‘heat island’ effect, and to prevent floods by soaking up heavy rainfall. 

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