To protect life

Covid-19 has shown us that swift action on global health is possible, even if it still falls short. What could we achieve, asks Amy Hall, if we took an urgent approach to air pollution, another widespread killer?

A young boy wears a gas mask to protect himself from the fumes during a fire in Kibera, the largest slum in Nairobi, Kenya. DONWILSON ODHIAMBO/Sopa Images/Lightrocket via Getty

A global health crisis can come in different forms. It can sweep across countries, stalling economies, paralysing health services and killing far too many people before their time. It can lead to overnight job losses, business closures, food supply problems and restrict the movement of entire states. It can lead to governments promising hundreds of billions of dollars to support health services, people out of work and the homeless. It can see neighbourhoods spring into action to help each other out.

As I write this, over 30,000 people around the world have died from Covid-19. The World Health Organization’s cumulative cases curve is rising every day, with no sign of levelling out. It feels like society is crumbling and everything has changed. I’m scared for my family, loved ones and my sanity. I’m scared for my friends with no homes, with no papers, and for those on the frontline of essential services who try to keep us all going. I’m scared about what we will be left with when this is over.

Even if humans have nothing else in common, we all need to breathe. But over 90 per cent of us are breathing air that is unsafe and exceeds WHO pollution guidelines.

But not every health crisis bursts in, slamming doors. One could slip in almost unnoticed, kill millions and destroy habitats, without there being anything tangible towards which we can point the finger of blame. It can be an emergency that, despite putting us in hospital or early graves, we don’t consider enough; we think, instead, that it actually makes our lives easier.

It can be a crisis for which the response is discussion and debate, tweaking things around the edges, and exporting the problem onto poorer communities – across town, or across the world. And, largely, to continue business as usual. Air pollution is one such crisis.

In a normal year on planet Earth over seven million people die because of air pollution.1 Like Covid-19, the most vulnerable people are likely to be affected the worst, but nobody is immune. Even if humans have nothing else in common, we all need to breathe. But over 90 per cent of us are breathing air that is unsafe and exceeds WHO pollution guidelines.

Often in the name of progress and comfort, we are pumping our own lifeline with poison – in our towns and cities, in the countryside, and inside our homes.

‘It must be in truth a supreme example of the way in which a metropolis of eight and a quarter million people can experience a disaster of this size without being conscious of its occurrence’ – these are words from a report by the UK Ministry of Health after a long weekend of bad London smog in 1952 led to the deaths of 12,000 people. Four thousand of these deaths were recognized in official government figures at the time; the rest were added by experts later when reassessing the smog’s impact.

In fact, in the UK (where I live), there were an additional 1,649 deaths thanks to smog in March and April 2014. I didn’t even notice.

Quick fixes?

Air pollution is damaging to almost every organ and cell in the human body. The impacts can start before birth; soot has been found on the foetal side of placentas.

From then on it just gets worse. Research points towards effects from air pollution on growth, intelligence, and development of the brain and co-ordination. Harm to babies and children will have an impact that lasts far into the future and permanently stunts the growth of their lungs. Dirty air can aggravate debilitating or potentially fatal asthma.

It can be linked to heart disease, stroke, breathing problems, lung cancer, dementia and psychological problems. It’s not just the long-term health issues: short-term problems such as sneezing and coughing, eye irritation, headaches and dizziness can also be caused by air pollution.

Non-human animals can experience a lot of the same health impacts, in addition to devastation to their habitats caused by acid rain, which pollutes soil, water and trees.

Air pollution is damaging to almost every organ and cell in the human body. The impacts can start before birth; soot has been found on the foetal side of placentas

The air pollution crisis and the climate crisis are inseparable. Many types of air pollution could be reduced at the same time as greenhouse gases, as they come from the same sources. Heatwaves brought on by climate change also make pollution worse. For example, diesel cars emit more pollution on hot days. Global air pollution from agricultural and forest fires (wild and otherwise) – the latter made worse by climate change – has been estimated to cause 339,000 early deaths each year.

