Promises of changes to how information on air quality is disseminated, a cash injection into the Air Quality Grant programme and a future consultation on new targets have been made. They are in response to the ‘prevention of future deaths’ report submitted by assistant coroner Philip Barlow in April, following his conclusion that nine-year-old Londoner Ella Kissi-Debrah had died due to breathing polluted air.
The groundbreaking ruling was made in December, after a long campaign to overturn the original death certificate. Issued in 2013, it said that her death was due solely to an extremely strong asthma attack, without explaining what had triggered it.
But DEFRA’s response, which it has only published in summary, is significantly weaker than Barlow’s recommendations. He said that the government should adopt the guidelines on fine particulates (PM2.5) established by the World Health Organisation (WHO) and improve awareness of air pollution among both the public and medics. He ordered that the government should respond by 17 June – Clean Air Day.
Jocelyn Cockburn, the Kissi-Debrah family’s lawyer, said it was a “very apt” deadline.
But the government’s response skirts embracing the WHO standards, instead saying that they will “inform” targets to be set in regulations made under the Environment Bill by October 2022. A public consultation will open early next year.
The commitment is not new, having been announced by environment minister Rebecca Pow last month. It left Ella’s mother Rosamund unimpressed.
“Ella’s death has shown health is a priority and the government has a legal obligation to protect life. I have written to the secretary of state for the environment seeking a meeting to explain what his intentions are in regards to WHO limits as I am unclear,” she tweeted, adding, “I may not have won the battle but the war is looming.”
Other measures promised by the government are:
“Immediate action” to improve public awareness of air pollution, including a “comprehensive review” of the DEFRA’s UK Air website and the Daily Air Quality Index, last revised ten years ago. It will include specific messaging for vulnerable people, which will help medical professionals provide advice.
A “more sophisticated” population exposure reduction target for PM2.5 will be developed, seeking to drive reductions across the country, rather than in hotspots of pollution. This would also mean a significant increase in the monitoring network. But this is again old news, having been announced last August.
The newly-formed Office for Health Promotion will “consider as a priority” how public health benefits can be achieved through reducing PM2.5 exposure, “taking into account the particular circumstances experienced in London and the South East”.
Adding £6m to the Air Quality Grant pot, bringing it to £11m this year. It was only £2m for 2020. Part of this will go towards improving public awareness.
Working with health charities on longer-term campaigns aimed at vulnerable groups
“Further discussions” on providing air quality alerts through the broadcast and print media and app developers. National SMS alerts could also be introduced, replacing a patchwork of local systems.
“A more systematic approach to asthma management” from the NHS, including the identification of environmental triggers. The government has also offered to work with the nursing and medical Royal Colleges in training their members and making changes to teaching curricula.
A full version of the response is expected to be published by the coroner in due course.
Environment secretary George Eustice paid tribute to Ella’s friends and family, who “campaigned so tirelessly on this issue, and continue to do so. Today’s response is part of a much wider cross-government effort to drive forward tangible and long-lasting changes to improve the air we breathe, as well as doing more to inform the public about the risks”.
But ClientEarth, which has won a series of legal challenges related to air pollution, reacted with disgust.
Katie Nield, lawyer at environmental law charity ClientEarth, said: “The coroner couldn’t have been clearer on the need to align UK law with the World Health Organization guidelines on PM2.5. He said it would save lives. Yet the government has totally disregarded this. If the prime minister really wants to make the Environment Bill a lodestar, his government has to massively step up.”
Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, said the plans “just scratch the surface of what needs to be done” and called for the WHO standards to be enshrined in law. “Without bold action, tens of thousands of people will continue to die early from air pollution each year,” she added.
The coroner also ordered the mayor of London and medical bodies to respond to the report.
Mayor Sadiq Khan accordingly announced an expansion of the capital’s air quality monitoring systems, adding 131 sensors to hospitals, schools and other priority locations, bringing the Breathe London network to 322 locations.
He also revealed that research had found that growing up breathing London’s dirty air leads to an average 5% reduction in lung volume, with worse results in the most polluted areas. A separate study concluded that the mayor’s air quality measures would increase the life expectancy of a child born in 2013 by six months.
The Royal College of Physicians said it would review the internal medicine curriculum, work out how to raise doctors’ understanding of the health impacts of air pollution and “consider how we might help medical professionals become local advocates for reducing air pollution”.
Its registrar Cathryn Edwards said: “The coroner identified that ‘legally binding targets based on WHO guidelines would reduce the number of deaths from air pollution in the UK’. The Environment Bill currently passing through parliament is an opportunity to do that; it is not too late for the government to commit the UK to meeting WHO guidelines for PM2.5.”