Mum grieving Ella tells nursery staff to be vigilant against 'filthy' air

Schoolgirl Ella Kissi-Debrah’s death is the first person in the world to have air pollution listed as a cause of death on her death certificate, but her mother says Ella’s death will not be the last. As the government delays taking any action against the UK’s high pollution levels till 2040, she tells nursery staff to be vigilant.

Ella Kissi-Debrah. Credit: Rosamund Adoo-Kissi-Debrah

Clean Air Day takes place on 16 June but it is no celebration for bereaved mum Rosamund Adoo-Kissi-Debrah who is “pushing” the government to protect the nation’s children from toxic air.

She has spent several years campaigning for a second coroner's inquest into her daughter Ella's death to determine whether it was linked to air pollution. In a landmark decision in December 2020, the coroner ruled it was.

Ella was in good health until 2010

Ella died at the age of nine-years-old. She lived 25 metres away from London’s congested South Circular Road in Lewisham when she died after suffering an asthma attack in 2013.

Until the end of 2010, Ella had been “extremely active and in good health”. Yet following a chest infection in October 2010, the schoolgirl suffered respiratory issues. For the last three years of her life she had seizures and was admitted to hospital 27 times for asthma attacks. On 15 February 2013 she had an asthmatic episode at home and was taken to hospital where she suffered a cardiac arrest and died.

Air pollution causes around 40,000 premature deaths per year in the UK, and levels of nitrogen dioxide have been illegally high since 2010 in the vast majority of urban areas in the UK, according to the Ella Roberta foundation run by Ms Adoo-Kissi-Debrah.

Rosamund Adoo-Kissi-Debrah. Credit: Rosamund Adoo-Kissi-Debrah

Coroner Philip Barlow found Ella had died of asthma contributed to by exposure to excessive air pollution. During the course of Ella's illness between 2010 and 2013 she was exposed to levels of nitrogen dioxide and particulate matter in excess of World Health Organization (WHO) guidelines. The principal source of her exposure was traffic emissions.

The coroner said in his report that ‘there was a recognized failure to reduce the level of nitrogen dioxide to within the limits set by EU and domestic law which possibly contributed to her death’.

He described ‘a low public awareness’ of information about national and local pollution levels. But his report stated, greater awareness would help individuals cut their personal exposure to air pollution.

We can teach kids, staff and parents about air pollution

Speaking to an audience of nursery staff at the Early Years Alliance virtual conference in June, Ms Adoo-Kissi-Debrah said: “My experience of early years has been absolutely fantastic. I am a big, big champion of early years”.

Admitting she still looks at Ella’s photographs in folders from early years, she says “I like to think of my daughter sometimes when she wasn’t ill. When I have one of those horrible days I do pick up the folder”. Ms Adoo-Kissi-Debrah said: “When I think about early years I think about play. “I do think we can teach young kids about air pollution but we can make it fun.

“If I want to be brutally honest about my daughter’s case and situation I think she became ill quite a long time before it actually came out. Maybe on those journeys to pre-school when she was breathing in the filthy air.

“I remember the coroner saying that there were illegal levels of air pollution throughout Ella’s life.”

Mayor of London Sadiq Khan, who received a copy of Ella’s coroner’s report, has repeatedly called for the government to adopt World Health Organization clean air targets. Ms Adoo-Kissi Debrah said: “When there is a spike in air pollution in London, one of the things that has changed is the Mayor of London does give warnings.

Addressing early years staff, she said: “We need to raise the awareness about air pollution. Everybody who works in this field needs to empower themselves to know about air pollution."

Last 28 months of Ella's life was 'horrendous'

“Ella’s asthma didn’t start until she was almost seven… but the last 28 months of her life were “horrendous”. She urged early years staff to let parents know about air pollution.

“I’m sure a lot of you keep asthma pumps…that you have to administer to children. Please always make sure the medicine is up to date otherwise the inhalers are not as effective." She also urged staff that if a child has asthma, make sure they have an asthma plan “because when things go wrong…and there are inquests, we find the basics are not adhered to".

Traffic on a busy road. Credit: Magic Bones/ Shutterstock

For children under the age of five, she talked about the term “pre-school wheeze” for children who do not yet have an asthma diagnosis. For a child that goes into hospital a lot, she said it was something early years staff could “keep an eye on”.

“Sadly we do not all breathe the same air.”

If you live in or your school is near a busy road…”then unfortunately the air isn’t as great”. If living close by to their nursery, the clean air advocate said parents and staff shouldn’t drive, if possible, because that counts towards the traffic. She advises parents to walk with their children to nursery (if they can), consider changing their routes and taking quieter routes.

If people drive especially in winter, they shouldn’t leave their cars idling because in areas where cars are idling the pollution is 50 per cent more.

She said nursery staff "are well within your rights” to “ask the parent to switch off” their car engine, rather than leave the car idling, if a parent is parked outside the nursery with their car engine running.

"It is actually against the law".

Ms Adoo-Kissi-Debrah is a WHO BreatheLife ambassador and an Honorary Fellow of the British Science Association. She is named on The Times' Green Power List 2021.

During the conference, she called for early years training courses to help people "understand the detrimental impact of air pollution on health".

If early years leaders believe their nursery is in an air pollution hotspot, she said they should ask for an air pollution monitor there. She said she did not want “to scare people” but it was better to be “armed and to know rather than not”.

Ms Adoo-Kissi-Debrah is also campaigning for daily weather reporting to include weather pollution levels and let the public now when there are days of high pollution, to enable better protection for children and vulnerable adults.

She also suggests the Early Years Alliance could publish leaflets for early years staff.

'Let's not us have many more Ellas'

“There is no cure for asthma…for some children its something they will have to manage for the rest of their lives. Early years should be about play, it should be about fun and for some children unfortunately that isn’t the case. Let’s not us have many more Ellas.”

The Environment Act 2021 requires the government to set at least one long-term target in air quality and demands targets be set for fine particulate matter (PM2.5). The Mayor of London pledged to reduce PM2.5 pollution in London in line with WHO's guidelines by 2030.

London's mayor Sadiq Khan said: “We know that here in London we can achieve the government’s target for PM2.5 a decade earlier than they [the government] are proposing by introducing measures proven to be effective. We know that achieving the WHO 2005 guidelines by 2030 is achievable and affordable. Achieving targets set in 2005 by 2040, 35 years later, is too long to wait.

“A target set this far into the future consigns yet another generation of children to the lifelong health effects of early exposure to excess air pollution and embeds existing inequalities in exposure particularly for black and ethnic minority Londoners and people on low incomes who are least likely to own a vehicle.”

The Mayor is urging people to respond to the government‘s consultation on environmental targets by clicking here. The consultation closes on 27 June.

In her speech to nursery workers, Ms Adoo-Kissi-Debrah told them: “Individuals are asked to do an awful lot but policy makers should do more”.

click here for more details or to contact Early Years Alliance