So could we just clean the air and make it safer? There is a growing market for air purification devices which could be worth more than $30 billion per year by 2023. Purifiers can make a difference in a well-sealed home, says Alastair Lewis, a professor at the National Centre for Atmospheric Science in York, England. But when it comes to outdoor pollution they are less effective and use a massive amount of energy. There is also the issue of what happens to the chemicals and particles that can be removed.

‘If hundreds of millions of filters from millions of homes are then all dumped in the same few city landfills we double down on the concentration process,’ Lewis wrote for The Conversation. ‘Are we simply shifting a problem from the air into a problem of those same chemicals now leaching out into the soil and water?’

‘It fights against the laws of thermodynamics,’ Lewis told me. ‘When the pollutants are in the atmosphere they are incredibly dilute and extracting them takes a huge amount of energy.

‘I think actually in the end air purifiers are completely impractical and something of a distraction, but they’re very popular with politicians, particularly at the local level – it makes it look like you’ve done something.

‘Once people have heard that there is a little air filter or someone has planted a hedge or something, they take that to mean “well, I don’t need to do anything now because someone else has come up with this solution.”

‘It is really far more efficient to remove the problem before it becomes a problem.’

Old King Coal: cooling towers of a coal power plant against the sun. MICHAL KODYM/ALAMY

What’s it worth?

There’s no doubt that human activity is a dominant factor in what makes our air so toxic, but the overall picture is complicated. There are a multitude of pollutants to combat and they affect different places in different ways. Factors such as geography, weather conditions and whatever pollutants are in the air all combine and determine the impact.

But one thing cannot be denied. If we reduced polluting human activity, we would all be better off, and so would the planet. Polluting activity makes other health crises worse, and since the Covid-19 pandemic began, experts have warned that the disease could have a more serious impact on those living in urban areas because of the air pollution.

The dirtier the air, the more likely the death rate from Covid-19 will be higher, as elevated pollution levels are already damaging to people with heart and lung problems.

Once you start reading about it you get terrified really quickly. Me and other mums were talking about it and then we wanted to do something – turn our anger into action​

A major source of urban pollution is transport pumping pollutants – such as nitrogen oxides and particulate matter – into the air. In Europe, which has a particular problem with diesel, the health costs of air pollution caused by road transport have been estimated to range from €67-€80 billion ($72-$86 billion) annually. Half of the countries in the world do not have any vehicle emission standards. The aviation and shipping industries are also massive air polluters.

The extraction and burning of fossil fuels are the main cause of air pollution, with coal one of the biggest culprits. Whether burnt in power plants or people’s homes, coal emits particulate matter, sulphur dioxide, nitrogen oxides, carbon dioxide, mercury and arsenic. Coal is responsible for over 800,000 premature deaths per year globally – 670,000 in China alone. It is the biggest source of carbon-dioxide emissions from human activity.

The use of inefficient fuels for cooking and as light sources is the biggest global factor in indoor air pollution. A quarter of households in poorer cities are reliant on solid fuels for cooking. Those households can face a double burden – polluted air both outdoors and inside the home. Women and girls bear the biggest health impacts.

Meanwhile, a wood-burning stove has become a fashionable accessory in many colder Western countries with a cosy, romantic image of nights by the fire. But wood stoves aren’t good news for people with asthma, or anyone wanting to breathe clean air. Burning wood releases more carbon dioxide into the atmosphere than burning gas, oil and coal for the same amount of heat or electricity. A 2018 study in the UK found that wood burning was adding between 24 and 31 per cent to particle pollution in the major cities of Birmingham and London.

Air inequality

While we all need safe air to breathe, it’s easier for some to come by it than others.

On a global scale, low- and middle-income countries suffer from the highest exposures to air pollution. It is also a problem that wealthier countries displace elsewhere – externalizing their health and environmental costs, often looking for the ‘cheapest’ means of production. Goods and services produced in one region, for use by another, are responsible for 22 per cent of air pollution-related deaths worldwide.

