How air pollution increases India’s burden of disease

How air pollution increases India’s burden of disease
Indoor and outdoor air pollution made up more than 10% of the total burden of disease in 2016, second only to child and maternal malnutrition
I have just discovered, courtesy of the first such study conducted by the ministry of health and independent health agencies, that I live in the Indian region with the highest number of life years lost due to air pollution.

I’ll explain.

That Delhi’s air is among the foulest is well known—it’s close to being declared a hardship assignment for foreign diplomats. What is new is that we now have a much better idea of exactly what this is costing the residents of Delhi in terms of their health and general well-being.

It’s an internationally accepted measure called DALY, short for Disability Adjusted Life Years, and it is aimed at explaining what we see around ourselves every day—at work, on the street and at home. This measure gives you a good picture of the cost of a disease, or condition or environmental risk—not only in terms of death. One DALY, according the World Health Organization (WHO), is one full year of lost healthy living per 1,000 population (in India, per 100,000). It is a measure of the burden of disease carried by a nation, region or sub-region.

On 14 November, the health ministry published a report on the Health of the Nation’s States—a study of how the burden of disease has changed in Indian states from 1990 to 2016 (see page 18). The study is the outcome of research by the Institute for Health Metrics and Evaluation, a global health research institute at the University of Washington in Seattle; the Public Health Foundation of India, a premier public health institution in India with a presence across the country, and the Indian Council of Medical Research, the apex government body for the formulation, coordination and promotion of biomedical and health research.

This report defines DALY as “years of healthy life lost to premature death and suffering. DALYs are the sum of years of life lost and years lived with disability”.

The importance of this report cannot be over-emphasized. It is a landmark publication in disaggregated health data in India, a country that must make heroic efforts (including by massive increases in government spending) to improve the health of its people if it is to enjoy the full benefits of its slowing but still rapid economic growth.

Essentially, the report shows that India is faced with the double whammy of increases in the burden of both lifestyle and infectious diseases. The first is commonly associated with sedentary lifestyles brought about by greater wealth, the second a classic indicator of poverty. Not surprisingly, the first category is dominant in wealthier states and the latter, alongside malnutrition, in poorer states.

This, in other words, is India’s health gap.

However, cutting across both categories is air pollution. The report, correctly, makes a distinction between indoor and outdoor air pollution. Nationally, indoor air pollution, mainly the result of cooking with fossil fuels such as coal and wood, has come down markedly since 1990, but outdoor air pollution has increased.

The really worrying part? Taken together, indoor and outdoor air pollution made up more than 10% of the total burden of disease in 2016, second only to child and maternal malnutrition. The main risks from air pollution are cardiovascular and respiratory diseases—to which it makes a “substantial contribution”.

Broken down, the risk from air pollution was higher in the poorest states—these are eight so-called Empowered Action Group (EAG) states that receive special development effort attention from the government of India, namely Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh. This means the poor as ever will be disproportionately impacted by air pollution, unlike those who are able to afford air purifiers and good quality pollution masks, while benefiting from the protected environment of sealed and confined spaces such as cars and offices.

“The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest. On the other hand, the burden due to outdoor air pollution is the highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal,” the report says.

The report says risks from outdoor air pollution increased due to a variety of pollutants from five sources—power production, industry, vehicles, construction and waste burning. As advocates of green development will point out, these are all outcomes of a path of development that ignores environment-friendly solutions.

What does the report recommend? Air pollution, it says, can be effectively dealt with “only if the efforts of the ministry of environment, forest and climate change, ministry of power, ministry of new and renewable energy, ministry of road transport and highways, ministry of housing and urban affairs, ministry of health and family welfare, and a variety of non-governmental partners come together.”

What the report does not mention is that there must be political will too—for political parties and governments ruled by them to firstly acknowledge the scale of this health emergency and then work together, sinking differences for the greater good.

What’s been the policy response so far? One of jaw-dropping inefficiency and political bickering. In Delhi, air pollution is seasonal: with the onset of the winter, two things happen. On the one hand, paddy farmers in neighbouring Punjab, Haryana and Uttar Pradesh, having harvested the rice, start burning the leftover stubble in order to prepare the farms for winter sowing. At the same time, as climate scientist Krishna Achuta Rao writes in a recent article, “Like Los Angeles and Mexico City, Delhiites are cursed by geography to be prone to a meteorological phenomenon called inversion where warm air rests above the colder air closer to the ground, preventing it from mixing upwards, thereby trapping all that we put into it—almost like a lid.”

This is an annual affair, but the policy response has been marked by a complete lack of preparedness, and charges traded between the governments of Delhi, Punjab and Haryana that are ruled by three rival political parties, the Aam Aadmi Party, the Congress and the Bharatiya Janata Party, respectively. There are no signs that these governments are even prepared to work together, in contrast to the consensus (albeit not without its difficulties) that marks efforts to execute a single goods and services tax for the country.

Neither, surprisingly, has there been any firm signal from the Union government that there’s an emergency that needs to be dealt with.

Delhiites are a beleaguered lot and a degree of resignation characterizes the popular response to this health crisis. “What’s the point of purifiers; we still need to step outside,” is something you hear commonly. Yet, pollution masks are now far more ubiquitous than they were a year ago.

The day the report was launched, 14 November, is celebrated as Children’s Day in India, which knows from bitter experience that environmental pollution can impact generations. For those looking to get away, I can offer you a quick data-based solution from the report cited above: the states with the lowest levels of DALY rates due to risks from air pollution (unfortunately, not disambiguated between indoor and outdoor) in 2016 were: Nagaland (1,409), Arunachal Pradesh (1,436), Goa (1,482) and Kerala (1,698). The national mean is an eye watering 3,469.