Toxic air hits the crib; especially in India

The collective memory of the blue skies of the lockdown faded quickly, as the newly released State of Global Air 2020 dropped a new shocker.

While globally air pollution moved up a notch to the fourth rank among 87 health risk factors in 2019, India recorded the highest PM2.5 exposure and the most increase in deaths between 2010 and 2019.

But the biggest scare is the evidence of the effect of air pollution on infant deaths. 

While air pollution accounts for 20 per cent of newborn deaths worldwide, 24 per cent of these infant deaths — the highest, occur in India. This defies the principles of inter-generational justice. 

The State of Global Air that is a collaborative study of Health Effect Institute and Institute for Health Metrics and Evaluation of Global Burden of Disease Project has presented stark evidences on India.

Out of the total tally of 6,670,000 particulate matter (PM) 2.5-attributable deaths globally, 980,000 deaths occurred in India — a 61 per cent increase since 2010.

The other silent killer creeping up in India is ozone: the country has recorded an 84 per cent increase in ozone-related deaths since 2010. 

Clearly, the new evidences reaffirm the health emergency that requires radical change in the scope, scale and speed of action under the National Clean Air Programme. 

Cradle deaths

The new report has, for the first time, estimated the effect of air pollution on infants that shows an estimated 1.8 million deaths worldwide — largely within 27 days of childbirth. Mothers’ exposure to toxic air leads to pre-term birth and lower birth weight.

Thus, babies born too small or too early become more susceptible to lower-respiratory infections, diarrhoeal diseases, brain damage, inflammation, blood disorders and jaundice. 

This report warns that if these babies survive, they continue to remain at a higher risk of infection and major chronic diseases throughout their childhood and life. Evidently, particles and their toxic components move across membranes of the lungs and get carried to different parts of the body and affect placental function and the fetus.

Inflammation and oxidative stress deeply affect the health of pregnant women and babies. 

Poorer women, their underlying health issues and nutrition status further influence and enhance the vulnerability. Even today, burning of solid fuels for cooking accounts for 64 per cent of infant deaths while the rest is due to outdoor air pollution.

Responding to these new evidences, Randeep Guleria, director of All India Institute of Medical Sciences said:

This is a deep concern. There are evidences even in India such as from studies done in Chennai that have traced markers of air pollution exposure among pregnant women and its effect. Moreover, the young and the infants whose lungs and respiratory systems are not yet developed have higher chances of chronic illness, lung damage, and death. This compromises their quality of life.

COVID-19 connection

This report has acknowledged the emerging link between air pollution and higher death rates or severity of disease and complications due to the novel coronavirus disease (COVID-19) pandemic. Studies have been taken on board to indicate that exposure to air pollution can compromise immune defense, making people more susceptible to respiratory and other infections.

While seeking deeper investigation into this link, the report underscores the importance of ensuring lasting improvement in air quality to reduce a major risk for severity of COVID affects on lungs, blood vessels, and other parts of the body. 

Case for green recovery

The new evidences on health emergency in India make a compelling case for the National Clean Air Programme to scale up legally enforceable multi-sector action across regions to clean up all air sheds.

Keeping in view that this has been a year of unprecedented health and economic shock this requires inventive strategies for green economic recovery. We need deeper sectoral reforms to clean up emissions from vehicles, power plants, industries and local sources like construction and waste.

The new report builds confidence in the fact that effective intervention can lead to verifiable improvement in health outcome. This is evident in the reduction in household pollution exposure from 54 per cent to 36 percent due to improved access to clean fuels in India.

Clearly, health benchmark has to be the defining parameter for mitigation.

From the standpoint of the growing burden of air pollution related diseases, Guleria also draws attention to its implications for the health care system:

This growing disease burden creates enormous stress and strain on the healthcare system but that is not part of the narrative. There can be substantial economic benefit from improvement in health outcomes related to air pollution, as a lot of these diseases are preventable. We need to bring this into the narrative as well.

He hopes that this time with added risk of the COVID-19 pandemic, health can be put on the centrestage.  

The message is clear. In these extraordinary times, the economic recovery policies for the new normal must not lock in more pollution and ill health. The evidence on the insidious link between infant deaths and toxic air is a ticking time bomb waiting to explode. 

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