Health inequalities, which are more pronounced in deprived neighbourhoods across the world, are made worse by air pollution. Poorer communities are more often sited near environmental hazards, such as big roads, power plants and waste disposal. The impact can be compounded by poor housing and indoor air-quality conditions, the stress of living on a low income, and having limited access to healthy food and/or green space.

Class plays its part in who has to endure the worst pollution. There are people who can choose to move out of cities like Beijing, London and Delhi when pollution gets really bad, or stay inside purified buildings during the worst smogs. Not everyone has that option, particularly those who live or work at street level, or in factories or energy plants.

Air pollution is also an issue of racial justice. Not only are people living in Africa and other parts of the Global South more affected by it, but black, brown and indigenous people in Western countries also bear the brunt. One study found that white people in the US breathed in 17 per cent less pollution than they create. This ‘pollution advantage’ is a stark contrast to the ‘pollution burden’ experienced by black and Hispanic people, who respectively experience 56 per cent and 63 per cent more pollution than they create.

Rosamund Kissi-Debrah outside the High Court in central London, on 2 May 2019, after judges ruled that a new inquest could be held into the death of her daughter Ella from an asthma attack. SAM TOBIN/PA ARCHIVE/PA

Gasping for change

There is also inequality in terms of accessing air-quality information. There are more public monitoring stations, providing publicly available data, in Greater London than the entire African continent. While there are still plenty of people pushing for improvements on air pollution in Africa despite this lack, having access to information about air quality would be a further catalyst for action.

Jonathan Gray is a lecturer in Critical Infrastructure Studies at King’s College London. He researches the politics of sensor data and its role in activism, including people using their own, lower-cost air-pollution monitors.

Although the reliability of such monitors can be questioned, Gray says they are a useful tool for pointing out to authorities where there is a problem, as well as bringing the issue to life for a wider range of people. ‘

Sensing devices can play many different roles in helping to bring the environment into social and political life. This is relevant not just from the point of view of noxious emissions from cars, but also climate change. The massive problem is trying to make a very intangible issue relatable.’

One of the people for whom the issue is far from intangible is Rosamund Kissi-Debrah. Her daughter Ella was a healthy, active child until she was seven. Two years later, in 2013, she died from a rare form of asthma. Ella grew up less than a mile away from London’s South Circular Road.

After the first inquest into Ella’s death – which didn’t mention air pollution – Rosamund founded a charity, the Ella Roberta Family Foundation, to support children suffering from asthma in southeast London. Someone rang her up to tell her about the big spikes in air pollution in the days around Ella’s death.19

In 2018, a report by Professor Stephen Holgate, special adviser on air quality to the Royal College of Physicians, mapped Ella’s admissions to hospital to spikes in air pollution levels around her home. The family were eventually granted another inquest and are fighting to have air pollution recorded on Ella’s death certificate.

Rosamund continues to work tirelessly to raise awareness about pollution. ‘Ella would have expected it of me,’ she said in 2018. ‘I am doing this for her, and I am doing this for all the other children who are suffering.’

Two London boroughs to the west, Ella’s story was one of the inspirations for Jemima Hartshorn and other parents to form the campaign group Mums For Lungs.

Three years ago, Hartshorn was on maternity leave, living on Coldharbour Lane, a major road in Brixton. ‘I was pushing the pram with this precious little boy in it, thinking about the traffic, and I thought, “Something is wrong here”.’ She started to find out more about air pollution. ‘Once you start reading about it you get terrified really quickly. Me and other mums were talking about it and then we wanted to do something – turn our anger into action.’

The first Mums For Lungs meeting had four people, the second six and now the group is active in three areas of London and working with other air-pollution campaigns.

Since Mums For Lungs started, Hartshorn has seen a great improvement in the way local authorities in her area are dealing with air pollution. ‘It’s really picked up in speed and ambition,’ she says. ‘The highlight has been to have an impact but also to really raise awareness. More and more, we have people coming to us and saying, “Can I have a flyer, can you give me 100 flyers for the whole school?”’

