19th September 2024
Image credit: https://www.adamisfendiyar.com/
The World Health Organisation says that air pollution contributes to seven to eight million premature deaths a year, but only one person, Ella Kissi-Debrah, has ever had air pollution on their death certificate. She has it on her death certificate because of a long struggle led by her mother, Rosamund Kissi-Debrah, supported by doctors and lawyers. On Saturday 7 September, International Day of Clean Air for Blue Skies and Clean Air, about 20 of us gathered in Mountsfield Park, a park that Ella loved and where she played, to Ride for Ella. Her mother saw us off and greeted us back.
I’ve met Rosamund before, and like every campaigner for clean air, I knew about Ella having air pollution on her death certificate, but I must confess that I didn’t know the full story until I read it on the website of the Ella Roberta Foundation, a foundation founded by Rosamund. https://www.ellaroberta.org/ You can read it there, and I urge you to do so as it’s a story full of important messages.
In brief, Ella was born in 2004 and was a bright child keen on reading. gymnastics, football, and music. Just before her seventh birthday she developed a cough and was eventually diagnosed as having asthma, a condition that led to her death in February 2013 and 30 emergency admissions. She had multiple tests, almost all of them unhelpful, but no doctor ever mentioned air pollution as a contributing cause. Nor did Rosamund ever consider it while Ella was alive.
In retrospect this might seem extraordinary, but I have written before about how the medical profession has failed woefully in recognising the importance of air pollution—and I am to blame as much as anybody. https://blogs.bmj.com/bmj/2019/11/01/richard-smith-waking-up-to-the-lethal-effects-of-air-pollution/ In my 13 years as editor of the BMJ we published little on air pollution, in contrast to the huge amount we published on the dangers of tobacco. Doctors will always ask about smoking in patients with respiratory problems, but it’s a rare doctor who mentions air pollution.
It was more than a year after Ella’s death that not a doctor but a “local resident” suggested that Rosamund “have a look at the air pollution levels on the night Ella died.” She discovered that the area where Ella lived had (like most cities) high levels of air pollution. At the same time Stephen Holgate, a respiratory physician who has paid great attention to air pollution examined Ella’s medical records and concluded that the severity of her asthma and her death were linked to the air pollution.
The original inquest into Ella’s death had not considered air pollution, but with the help of a lawyer Rosamund managed to have a second inquest, where they presented strong evidence on the importance of air pollution. After a nine-day hearing the coroner concluded:
“Air pollution was a significant contributory factor to both the induction and exacerbations of her asthma. During the course of her illness between 2010 and 2013 she was exposed to levels of nitrogen dioxide (N02) and particulate matter in excess of World Health Organisation Guidelines. The principal source of her exposure was traffic emissions. During this period there was a recognised failure to reduce the level of NO2 to within the limits set by EU and domestic law which possibly contributed to her death. Ella’s mother was not given information about the health risks of air pollution and its potential to exacerbate asthma. If she had been given this information she would have taken steps which might have prevented Ella’s death.”
I cycled the nine miles from my home in Clapham to Mountsfield Park along busy roads, and thanks to the campaigns of Rosamund and others I was exposed to less air pollution than Ella was regularly exposed to because the quality of air has improved. It is, however, still filthy, considerably above the WHO guidelines. Traffic was particularly thick as I cycled through Lewisham, which I had visited in decades, and what hit me was how the hospital has grown enormously. I reflected that we are still investing far more resources in pulling people out of the river than in stopping them falling into the river.
But I shouldn’t be too cynical. The World Heart Federation has just ranked London second best among 50 cities for heart health. https://world-heart-federation.org/city-heartbeat-index/ One of the main reasons London scored so well was because of the steady extension of the ultra-low emission zone (ULEZ), the zone in which heavy-polluting vehicles must pay a penalty. Rosamund, driven on by Ella’s death, is one of the main reasons for ULEZ. She has forged a creative relationship not only with Sadiq Khan, the London Mayor, but also the leaders at WHO.
