How Toxic Is the Air You Breathe?

The Trump administration is rolling back restrictions on air pollution in the U. S., and some experts say this could affect the health of millions of people. And what makes air pollution especially dangerous is that we often can’t see it at all. So today, we’re going back to the story of Ella Kissi-Debrah, a little girl who suddenly got sick and landed in the hospital. In this episode, her mom, Rosamund, takes on the fight to find out what exactly happened to Ella. And the answer has BIG implications — for us all. We’ll hear from Rosamund Adoo-Kissi-Debrah and Professor Stephen Holgate. Find our transcript here: https://tinyurl.com/ScienceVsAirPollution In this episode, we cover: (00:00) Ella’s story (13:02) The campaign and investigation (21:01) Why air pollution is so dangerous (25:39) Accountability and change This episode was produced by Ekedi Fausther-Keeys with help from Rose Rimler, Wendy Zukerman, Michelle Dang, Meryl Horn, and Courtney Gilbert. We’re edited by Blythe Terrell. Wendy Zukerman is the Executive Producer. Extra help by Saidu Tejan-Thomas, Nicole Beemsterboer, Kendra Pierre-Louis, and Alex Blumberg. Fact checking by Erica Akiko Howard. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Emma Munger, Bobby Lord and SoWylie. Thanks to all of the researchers and experts we got in touch with for this episode, including Jocelyn Cockburn, Professor Vernon Morris, Dr. George Thurston, Dr. Lauren Zajac, Dr. Jennifer Burney, Dr. Sacoby Wilson, Dr. Melissa Burroughs, Dr Wei Peng, Professor Barbara Hoffman, Dr Michael Craig, and Dr Wes Austin. Special thanks to Rachel Humphreys, BBC Motion Gallery / Getty Images, Jonah Delso, Jackie Llanos, the Zukerman Family and Joseph Lavelle Wilson. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Wendy Zukerman?

  Hi, I'm Wendy Zukerman and this is Science Versus.

• 0:06Wendy Zukerman?

  Before we get into today's episode, I just want to say that we're getting advertising from various companies about AI products, but we are going to be rethinking our policy on all of this. For those who have been writing to us, we are reading your comments. We totally hear you. We have to take a lot into account to try to keep this show going, and there are some balances we need to strike, but sometimes we make the wrong call. So I just wanted to say thank you for getting in touch. And now, on with the show.

• 0:44Wendy Zukerman?

  Recently, the Trump administration has been rolling back protections that are designed to keep the air clean in the US. And he's been making it easier for certain industries to pump potentially dangerous chemicals into the air.

• 0:58Speaker 01

  They want to make pollution great again.

• 1:01Speaker 02

  So in case you don't know, the EPA just announced that they're doing massive deregulation.

• 1:06Speaker 03

  It means pollutants from cars, trucks, and power plants will no longer be regulated at the federal level.

• 1:13Speaker 04

  We cancelled the EPA's absurd, just totally absurd, tailpipe emission standards, which was a disaster.

• 1:23Wendy Zukerman?

  Trump says that he's doing this to save money for the automotive and fossil fuel industry, and to make cars cheaper for consumers. And since he's said that climate change is a scam, he's obviously not worrying about that, unlike us. But the thing is, even away from climate change, these changes that he's making, it made us at Science Versus want to go back to an episode that we published several years ago. It's one that I find myself thinking about a lot these days. And I won't say too much more about it. I've probably said too much already. Except that this story unfolds as a medical mystery. So let's just

• 2:08Wendy Zukerman?

  jump in. To tell us about it is Rosamund Adu Kissy Deborah. She's a former teacher in London.

• 2:15Speaker 05

  One second, one second. This is my daughter. Let's see what's in here. Hi, Barb's. Can you go what?

• 2:23Speaker 05

  Yeah, okay. Oh, thanks. Bye. I love you. I love you too. Bye.

• 2:28Wendy Zukerman?

  Rosamund is a single mum and just as we got on the call, one of her twins phoned. It was about her birthday. What did she want?

• 2:36Speaker 05

  For one day in the year, I allow them to have chocolate cereal.

