The poorest, the most vulnerable and ethnically diverse communities, however, are suffering the most. At the same time, these communities are also the least likely to contribute to the problem and, often, least equipped to fix it.
In recent years, thousands of determined ordinary people have taken up the fight for clean air, from concerned parents to fed up residents from polluted areas.
While they’ve scored some key victories, they now face daunting challenges. Private car ownership is growing, public transport is being slashed and a new government is poised to rip up key environmental legislation.
This month, the government is supposed to set new air pollution targets for the UK, marking a pivotal moment in the fight for clean air.
With strong targets and bold governance, eradicating air pollution – and saving thousands of lives – could be an easy win for the environment and climate.
Without this leadership, every one of us is condemned to years more of breathing in toxic air.
“Can you imagine not being able to breathe?”
When I arrive to meet her in a Lewisham cafe, it’s Rosamund Adoo-Kissi-Debrah who asks the first question.
As I sit down, Adoo-Kissi-Debrah asks how old I am. She’s wondering, she explains, whether I and her daughter Ella belong to the same generation. This year, Ella would have turned 18.
In 2023, Adoo-Kissi-Debrah will mark 10 years since her eldest daughter, Ella Adoo-Kissi-Debrah, died at nine years old from a fatal asthma attack.
Ella and her family lived just 25 metres from London’s polluted south circular road, and in 2020, a coroner ruled – for the very first time in the UK – that air pollution was one of the causes.
This landmark judgement was the result of a years-long, hard-won battle fought by Adoo-Kissi-Debrah, who found herself wanting for answers after Ella passed away.
Initially, Adoo-Kissi-Debrah had no idea that her daughter’s death could have been linked to air pollution.
“Why would I? Remember this was more than 10 years ago, [air pollution] didn’t really feature in the popular press,” she says.
Ella had also been born a “happy, healthy child”, Adoo-Kissi-Debra tells me. She was enthusiastic about sports and had a reading age well beyond her years. Even in the worst parts of her illness, Ella was devastated about her school attendance dropping.
The problems began just before Ella’s seventh birthday with a cough that started “basically like a cold”, Adoo-Kissi-Debrah says. When it continued, doctors diagnosed Ella with asthma.
From there onwards, Ella’s health deteriorated rapidly. Over the next 18 months, she would be admitted to hospital at least 28 times as coughing fits left her gasping for air. At one point, doctors were forced to place her in an induced coma.
Ella was tested for everything from cystic fibrosis to epilepsy in an attempt to get to the bottom of her asthma triggers, but air pollution was never considered. Ella, says Adoo-Kissi-Debrah, was terrified.
“I could tell by the look in her eyes. Can you imagine not being able to breathe? It’s been described as like she was drowning in her own mucus,” she says.
After months of hospital visits, scares and sleepless nights, Ella died following an asthma attack in the early hours of February 15, 2013. She had turned nine just weeks before.
In some ways, Adoo-Kissi-Debrah says she was relieved that Ella was no longer suffering. This had been the most unbearable thing to endure.
“For all that I miss her, I wouldn’t trade it in for how much she was suffering. Even if the selfish part of me as a mother would have wanted me to die first,” she says.
Heartbroken, and searching for answers, Adoo-Kissi-Debrah gave an interview urging the public to get in touch if they knew what might have caused her daughter’s death.
When somebody suggested checking air pollution data for the night Ella died, the penny dropped: nitrogen dioxide concentrations had rocketed to illegal highs on the night that Ella suffered her fatal asthma attack.
Alongside lawyer Jocelyn Cockburn and asthma management expert Professor Stephen Holgate, Adoo-Kissi-Debrah fought tooth and nail for a second inquest to prove that air pollution played a role in her daughter’s death.
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The initial inquest concluded that Ella died of acute respiratory failure, and with no precedent for what Adoo-Kissi-Debrah was attempting, she was told her chances were slim.
“Our chances weren’t high” she says. “Once an inquest is done it’s usually done. It takes something extraordinary to change that.”
Yet after more than five years, a fresh inquest decision was made in December 2020. Southwark Coroner’s Court found that air pollution “made a material contribution” to Ella’s death.
A significant spike in air pollution the day that Ella died was a key piece of evidence. Without it, according to Holgate, Ella might have survived that night in February 2013.
“Thousands of people are living much worse lives”
Living near the south circular road, Ella spent years of her life exposed to two main types of air pollution: nitrogen dioxide and particulate matter.
Though other types of outdoor air pollution exist, nitrogen dioxide and small particle pollution are considered the biggest threats to human health. In both cases, road transport contributes a significant proportion.
Ella, with her lungs weakened by a rare form of asthma, is an extreme example of the damage that air pollution can do, but even those with a full bill of health can’t escape negative consequences.
The UK has missed previous targets on reducing air pollution, and, according to the National Audit Office, is set to miss its 2030 targets too.
Thanks to this delay in combating the problem, almost everyone who ventures outdoors in the UK is exposed to pollution every day.
As the vehicle fleet moves slowly towards electrification, the nitrogen dioxide problem may improve. Yet even electric cars produce small particle pollution from tyre wear and breaking.
Walk along any busy UK road and these tiny particles will travel, invisibly, through your mouth or nose and down into your lungs.
Once they get there, explains air pollution expert Professor Frank Kelly, your body will interpret these particles as a foreign invader.
White blood cells – those that provide immune support – are sent over to neutralise the threat, only to find that they aren’t equipped to do so.
As well as creating damage by causing the immune system to attack the lungs, scientists believe that these air pollution particles are also able to carry toxins from the outside environment into your lungs and even your bloodstream.
