Ella Addo-Kissi-Debrah is the first person in the UK whose death certificate lists air pollution exposure as a cause of death. The inquest into her death comes after her mother, Rosamund Adoo-Kissi-Debrah, campaigned tirelessly for air pollution to be recognised as a factor in her daughter’s death.
Ella lived in Lewisham, South London, just 25 metres from the South Circular Road in Lewisham – a notorious pollution “hotspot” – which she used to walk along to get to her local primary school. Having been admitted to hospital after a coughing fit in 2010, she was subsequently hospitalised nearly thirty times and saw six different consultants over the three years before her death.
Former school teacher Miss Kissi-Debrah told the inquest that her daughter was put into a medically induced coma for three days to stabilise her condition. By the summer of 2012, Ella was classified as disabled, and her mother said she often had to carry her by piggyback to get her around.
Ella died in the early hours of 15 February 2013 following a severe asthma attack. An inquest into her death in 2014, which focused on Ella’s medical care, concluded acute respiratory failure and severe asthma as causes of death.
According to a report written by former government adviser Professor Sir Stephen Holgate, there was a “real prospect that Ella would not have died had it not been for unlawful levels of air pollution”.
Sir Stephen, a Professor of Immunopharmacology at the University of Southampton, told the court that Ella’s condition, along with her surroundings, had meant she was at risk and that her life was on a “knife edge”. “During these winter months, when air pollution was getting worse in her neighbourhood… this is when she would be experiencing her worse exposures,” he said.
His report also highlighted that pollution levels at the Catford monitoring station, one mile from Ella’s home, had “consistently” exceeded lawful EU limits over the three years before her death.
In addition to Sir Stephen’s comments, the fresh inquest was also permitted because illegal levels of air pollution were a potential breach of human rights under Article 2 of the European Convention on Human Rights – which protects the right to life.
The evidence of how poor air quality, primarily created by road traffic exhaust emissions, can affect vulnerable people has been building for years. A key review from Public Health England (PHE) last year recommended that cars should be banned from idling near schools and congestion charges imposed across the UK.
Inaction by the local government was one of the biggest concerns at the inquest. The family’s barrister, Richard Harmer QC, said Lewisham Council did not treat air pollution as a priority, despite knowing how dangerous it is. After studies indicated soaring pollution levels, especially on the South Circular Road and A21 trunk route, he told the Court that the council took seven years to produce the first strategic needs assessment.
Lewisham Council said it had little control over emissions or traffic flow. The Council’s Head of Environmental Health, David Edwards, who took over after Ella’s death, said the Council had tried to control pollution by implementing a banded system of parking permits based on emissions. They also encouraged cleaner vehicle use and alternative forms of transport among its residents.
In 2002 when then-mayor Ken Livingstone was concerned about the lethal potential of nitrogen oxides (NOx) in London. In giving evidence, Philip Graham, Executive Director of the Greater London Authority’s (GLA) Good Growth Fund, said each mayor had found appealing to the government for support “more of a source of frustration than an effective means” of change.
The inquest also revealed the lack of information available to local residents about the day to day risks they faced, perhaps because Councils’ feared the legal implications of their inaction.
Miss Kissi-Debrah said at the inquest that she “would have moved” if she had known how dangerous local air pollution was. She said she was aware of the car fumes but had never heard of NOx or their risks. Because of this, she never spoke to doctors about moving. It shone a light on the lack of awareness of how inner-city residents daily run the gauntlet of poor air quality.
The mayor of Lewisham, Damien Egan, said Ms Adoo-Kissi-Debrah’s campaign for clean air had been “hugely impactful”.
He added: “Our hope is that today’s ruling is the evidence needed to effect lasting change, to finally secure a national commitment to tackling air pollution in a meaningful way.”