Air pollution causing irreversible damage to India’s urban children

If China wants to avoid the long-term health impacts of air pollution, it should heed the warning signs from India

Last November, an eight-year-old girl in China’s Jiangsu province made international headlines when Chinese media reported that she was the youngest in the country to be diagnosed with lung cancer. The girl lived near a busy street and had been inhaling dirty air. Air pollution was largely to blame, the doctor treating her said. As the media glare heightened, the hospital played down that report. In an e-mail sent to China Daily, it said the “cause for the girl’s lung cancer could not be determined, as cancer’s cause is complicated.”

The controversy is a telling illustration of the daunting challenges facing Asia’s emerging powers as they wrestle with the health impacts of environmental pollution. Both China and India have won plaudits worldwide for their rapid economic growth. Now, there is mounting attention on some of the costs of that growth. While China’s dirty air and contaminated water have been in the media spotlight for quite some time, the situation in India has received less attention, but it is also cause for grave concern.

A growing body of research suggests that air and water pollution in India, a country of over a billion people, have severe public health consequences. Although pollution affects the population in general, children are more vulnerable to its toxic effects. Diarrhoea and respiratory infections are the number one cause for child deaths in India, says the United Nations Children’s Fund.

Delhi’s bad air competes with Beijing’s for the worst air pollution rankings, though the problem is not confined to the Indian capital. Air pollution is now the fifth largest killer in India, says The Global Burden of Disease Study 2010 (GBD 2010), the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries and health risk factors, which was published in The Lancet in December 2012.

According to the report, approximately 620,000 premature deaths occur in India from air pollution-related diseases each year. This is up from 100,000 in 2000. The India and South Asia-specific findings were released at a workshop jointly organised by the Delhi-based non-profit Centre for Science and Environment, the Indian Council of Medical Research and the US-based Health Effects Institute.

One of the key challenges is that while lots of data on air quality is available from Central and State pollution control boards and independent monitoring agencies in India, “there is no authentic national-level data on the impact of air pollution on children’s health, though there are some studies that show increased frequency of respiratory symptoms with increasing pollution in children in small groups,” said Sunil Kumar Chhabra, a senior heart and lung specialist at Vallabhbhai Patel Chest Institute, Delhi.

For example, a 2008 survey of Delhi schoolchildren by India’s Central Pollution Control Board found a higher prevalence of upper and lower respiratory disease symptoms and lung function deficits compared to age-and sex-matched rural controls. It showed respiratory problems in 32% of children examined in Delhi, in contrast to 18.2% of the rural children. Reduced lung function was recorded in 43.5% of school children in Delhi, compared to 25.7% in villages.

“The air quality in most urban areas in India has been consistently poor, with particulates (PM10 and PM2.5) often being 2-3 times above upper limits of standards,” Chhabra told chinadialogue. “It worsens in winters. Delhi saw real improvement between 2000 and 2005, but since then the quality has worsened again,” he added.

The main reason, he pointed out, is the increasing number of vehicles in India’s capital. Remedial measures have been taken over the last 15 years, including phasing out leaded petrol and old vehicles, introduction of compressed natural gas, improved engine technology and stricter emission norms, better fuel quality, traffic management and planning. But the rise in the number of vehicles has more than negated all these measures. By March 2012, Delhi had over 7.4 million motor vehicles, with half a million being added every year.

“Those with pre-existing asthma, chronic obstructive pulmonary disease and coronary artery disease suffer the most. More coughs and colds in general population, asthma attacks and angina/heart attacks are some of the problems. Long term exposures reduce lung growth in children, probably interact with allergens to increase asthma, predispose to vascular disease along with other risk factors,” Chhabra added.

Sanjeev Bagai, a Delhi-based paediatrician, told chinadialogue that the number of patients he has seen who have been impacted by air pollution has more than doubled in the last 10 years. “I used to see 10 children out of 50-odd patients daily with ill effects of environmental pollution. Now it’s 22-25 out of 50 cases every day."

Bagai said children in all age groups are vulnerable. In the last two years or so, he said, “even newborns have respiratory diseases, which were previously not seen so early in life.” Other short term effects of air pollution on Delhi’s children include; wheezing, allergies, bronchitis, pneumonia, ear infections, tonsillitis, asthma exacerbation, dermatitis, sore eyes, headaches, giddiness. Long term effects include bronchial asthma, chronic obstructive pulmonary disease, cardiac disorders and cancer.

Asked what children living in Delhi should do to stay healthy, Bagai recommended avoiding polluted areas, staying away from congested vehicular traffic areas, using a face mask and prophylactic inhaler medication.