Air pollution, a public health emergency

A recent study released by science journal The Lancet ’s ‘Commission on Pollution and Health’ throws up some alarming figures for India. According to the study, pollution resulted in 2.5 million deaths in India in 2015 — the highest anywhere in the world. The disturbing number underlines the urgent need to address this mounting public health challenge.

Experts at the Centre for Climate Change and Environmental Health (CCCEH) at Indian Institute of Health Management Research Delhi stress that with the rising pollution related death toll, India can no longer afford to lose time in tackling the problem. The Centre has been created to integrate over two decades of expertise related to environment and health to accelerate evidence based policy recommendations.

There is an urgent need to identify the main sources of air pollution through specialised research, and address the problem through innovative and targeted approaches.

While solutions like shutting down power plants, introducing traffic restrictions like the Delhi government’s ‘odd-even’, and even the recent cracker ban on Diwali, appear well intentioned, India’s battle against pollution needs much more than such ad-hoc, knee-jerk reactions that end up working as mere window dressing for the problem.

There is no denying that air pollution is a major cause of preventable diseases and deaths in India. Gauging its precise impact on health, needs intensive research, on how air pollution affects not just the lungs, but different organs of the body. The evidence available in this regard is more than adequate to formulate a well-targeted action plan at the earliest. The key to arriving at solutions to these issues lies in inter-sectoral action for health. The health sector is just one of the players in this fight against air pollution.

Local bodies such as municipalities, state and central governments need to work in tandem against this public health challenge, since pollutants travel long distances, beyond administrative, geographical and national boundaries.

The sources of air pollution are varied: industry and brick kilns, transport vehicles, diesel generators, domestic fuel, road dust, crop burning among others. The government has installed air-quality monitors at different locations in cities for outdoor air assessment. Since air pollution levels vary from location to location, increasing the number of monitors will result in better assessment.

Information related to these monitors is easily available through the Internet on websites such as SAFAR-India and ACQIN, as well as through mobile app versions which are freely downloadable.

These offer indicators on both particle matter constituents like PM10,PM2.5 and lead as well as gaseous components such as Ozone, Ammonia, NO2, SO2., CO. These determine the National Air Quality Index, a system of air quality assessment that enables comparison across sites and time possible.

Amongst these it is PM 2.5 — the tiny 2.5 micron size and smaller particles that can permeate the lining of the lungs and move into the blood stream — which is the most harmful. It can lead to not only to respiratory problems such as asthma but also increase problems of heart attacks , dementia, diabetes and possibly even depression.

It is crucial to understand the adverse implication of air pollution on human health. Priorities for pollution abatement often do not take into account its long-term health impact. Air pollution also makes children prone to obesity and cognition deficits. It can adversely affect pregnant women too, resulting in low birth weight and premature births which are already high and leading cause of high infant mortality in India.

As the urgency for putting in place effective solutions gathers momentum, it is critical to prioritise options in the local context, particularly since resources are always limited. Basic management approaches such as Pareto’s Principle show that efficient priority setting can ensure significant results through optimal use of available resources.

A classic example is Delhi, which was till recently the most polluted amongst 1600 cities, according to WHO ranking. An IIT Kanpur report has brought out that only 30 per cent of the pollution in Delhi is from local sources, while a staggering 70 per cent is traced to sources outside the city, including the NCR and beyond including Punjab and Haryana.

Delhi’s Graded Response Action Plan is a step in the right direction but needs to be fine-tuned further. The Plan envisages a series of measures depending on the level of the pollution in the city ranging from information dissemination measures at the lowest level, to curbing construction activity and even closing schools at the highest level.

In addition, abatement strategies which can yield tangible results in the short-term include regulating the movement of heavy commercial vehicles. They should be kept outside the NCR. For this the Western and Eastern Expressway bypass need to be completed on urgent basics and. non-polluting modes of transport need to be increasingly adopted.

An effective measure would be curtailing the use of solid fuel in households. Found in abundance in the rural areas surrounding Delhi, it is relevant to point out that emissions from this one source alone account for 25-50 per cent of fine particles, according to an article published in Environmental Health Perspectives . While schemes such as the Ujjwala Yojana, one of the flagship programs of the NDA government, and the ‘Give it Up’ subsidy transfer for LPGs are effective measures intended at rapid replacement of solid fuel use, the growing problem of air pollution calls for more sustained efforts. The expected health benefits of these initiatives need to be assessed on a continuing basis.

Another major source of air pollution, crop burning, needs to be replaced with measures which are affordable and can benefit small farmers too. Pollution from industry and brick kilns both within the NCR and outside need to be tackled on priority.

By not focusing on core issues in the air quality crisis, we are all seeking solutions to the figurative ‘Gordian knot’ without cutting straight through the problem.

The writer is Associate Professor, IIHMR Dehi and Convenor, Centre for Climate Change and Environmental Health