In a groundbreaking decision on Wednesday, a UK court ruled that polluted air was a contributing factor to the 9-year-old Ella Kissi-Debrah’s untimely, tragic passing in 2013. She is the first person in the world to have a death certificate that lists air pollution as a cause of death. The declaration could reverberate around the world as countries both rich and poor try to clean up deadly pollution.
Kissi-Debrah suffered episodes of cardiac and respiratory arrest due to severe asthma, for which she frequently was hospitalized. In the last two years of her life, her lungs partially or partially collapsed on five separate occasions, the Guardian reported.
At the Southwark Coroner’s Court on Wednesday, inner south London coroner Philip Barlow said air pollution, principally from nearby car traffic, was a “significant contributory factor to both the induction and exacerbation of her asthma.”
He said that during Kissi-Debrah’s short life, emissions of nitrogen dioxide and particulate matter in her hometown of Lewisham exceeded legal limits set by England and the European Union as well as safe limits outlined by the World Health Organisation.
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“The whole of Ella’s life was lived in close proximity to highly polluting roads. I have no difficulty in concluding that her personal exposure to nitrogen dioxide and PM was very high,” he said.
The world-first ruling followed years of fighting on the part of Rosamund Kissi-Debrah, Ella Kissi-Debrah’s mother, which culminated in a two-week judicial inquest. The decision could inspire similar action in other parts of the world.
“In my mind, the important lesson here is that we know that in the U.S., just as in the UK and in other parts of the world, we have children who are given such an unfair shake in life because they’re breathing in the combustion products of fossil fuels. And that’s morally wrong,” Aaron Bernstein, an assistant professor of pediatrics at Harvard Medical School and president of Harvard’s Centre for Climate Health and the Global Environment, said. “Morally wrong would be bad enough. But the reality is that it’s not just children…we’d all be better off if we found a way to get ourselves off of fossil fuels because of the damages they’re causing to our health.”
Indeed, World Health Organisation data shows that air pollution levels remain dangerously high for 9 out of 10 people around the world, and that 7 million people die every year from exposure to toxic air. Among the most vulnerable to its impacts are children and seniors, particularly in poorer areas of colour, near which polluters are more likely to site dirty infrastructure. Kissi-Debrah was Black, and in her town of Lewisham, nearly 35% of children live in poverty.
Despite this, autopsy reports around the world have not included pollution as causes of death — until now. Bernstein said this is largely due to the fact that legal language doesn’t line up with medical language, a phenomenon that’s similar to damage made worse by climate change.
“[Scientists] might say a storm like Hurricane Katrina was more likely because of climate change, or that heat wave was more likely. Similarly, scientists would look at a case like this and say, ‘well, air pollution probably increased the risk of [Ella Kissi-Debrah] having more severe asthma, which meant she was more likely to die,’ but they maybe can’t with total certainty say that the pollution caused any individual death.” he explained. “So, there’s legal standards and there’s scientific standards, but at the end of the day, we definitely know that air pollution is harming our children.”
What’s listed on autopsy reports are ailments like cardiac arrest, heart attack, stroke, pulmonary disease, and lung cancer. These reports, however, fail to take into account the underlying environmental factors. That means that ultimately, courts’ understanding of pollution needs to change to better account for situations where it’s clear that it contributes to an individual’s mortality. There’s no reason that coroner’s reports in the U.S. couldn’t include pollution as a cause of death, but Christine James, an allergist at San Diego’s Institute for Asthma and Allergy who works with the health advocacy organisation Climate Health Now, said this will take some serious work.
“We have a long way to go in order to convince people of the link between pollution and health,” she wrote in an email. “More and more healthcare professionals are raising awareness and pushing our communities and legislative bodies to acknowledge the relationship; however, this is an uphill battle — with the ruling in this case, hopefully more people will sit up and take notice.”
She hopes that moving to acknowledge how deadly air pollution can be could push world leaders to act to curb it. The medical community can only do so much to treat the impacts of air pollution such as asthma, but James said “instead of continually reacting to things we need to get ahead and take a preventative approach” by reducing pollution in the first place.
Though the case of Kissi-Debrah’s death won’t directly compel the UK government to make changes, it could put pressure on regulators and companies to clean up their act. The same could be true in other places, too.
There are myriad ways that local, state, and national leaders could tackle air pollution, ranging from better enforcement of domestic and international legal standards and enacting stronger caps on pollution levels to launching education campaigns about how to protect oneself from emissions.
To really meet the scale of the problem, James said officials will also have to stop catering to the interests of polluters, like car manufacturers, oil and gas companies, and the petrochemical industry.
“These industries have been protected in so many ways from being taken to task on this issue. But this case puts much more pressure on these industries to admit to their role in worsening our health,” she said. “And if they are unwilling to do so, this case lays the groundwork in how they may be legally held accountable.”
Gaurab Basu, co-director of the Centre for Health Equity Education and Advocacy, said these actions are crucial from a medical standpoint.
“I believe ending the use of fossil fuels is the most critical intervention we can pursue to protect people’s health,” he said.