Air Pollution's First Fatality: A Case Study

Air pollution is a leading cause of premature death, with millions dying annually due to the inhalation of toxic gases and particles. While air pollution has long been known to have detrimental health effects, the first case study of an air pollution-related death was recorded in 2020, when a coroner ruled that air pollution had contributed to the death of 9-year-old Ella Adoo-Kissi-Debrah in London, UK. Ella suffered from acute asthma and lived near a highly polluted road, with levels of nitrogen dioxide and particulate matter exceeding legal limits. This landmark ruling brought attention to the urgent need to address air pollution as a public health crisis and set a precedent for recognizing air pollution as a cause of death.

Air pollution recognised as cause of death

Air pollution has long been known to have a detrimental impact on human health. However, in 2020, air pollution was formally recognised as a cause of death for the first time in the UK, and possibly the world.

In the case of 9-year-old Ella Adoo-Kissi-Debrah, a coroner ruled that dangerous levels of air pollution near her home in Lewisham, London, contributed to her death in 2013. Ella suffered from a rare type of acute asthma, which made her particularly susceptible to toxic gases and particles in the air. She lived close to the South Circular Road, where she was exposed to excessive levels of nitrogen dioxide (NO2) and particulate matter, with levels exceeding World Health Organization (WHO) and European Union guidelines. During her life, she experienced multiple seizures and was admitted to the hospital 27 times in the three years before her death.

The coroner's ruling stated that air pollution induced and exacerbated Ella's severe asthma, concluding that it made a material contribution to her death. This landmark ruling has brought attention to the issue of air pollution and its impact on public health, with the mayor of London, Sadiq Khan, calling for bolder policies to address this "public health crisis".

While this ruling is a significant step forward, it is important to acknowledge that the link between air pollution and mortality has been well-established in scientific research. Studies have shown that air pollution causes hundreds of thousands of premature deaths each year, with vehicle emissions being a major contributor. The recognition of air pollution as a cause of death in Ella's case sets a precedent and underscores the urgency of tackling air pollution to prevent further loss of life.

Going forward, this case will likely influence policies and interventions aimed at reducing air pollution and protecting public health. It highlights the need for collaboration between different sectors and governments to implement effective solutions. While the battle against air pollution is ongoing, this ruling serves as a turning point in acknowledging the deadly impact of air pollution and advocating for change.

Inquest found excessive pollution exposure

In 2020, a coroner's inquest ruled that air pollution contributed to the death of nine-year-old Ella Adoo-Kissi-Debrah, marking a landmark case in the United Kingdom and possibly the world. Ella, who lived near the South Circular Road in Lewisham, London, died in 2013 following an asthma attack. She had a rare type of acute asthma and was particularly susceptible to the toxic gases and particles in air pollution.

The inquest found that Ella had been exposed to excessive levels of pollution, including nitrogen dioxide (NO2)—a gas emitted by combustion engines that can irritate the airways and aggravate respiratory diseases. Levels of NO2 near her home exceeded the guidelines set by the World Health Organization (WHO) and the European Union. In the three years before her death, Ella had multiple seizures and was admitted to the hospital 27 times.

Professor Stephen Holgate, an immunopharmacologist and consultant respiratory physician, served as the star witness in the inquest. He asserted that the cumulative effect of the toxic air Ella breathed living in close proximity to the South Circular Road caused her final acute asthma attack. He likened Ella to "a canary in a coal mine," signalling the risk to other Londoners from pollutants such as nitrogen oxides.

The coroner's conclusion was hailed as a "landmark moment" by the Mayor of London, Sadiq Khan, who emphasised the need to tackle the public health crisis of toxic air pollution. The ruling is expected to increase pressure on the government to address illegal levels of air pollution and prioritise public health programmes.

While this ruling specifically pertained to Ella's case, it adds to the growing body of evidence highlighting the adverse health effects of air pollution. Researchers estimate that air pollution causes millions of premature deaths worldwide each year. Studies have consistently linked air pollution to respiratory and cardiovascular diseases, cancers, and other serious health conditions.

Air pollution a public health crisis

Air pollution is a significant public health crisis. It is the largest environmental risk to health, causing an estimated 7 million premature deaths annually. The sources of air pollution are multiple and context-specific, with outdoor and indoor pollution contributing to morbidity and mortality. Outdoor air pollution is caused by residential energy use, vehicles, power generation, agriculture, waste incineration, and industry. Indoor air pollution is caused by household combustion devices, such as open fires or simple stoves for cooking.

The health effects of air pollution are well-documented and include respiratory diseases, strokes, heart diseases, lung cancer, and adverse effects on children's health and prenatal development. Research has also found a link between long-term exposure to fine particle pollution and an increased risk of early death, with an elevated risk of mortality from cardiovascular and respiratory causes.

Despite improvements in air quality in some regions, large parts of the population in urban areas still breathe air that does not meet health-based standards. This is particularly true in low- and middle-income countries, which suffer from the highest exposures to air pollution.