• 2:40Wendy Zukerman?

  Oh, she wanted chocolate cereal.

• 2:42Speaker 05

  Of course, she makes me sound like such a strict mum. Oh, no. She did say I love you at the end. So see, I'm, I'm, I'm, I'm doing good.

• 2:52Wendy Zukerman?

  But our story today isn't about the twins or chocolate cereal. It's about Rosamund and her oldest daughter Ella. She was the big sister to those twins. She had big brown eyes and often wore her hair in braids. Rosamund told us that she loved to swim and bike and she was super competitive.

• 3:12Speaker 05

  Like she would play chess, Connect Four. So she was into board games. She was into beating people, you know, like luring you people in, pretending that, you know, like a chess game was equal. Then when you got comfortable, eh, bang, bang, bang, checkmate. Mum, would you like to play chess? No, thank you very much, Ella. I don't want to play chess with you.

• 3:32Wendy Zukerman?

  So Ella was smart. At nine years old, she was picking up Jane Eyre. And just the other day, Rosamund found this book that Ella had been reading. It was called The Observer Book of Genius.

• 3:45Speaker 05

  So who did Ella compare herself to? I thought, let me have a look in there. Plato, she would, um, Pythagoras. So she had a great sense of humour.

• 4:00Wendy Zukerman?

  But a few years before all this, Ella's life had taken a turn. It started in October 2010, when she was six years old. Ella and her mum had gone to visit the monument to the Great Fire of London. It's this tall tower and to get to the top, you have to walk up more than 300 steps. So together, they were climbing this tall tower. But weirdly, Ella was struggling. She'd been a little sick, had a bit of a cough.

• 4:32Speaker 05

  And when she was climbing up the stairs, she said, oh, I can't climb up the stairs. And then I remember, typical mum, I said, you've only got a cold. Little did I know, it was the beginning of the end.

• 4:46Wendy Zukerman?

  That night on the way home, Ella fell Asleep on the train, which was also strange. And from there, things got bad quickly.

• 5:03Wendy Zukerman?

  That little cough that Ella had turned into these terrible coughing fits that seemed to come out of nowhere. Sometimes she'd cough so hard that she couldn't breathe.

• 5:13Speaker 05

  What used to happen is she used to get so much mucus, her lungs would collapse and she would stop breathing. So we had to resuscitate her to live.

• 5:21Wendy Zukerman?

  And because oxygen wasn't getting into her brain, sometimes she'd have a seizure and even pass out.

• 5:28Speaker 05

  And by Christmas time, she had been admitted to ICU for the first time. She was admitted to hospital 28 times.

• 5:36Wendy Zukerman?

  28 times?

• 5:38Speaker 05

  Yes, yes. So she had hundreds of attacks.

• 5:47Wendy Zukerman?

  And the scariest part of this was that Rosamund didn't know why any of this was happening. How did her kid go from being perfectly healthy to being in the ICU in just a couple of months? Ella would go to some of the best doctors in London, many different hospitals, and yet no one could tell them what was going on.

• 6:11Wendy Zukerman?

  After the break, the story of Ella's medical mystery and how it made the invisible visible.

• 6:29Speaker 06

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• 6:59Wendy Zukerman?

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• 7:35Wendy Zukerman?

  Welcome back. Where we left off, Ella, who had been this really healthy little kid, was now in and out of hospital. And her mum was desperate to figure out what was making her sick. What did doctors tell you, you know, when you were going into hospital?

• 7:50Speaker 05

  We didn't know. We were testing her for loads of things: epilepsy, cystic fibrosis, loads of things we were testing her for.

• 7:58Wendy Zukerman?

  Doctors were confused because her symptoms were kind of all over the place, like Ella's lungs were producing way too much mucus, which made it harder and harder for her to breathe. And that kind of thing can happen in people with cystic fibrosis. So they tested her for that, but it came back negative. Doctors also tested her for epilepsy because of the seizures, but that didn't pan out either. After tons of blood tests, EEGs and doctors' appointments, Ella finally got a diagnosis. They told her she had asthma, but that was weird, too.

