We cannot have a laid-back approach to the public health emergency caused by poor air quality.
By Poornima Prabhakaran
June 2019: We are at the cross-roads in more ways than one. Half-way through yet another year, as the air ‘clears’ on the political arena and the ‘dust’ settles down on yet another frenzied poll campaign culminating in its final verdict, the focus needs to move back on India’s prevailing, unabated problems. Air pollution must figure on top of the list of priorities. Incidentally, #BeatAirPollution was the theme of the World Environment Day (June 5, 2019).
India has had the dubious distinction of being the diabetes capital of the world. Now we vie for the top by being home to some of the world’s most polluted cities. The National Clean Air Programme had envisioned a game plan for strategic action to curb the rising levels of air pollution, beginning with 43 smart cities that fall in the category of 102 non-attainment cities (those that consistently show poorer air quality than the National Ambient Air Quality Standards). Loopholes in its structure have been identified and suggestions for revision were aplenty. While one hopes a stable government will foster strengthening of the resolve to fight this new ‘killer’, what can the scientific community do to catalyse appropriate action?
The evidence base for galvanising policy and action, besides allocating resources for air action plans, has been questioned, not least because of the ‘lack of enough local evidence’ for health effects of air pollution in India, with most knowledge emanating from studies elsewhere. A consortium steered by the PHFI’s Centre for Environmental Health and Centre for Chronic Disease Control, in collaboration with researchers from the Harvard School of Public Health and Karolinska Institutet, Sweden, has infused renewed energy amongst exposure scientists and health researchers in India, to work with each other to build scientific knowledge that will feed into effective policymaking for air pollution control.
The mantra of ‘health in all policies’ is central to this effort that will assess association of exposure to ambient PM2.5 levels during 2010-18 with a range of health outcomes. A nationwide model that uses data from multiple sources for exposure assessment from monitoring stations, satellite data, land-use data, weather data and chemical transport models in a unique comprehensive ‘ensemble’ approach is being constructed and will help build a strong evidence base for studying health effects of air pollution in India. The consortium will help establish evidence base for health effects of air pollution. Once this is done, effective policymaking emanating from India-specific evidence, appropriate resource allocation and targeted action can take place.
This new knowledge will help build awareness amongst healthcare providers. While tobacco-use as a risk factor for respiratory diseases, lung cancer and cardiovascular disease has been taught in the medical curricula, air pollution rarely figures in medical textbooks. A sea change is warranted across mind-sets of doctors and allied healthcare professionals, researchers, policymakers, city planners and the general public on the dangerous exposure to air pollution.
The economic cost of poor air quality is manifested through direct and indirect pathways—illness impacting work-days, increased burden on health services, widening inequalities by virtue of lower socio-economic status being a major factor for greater vulnerability to illness, coupled with poor access to healthcare amongst these categories—all feeding into a vicious cycle that has ripple effects on individual, household and national economies.
Much of the control must focus on dealing with the sources of air pollution. Major causes like industrial pollution, fossil fuel use, vehicular pollution, road dust, waste and stubble burning all require coordinated multi-stakeholder consultation for evolving a cohesive plan for mitigation and control.
While it will take national-level policymaking for dealing with issues like fossil fuel burning in thermal power plants, effective state air action plans must be facilitated with appropriate capacity-building at all levels for implementation.
India cannot afford to have a laid-back, lackadaisical approach to the new public health emergency caused by its deteriorating air quality. The time to act is now.
(The author is Head, Environmental Health & Additional Professor, PHFI, and deputy director, Centre for Environmental Health. Views are personal)