AIR pollution kills 7 million people a year worldwide. In the US, the figure is about 200,000 people. In the European Union, it is a shocking half a million.
At least, these are the sorts of figures health authorities release. But they don’t mean we can identify any of the 7 million individuals killed by air pollution each year. Rather, it is a way of representing statistically the years of life lost to air pollution, as most of us will die earlier from the toll it takes on our health.
If the family of Ella Kissi-Debrah get their way, though, this might change. Ella was a Londoner with severe asthma who died aged 9 in 2013. An inquest in 2014 found she died of respiratory failure, caused by asthma. Her family want a new inquest to rule that air pollution killed her. “We will be arguing that there’s a real prospect that without air pollution Ella would not have died,” says the family’s lawyer, Jocelyn Cockburn.
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It is an extraordinary case. There have been legal battles over air pollution before, but none like this. So is it possible to attribute an individual death to air pollution? And what would it mean if we can?
Ella’s family live next to a very busy road, and she walked or was driven along it to get to and from school. Between 2010 and her death in 2013, she was taken to hospital nearly 30 times with asthma attacks.
At the time of the inquest, her family had not given air pollution any thought – no doctor had even mentioned it. But Ella’s mother, Rosamund Kissi-Debrah, regarded her death as unexplained and kept looking for answers.
In 2015, she was told that local air pollution was high at the time Ella died, and began to wonder if there was a link. Ella’s case has now been investigated by Stephen Holgate, a doctor at Southampton General Hospital and an .
“We have strong evidence that air pollution in her locality in London played a major role in her asthma throughout her short life and her subsequent fatal attack,” says Holgate. “But since my report is helping in a legal case, it cannot be made public yet.”
On the basis of the report, Ella’s family are appealing for the verdict of the 2014 inquest to be overturned, paving the way for a new one to take a wider look at the circumstances of her death. “We say there’s a public interest in there being a new inquest which looks not just at whether air pollution contributed to Ella’s death, but also what lessons must be learned to avoid future fatalities,” says Cockburn.
“We will be arguing that there’s a real prospect that without air pollution Ella would not have died”
The legal argument hinges on EU nitrogen dioxide limits set in 2010. The UK still breaches them. The family’s hope is that a new inquest will conclude that the state failed to protect Ella from illegal levels of air pollution, violating her right to life as set out in human rights laws.
The case isn’t about damages or compensation. Rather, Rosamund Kissi-Debrah says she wants air pollution tackled so no other children and families will suffer.
“This is the latest of a growing wave of legal actions based on human rights, where courts are called upon to establish a link between air pollution and health impacts suffered by particular individuals,” says Ugo Taddei of the environmental group ClientEarth. “If established in the courts, this precedent could be very significant.”
Hard to breathe
There is no doubt that air pollution is bad for us. The damage can start before a child is born, restricting growth and brain development in the uterus, with lifelong effects. Children exposed to high levels of air pollution have lower lung function and have far more respiratory infections.
In adults, the result is more likely to be cancer, cardiovascular disease, diabetes or obesity. A that followed half a million people for 15 years found that those exposed to greater amounts of air pollution were more likely to die early.
Findings like these allow statisticians to calculate, say, that kills 40,000 people in the UK each year. But these figures are a construct. If a bus driver drops dead of a heart attack aged 40, that early death might be due to air pollution – or it might not. There is usually no way to establish what role air pollution played in individual cases.
Asthma is somewhat different. For one thing, some studies suggest air pollution can make children develop asthma in the first place. In the city of Yokkaichi in Japan, in the 1950s after a petrochemical plant opened. More than 500 people sued the oil company and won compensation in 1970.
It is plausible, then, that Ella would not have developed asthma if she had lived in a less polluted area – but as yet there is no way to prove this. However, there is also , and that some people are very sensitive to it (see graphic).
The claim in Ella’s case is that all but one of her attacks coincided with high levels of local air pollution. Her lungs also showed signs of pollution damage, says Cockburn, and other possible causes have been excluded.
Correlation is not causation, though, points out an expert on air pollution who did not want to be named. What’s more, the evidence that nitrogen dioxide exacerbates asthma is not as strong as that for particulate air pollution. Scientifically, there is no way to be 100 per cent sure that high nitrogen dioxide levels caused Ella’s death.
Legally, that does not matter. For most , the standard of proof rests on “a balance of probabilities” rather than “beyond reasonable doubt”.
If a new inquest does blame air pollution, what happens next is unclear. The UK government has already lost a series of court cases brought by ClientEarth over its failure to take swift action to meet the nitrogen dioxide limits. Earlier this year, the EU said it would sue the UK and five other countries for failing to comply.
Meanwhile, all the media coverage around the ClientEarth cases has greatly increased public awareness. A recent opinion poll suggests that and half want the state to do more. Yet despite all this pressure, the government is still dragging its feet.
The main problem is that there are lots of highly polluting diesel vehicles on the roads. Air pollution will gradually fall as the oldest, most polluting vehicles are replaced. Yet the courts have ruled that the government must act now, regardless of cost. Air pollution campaigners say ministers have instead taken the cynical decision that it is cheaper to continue breaking the law.
But this delay is opening up a new legal front. The continued failure of countries to meet the EU limits means governments are set to be sued for damages, as in Yokkaichi. In the UK, barrister Frances Lawson is preparing a test case on behalf of a child with severe asthma.
The legal test will be whether air pollution “materially contributed to” the child’s condition, decided on the balance of probabilities. That means the case has a good chance of success, says Lawson. “I’m hopeful.”
What will strengthen the case is if another inquest into Ella’s death takes place and a coroner’s ruling that she died because of illegal air pollution arrives in time. But it might well succeed on its own merits. The plan is then to bring a case on behalf of a group of people with asthma. With 5 million such individuals in the UK, this could prove costly for the government.
And it’s not just people with asthma who could sue. Air pollution has also been shown to worsen other conditions, , which causes coughing and breathlessness.
Although unlikely to be pivotal, Ella’s case could bolster bigger legal battles. And putting a human face on the abstract numbers might be of huge symbolic importance. That could ramp up awareness among doctors and parents around the world of how air pollution can exacerbate asthma, and lead to yet more pressure for action. “This case brings a new perspective,” says Cockburn. “It is this human story that will resonate, hopefully.”
This article appeared in print under the headline “A life cut short”