• 8:35Speaker 05

  Because she didn't present herself like a normal asthmatic.

• 8:40Wendy Zukerman?

  Like one of the best medications that we use for asthma: steroids. It didn't work for Ella. And then there was her cough. There was just something weird about it.

• 8:51Speaker 05

  You know what? I would recognise Ella's cough anywhere. If you gave me a thousand coughs, I could still pick out her cough.

• 8:58Wendy Zukerman?

  The medical name for a cough like Ella's, where you cough until you pass out, is called cough syncope. And one day, while Ella was getting one of her many tests, Rosamund started Googling it.

• 9:13Speaker 05

  I was looking it up in hospital. And the research, because I'm a bit obsessed with research in my job as a teacher, the research at the time when it came to coughing syncope, showed me there were mainly men in their 50s and they'd been long-distance lorry drivers. And I remember looking at the time going,

• 9:34Speaker 05

  "They are men in their 50s, she's nine, I've never smoked, don't get the connection." And I remember showing it to the doctor and didn't get the connection. It wasn't a thing that a child got, so it didn't make sense she had it.

• 9:50Wendy Zukerman?

  Yeah, most of the people with cough syncope are middle-aged men who have been smoking for years. It rarely happens to kids. One of Ella's doctors said that her case was so odd that they wanted to write about it in a medical journal, which Ella was actually kind of excited about.

• 10:10Wendy Zukerman?

  And Ella would go on to be written up in many medical journals, making international news and helping perhaps thousands of people breathe easier.

• 10:21Wendy Zukerman?

  But in the middle of all this, Rosamund and Ella didn't know any of that.

• 10:27Wendy Zukerman?

  And then there was this one final but really important mystery here. If this truly was asthma, then what was triggering it? For most asthmatics, you get an attack because it's triggered by something: cigarette smoke, mould, cleaning products. That stuff gets in your lungs and causes this huge inflammatory reaction and then your airways constrict. But doctors tested Ella for all kinds of stuff and none of those triggers made sense.

• 11:03Wendy Zukerman?

  And the thing is, Ella didn't always have attacks. They'd come in clusters, but when she was feeling okay, Rosamund would try hard to keep things normal. Ella loved listening to music, so they'd put on her favourite songs and dance around to them. Rosamund remembers this one song that she loved by Justin Timberlake and Jay-Z. It had just come out, this was early 2013. It's called "Suit and Tie".

• 11:29Speaker 05

  "Oh, I love Suit and Tie." See, I can see her dancing. And Ella used to like jump on the sofa, so you know how Justin used to jump. "Mama, don't break your neck. Seriously, Mama, don't break it. We have enough problems," I used to say to her.

• 11:45Wendy Zukerman?

  Soon after, Ella had another asthma attack. Rosamund said that it started out just like a normal night. Ella was listening to music, "Skyfall" by Adele. She was kind of obsessed with that song.

• 12:00Speaker 05

  And I remember that night, she was in the playroom on the computer, playing "Skyfall" again and again. And I remember, because it was Valentine's Day and I'd gone and bought food, I was cooking. I was like, "Look, you need to go and have a shower and be ready to come and eat, because we needed to eat by a certain time. You know, we had school the following day." And I remember, so my kids will say to you, "Oh, Mum shouted at her the night before she..." I was like, "Look, I know what happened, it wasn't meant to happen, but we need to eat, and I've cooked." And then she is on there. And I remember being so upset when Adele won the Oscar, that Ella wasn't alive to see it.

• 12:45Wendy Zukerman?

  Ella had a coughing fit that led to a seizure and then a heart attack. She died in the middle of the night, at 3am on February 15th, 2013.

• 12:58Wendy Zukerman?

  In the UK, when someone dies of unknown causes, a coroner is called in to do the assessment. In 2014, the coroner declared that Ella died as a combination of acute respiratory failure and severe asthma. But still, none of this made sense to Rosamund. And she still wanted to understand what had triggered the attacks. What killed Ella?

• 13:26Speaker 05

  It was important to know why she died. She has siblings, and I knew as they got older, you know, what was I gonna say? She got asthma, why, how? I had no answers.

