air pollution

How many deaths will it take for India’s environment minister to admit air pollution is a killer?

The minister Harsh Vardhan has questioned existing evidence on pollution-related deaths and said Bhopal in 1984 was an emergency, Delhi’s smog is not.

Even as air pollution continues to smother Delhi – air quality moved from “severe” to “ very poor” on Wednesday – Union Environment Minister Harsh Vardhan has downplayed its role in causing severe health problems, even deaths. In comments to news organisations, Harsh Vardhan has repeatedly said that air pollution can cause illness and distress in people who already have respiratory problems. He has also called for India-centric scientific studies to estimate the effects of air pollution on people living in India.

What the minister has ignored is that air pollution can kill, even if it kills slowly, and that there is plenty of scientific data to show its role in premature deaths.

In an interview to News18, Vardhan said that “no death certificate has a cause of death as pollution”.

In an interview to NDTV last week, he emphasised the need for studies conducted in India, to evaluate the extent of mortality in India in the Indian context using Indian parameters. “I do not think we can generalise and say so many people die of pollution,” he told NDTV.

His recent statements contradict his remarks from February this year when he had said that when pollution affects the lungs, especially in little children, it can be a killer. He had then also referred to pollution as “slow poison”. He was speaking in context of the release of a report by The Lancet Commission on Pollution and Health, which showed that that environmental pollution caused 25 lakh premature deaths in India in 2015.

Another Lancet analysis released this week shows that air pollution is the second biggest risk factor for disease in India. Air pollution mainly contributed to cardiovascular disease, chronic respiratory disease, and lower respiratory infections. Ischemic heart disease and chronic obstructive pulmonary disorders are, in fact, the leading cause of death and disability in the country.

In 2015, the Ministry of Health and Family Welfare formed a 16-member steering committee “to frame an action plan for mitigating the adverse health impacts of indoor and outdoor air pollution”. The report concluded that cities across India need a drastic clean up of air. This conclusion was drawn from evidence cited in the the Global Burden of Disease report of 2010, which shows that air pollution had caused of millions of premature deaths. According to the Global Burden of Disease, in 2010, household air pollution from the use of solid cooking fuels resulted in approximately 1.04 million premature deaths in India. About 6,27,000 lives were lost due to ambient air pollution, the kind caused by dirty emissions from vehicles and is causing the smog in Delhi right now. The 2016 Global Burden of Disease shows that 9,20,000 premature deaths occurred in India due to household air pollution and 5,90,000 premature deaths due to ambient air pollution.

“I agree we need to have Indian studies that monitor long term benefits,” said Dr Damodar Bachani, who works with John Snow International, a public health management consulting organisation. “But based on the current evidence, we have no excuse to postpone action against pollution.”

Bachani worked at health ministry on control of noncommunicable diseases till last year and helped formulate its air pollution report.

“Where is the evidence that Indians have special set of lungs?” said Kirk Smith, professor of Global Environmental Health at the University of California, Berkeley. “In fact, the scientific evidence is that Indians are more vulnerable. An average Indian has less nutrition and less access to medical care.”

Smith also agrees there is no need to wait for more studies to be completed in India to ascertain that air pollution causes premature deaths.

“If anything, the burden of proof is on [people who dismiss pollution as a cause of mortality] to show how Indians are not as vulnerable,” he said.

Cause of death

Pollution is not cited as cause of death in death certificates because it kills slowly, said Dr Arvind Kumar, chest surgeon from Sir Ganga Ram Hospital in Delhi. “It affects your lungs, heart, brain and other parts of your body slowly before causing death. You see the effects of pollution 20 years later.”

Diseases have multiple causal factors. For instance, respiratory diseases may be caused by both smoking and air pollution.

“In such multifactorial diseases, there is no other way of attributing risk than using mathematical modelling,” said Bachani, indicating that further studies are not likely to change the estimates of disease and death due to air pollution.

Dr Arvind Kumar's patient who is a non smoker had black sports in his lungs.
Dr Arvind Kumar's patient who is a non smoker had black sports in his lungs.

No emergency?

Harsh Vardhan also told News18 that the spike in pollution levels in Delhi last week should not be treated as an emergency and that there was no cause of panic among the people. The minister’s standard for an emergency seems to be the world’s worst industrial disaster, the Bhopal gas tragedy of 1984 when thousands of Bhopal residents were exposed to the deadly chemical methyl isocyanate that leaked from a Union Carbide pesticide plant. The disaster killed more than 2,000 people.

“I am talking in practical terms. You see, what happened in Bhopal when there was a gas leak and hundreds of thousands of people fell acutely sick and had to be rushed to the hospital. We call that an emergency situation where you have to panic and you have to see what you have to do. I’m not saying we shouldn’t do anything about it (Delhi smog); everyone has to respond to what he is supposed to do. But there is no need to spread panic among the people.”

However, do residents of Delhi and other pollution affected cities in India really need to wait for thousands of people to die sudden deaths before authorities declare a health emergency and undertake clean-up measures on war-footing?

To some doctors in Delhi, this denial of the severity of air pollution sounds like the denial of tobacco-linked mortality 30 years ago.

For instance, Kumar has found that over the past five years, he started seeing black spots on lungs scans of Delhi residents, even those who are not smokers.

“Earlier we would see black spots only in the lungs of smokers,” said Kumar. “Now we see this in teenagers.”

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“My body instantly craves chai and samosa”

German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

Consequently, Ilka feels India is “so full of life. The social life here is more happening; people smile at you, bond over food and are much more relaxed.” Isabelle, too, can attest to Indians’ friendliness. When asked about an Indian characteristic that makes her feel most at home, she quickly answers “humour.” “Whether it’s a taxi driver or someone I’m meeting professionally, I’ve learnt that it’s easy to lighten the mood here by just cracking a few jokes. Indians love to laugh,” she adds.

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Isabelle, meanwhile, feels some amount of Indianness has seeped into her because “whenever its raining, my body instantly craves chai and samosa”.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.