It was mid-January when Londoner Ruth Fitzharris’ six-year-old son began erupting into a ‘hacking and intense’ cough.

Then came the wheezing, ‘which sounds like a crackle coming from the lungs’, Ruth says. Soon, the sheer effort of inhaling was causing her little boy to grunt with each breath, and his body to jolt. 

Ruth’s son, who has asthma, became so ill he had to be admitted to hospital for 12 nights –  including two at the paediatric respiratory ward at the Royal Brompton Hospital – missing three weeks of school in total. 

At exactly the same time as he was experiencing this ‘really serious exacerbation’ of his condition in 2022, the capital was suffering its worst period of air pollution in six years.

The government’s air quality index reached level 10 – the highest possible – while mayor Sadiq Khan issued an alert warning people to ‘be careful’ and avoid driving.

This wasn’t Ruth’s son’s first health ordeal. He started having asthma attacks during a high pollution event in 2018 and was admitted to hospital seven times that year, followed by a further six in 2019. His second most recent episode, in August last year, also came at a time of high pollution.

For Ruth, this correlation is no surprise. ‘The evidence is already there that this is what happens,’ she says.

Research has proven that, on days where pollution levels are high, both hospital admissions and GP visits increase, while the number of inhaler prescriptions also rises significantly. 

People with lung problems such as asthma – which affects one in ten children and one in 12 UK adults –  may be most impacted. However, bad air quality affects everyone.

Mounting evidence links air pollution to a range of health problems, from lung disease, heart attacks and strokes, to dementia, diabetes and even teenage psychosis.

One 2019 global review found that air pollution may be damaging every organ and almost every cell in the human body, while up to 43,000 deaths in the UK each year are attributed to long-term exposure to dirty air. 

In 2020, Ella Adoo-Kissi-Debrah – who died following an asthma attack ten years ago this month – became the first person in the UK to have air pollution officially listed as a cause of death.

The nine-year-old, who lived near the South Circular Road in Lewisham, had multiple seizures and was admitted to hospital 27 times in the three years before her death.

Now, a bill nicknamed Ella’s Law in her honour, which would enshrine the right to clean air, is making its way through Parliament and is due to be debated by MPs this month.

Ruth says of air pollution: ‘I think because it’s invisible, people don’t realise the impact it’s having on them. You don’t see it.’

Vehicles are the single biggest cause of toxic air in the capital, according to Transport for London, and navigating the danger posed by busy roads is a daily challenge for Ruth. 

‘There’s areas we just don’t go to,’ she says. ‘I don’t take my son to the local high street. If I need food, I always get it when he’s at school – I don’t take him shopping with me. 

‘If we’re going to go somewhere different, I always check the route in advance. Are we going to have to wait at the bus stop by a busy road for ten minutes? We take these long really convoluted routes, just to avoid walking down big traffic-filled roads.’

Having to make these constant calculations and adjustments is ‘a massive emotional burden’, Ruth says. ‘That’s something that really makes me feel very, very trapped.’

A third of people with lung conditions say they do not leave their homes when air pollution is high, according to a survey by the charity Asthma and Lung UK, while a quarter said it made them feel low or depressed. 

Dave Lawson, who lives with a lung condition called Bronchiectasis, avoids travelling into Manchester city centre from his home in the outskirts as much as possible. ‘I only go in when I absolutely have to, because I just find it very detrimental,’ he says. 

The 39-year-old has only 10% capacity in one of his lungs, which he describes as feeling ‘a bit like having a belt around your chest’. Breathing polluted air makes it far worse, he says. 

‘I always think to myself, it shouldn’t be this way, I should just look forward to jumping on the train and getting into the city, having a wander around and enjoying all the things that are there,’ adds Dave.

‘But the reality of it is: oh, I’ll be coughing and wheezing and spluttering for several days afterwards, because it’s just so, so congested now.’

He recalls suffering daily when he used to work in the city. ‘It was very, very difficult to just do what I would class as a normal day – just going from the train to work and back, or going to get a sandwich at lunch,’ he says. ‘The air felt very heavy, very oppressive.’

It didn’t help that his office was located on a main thoroughfare for buses and taxis. ‘Just the heat that was emitted from them, all the fumes, coupled with a very hot weather day, it just made it really difficult to breathe,’ he says, adding that it was ‘a relief’ when he was offered a different job elsewhere. 

Dave may be acutely affected, but he says pollution in Manchester is a problem for everyone.

‘For me personally, it is life and death, because it’s a situation that does get to that extreme,’ he says. ‘But for plenty of people I’m sure, it’s not somewhere you want to be at the current state it’s in, because it’s such a restrictive and oppressive environment now. It’s getting worse and worse.’

Alarmed by the situation, people all around the country are demanding a solution to poor air quality.

For years, Dave has been part of a campaign for a clean air zone in Manchester, yet to his frustration, plans for a scheme were paused last year (the government is currently reviewing a revised proposal). 