• 13:38Wendy Zukerman?

  The coroner's report was mostly useless to Rosamund. Except, there was this one thing. A clue.

• 13:50Speaker 05

  Her trigger was to do with something in the air. It didn't specifically state what it was. And that gave me some hope. But I thought, oh, at least this is a bit further than we've got before.

• 14:02Wendy Zukerman?

  To push it even further, she started doing a bunch of media interviews.

• 14:06Speaker 05

  To say, look, this is what's happened to my daughter. If anyone's got any ideas out there, if they can help me get to the bottom of this mysterious thing, can they let me know? And that is how the ball began to roll.

• 14:19Wendy Zukerman?

  People got in touch from all over the country, throwing out all kinds of ideas for what might have happened to her. And this eventually led her to Stephen Holgate, a professor at the University of Southampton who specializes in asthma and allergies. One day in 2016, he was on the train heading home from London.

• 14:40Speaker 05

  On the long journey back, he picked up the Standard and he was reading it.

• 14:43Speaker 04

  I happened to pick up the Evening Standard, and I saw Rosamund, Chrissie Debra. I mean, it was just a dreadfully sad story.

• 14:51Wendy Zukerman?

  Stephen had spent his entire career researching asthma, getting to know the lungs inside and out. And here was his life's work sitting in front of him in the form of a medical mystery.

• 15:03Speaker 04

  Yeah, I mean, I'm a doctor, you know, and there was clearly an opportunity to try and unravel what had happened. And I know Rosamund couldn't do that, and one of the doctors... In all these hospitals could do it either. But because I, I had spent, you know, my life researching asthma. You know, I knew a lot about the disease.

• 15:28Wendy Zukerman?

  He got in touch with Rosamund and said, would you mind if I look through your daughter's medical records? And she was like, yes, go for it. Handed them over and Stephen dove in.

• 15:39Speaker 04

  Mounds and mounds and boxes of hospital notes and GP records and all the rest.

• 15:46Wendy Zukerman?

  Stephen also went to the hospital where sections of Ella's lungs were being preserved. He pulled out these tiny lung scrapings that are about the size of a fingernail. Put them under the microscope and straight away, he saw something odd.

• 16:03Speaker 04

  And what I saw in the sections was almost unbelievable, really.

• 16:07Wendy Zukerman?

  The lining of her lungs, which should protect them from gunk in the air, had been totally destroyed.

• 16:15Speaker 04

  It's as if you'd lost your skin and had kind of raw, raw areas underneath.

• 16:23Wendy Zukerman?

  In a healthy lung, you should see these lovely cells that look like columns with little hairs. But with Ella, those little columns had been replaced by a totally different cell. One that pumps out mucus and this was mucking everything up.

• 16:40Speaker 04

  This lining had peeled, in large areas, had peeled off and was rolled up into the airway itself. It was coming away and was rolling up with mucus, very sticky, viscous mucus. So she had these large plugs of mucus that blocked her airways.

• 17:00Wendy Zukerman?

  You are supposed to have some mucus in your lungs and it's helpful. It captures gunk in the air and helps you to cough it out. But Ella's lungs had become a bit like a mucus factory. Stephen looked for signs of what might have been irritating her lungs so much, like a bacterial or fungal infection. But nothing could explain this.

• 17:24Wendy Zukerman?

  But then, a new clue emerged, away from the lab. Something that clinched it for him.

• 17:32Speaker 04

  We were, I suppose, I hate to use the term fortunate, Wendy, but, I mean, in a way it was. It just so happened that there was a monitoring station for air pollution one mile from Ella's house.

• 17:47Wendy Zukerman?

  An air pollution station. It was monitoring stuff like nitrogen dioxide, which gets spewed out by London traffic and can damage lung cells. Now, by this point, Rosamund already had a lawyer to help out with Ella's case. And so, her legal team and Stephen got to work. Here's what they did. They matched up the pollution levels for the days surrounding when Ella would have these really bad attacks. And bam.

• 18:18Speaker 04

  We could see the local air pollution levels were astronomically high. Illegal levels of nitrogen dioxide. Oh, gosh.

