3 years

Health

Breathing Bad

Photographer
Rohit Chawla
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Air quality in north India divides the rich and poor more than ever amid official apathy and public indiscretion

AT DYSON’S TRENDY showroom in Delhi’s DLF Promenade mall in Vasant Kunj, sales of the British company’s air purifiers have shot up in the past month as people from various parts of the National Capital Region and elsewhere, alarmed by the rise in pollution levels and chances of related long-term health hazards, especially for their children, have begun spending big money on products such as Dyson Pure Cool and variants that promise to ‘automatically’ clean ‘a whole room properly, capturing 99.95% of harmful pollutants as small as 0.1 microns’. This gadget, an aesthetic treat of minimalism, is priced at close to Rs 45,000, but the well-heeled, anxious about their respiratory and cardiovascular health—not to mention their fear of cancer—don’t think twice before acquiring it, a salesperson at the shop tells me. “The health of my only son is of primary concern to me,” says Vivek, 45, one of the several customers at the shop on a wintry November morning.

This MNC executive with a degree in engineering reels out health figures to justify his expensive purchase to fight a menace that is now being termed ‘the new tobacco’. Anyone with some general awareness knows of the recent World Health Organization (WHO) report that was widely covered in the country’s media and heavily discussed. Close to 600,000 children under the age of 15 die from exposure to toxic air every year, said the WHO, marking India out as among the worst places to live in the world. The study examined the health toll on minors breathing both outdoor and household air with hazardous levels of pollution— particularly dangerous particulate matter with a diameter of less than 2.5 micrometres (PM2.5), sulfate and black carbon. The report also found that children in poorer countries are far more at risk than others: 98 per cent of all those under five in low- and middle-income countries are exposed to PM2.5 levels much above WHO’s air quality guidelines. “Polluted air is poisoning millions of children and ruining their lives,” WHO chief Tedros Adhanom Ghebreyesus said in a statement.

Have no doubt: Indians suffer the most. According to WHO, 100,000 children died from air pollution in India in 2016 alone. India reported the highest toll of 1.1 million deaths and 1.7 million casualties globally that year. Among minors, air pollution impairs IQ, besides making them vulnerable to cardiovascular and respiratory diseases. “I have read the numbers [published by the WHO]. Which is why I don’t want to take a risk so long as we can afford it,” says Vivek, the parent shopping at the Dyson store.

If you are richer, you are more or less insulated from a highly polluted environment, says Dr Naresh Trehan, chairman, Medanta, The Medicity, Gurugram

The ‘numbers’ Vivek talks about paint a grim portrait of air pollution levels in north India. Of 14 cities with the worst air quality in the country, 11 are in Uttar Pradesh, according to data of the Central Pollution Control Board (CPCB). While the WHO report lists Kanpur among the most polluted cities in the world, the CPCB lists Ghaziabad, Gurugram, Bulandhshahr, Faridabad, Noida, Hapur, Baghpat, Delhi, Greater Noida, Kanpur, Agra, Muzaffarnagar, Lucknow and Moradabad among the most polluted Indian cities.

A senior Health Ministry official rues that though India has launched various schemes under several government agencies to battle the scourge of air pollution caused by particulate matter and sulphur and nitrogen dioxides, besides others, implementation of these programmes has been tardy. He is of the view that while India, an emerging nation with a large number of poor people, bears the brunt of toxic air, the poor (he calls them ‘have-nots’) suffer far more than the well-off (whom he refers to as ‘haves’) in the country.

100,000 children died as a result of air pollution in India in 2016

Air quality, he argues, divides the rich and poor more than ever. Rich kids and adults grow up in cleaner environments; they have air filter systems in cars, and offices and schools. In contrast, the country’s poor inhabit areas with high dust pollution and are exposed to toxic dioxides and outdoor pollution, including vehicular emissions. “Unfortunately, studies in this area and measures to safeguard the poor against this potential healthcare burden are pathetic in implementation,” he says. With inadequate access to advanced healthcare and overexposure to outdoor as well as indoor pollution, the poor lead a wretched existence and are easy victims to toxic air-related health hazards.

