Of the total deaths in India in 2017, 1.24 million deaths, equivalent to 12·5 percent of total mortalities, could be attributed to air pollution, said a paper by India State Level Disease Burden Initiative, published in The Lancet in December.

Air pollution (both outdoor and that within households from cooking) is a major and under-appreciated contributor to ill health in India, on average responsible for nearly 2 years of life expectancy loss across the population.

Air pollution has its greatest impacts on the very young and on the older members of the population. A WHO report released in October 2018 said that over 1.25 lakh children in India below the age of five died in 2016 due to the impact of polluted air.

But even as studies untangle the link between poor air quality and human health, the Indian government has said there are no conclusive data available in the country to establish direct correlation of death/disease exclusively due to air pollution.

India’s death and disease burden due to air pollution, an “under-appreciated contributor” to ill health, is disproportionately high, a study has said, underscoring that toxic air prematurely kills 11 percent of people younger than 70 years.



Of the total deaths in India in 2017, 1.24 million deaths, equivalent to 12·5 percent of total mortalities, could be attributed to air pollution, said the paper by the India State Level Disease Burden Initiative, published in The Lancet in December.



This means air pollution is responsible for one out of every eight deaths in India.



These fatalities include 0·67 million deaths due to outdoor particulate matter pollution while 0·48 million human lives are snuffed out due to household air pollution.



Connecting the dots on air pollution, death and disease burden, the study revealed that India comprised 18 percent of the global population in 2017, but had 26 percent of global DALYs (a measure of disease burden) attributable to air pollution.

Disability-Adjusted Life Year (DALY) denotes the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.

“Many don’t die but have sickness which impacts their life. The DALY or overall disease burden captures both the burden of mortality and morbidity (non-fatal health problems),” Lalit Dandona, distinguished research professor, Public Health Foundation of India, and Director, India State-Level Disease Burden Initiative, told Mongabay-India.

Bad air affects the very young and very old

Air pollution has its greatest impacts on the very young and on the older members of the population, highlighted The Lancet study co-author Michael Brauer, professor at the University of British Columbia, Canada.



According to the study, a substantial eight percent of the total disease burden in India and 11 percent of premature deaths in people younger than 70 years could be attributed to air pollution.



“For the very young, air pollution increases the likelihood of acute respiratory infections (pneumonia) which can be fatal,” said Brauer.



For older people, air pollution accelerates the progression of some of the most important diseases – chronic lung disease, heart disease, diabetes as well as strokes.



Air pollution isn’t the main reason people die, but because essentially everyone in India is exposed to unhealthy levels of air pollution, it has a very large impact on the population as a whole, he said.



“We know that in places with lower levels of pollution, people will live longer than those who live in more polluted areas (after controlling for other factors that also contribute to life shortening),” Brauer reasoned.

Air pollution (both outdoor and that within households from cooking) is a major and under-appreciated contributor to ill health in India, on average responsible for nearly 2 years of life expectancy loss across the population, Brauer said.



“This is a much higher impact than in most other countries in the world – in part because India faces both of these forms of air pollution but also because the levels of outdoor air pollution are among the highest in the world in some of the most densely populated parts of India,” he explained.



The India State-Level Disease Burden Initiative is a joint initiative of the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME) in collaboration with the Ministry of Health and Family Welfare, along with experts and stakeholders associated with over 100 Indian institutions.



As shown in the study, 77 percent of India’s population is exposed to outdoor air pollution levels above the National Ambient Air Quality Standards safe limit, with the northern states having particularly high levels.

“Air pollution now contributes to more disease burden in India than tobacco use, primarily through causing lower respiratory infections, chronic obstructive lung disease, heart attacks, stroke, diabetes, and lung cancer,” Dandona of PHFI said.

Outdoor air pollution worsening, household air pollution improving

There is substantial variation within the population – the northern region (Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan) has the largest impacts from outdoor air pollution while the states with the lowest levels of sociodemographic development (Chhattisgarh, Rajasthan, Madhya Pradesh, Assam) have the largest impacts from household air pollution.

The highest PM2.5 (particulate matter) exposure level was in Delhi, followed by the other north Indian states of Uttar Pradesh, Bihar and Haryana.

