Air quality: India's poor response to pollution could fuel social epidemic

If the country doesn't pull up its socks now, deaths due to pollution could touch 3.6 mn a year by 2050 -- and the poor will be the biggest sufferers

Delhi’s worsening air quality is making the headlines again. But now it is a well-known fact that pollution has become intrinsic not just to Delhi, but to most cities in India. This is evident from the fact that our children are increasingly battling cough-induced infections, while bronchitis and lung disorders are taking a toll on adults more frequently than before.

Earlier this week, President Ramnath Kovind indicated that social troubles will become exacerbated if pollution remains unchecked. “If a child suffers from asthma due to air pollution, I would consider that [as] a gap in providing social justice,” he said in his Constitution Day address.

India's poor to bear the brunt

The injustice he mentions is in the making, with the poor, who aren't able to spend as much on medical care as the affluent, suffering much more from air pollution-induced diseases than their well-to-do counterparts. 

But how exactly does this injustice manifest itself? In death, at worst; in healthy years of life lost to disabilities, at best. And while heart ailments or cancer largely affect the adult population, pollution-induced diseases affect infants and children in more or less equal measure. 

Stubble burning: Not the biggest culprit

Let us look at some data that seems to confirm this. About 1.1 million people in India died in 2015 exclusively because of diseases with roots in particulate matter pollution, a collaborative research published earlier this year has shown. Most of these deaths—hold your breath—were caused due to residential biomass burning and not from farm residue burning or vehicular pollution.

In addition, infants (less than a year of age) occupy a five per cent share in such deaths, higher than that of school-going children and youngsters, census data for the same year has shown.

Further, in the past few decades, air pollution has become the second leading cause of losing healthy years of life among Indians, malnutrition among mothers and children being the biggest disabler.

The data suggests that air pollution is increasingly getting close to becoming the biggest contributor to a set of diseases associated with changing urban lifestyle, affecting infants and geriatrics alike.

A social epidemic in the making

Annual deaths due to pollution could treble in 35 years, to about 3.6 million deaths by 2050, if timely action isn't taken, warns the study titled 'Global Burden of Disease from Major Air Pollution Sources', by Health Effects Institute, IIT Bombay and Institute for Health Metrics and Evaluation, USA (HEI report).

The study finds that residential biomass burning was the biggest killer, causing a fourth of pollution deaths—about 270,000 of 1.1 million. Vehicular pollution and farm residue burning, which are often cited as culprits, account for less about 10 per cent of deaths, at about 107,000 in 2015. Including the three, six major sources account for two-thirds of total air pollution related fatalities in India.

But the scenario is likely to change in 2050, if we do not act now. power plants and dust from construction and other activities could go on to become the biggest killers three decades later, at 830,000 and 743,000, respectively.

But disease-related death is more in the face, healthy life years lost to disabilities (disability-adjusted life years, or DALYs) have not been given as much recognition, even though they reduce life span significantly. Loss of one million DALYs effectively means that one million people lose one healthy year of their life.

While the six major sources accounted for 17.7 million DALYs in 2015, they could account for 56 million DALYs, if action is not taken. Of these, about 32 million DALYs could be due to coal-based power plants and dust, the study noted.

Children, seniors at great risk 

What makes this more severe, is that the deaths and DALYs due to air pollution are relatively equally distributed among age groups. Census data on causes of death (2015) shows that the share of infants aged less than one form 5 per cent of deaths due to respiratory disorders. Air pollution disorders are a subset of these.

What is even more revealing is the fact that the share of both, those in the 5-14 and the 15-24 age groups is less than four per cent.

Senior citizens above 70 constitute about a third of such deaths.

The situation becomes more severe when we factor in the fact that air pollution has now become the second biggest reason for loss of healthy life, after malnutrition. This change is a part of the larger health phenomenon that India is undergoing: that of the epidemiological transition.

The shift from cholera to cancer
 

In simple terms, it means that the disease burden over the Indian population is shifting from communicable diseases such as cholera and other nutritional disease associated with poverty, to non-communicable disease such as heart issues, obesity and cancer, associated with lifestyle and conspicuous consumption, and lack of exercise.

The GBD report notes that DALYs due to air pollution have risen 24 per cent since 1990. Only a couple of other risks associated with the urban lifestyle have grown faster.

What's more, women are more prone to lose healthy life years due to air pollution than men. The latter are more prone to dietary risks than air pollution.