Choking To Death

Choking To Death

Exposure to high levels of air pollution can cause a variety of adverse health outcomes. Air pollutants that are inhaled have serious impact on lungs and the respiratory system
By Dr A K Agarwal

Massive air pollution increases the risk
of respiratory infections, heart disease as well as stroke and lung cancer. Both short and long term exposure to air pollutants have been associated with health impacts. More severe impacts of air pollution affect people who are already ill, children, the elderly and the poor people are even more susceptible.
Although air quality in developed countries has been generally improved over the last decades, the adverse health effects of particulate air pollution, even at relatively low levels, remain a global public health concern. The most health-harmful pollutants – closely associated with excessive premature mortality – are fine PM2.5 particles that penetrate deep into lung passageways. Particulate matter, or PM, is the term for particles found in the air, including dust, dirt, soot, smoke, and liquid droplets.

Controlling the demon
Exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels. The health sector can play a central role in leading a multi-sectoral approach to the prevention of exposure to air pollution. It can engage and support other relevant sectors (transport, housing, energy production and industry) in the development and implementation of long-term policies to reduce the risks of air pollution to health.
Alarmed at the current air pollution levels in the city, the Delhi high court recently termed it like living ‘in a gas chamber’ and demanded an immediate action plan from the Centre and the state government to combat deteriorating air quality. Zeroing in on emissions by vehicles and constructionrelated particulates as key pollutants in the capital, the court recently ordered a clampdown on both, asking the government agencies to take steps.
As per the report many families with elderly members ailing from respiratory illnesses have installed oxygen cylinders at home for emergency purposes because they can’t keep running to the hospital for every frequent breathing crisis that arises.
The medical practitioners feel that problem needs the attention of not just a single man, but of an entire system, whose combined effort must be to make whole capital city’s air breathable again.

Delhi, Beijing neck-and-neck
After a neck-and-neck race with Beijing over the past few winters, Delhi may soon find itself without a rival for the `most-polluted-city’ crown. The Chinese city is doing its best to fall behind although, as happened last week, it sometimes nudges ahead with a wind-aided spurt.
A recent assessment by Beijing-based Greenpeace East Asia shows that between August 2014 and August 2015, Delhi’s levels of PM2.5 (fine, respirable pollution particles) were far higher than those in Beijing.
The air quality of capital of India is being deteriorated day by day due to increasing level of pollution. When people of Metro city breathe, it seems something they stuck inside. Despite precautions many are experiencing the adverse effects of poor air. Almost all of them claimed to be suffering from respiratory problems or chest congestion.
A report released by Delhi Pollution Control Committee (DPCC) and Beijing Municipal Environmental Monitoring Centre stations in Beijing, Greenpeace East Asia has highlighted that the Chinese city’s monthly PM2.5 averages were between 100gm3 and 200g m3. Delhi’s monthly averages for October, November, December and January were well above 200gm3. A microgram (g) is a thousandth part of a milligram.
The report suggests that health interventions must be guided by both emission and exposure estimates. A policy that addresses multiple sources of pollution will be critical for prevention and dealing with existing health impacts of air pollution. This is why we have recommended representation of many ministries and coordination between them to achieve this. The health effects of air pollution highlighted by the committee range from childhood pneumonia and asthma to cardiovascular diseases (heart attacks and strokes), chronic lung disease, cancers and low immunity in adults.
It is not simply those who spend a lot of time outdoors who are affected. We get month-old babies suffering from blockage of the nose due to pollutants. They are unable to breathe normally .All we can do is to open up the upper airway by administering saline drops.
Large concentrations of particulate matter are typically emitted by sources such as diesel vehicles and coal-fired power plants. Particles less than 10 micrometers in diameter (PM10) pose a health concern because they can be inhaled into and accumulate in the respiratory system. Particles less than 2.5 micrometers in diameter (PM2.5) are referred to as “fine” particles and pose the greatest health risks. Because of their small size (approximately 1/30th the average width of a human hair), fine particles can lodge deeply into the lungs.

Choking to death
Worldwide 3.7 million premature deaths are attributable to ambient air pollution in 2012. About 88% of these deaths occur in low and middle income countries.
The WHO maintains a worldwide, public database on urban outdoor air pollution in its Global Health Observatory. The database contains measured outdoor air pollution levels of PM2.5 and PM10 from 1100 cities in 92 countries for the years 2003-2010. These are used for estimating mean annual exposures of the urban population to fine particulate matter. In 2013, WHO began collaborating with major institutions and agencies worldwide in the development of a global air pollution platform that includes data on air pollution concentrations based on satellite monitoring, chemical transport models and ground measurements, inventories of pollution emissions from key sources, and models of air pollution drift – permitting estimates of air pollution exposures even in areas where there are no ground level monitoring stations.

Government’s role imperative
The Governments can identify their main sources of ambient air pollution, and implement policies known to improve air quality, such as promotion of public transport, walking, and cycling (rather than transport relying on private motor vehicles); promotion of power plants that use clean and renewable fuels (e.g. not coal), and improvements in the energy efficiency of homes, commercial buildings and manufacturing.
Essential accompanying steps include increasing awareness about the high disease burden from ambient air pollution and its main sources, as well as highlighting the importance of taking action now to implement country-specific interventions. In addition, the use of effective monitoring to evaluate and communicate the impact of interventions is also an important tool in raising awareness. It can help drive policy action that brings benefits for health, climate and the environment.
The WHO estimates that 12.7% of deaths could be averted by improving air quality worldwide. Lower levels of air pollution will reduce the burden of respiratory and cardiovascular disease-related illnesses, health-care costs, and lost worker productivity due to illness, as well as increasing life expectancy among local populations.
In addition, actions that reduce ambient air pollution will also cut emissions of short-lived climate pollutants, particularly black carbon which is a major component of soot emissions from diesel vehicles, and other sources, as well as greenhouse gases (CO2) contributing to longer-term climate change impacts. Climate change produces a number of adverse effects on health. This includes those from drought and extreme weather events (e.g. windstorms, floods), such as water-borne and food-borne diseases. It also increases the prevalence of vector-borne diseases like dengue or malaria.

Developing Vs Developed countries
Public health recognizes air pollution as an important determinant of health. Today this is especially the case in developing countries where exposure to air pollution is now higher than in developed countries, where mitigation measures led to reductions in exposure. There is significant inequality in the exposure to air pollution and related health risks: air pollution combines with other aspects of the social and physical environment to create a disproportional disease burden in less affluent parts of society.
Mortality from heart disease and stroke are also affected by risk factors such as high blood pressure, unhealthy diet, lack of physical activity, smoking, and household air pollution. Some other risks for childhood pneumonia include suboptimal breastfeeding, underweight, second-hand smoke, and household air pollution. For lung cancer, and chronic obstructive pulmonary disease, active smoking and second-hand tobacco smoke are also main risk factors. These risk factors may contribute to deaths that are caused by ambient air pollution.
Reducing the public health impacts of ambient air pollution requires addressing the main sources of air pollution, including inefficient fossil fuel combustion from motor vehicle transport, power generation and improving energy efficiency in homes, buildings and manufacturing.
Reducing the health effects from ambient air pollution requires action by public authorities at the national, regional and even international levels. Individuals can also contribute to improving air quality by choosing cleaner options for transport or energy production.

(The author is Professor of Excellency and Ex-Dean, Maulana Azad Medical College, New Delhi)