This is an excerpt from Choked by Pallavi Aiyar. It is exclusively available on the Juggernaut app.
In India, 627,000 premature deaths are attributable to ambient, or outdoor, PM2.5 exposure. (When household or indoor pollution caused by the incomplete burning of biomass cakes like cow dung, used for cooking in poor homes, is added to this figure it rises to 1.6 million.) That the air in Delhi and many other Indian cities makes you sick is increasingly undeniable. There are numerous city-specific and national studies that establish associations between pollution and respiratory infections in infants, low birth weight, chronic lung illnesses and cancers in adults, heart disease and strokes. One important 2010 study by Dr Sarath Guttikunda, possibly India's leading expert on air pollution, found that PM2.5 was linked to between 7350 and 16,200 premature deaths (and a staggering six million asthma attacks) per year in just the city of Delhi.
It is sometimes claimed that living in polluted megalopolises like Beijing or Delhi is the equivalent to smoking a couple of packs of cigarettes a day. The science behind these claims is debatable. Regardless, many of the diseases associated with air pollution are similar to those linked to smoking. And although an active smoker is at a greater health risk than a non-smoker exposed to pollution, far more people, including young children and even babies, breathe dirty air than smoke. Household air pollution, wherein women cooking over gobar chulhas in badly ventilated rooms inhale huge quantities of toxic fumes, comes out ahead of smoking as a factor contributing to the national burden of disease in India, while ambient air pollution is not far behind.
While researching this book I spoke to a range of experts working in the area of public health. One of them was Dr Bhargav Krishna, a research fellow at the Public Health Foundation of India. It was often difficult to follow his explanations. His language was jargon-heavy and he constantly referred to 'dose-response relationship models' and 'systemic inflammatory markers'. He told me the 'pathophysiology of ozone and cardio vascular mortality' wasn't quite established.
But he was crystal clear when I asked him straight up for advice on whether I should move to Delhi, given that I had two young boys. (As mentioned in the introduction, this is a move I have been contemplating off and on since my first son, Ishaan, was born--so that my children could be closer to their grandparents.) 'No,' he said firmly. 'I would not choose to bring children to this city.' He also revealed that he had developed bronchitis himself for the last two winters running.
Dr Krishna was not alone in his suffering. I have spoken with Delhi-based activists, clean air equipment entrepreneurs, policy wonks and doctors. The majority shared respiratory symptoms that they attribute to air pollution.
The most frightening data relates to children, for it shows that no matter how hard parents work to ensure the best schooling and nutrition for their kids, the most-taken-for-granted element, air, remains poisonous.
Exactly how much of a health hazard air pollution is depends on a number of variables, including length of exposure (long-term residents are obviously at greater risk than visitors) and age. The elderly and the young are disproportionately vulnerable. The most frightening data relates to children, for it shows that no matter how hard parents work to ensure the best schooling and nutrition for their kids, the most-taken-for-granted element, air, remains poisonous.
Children's respiratory defences have not reached their full capability. They also breathe in more air per kilo of body weight than adults, so they take in more toxins per kilo of body weight than adults do. Moreover, children generally exercise outdoors more than adults do.
One 2015 survey conducted by the HEAL Foundation and Breathe Blue found that four out of every ten children in the Indian capital suffer from serious lung problems. In another 2013 study, the World Allergy Organization Journal reported serious respiratory disorder symptoms among students living in certain high-density neighbourhoods in Delhi. Sixty-six per cent of students observed in Chandni Chowk, 59 per cent in Mayapuri, and 46 per cent in Sarojini Nagar reported problematic symptoms. The 2010 Dr Guttikunda study blamed Delhi's air for 391,500 annual cases of acute bronchitis in children.
Among the more disturbing studies I came across was one conducted by the Chittaranjan National Cancer Institute (CNCI), one of India's top cancer institutes. It tracked 11,000 Delhi schoolchildren aged four to seventeen, drawn from thirty-six schools, for three years. The results were unequivocal: kids in Delhi scored significantly worse (two to four times as badly) on key indicators of respiratory health and lung function, compared to control groups in other Indian cities in Uttaranchal and West Bengal.
Almost 44 per cent of schoolchildren in Delhi had reduced lung function compared to 25.7 per cent in the other cities studied. Delhi kids were also 1.8 times more likely to suffer from upper respiratory symptoms like sinusitis and common colds, and twice as likely to suffer from lower respiratory tract indications like a sputum-producing cough, wheezing and chest pain. Two times as many kids in Delhi were asthmatic than in the control group.
Asthmatic children can struggle to take in air when doing simple tasks like climbing up stairs. Schoolyard games of tag and hopscotch turn into traumatic episodes leaving the child gasping and frightened. Sleeping can be difficult. During an attack it can feel akin to drowning. No wonder that respiratory disorders negatively affect childhood not only physically, but also emotionally, often leaving afflicted children feeling like outsiders to everyday life.
An investigation by the Indian Express newspaper showed how the CNCI study had languished with the Central Pollution Control Board (CPCB), the very bureaucracy that had commissioned it, for years.
An investigation by the Indian Express newspaper showed how the CNCI study had languished with the Central Pollution Control Board (CPCB), the very bureaucracy that had commissioned it, for years. The study's findings had not been properly publicized, nor had any of the remedial actions listed in it been implemented. It was scandalous. Or perhaps more accurately, the fact that such a phenomenon is routine in In
I also discovered that much of Delhi's particulate matter comprises toxic chemicals and metals. Road dust, what we refer to as dhool mitti, is actually a deadly mix of soil, dust, tailpipe emissions from vehicles, bits of tyres and other car components, as well as gases released from wood, coal and waste burning along the side of the roads. In 2013, a Birmingham University researcher studied the composition of road dust along Mathura Road, the avenue that runs right by the neighbourhood I had grown up in. She found barium, lead, cadmium and polycyclic aromatic hydrocarbons. These are all carcinogenic compounds, linked to cancers including those of the kidney, brain, lungs, skin, liver and stomach.
Studies focused specifically on gases rather than particulate matter are few. However, the Delhi Pollution Control Committee (DPCC) has monitored benzene levels in Delhi and found that the daily average of benzene can vary between 35 μg/m3 and 60 μg/m3. We know that even in small trace amounts benzene, a base of unleaded petrol, can cause cancer and birth defects and damage the immune system.
All of this reads like a horror story and yet the majority of those in India's National Capital region, a territory inhabited by twenty-five million people, continue to be sanguine. Most peculiar of all, I thought, is the attitude of the medical community. Doctors routinely prescribe steroids for patients with respiratory symptoms and yet rarely talk about practical ways to mitigate the worst effects of the air.
Pollution tends to be viewed by them as a 'non-modifiable' factor, as a fact of life that not much can be done about.
Dr Bhargav Krishna told me of a survey he had been involved in that examined the mindset of health practitioners towards air pollution. The findings showed that despite the causal linkages between dirty air and a smorgasbord of health problems, doctors in India rarely brought up pollution when advising patients clearly suffering from its effects. The reason, he explained, is that pollution tends to be viewed by them as a 'non-modifiable' factor, as a fact of life that not much can be done about. In extreme cases, some doctors recommend that patients with young children move out of the city. But more commonly, air pollution is simply not discussed in doctor–patient settings.