• 18:29Wendy Zukerman?

  The team found a pattern. So Ella's attacks would come in these clusters. And mostly, they hit when pollution levels were particularly high. Much higher than the World Health Organization sets for maximum safe levels of pollution. And higher than the UK government is supposed to allow. And in the days before Ella died, the pollution levels were bonkers in her neighborhood. Through his academic research, Stephen had suspected that air pollution might have played a role here. But now, here was the evidence. And he was sure. Pollution had been triggering Ella's asthma attacks.

• 19:13Wendy Zukerman?

  And it all made a lot of sense. Because it turned out that Ella's family lived near one of the busiest roads in London. So all of Ella's life, she'd been breathing in lots of car exhaust and other pollution. When Rosamund found out about all this, she was shocked.

• 19:30Speaker 05

  Like what the air is, is what's killing her. What I now know is every day she was going out on her bikes, you know, she was really active. She was breathing in the air around, yeah, even in the garden. It's, it's kind of a bit hard because the pollution is invisible. You can't see it with the naked eye.

• 19:49Wendy Zukerman?

  We're still not sure why Ella's asthma was so deadly. Like, one of her siblings has asthma, but it's not nearly as bad. Stephen thinks it's perhaps some very unlucky genetic predisposition. But what Stephen did know was that every time little Ella breathed in all that pollution, it kept irritating her lungs more and more and more, until it destroyed them.

• 20:18Wendy Zukerman?

  Rosamund started researching about pollution. And she realized that in the UK and the US, pollution levels tend to be higher in black and brown communities. And that's partly because the government and industry have gotten away with building things like highways through black and brown neighborhoods. And the thing is, the neighborhood where Rosamund lives, it has a pretty large black population. Rosamund herself is black.

• 20:48Speaker 05

  If we, if we didn't live, I think that's what blows my mind. If we probably didn't live in this house near this road, then maybe my daughter will still be alive. So it, it, it is as simple as that. I, if we live somewhere else, then this might not have happened. Now, if, if I think that, then I'll be sad all the time. So I try not to drive myself crazy.

• 21:10Wendy Zukerman?

  And once Rosamund knew that air pollution had played this big role in killing her daughter, her next question was, why didn't any of Ella's doctors know about this? Like, why didn't they even suggest that air pollution could have been triggering her asthma? There'd been heaps of studies, even at the time, showing that air pollution could make asthma worse. But despite that, it just wasn't on the radar of some of the best doctors in London.

• 21:42Wendy Zukerman?

  How is that possible? That answer is coming up just after the break.

• 21:56Speaker 06

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• 22:26Speaker 03

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• 23:01Wendy Zukerman?

  Welcome back. We just heard that pollution was a major trigger for Ella's asthma. But until Stephen and the team came along, none of her doctors had even suggested it as a possibility. So why is that? Well, some researchers told us that it could be because these days, you often can't see the pollution around us. It's a little out of sight, out of mind. And that is not how it used to be. In fact, London used to burn so much coal that the air turned to this gross, puky color. When that happened, it was known as a pea-super. So time for a bit of history and then we'll get back to Rosamund's story.

• 23:45Wendy Zukerman?

  One of the worst events where smog took over London was known appropriately as the Great Smog of London. If you're a fan of the Crown, you know what I'm talking about. It happened in December 1952. Here's a BBC doco about it. This was smog on the grand scale. There'd never been anything like it before. The sky and the light were... were blotted out and London coughed and crawled almost to a standstill in murky yellow gloom. The smog stuck around for five days and ended up killing thousands of people. And while people coughed and choked, the smog got thicker and darker. And nobody could do anything about it.

• 24:27Wendy Zukerman?

  But they could do something about it, and they did. Events like this kicked governments in the butt to get rid of the smog. In places like the UK and the US, where similar events happened, they started passing clean air acts to cap how much gunk power plants, homes and cars could spew into the air. And these laws, they made a big difference. Car exhaust is safer than it used to be, and many power plants now have doobie whackers on them, like scrubbers, to keep some of the pollution out of the air. So yeah, for London, no more pea supers. But over the years, scientists have come to realise that the invisible stuff that

• 25:12Wendy Zukerman?

  is still getting pumped into our air, it can do some dangerous things to our health. One researcher told me, "It scares the [__] out of her." This pollution can break down into teeny tiny pieces about the same size as bacteria. They float in the air, and when you breathe them in, they're so small that they can just sneak inside us. Here's Stephen again.

