The hard truths

The first time I heard anyone talking about the air in Delhi in truly frightening terms was as recently as December 2014. I was visiting Delhi for the Christmas holiday and went across for dinner to the home of a newly posted senior official at the European Union’s India delegation. The official and his spouse were good friends of ours and I had advised them on what to expect in Delhi, ahead of their move. I’d warned Heike, the spouse, that Delhi might be a shock. We had discussed all the standard challenges of safety, congestion and the heat. I had not brought up air pollution because it had simply slipped my mind. It was not a problem that loomed large in a discussion of the city.

Heike had been gung-ho about the move. Her parents were retired diplomats and so she believed herself to be comfortable in diverse cultures and circumstances. She had even spent a few years as a child in Pakistan. There was nothing about life in India that would pose an insurmountable difficulty, she assured me blithely.

When I arrived at our friends’ place, I was taken aback. There was only one way to describe how Heike looked: haggard. I asked how things were going and by way of reply she shook her head muttering, ‘I can’t believe no one told us.’ ‘Told you what?’ I queried, puzzled. ‘About the air,’ she said with genuine anguish. My friends had lived in Delhi for just about six months at this point.

Heike had been constantly sick with a low-grade nasal and throat irritation since moving to India. Her son was suffering as well. What seemed to bother her, however, was not just the effect of the air pollution, but the silence on the matter — the fact that no one at headquarters in Brussels had mentioned pollution as something the family would have to contend with in India. Of course, I too had been guilty of this omission.

A partial explanation for the foreign community’s reticence on Delhi’s air had to do with sympathy for India’s democracy. While foreign correspondents in China saw their role as one of holding an authoritarian, censorship-prone government to account, India was cut greater slack. India was worse off than China on most parameters of human development. Yet, because it is a democracy and therefore assumed to be an ally of western ‘values’, India was often let off the international hook on issues that China was skewered for. Air pollution was one case in point.

A clear example of this double standard was in the run-up to the Commonwealth Games that Delhi hosted in 2010. These were held only two years after the Olympic Games in Beijing where air pollution had loomed over the international coverage of the event like a smoggy colossus. Yet, in the case of Delhi, although the foreign media did express concerns about the lack of cleanliness at the athletes’ village, corruption and an outbreak of dengue fever, pollution was startlingly missing from their writings.

The absence of awareness in domestic circles was more egregious. The reaction of most Indians to her observations on pollution astonished Heike. One lady dismissed her concerns with an airy ‘But Delhi is one of the greenest cities in the world’. Even the doctor whom she visited about her throat complaints brushed off her suggestion that air pollution might have a role to play. ‘You live in Shanti Niketan [a posh south Delhi neighbourhood],’ he said. ‘Don’t worry, the air is clean there.’

‘Perhaps you’re just allergic to your husband?’ the doctor had haw-hawed in jovial banter. But Heike did not find it a laughing matter. And it wasn’t. A few months later Heike purchased a laser egg, a small, hand-held device the size of an orange, that monitors the air quality index and found that the PM2.5 level inside her bedroom was 400.

The air quality outdoors is usually worse than inside modern homes, so the actual ambient air in Heike’s neighbourhood must have been horrendously bad on that day. The permissible 24-hour average of PM2.5 according to the WHO is 25.

The silence around air pollution made it easy to ignore. It was only after my dinner with Heike that I really looked at the air with attention. This despite the fact that I was more tuned in to pollution than most of my Delhi friends, given my China experience.

The air that winter in Delhi was like caustic pea soup. Suddenly I was less keen on taking the kids to gambol about the city’s gardens and historic monuments. I watched them for signs of dripping noses. Their coughs sounded dry and hollow. I had been worried about dengue fever and had carried armloads of mosquito repellent and citronella patches with me, but my boys were without protection against the most ubiquitous health hazard of all — the air.

