There is clear and mounting evidence today to demonstrate that exposure to dirty air, both outdoors and indoors, is severely injurious to health, and is snuffing out lives prematurely, especially in low and medium-income countries. Numerous presentations at the recently-concluded and first-ever World Health Organisation Global Conference on Air Pollution and Health in Geneva sledge-hammered home this key message.

Those living in Delhi, India’s capital city, know this first-hand. This is the season of smog, gasping for breath and blame games. The situation is exacerbated by farm stubble-burning by farmers in the neighbouring states of Punjab and Haryana though this is by no means the only reason for the poor air quality.

For the past week, barring small intervals, this metropolitan city of nearly 19 million people has been enveloped in an acrid, choking smog. As in the past, with the onset of autumn, Delhi’s dirty air is top news. Those with respiratory problems are huddling in their homes. Those who can afford it switch on air purifiers. School authorities have shifted the morning assembly of students indoors, and mandated that children wear masks while on the playground. And so on.

The state of the times – the Oberoi, Delhi’s 52-year-old iconic luxury hotel, has installed state of the art clean air technology and welcomes guests with the promise of air quality on par with global standards. Photo Credit: Patralekha Chatterjee
The state of the times – the Oberoi, Delhi’s 52-year-old iconic luxury hotel, has installed state of the art clean air technology and welcomes guests with the promise of air quality on par with global standards. Photo Credit: Patralekha Chatterjee

The Environment Pollution (Prevention & Control) Authority for the National Capital Region or EPCA, a body appointed by India’s Supreme Court, has warned that pollution levels in Delhi and the adjoining cities in the NCR would be “severe” in the coming days. It has called for a host of measures including a ban on entry of trucks in the capital between November 8 and 10, immediately after Diwali, the festival of lights. It has also recommended that commuters not use diesel-run cars during this period.

Supreme Court order violated with impunity

In the run-up to Diwali, India’s top Court banned all firecrackers except those certified “green”, and mandated that people burst crackers only between 8 pm and 10 pm. In a few Delhi neighbourhoods, the message seemed to have gone home. But in most, the court orders were violated with impunity. Many Delhi residents continued to burst crackers way beyond 10 pm. Delhi Police called such actions “sporadic” breaches, according to one media report.

The result was a thick smog that enveloped most of the capital early the next morning, with the Central Pollution Control Board monitors showing an air quality index of 999 in many parts of North, West and Central Delhi. An AQI above 100 is considered unhealthy. The Central Pollution Control Board described the November 8 morning levels as “hazardous”, beyond the “poor”, “very poor”, “severe” and “very severe” categories.

Despite the Supreme Court ban on Diwali fireworks after 10 pm, celebrations with fireworks continued, violating the ban. Photo Credit: Siddheshjoshi/Wikimedia Commons
Despite the Supreme Court ban on Diwali fireworks after 10 pm, celebrations with fireworks continued, violating the ban. Photo Credit: Siddheshjoshi/Wikimedia Commons

Are Indians aware of the health impacts of air pollution?

This leads to two key issues – does India have the political will to tackle air pollution on a war-footing? How aware is the Indian public of the severe health impacts of dirty air?

Among the masses of statistics on the deleterious health impacts of air pollution that came up at the Geneva meet, a few leap out. Polluted air is damaging India’s future – its children. Girl children bear the worst brunt of polluted air.

A new report by the WHO reveals that in 2016, over a lakh (100,000) Indian children below the age of five were killed by exposure to air pollution, indoors and outdoors. With a death rate of 96.6 per 100,000, girls fared worse than boys, whose death rate was 74.3 per 100,000. Compare this with the situation with Indonesia, another country where forests are often set ablaze to clear land for palm oil plantation. In 2016, in Indonesia the death rate for girls below five was 35.6 per 100,000 and for boys in the same age group 35.2. In the same year, in China the death rate from air pollution of girls below five was 12.5 per 100,000, and for boys 13.8.

Older children, those between the ages of five and 14, fared better, the same WHO report shows. The death rate from indoor and outdoor pollution among Indian girls in this age group in 2016 was 3.4 per 100,000, and for boys 2.3. India still fared far worse than China, where the death rate of girls in this age group from air pollution was 0.6 per 100,000, and for boys 0.4. In Indonesia, the death rate was 1.2 per 100,000 for both boys and girls in this age group, still considerably better than the situation in India.

