Family and friends of Ella Adoo-Kissi-Debrah describe a funny, busy, clever, curious, sporty and musical child. And now she is also a child who made history for a very sad reason.
After developing asthma, she died in 2013 aged just nine.
Her mother wanted answers to what caused it and, just before Christmas, a second inquest led by Coroner Philip Barlow set a legal precedent. He concluded Ella had been exposed to “excessive” levels of pollution.
“There was a recognised failure to reduce the levels of nitrogen dioxide, which possibly contributed to her death,” he said.
Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, says the verdict “sets the precedent for a seismic shift in the pace and extent to which the government, local authorities and clinicians must now work together to tackle the country’s air pollution health crisis”.
How bad is it? Currently in the UK three people die from asthma every day and at least two of those deaths are avoidable, according to Asthma UK.
But the true extent of poor air quality isn’t known. The biggest places of concern are urban areas and they change every day. Complex urban environments make it difficult to predict how much pollution we breathe in on a day-to-day basis. Our exposure to air pollution can vary based on something as simple as which route we take to work. Variations in the weather are another factor. According to the National Centre for Atmospheric Science, cold, still air can exacerbate the effects of the pollution because it stays in one area.
Monitoring the impact
Part of the problem is that monitoring by the government covers wide areas such as cities and methods involved haven’t changed. So, a team at the University of Exeter, working with The Met Office has begun using AI to narrow the data to an individual level, to measure how pollution impacts each person directly and the effectiveness of intervention actions. But it’s early days.
Professor Gavin Shaddick, Chair of Data Science and Statistics at the University of Exeter, leads the WHO Global Platform on Air Quality and Health Data Integration Task Force and serves on the UK government’s Committee on the Medical Effects of Air Pollutants (COMEAP).
He says: “The primary source of information for estimating population exposures to air pollution has been measurements from ground monitoring networks but, although coverage is increasing, regions remain in which monitoring is limited.”
But what are the causes?
There are two main air pollutants of concern in London, based on their impact on human health: nitrogen dioxide (NO2) and particulate matter that becomes fine dust (PM2.5).
According to the Department for the Environment, Food and Rural Affairs (DEFRA), the sources are:
• Sulphur dioxide
• Nitrogen oxides
• Particulate matter (formed by a mixture of solid particles and liquid droplets suspended in the atmosphere)
• Ozone and volatile organic compounds
• Toxic Organic Micro-Pollutants (TOMPS)
• Carbon monoxide
• Lead and heavy metals
What’s creating the pollution? The breakdown, according to scientists and DEFRA is: :
• 38% from burning wood and coal in domestic open fires and solid fuel stoves
• 12% from road transport
• 13% from solvent use and industrial processes
• 16% from industrial combustion (non-domestic burning).
Today, just as in the Victorian era of unregulated factories and smog, poverty is a factor in who is most affected by air pollution. Oliver Lord, head of policy and campaigns at Environmental Defense Fund Europe said: “The health burden of air pollution is not equal. Whether kids attend school on a main road or in a leafy suburb should not determine the quality of air they breathe, which will affect them for the rest of their lives.”
The government says transport is the biggest offender, but data collected during the first lockdown in spring 2020 showed our homes and offices are also a big problem.
The National Centre for Atmospheric Science calculated that during lockdown, levels of nitrogen dioxide were 43% lower in urban areas, compared to the same period over the previous five years. But there were smaller changes for small particle pollution, known as PM2.5 - which is linked to housing.
The Climate Change Committee (CCC) the statutory body established under the Climate Change Act 2008, made the link. A report by its health advisory group to the government, published in November last year called for the design and retrofit of homes to be energy efficient and healthy. The CCC’s chief executive, Chris Stark, says: “There is no doubt that reducing polluting emissions has significant health benefits.”
Indoor air quality
Scientists are also warning that the indoor environment is just as big a concern. Badly built, poorly maintained buildings that circulate dust or spores are just as lethal as a road full of traffic.
Professor Nicola Carslaw of the University of York set out new research showing the risks. She warns that damp, the burning of fossil fuels and wood, dust, and chemicals from building materials all lower the quality of air in the place where people spend most of their time. She says: “Although people are generally very aware of air pollutants outdoors and their exposure to them – such as when they walk along a heavily trafficked street – they are much less aware that they can be exposed to pollutants in their homes.”
Professor Jonathan Grigg, Paediatric Respiratory Consultant from the Royal College of Paediatrics and Child Health (RCPCH) said: “We’re finally paying attention to the quality of our indoor air, and this is long overdue. Too many of our homes and schools are damp and poorly ventilated – this is adversely affecting the health of children.”
