On November 30, 2012, health minister Ghulam Nabi Azad said in the Lok Sabha that “no conclusive information is available regarding high prevalence of respiratory and other diseases due to air pollution”.
The statement sparked outrage. Almost every year since 2000, experts point out, one Indian publication or the other has reported how suspended particulate matter has caused a sharp rise in diseases, particularly in Delhi. Even the health ministry’s National Institute of Health and Family Welfare published in 2007 a study on Delhi’s children that concluded that “air pollution has a deleterious effect on various systems of the body”.
As per the Global Burden of Diseases report released last year, air pollution is the fifth largest killer in India. WHO has classified air pollution as a class one carcinogen.
“Suspended particulate matter definitely has a role to play in contributing to the compromised lung function and respiratory diseases such as asthma, bronchitis, and worsening the symptoms of those genetically predisposed to contracting these diseases, and other high-risk groups such as women and children,” said Dr Raj Kumar, head of respiratory allergy and pulmonary immunology at the Delhi government’s Vallabhbhai Patel Chest Institute.
A 2004-08 study, carried out jointly by by Dr Kumar and Delhi University’s geology department, found asthma in 7.7 per cent of 3,500 children aged seven to 15 in Delhi, particularly in industrial areas.
The study “Outdoor air pollution and emergency rooms visits at a hospital in Delhi”, carried out by AIIMS from January 1997 to December 1998 and published in the Indian Journal of Chest and Allied Sciences, found that, “The ambient levels of pollutants exceeded the national air quality standards on most of the days… Emergency room visits for asthma, COAD and acute coronary events increased by 21.30%, 24.90% and 24.30% respectively on account of higher than acceptable levels of pollutants.”
According to Dr Randeep Guleria, head of pulmonary medicine at AIIMS, “We have been able to correlate that in the winter months when there is a smog cover, or after Diwali, when particulate matter levels shoot up, our respiratory OPDs see 20-30 per cent more patients of chronic respiratory diseases and also increased hyperactivity of the lungs which leads to wheezing, coughing, respiratory allergies, and bronchitis. We also see a rise in hospital admissions.”
The world over, controlling pollution has led to better respiratory health. “Long-term management, as demonstrated around the globe, has always required sustained efforts to reduce the levels of these particulate matters over continued periods of time,” Dr Guleria said. In Los Angeles and London, which faced similar problems about two decades ago, promoting public transport and the use of bicycles for short distances helped control pollution levels, he said.
Dr Kumar of VPCI said studies carried out at the institute over the last decade had also showed that outdoor air pollution was also entering indoors, which was contributing to poor respiratory health in children. “Shutting schools, and issuing health advisories to people to stay indoors during periods of acutely high air pollutants cannot be a self sustaining method because air pollution is entering households.”
In 2012, an epidemiological study on children in Delhi carried out by the Central Pollution Control Board and the Chittaranjan National Cancer Institute of Kolkata found that among 11,628 children of 36 schools, every third child has reduced lung function. “What is most worrying is that 10-15 years ago, when air pollution levels had come down, our OPD attendance and admissions in respiratory medicine at AIIMS saw about a 20-per-cent decline. We seem to have lost out on our own achievements. As pollution levels have gone up, our public health success has also been reversed,” Dr Guleria said.
In 2011, an American Thoracic Society meeting reported that Indians have the worst lung function among people of 17 countries.
A study had found lung function of Indians and South Asians was 30 percentage points lower than that of Europeans. Dr K Shankar, an epidemiologist with St John’s Medical College in Bangalore, who was one of the authors in the study, said, “The accepted standard of Indian lung function so far was 10 percentage points lower than the European standard, but this study has shown that India and South Asia are much worse than that.”