Dirty air killing Indians early and in large numbers

Over 1.2 million Indians died early due to exposure to unsafe air in 2017. Air pollution is now the third-highest cause of death among all health risks, ranking just above smoking, in India. This is a combined effect of outdoor PM2.5, ozone and household air pollution. Due to this combined exposure South Asians including Indians are dying early — their life expectancy has reduced by over 2.6 years. This is much higher than the global tally of reduced life expectancy by an average of 20 months. While globally a child born today will die 20 months sooner, on average, then would be expected without air pollution, in India they would die 2.6 years earlier.

This shocker comes from the State of Global Air Report 2019 the annual tracker of global burden of disease estimates of the US based Health Effect Institute (HEI) and Health Metrics and Evaluation (IHME). The earlier report had estimated 1.1 million deaths in India in 2015. The report has pointed out that entire Indian population lives in areas with PM2.5 concentrations above the WHO Air Quality Guideline of 10 µg/m3, and only about 15 per cent of the population lives in areas with PM2.5 concentrations below the WHO’s least-stringent target of 35 µg/m3.

Out of the 1.2 annual premature deaths 673,100 deaths were due to exposure to outdoor PM2.5, and more than 481,700 deaths due to exposure to household air pollution in India. While exposure to outdoor PM accounted for a loss of nearly 1 year and 6 months in life expectancy, exposure to household air pollution accounted for a loss of nearly 1 year and 2 months. Thus, together Indians lose 2.6 years. Also household air pollution contributes about a quarter of the outdoor air pollution in India. 

In India early deaths are linked to respiratory diseases, heart disease, stroke, lung cancer, and diabetes that are influenced by air pollution. Exposure to ambient ozone is linked to COPD. The deadly tally broken up by diseases shows that chronic obstructive diseases due to air pollution is responsible for close to half of deaths at 49 per cent followed by lung cancer deaths at 33 per cent, diabetes and ischemic heart disease 22 per cent each, and stroke 15 per cent. It is scary how COPD, lung cancer and ischemic heart diseases dominate the dubious tally. 

New spotlight

For the first time this annual tracker has tracked two new indicators — impacts of air pollution related diseases on life expectancy ie how long a person can expect to live and how much air pollution reduces life expectancy in countries around the world. And also for the first time this has accounted for risks from type 2 diabetes linked to air pollution. This emerges from the scientific evidences that have indicated this insidious link between air pollution and development of type 2 diabetes.

This has serious implications for India where type 2 diabetes has taken an epidemic form. The new report states that the economic costs of diabetes are substantial — estimated as 1.8 per cent of worldwide gross domestic product in 2015 and is a growing challenge to health care systems in countries at all levels of development. Epidemiological studies in Asia, Europe, and North America, supported by toxicology research, have provided strong evidence that exposure to ambient and household PM2.5 contributes to type 2 diabetes incidence and mortality. In the 2017 GBD analysis, exposure to PM2.5 was found to be the third-leading risk factor globally for type 2 diabetes deaths and DALYs, after high blood sugar and excessive body weight. Exposure to PM2.5 pollution contributed to 276,000 deaths and 15.2 million DALYs from type 2 diabetes in 2017 worldwide.

This burden is the highest in India, where PM2.5 exposure account for 55,000 deaths and 2.7 million DALYs. Reducing the burden of disease from type 2 diabetes and other diseases will require multipronged public health strategies aimed at reducing exposure to multiple risk factors including air pollution.

Global tally

Overall globally, more people die from air pollution-related diseases than from road traffic injuries or malaria each year. Air pollution ranks fifth among global risk factors for mortality globally, exceeded only by behavioral and metabolic factors: poor diet, high blood pressure, tobacco exposure, and high blood sugar. It is the leading environmental risk factor, far surpassing other environmental risks that have often been the focus of public health measures in the past, such as unsafe water and lack of sanitation, mentions the report. China and India together continue to remain responsible — as was found last year — for over half of the total global attributable deaths. 

Overall, long-term exposure to outdoor and indoor air pollution contributed to nearly 5 million deaths from stroke, diabetes, heart attack, lung cancer, and chronic lung disease in 2017.  South Asian countries — Bangladesh, India, Nepal and Pakistan — led the world as the most polluted region, with over 1.5 million air-pollution related deaths.

The State of Global Air 2019 is an annual tracker of global burden of diseases that is carried out by Health Effects Institute in cooperation with the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, the University of British Columbia, and the University of Texas, Austin. The Global Burden of Disease is an international effort to estimate the number of deaths and lost years of healthy life due to about 300 diseases in 195 countries, and how much of this burden is caused by 84 different risk factors, including diet, high blood pressure, tobacco smoking and air pollution.

Act now

This report is the lasting reminder of India’s health emergency and comes at the right time when the country is shaping up its electoral mandate. Addressing this health crisis has to the part of the electoral and political mandate to drive the National Clean Air programme (NCAP). India is running against time and the pollution levels and health risk must decline significantly to offset the health impacts from growing numbers and ageing — the essential part of demographic transition. The new report thus also provides the positive inducement that life expectancy can improve if air pollution is reduced. Clearly therefore, steps are needed in leaps and not in small steps.

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