Delhi Pollution Crisis Raises Alarm On Decreased Life Expectancy

The air pollution levels in Delhi and the NCR area went off the charts on Sunday, with most ratings reading 999 in most areas because the rating couldn’t go beyond that. A couple of days ago, on Friday last week, a Supreme Court-mandated panel finally declared a public health emergency in the Delhi-NCR region due to the pollution levels reaching severe levels. Construction activity is now banned till November 5 to keep pollution levels down. Schools have been declared shut. But this declaration comes long after the pollution levels in the NCR region have crossed the severe plus category and with stubble burning of the crops in the neighbouring states continuing, this is only likely to intensify.

EPCA chairperson Bhure Lal said in a letter to the chief secretaries of Uttar Pradesh, Haryana and Delhi, “We have to take this as a public health emergency as air pollution will have adverse health impact on all, particularly our children.”

While the ill effects of pollution on the health of children is well known, new research has declared that living in North India itself could reduce life expectancy by as much as seven years due to pollution.

The Air Quality Life Index (AQLI), produced by the Energy Policy Institute at the University of Chicago (EPIC), states that pollution in the region has increased by a whopping 72 percent from 1998 to 2016. This region is the most populous in the country, with over 40 percent of India’s population-based here. The statistic for reduced life expectancy due to polluted air in 1998 was 3.7 years, which itself was higher than the global average. According to the report, back in 1998 those living outside the Indo Gangetic Plain region lost 1.2 years of their life expectancy compared with what their lives would have been like if air quality was in keeping with the WHO guidelines. This rose to 2.6 years in 2016 for non-IGP residents. For citizens living in the Indo Gangetic plain region, the figure is now at seven years of reduced life expectancy.

Add to this, the socio-economic factor that also affects reduced life expectancy especially in the urban-rural divide, given access to minimal or suboptimal health care in rural areas. To quote from the report, Socioeconomic inequality in life expectancy in India released in April 2019, “The greater access to healthcare and better nutrition found in urban settings begins to outweigh the higher potential risk of catching infectious diseases in these more densely populated environments tilting childhood mortality rates in favour of urban populations.”

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A study titled, “The impact of air pollution on deaths, disease burden and life expectancy across the states of India: the Global Burden of Disease Study 2017” released by The Lancet in 2019 states, “Our findings highlight that 77 percent of India's population was exposed to an annual population-weighted mean PM2·5 greater than 40 μg/m3 in 2017, which is the level recommended by the National Ambient Air Quality Standards in India, and none of the Indian states met the WHO-recommended criteria of ambient particulate matter air quality of less than 10 μg/m3. Even with substantial increasing provision of clean cooking fuels in India, more than half of India's population was exposed to household air pollution from solid cooking fuels in 2017. We report that one out of every eight deaths in India in 2017 could be attributed to air pollution.”

This same study also concluded, “Among the low SDI states, the point estimate of the number of deaths attributable to ambient particulate matter pollution was two times higher than that of household air pollution in Uttar Pradesh and 1·4 times higher in Bihar, although with wide uncertainty ranges, consistent with the very high exposure to ambient particulate matter pollution in these states.”

Says Dharmesh Shah, Plastic Policy Advisor with Global Alliance for Incinerator Alternatives (GAIA), “This is not alarming to see. We always knew that air pollution is deadly, this study just gives us a good metric to help relate to the issue. From an evolutionary point of view and logically, we should just stop doing things that are killing us. Put simply, if fire crackers are killing us we ought to stop bursting them. However, economics doesn't allow us to apply such logic so we seek "sustainable solutions", that can allow us to party as usual without giving a hangover. I am not sure if real solutions are possible under such circumstances.”

Dr Mitali Agarwal, Attending Consultant Max Hospital, MD Pulmonary Medicine advises all residents to keep these factors in mind when buying respirator masks. "Use N-95 respirators  with or without valve. The ones with valve are more comfortable but more expensive. The mask should be fitted tightly with proper air seal, for it to be effective. Say no to surgical masks."

Says Tamseel Hussain of LetMeBreathe.in, "It’s mainly around the common people being more aware, moving beyond English to Hindi engagement with examples of how people are using air quality data now during the Delhi pollution."

From an evolutionary point of view and logically, we should just stop doing things that are killing us. Put simply, if fire crackers are killing us we ought to stop bursting them. - Dharmesh Shah

To quote from news reports about the release of the Air Quality Life Index (AQLI), produced by the Energy Policy Institute at the University of Chicago (EPIC) last week, Dr Arvind Kumar, chest surgeon from Sir Ganga Ram Hospital, spoke about how severe pollution is impacting residents of Delhi. “It’s a public health emergency in Delhi. Half a decade of concentrated focus on air pollution with zero results. I am seeing 28-year-old non-smokers with stage four lung cancer. It’s a very painful experience for me. I am very angry because I am losing young patients to air pollution.”

He presented images of the lungs of a 14-year-old with black pollution-induced spots. He shared that when he had joined AIIMS back in 1988, 90 percent of the lung cancer cases were those of chronic smokers but now that statistic has changed to 50 percent nonsmokers. He stated, “Air pollution is a group one carcinogen. The content of polluted air is similar to cigarette smoke.”