So, what can the HVAC industry do and are there any innovations that are on the way?
Good building ventilation along with practical measures, such as cleaning ductwork in HVAC systems can all help. But there are bigger wins to be had.
Reducing gas dependency is another factor. Boiler emissions are cited as a major source of air pollution – up to 12% in urban areas. There are 21 million gas boilers in the UK and less than 5% of homes are heated by low carbon sources.
Natural gas, used mainly for heating buildings and water, accounts for 37% of all greenhouse gas emissions in London.
A report by the Energy and Climate Intelligence Unit warned last autumn: “Nitrogen oxides (NOx) emission from gas boilers, could spike over the course of a winter spent working from home, potentially compromising the UK’s ability to meet legally binding air quality targets.”
The Mayor of London has already been looking at this. Last year testing was carried out to compare emissions against the manufacturers’ stated emission rates for each boiler. The aim was to start gathering data. With the exception of one boiler, measured and manufacturer’s stated emission rates compared well, with an average of 94 per cent agreement.
Given killer air supply is a problem today, what can be done immediately?
Right now, the best advice from the government is to meet the emission and design standards we have. For industrial boilers and furnaces in England there is a government permit scheme that sets design and limits aimed at reducing pollution. Small changes at home can make a big difference too.
Professor Carslaw says: “Using an extractor fan that vents outdoors when cooking is one way to improve air quality in the home, and making sure that cleaning is carried out in a well-ventilated space is another.”
The CIPHE advice is to ensure that HVAC systems are maintained and cleaned so they not only remain at optimum performance but don’t pump through accumulated dust particles.
Long-term, policymakers are already saying that the retro-fitting of low carbon HVAC systems, such as ground source heat pumps, is going to be part of the solution.
London, with a population of 8 million, is set to lead the way. A report by the Carbon Trust commissioned by Mayor Sadiq Khan published last summer set out a blueprint of how to do it. It included detailed analysis of the potential to retrofit heat pumps across a range of existing buildings in London and recommended an action plan for scaling up energy efficiency and heat pump retrofit across the capital.
The report’s findings will be familiar to CIPHE members who have been following the development of the low carbon agenda over the last two years.
“Heat pumps are not a like-for-like replacement for gas boilers, and good practice system design will be essential to their effective deployment,” it says.
The report contains guidance for building owners on the technical options for installation and the principles of good practice system design in heat pump retrofit.
The Carbon Trust adds: “A prerequisite for the roll out of heat pumps in many buildings will be improved thermal energy efficiency, which is likely to require significant investment from central government, alongside investment and co-ordination with local authorities and the private sector.”
Tom Delay, chief executive of the Carbon Trust, is realistic that cutting building emissions is not going to solve the big problems: “As always, heat pumps are not a silver bullet solution, which is why we have provided a suite of policy recommendations, including investment in energy efficiency in buildings and flexibility in the energy system.” The trust isn’t the only organisation to make clear that achieving clean air will have to be a national effort led by the government rather than relying on early adopters and one or two politicians.The Royal College of Physicians wants the government to “require national agencies and local authorities to protect those most at risk and to reduce exposure to air pollution among vulnerable groups such as children, older people and those with pre-existing health conditions”.
Sadly, the scale of the problem after decades of failing to take action – and the lack of meaningful data – means illness caused by poor air quality is going to be an issue for years to come.But the verdict in the case of Ella Adoo-Kissi-Debrah could be the wake-up call needed because of future legal implications.
The CIPHE is lobbying the government and working with industry to get improvements but it’s a complex task. Kevin Wellman, CEO of CIPHE said: “Just banning cars isn’t going to deliver the change we need. It’s also about better building design and build as well as cutting building emissions. None of this is easy or cheap. But if continuing as is will result in preventable deaths, then it is clear that action must be taken.”
Building the new
The Royal College of Paediatrics and Child Health (RCPCH) is calling for:
• Legally binding performance standards for indoor air quality to include ventilation rates, maximum concentration levels for specific pollutants, labelling of materials, and testing of appliances
• Air quality tests when local authority construction is complete and before the building is signed off
• Compliance tests after construction stages and assessment of buildings once occupied – this may require ring-fenced resources for local authorities to take enforcement action.
Pure in deed
Air purifiers are a quick solution to getting clean air into a building.
There are stand alone domestic units on the market starting from £120 up to medical-grade units which cost more.
They must meet the High-efficiency particulate air (HEPA) standard for filtering. A unit rated HEPA H14 will pass up 0.005% of 0.1 micron particles per litre of air.
Products include the Blueair Blue Pure 411 and the Dimplex DXAPV3N Air Purifier.