The harmful impact of air pollution has been recognized in landmark legal cases. In 2020, a coroner's ruling in London found that air pollution contributed to the death of a child, Ella Kissi-Debrah, who lived close to a highly polluting road and suffered from severe asthma. This ruling was described as a "landmark moment" by the Mayor of London, who acknowledged the need for bold policies to address the public health crisis of toxic air pollution.

Addressing air pollution requires a combination of public attitude shifts, effective monitoring and reporting systems, and the implementation of bold policies that prioritize public health. By tackling air pollution, we not only improve public health but also contribute to mitigating climate change, as many of the drivers of air pollution are sources of greenhouse gas emissions.

Vehicle emissions cause premature deaths

Vehicle emissions are a significant contributor to air pollution and have been linked to a range of adverse health effects, including premature deaths. A 2013 study by MIT's Laboratory for Aviation and the Environment found that air pollution causes about 200,000 early deaths each year in the United States, with vehicle emissions being the biggest contributor. The study mapped local emissions in 5,695 U.S. cities and found that the highest emissions-related mortality rate was in Baltimore, where 130 out of every 100,000 residents are likely to die prematurely due to long-term exposure to air pollution.

The health impacts of vehicle emissions are caused by a mix of pollutants, including fine particulate matter (PM2.5) and nitrogen dioxide (NO2). These pollutants can have severe health consequences, including cardio-respiratory diseases such as lung cancer and childhood asthma, as well as adverse birth outcomes and diabetes. Children and unborn babies are particularly vulnerable to the effects of air pollution.

In a sector-by-sector analysis, the MIT study found that emissions from road transportation contributed to the most significant number of premature deaths, with 53,000 early deaths per year attributed to exhaust from the tailpipes of cars and trucks. This is partly because vehicles tend to travel in populated areas, increasing large populations' pollution exposure. The study also found that pollution from electricity generation accounted for 52,000 premature deaths annually, with the largest impact seen in the east-central United States and the Midwest due to the higher sulfur content of coal used in power plants in these regions.

Outside of the United States, vehicle emissions have also been found to cause premature deaths in other countries. For example, researchers have estimated that vehicle emissions may cause over 11,000 deaths per year in Australia, with traffic pollution causing ten times more premature deaths than road accidents. The lack of new vehicle carbon dioxide standards and the lag in meeting European standards for fuel quality and vehicle emissions in Australia have been cited as contributing factors.

To address the health risks associated with vehicle emissions, the implementation of stringent fuel and vehicle standards has been proposed. The International Council on Clean Transportation suggests that accelerated adoption of regulations equivalent to Euro 6/VI or U.S. Tier 3 standards would prevent 210,000 premature deaths in 2030 and mitigate 1.4 GtCO2e cumulatively from 2015 to 2030. Additionally, advanced aftertreatment technology, engine tuning, and the use of ultra-low sulfur diesel fuel can significantly reduce tailpipe particulate matter emissions.

Pollution levels: a country's development indicator

Pollution is a pressing issue that affects countries worldwide, and its impact on human health and the environment cannot be overstated. As such, assessing pollution levels is a critical aspect of evaluating a country's development. This is particularly evident in the case of air pollution, which has been linked to adverse health effects, including allergies, asthma, and even death.

In December 2020, a landmark ruling in the UK brought air pollution into sharp focus. For the first time, air pollution was recognized as a contributing factor in the death of nine-year-old Ella Adoo-Kissi-Debrah, who lived near a highly polluting road in Lewisham, London. The coroner's conclusion highlighted the dangerous levels of nitrogen dioxide (NO2) and particulate matter (PM) in the area, exceeding legal limits set by both the EU and the World Health Organization (WHO).

This tragic case underscores the significance of pollution levels as a key indicator of a country's development. While economic indicators like gross national income per capita are traditionally used to gauge development, pollution levels provide a more nuanced understanding. They reflect the environmental and health consequences of a country's policies and practices, highlighting areas requiring urgent attention.

Various organizations and indices are dedicated to tracking and analyzing pollution levels globally. The European Commission and the Netherlands Environmental Assessment Agency maintain the EDGAR database, which records CO₂ emissions data from 1970 onwards. The Integrated Carbon Observation System's Global Carbon Project also provides valuable pollution data. Additionally, the Environmental Performance Index (EPI) ranks 180 countries based on environmental performance, considering factors like air quality, PM2.5 exposure, and sanitation.

The EPI reveals that countries in the European Union, such as Denmark, Switzerland, and Germany, tend to be the most environmentally friendly. In contrast, developing countries in East Asia and even highly developed nations like the United States struggle with significant pollution issues. These rankings offer insights into the effectiveness of different countries' environmental policies and their overall development.

In conclusion, pollution levels serve as a critical indicator of a country's development, going beyond economic metrics to encompass the health and environmental implications of a nation's progress. The case of Ella Adoo-Kissi-Debrah underscores the deadly consequences of air pollution and the need for bold policies to address this public health crisis. By recognizing the impact of pollution, countries can prioritize sustainable practices, safeguard public health, and foster a more holistic development paradigm.

Frequently asked questions