The inquest ruling in 2014 concluded that she died of acute respiratory failure, but her mother Rosamund Kissi-Debrah, campaigned for years to have her daughter’s death examined by a second coroner.
As a result, in December 2020 a landmark ruling by coroner Philip Barlow made legal history, describing her cause of death as acute respiratory failure, severe asthma and air pollution exposure. This is the first time a coroner has found that air pollution was a contributory cause of illness and death.
Explaining that Ella had been exposed to nitrogen dioxide and particulate matter pollution in excess of World Health Organization guidelines, with traffic emissions as the main source, he concluded that she died of asthma contributed to by exposure to excessive air pollution, failure to reduce pollution levels to legal limits, and failure to provide her mother with information about the potential for air pollution to exacerbate asthma
An expert witness Prof Stephen Holgate, said Ella, who had lived with her family in close proximity to highly polluting roads all her life was “like a canary in a coalmine”.
As city mayors representing more than 17 million people across the UK urge Boris Johnson to commit to tougher air pollution targets, we are asking: what are the implications for nurses given this landmark ruling in the case of Ella’s death?
The President of the International Family Nursing Association (IFNA), Professor Sonja Meiers said: “Ella’s illness, suffering, and death certainly highlights the need for reforms to improve the health of our most vulnerable families. Only when we achieve planetary health can we achieve family health for all. The International Family Nursing Association is committed to advancing family health through planetary health.”
The IFNA 2020 position statement on Planetary Health and Family Health affirms that “nurses worldwide should understand how the health of the planet affects families, and family nurses should collaborate to act on this relationship through education, research and practice”.
Incorporating a planetary health lens in family nursing education, research, and practice will positively influence family health and the IFNA have outlined a number of outcomes in the wake of Ella’s death which should be considered.
One such recommendation is around ensuring future nurses are taught about the relevance of planetary health to family health. This could be integrated into pre-registration and post-graduate training modules on public health issues, including impact of pollution, inequalities in health and intersectionality between the two, to inform and educate students around this agenda.
Ella had over 30 hospital admissions and more than likely multiple primary care interactions. What could nurses have done at these interactions? Does a nursing assessment consider pollution impact?
The IFNA also recognises a need to contribute to the research agenda for planetary and human health. Family nurses are called upon to examine upstream prevention efforts to mitigate climate sequelae downstream with the goal of identifying the most promising areas for family nurses to contribute to adaptation and resilience within families. How might this apply to Ella’s family?
To address planetary health, a mix of research is needed using a variety of methods including epidemiology, big data analysis, action research, and phenomenology. Family nurses are in a unique position to gain insight through their connections with individuals and families and learn about their behaviours as family nurses and establish partnerships with communities affected by planetary health.
The Mayor of London, Sadiq Khan, said “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”. What are family nurses’ responsibilities?
According to The New Scientist Ella’s case is not an isolated tragedy, with as many as 36,000 UK deaths a year linked to air pollution, and predicted that this ruling could “herald a seismic shift in efforts to clean up air pollution in the UK”.
In advanced family nursing practice, nurses have a responsibility to advocate for equity and justice for families and to promote environments that safeguard the health of families.
With this in mind, implementing generalist and advanced family nursing practice with a planetary health lens is advisable in order to help engage and promote good practice for other families like Ella’s who live in highly polluted environments.
Changes in the earth’s ecosystems are inevitable and impose unprecedented challenges to families around the world. Family nursing will therefore become increasingly important.
All nurses should understand the principles of planetary health, how changes in the earth’s ecosystems affect families, and what nurses can do to promote health, adaptation, and resilience of individuals and families.
As a healthcare sector we can start to look at how we can play our part in helping to reduce environmental impact and educate health professionals, the public and policy-makers about the connection between planetary health and family health.
This article was co-written by Diana Greenfield, a consultant nurse, an honorary professor at the University of Sheffield and a member of the UK and Ireland International Family Nursing Association (IFNA) chapter executive and Veronica Swallow, professor of child and family nursing and healthcare, Sheffield Hallam University; President Elect of IFNA and Co-Chair of the UK&I Chapter.