For Hartshorn, cars – and people’s attachment to them – are the biggest barrier to change in her local community. ‘I totally get that if you have mobility issues or several young children, cycling may not be an option, but people are so used to driving and there is a huge sense of entitlement around it.

‘I think there’s a strong belief that you have the right to drive no matter what that costs. The reality is, every drive you’re taking is polluting someone else. What else would I be able to do that inconveniences others simply for my own convenience?

‘I think that is the biggest stumbling block we’re fighting as a society. That the way life is at the moment is so accepted as being normal.’


Right now, life for so many people has changed in ways I couldn’t imagine just weeks ago. These changes – and the threat of the pandemic – have brought anxiety, fear and heartbreak. But at the same time, they have also shown the potential for radical changes to aid the greater good. These changes are being made because, if we don’t make them, there is a massive threat to human life.

Recently a friend shared one of those cheesy motivational statements on social media that stuck with me: ‘If we get this right, we’ll never go back to normal.’

While so many things will be worsened and even destroyed by this pandemic, there could also be some things that we can keep doing in the future – like travelling less. As a global society we could respond to air pollution with half the current level of extremity and still save lives. Reducing levels of toxic air can lead to dramatic reductions in asthma, heart attacks and the number of underweight and premature babies, within weeks.

As the virus has shut down our usual way of life, air pollution has plummeted. ‘‘We are now, inadvertently, conducting the largest-scale experiment ever seen,’ Paul Monks, professor of air pollution at the University of Leicester, told The Guardian in March. ‘Are we looking at what we might see in the future if we can move to a low-carbon economy? Not to denigrate the loss of life, but this might give us some hope from something terrible.’

In the midst of a pandemic, it is hard to accurately predict how many people will die. It’s even harder to then compare this with how many would have died from air pollution, had levels not dramatically fallen due to Covid-19 related measures and behaviour change.

‘Strangely enough, I think the death toll of the coronavirus at the end of the day might be positive, if you consider the deaths from atmospheric pollution,’ said François Gemenne, director of The Hugo Observatory research centre, on the television channel France 24 in March.

‘What surprises me most is that the measures that we are ready to take to face this coronavirus are much more severe than the measures we would be ready to take to face climate change or atmospheric pollution.’

This pandemic is not to be celebrated. There will undoubtedly be short- and long-term impacts of Covid-19 that go further than people getting sick or dying from the virus itself. More people will die from other ailments because of the extreme pressure put on health services by the Covid-19 crisis. More people will be made jobless and homeless, thrown into poverty, or pushed deeper into it.

Like combating a pandemic, reducing air pollution is as much about the impact of our behaviour on our neighbours – whether in the same town or internationally – as it is about protecting our own health and environment. ‘All cities have a responsibility for their contribution to wider air pollution that spreads across hundreds of kilometres. It’s like with a factory: the responsibility for its pollution doesn’t end at the factory fence,’ says Gary Fuller, air-quality measurement expert at King’s College London.

Many places in the world have made significant improvements to their air-pollution levels. We know that change is possible, but maybe it’s time we picked up the pace. There may well be some air-pollution questions we don’t yet have all the answers for, but, as Fuller points out, there’s no need to wait for more evidence.

‘We already have more than enough research to justify vigorous action, we’ve had enough evidence for decades. We just need to treat our air as a vital life source and not a waste-disposal mechanism.’

World Health Organization: Global information and data
Pakistan Air Quality Initiative: Community-driven air quality reports
The Rise Up Movement: Climate campaign network to amplify the voices of African activists
Center on Race, Poverty, & the Environment: US-based environmental-justice organization
#FridaysForFuture: Youth-led climate movement
Clean Air Day: Annual UK campaign. This year, Clean Air Day is on 18 June 2020
ClientEarth: Charity leading legal fights for clean air across Europe
The Invisible Killer: The rising global threat of air pollution – and how we can fight back
by Gary Fuller, Melville House, 2019
Choked: The age of air pollution and the fight for a cleaner future
by Beth Gardiner, Granta, 2019
Clearing The Air: The beginning and end of air pollution
by Tim Smedley, Bloomsbury Sigma, 2019