India accounts for 25% of all air pollution deaths in the world

A few months ago, my doctor told me that I couldn’t run outside anymore. I didn’t protest. For the past four years, I’ve gone on a run every alternate day in Gurgaon, in the NCR region. However, I find my stamina decreasing each year. And the headaches and coughs are getting worse. I finally caved in and went to a doctor after a bout of incessant coughing kept me up for hours at night. “Go to a gym,” he said, “and make sure that the gym has an air purifier”.

On April 17th, a report released by the Health Effects Institute, an American non-profit, showed that India accounted for roughly 25% of all deaths related to air pollution in 2016, while China led with 26%. Furthermore, India and China together accounted for 50% of all 106 million disability-adjusted life years, which is the number of healthy years lost in a person’s life due to air pollution.
The report, titled “The State of Global Air”, explained that outdoor air pollution, or exposure to PM2.5 (particulate matter with a diameter of less than 2.5 micrometers), and indoor air pollution (the residential burning of coal, biomass and waste) together accounted for well over 6 million deaths in 2016. This makes air pollution the highest environmental health risk and the fourth highest cause of deaths in the world after high blood pressure, obesity and tobacco usage.

And the problem is getting worse. The number of annual deaths attributable to PM2.5 have increased by more than 20% from 1990 and 9% from 2010 on a global level. Not only does being exposed to PM2.5 lead to lung diseases and respiratory infections, but it can also increase the chances of heart attacks and strokes and has been linked to diabetes, mental illnesses and degenerative brain diseases like dementia.

As recently as last year, a toxic smog over Delhi (in November 2017) resulted in a threefold rise in patients at the city’s Vallabhbhai Patel Chest Institute. Manoj Khati, a shopkeeper and long-time resident of Delhi, said that what he initially thought was a heaving cough turned out to be chronic bronchitis. "For three days I haven't stopped coughing, I felt as though I would die," he said in a statement to the AFP at the time.

The Health Effects Institute’s report initially presents air pollution as a global problem by saying that 95% of the world’s population live in areas that exceed the WHO’s guidelines for healthy air. However, 58% live in areas that do not meet the body’s least-stringent air quality target (PM2.5 concentrations above 35 micrograms per cubic meter), and they are largely in the developing world - North Africa, West Africa, the Middle East, South Asia and China. In fact, the relative difference in PM2.5 concentrations between the least-polluted and most-polluted countries is rising rapidly, from a 5-fold gap in 1990 to a 11-fold gap in 2016, as developing countries are prioritising economic growth over pollution control.

The report, does however, highlights China’s progress in reducing air pollution compared to countries in the Indian subcontinent. India has a population-weighted annual average concentration of 76 micrograms per cubic meter compared to China’s 56. While China experienced a dramatic increase in average weighted concentrations prior to 2010, its exposure levels have since declined. Meanwhile, from 2010 to 2016, Bangladesh, Pakistan and India have recorded the sharpest increases in PM2.5 concentrations in the world.

The air pollution problem isn’t only restricted to cities. People living in rural areas are becoming increasingly vulnerable to health problems caused by the burning of solid fuels like biomass and coal for the purposes of cooking and heating. Household air pollution lead to 2.6 million deaths in 2016, a large share of which came from countries in South Asia and Sub-Saharan Africa.

A total of 2.45 billion people in the world are exposed to indoor pollution, of which 560 million are in India and 416 million are in China. The lower access to healthcare in rural areas makes the problem especially acute. Nearly 75% of deaths due to air pollution in India are said to take place in rural areas.

Most importantly, the burden of air pollution falls disproportionately on the very old and the very young. Around 62% of the burden of disease attributable to exposure to PM2.5 falls on people above the age of 50, while 28% of the total years lost due to indoor burning of solid fuels fall on children below the age of 5. Not only are we failing our senior citizens, but we’re also failing the youngest members of our global population.

I’ve started running on a treadmill in a swanky gym not too far from my house. I’m slowly building up my stamina again. But the headaches and coughs, while less severe, are still a problem. I can’t completely avoid exposure to the air outside. I have no option to leave my house every day during the week for work or on the weekend in pursuit of a social life. Like every other resident in the National Capital Region, I am trapped in a gas chamber. And because the day-to-day changes in air quality are minimal, we choose to ignore the problem.

As the saying goes, if it’s everyone’s problem, then its no one’s.

While the Modi administration has sought to protect its own by installing air purifiers in the Prime Minister’s office and six other government agencies, the government’s efforts to reduce air pollution on a local and national scale leave a lot to be desired. There have been a few steps in the right direction, however.

At the beginning of this month, fuel stations in New Delhi started selling Bharat Stage VI, the cleanest category of fuel in the country. The move will need to be backed up the gradual phasing out of old vehicles and the priority production of compliant vehicles by manufacturers. Additionally, in order to reduce indoor air pollution, the government is also expanding the distribution of liquefied petroleum gas to people in rural areas. The Central Pollution Control Board is also setting emission standards for a range of industries from power to cement.

In January this year, the government announced the launch of its National Clean Air Programme, aimed at controlling air pollution in the medium term. Coincidentally, the environment ministry released the draft guidelines of the programme yesterday, inviting recommendations by the 17th of May. The guidelines include protocols for setting up an extensive network of monitoring stations, an air quality forecasting system, a pollution management plan for 100 cities and a plantation drive. However, the guidelines did not include any specific targets for pollution reduction and they were heavily skewed towards the monitoring of air quality as opposed to its improvement.

The State of the Air report concluded on a note of urgency with respect to India. “If no further action is taken, population exposures to PM2.5 are likely to increase by over 40% by 2050”.

If you thought the air in Indian cities was unbreathable now, it’s going to get a lot worse over the next three decades. We can all go to gyms if we can’t run outside, but where will we go if we can’t walk outdoors anymore?