• 25:39Speaker 05

  We know that these pollutants can penetrate the lung and pass through into the bloodstream and circulate to all parts of the body now.

• 25:49Wendy Zukerman?

  Really, all parts, like all parts of the body?

• 25:51Speaker 05

  Yeah, brain, the heart, the pancreas.

• 25:54Wendy Zukerman?

  And Stephen says air pollution is now being linked to all sorts of diseases.

• 25:59Speaker 05

  Heart disease, dementia, diabetes, it accelerates blindness.

• 26:04Wendy Zukerman?

  Blindness?

• 26:05Speaker 05

  Yeah.

• 26:08Wendy Zukerman?

  Yeah, it's thought that tiny bits of pollution can mess with our retina, increasing our risk of eye disease. And some of these bits of pollution are so small that they can actually cross the placenta, potentially affecting fetuses. They can even get into our brains. We're still working out exactly what all of this means, but some of the other effects of pollution are more clear. Like, besides fouling up our lungs, we've known for years that crap in the air increases our risk of getting heart disease. For example, a study of around half a million older folks found that those living near a highway or busy street

• 26:49Wendy Zukerman?

  were 30% more likely to die from coronary heart disease than those living further away. And that's why, for years, places like the World Health Organization and the EPA had been lowering what a safe level of pollution is. But the truth is that almost nowhere in the world actually meets those standards every day. And actually, this big report just came out last month from the American Lung Association, and it says that nearly 50% of US kids now live in a place with unhealthy levels of air pollution. So even though it's really rare to get sick like Ella did from pollution, to Stephen, he sees what happened to her

• 27:35Wendy Zukerman?

  as an extreme example of what's happening to all of us.

• 27:40Speaker 05

  Ella really was like the canary in that she was able to sense the pollution and be a warning to others and a warning to government, really, that something needs to be done about this.

• 27:53Wendy Zukerman?

  And so, Rosamund hatched a plan. She wanted to get air pollution listed on Ella's death certificate. And if she could do that, it would be a world first. Rosamund wanted the real reason that Ella died to be official, but she also thought that perhaps Ella could put a face to all these awful statistics about what pollution is doing to us. Her lawyer also thought that it would open the door to more lawsuits for other people to force governments around the world to clean our air.

• 28:27Speaker 05

  So can you see, as the journey was going on, the whole thing then got bigger and bigger. But I am very honest to say, in the beginning, it was definitely all about her.

• 28:37Wendy Zukerman?

  Forgetting air pollution on a death certificate, it was going to be tricky. Rosamund had to go to a court to convince a coroner that there was a direct link between pollution and Ella's death. And even though we have statistics showing that pollution contributes to millions of deaths each year, it's actually really hard to point to a person and say, "air pollution killed them."

• 29:05Wendy Zukerman?

  But with Ella, the data was so damning. She was living under illegal levels of pollution. And so Rosamund thought, she could do this.

• 29:16Speaker 05

  There would have not been any point, knowing all that research and failing in court. That wasn't going to help anything. So the most important thing still was to get that on her death certificate.

• 29:29Wendy Zukerman?

  In late 2020, almost eight years after Ella died, the second inquest into her death began. Stephen was an expert witness. Did you think you'd win? Was it like you thought this was a slam dunk?

• 29:44Speaker 05

  I had no idea what would happen. What I did know was that I knew about Asma. I knew about Ella because I'd spent the last two and a half years poring over all this material.

• 29:59Wendy Zukerman?

  And as Stephen remembers it, the government lawyers really put him to task.

• 30:04Speaker 05

  My evidence was only about nearly two hours. But my God, they really tried to put me through the mincer. He kept saying, "You will agree." You know, he pointed to some document. He had a bunch of documents about two feet high. And every time he said that, and I said, "No, I do not agree." And actually, that is wrong.