The World Health Organisation’s Geneva meet had key messages, which India can ignore only at a very high cost to the health of its people. Globally, air pollution is the second leading cause of non-communicable diseases. Nearly 61% of deaths in India are now attributed to non-communicable or lifestyle diseases including heart disorders, cancer and diabetes.

And it is not just deaths. Polluted air leads to a host of adverse health effects in children –neurodevelopmental disorders, cognitive conditions, childhood obesity, lung function, acute lower respiratory infections including pneumonia, asthma and even childhood cancers. There is new evidence including from cohort studies by Indian scientists linking exposure to polluted air with adverse birth outcomes.

Impact on pregnant mothers and children

Fine particulate matter below 2.5 microns in diameter (PM2.5), which gets into lungs, heart and the bloodstream, has been associated with low birth weight, already a serious problem in India. Outdoors, PM2.5 has been particularly high in recent weeks. Indoors, it has always been high in households too poor to cook in anything other than wood or animal dung.

One of the less-known health effects of polluted air is the emerging evidence of connection between maternal exposure and adverse outcomes such as stillbirth, premature birth and low birth weight. What is of great concern is the strong evidence establishing links between exposure to indoor air pollution and a whole range of health disorders including formation of cataract, a prime cause of blindness in adults in developing countries.

While the polluted air in Delhi is typically on the radar, many other cities, particularly across northern India, like Kanpur and Faridabad, are also intensely impacted, according to another WHO report, released earlier this year and cited extensively in the Indian media.

Making air pollution a political issue

At an event organised by the Delhi Centre of the University of Chicago in the run-up to the Geneva conference, Deepender Hooda, a Member of Parliament from the opposition Congress Party, said that while air pollution is a big talking point in urban India, it is not “a political issue”.

The reason is not difficult to guess. Real action to tackle the key causes of air pollution – vehicular emissions, construction dust, factory chimneys, stubble burning – would hit special interest groups who make up key vote banks. No one is willing to take on these groups, and are unlikely to do so when the country is gearing up for parliamentary elections in 2019. In contrast, the victims are the amorphous general public.

A new report by the WHO reveals that in 2016, over 100,000 Indian children below the age of five were killed by exposure to air pollution, indoors and outdoors. Photo Credit: Nvssafu photography/Wikimedia Commons
A new report by the WHO reveals that in 2016, over 100,000 Indian children below the age of five were killed by exposure to air pollution, indoors and outdoors. Photo Credit: Nvssafu photography/Wikimedia Commons

Hooda says he plans to bring a private member’s bill on the Right to Clean Air in Parliament but the jury is out on when that may be and whether it has any chance of becoming a law.

The nub of the matter is political will or the lack of it to take all the tough measures that need to be taken on a war footing to tackle the problem of polluted air. For most Indian politicians, air pollution is something that is irksome for small periods at specific times of the year and then forgotten. In reality, it is a year-long menace.

India – which has several cities which rank among the worst in the world when it comes to air pollution and which is a global hot spot for non-communicable diseases – maintained a low-profile at the Geneva meet. Neither India’s health minister nor its environment minister attended. Officials from the two ministries spoke about some key measures that the government had taken to deal with polluted air and the various plans.

Positive impact from shift to LPG stoves

Arguably, India has taken some positive measures. One key initiative mentioned several times by Indian officials is the Pradhan Mantri Ujjwala Yojana, which seeks to move poor Indians to cleaner cooking fuels. In a country where, according to the 2011 Census, nearly 121 million households used traditional biomass cooking stoves or chulha, the Pradhan Mantri Ujjwala Yojana has already achieved its initial target to provide 50 million LPG connections and efforts are underway to reach an additional 30 million households.

From April 1 this year, industrial and transport fuel norms have been made more stringent in Delhi and the move will be extended across the country. Delhi has banned pet coke. Electric vehicles are being promoted and India has had a National Action Plan on Climate Change since 2008.

But implementation is weak and timelines not respected, as Indian officials attending the Geneva meet acknowledged in public. And it is difficult to blame others when government-run coal-fired power plants are repeatedly pushing back deadlines to clean up the emissions from their chimneys.

That in a nutshell is the main issue. India has never fallen short of policies and programmes. There is intent, but political will and compliance continue to be weak. Can citizen action and pressure show the road ahead, as has happened in many countries, including China? Air pollution is the great leveller, since it affects rich and poor, the devout and the non-believer, alike, though it affects children and the elderly worse. To tackle it, all citizens will have to act together right now.

This article first appeared on Mongabay.