TThe investigation last December into the death of nine-year-old Ella Adoo-Kissi-Debrah caused a sensation around the world. The photograph of Ella, which was displayed in the forensic court and described by the coroner as showing Ella with a smile “as wide as the photograph,” appeared on screens and newspapers around the world. As attorneys for the family, we watched the evidence unfold over nine days. The culmination of years of tireless campaigning by Ella’s mother, Rosamund, had led to a historic moment: the first time air pollution had been officially recognized as a cause of death.
Last week, in his monitoring report, Phillip Barlow expressed concern that more action would be needed to prevent future similar deaths. The coroner identified three areas of concern: the discrepancy between current national targets for particulate matter and those recommended by the World Health Organization; the lack of public awareness; and insufficient communication from doctors to patients about the risks of air pollution.
Although the UK violated legal limits for nitrogen dioxide during Ella’s lifetime (many areas are still in breach today), the UK’s annual legal limits are in line with those recommended by the WHO. However, this is not the case for particulate matter, where current UK legal limits are well below those recommended by the WHO. For fine particulate matter, or PM2.5, the current UK annual limit is two and a half times higher than that recommended by WHO, and there is currently no limit in relation to hourly levels. The medical examiner has recommended that this disparity be rectified and that the WHO limits be considered the minimum acceptable standard.
The investigation also identified that while Ella had been cared for by multiple specialist doctors, none had warned her mother about the risks of air pollution. It was only after his death that Rosamund realized the risk posed by air pollution. The medical examiner has identified public awareness and training of physicians as an ongoing problem.
It’s rare that coroners are so bold in their recommendations. The urgency of the issues must be understood in the context of the inaction of successive governments, which was exposed in the course of the investigation.
The investigation heard that government reports had sounded the alarm about the risks and causes of air pollution many years before Ella was born. In particular, in 1998, the Department of Health committee on the medical effects of air pollutants reported that air pollution contributed to tens of thousands of deaths each year. However, as the committee’s former chairman Professor Stephen Holgate explained, it appeared that the agency’s reports simply stayed on government shelves.
Faced with these warnings, successive governments did not respond. Rather, the next round of incoming European vehicle emission standards was expected to solve the problem. Even if that approach had been effective, the evidence presented by the government suggested that it would only have been at a lethally slow pace.
The insufficiency of this rhythm was recognized by the government in the Air quality strategy 2007. The strategy noted that without further action, the UK would not succeed in reducing nitrogen dioxide levels below legal limits until more than a decade after it came into force in 2010. It proposed several policies to reduce air pollution, but not a single one was implemented.
In 2015, it became clear that engine manufacturers had been cheating laboratory vehicle emissions tests for diesel cars, and real-world emissions far exceeded emission limits. However, as the Department of Transportation witness Bob Moran accepted In the research, the evidence of the unreliability of the laboratory tests has been known since 2004 (the year Ella was born).
Unsurprisingly, the UK exceeded the legal limits regarding nitrogen dioxide when they came into force in 2010. That same year, Ella began suffering terribly severe asthma attacks. Finally, in February 2013, after about 30 of those attacks, Ella sadly died.
It took the death of a young girl and the exceptional courage of her mother to bring this issue to the fore. Until now, the health effects of air pollution have largely been considered through population-based epidemiological data, rather than through the impact on people. Perhaps this has allowed governments to speak lip-service about the “public health emergency” without treating it as such. Now the human cost of air pollution has a face, and it is the moving, radiant smile of a nine-year-old girl named Ella.
The coroner’s warnings come at a significant time, as the environmental bill must return to parliament. Before the bill was first published, it was expected to include a legally binding target for PM2.5 in accordance with WHO guidelines. However, this did not turn out to be the case, as the bill only committed to setting targets by the end of October 2022 and gave the secretary of state broad powers to revoke or lower targets.
Rosamund insists that lessons are learned from Ella’s death. She is asking the government to make changes to the environmental bill that will protect public health. She wants the government to heed the coroner’s recommendations and set legally binding air quality targets based on WHO guidelines and a duty to inform the public. These changes could be described as “Her law.”
Although Ella’s death certificate is the first to recognize air pollution as a cause of death, it has actually caused thousands of deaths and continues to do so. The government’s response will speak volumes about how seriously air pollution is really taken. More inaction now, following the precedent of successive previous governments, will be fatal.
Jocelyn Cockburn is a partner in civil freedoms and human rights, and Guy Mitchell is a lawyer in civil freedoms and human rights, at Hodge Jones & Allen lawyers
George is Digismak’s reported cum editor with 13 years of experience in Journalism