Smog and health of aam aadmi

Delhi is enveloped in the seasons’ worst killer smog at present. Over the past 24 hours the wind has nearly stopped blowing and cold has set in good and proper. Sunday night was a nightmare for those who were out of their homes or or had a flight or train to catch. People reported difficulty in finding their way through the thick smog. The daily pollution average on January 5 was the highest this winter. Shouldn’t all Delhiites now wake up to what winter and the trail of smog episodes is doing to their health and shouldn't air pollution be among the priorities in the 18 point agenda of Aam Aadmi Party (AAP), which it is not?

Nearly all through this winter we have kept our eye on the continuous air quality monitoring reports of Delhi Pollution Control Committee (DPCC) and Central Pollution Control Board (CPCB) that relay real time air quality data. Throughout the season, the level of airborne and invisible tiny particles that harm the most remained at least two to three times higher than the permissible levels. But understand how killer smog builds up. December 31 was one of the better days with wind blowing and average PM10 particle levels in Mandir Marg, Punjabi Bagh and R K Puram was close to the seasons’ average trend of close to two times the standard. But by January 5 it surged to the dizzy height of 958 microgramme per cubic metre (µg/m³)—a five time increase within five days and nine times higher than the standard. Even PM2.5 particle level was nine times the standard (see graphs).

Scientists tell us that these suspended particles that measure between 10 micrometre in diameter (PM10) down to 2.5 micrometre (PM2.5) are about 1/10th the thickness of a human hair or just invisible. Even our nose and throat cannot trap and excrete them. They carry toxic chemicals, metals into our airways, lower lungs and stay there for years. The tinier ones from vehicle tailpipes and other combustion sources can go directly to our blood stream and spread all over our body. The reason why WHO also says there is no safe level below which symptoms go away. WHO says that the 24 hour average level of PM2.5 must not exceed 25 µg/m³ as against the lax Indian standards that allow 60 µg/m³ (for PM10 WHO recommends 50 µg/m³ as against 100 in our standard). Thus the current levels of both PM 10 and PM2.5 in Delhi are 36-38 times higher than what WHO considers acceptable.

How much more evidence needed?

Since 2000, at least one study a year has been published in Delhi to give clinching evidence of smog's toxic risk. Many of these studies have been carried out by doctors—from All India Institute of Medical Sciences, Vallabhbhai Patel Chest Institute, St Stephens Hospital and others (see 'Every breath you take'). Over the years they have widely reported prevalence of chronic respiratory symptoms; increase in emergency room visits during winter for asthma, chronic obstructive long disease, and acute coronary event; the increase is  by 21.3 per cent, 24.9 per cent, and 24.3 per cent respectively. The reports also show the genotoxic effect of vehicular fumes; vitamin D deficiency among Delhi children in polluted localities which increases risk of developing rickets; significant increase in eye symptoms and disorder in polluted areas; policemen showing high benzene exposure; and particulate combined with other pollutants like nitrogen oxide leading to very high incidence of respiratory disorders.

Most extensive scary evidences have come from the epidemiological study on children in Delhi carried out by CPCB and Chittaranjan National Cancer Institute in Kolkata and published in 2012. This study had covered 11,628 school-going children from 36 schools in different parts of Delhi and in different seasons.  Every third child has reduced lung function. There is a marked increase in number of bio markers like alveolar macrophages (the first line of cellular defense against inhaled pollutants) in sputum of children that shows greater exposure to particulate pollution. Sputum of Delhi’s children contains four times more iron-laden macrophages than those from cleaner environs, indicating pulmonary hemorrhage.  They have found the level of these bio markers in children higher in areas with high PM10 levels.

Delhi’s children also have nearly two times more upper respiratory symptoms (sinusitis, running or stuffy nose, sneezing, sore throat and common cold with fever) and  two times more lower respiratory symptoms (frequent dry cough, cough, wheezing breath, breathlessness on exertion, chest pain) and they suffer more during winter.

Significantly, in 2013 scientists from Jawaharlal Nehru University who had earlier reported decline in the level of toxins like polycyclic aromatic hydrocarbons (PAH) after the introduction of CNG programme and replacement of diesel buses now say based on their new evidences that its levels have gone up again due to rising number of vehicles. They conclude that a maximum of 39,780 excess cancer cases might occur due to lifetime inhalation and exposure to the PAH concentrations. AIIMS doctors have already reported this winter that cardiac and respiratory disease has already increased by about a quarter. More evidences from studies of University of California, Berkeley, in Delhi, show PM2.5 concentrations inside vehicles while travelling can be 1.5 times higher than the surrounding background air and ultra-fine levels about 8.5 times higher. The exposure to vehicular fumes in Delhi is among highest in the world.