The list of complications this can cause is terrifyingly long, from asthma and heart disease to dementia and lung cancer. Scientists have even found air pollution particles in the lungs, livers and brains of unborn babies.
The problem is, it’s difficult to prove direct causation, and even more difficult to quantify air pollution’s impact on quality of life more generally. For clean air campaigners, this makes life very difficult.
“It’s not just that people are dying prematurely, it’s that thousands of people are living much worse lives because they can’t sleep, or can’t work because of conditions they have as a result,” says Jemima Hartshorn, human rights lawyer and co-founder of campaign group Mums for Lungs.
“Air pollution is an endemic public health issue, but we can’t link it to health issues in the same way as we can with a virus.”
“Imagine if all politicians were affected by air pollution”
Since Ella’s death, Adoo-Kissi-Debrah has become one of the most prominent air pollution campaigners in the country.
Her aim, she explains, has never been to prove a point. Her only wish is to stop other children suffering and dying in the way her daughter did. It hasn’t always been easy.
“I’m having to sell something people can’t see,” she says, adding that a lack of education around air pollution and the damage it causes makes things even more difficult.
The landmark judgement on Ella’s death in 2020 galvanised many people into action and led to widespread calls for tougher limits on air pollution. Yet when it comes to leadership at the very top, progress has been frustratingly slow.
When the government opened a consultation on air pollution targets earlier this year, they proposed a fine particulate matter limit which was twice as high as WHO recommendations and wouldn’t be achieved until 2040.
At the time, Adoo-Kissi-Debrah called the proposed target “appalling”, and was joined by a host of environmental groups who condemned the government’s continued failure to clean up the UK’s air.
Zack Polanski, deputy leader of the Green Party and the chair of the London Assembly’s environment committee says the government has “failed to speak to the magnitude of the moment” with its proposals.
“The work of people like Rosamund [Adoo-Kissi-Debrah] in raising awareness has been fantastic. The thing we now need is government leadership,” he says.
Yet Polanski thinks there’s another reason why decision makers have dragged their feet on the issue: air pollution doesn’t affect everyone equally.
According to data gathered by Friends of the Earth, (FOE) people of colour in England are three times more likely to live in neighbourhoods with high air pollution than white people. Half these neighbourhoods are also among the most deprived in the country.
Measures to combat air pollution such as clean air zones (CAZ) and low-traffic neighbourhoods (LTNs) are often attacked by those in opposition as an assault on ordinary working class people.
On the contrary, FOE’s data found that those living in the areas with the highest levels of air pollution are three times less likely to own a car than people living in other areas. In short, they’re suffering the consequences of emissions created by wealthier people.
This situation is largely driven by the fact that cheaper housing is built, sold and rented alongside major roads. Often, people with fewer means have little choice over their exposure to air pollution as a result.
Meanwhile, the chief medical officer for England pointed out in 2017 that deprived communities face a “triple jeopardy” of higher exposure to air pollution, a greater burden of poor health, and a greater susceptibility to the impact of pollution.
“Imagine if all the politicians were impacted by air pollution. I think they’d do something more quickly,” Adoo-Kissi-Debrah muses.
“I worry about people from my community and marginalised groups. I would like some of them to be decision makers, but they’re not. They’re stuck on a lower level,” she says, gesturing with her hands.
“I worry I’ll be sitting here saying the same thing”
Unlike climate change, which will continue for some time even if we ditch fossil fuels entirely, measures to combat air pollution can have dramatic, almost instantaneous effects.
The pandemic was a prime – if unintentional – example.
Prof Kelly, who studied air pollution during lockdown periods, found reductions of more than 50 per cent in London’s nitrogen dioxide levels. The drop in particulate matter was lower than expected thanks to particles being blown over from agricultural fields in Europe.
As the air cleared in cities across the globe, billions of people caught a glimpse of what a world without air pollution could look – and feel – like.
It’s clear that lockdowns aren’t the solution to cleaner air, but the right solutions could create rapid change. All it would take, say campaigners, is leaders bold enough to see them through.
For all clean air campaigners, a better, cheaper public transport system is of utmost importance, as is “better, more accountable strategies for home and online deliveries,” says Hartshorn.
For his part, Polanski has been pushing for rollout of road charging in London to keep cars off the road and pollution down.
Though he says more action is needed faster, both he and Hartshorn say improvements in London’s air quality in recent years proves that decisive action works. It’s also hoped that a clean air bill making its way through the Lords (nicknamed “Ella’s Law”) could push politicians even further.
What all campaigners fear, however, is a lack of political will and leadership around the issue, along with a reluctance for those in power to be seen as restricting personal freedoms.
“When the smoking bans came in, that wasn’t popular, but it worked. They [the government] aren’t being honest with the public about how sick it’s making them, how much the NHS is spending to deal with it,” Hartshorn says.
“They come back to our demands saying: ‘We only want to take action with public will’ – it feels like a cop out.”
Following a change of government and months of domestic and global instability, Adoo-Kissi-Debrah fears the moment for action is now at risk of slipping down the priority list.
“I worry that in five years’ time, I’ll be sitting here saying the exact same thing,” she says.
With monitoring and advances in science, the danger presented by air pollution is clearer than ever before. To tackle it, it’s time for politicians to step up, says Polanski.
“Everyone agrees that there’s a problem, and everyone agrees that we shouldn’t be breathing toxic air,” Polanski says.
“What’s not been agreed on is exactly what the options are – but we need these solutions to happen. We’re moving in the right direction, but we really need to step it up.”
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