UK Lists Air Pollution as Cause of Death in Historic First

In a historic decision, the United Kingdom will issue the first known death certificate to list air pollution as a cause of death. The decision was made following a long-standing debate over the death of Ella Kissi-Debrah, a 9 year old British girl who passed away in 2013. The move could set the stage for wider recognition of the role air pollution can play in increasing mortality rates.


The case centered around the question of whether high levels of air pollution in Lewisham, the girl’s hometown, could have contributed to the young girl’s death. According to authorities, levels of common pollutants in Lewisham significantly exceeded the limits set by British and European law. Ultimately, it was decided that pollutants from vehicle emissions played a role both in causing and worsening the severe asthma that led to Kissi-Debrah’s death. Specifically, particulate matter and nitrogen dioxide were implicated as root causes.


While tragic, Kissi-Debrah’s case marks a turning point in the recognition of the public health implications of severe air pollution. Air pollution has never before been listed as a contributing cause of death on an official death certificate. By doing so, Britain’s health authorities have lent official recognition to the very real threat of low air quality to human health.


Up to now, lack of certainty has made coroners reluctant to attribute any specific death to air pollution. While it is demonstrable that low air quality contributes to huge numbers of deaths at the population level, it’s much more difficult to say that it played a role in any individual case. This is the reason it took 7 years and a drawn-out process to prove that air pollution was a main cause of death in the case of Ella Kissi-Debrah. Now that the precedent has been set, though, it’s possible that air pollution will begin cropping up more regularly on UK death certificates.


According to the World Health Organization, air pollution contributes to more than 7 million deaths worldwide each year. This includes more than 4 million deaths caused by the kind of ambient air pollution that is believed to have contributed to Kissi-Debrah’s death. Despite these shocking figures, polluted air has never before been listed officially as a cause of death. Generally, it has been seen only as an environmental factor that contributes to the conditions that lead more directly to death.


There is, however, much cause for optimism in the effort to reduce air pollution’s impact on human health. Even small improvements in air quality have been shown to substantially reduce the death toll that can be attributed to polluted air. As we covered in a blog post last month, the European Environment Agency reported that the number of annual deaths caused by air pollution in Europe decreased by 60,000 between 2009 and 2018.


Although we’re still a long way from solving these problems, the official recognition that air pollution causes specific deaths is a historic move and may help to drive public policies that will improve air quality in the United Kingdom and around the world.