Ella Adoo-Kissi-Debrah verdict shows human cost of air pollution

A groundbreaking ruling that air pollution was a cause of death of a nine-year-old girl will make it harder for governments to ignore the human cost of air pollution and the public health emergency.

Southwark Coroner's Court yesterday (16 December) found that air pollution made a “material contribution” to the death of Ella Adoo-Kissi-Debrah. Ella is the first person in the UK, and probably the world, to have air pollution listed as a cause of death.

Ella, who lived near the busy South Circular Road in Lewisham, in south-east London, died in 2013. In the years leading up to Ella’s death, nitrogen dioxide emissions in Lewisham exceeded EU and UK legal limits and particulate matter levels were above the WHO guidelines.

During the inquest harrowing testimony was heard detailing how Ella would drown in lung secretions every one to five weeks, leading to her being admitted to hospital 27 times up to her death.

The coroner recorded the cause of death as: acute respiratory failure; severe asthma; and air pollution exposure. He added the lack of information given to Ella’s mother may also have contributed.

Human rights lawyer Jocelyn Cockburn, who represents Ella’s mother Rosamund and who is also an asthma sufferer, said: “We've had two weeks looking at what happened to poor Ella, who was a little girl who started becoming ill aged six and who died at nine.

“And what the coroner has set out is the impact that air pollution had on her lungs, the toxic effect, and how it ended up leading to both the development of her asthma and the exacerbation, which led to her death. So it really brings air pollution death to a human level, an individual micro level, which I think will make it be harder to be ignored.”

Cockburn said the verdict raised the question of whether other deaths in the UK are caused by air pollution and should be considered during inquests.

Studies have found up to 40,000 deaths are caused by air pollution each year in the UK, but during her work on the case Cockburn found a reluctance to acknowledge the link between air pollution and individual deaths. She said: “There is a disconnect between acknowledging that - and even acknowledging it is a public health emergency - and recognising that that is real impact on real human beings.”

Even among medical and pollution experts she said “there was almost a prevailing view that you could only ever look at it in the population and that it wouldn’t be possible to drill down to an individual level, which I felt was wrong”. It was thanks to a report in 2018 from Stephen Holgate, a professor of immunopharmacology, who also gave evidence at the inquest, that this “missing link was established”. This led to a campaign to quash the original verdict and open a new inquest into Ella’s death.

Cockburn said she was also surprised that there had not been more of a public health approach to air pollution in the UK, and that it has remained in the realm of the responsibilities of the Department for Environment, Food and Rural Affairs (Defra) in terms of air emissions standards with only “lip service” being paid to human health. She argued there was a “need for a more joined-up approach at government level to really learn the right lessons about policy, focused on health and how air pollution affects individuals”.

Cockburn also explained why she took on the case. “I felt personally, as a human rights lawyer that there is a case to be made – to say there is a human right to breathe clean air, in that there is a right to life under article 2 – and the government needs to take reasonable steps to address risk a risk to life, which we thought that air pollution posed.”

As well as having asthma, Cockburn has a spinal disability that restricts her lung capacity. “This was a personal thing to me as well. Ella's case was so disturbing to work on, but I could see although Ella had rare asthma, there must be evidence which can be found to show the damage that this causes to people. And it must also be the case that people are dying from it - and those deaths, the cause of those deaths, should be properly recognised.”

Following the verdict, the coroner has also requested submissions for a prevention of future deaths report that could make recommendations on tackling air pollution, and further news on this is expected in January.

Cockburn added: “You'll understand it's been an incredibly exhausting process for the family, who will be taking a well deserved break over Christmas to process what this ruling means. I think there will be more to come, not least the prevention of future deaths hearing next month.

“Rosamund is amazing person, and she's determined not only to get justice for Ella, but she wants lessons to be learnt from this. She wants positive change to happen as a result of this. So I've no doubt that she will continue to fight on.”