Meanwhile, Ruth now works as a campaigns assistant and spokesperson for Mums for Lungs, a grassroots organisation calling for clean air zones in every city and ‘school streets’ to cut pollution, among other measures. 

The group also raises awareness of the danger posed by people using wood burners in their homes.

This is now the biggest single source of PM2.5 – one of the most dangerous air pollutants – producing more emissions than road transport and industry, according to government analysis. 

Ruth says smoke from wood burners in nearby homes often seeps into her flat. The very day she returned from hospital earlier this year, she opened the window and ‘the smell of woodsmoke just came straight in, this acrid smell’.

‘My son’s airways were still inflamed from being in hospital and I was just so worried by it,’ she says. 

For me personally, it is life and death

Only 8% of homes in the country have wood burners and of these, 95% have other sources of heating – which indicates that it’s a ‘lifestyle choice’, says Ruth.

‘It’s a really tricky thing to campaign on, because people are attached to the cosiness of it and it’s a bit confusing at first, but now I think the message is getting through,’ she says.

However, while the government calls air pollution ‘the biggest environmental threat to health in the UK’, Ruth feels there isn’t enough being enough to improve it.

She says the government’s recently announced target to reduce levels of PM2.5 to 10 micrograms per cubic metre by 2040 – double the level recommended by World Health Organisation (WHO) – were ‘extremely weak’ and is calling for more ambitious goals.

But a spokesman for the Department for Environment, Food and Rural Affairs (DEFRA) said that while it had wanted to achieve this target by 2030: ‘The evidence shows this would not have been possible by the end of this decade – particularly in London. 

‘Our dual target approach will ensure reductions where concentrations are highest as well as reducing average exposure across the country by over one-third by 2040 compared with 2018.

‘We have already taken action including by legislating to restrict the sale of wet wood and coal, and our new Environmental Improvement Plan sets out further action to improve air quality and to meet our long-term targets and ambitious interim targets for PM2.5.’

Tim Dexter, Clean Air Policy Manager at Asthma and Lung UK, wants to see ‘a massive reduction in the most polluting vehicles on our roads’. 

This requires measures such as helping businesses to upgrade their vans to cleaner vehicles, as well as investing in public transport, particularly outside of main cities.

‘People can’t afford to get rid of their cars because there’s no other option for them to get to work,’ he says. ‘So making sure there’s a proper, well established public transport system in place so people are able to make that change is really important.’

He welcomed efforts to introduce Ella’s law, which is officially called the Clean Air (Human Rights) Bill. 

According to Simon Birkett, Founder and Director of Clean Air in London, the bill would – if enacted – enshrine the human right to clean air ‘precisely and explicitly’ in UK law. 

‘This would transform the quality of decision making at every level of government overnight by requiring air pollution to be considered alongside equalities to protect health, the environment and the climate,’ he says.

Specifically, the bill would require local authorities to achieve clean air within five years, with support from the Government. 

Some councils around the country are already taking bold action to improve air quality – though their plans aren’t always popular with everyone. 

Low Traffic Neighbourhood (LTN) schemes in areas such as Haringey have attracted protests, with detractors even setting alight to traffic-calming bollards, while Conservative MP Nick Fletcher has claimed proposals for 15-minute cities – where everything a person needs should be within a 15-minute walk or cycle from any point in the city, as put forward in Oxford – will ‘take away your personal freedoms’. 

Elsewhere, residents are pressuring their local authorities to do more to tackle pollution. 

When Manchester City Council approved plans for a 440-space car park in the city centre, right next to her children’s school, mother-of-three Julia Kovaliova was appalled. 

Great Ancoats Street, where it would be located, was already one of the most polluted streets in the city, with levels of nitrogen dioxide breaching legal limits.

Julia and a small group of campaigners formed Trees Not Cars and, citing the impact it would have on air quality, launched a judicial review against the council’s decision – which they won.

For Julia, it was personal. Her eldest son, 13-year-old Maksim, suffers from asthma, which she blames on pollution in the city centre where they live and nearby Great Ancoats Street. ‘He learnt how to ride his bike on this road, we often walk down to the city centre on this road,’ she says. 

And he’s not the only child affected. Julia says that, over the years, Maksim had noticed an increase in the number of inhalers at his school. 

‘There are a couple of boxes [of them] now, while when he was first diagnosed there were just two or three inhalers,’ she says. ‘I think that’s quite a powerful observation.’

She is passionate about raising the alarm on air pollution and calling for more green spaces in the city centre. 

‘In my free time, instead of playing with children, I’m giving out leaflets, raising awareness,’ she says. ‘I do what I can to be vocal about it and say this is a real issue.’

She shares with other campaigners a vision for a better environment. 

As Ruth says: ‘I love London so much, it has so much going for it. And trying to imagine a future where we have massively reduced car use, and fantastic public transport available and lots of walking and cycling – it has the potential to be an amazing city that’s really pleasant and green and lovely.

‘I just really hope that’s the direction we’re going in.’

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