Dr Suhela Kapoor, a Tata Trusts fellow at the Centre of Environmental Health who has been conducting a landscape study of more than 500 children to see how indoor air pollution affects a child’s neurological development, has found that the use of biomass fuels for traditional cooking stoves in ill-ventilated kitchens with no chimneys, the indoor smoke of hookahs, poor sanitation and exposure to pesticides are some of the extreme environmental adversities faced by the urban poor, apart from ambient air pollution and lack of green spaces. Exposure to these has long-lasting effects on the mental, behavioural and neurological health of Indian children, she says. Pulmonologists add that the prevailing air pollution levels in north India put patients suffering from chronic obstructive pulmonary disorder (COPD), stroke and heart ailments in great jeopardy. Vulnerable groups such as former smokers, the healthy elderly and those with respiratory conditions are also at abnormally high risk.

Ghaziabad, Noida, Delhi, Gurugram and Faridabad are among the worst polluted urban centres in India

Dr Naresh Trehan, chairman, CII Healthcare Council, and managing director of Medanta, The Medicity, in Gurugram, emphasises that people at the bottom of the economic pyramid naturally tend to suffer more thanks to greater exposure to all kinds of pollutants, be it noxious vehicle fumes or construction site emissions. “They live in crowded places where there is no proper air circulation, [often] close to roads and leaking sewage systems, [and also face] enormous amounts of dust. On the other hand, if you are richer, you are more or less insulated from such a highly polluted environment,” the heart surgeon says.

Air pollution raises the occurence of cardiac problems in India. Dr Trehan says diseases of the lungs and of the heart are closely linked. Many of those who breathe polluted air end up having breathing difficulties and diseases such as asthma, he explains, adding that as those pollutants go deep into the bloodstream, people risk developing cardiovascular diseases. The economic costs of debilitating ailments are huge, especially among children and able-bodied men who are often breadwinners for their families, not to speak of the devastating knock-on effect such diseases can have on homemakers in families, especially the poor.

THERE ARE also companies that are marketing affordable air purifiers for the not-so-well-off. For instance, The Tree Company, co-founded by Samayak Jain and Manav Ailawadi in 2016 which started by selling an imported product to reduce indoor pollution, now makes air purifying bags at its Lado Sarai facility. According to the company, these bags of various sizes contain coconut- based activated carbon that absorbs pollutants 100 times its own weight and can be ‘rejuvenated’ once a month by placing it under direct sunlight.

Doctors say that breathing Delhi's air is equivalent to smoking 30-40 cigarettes a day

Similar products have hit the market in recent times, offering to remove odour, allergens and pollutants from rooms, cars, closets and so on—all priced between Rs 300 and Rs 600. Ailawadi and his team had earlier sold a German-made product named Airy, an air-purifying pot made using NASA technology that the company claimed ‘enhanced the ability of an air purifying plant 10 times’. It costs Rs 7,500. Such products promise to tackle indoor pollution. “We have tested our products and found them to reduce indoor pollution drastically at a time when people tend to ignore pollution inside and focus more on outdoor pollution alone,” says Ailawadi.

One of the biggest challenges of combating air pollution of all types in India—including cooking on firewood and stubble-burning by farmers in adjoining states of Delhi—is that it comes under review only in winter when air pollution levels rise and result in smog, a dangerous combination of smoke and fog.

Every year, come November, northern India gears up to face yet another year of record air pollution, and media stories, activism and official concerns routinely put the spotlight on various aspects of the scourge, including poor governance, lessons to learn from other countries in fighting the menace, expensive and affordable technologies available to combat the problem, concomitant diseases, drugs and treatment, etcetera.

“A concerted and coordinated effort along the lines of what Western countries have experimented with successfully can be implemented in India as well,” says a Health Ministry official, citing examples of cities such as Beijing which some years ago, he adds, was the world’s largest “gas chamber” of a city.

In 2013, Beijing’s Air Quality Index was at unprecedentedly dangerous levels, prompting China’s communist party-led government to launch a war on air pollution. By 2017, many cities in the most populous country in the world had cut concentrations of fine particulate matter in the air by 32 per cent on average, according to official reports.