The World Allergy Organisation (WAO) Journal also published in 2013 reported high respiratory disorder symptoms in students residing in Chandni Chowk (66 per cent) in north Delhi, Mayapuri (59 per cent) in west Delhi and Sarojini Nagar (46 per cent) in south Delhi. Heavy traffic movement has been found to be the factor in the relative difference among the localities. WAO also alerts that allergic problems will increase further as air pollution increases.

How much more evidences do we want our children, elderly and all of us who are already vulnerable to generate to get our governments to acknowledge the seriousness of this risk and act on it? Local evidences in Delhi are only reconfirming what the world already knows from large-scale studies across global cities that have already proven not only respiratory and cardiac impacts of air pollution but also a range of other health outcomes, including diabetes, low birth weight, cancer, and effect on foetus.

No one issues public health alerts
 
No one alerts us when smog episodes occur. Even though Delhi has made the exemplary move to generate real time online air quality data to relay change in air quality by the minute, it is not used to issue public health alerts and advisory to people to make them aware of the daily dose of poison, take precaution, and kick in pollution emergency measures. Delhi is still dragging its feet in announcing air quality index and public health advisory that are needed to inform and help people protect themselves from the severity of pollution and harmful effects.

The city cannot continue to perpetrate this silence that allows killer pollution to sap life. But our governments remain hesitant as they fear public and political backlash from such measures. But public information and awareness on daily air quality will only help governments to build support for aggressive action that otherwise faces public disdain.

Take pollution emergency measures

In many global cities, the pollution level as recorded in Delhi on January 5 would have led to pollution emergency. During high pollution episodes, Paris authorities recommend drivers to postpone trips to Paris; or bypass Paris city; use public transport; organize car-pooling; minimize combustion of high sulphur fuels in industry; curtail industrial operations and so on.  In fact, this year Paris government has also asked people to refrain from using diesel vehicles that are not fitted with particulate trap.

In Mexico, phase one pollution alert requires cutting down of 30-40 per cent of industrial pollution; halting of 50 per cent of government of vehicles; stopping of most polluting vehicles; alternative fuel vehicles are exempted from restrictions. In phase 2 alert, schools are closed; one day a week ban on vehicles are extended to two days etc. Phase 3 alert leads to closing down of industry in addition to the other curtailment.

Even Chinese cities have adopted air quality index and health alert system to inform and warn people about the severity of daily pollution and the need for precaution. This year, the smog in Chinese cities have also been notorious and led to closing of some of the large cities in the northeastern provinces like the Harbin the capital of Heilongjiang province and forced schools to suspend classes. Moreover, the local governments in China are now liable to pay a fine if air pollution levels hit critical rank. Local governments in eight cities in northeast China’s Liaoning province have been fined of US dollars 8.9 million.

Out of desperation Chinese cities are now clamping down to control vehicle numbers. In Beijing the government has proposed banning half of private cars on roads based on odd and even license plate numbers if the red alert on pollution persists for three or four days. For longer term effect, Beijing government which has already fixed the number of cars that can be sold in one year in the city to 240,000, will now issue only 150,000 new licenses annually instead to further lower the sale of cars.

Act now

Pollution hurts not only the health of our people but also our economy. The World Bank’s Diagnostic Assessment of Select Environmental Challenges in India released in 2013 has shown that the cost of particle pollution related health damage already amounts to 1 per cent of India's GDP. In the past, high pollution levels have led to flight of industry and capital from Hong Kong. This year smog is reported to have affected tourism in Chinese cities. Read these signs on the wall and the restive discontent among the citizens of Delhi who are aware and know.

The mandate is clear. Delhi will have to fulfill the 12th Five Year plan target of meeting the ambient air quality standards by the end of the plan period. This will require time-bound action plan for each source of pollution, especially vehicles that emit toxic fumes in our breathing zone. Agencies will have to be made accountable for meeting these targets. We cannot fail in this. At this rate, every winter will turn back the pollution clock. Every year, asthma and other respiratory diseases will only increase. Policy inaction will be nothing less than genocide.

Glimpse of smog peaks in winter of 2013-14 in Delhi

PM2.5: 24 hour average of Punjabi Bagh, Mandir Marg and R K Puram stations  (Nov 13 - Jan 14)

PM10: 24 hour average of Punjabi Bagh, Mandir Marg and R K Puram stations  (Nov 13 - Jan 14)