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Edging towards toxicity

The WHO study is a wake-up call for the government to act as it shows an undeniable link between air pollution and major health risks

Edging towards toxicity

It is deeply disturbing to know that India records highest premature deaths among under-5 children due to toxic air. This has emerged from the newly-released report of the World Health Organization (WHO) titled 'Air Pollution and Child Health Prescribing Clean Air'.

In 2016, an astounding number of under-5 children (101,788) died prematurely due to outdoor and household air pollution. This is virtually close to 12 deaths an hour. Close to seven children die every hour due to outdoor air pollution alone, and more than half of them are girls. Nearly all Indian children (98 per cent) breathe unsafe air that exceeds WHO guidelines. Only Afghanistan and Pakistan in Asia and some poorer African countries have recorded death rate higher than India. Staggering numbers of life-years are lost due to the debilitating illness that compromises the quality of life. This is extremely shameful when, according to the World Economic Forum, India is the seventh biggest economy and is likely to be the fourth biggest within a few years.

If this does not wake up all who are still in denial about the link between air pollution and health damage, what else will? This report has comprehensively presented robust scientific evidence from a large number of global and national studies on several health outcomes among children to draw attention to the dangerous health risk transition underway.

Scary times

It is scary to know about the mounting evidence on diverse and dangerous health outcomes in children below five years; mutation and seeding of deadly diseases so early in life simply from breathing.

A plethora of shocking evidence has exposed how unsafe foetuses are inside the mother's womb and how vulnerable infants are to lesser chances of survival. Exposure of pregnant women to toxic air causes very serious health damage in foetuses and infants. This leads to stillbirth, preterm birth, and low birth weight. There is a strong link between infant mortality and exposure to outdoor and household air pollution. Infants' lungs are highly susceptible to pollutants and airborne exposure.

Dubious tally: India's air pollution and health scorecard is among the worst in Asia

Early exposure to air pollution affects the brain and neurological development, and lung function. Toxic exposure leads to cancer and also obesity among children. Increasingly studies are finding neurological disorders including attention deficit hyperactivity disorders, lower intelligence, and impaired neurodevelopment due to environmental pollution. Children's lungs, which are still in formative stages and are maturing, are deeply affected by air pollution that impedes lung function growth. It is said that even at a lower level of exposure children can develop a lasting deficit in lung function. This deeply affects their quality of life and leads to long-lasting chronic conditions including asthma and chronic obstructive pulmonary diseases.

The most fearful evidence that is emerging from the cancer registries of 68 countries is the growing incidence of cancer among children especially leukaemia. Studies have found a strong association between prenatal exposure and high risk of cancer in children, who are exposed to a wide range of cancer-causing pollutants. The report has made a special mention of diesel particulate emissions that are classified as the class 1 carcinogen and states that traffic exhaust contains a large number of harmful contaminants that are associated with childhood leukaemia.

The report warns that exposure to air pollution in early life can lead to serious long-term illness during adulthood as well. While early exposure can impair lung development and reduce its function, it can also raise the risk of chronic lung disease in adulthood. Exposure during pregnancy can predispose the offspring to cardiovascular disease later in life.

A silver line: Deadly trends can be reversed

It is, however, encouraging to read that verifiable evidence are also emerging from studies that suggest that policy action to clean up air pollution can also reduce health risks, reverse trends and provide health benefits. For instance, this is evident from studies in China that have assessed the 'before and after effects' of introducing stringent air pollution regulation.

In 1998 the Chinese power plants were heavily dependent on coal and were the major source of sulphur dioxide. Dramatic reduction in the emissions thereafter was associated with a 20 per cent decrease in infant mortality rate, with a 63 per cent reduction during the neonatal period, especially from deaths associated with the nervous and circulatory system. Reduced maternal exposure to pollutants benefitted foetal development and increased probability of survival. Such evidence provides confidence and compelling reasons to take urgent strong actions to reduce deaths and illnesses among children.

Stop being in denial

The scary tally of deaths and illnesses among under-5 children makes a mockery of India's growth story. It will be suicidal for India to not act on the mounting health evidence. Indian cities also have their own set of shocking pieces of evidence. The large-scale study of the Central Pollution Control Board and National Chittaranjan Cancer Research Institute has shown that every third child in Delhi has impaired lungs; there are signs of pulmonary haemorrhage in a large number of children. There are scary photos of changes in the lungs of children. More studies from the Patel Chest Institute in Delhi have shown how children are growing up with smaller lungs in polluted cities like Delhi. More studies have shown how smog is blocking sunlight and interfering with the vitamin D absorption among children and many more.

It was, therefore, disturbing when the concept note on National Clean Air Programme (NCAP) that the Ministry of Environment and Forests and Climate Change had put out a few months ago to plan the national clean air programme had expressed scepticism about the existing health studies. It had asked for "authentic health studies as international studies are not realistic".

New studies are welcome in India, but NCAP needs to urgently leverage existing national and international studies and health evidences to refine and strengthen its scope of action to prevent further escalation of health risk. In fact, the new health studies in India can help evaluate India's unique risk factors that enhance health risks and include exposure to very high levels of pollution, a large-scale incidence of urban poverty associated with malnourishment and underlying diseases, and multi-pollutant crisis. NCAP will have to be adequately and effectively designed to address country-wide exposure reduction and reduce the growing burden of non-communicable diseases.

Currently, air quality management in India does not require any review of health information, health impact assessment or health cost-benefit analysis to guide policy action and are not a requirement for policymaking. NCAP will have to rectify this. As per global best practice, the major regulation requires Regulatory Impact Analysis that explains the reason for the regulation, and benefits to public health.

NCAP needs to adopt such approaches and align with the national level health surveillance, health service delivery systems and disease database for such air quality and health-based evaluation and assessment of health outcomes of NCAP interventions. Often ambitious action plans are discouraged for fear of economic impacts. But all available studies show that the cost of mitigation is always lower than the health and environmental costs associated with air pollution. In fact, the clean air action plan will generate more economic opportunities and jobs to facilitate clean and renewable energy, mobility transition, and improved waste management.

This agenda is non-negotiable as the harmful effect of toxic air on children is a ticking time bomb waiting to explode as the uncontrollable epidemic of deadly diseases in the future.

(The views expressed are strictly personal)

Anumita Roychowdhury

Anumita Roychowdhury

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