‘Invisible killer’: WHO particulate standards should become legally binding, says coroner

The coroner who declared that young Londoner Ella Kissi-Debrah’s death was caused by exposure to air pollution says that adopting tighter legal limits on particulate concentrations would reduce the death toll from the pollutant.

Ella died of a rare and extreme form of asthma in 2013 at the age of nine, having been hospitalised dozens of times beforehand. Following a long campaign, her death certificate was revised earlier this year to include air pollution as a factor. It was the first time such a ruling had been made, though epidemiologists have long concluded that dirty air kills tens of thousands of people per year in the UK alone and millions around the world.

“The national limits for particulate matter are set at a level far higher” than guidelines published by the World Health Organization (WHO), Philip Barlow, assistant coroner for inner South London, wrote in a ‘prevention of future deaths’ report released today.

“The evidence at the inquest was that there is no safe level for particulate matter and that the WHO guidelines should be seen as minimum requirements. Legally binding targets based on WHO guidelines would reduce the number of deaths from air pollution in the UK,” Barlow added.

The government at first said that the Environment Bill would set the recommendations in law directly, then reversed course and said that a new target would be set by October 2022. The whole of the capital breaches the WHO guideline level of ten micrograms per cubic metre, as do many other towns and cities across the UK.

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Barlow’s report is addressed primarily to DEFRA and the Department for Transport, who together are responsible for delivering on air quality goals. But the Department for Health and Social Care, the mayor of London, the London Borough of Lewisham and medical bodies such as the General Medical Council, Royal College of General Practitioners and the National Institute for Health and Care Excellence are also mentioned.

All are obliged to respond to the report within 56 days under regulation 29 of the Coroners (Investigations) Regulations 2013, describing what action they are taking in response – or explain why they are doing nothing.

The medical organisations are mentioned as the report makes a plea for nurses and doctors to inform patients and carers about the adverse impacts of air pollution. Ella’s family only learned about the damaging impacts after her death.

The report says that improving the situation necessitates better training, both through undergraduate and graduate courses and via continuing professional development.

Similarly, the need to raise the public’s limited awareness of sources of information on national and local levels of air pollution, “is an issue that needs to be addressed by national as well as local government”, says the report. “The information must be sufficiently detailed and this is likely to require enlargement of the capacity to monitor air quality, for example by increasing the number of air quality sensors,” it adds.

Katie Nield, lawyer at environmental law charity ClientEarth, said: “The coroner’s report highlights that air pollution is still putting people’s lives at risk in the UK – eight years after Ella’s death and over a decade after legal limits should have been met.

“Pollution is often touted as an ‘invisible killer’ but for a long time public bodies have been well aware of where harmful emissions are coming from and the impacts they are having on people’s health. All the while, solutions have been at their fingertips: a network of clean air zones would quickly remove the most polluting vehicles from our roads. The coroner himself has highlighted that legally binding targets based on stricter WHO guideline levels for harmful particulate matter would prevent future deaths. 

“Toxic air is clearly not going to disappear on its own. The government needs to get its act together and explain what more it is going to do to prevent lives like Ella’s being cut short.”

According to Geraint Davies, chair of the All-Party Parliamentary Group on Air Pollution, the report underlines, the need for legally enforceable WHO air pollution limits for both nitrogen oxides and particulates in the Environment Bill. Let the tragic case of Ella be transformed into an opportunity to save thousands of other children from early death by enforcing air pollution limits. 
“COP26 is an historic opportunity for the UK to take leadership in confronting the global annual air pollution death toll of 7 million people by introducing legally binding WHO limits. Strategies to enforce air pollution limits will reduce climate change,” he added.