• 30:27Wendy Zukerman?

  After all the evidence was presented, the coroner had to decide. Did pollution kill Ella?

• 30:34Speaker 05

  I remember the agonizing wait. It was really a stressful time.

• 30:43Speaker 05

  In the first ruling of its kind, pollution from

• 30:46Speaker 04

  Busy roads, a coroner found today, contributed to the nine-year-old's premature death. Ella tragically made history when she became the first person to have air pollution listed as the cause on her death certificate.

• 31:01Speaker 03

  Today, a victory for her mother. A coroner's inquest found that air pollution made a material contribution.

• 31:16Speaker 05

  Oh my goodness me. Apparently, her story was written up two, two and a half thousand times around the, around the world. India, Australia, everywhere. It was enormous because it had never been done before. Ella is the first person in the world to have air pollution on her death certificate.

• 31:36Wendy Zukerman?

  The new coroner's report listed air pollution, along with asthma and acute respiratory failure, as Ella's official cause of death. And since that happened, things have been getting better. The council where Ella lived has made it way easier for people to find out what's going on with the pollution on any given day. And doctors' groups in the UK are updating guidelines and training manuals to make sure that doctors know that air pollution can trigger asthma. And in London, they already had this program that basically charges a fee for some of the dirtiest cars and trucks, but it was only in central London.

• 32:16Wendy Zukerman?

  So after this decision came down, they decided to expand it even further to neighborhoods like where Ella lived. And today, it now covers all of Greater London. And it has worked to make the air cleaner. The city reported that since that program started, nitrogen oxide levels have dropped almost 30% across all of London. Stephen told us that this case, this little girl, was able to break through and stir up real change when tons of research, I mean, mountains of papers on air pollution and asthma, didn't. I can't tell you what a big impact this has had. You can have all the epidemiology.

• 33:00Speaker 04

  In the world, but having the story of a single mother and a child, you know, with real facts actually is more influential in many ways than all of the sort of complex statistics and everything else put together.

• 33:14Speaker 05

  We now know the detrimental impact of air pollution on on the public's health. So can you see how much things have have have changed compared to where I was?

• 33:24Wendy Zukerman?

  And for all of this work, in two thousand and twenty one, at the United Nations Big Conference on Climate Change, the World Health Organization dedicated a special report to Ella. Right there on the cover, it says.

• 33:38Speaker 05

  In memory of Ella, Sister Deborah, and all other children who have suffered and died from air pollution and climate change.

• 33:45Wendy Zukerman?

  Oh, my gosh.

• 33:46Speaker 05

  It shows you the enormity. And you know what? It's too big to even contemplate it. I don't sit there, as you can see, when you first jumped on, you know, I'm trying to organise my twins' birthday. I don't sit there and think, oh, you've achieved this enorm. Then it will get too big. So I do, I continue on my journey and do that. And I try and be a a good enough mum as I am for my other. I don't sit there and say, oh, this enormous state, no.

• 34:13Wendy Zukerman?

  But Rosamund knows that what they've done so far, it's not enough. She quit her job as a teacher and became a full-time clean air advocate, giving speeches, starting a foundation and organising protests. She wants our air to be cleaner. She wants us to do the stuff we've been talking about since Captain Planet came out. Burning less fossil fuels, having fewer cars on the road, and the vehicles that are on the road need to be electric and run from the power of the wind and the sun. We also need to be thinking about things like preventing wildfires, because scientists say that wildfire smoke in some places is starting to reverse the decades of progress we've made on improving air quality.

• 34:58Wendy Zukerman?

  And, you know, Rosamund says that these changes, like getting off fossil fuels, we need to do them anyway.

• 35:05Speaker 05

  Fossil fuels are killing us, and they can do it any which way they like. Sooner or later, they're going to have to address it.

• 35:15Wendy Zukerman?

  What do you think Ella would make of this work that you've done and all of this?

