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A court has ruled that dirty air made a material contribution to the death of an asthmatic 9-year-old girl in south London, in a significant decision marking the first time a person in the UK has had air pollution listed as part of the cause of death.

An initial 2014 inquest into the death of Ella Kissi-Debrah in 2013 focused on her medical care and concluded that the cause of death was acute respiratory failure.

Today, after a fortnight-long inquest that heard from health, transport and air quality experts along with representatives of her family, three government departments, the mayor of London and the borough of Lewisham where she lived, coroner Philip Barlow ruled that air pollution had also contributed to her death.

“My conclusion is air pollution made a material contribution to Ella’s death,” Barlow said as he gave his verdict.

Barlow said that Ella had been exposed to levels of two air pollutants, nitrogen dioxide (NO₂),��a toxic gas largely emitted by diesel cars, and particulate matter, in excess of World ��ҹ����1000���� Organization guidelines, which are stricter than the UK and EU’s limits.��“The level of air pollution she was exposed to was therefore excessive,” he said.

Excessive air pollution

The coroner added that inaction by authorities to reduce levels of NO₂, and a lack of information given to her mother, both “possibly contributed to her death”.

The official cause of her death was�� as “died of asthma contributed to by exposure to excessive air pollution”.

Mayor of London Sadiq Khan said the decision was a reminder of the need for more action to curb pollutants. “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 in a statement. Green MP Caroline Lucas�� that it “must lead to a seismic shift in efforts to clean up the air”.

Up to , and the issue has climbed up the political agenda since Khan was elected mayor of London in 2016. However, the precedent set by today’s ruling could herald a seismic shift in efforts to clean up air pollution in the UK, as local and national authorities scramble to avoid falling foul of legal challenges for failing to uphold .

A key piece of evidence in the case was a 2018 report by Stephen Holgate at the University of Southampton, UK.

He examined tissue samples taken from Ella and data from pollution sensors near her home close to the South Circular, a major road along which she walked for much of her route to school. Holgate concluded that exposure to illegal levels of NO₂��was a “key driver” of her asthma, which saw her admitted to hospital 27 times before a fatal asthma attack in February 2013.

Speaking on 9 December during the inquest, Holgate was asked if her exposure to NO₂ made her a “canary in a cage”. Holgate replied: “I would probably use the expression ‘canary in a coal mine’.” Holgate told the coroner’s court it would be “abnormal” if Ella didn’t have “psychological problems” because of her illness, but rejected the suggestion that psychological factors had directly driven her asthma.

The inquest heard on 7 December from Ella’s mother, Rosamund Kissi-Debrah, that the 9-year-old played up to 10 musical instruments, was a great dancer, extraordinary swimmer, had a reading age well beyond her years and was “incredible well-liked”. She wanted to be a pilot. “She was a joy. She was the centre of our world,” said Rosamund, a former teacher who is now campaigning on air quality.