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Unattended toxic air: A genocide in making

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Increasing air pollutants are clogging India’s skylines and it is turning out to be a silent killer

The day is not far away when people will have to buy canned pure air and carry oxygen cylinders when they step out of their home, as inhaling fresh air is turning out to be a luxury in the ensuing years. With alarming levels of air pollutants, cocktail of toxic air emitted out is transpiring to be a rising health hazard for India. As per World Health Organisation (WHO) 1.4 million people in India die pre-maturely due to air pollution, which is one life lost every 23 seconds.

GlobalData, a data and insights solution providers, shared WHO’s ‘Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease’ report 2016, revealing that air pollution had caused a total of 0.6 million deaths in India in 2012. Acute lower respiratory infections (ALRI), Chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), lung cancer and stroke were key responsible diseases that caused these deaths. Furthermore, due to air pollution associated diseases, India has also lost approximately 20 million disability-adjusted life years (DALYs) and approximately 12 million years of life lost (YLLs). WHO’s satellite data and ground monitoring data indicates that the Ingo-Gangetic plain in particular is highly exposed to air pollution.

A report published in The Lancet on the first annual assessment of Sustainable Development Goals (SDG) health performance, launched at a special event at the UN General Assembly in New York, ranked India at 143rd, which was below Comoros and Ghana. India was placed just ahead of Pakistan and Bangladesh that were ranked 149th and 151st respectively. India’s poor performance on air pollution was one of the factors that placed it lower than countries like Bhutan, Botswana, Syria and Sri Lanka.

Several studies have shown that large parts of India fail to meet the safety levels of exposure, indicated Global Data, and it informed that a survey conducted by the US-based institutes Health Effects Institute (HEI), University of Washington and the University of British Columbia, observed that India’s worsening air pollution caused approximately 1.1 million premature deaths in 2015. The developed nations such as the US, Australia and Spain are considered the least polluted countries of the world. On the other hand, India, China, the Middle East and North African countries are the most polluted nations in the world.

Dr T Raja

Stating that a large number of Indians are breathing unsafe air, Dr T Raja, DM (oncology), Apollo Hospitals, Chennai said, “More than one million Indians are killed every year by indoor pollution inhaled from dung-fuelled fires, stoves and lights. Low standards for vehicle pollution and fuels are the reason for this situation. The serious impact of this is reflected in the rising asthma rates in the population, including children. PM2.5 is causing cancer, triggering heart attacks and stroke. Air pollution produces ‘oxidative stress’, which damages the cells caused by excessive oxidation in the body. This, in turn, lead to the development of cancerous lung cells. Research also prove that exposure to polluted air can cause serious damage to the respiratory tract in multiple ways.”

A worldwide analysis conducted by the WHO in 1622 cities for PM2.5 reported that 13 of the 20 most polluted cities in the world, are in India, which showcases that a large number of Indians are breathing unsafe air. This is true in cities, but the rural areas are neither spared.

Air pollution – a ticking time bomb

India is sitting on a ticking time bomb called air pollution and if we delay, we are bound to reach a point of no-return. Air pollution poses a far more extensive health hazard, and triggers a  rising number of asthma cases, especially in children and the elderly. Long-time exposure to polluted air is now being recognised as a leading cause of lung cancer, in addition to causing heart attacks and strokes. There are short and long-term effects of air pollution. Short-term effects may be temporary and include pneumonia, bronchitis, irritation to the nose, throat, eyes, or skin, headache, dizziness and nausea.

If the air quality is not fixed, we will face long-term effects. Long-time exposure to polluted air is recognised as a leading cause of lung cancer, in addition to causing heart attacks, strokes and respiratory diseases such as emphysema. It can also cause damage to people’s nerves, brain, kidneys, liver, and other organs. Air pollutants are also suspected to be linked to birth defects.

According to the The United Nations Children’s Fund (UNICEF), every year, approximately two billion children in the world are breathing polluted air. It is noteworthy that most of these children live in North India and neighbouring countries. Similarly, the total mortality of children (age five years or below) due to air pollution is around 0.6 million across the globe.

The same report denotes that approximately 300 million kids are getting exposed to a pollution level which is almost six times higher than the international standards set by the WHO. Out of that, approximately 220 million kids are living in South Asia. As per Breathe Blue survey conducted by Heal Foundation, approximately 21 per cent of school-going children in Delhi have poor lung health (based on the Lung Health Screening Test [LHST]), 14 per cent in Bengaluru, 13 per cent in Mumbai and nine per cent in Kolkata.

Prof D Prabhakaran

“Children are particularly vulnerable to air pollution exposure as evident in the GBD 2015 assessments, which revealed that there are over 100,000 deaths annually in attributable to air pollution in children under 14 years of age. Much of this is under the age of five, and through acute respiratory illnesses in children exposed to high levels of household air pollution due to cooking and heating using biomass fuels. Initiatives such as the Pradhan Mantri Ujjwala Yojana is aiming to provide Liquefied Petroleum Gas (LPG) in rural areas are a welcome step to reduce particulate pollutants exposure in rural households,” said Prof D Prabhakaran, Vice President Research and Policy, Public Health Foundation of India (PHFI).

Damodar Bachani

Appreciating the efforts made by Ministry of Petroleum and Natural Gas (MPNG), under the Pradhan Mantri Ujjwala Yojana scheme, Damodar Bachani, Deputy Commissioner (NCD), MoH&FW said, “The scheme aims to replace the unclean cooking fuels mostly used in the rural India with the clean and more efficient LPG. Adding to it, we in Ministry of Health and Family Welfare suggested that they should have a programme called ‘Ujjwala Mamta’ scheme. By this, on priority we can give LPG connection for the expectant mothers. Expectant mothers breathing polluted air results in premature birth and is one of the main reason for low birth weight. When a baby is born preterm (less than 37 weeks of gestation), there is an increased risk of death or long-term physical and neurological disabilities.