The Air Quality Index (AQI) is a yardstick for measuring air pollution levels on a scale of 0 to 500. While 0 to 50 is the ideal of good air, 300 to 500 is considered hazardous. In fact, the big advance that China made was thanks to its partial ban on new coal-powered plants in its national capital region. It also managed to get existing plants to slash emissions and in several cases, replaced coal with natural gas.

Polluted air is poisoning millions of children and ruining their lives, says Tedros Adhanom Ghebreyesus, director-general, WHO

By all accounts, the situation in India is worse than in China, which had long been criticised globally for its injudicious development and housing of hazardous industries to generate jobs for its vast working-age population. China may be the world’s most populous nation, but according to a report by the Lancet Commission on Pollution and Health, more people die in India than any other country due to pollution.

There were once such ‘gas chambers’ in the West, too. Last year, as Delhi reeled under severe smog, some experts compared the plight of Delhi residents to the dreaded 1952 Great Smog of London, when cold and windless conditions in December killed close to 4,000 unsuspecting Londoners in four days.

Last year, tourism was badly hit across north India and cases of COPD and other lifestyle-related diseases have spiked. An AIIMS doctor has said the use of N95 respirators (masks are widely believed to be efficient in the filtration of airborne particles) and air purifiers isn’t enough to safeguard people from the high pollution levels in Delhi. Notably, AIIMS Director Randeep Guleria, also a renowned pulmonologist, while acknowledging the rise in awareness among people, had said the situation in Delhi could be life-threatening even for healthy people. “Merely breathing Delhi air is equivalent to smoking 30- 40 cigarettes a day,” says Delhi-based chest specialist Dr Hemant Kalra.

India can learn from how cities such as London, Brussels, Paris, New York and Los Angeles overcame similar man-made disasters accompanying large-scale manufacturing and construction. In these cities, aggressive government action and public participation have produced fruitful results. In India, at one point, though there has been a marginal slide in PM 2.5 levels following a National Green Tribunal (NGT) order asking the governments of Uttar Pradesh, Haryana, Punjab and Rajasthan to enforce a ban on stubble burning by farmers, there is a lot of improvement that is yet to be achieved. Last year, a public health emergency warning had been issued in Delhi with the AQI figure going above 500 in some parts and even off the charts in other areas, making air pollution an issue over which governments of various states and at the Centre simply had to concede defeat.

A widely reported study by Harvard University’s John A Paulson School of Engineering and Applied Sciences (SEAS) says a major chunk of the air pollution that causes health emergencies in the national capital every winter is to be blamed on crop stubble burning in Delhi’s neighbouring states.

According to a parliamentary panel report on air pollution, ‘The existing capacity of the government of Delhi to treat municipal solid waste is 46% less than the required capacity’ which contributes to the existing woes. It adds, ‘The unprocessed municipal waste is a threat to the environment and ecology of the region.’ It suggests that there is an urgent need to augment the available capacity for the treatment of municipal solid waste: ‘The plans of government of Delhi to set up new waste-to-energy plants and enhance the processing capacity of existing plants should also be materialised expeditiously.’ Dwelling on road dust, the parliamentary committee report also says that the Centre ‘must ensure that state governments take action on all the action points for control of road dust/re-suspension of dust and other fugitive emissions’. Further, it notes that unpaved roads add to the problem of road dust and should be paved at the earliest: ‘In this regards, civic agencies should be held responsible for their maintenance.’ On construction activities, ‘efforts should be made for stringent enforcement of construction guidelines specified by the Central Pollution Control Board (CPCB) and adoption of international best practices’.

For its part, the CPCB says that it has been imposing penalties on violators while implementing measures to combat pollution in the Delhi NCR region under the official Clean Air Campaign. However, several experts who have been tracking the action taken contend that the CPCB’s punitive steps are too incremental to have a significant impact. The Board’s member-secretary Dr Prashant Gargava didn’t respond to emailed questions from Open about the various moves initiated by the organisation to fight air pollution.

Meanwhile, a Down To Earth report says that the Environment Pollution (Prevention & Control) Authority for the National Capital Region EPCA, a body appointed by the Supreme Court, has recently issued an advisory in which it has warned that pollution levels in Delhi-NCR would be ‘severe’ over the next few weeks.

As history repeats itself year after year, the fear of air among residents of the capital is palpable. What’s missing is prompt governmental action and public participation.

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