It's a public health emergency, new approach needed

The approaching winter brings with it renewed discussion on the harmful effects of air pollution at dinner tables and in television studios. It also brings with it a spate of new reports on the health impacts of air pollution. The most recent of them, the Lancet Commission on Pollution and Health, said India saw the highest number of premature deaths due to pollution in the world in 2015. Almost as if on cue, a series of rebuttals are published each year, with the government challenging the validity of these estimates and the data. Regardless of the decimal point accuracy of the data, however, it is irrefutable that addressing exposure to air pollution is imperative to improving the health of Indians.

India has had a problem with air pollution and health for a long time. While it was earlier mostly household pollution due to burning of solid fuels indoors for cooking and heating,  economic growth in the last 30 years has brought with it a polluted ambient environment as well, with large increases in emissions from vehicles, industries, brick kilns, etc. In the period 2000 to 2010 alone, while the use of solid fuel for cooking declined, ambient PM-2.5 exposure increased by about 15 µg/m3 with several hotspots identified across the country. While this may be commensurate with increased industrial activity and economic growth, it is startling that just the increase in exposure alone is greater than the World Health Organisation’s prescribed maximum limit for annual exposure (10 µg/m3).

In the last four decades, India has put in place several pieces of legislation and has initiated programmes to address both household and ambient air pollution. This has been bolstered by timely interventions from citizen’s groups, aided by the Supreme Court and National Green Tribunal, as in the case of Delhi-NCR. What the data tells us, however, is that policies till date have not been effective in reducing pollution, nor in addressing the health burden effectively. While more recent actions such as the advancing of Bharat 6 standards for fuels and engines, and the Pradhan Mantri Ujjwala Yojana (PMUY) are great steps, there is need for a radical re-think of the approach to addressing air pollution and its impact on health. Our analysis of the data for 2016 shows that the need to look beyond Delhi-NCR is greater than ever, with several new hotspots emerging in the mining belt (Jharkhand, Chhattisgarh, West Bengal), and ambient PM-2.5 rising rapidly in tier 2 and 3 cities.

One such approach was outlined in the 2015 report of the Union health ministry's Steering Committee on Air Pollution. The committee comprised experts from public health, environmental sciences, energy, economics, public policy, and representatives from several line ministries, reflecting the multi-sectoral nature of the problem and solutions required. The report documented the wealth of evidence already published in India on the health impacts of air pollution. Its primary recommendation centered on taking a new approach to air pollution focused not on ambient air quality management, but rather on exposure reduction. This acknowledged that the sources that people are most exposed to and are closest to contribute the greatest to exposure and need to be tackled on priority (for example, cooking stove emissions, vehicular emissions, waste burning).

With this approach, the committee outlined actions to reduce people's exposure, with some of these recommendations reflecting in subsequent government initiatives, such as the Pradhan Mantri Ujjwala Yojana (PMUY). The committee also emphasised the need for regional cooperation given the linked airshed of the Indo-Gangetic plain, and the development of time-bound action plans across the country with a roadmap to achieve the national ambient air quality standards.

Till date, the recently notified plan for Delhi-NCR is the only such plan that recognises the need for time-bound action across a multitude of sources. If India is to stem the tide of this public health emergency, however, this health-centered approach will need to be replicated across the country, with efficiency and accountability as its guiding values. Until that time, the health burden will continue to grow.

(The writer manages the Centre for Environmental Health, Public Health Foundation of India, and is co-founder, Care for Air).