child wearing a mask
Julie Hambleton
Julie Hambleton
May 14, 2024 ·  6 min read

Air pollution a cause in girl’s death, coroner rules in landmark case

A coroner in London ruled that air pollution was a major contributing factor to a little girl’s death in 2013. This landmark decision has now pushed the mayor and health ministers to take on the problem of polluted air both in London and across the UK. (1)

Air Pollution Caused Little Girl’s Death

In February 2013, nine-year-old Ella Kissi-Deborah died after a long battle with severe asthma. This month, after years of fighting by her mother Rosamund, a coroner ruled that Ella died of acute respiratory failure, severe asthma, and air pollution exposure. (1)

This is being called a landmark ruling, as it is the first time that a coroner has named air pollution as a direct cause-of-death. (1)

Little Ella lived in the London borough of Lewisham within 30 meters of South Circular road, where she spent most of her time. It was there that the coroner says she was exposed to nitrogen dioxide and particulate matter (PM) that far exceeded the World Health Organization (WHO) guidelines. (1)

“Ella died of asthma contributed to by exposure to excessive air pollution,” the coroner said in a statement. “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.” (1)

He says that the illegal levels of pollution and PM in the air without a doubt caused and exacerbated her asthma. (1)

A Canary in a Coalmine

In the three years leading up to her death, terrible seizures sent Ella to the hospital nearly 30 times. The winter months were particularly bad. Immunopharmacologist and consultant respiratory physician of the University of Southampton and Southampton general hospital Stephen Holgate said this was caused by the seasonally higher air pollution. (1)

Holgate says that the tragic event is a sign to all Londoners that they are at risk for numerous health complications from the toxic London air, especially children and those with pre-existing conditions. (1)

London Mayor Sadiq Khan is now calling this a public health crisis and is planning big changes to clean up the city’s air. (1)

“Today must be a turning point so that other families do not have to suffer the same heartbreak as Ella’s family. Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the ultra-low emission zone to inner London,” he said. “Ministers and the previous mayor have acted too slowly in the past, but they must now learn the lessons from the coroner’s ruling and do much more to tackle the deadly scourge of air pollution in London and across the country.” (1)

He announced the city has a £3.8bn ($5.1bn USD) plan to reduce air pollution and clean up transportation. The bill has new, far more aggressive air quality targets and is focused on public health. (1)

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The Effects of Air Pollution

Air pollution, without a doubt, has major implications for our respiratory tract, and it is well-known that it has negative effects on the immune system. For those who suffer from asthma, chronic obstructive pulmonary disease (COPD), and allergies, air pollution causes an inflammatory immune response that makes breathing and remaining healthy highly difficult. (2)

It doesn’t only affect the immune systems of those with pre-existing conditions. Even in otherwise healthy individuals, it affects the (2):

  • Respiratory tract
  • Gastrointestinal tract
  • Cardiovascular system

High levels of air pollution can be particularly dangerous for babies and young children. (2)

Air Pollution and Early Death

High levels of toxic air pollutants such as nitrogen dioxide and PM are definitively linked to oxidative stress and premature death. (3) People who live in areas with poor air quality are at higher risk for:

  • Cardiovascular disease and heart attacks (3)
  • Excessive blood clotting and strokes (3)
  • Free-radical exposure (3)
  • Metabolic syndrome and diabetes, particularly in children (4)
  • Negative effects on the blood-brain barrier (3)
  • Higher levels of LDL (“bad” cholesterol) in the blood (3)
  • Decreased levels of antioxidants in the blood (3)
  • Irregular heart rate (heart arrhythmia) (3)

A study done in Los Angeles shows that people above the age of 75 who spend large amounts of time down-wind from a highway have a shorter lifespan of 3.8% to 6.5%. (5)

The Psychological, Social, and Economical Effects of Air Pollution

Breathing in bad air has more than just physical effects on our bodies. In April 2020, The Current Opinion in Psychology journal published a systematic review of how the pollutants we breathe in every day affect the other aspects of our lives. (6)

The review found that air pollution:

Decreases happiness and life satisfaction
Increases risk for annoyance, anxiety, mental disorders, self-harm, and
Impairs cognitive functioning and decision making.
Triggers coping strategies of avoidant behavior,
defensive expenditure (spending money on things that don’t increase our well-being but attempt to avoid decreasing it), and
Moving/migration. (6)

Low air-quality decreases work productivity and stock-markets, increases crime rates, and lowers public trust in government. All of these issues impact people on an individual level as well as the community as a whole. (6)

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Cities with the Highest Air Pollution in the World

Naturally, if you live in a small town or rural area, you are going to inevitably be exposed to less air pollution on a typical day than someone who lives in a big, busy city. That being said, some cities are worse than others.

The top 10 cities in the world with the most polluted air are:

  1. Delhi, India
  2. Lahore, Pakistan
  3. Ulaanbaatar, Mongolia
  4. Dhaka, Bangladesh
  5. Sarajevo, Bosnia Herzegovina
  6. Kolkata, India
  7. Bishkek, Kyrgyzstan
  8. Kathmandu, Nepal
  9. Karachi, Pakistan
  10. Kabul, Afghanistan (7)

The top 10 cities in the United States with the poorest air quality are:

  1. Bakersfield, CA
  2. Fresno-Madera-Hanford, CA
  3. Visalia, CA
  4. Los Angeles-Long Beach, CA
  5. San Jose-San Francisco-Oakland, CA
  6. Fairbanks, AK
  7. Phoenix-Mesa, AZ
  8. Pittsburgh-New Castle-Weirton, PA-OH-WV
  9. El Centro, CA
  10. Detroit-Warren-Ann Arbor, MI (8)

As the tragic death of young Ella Kissi-Deborah in the UK has shown, air pollution is an issue that needs to be taken more seriously by everyone – policymakers and citizens alike. If we improve the quality of our air, we will not only protect the planet, but we will protect our own lives in ways we are only just beginning to understand.

Keep Reading: Meet Leydy Pech, the Mayan Woman Who Stopped Monsanto and Won the ‘Nobel For the Environment’


  1. Air pollution a cause in girl’s death, coroner rules in landmark case.” The Guardian. Sandra Laville. December 16, 2020.
  2. “Air pollution and its effects on the immune system.” Science Direct. Drew A.Glencross, Tzer-Ren Ho, Nuria Camiñab, Catherine M. Hawrylowicz, Paul E. Pfeffer. October 31, 2019.
  3. Oxidative stress and the cardiovascular effects of air pollution.” Science Direct. Mark R.Miller. May 2020.
  4. “Metabolic effects of air pollution exposure and reversibility.” JCI. Sanjay Rajagopalan, Bongsoo Park, Rengasamy Palanivel, Vinesh Vinayachandran, Jeffrey A. Deiuliis, Roopesh Singh Gangwar,Lopa Das, Jinhu Yin, Youngshim Choi,Sadeer Al-Kindi, Mukesh K. Jain, Kasper D. Hansen,Shyam Biswal. August 11, 2020.
  5. “As the Wind Blows: The Effects of Long-Term Exposure to Air Pollution on Mortality.” Academic. Michael L Anderson. October 3, 2019.
  6. Air pollution: A systematic review of its psychological, economic, and social effects.” Science Direct. Jackson G. Lu. April 2020.
  7. Air quality and pollution city ranking.” IQ Air. December 22, 2020.
  8. “Most Polluted Cities.” ALA.