Declining air quality in India - a primer on how to survive living with poor AQI

The Centre in its recent order to States, and Union Territories warned that air pollution is a significant contributor to acute health conditions. It has asked them to initiate measures to ensure preparedness in view of the deteriorating air quality across northern India, with the onset of winters, and its adverse impact on people’s health 

The combination of festive activities and the onset of winter have further deteriorated the Air Quality Index (AQI) in certain States and Union Territories across India forcing the Union Health Ministry to issue an advisory directing state health departments and healthcare facilities to enhance their preparedness to safeguard the health of public against the ill-effects of rising air pollution levels.

Recently, the Ministry has said that people should limit outdoor activities including early morning/late evening sports and walking (particularly the elderly and vulnerable groups, including pregnant women, children, and those working outdoors like traffic police officers).

The Central government in its recent order to State and Union Territories warned that air pollution is a significant contributor to acute health conditions and exacerbates the progression of related chronic diseases. It has asked them to initiate measures to ensure preparedness in view of the deteriorating air quality across northern India, with the onset of winters, and its adverse impact on people’s health.

The letter from the Centre has directed that public awareness campaigns using regional languages through mass media be pressed into action and has also called for strengthening the healthcare workforce and increasing participation in sentinel surveillance for air pollution-related diseases. Weather experts have noted that air quality in the National Capital is currently in the ‘very poor’ category with hospitals registering a rise in the number of patients coming in with adverse respiratory symptoms.

In his letter, Director General of Health Services Atul Goel said that the adverse effects of air pollution are “particularly severe” for vulnerable groups. Stating that chronic illnesses, attributed to prolonged exposure to air pollution, often lead to an increase in premature mortality, the letter said that there is a need to ensure “enhanced preparedness.”

The Central government has sought to discourage stubble and waste burning, promoting the use of public transportation, limiting reliance on diesel-based generators etc.

Also, individuals have been advised to minimise their exposure to polluted air by monitoring air quality indices through government mobile applications before venturing outdoors, avoiding heavily congested areas, and opting for cleaner fuels at home for cooking, heating, and lighting.

The Capital and its nearby area along with other regions of the country have been witnessing an alarming rise in pollution levels with the Delhi-NCR Air Quality Index (AIX) hovering around 300-400 range and has even gone up to over 500.

Experts said, in the month of October and on the onset of winter, they have been witnessing nearly 40% spike in the cases of cardio and respiratory problems including asthma, triggered by high levels of pollution. The World Heart Federation’s (WHF) World Heart Report 2024, indicated alarming statistics on the relationship between air pollution and cardiovascular disease (CVD) globally. In India, a country already burdened with a high prevalence of CVDs, the impact of environmental factors, particularly air pollution, poses a significant public health challenge. 

Experts are now calling for urgent attention and action to address these environmental triggers of CVDs. Indian cardiologists and public health professionals emphasise that without addressing pollution, tackling cardiovascular health challenges will remain an uphill battle.

Emphasising the clinical mechanisms through which pollution impacts heart health, Faraz Ahmed Farooqui, consultant- Cardiology, at PSRI Hospital, said that long-term exposure to air pollution leads to endothelial dysfunction and oxidative stress, both of which are critical precursors to cardiovascular diseases.

“In India, the incidence of conditions such as coronary artery disease, stroke, and heart failure has seen a marked increase in polluted areas. These pollutants not only increase blood pressure but also trigger inflammatory responses in the blood vessels, accelerating atherosclerosis, which further heightens the risk of heart attacks and strokes,” he said.

The World Heart Report also highlights how particulate matter from agricultural practices, particularly residue burning in North India, significantly impacts air quality. The plumes from burning crop stubble contribute to spikes in particulate matter (PM2.5 and PM10), aggravating the cardiovascular health of millions . Praveen Gupta, principal director & chief of Neurology, at Fortis Hospital, added that pollution causes a significant impact on human health.

“It can exacerbate respiratory problems such as COPD and asthma. It increases the risk of heart disease besides being the major cause of cancer. It is also a leading risk factor for stroke, cognitive impairment, and dementia. Pollution has a negative influence on mental health, producing loss of focus, irritation, and brain fog. There is mounting evidence that exposure to air pollution increases the risk of cognitive decline and neurodegenerative disorders such as Alzheimer’s and Parkinson’s. Poor air quality has a substantial impact on our mental health, increasing the risk of anxiety and depression,” he said.

The primary causes of this heightened risk include traffic exhaust fumes, home wood burning, and elevated levels of nitrogen dioxide, which can be ascribed to industrial emissions, gardening equipment, power plants, and construction and exhaust fumes.

Experts are now advocating for steps to decrease air pollution in their communities, such as utilizing public transportation wherever feasible, reducing the use of wood and coal in the house, repairing cars on a regular basis, and inspecting tyres often.``We may also avoid being exposed to high levels of air pollution by limiting the amount of time we spend in regions with high amounts of traffic or other pollutants, as well as using filtration systems to keep the air in our homes pure,” Dr. Gupta added. He warned that household air pollution is associated with increased mortality from ischemic heart disease and stroke, with women and children in rural areas being particularly vulnerable.

The World Health Organization (WHO), notes that air pollution can cause a variety of health issues including -- cardiovascular disease (strokes and heart disease), respiratory disease (chronic obstructive pulmonary disease (COPD), acute respiratory infections, and asthma), cancer (lung cancer), preterm and low-birthweight, cognitive and neurological impairment.

Air pollution is a major environmental health problem that affects people in all income levels. In 2019, the WHO estimated that 4.2 million people died prematurely due to outdoor air pollution. Low- and middle-income countries (LMICs) are disproportionately affected by air pollution, with 89% of premature deaths occurring in these areas. Air pollution is the second leading cause of non-communicable diseases (NCDs) globally after tobacco.

 ``Ambient (outdoor) air pollution in both cities and rural areas is causing fine particulate matter which results in strokes, heart diseases, lung cancer, and acute and chronic respiratory diseases. Additionally, around 2.6 billion people are exposed to dangerous levels of household air pollution from using polluting open fires or simple stoves for cooking fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal,’’ notes the WHO. It adds that air pollution is contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere.

Household combustion devices, motor vehicles, industrial facilities and forest fires are common sources of air pollution. Pollutants of major public health concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide. Outdoor and indoor air pollution cause respiratory and other diseases and are important sources of morbidity and mortality. 

WHO data show that almost all of the global population (99%) breathe air that exceeds WHO guidelines limits and contains high levels of pollutants, with low- and middle-income countries suffering from the highest exposures. Air quality is also closely linked to the earth’s climate and ecosystems globally.)

Published - November 22, 2024 12:02 am IST