Although my parents lived many years close to Mountsfield Park, I had never visited it and was struck how lovely it was with children playing football, a community garden, and a community café serving among much else Bombay rolls, which I strongly recommend. As you look west from the hilltop you see almost only trees, as if we were in the countryside, not a densely populated urban area.
As Rosamund saw us off she urged us to be ever more energetic in campaigning for clean air. As António Guterres, the UN secretary general, said on the day we were cycling, “99% of humanity breathes polluted air – leading to an estimated 8 million premature deaths. Investing in clean air saves lives, combats climate change, strengthens economies and builds fairer societies.” Rosamund hopes that the new government will take air pollution more seriously than the last but then told us how she’d met a new MP who was wholly unaware that air pollution was bad for health. She congratulated the “water people” for getting polluted water high on the political agenda and hoped that the same could be achieved for clean air. (Despite swimming in sewage being horrible, there are few deaths in the UK from polluted water, whereas the Royal College of Physicians estimates that there may be 40,000 from polluted air. Sewage smells and is sometimes visible; modern air pollutants are invisible and have no odour.)
We line up for a photo like Henry V’s army at Agincourt with Rosamund and a small girl at the front, and we are off. Ride for Their Lives was started by paediatricians and began with some 50 or so health professionals cycling from London to Glasgow for the start of COP26 in 2022. https://ridefortheirlives.net/ The riders carried a blue satchel with messages from children, evidence on the harm to health from air pollution, climate change, and the destruction of nature and proposals on how to respond and promote health. I got to present the satchel to Gordon Brown, a former prime minister. The satchel has been many places since, including by bike to WHO in Geneva where it was presented to Dr Tedros Adhanom Ghebreyesus, director general of WHO. We carry it with us today as we honour Ella.
Ride for Their Lives is not so much a protest as a bearing witness to what is happening to our world and a call to put it right. There are now rides across the world. We cycle together to support and energise each other, holding multiple conversations as we make our journey. The rides are fun.
Our ride today begins downhill to the busy road running from Lewisham to Catford. We are led by Zeshan Rawn, senior Information Manager at Evelina Children’s Hospital and London Neonatal Operation Delivery Network, who has been involved in Ride for their Lives since it started in 2021. There is a great emphasis on safety. At the busy road outriders block the traffic as the rest of us cycle across. We come to Ella’s school, which has exactly the same design as the school I and my children attended and my grandchildren attend now. We line up for a photo, ignoring the squashed rat in the middle of the road.
We cycle through Ladywell Park, where I remember competing in athletics as a teenager, and past the fast-flowing (and no doubt polluted) Ravensbourne to the wellness garden at the back of the monstrous hospital. Another photograph and on, this time uphill causing many to gasp for air. I’m intrigued to pass Prendergast School, which was a local girls’ school when I attended an all-boys’ school. My memory of the school is four schoolgirls getting pregnant.(London, I learn later, has had a dramatic drop in teenage pregnancies.)
Our destination is Brockley Station, which surprises me. My memory of Brockley is of a drab, soulless block of South East London, but now the station has a large and lovely garden, and tables from a café fill the street in front of the station. It’s vibrant. We have come to see the mural of Rosamund under the railway bridge. Her face is about 20, maybe even 50, times life size. Later she jokes that she’s glad that she doesn’t live close to the station and see her “ugly mug” every day. But the mural is a great tribute to her enterprise, energy, and spirit. We line up for another photo, which annoyingly must be taken from the other side of a busy road.
From the mural we return to the park, taking in two hills on the way. Rosamund greets us and points to the spot where the foundations will be laid for a statue of Ella. It should be installed next year. With a big smile on her face she tells us as well of the appalling racist abuse she experiences every day because of her successful support of ULEZ. I reflect that the only policy of some six candidates who stood to be London mayor early this year was to get rid of ULEZ. I don’t suppose that they are in favour of air pollution but they resent any infringement (actually small) of their right to pollute.
But standing close to the spot where Ella’s statue will stand, Rosamund says that she knows that most people support ULEZ because people around Lewisham who know her never object. Most of the work, she emphasises, to provide Londoners and people across the world with clean air, surely not an unreasonable ask, remains to be done.