“Ella was like a canary in a coalmine…”

Air pollution by cars on the road
Photo by Vlad on Unsplash, free for use

Air can kill

In February 2013, a nine year old girl, Ella Adoo-Kissi-Debrah, died of an acute asthma attack. She lived within 30 metres of the London South Circular and had been suffering with life threatening breathing problems for several years. Ella’s mother did not know that toxic air was contributing to her daughter Ella’s death and disability.

This begs the question whether her doctors considered air quality as a major factor. Ella had been hospitalised 27 times during the preceding three years, had suffered multiple seizures and been registered disabled the previous year and yet the air quality of Ella’s environment was not mentioned to her mother. No environmental factors were mentioned at the first inquest.

Air pollution as cause of Ella’s death: a Landmark decision

Ella’s 2014 inquest ruled that acute respiratory failure was the cause of death. Then something extraordinary happened. There was an air quality monitoring station just one mile from Ella’s home in which unlawful levels of pollution were found. A report indicated that this had contributed to Ella’s death.

The previous inquest finding was quashed, a new inquest was opened and a landmark decision was made by the second coroner. It made legal history. He ruled that air pollution was one of the causes of Ella’s death instead of simply associated with her death. Levels of nitrogen dioxide (NO2) and particulate matter (PM) exceeded World Health Organization and European Union guidelines.

The quality of the air we breathe is taken seriously as a public health issue and more so each year as we increase our understanding of the harmful effects of air pollution. Public Health England estimates that between 28,000 and 36,000 deaths each year can be attributed to human made air pollution. Not only does this have a close association with lung disease and cancer but there is emerging evidence that other organs may be affected.

Toxic air may contribute to dementia, diabetes, low birth weight and poor lung development. Young children are particularly vulnerable as their bodies are growing and developing. Air pollution can harm the heart, brain, hormone systems and immunity. This research makes Ella’s death all the more understandable. Almost 250 Kent schools are within 500 metres of an Air Quality Management Area (AQMA). Monitoring air quality and putting in place mitigations is essential.

The pollutants of most concern for public health according to DEFRA:

Sulphur Dioxide
Nitrogen Dioxide
These gases irritate the airways if the lungs, increasing symptoms of those suffering from lung disease
ParticlesFine particles can be carried deep into the lungs where they can cause inflammation and a worsening of heart and lung diseases
Carbon MonoxideThis gas prevents the uptake of oxygen by the blood. This can lead to a significant reduction in the supply of oxygen to the heart, particularly in people suffering from heart disease.

Fine particulate matter (PM) is especially dangerous as it can penetrate deep into the lungs and enter the bloodstream causing systemic danger to tissues and cells. This is why citizens of particularly polluted countries often wear a filtering mask outdoors.

Some effects of air pollution can be sudden onset, such as a sudden difficulty in breathing. Long term exposure may lead to later chronic disease. Consequently, monitoring of air quality is a public health priority and it is set out in the local authority Air Quality Action Plan.

Air Quality Action Plans and Air Quality Management Areas

Under the Local Air Quality Management framework, each local authority has a statutory duty to produce an Air Quality Action Plan. Areas of concern within their local authority will be declared an Air Quality Management Area.

These are areas where concentrations of nitrogen dioxide (NO2) or particulate matter (PM) are above or close to the national air quality standards. There are around 43 Air Quality Management Areas declared across the county. These action plans are all available to download.

From the Canterbury City Council Air Quality Action Plan Executive Summary:

In Canterbury city, in line with the national picture, road traffic emissions producing nitrogen dioxide (NO2) along major roads are the main source of the issues identified by the city council in relation to compliance with air quality standards.

The city centre roads are subject to frequent congestion in peak hours due to the high volume of vehicle movements linked to business, school runs, shoppers, university students and tourists into a historic layout of roads. In addition, there is an air quality ‘hotspot’ at the mini roundabout in Herne, again as a result of traffic volumes giving rise to emissions of NO2 and due to the close proximity of the residential properties to the roadside at this specific location.

The primary focus of this air quality action plan is to put measures in place which will ensure levels of NO2 across the district, and hot spots, are consistently below the objective annual mean of 40µg/m3.

Ella’s death and Traffic Pollution

As explained in the executive summary, the main threat to clean air is traffic pollution. Pollution from industrial and domestic sources is generally reducing but traffic pollution is worsening world-wide. This is particularly concerning as petrol and diesel engines emit a wide range of pollutants. Those who live near busy roads are most impacted but many of these pollutants can disperse far and wide. Studies show that changes in behaviour must accompany technological innovation.

From KCC Pathways to Net Zero

The KCC Behavioural Insight Study explores the appetite for this change with residents: Over half (52%) of surveyed Kent residents are currently willing to buy or lease an electric car, with 48% willing to transition to active transport. Of those unwilling or unable to make the switch to EV, just under one in five cited concerns that this would not make a tangible difference to climate change.

Of course we wish to reduce our reliance on fossil fuels as a crucial climate crisis measure. However, reducing petrol and diesel transport movements is much more immediate and closer to home. Polluted air, some would say poisoned air, from transport is literally killing thousands of our friends and family.

To quote Professor Holgate, an immunopharmacologist and consultant respiratory physician of the University of Southampton and Southampton General Hospital, “If this was happening to water and 40,000 deaths were being brought forward due to poisoning in water, we’d be outside Parliament shouting”.

Photo by Ella Ivanescu on Unsplash, free for use

Air Pollution Strategies


We start by monitoring the situation. The case of Ella’s death exemplifies this. Without that 24-hour monitoring system it is unlikely that toxic air would ever have been linked to her death. These systems are expensive. There are only two in Canterbury despite the huge house building programme embarked on by the city council.

