Delhi pollution: Act now, else we will all choke to death

The potential for serious health consequences of persistent exposure to high levels of ambient air pollution was made clear in the mid-20th century, when cities in Europe and the United States experienced episodes of air pollution in its most sinister form, the infamous London Fog of 1952 and Donora Smog of 1948, Pennsylvania.

These resulted in large numbers of excess deaths and hospital admissions. The day is not far when Delhiites will experience something similar if air legislation and other regulatory actions are not taken in time to reduce ambient air pollution in and around the National Capital Region (NCR).

The air pollution in Delhi has been worsening year after year. This winter, pollution has reached the worst levels, making Delhi air unfit for human habitation. For the last one month, Delhiites have been gasping for breath, coughing relentlessly. Pneumonia cases are there in dozens and the emergency departments of all hospitals have been flooded with patients with respiratory ailments. The sale of antibiotics, nebulisers and other respiratory medicines has risen several folds.

In order to truly understand the scale of air pollution that we are facing today, it is imperative that we understand the unit used to measure air pollution so that we can assess the severity of the situation in its true perspective.  The level of air pollution is measured in terms of Particulate Matter (PM), a component that has been consistently linked with serious ill effects on health.

Particulate Matter is the general term used for a mixture of solid particles and liquid droplets in the air including aerosols, smoke, fumes, dust, ash and pollen. Exposure to PM has been associated with a wide range of effects on health.  Amongst these particulate matter, PM 2.5 and PM 10 are the most dangerous small particles and the best indicators of the level of health risks from air pollution.

According to the Central Pollution Control Board (CPCB) November 2015 press release - Monitoring of Ambient Air & Noise Monitoring – average PM 2.5 and PM 10 levels have been noted to be five to six times higher than the World Health Organisation (WHO) defined highest permissible levels for healthy air. The levels have been increasing steadily with a nearly 0.6 – 1.1 per cent increase over the values measured last year. Additionally, carbon monoxide (CO), another poisonous and injurious substance, which is responsible for worsening of heart diseases, has been noted to be three times the permitted level.

These poisonous substances get trapped under the layer of fog, leading to alarmingly high levels. It’s like we are all living and breathing in a gas chamber. This is causing throat problems, nasal allergies, breathing difficulty and a multitude of other ailments. The doctors are observing an epidemic rise in patients presenting with nasal allergies, which is due to exposure to high levels of smoke.

Viral fever cases
Patients with asthma are experiencing significant aggravation of their symptoms while those who never had asthma are beginning to experience asthma like symptoms such as wheezing and breathlessness. There is a sharp rise in incidence of viral fever – a direct effect of smoke-induced inflammation of the lining of our wind pipe which makes us vulnerable to all kind of viral and bacterial infections.

Based on the Global Health Disease Burden report published in 2010, air pollution is the fifth leading cause of death in India amounting to 6,20,000 premature deaths in 2010 which is a six-fold increase (1,00,000 in 2000).

Further, air pollution is the seventh leading cause behind loss of healthy years of life due to illnesses in India after indoor air pollution, tobacco smoking, high blood pressure, childhood underweight, low nutritional status, and alcohol use.

This constitutes a loss of 18 million healthy years from a developing nation that prides on its human resources. The most common reasons for air pollution-induced premature deaths are respiratory and cardiovascular diseases. This includes a wide spectrum from chronic diseases from chronic obstructive pulmonary diseases such as lung cancer, all of which are rising in great numbers every year.

The worst affected are the children (since they have very small airways and any swelling of airways causes a lot of obstruction to the passage of air) and elderly who have very little reserve to fight infections. The situation has reached to a level that very soon, people will be considering to leave the city of Delhi just on health grounds.

We all are working hard for better life, for better houses and for securing the future of our families so that they can enjoy a good life. However, it is ironic that none of us is bothered about leaving a “good” or “decent” air to breathe for our children.

“Can they enjoy a house without clean air?” While we can have our own power generator in every house, skilful arrangements for water supply (tube-well) in every house, there is no way to have “our own air supply”.

It is imperative for all to stand up right now and act together to save ourselves and our future generation. If we do not act now, we will all choke to death - of course slowly but definitely - in the world’s most polluted city of Delhi. The only way to have “clean air for us” is to “clean the air around us”!

(The writer, a leading robotic and thoracic surgeon, is Chairman, Centre for Chest Surgery and Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi)

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