London—”The Big Smoke”—England's capital is a vibrant metropolis with a population of more than eight million. However, the global powerhouse has a “sickening” problem admits London Mayor, Sadiq Khan. Every person in the capital is breathing air containing high levels of fine particulate matter (aerodynamic diameter <2·5 μm); with concentrations in the city almost double that of WHO guidelines. 2017 marks 65 years since the worst air pollution crisis in European history, the Great Smog of 1952 (cogently called “the Big Smoke”), but this event is sequestered in history books, and largely unknown to today's younger generations. Eyewitness descriptions of the smog describe a sickly yellowish noxious fog mixed with filthy soot, which suffocated and choked the city's population in a sulfurous blinding mist for five days—images that wouldn't be out of place in a cult horror or apocalyptic disaster movie. But it really happened; so what about now? What do we know about urban air pollution, and what can we do to sway the tide of an increasingly lethal environmental crisis?

Following the smog of 1952, there were others, but none so devastating in terms of lives lost. An estimated 8000–12 000 people died as a result, predominately older people, young children, and people with respiratory problems, including smokers. A notable increase in deaths from bronchitis and pneumonia was observed in subsequent years and in poorer areas such as London's East End, the premature death rate was said to have increased by nine times among all age groups. A government investigation followed, although reports indicate the response was slow and inadequate. Parliament eventually passed the Clean Air Act of 1956, restricting coal burning in urban areas. In 2017, the government needs to act again, with little time to waste.

Brace yourself, a group of teenagers are taking to the stage to voice their opinions. It is refreshing to see young people given a platform to speak up about what matters to them—even more exciting when the opportunity creates a heightened awareness about an issue that has been widely ignored. “People consider money issues [debt] and terrorism to be bigger threats than air pollution”, the creators and performers of the Camden People's Theatre production, Fog Everywhere, tell me. “We never knew that London's air was toxic.”

Data on air pollution in the capital is easily available—eg, the London Air Quality Network's nowcast shows current pollution levels across the city, and the facts speak for themselves. Which messages will resonate with the next generation whose health is at risk because of polluted air? The cast and crew of Fog Everywhere tackle this question head on. Director Brian Logan explains the concept; to “make a show that spoke in the voice of the young people…[and enable them] to express their feelings about growing up in a city that poisons them”. He was under no illusion that air pollution would be high up on the agenda, but giving them starting points around which to devise and improvise, “a patchwork of scenes came together, offering an abstract of their deepening engagement with the air quality issue: what's caused it, how it affects them (mentally, physically, politically), what the future might hold”.

The Camden People's Theatre is a small venue, the set minimal, and the performers—eight students aged between 17 and 18—deliver an ensemble of movement, mime, song, dance, and spoken word while interacting with the audience and reading from historical narratives. In just over an hour's performance time, the patchwork that Logan referred to was more than evident; a great deal of thought, research, energy, and emotion was crammed into the play and conveyed with conviction by the actors. The play started with a tongue-in-cheek balloon-blowing competition. Immediately relatable, since most people have blown up a balloon. A spirometer measures lung capacity, but a balloon, although not as accurate, can be a substitute. Immediately, the awareness of our breath, of breathing difficulties, was in the air, and stayed in the room throughout the performance.

The authenticity of the actors (who were encouraged to be themselves as much as possible), created familiar scenes of teenage social interaction and culture that can be seen and heard on London streets, in schools, and in homes. Importantly, with no one older than 18 years on stage, there was no one to suppress the cast's ideas, silence their voices, or tell them what to think. They talked about their hopes for the future, their fears, and their passions, which was both entertaining and inspiring. There were some particularly great scenes: a group of happy mooing cows, until one started to choke to death; an insightful, and funny—but scary—sketch about products available on the market to combat the harm of pollution on our health, such as air in a can, air-cleaning trousers, anti-smog martial arts moves; and a chilling moment where a world in which removing your mask risked imprisonment. They raised concerns about the political agenda on air pollution, for example, will it be too late in 2040—will the environment be irrevocably damaged? Always creative, these young performers told these stories in their own way.

Copyright © 2017 Corad Murray

Copyright © 2017 Corad Murray

Scientific research plays a vital role in influencing government policy, and translating evidence into new treatments for patients—one ongoing study aims to identify links between pollution and childhood asthma in London. However, population health is also an individual's concern. Knowledge is power: lobbying parliament is one avenue, and doing our bit is another, and this includes campaigning and educating, and the stage is a perfect vehicle (with no toxic emissions).

Fog Everywhere is an activist-theatre project, and Logan hopes “at the very least it will educate and influence the behaviour of the hundreds of young people that engage with it. It's a point of principle to us to make theatre that grapples with things that matter to people, on our doorstep, and beyond”. As Logan proves, it is precisely these types of projects, involving these types of people, in these types of theatres that make London what it is.

Fog Everywhere Camden People's Theatre, London, UK Directed by Brian Logan, in partnership with Westminster Kingsway College and the Lung Biology Group at Kings College London Oct 31, 2017–Nov 11, 2017 Part of Shoot The Breeze: a fortnight of work addressing climate change and the environment Further suggested reading: Christine L Corton, London Fog: The biography, Harvard University Press, 2015