Mainstreaming Air Pollution to Public Health Paradigm

Dr. Karan Thakur

New Delhi, January 9-India holds the unenviable distinction of having half of the world’s top twenty most polluted cities. A 2015 World Bank report on air pollution had highlighted the magnitude of the disease and economic burden caused by atmospheric pollutants the world over.

Key findings included that as far back as 2012 over 3.7 Million people died worldwide from the acute effects of breathing atmospheric pollutants. When the effects of household pollutants were added, the number rose to a staggering 7 million. Of these, 88% deaths were in the developing world.

The socio-economic costs of air pollution are tremendous. The World Bank estimates that the economic cost of the health damage caused by air pollution range between 0.1 to 3.2% of GDP. This number can reach up to 9% when the costs of environment related malnutrition and its long-term adverse impacts are taken into account. Air pollution remains a global and rising phenomenon – with the World Health Organization estimating that over 92% of the world’s population living in places whose air does not meet its criteria.

Further, according to the OECD’s calculations, global air pollution-related healthcare costs are projected to increase from USD 21 billion (using constant 2010 USD and PPP exchange rates) in 2015 to USD 176 billion in 2060. By 2060, the annual numbers of lost working days, which affect labour productivity, are projected to reach 3.7 billion (currently around 1.2 billion) at the global level. The effects of air pollution are therefore crippling the economy and are putting our long-term wellbeing and productivity in serious jeopardy.

The effects of air pollution on our health are well documented. Long-term exposure include mortality due to cardiovascular disease; chronic respiratory disease incidence like – asthma, chronic obstructive pulmonary disease (COPD); lung cancer; and intrauterine growth restriction, for example, low birth weight.

Experts agree that a rising number of patients with these conditions are making their way through the health system. This disease cohort may all be categorized as Non-Communicable Diseases (NCD’s), a grouping on which a lot of awareness, investment and preventive initiatives are being undertaken in India. NCD’s contribute an overwhelming 60% of deaths in India.

While conditions like diabetes and cardiovascular disease have received adequate attention, diseases that can be attributed to air pollution rank lower on the priority list. And even in cases where awareness is rising on conditions like asthma, COPD or lung cancer, the obvious linkage with air pollution is stated less often. Be that as it may, there is no denying a clear linkage. The 2013 assessment by WHO’s International Agency for Research on Cancer (IARC) concluded that outdoor air pollution is carcinogenic to humans. Further a clear trend on the rising number of respiratory conditions can be linked with an (dis) proportionate increase in air pollution and PM levels of any city.

The need is to therefore mainstream air pollution, like tobacco, sugar, inactivity and other causal agents into the public health mainstream.

Currently, no Government assessment on health of a population lays adequate or any co-relation to air pollution. No estimates of the number of days missed at work or school due to pollution or related conditions is maintained. No air quality-versus- disease incidence is being carried out for our major towns and cities. The need is to therefore move towards a new paradigm.

State Governments must be encouraged to measure air pollution and index it against rise in diseases that can be attributed to it. The economic cost of the disease burden due to air pollution must also be maintained. A tax on polluting industries that can be used for public health awareness and treatment is also a possible move. These would need to be coupled with proven policy interventions like reducing end of pipe emissions, increasing public transport, better waste management infrastructure, use of cleaner fuels and renewables etc. to make a real difference. Many great examples of such interventions in places like Peru, Mexico, Mongolia and Thailand exist.

The dangers of not being proactive will be catastrophic. The OECD estimates that the number of cases of bronchitis is projected to increase substantially, going from 12 to 36 million new cases per year for children aged 6 to 12, and from 3.5 to 10 million cases for adults. These increasing cases of illness can be translated into an equivalent number of hospital admissions, which are projected to increase from 3.6 in 2010 to 11 million in 2060. Per capita welfare costs from illness and restricted activity days due to outdoor air pollution for India projected to be $400 by 2060. By the end of the day today, over 500 lives worldwide would be lost to air pollution. These are lives that cannot be hindered or costs that can easily be truncated.

(The writer is Vice President, Indraprastha Apollo Hospitals)

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