What the experts say

In India, 627,000 premature deaths are attributable to ambient, or outdoor, PM2.5 exposure. (When household or indoor pollution caused by the incomplete burning of biomass cakes like cow dung, used for cooking in poor homes, is added to this figure it rises to 1.6 million.) That the air in Delhi and many other Indian cities makes you sick is increasingly undeniable. There are numerous city-specific and national studies that establish associations between pollution and respiratory infections in infants, low birth weight, chronic lung illnesses and cancers in adults, heart disease and strokes. One important 2010 study by Dr Sarath Guttikunda, possibly India’s leading expert on air pollution, found that PM2.5 was linked to between 7,350 and 16,200 premature deaths (and a staggering six million asthma attacks) per year in just the city of Delhi.

It is sometimes claimed that living in polluted megalopolises like Beijing or Delhi is the equivalent to smoking a couple of packs of cigarettes a day. The science behind these claims is debatable. Regardless, many of the diseases associated with air pollution are similar to those linked to smoking. And although an active smoker is at a greater health risk than a non-smoker exposed to pollution, far more people, including young children and even babies, breathe dirty air than smoke. Household air pollution, wherein women cooking over gobar chulhas in badly ventilated rooms inhale huge quantities of toxic fumes, comes out ahead of smoking as a factor contributing to the national burden of disease in India, while ambient air pollution is not far behind.

While researching this book I spoke to a range of experts working in the area of public health. One of them was Dr Bhargav Krishna, a research fellow at the Public Health Foundation of India. It was often difficult to follow his explanations. His language was jargon-heavy and he constantly referred to ‘dose-response relationship models’ and ‘systemic inflammatory markers’. He told me the ‘pathophysiology of ozone and cardio vascular mortality’ wasn’t quite established.

But he was crystal clear when I asked him straight up for advice on whether I should move to Delhi, given that I had two young boys. (As mentioned in the introduction, this is a move I have been contemplating off and on since my first son, Ishaan, was born — so that my children could be closer to their grandparents.) ‘No,’ he said firmly. ‘I would not choose to bring children to this city.’ He also revealed that he had developed bronchitis himself for the last two winters running.

Dr Krishna was not alone in his suffering. I have spoken with Delhi-based activists, clean air equipment entrepreneurs, policy wonks and doctors. The majority shared respiratory symptoms that they attribute to air pollution.

Exactly how much of a health hazard air pollution is depends on a number of variables, including length of exposure (long-term residents are obviously at greater risk than visitors) and age. The elderly and the young are disproportionately vulnerable. The most frightening data relates to children, for it shows that no matter how hard parents work to ensure the best schooling and nutrition for their kids, the most-taken-for-granted element, air, remains poisonous. Children’s respiratory defences have not reached their full capability. They also breathe in more air per kilo of body weight than adults, so they take in more toxins per kilo of body weight than adults do. Moreover, children generally exercise outdoors more than adults do.

One 2015 survey conducted by the HEAL Foundation and Breathe Blue found that four out of every 10 children in the Indian capital suffer from serious lung problems. In another 2013 study, the World Allergy Organization Journal reported serious respiratory disorder symptoms among students living in certain high-density neighbourhoods in Delhi. Sixty-six per cent of students observed in Chandni Chowk, 59 per cent in Mayapuri, and 46 per cent in Sarojini Nagar reported problematic symptoms. The 2010 Dr Guttikunda study blamed Delhi’s air for 391,500 annual cases of acute bronchitis in children.

Among the more disturbing studies I came across was one conducted by the Chittaranjan National Cancer Institute (CNCI), one of India’s top cancer institutes. It tracked 11,000 Delhi schoolchildren aged four to 17, drawn from 36 schools, for three years. The results were unequivocal: kids in Delhi scored significantly worse (two to four times as badly) on key indicators of respiratory health and lung function, compared to control groups in other Indian cities in Uttaranchal and West Bengal.

Almost 44 per cent of schoolchildren in Delhi had reduced lung function compared to 25.7 per cent in the other cities studied. Delhi kids were also 1.8 times more likely to suffer from upper respiratory symptoms like sinusitis and common colds, and twice as likely to suffer from lower respiratory tract indications like a sputum-producing cough, wheezing and chest pain. Two times as many kids in Delhi were asthmatic than in the control group.

(Excerpted with permission from Choked by Pallavi Aiyar, exclusively available on the Juggernaut app)

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