Nine-year-old Ella Kissi-Debrah often walked the half-hour route to school along London’s South Circular Road — a hot spot for pollution in the U.K. capital — and suffered three years of seizures and coughing fits before dying of an asthma attack in 2013. A recent report found a “striking association” between her hospital admissions records and spikes in nitrogen dioxide and PM10, the most noxious pollutants, in the area. It said that there was a "real prospect that without unlawful levels of air pollution, Ella would not have died."

Ella’s death was the first of an individual in the United Kingdom to be directly linked to air pollution but will not be the last. Outdoor air pollution is estimated to contribute to 40,000 deaths in Britain annually. Across the world, polluted air contributes to an estimated 7 million deaths each year. It is linked to diseases ranging from lung cancer to stroke and respiratory infection. Evidence suggests it suppresses children's lung growth and fetal brain development, and could be linked to diabetes, dementia and mental-health problems.

“Air pollution presents a stress factor on the body, which when combined with other stress factors, or existing disease, leads to worsening of illness, and ultimately — in people who otherwise have compromised health — may well lead to premature death,” explains Roy Harrison OBE, professor of environmental health at the University of Birmingham. “The outcomes tend to be increased death on high pollution days, an increase in hospital admissions, and increased GP consultations for asthma exacerbations.”

Establishing where air pollution stems from, in order to control emissions and reduce public-health impacts, is a challenge facing governments across the world. The University of Birmingham is forging international partnerships to help meet this challenge. Birmingham’s strength lies not only in establishing causes of air pollution, but in applying that learning to public policy. “We have the high-level scientific understanding, tools, and critical mass to study atmospheric processes, but with a particular strength in applying the science to provide advice for policy,” notes William Bloss, professor of atmospheric science.

A global scourge

Research into air pollution in the United Kingdom will be given a shot in the arm by a new air-quality supersite, hosted at the Birmingham campus. It is one of three across the country that will use state-of-the-art monitoring systems to identify harmful pollutants more accurately than ever before.As vehicle-exhaust emissions fall in Britain, Harrison notes that they have been superseded by “non-exhaust” pollutants such as tire-wear. He cites indoor wood fires as “an up-and-coming problem as far as local pollution is concerned,” and agriculture as a source of 90 percent of all emissions of the pollutant gas ammonia. “If we were to reduce our ammonia emissions substantially, we would reduce people’s exposure to airborne particles, which is a big cause of health effects,” he notes.

Yet air pollution is declining across much of the global West as public awareness and regulation take hold, leaving the burden falling most heavily on developing nations. Responding to this trend, the university is working with partners to identify the different causes and effects of air pollution in China and India, which together account for half of all deaths linked to air pollution.

“The haze that Beijing is famous for forms quite quickly, in waves that build over a day or so, and persists for two or three days, and then tends to die off,” notes Harrison, who leads the university’s work in that region. “We are in the process of trying to understand the precise combination of meteorology and emissions, and their processing in the atmosphere that causes that to happen.”

In partnerships with local research institutions, he notes that the university offers China valuable expertise. “What we can bring is a perspective from the U.K., which has historically done a lot to improve its air quality. It has gone through the smogs of the 1950s, addressed those, and reduced coal burning in cities, and burning of high-sulphur fuels,” he says. “The combination of the science and how that science has been implemented into public policy is very much of interest to our Chinese partners.”

China’s government is responding to the air quality challenge, clamping down on emissions from coal-burning power stations leading to air-quality improvements for some pollutants like sulphur dioxide; and Bloss notes a rapid change in attitude. “They have moved really quickly to supporting a wide network of urban monitoring stations and making that data publicly available,” he explains.

In India, though, Bloss notes that policy efforts to reduce emissions are challenged by rapid population growth. Its capital Delhi and the surrounding region are home to about 46 million people and are impacted by particulate matter levels up to 15 times above World Health Organization guidelines.

“One positive measure was the conversion of buses and autos - three-wheeled tuk-tuks - to run on compressed natural gas,” he says. “That removed a key pollution source from around the year 2000. But that has now been overtaken by the growth in population, and growth in car ownership and traffic across the city.” Over the next 10 to 15 years, vehicle ownership is set to increase fivefold. Ramping up academic research to anticipate and respond to these demographic changes is crucial.

Birmingham is Ieading ‘An Integrated Study of Air Pollutant Sources in the Delhi National Capital Region’ (ASAP Delhi) – a project funded by the U.K. National Environment Research Council and the Medical Research Council. The four-year programme brings together researchers from universities in India and the United Kingdom to investigate the causes of pollution in the capital.

East Africa: averting environmental disaster

The problem is not yet that severe in still-less developed regions such as East Africa, yet pressures are mounting as its cities grow in size and wealth. In Uganda’s capital Kampala, the population is expected to expand by 103 percent between 2015 and 2030. Those of Nairobi and Addis Ababa will rise by roughly 80 percent over the same period.

Already in Ethiopia and Uganda, outdoor and household air pollution leads to a greater number of premature deaths than unclean water, bad sanitation, and childhood malnutrition. “In East Africa, it’s already pretty much the No. 1 environmental risk factor,” says Francis Pope, professor of atmospheric science at the University of Birmingham. The university hopes to avert further harm through a holistic program funded by the U.K. Department of International Development.

A ‘Systems Approach to Air Pollution in East Africa’ project (ASAP East Africa) brings together experts in multiple disciplines to assess the growth of East African cities and build a framework to avert deaths linked to air pollution. “The hope is there will be easy ways to sidestep some of the worst excesses,” explains Pope.

His team is using new low-cost sensors and advanced modelling for vehicle emissions to establish the causes of local air pollution. “Whereas in the U.K., it’s really outdoor pollution that worries us, in East Africa, indoor pollution is a major worry because of mass burning inside for cooking and heating,” he says.

The data that the program generates will be crucial in informing domestic policy making, according to George Mwaniki, senior research fellow at the African Centre for Technology Studies, a partner in the program. “In Kenya, data on air pollution is scarce,” he notes. “There are still a lot of gaps in understanding the full picture.”

Without adequate information, air pollution is often neglected by county governments facing competing development challenges. “We need to have great advocacy skills, supported by credible data, if air pollution issues are to gain traction in development circles in Kenya,” he says. “It will also be critical to demonstrate a clear link between air pollution and other high priority areas like high expenditure in the health sector.”

The researchers remain hopeful that East African countries can leapfrog the challenges faced by other fast-emerging economies. “With such readily available natural resources for power, it is conceivable that Africa could sidestep some of the fossil-fuel dependence that Western countries and some of the Asian countries have gone through,” Pope explains.

Mwaniki believes a policy focus on electric vehicles might also play a role in avoiding the pollution-heavy development model followed by other emerging economies. “The government has already put in place a few incentives to encourage the purchase of hybrid and electric vehicles,” he says.  “This might really help us to avoid the conventional route of incrementally improving on vehicle emissions… and jump straight from no vehicle standards to electric vehicles.”

The University of Birmingham will continue to grow its research capacity across the United Kingdom and in affected developing nations in Asia and sub-Saharan Africa. In doing so, it will play a vital role in providing the air-quality data and science to inform policy makers and protect the public health of citizens in the world’s emerging cities, and to support the emergence of low pollution development models.