• 35:21Speaker 05

  The fact I'm talking to you guys in the States now. Oh, let me think of something. I think she'd be very proud, seriously, seriously. She'd be, I don't know, it's really difficult because her aim was to be a pilot. And we had started steps towards that. She was very clever, like I said to you. She was passionate about flying. And ultimately, the air that she loved so much was in effect killing her. So I don't know what she would say about that on a very serious note.

• 35:52Speaker 05

  So she was here. She definitely made her, her voice heard. How would she feel? I think she'd be quite happy we're talking about her today, if you ask me.

• 36:07Wendy Zukerman?

  We spoke to Rosamund in 2022. And since then, she's continued to fight for accountability after Ella's death. Rosamund sued three UK government departments in 2024 and later received a settlement from them. They wrote in a statement to her, quote, "Young children like Ella should not have to suffer because of our air."

• 36:30Wendy Zukerman?

  Meanwhile, Rosamund and her team have worked towards creating a bill that they call Ella's Law or the Clean Air Human Rights Bill, requiring the UK to meet clean air targets by 2030 and legally enshrine clean air as a human right. The bill was published just a couple of months ago and it's making its way through Parliament. But over in the US, as we mentioned at the start of the show, things are moving in the opposite direction. And experts say that those rollbacks, which make it easier for industry to pollute, it's expected that they will make the air dirtier. And that could affect the health of millions of people in the US.

• 37:16Wendy Zukerman?

  That's Science Buses.

• 37:21Speaker 03

  Hello.

• 37:22Wendy Zukerman?

  Hey, Akedi, producer at Science Versus.

• 37:26Speaker 03

  Hi, Wendy, host of Science Versus.

• 37:29Wendy Zukerman?

  How many citations in this week's episode?

• 37:31Speaker 03

  There are, drumroll, 128 citations. It's a big one.

• 37:40Wendy Zukerman?

  And if people want to see these citations, where should they go?

• 37:43Speaker 03

  They can click on the link in our show notes.

• 37:46Wendy Zukerman?

  And through researching this episode, have you changed anything about how you're living your life?

• 37:53Speaker 03

  Yeah, I will say at first I was like pretty freaked out. I remember there was this one time that I saw like this giant, like nasty, like 12-wheeler truck come down and I was literally looking for roads to run away to.

• 38:08Wendy Zukerman?

  Oh, my God, I'm doing the exact same thing. I'm doing the same thing.

• 38:12Speaker 03

  It's so bad, but it really doesn't have to be like that. I think the biggest thing that I've changed is I've started actually really paying attention to the air quality on my phone, on the weather app.

• 38:24Wendy Zukerman?

  Oh, tell me more about this.

• 38:25Speaker 03

  It's like a scale between zero and 500 and typically air quality is pretty good if it's at 50 or below. And so if it's above that nowadays, I probably won't go on like a run. I'll wait until the air quality is better. I don't know, I just like to be cautious and I like to know what's going on and it makes me feel better.

• 38:48Wendy Zukerman?

  Thank you so much.

• 38:49Speaker 03

  Thank you.

• 38:58Wendy Zukerman?

  This episode was produced by Akedi Foster Keys with help from Rose Rimler, me, Wendy Zukerman, Michelle Dang, Merrill Horn, and Courtney Gilbert. We're edited by Blythe Terrell. I'm the executive producer. Extra help by Said Tejan Thomas, Nicole Beamstabor, Kendra Pierre-Louis, and Alex Bloomberg. Fact checking by Erica Ekigoh-Howitt. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Emma Munga, Bobby Lord, and So Wiley. Thanks to all of the researchers and experts that we got in touch with for this episode, including Jocelyn Coburg, Professor Vernon Morris, Dr. George Thurston, Dr. Lauren Zajac, Dr. Jennifer Burney, Dr. Shakobi Wilson, Dr. Melissa Burroughs, Dr.

• 39:41Wendy Zukerman?

  Wei Peng, Professor Barbara Hoffman, Dr. Michael Craig, and Dr. Wes Austin. A special thanks to Rachel Humphreys, BBC Motion Gallery Getty Images, Jonah Delso, Jackie Yanis, the Zukerman family, and Joseph Lavelle Wilson. I'm Wendy Zukerman, back to you next time.

• 40:12Wendy Zukerman?

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