A study published in the journal Environmental International by a team from the Stockholm Environment Institute at the University of York, in 2010 stated that the largest contribution to global PM2.5-associated preterm births was from South Asia and East Asia, which together contributed about 75 per cent of the global total. India alone accounted for about one million of the total 2.7 million global estimate and China for another 500,000.


Experts indicated that India’s air quality is affected by several factors, so it is important to take into account control strategies from several places. The roadmap is already there in terms of stronger emissions standards for power plants and industrial emissions, stronger vehicular emissions standards, enforcement of bans on waste burning, enforcement of regulations on construction waste management, etc. It is a question of implementing them effectively and with time-bound deliverables which is where we have been lagging.

Tackling pollution challenges

The Ministry of Health and Family Welfare (MoH&FW) is taking rapid strides to address the substantial national health burden attributable to ambient air pollution. The first step was the constitution of expert committee followed by a health centered declaration for air pollution and making a cross-ministerial effort to curb air pollution and detecting 100 districts.

Informing that the MoH&FW is in the forefront oftackling air pollution, Bachani, said, “Sources of air pollution are different, so we need evidence and detailed analysis. With the help of WHO, we came out with a draft, which was circulated to varied ministries. After looking into it, the Ministry of Environment and Forest (MoEF) had a meeting, in which it was decided that Indian Council of Medical Research (ICMR) will do a continuous surveillance and collection of data on environmental indicators and also its effects on health. ICMR is continuously monitoring air pollution index in major cities on one side and disease occurrence on the other side. By this effort, we have evidence to show that whenever there is an increase in pollution  cases of asthma, bronchitis go up.”


“We are trying to constitute a standing committee, where MoH&FW and MoEF secretaries will chair, which and will have various other ministries like Ministry of Petroleum & Natural Gas (MPNG), Ministry of New and Renewable Energy (MNRE) and industry representatives. The co-chairs of already existing steering committee, IIT Delhi and Public Health Foundation of India (PHFI) will go through the draft submitted. The standing committee is yet to be functional,” Bachani said.

Informing that there is no one prescription for this issue, he informed that it is a combined effort and smart city projects need to instil action points like a city can be identified clean or smart only when its air quality as per the parameters of the air quality index.


Bachani further said, “MoH&FW has given clear direction to the state governments to identify districts which have high levels of pollution. Per state each district would be identified, and on a pilot basis first 100 districts will  receive potable spirometer that can measure lung capacity. These can be taken to community health centres (CHCs) where screening for COPD will be done along with other NCDs like diabetes, hypertension, common cancers. MoH&FW constituted an expert committee which prepared technical guidelines and training modules for medical officers in each districts. Around Rs 25 lakhs has been allotted per district.Once hundred districts are identified, medical officers and frontline staff will be trained. It will expand gradually to other districts.”

Stating that constituting a steering committee to document the health impacts in India and chart a health-centric framework to reduce exposure is a welcome step, Prof D Prabhakaran, VP, Research and Policy, PHFI, said, “The recommendations of the committee are being taken on board, and it is leading to real policy change. The ministry is also keen to engage other sectors in the spirit of inter-sectoral policy making to ensure that this key risk factor for ill health is addressed.”

Lot of cities around the globe have realised the ill-effects of air pollution and have taken measures to reduce it. Particularly China and it’s capital city Beijing, which suffered from serious air pollution now no longer features in the WHO’s list of 20 most polluted cities.

Awareness is the key

Experts cite that in India debates over air pollution and health impacts increase only when smog covers Delhi and neighbouring cities. But the level of awareness and the impact of air pollution on health is very low, they say.

Listing out lessons to be learned from China, Prabhakaran, said, “The strong shift in focus towards renewable energy is certainly something that can be learned from the Chinese experience. In a decade, they have gone from the backwaters to the largest producers of Solar PV in the world and are installing more wind capacity in a month than most countries do in a year. This is being backed with large investments in grid capacity to take up the electricity produced. We in India have tremendous potential to produce electricity from renewables but are stymied by a lack of investment in grid capacity.”

Dr Sandeep Nayar

Adding to it, Dr Sandeep Nayar, Sr Consultant and HOD, Respiratory medicines, BLK Super Speciality Hospital, said, “Beijing closed hundreds of industries that lead to high emission of pollutants and switched some of them to alternate mode of energy. These are welcoming steps to curb the pollution levels. China instituted a broad, regionally-coordinated system of air pollution monitoring. They installed pollution-abatement equipment on a majority of its power plants as well as devised means to restrict car ownership in major cities. It has developed a network of 1,500 air quality-monitoring stations in over 900 cities whereas India has only 39 stations covering 23 cities. To curb industrial pollution, China has installed basic pollution abatement equipment on 95 per cent of thermal plants whereas in India only 10 per cent of thermal plants have these equipment.”

Experts also warn that it is essential for India to work towards addressing the air quality problems nationally. They claim if we are not working towards it, the country will only nurture an unproductive workforce that cannot contribute effectively to its developmental goals.

“Tackling air pollution requires an integrative exposure management–driven approach and concerted effort from each individual not just the government. Breathing cleaner air is a birth right, and we cannot leave masks, oxygen cylinders for generations to come,” concludes Bachani.

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