Clean Air – A Human Right Not A Commodity

When I initially read that businesses were successfully selling bottled clean air, I thought it implausible. Yet, given the devastating effects of air pollution on our health, maybe it is an unsurprising market development.

In 2016, it was estimated that approximately 40,000 deaths in the UK per year were attributable to exposure to air pollution. Globally, data from the World Health Organisation (WHO) shows that 90% of us breathe in air that exceeds the WHO guideline limits on pollutants.

One consumer reviewing the clean air they had purchased stated that it made a real difference to their breathing. Perhaps the perfect gift for today, Clean Air Day, or perhaps a sober reminder that clean air should actually surround us all, rather than be a product to be purchased.

Dangers of air pollution

The inquest into the death of Ella Adoo-Kissi-Debrah brought into sharp focus the fatal dangers of air pollution. The Coroner at the inquest concluded that Ella died of asthma contributed to by exposure to excessive air pollution. She is the first person in the UK to have air pollution listed as a cause of death on her death certificate. Unfortunately however, she is unlikely to be the last without urgent government action.

Ella Adoo-Kissi-Debrah and her exposure to air pollution

Ella was diagnosed with asthma in 2010 and died in 2013, at the age of nine. During this period, the Coroner found that Ella was exposed to levels of nitrogen dioxide in excess of the legal limits. Whilst levels of particulate matter (PM 2.5 and PM10) did comply with the relevant legal values in the UK, they exceeded the WHO guidelines. The legal limit for PM 2.5 is currently two and a half times above that recommended by the WHO. This is significant because the WHO guidelines are health based whereas the UK limits, based on an EU Directive, will have been influenced by political and economic factors as opposed to pure health considerations. It is notable however that the WHO actually acknowledges that there is no safe level of PM2.5 based on current evidence.

From at least 2006, the UK government has been aware of its failure to meet these targets and during the inquest it was made apparent that opportunities they had to reduce pollution levels were not taken. In 2007, the government introduced the Air Quality Strategy for the UK to address this failure. A number of policies to reduce air pollution were proposed as part of the strategy and yet none of them were actioned.

In 2015, the Dieselgate scandal broke. We became aware that car manufacturers had been cheating laboratory vehicle emission tests for diesel cars and that their actual, real-world emissions were far exceeding the legal limits. However, at the inquest evidence from the Department for Transport revealed that the unreliability of the laboratory tests had been known by the government since 2004 – the year Ella was born and some 11 years before the public were made aware of the dangers and the deliberate misselling. Despite this knowledge, and knowing the potential effect on the health of the public, the UK government allowed these highly polluting cars onto our roads and encouraged their sales. Even today, there are still an estimated 8.5 million diesel vehicles on UK roads whose emissions are in severe breach of the legal limits.

The principal source of Ella’s exposure to air pollution was traffic emissions. The Coroner stated that he had no difficulty in concluding that Ella’s personal exposure to both nitrogen dioxide and particulate matter was very high. Due to this exposure, Ella lived the last few years of her life on ‘a knife-edge’ – the description given by experts at the inquest. Whilst it has been acknowledged to some degree that air pollution could exacerbate the symptoms of asthma, the Coroner determined that in Ella’s case, air pollution was a significant contributory factor to both the induction and exacerbations of her asthma.

The health risks of air pollution have been known for many years. Children and older people, as well as those with pre-existing health conditions, are particularly vulnerable to the health risks of pollutants. Yet the inquest revealed that the link between air pollution and asthma has not permeated to health care professionals and there has been no related formal medical training on the health risks.

During Ella’s illness, through which she suffered terrifyingly severe asthma attacks, her mother was never informed about the levels of air pollution where the family lived and went to school. She was treated by a number of specialist clinicians, and yet the health risks associated with pollution and the steps that could have been taken to mitigate Ella’s symptoms were never discussed. After approximately 30 acute asthma attacks, which we now know were never adequately treated due to the omission to link the cause with her symptoms, Ella sadly died in February 2013. Remarkably, there have still been no large scale public health campaigns about the effects of air pollution.

Prevention of Future Deaths Report

Subsequent to an inquest, it is a requirement by law that Coroners publish a Prevention of Future Deaths Report (PFD) should they believe there is an ongoing risk to life. They are addressed to those who have the power to rectify the failures.

In April 2021, the Coroner published a PFD addressed to a number of central government departments and medical training bodies. The PFD identified three areas that pose a risk of future deaths to the UK public and made the following recommendations:

1. Adopt legally binding targets of Particulate Matter based on the minimum requirements for the protection of health, as set out in the World Health Organization guidelines.
2. Improve public information at a national and local level about air pollution levels so that people are aware of how to reduce their exposure (this will include increasing air quality monitoring capacity).
3. Educate and train medical and nursing professionals, and improve guidance about the adverse effects of air pollution on health.

Responses from government departments and others to the Coroner’s PFD are due today which is, notably, Clean Air Day. They will be published at a later date once reviewed by the Coroner.

We can only hope that the responses will detail the substantial and meaningful plans that are needed to improve air quality for everyone in the UK. Action is needed now to ensure that clean air is a human right for everyone, not a commodity.