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International Meet on Combating Air Pollution

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Why do we need an international meet in India, you may wonder. But most of you will not, if you are from India.

One only has to land in India by air to see the alarming levels of air pollution.

That is why we are holding an International Meet on Combating Air Pollution on March 10-11, 2017 in New Delhi.

Urgent need to address air pollution through Private Public Partnership Environment is the most important social determinant of health, causing morbidity and mortality in a given population. The WHO’s comprehensive global assessment of the burden of disease from environmental risks reveals that globally, an estimated 24% of the burden of disease and 23% of all deaths can be attributed to environmental factors. Further, globally, non-communicable diseases (NCDs) deaths, attributable to air pollution, are amounting to 8.2 million of the total 12.6 million death. NCDs, such as cardiovascular diseases including stroke, cancers and chronic respiratory disease, now claim nearly two-thirds of the total deaths caused by unhealthy environments.

The Global Burden of Disease (2010) data showed that household air pollution was ranked at the 3rd position and ambient air pollution at the 9th position among the leading risk factors that contribute to morbidity and Disability-adjusted life years (DALYs). Household and ambient air pollution are the leading risk factors contributing to burden of disease in India. Household air pollution contributed to nearly 3.5 million deaths and a loss of 3.5% DALYs globally (2010). Ambient air pollution contributed to another 3.1 million deaths and 3.1% DALYs. The ambient ozone pollution had a lower effect than the above and led to 0.2 million deaths and 0.2% DALYs in 2010.

Cognizant of the fact that air pollution needs to be addressed in right earnest, a Steering Committee was constituted, by the Ministry of Health & Family Welfare (MoHFW), Govt. of India in 2014, with members drawn from both health and non-health sectors. The report of this Committee, released in December 2015, has been able to shift the historical ‘urban air pollution centric focus’ to the ‘burning of biomass fuel across rural and periurban pockets in India’.

According to the Institute of Health Metrics and Evaluation (IHME), air pollution was found to be the leading cause of mortality and disability in India. In Indian settings there is need reducing sources of emissions, improving access to clean fuel and raising public awareness on health effects of air pollution. Major risk factors are household and ambient air pollution contributing to burden of disease in India. • Household air pollution is caused by solid fuels like wood, charcoal, coal, dung, crop wastes are being used by over 3 billion people for cooking at home. These inefficient cooking methods lead to indoor air pollution especially in houses that are poorly ventilated. • Indoor air pollution not only has adverse health effects but also has adverse social and environmental effects.

• Household energy and Poverty: Poor households are unable to afford LPG and other cleaner fuels and reliance on inefficient fuels reduces the time they could spare for income generating activities and education. As a result, a vicious cycle of poverty leading to use of inefficient fuels and these in turn contributing to poverty starts • Gender issues: In most of the cases, women carry out the household chores and hence are the major sufferers of indoor air pollution. • Environmental impact and climate change: Reliance on wood for fuel leads to deforestation and consequent loss of habitat and diversity. The simple biomass and other fuels are inefficient and incomplete combustion takes place. The pollutants like black carbon and methane that are produced as a result of incomplete combustion leads to climate change.

Major health effects of indoor air pollution include acute lower respiratory infections, chronic obstructive pulmonary disease (COPD), lung cancer, cardiovascular disease, burns Emerging evidence suggests that household air pollution in developing countries may also increase the risk conditions such as: low birth weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer and cervical cancer. Considerable evidence suggests that exposure to air pollution leads to adverse respiratory outcomes. Perinatal exposure to air pollution can impair organogenesis and can lead to long term complications.

Exposure to air pollution during pregnancy has also been linked to decreased lung function in infancy and childhood, increased respiratory symptoms, and the development of childhood asthma.

The WHO’s Ambient Air Pollution database for 2016, showed that the levels of PM10 and PM 2.5 in Delhi are way above the normal levels. The annual PM 10 level was found to be 229 μg/m3 and that of PM 2.5 was found to be 112 μg/m3.

In a study conducted at Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India by Garg Suneela et al in 2016, a total of 3019 individuals were screened through spirometry. Of these, 34.35% were found to have lung impairment. Almost 32.5% of the individuals screened were from the age group of 41-50 years. More than half of the subjects (57.6%) had been living in Delhi for more than 20 years.

Initiatives taken by the government for combating the problem of air pollution • Stringent regulations, development of environmental standards, control of vehicular pollution, spatial environmental planning including industrial estates and preparation of zoning atlas. • Use public mode of transportation: Encourage people to use more and more public modes of transportation to reduce pollution. Use of carpooling. The odd/even rule wherein cars with odd-numbered registration plates would ply on odd dates and those with even-numbered registration plates would do so on even dates. • Conserve energy: Switch off fans and lights when you are going out. Large amount of fossil fuels are burnt to produce electricity. Ban on burning of waste and fine on emission of construction dust • Understand the concept of Reduce, Reuse and Recycle: Do not throw away items that are of no use to you. Reuse them for some other purpose. For e.g. you can use old jars to store cereals or pulses. • Emphasis on clean energy resources: Clean energy technologies like solar, wind and geothermal are on high these days. Governments of various countries have been providing grants to consumers who are interested in installing solar panels for their home. This will go a long way to curb air pollution. • Use energy efficient devices: CFL lights consume less electricity as against their counterparts. They live longer, consume less electricity, lower electricity bills and also help you to reduce pollution by consuming less energy. • So there is a urgent need for body like Indian Medical Association (IMA) and other CMAAO countries to address the problem of air pollution in India with the objectives of • Creating awareness on the burden of health effects of air pollution • Discussing main sources of air pollution in India (source apportioning) • Facilitate mitigating the health impacts of air pollution through private public partnership. • Examine preparedness and capacities of respective ministry to address the problem of air pollution emanating from development driven activities.

Thanks to Dr KK Aggarwal National President IMA & HCFI (Contributions from Dr R N Tandon HSG IMA and Dr Ajay Kumar, Advisor CMAAO


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