Dr S K Chabbra, reader and head of the department of cardiorespiratory physiology, Vallabhbhai Patel Chest Institute, New Delhi, is among the few doctors to conduct an epidemiological study relating air pollution to respiratory morbidity among adults and children in Delhi. In an interview to Priti Kumar, he spoke about the role of doctors in educating the people about health hazards due to pollution
On the results of the study on childhood asthma among Delhi children:
The preliminary results show that nearly 16 per cent of the children, in the age group of five-16 years, suffer from asthma. If we add old asthma cases - those who had asthma in the past but do not have it now -- the prevalence is around 19-20 per cent. We have selected some 15,000 children from different schools in east, west, south, and central Delhi. Standardised questionnaires were given to the children and were answered by their parents. We carried out examination of selected children for the lung function testing to confirm the diagnosis.
On the results of the ongoing study relating air pollution to respiratory morbidity among adults in Delhi:
The results have not yet been analysed in detail. Air pollution may not be the only cause for respiratory morbidity. Other aspects like the type of fuel, cigarette smoking, general economic levels and proximity to industries have to be considered before arriving at any conclusion.
On how the respiratory morbidity study is being carried out:
The study has been undertaken exclusively for adults residing in Delhi for more than 10 years. We have selected people residing in selected areas of Delhi where there are permanent air quality monitoring stations. We are comparing different areas of Delhi, that we know differ in air quality. We then try to see if differences in the respiratory health of the selected persons can be explained with respect to the air quality. The health status of different segments of the population is compared. We are also measuring the lung function and estimating the appearance of chronic respiratory symptoms like chronic cough (persistence of cough for more than three months in a year), chronic production of phlegm and sputum, breathlessness, and wheezing, that are characteristics of asthma.
We are measuring what proportion of each of these segments is suffering from either of these symptoms. So this will give us an idea of the total respiratory morbidity, the prevalence of symptoms, the types of respiratory diseases, and the lung function status.
On whether any recommendations, based on this study, are being furnished to the ministry of health and family welfare or the Indian Council of Medical Research:
Not yet. This is our first study and once it is over we will surely give some useful data to the health planners to work on.
On whether air pollution creates new asthmatics:
A ir pollution does not create new asthmatics. However, it is known to increase the severity of asthma. In India, it is very difficult to say if the number of persons suffering from respiratory diseases has increased due to air pollution. There is no data to prove this as epidemiological studies have not been carried out in India. However, studies in the west have shown that the prevalence of childhood asthma among children in the us and the uk has increased from eight to nine per cent in the early 70s to the recent figure of 17 to 18 per cent. However, it must be noted that the air quality there, has improved over this period of time. Thus, if we are asked to explain the increase in asthma cases in the west, we can say that air pollution may not be responsible for it.
On the current levels of pollution in Delhi:
The Patel Chest Institute does not have the resources to measure the pollution levels. We are therefore, going by the data provided by the Central Pollution Control Board. According to their data, it is the suspended particulate matter that exceeds the permissible limit dangerously.
On whether lack of data on the link between air pollution and health is responsible for the apathy among doctors and people:
We don't need any data to prove that air pollution is bad for us. A lot of it is common sense. Doctors say that they cannot educate people as they lack the data. But, if they really want, they can still find a way out. Take the case of vehicular pollution. If people are aware that emissions from vehicles cause pollution which might affect their health, they will take care to keep their vehicles in proper condition. But they do not bother to do so. They do it only when they are forced by the police.
On doctors' role in informing people about effects of pollution:
Doctors do have an important role to play as the patients will certainly listen to a doctor. But then, doctors come from the same society, where the level of awareness on these issues is extremely poor. Doctors too need education regarding this. It is my impression that people are not concerned about the effects of pollution. In fact, there is a general feeling among people that air pollution is not affecting them. They, however, agree that it might be affecting other people. Hence it is necessary to educate the doctors so that they can inform and educate their patients about it. Health education will play a key role in the efforts to solve the pollution problem. Pollution control cannot be effective just by enforcing a law. Motivation and education alone can help us to achieve the goal.
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