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Communicating the adverse effects of air pollution on health

The RCP has responded to the Inner South London assistant coroner’s report to prevent future deaths following the death of Ella Adoo-Kissi-Debrah.

On 15 February 2013, 9 year old Ella Adoo-Kissi-Debrah died following an asthma attack. In 2019 the coroner re-opened the investigation and it concluded in December 2020.

The narrative conclusion of the inquest was that Ella died of asthma, contributed to by exposure to excessive air pollution. During the course of her illness, between 2010 and 2013 she was exposed to levels of nitrogen dioxide and particulate matter (PM2.5) that exceeded World Health Organization guidelines. It was the first time that air pollution was listed as a cause of death in the UK and was hailed as a landmark decision by campaigners in the health and environment sectors.

On 20 April 2021 the coroner issued a regulation 28 report to prevent future deaths based on the evidence presented at the inquest. One of the matters of concern identified by the coroner was that, “the adverse effects of air pollution on health are not being sufficiently communicated to patients and their carers by medical and nursing professionals.” The RCP was one of the organisations required to respond on that point, in relation to our responsibility for postgraduate education of physicians.

In our response, we have said that we will work with specialist societies, the Academy of Medical Royal Colleges and other royal college partners, the UK Health Alliance on Climate Change and others to:

  • continue to raise the profile of the impacts of air pollution on health
  • review the delivery of the internal medicine curriculum via the Federation of Royal Colleges of Physicians of the UK, in light of this report
  • decide how to increase knowledge among physicians of the impacts of air pollution on health
  • produce and actively promote resources that will help medical professionals
    • better understand the impacts of pollution
    • have conversations with patients and their families about avoiding air pollution and mitigating its impacts
  • work with government and the NHS to improve incentives to have these conversations and systems that indicate when they are necessary
  • consider how we might help medical professionals become local advocates for reducing air pollution
  • urge national and local government to tighten regulation of pollution generating activity and improve public information.

Dr Cathryn Edwards, RCP registrar, said: “It is absolutely tragic that Ella died as the result of air pollution, a cause of ill health we have known about for years and could have done so much more to reduce. As the coroner said in the report to prevent future deaths, nobody at the inquest disputed the fact that air pollution causes thousands of premature deaths every year.

“The RCP accepts the evidence presented at the inquest and thanks the coroner for helping us think about our role with regard to it. There is more we can do to support doctors and other clinicians to talk to patients, their families and carers about avoiding and mitigating the impact of air pollution.

“But as I say in my response, the risk of air pollution to public health will only be significantly reduced if government and other policy makers agree to widespread societal measures to regulate and reduce pollution-generating activity. The coroner identified that ‘legally binding targets based on WHO guidelines would reduce the number of deaths from air pollution in the UK’. The environment bill currently passing through parliament is an opportunity to do that; it is not too late for the government to commit the UK to meeting WHO guidelines for PM2.5.”

Read our full response below.