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We all know already that even breathing the air in our cities is now equivalent to smoking at least 20 cigarettes per day as previous research has shown. In cities like Delhi or the extended NCR, this number must be much higher.

According to research done by EPIC earlier, Delhi residents would be able to extend their life expectancy by 3.35 years if the National Clean Air Programme had been implemented given it had the target to reduce PM 2.5 by up to 30 percent by 2024. These targets though, seem a long way off now, seeing currently AQI levels.

The past week saw a surge in the patients visiting hospitals in the NCR region with complaints of respiratory and breathing complications. Doctors are now taking to writing “Stay Indoors” on prescriptions, and also “Avoid morning walks.” The most susceptible to pollution-related ailments are the children and the elderly with pollution hitting the severe-plus level in the post-Diwali week.

Common complaints are watering of the eyes, persistent and chronic cough, increase in number and intensity of asthma attacks, allergies, difficulties in breathing and chronic obstructive pulmonary ailments. The pollution can also result in the hardening of the arteries, due to inflammation and thus trigger a stroke or a heart attack in those already predisposed towards these ailments.

What, then, is the Air Quality Life Index (AQLI)?

It converts the level of air pollution concentrations into their impact of life expectancy for residents of certain pollution affected areas. The purpose of the AQLI is to allow policy makers to put into place regulatory mechanisms to improve the air quality in their countries, to impact longevity in a positive manner.

To quote Michael Greenstone of EPIC, Milton Friedman Professor in Economics, University of Chicago, “By converting air pollution concentrations into tangible terms—its impact on life expectancy—the AQLI establishes particulate air pollution as the single greatest threat to human health globally. Particulate air pollution shortens lives globally, even more than cigarettes. There is no greater current risk to human health.”

The past week saw a surge in the patients visiting hospitals in the NCR region with complaints of respiratory and breathing complications. Doctors are now taking to writing “Stay Indoors” on prescriptions, and also “Avoid morning walks.”

To quote from the report, “Some areas of the world are impacted more than others. For example, in the United States, where there is less pollution, life expectancy is cut short by just 0.1 years relative to the WHO guideline. In China and India, where there are much greater levels of pollution, bringing particulate concentrations down to the WHO guideline would increase average life expectancy by 2.9 and 4.3 years, respectively.”

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Why is Particulate Air Pollution so detrimental to life expectancy?

Particulate Air Pollution is soot, dust, smoke and emissions from vehicles, industries, construction, etc that are suspended in the air and enter the body when a person breathes. The particles, once breathed in, travel into the body and the internal organs, depending upon how fine they are. Particles which have their diameters smaller than 10 micrometers, called PM10, don't get filtered out by nose hair and travel through the windpipe into the lungs, where they cause damage to the lungs and increase the risk of lung diseases like chronic obstructive pulmonary disorder, bronchiectasis, cystic lung disease, and even cancer. Smaller particles, PM 2.5, namely the particles which have a diameter of less than 2.5 micrometers are so tiny that they can pass into the alveoli of the lungs which exchanges oxygen for carbon dioxide. When these particles hit the bloodstream after passing through the membranes of the alveoli, they can cause trouble by inflaming or constricting the blood vessels, dislodging plaque, creating clots, increasing the blood pressure which in turn could lead to strokes or heart attacks. These particles can also cause a decline in brain function by making the brain age faster, damaging the white matter in the brain, which in turn causes cognitive decline and illnesses like Alzheimer’s.

To quote from the AQLI report, “If all areas not in compliance with the WHO PM2.5 guideline in 2016 were to permanently reduce their particulate pollution levels to meet the guideline, then, globally:

• 288 million people, all in northern India would live at least 7 years longer on average. These people represent 23 percent of India’s current population.
• 347 million people in Asia would live 5-7 years longer on average. These include 35 percent of Nepal’s population, 16 percent of Bangladeshis, 13 percent of Chinese, 10 percent of Pakistanis, 9 percent of Indians, and 1 percent of Indonesians.
• 937 million people in Asia and Africa would live 3-5 years longer on average. These include 76 percent of Bangladeshis, 46 percent of Nepalis, 29 percent of the population of the Republic of Congo, 29 percent of Chinese, 29 percent of Pakistanis, 24 percent of Indians, and others in Southeast Asia and Africa.
• An additional 4.1 billion people around the world would live up to 3 years longer, with an average gain of 1.1 years.

In fact, India and China, which make up 36 percent of the world population, account for 73 percent of all years of life lost due to particulate pollution. On average, people in India would live 4.3 years longer if their country met the WHO guideline. Since life expectancy at birth is currently 69 years in India, this suggests that reducing particulate pollution to the WHO guideline throughout the country would raise the average life expectancy to 73.”

According to Shweta Narayan, Co-ordinator, Healthy Energy Initiative – India “In my opinion, the only solution is to stop pollution be it the power plants or the polluting industries or phasing our diesel vehicles. Reports like the one you have mentioned below are just a grim reminder of the implications of pollution on human health. It’s not the first time that such a report or number has been talked about and yet our policymakers have paid no heed to the alarming statistics. Unfortunately, we live in a system that often prefers tangible valuation (economics) over intangible factors like good health. That would mean we need to measure the harm in terms of economics/ cost/ money that air pollution is causing and then perhaps the policymakers will listen.”

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