The death of a nine-year-old highlights that pollution is killing Britain’s poorest

After Ella Kissi-Debrah’s death, a legal battle is underway to establish a link between the impact of poor air quality and deprivation.

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The death of a nine-year-old in 2013 from a fatal asthma attack has this month been linked to illegally high levels of air pollution near her home. Now, a legal battle is underway to cite pollution as a cause of death for the first time – but it also gives insight into the deadly effects of air pollution on society’s most vulnerable.

Ella Kissi-Debrah lived just 25 metres from South Circular Road in Lewisham, London, a pollution hotspot and one of the most deprived areas in England. There was a “striking association” between Ella's emergency hospital admissions in the three years leading up to her death and recorded spikes in nitrogen dioxide and other harmful pollutants in the atmosphere, according to a report by one of the UK's leading experts on asthma and air pollution, Prof Stephen Holgate.

“There were air pollution monitors close to where Ella lived and went to school, which is why we can see such a strong link. This isn’t a usual case because there’s usually only one or two in each city,” Holgate said.

As the cause builds up, air pollution continues to impact our health – and the most likely victims are those from poorer families living in deprived inner-city areas, including Lewisham. Up to 50,000 people a year may die prematurely because of air pollution, an influential committee concluded after a six-month investigation seven years ago. It found that in pollution hotspots, such as inner-city areas – which have been linked to higher levels of unemployment, lower wages and child deprivation – minute sooty particles, emitted largely from the burning of diesel and other fuels, could be cutting vulnerable people's lives short by as much as nine years.

“There’s quite good evidence that socioeconomic deprivation and inner-city areas are more exposed to air pollution,” Holgate said. “The data is pretty sound: socioeconomic deprivation is a driver of adverse health.”

Research suggests that it’s not just that poorer families are more likely to live in areas more exposed to air pollution, but that they’re also more vulnerable to its effects. Wealthier families living in polluted areas are more likely to work indoors and use private transport, and are more able to afford better-constructed housing, according to the European Commission’s 2016 Science for Environment Policy report.

There are hopes that Ella’s case could add to the pressure on the government, which was accused by a partnership of four committees of “dragging its feet” over air quality improvements in June, to act faster. The committees recommended that the government brings forward the ban on the sale of new conventional diesel and petrol cars currently planned for 2040.

“Until recently, the government’s whole strategy has been about complying to EU commission levels and not thinking about what those levels relate to, which is adverse health,” said Holgate, who is working with the government on its new Clean Air Strategy, which it plans to publish next year. The act will enshrine in law individual’s right to breathe clean air, he said, in a move towards complying with tougher standards set by the World Health Organisation, as opposed to the European Commission.

Any new policies must be implemented alongside efforts to raise public awareness, but Holgate says public health messages around the health risks of air pollution have so far been “dreadfully slow”.

“There are multiple factors driving adverse health in deprived communities, but air pollution is one of them and I’m not sure how much the public is aware of that. Unless people have the information, they don’t know how to respond, and this been part of whole issue; there hasn’t been wide publicity or PR exercise to increase knowledge about things. The public are beginning to get on to it now, but we have to keep pushing on,” he said.

Ella’s mother, Rosamund Adoo-Kissi-Debrah, who was working as a teacher when her daughter died, has said no medical professional from the five hospitals in which Ella was treated ever explained the link between air pollution and asthma.

But beyond the basics of knowing to close windows and avoid busy roads, Ella’s case could help shed light on the bigger picture, and how inner-city communities are ultimately powerless in the face of the adverse health effects of air pollution.

“Ella’s mother is such an amazing person; very intelligent and articulate, and a wonderful, caring mother. She was living in a poor area, bringing up four children on her own,” Holgate said.

“Cases like Ella's are crucial if they can show that pollution which is not of the family’s or child’s making contributed to the death of a child. It adds another reason for needing to act, which is why this case will get tested quite severely in the courts.”

A Public Health England (PHE) spokesperson said: “PHE is currently in the process of reviewing the evidence of the effectiveness of different interventions and will be reporting its findings to ministers later this year. When the outcome of this work is known, it will contribute to the evidence base for improving information provision on health improvement and mitigation of the risks of air pollution.”