These are fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller. This means the average human hair is 30 times larger than the largest fine particle.

The proportion of population using solid fuels in India was 55·5 percent in 2017, which exceeded 75 percent in states of Bihar, Jharkhand, and Odisha that ranked low in the sociodemographic development index (SDI), a new metric for measuring development.

SDI captures three different but important aspects of development: income, education, and fertility.

Mapping the household air pollution DALY rate, the study found that the disease burden due to household air pollution was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India.

“Outdoor air pollution is getting worse. Household air pollution is improving (more people using cleaner fuels such as LPG),” said Brauer.

This reduction is facilitated by the Pradhan Mantri Ujjawla Yojana but needs to be sustained, said Dandona.

“With substantial variations between the states, the estimates of outdoor and household air pollution exposure for every state, and the state-specific number of deaths and life-expectancy reduction associated with air pollution would be useful to guide policy suitable for the situation in each state,” he added.

According to an Energy Policy Institute at the University of Chicago (EPIC) study, which developed the Air Quality Life Index (AQLI), on average, people in India would live 4.3 years longer if their country met the WHO guideline—expanding the average life expectancy at birth there from 69 to 73 years.

They say the impact of particulate pollution on life expectancy is comparable to that of smoking, twice that of alcohol and drug use, three times that of unsafe water, five times that of HIV/AIDS, and more than 25 times that of conflict and terrorism.

“Over the past two decades, the concentration of fine particulates increased by 69 percent on average across India. As a result, sustained exposure to particulate pollution now reduces the life expectancy of the typical Indian citizen by 4.3 years compared to 2.2 years in 1998,” the EPIC study had said.

India says ‘no conclusive data available in the country’ to directly link deaths

But even as studies untangle the link between poor air quality and human health, the Indian government has said there are no conclusive data available in the country to establish direct correlation of death/disease exclusively due to air pollution.



Responding to questions on the latest estimates released by the World Health Organization ‘Air Pollution and Child Health: Prescribing Clean Air’ report on air pollution and child health, Mahesh Sharma, Minister of State for Environment, Forest and Climate Change said in a written reply in Parliament that the estimates published by WHO are based on models, simulations and extrapolations.



“The World Health Organization (WHO), from time to time, has been publishing estimates of mortality/ morbidity attributable to environmental pollution. Though air pollution is one of the triggering factors for respiratory ailments and associated diseases, there are no conclusive data available in the country to establish direct correlation of death/ disease exclusively due to air pollution,” Union Minister Mahesh Sharma said in a written reply in the Lok Sabha.



“Health effects of air pollution are synergistic manifestation of factors which include food habits, occupational habits, socio-economic status, medical history, immunity, heredity, etc. of the individuals.”



The WHO report released in October 2018 said that over 1.25 lakh children in India below the age of five died in 2016 due to the impact of polluted air and almost one in five children who die from toxic air exposure across the world is from India.



In order to address the increasing air pollution across the country in a comprehensive manner, Ministry of Environment, Forest and Climate Change has finalised the National Clean Air Program (NCAP) as a pan-India, time-bound, national-level strategy to tackle the increasing air pollution problem.



Taking into account the available international experiences and national studies, mid term target for reduction of PM2.5 and PM10 concentration by 2024 is part of the NCAP. This is keeping 2017 as the base year for comparison of concentration.



“Systematic efforts are necessary to address the multiple sources of air pollution in India: transport vehicles, construction activity, industry and thermal power emissions, residential and commercial solid fuel use, waste and agriculture burning, diesel generators, and manual road dust sweeping,” Dandona said.



“If air pollution improves then the entire population benefits – cleaning up the air is really a very efficient way to improve health,” signed-off Brauer.

CITATION

Balakrishnan, K., Dey, S., Gupta, T., Dhaliwal, R. S., Brauer, M., Cohen, A. J., … & Sabde, Y. (2018). The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017. The Lancet Planetary Health.



Banner image: Crop burning is a major source of air pollution in north India in winters. Photo by Neil Palmer (CIAT)/Wikimedia Commons.