Although diffusion tubes are placed in areas of concern, these do not give real time data. New developments will bring thousands more transport movements to Kent roads. For example, the new Thannington developments will bring many more cars wishing to pass through Wincheap. This is already an area of concern that currently only has diffusion tubes.

With house building exploding in many areas of Kent, should councils be prepared to invest in more 24-hour monitoring systems? Citizens should consider the air quality in their own environments and hold their councils to account.

Active Travel Strategy

Active travel means making journeys in an active way such as walking or cycling. It does not refer to walking and cycling as a leisure activity but as a way to get to a destination. This may seem like a simple, cheap and easy strategy to implement but no one is going to walk or cycle in areas that are not safe.

Cyclists may feel vulnerable if cycle paths are not available. Walking along busy, polluted roads is not good for health. Therefore the onus is still on councils to improve infrastructure and reduce traffic movements.

Green Infrastructure

This includes roadside trees, hedges, shrubs, parks, allotments, cemeteries, urban woodland, riverbanks, wetlands, private gardens, green walls and green roofs. The surface of leaves absorb carbon dioxide, dust particles and other pollutants such as sulphur dioxide.

Vegetation removes a huge amount of pollutants as it acts as a natural filter. Trees are particularly effective and certain species more effective than others. However, the placement of green infrastructure in the public space, what to use and where, is not as simple as just planting a few trees. The right species must be selected and there may be negative impacts on air quality if incorrectly placed.

Public Transport

It seems obvious that we need to increase public transport use across the county and the country, especially if the buses are electric, hybrid or hydrogen. According to the Kent and Medway Low Emissions Strategy:

“The Urban Transport Group’s national report into the cross-sector benefits of supporting bus services confirmed that for every £1 of public money spent on socially necessary bus services, in excess of £3 of benefits can be generated. Benefits include boosting employment, tackling physical inactivity, enabling access to education and cutting greenhouse gas emissions and congestion.”

It also highlights that 91% of people living in Great Britain are within 13 minutes’ walk of a bus stop. This figure may be lower for a rural county such as Kent, however county level data is not available. The socially necessary bus services funded by Kent County Council and Medway Council aim to ensure all rural communities are serviced by a bus service. The survey also confirms that bus journeys are mainly used for shopping, leisure and access to education.

Support local authorities

It is not difficult to surmise why people do not use buses to get to and from work. Local bus services are neither reliable nor extensive enough if a journey is time critical. Regular and reliable bus services could open up work opportunities for so many who cannot afford to run a car and have no work opportunities in their area. One of Canterbury City Council’s Air Quality Action Plan strategies is ‘a modal shift from private car to public transport’.

This seems like the proverbial ‘no-brainer’. However, they are currently consulting on further reductions to bus transport in order to save money. Bus services across Kent are set to lose dozens of routes. If central government wants to reduce car use, support all those who cannot drive or afford to run a car and fight social isolation, then they must support local authorities to maintain and invest in bus routes.

Air Quality Alerts – Kent Air

KentAir provides daily air quality forecasts across the county. There is an option to insert your postcode to receive localised data and alerts. If you, or any of your family, have health vulnerabilities this will give you real time advice on whether to travel, stay at home and whether to reduce physical activity. This website has a great deal of excellent information for those who want to be fully informed.

What can we do?

The government wants us to make fewer car journeys although many cannot afford train fares and bus services are being reduced, not extended. There is little evidence that safe cycling in much of Kent is being prioritised. Many people can’t walk to work because they live too far away and public transport is not available, affordable or reliable enough. Shopping in supermarket hubs has become the norm and that involves a car journey for many if not most people.

We are encouraged to change to electric vehicles. Although there is a strategy to put in many more car charging points, the wait for an electric vehicle for those who can afford one is up to a year for some models. We still have to generate the electricity needed and dispose of the car batteries.

However, we can make our voices heard

We can download our council’s Air Quality Action Plan and ask questions. Are the proposed strategies good enough? Are they being implemented? Are they considering air quality when they propose new developments that will bring thousands more traffic movements to the area? Why isn’t central government giving more support to local councils for public transport funding?

We can write to our local councillors, our MP and relevant government ministers. We can encourage friends and family to do the same. We can use social media to raise awareness. Yes it does work if our politicians see that we are holding them to account.

Real time data needed

If your school or your child’s playground is in an area of concern then start advocating for mitigations. Join with others to campaign for a 24-hour air monitoring system in your area. The harm to children’s development caused by poor air quality is well understood and real time data is a necessity.

Keep abreast of local planning applications on the council website and consider whether they may impact air quality. How many more cars will developments bring? Have they considered car gridlocks and pinch points which cause idling cars to poison the air? The government advice is to turn off your engine to avoid idling but this doesn’t work when the traffic is often stop/start.

Contact your councillors and don’t be fobbed off when they say they are going to put in measures to encourage active travel and public transport. Exactly what will they do and how will you stop them suddenly changing their minds when their proposed strategies are too expensive or unpopular with the developer?

Use the KentAir website to stay informed and to use their alerts and data. If you have a health vulnerability such as asthma, lung disease, heart disease or if you have small children then use the air alerts to keep yourselves safe. Keep track of the data and, if you discover you are in an area of concern, use that data to campaign for cleaner air.

Little Ella did not die in vain

Ella’s death was a watershed. Polluted air is now accepted as a cause of early death. Asthma is the number one childhood illness in the UK. The Ella Roberta Family Foundation was founded by Ella’s family to continue to raise awareness of asthma and its link to air pollution, to support research into asthma, to advance education and environmental improvements. They campaign because Ella died. We don’t need to wait for the death of another child. We can act now.






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