Yves here. The focus of this site is often, and too often, on first world issues because that is where the bulk of our readers live. The severity of pollution in China has gotten some attention in the US, in that advanced economy lifestyles have come to depend on shifting the cost of pollution onto emerging economies. But even though we read the occasional horror story about, say, what it means to have cadmium in the soil, most readers lack a visceral sense of what it means to live in an environment that is seriously contaminated.

This post about air pollution in Malaysia provides some perspective. The severity of air pollution in Beijing is well publicized, but it isn’t as well recognized how bad the air is in many other Asian cities. Although I gather the situation has improved since then, I was shocked to see how the air was so dirty in Bangkok in 1997 that you never saw a blue sky. I visited Hong Kong in 2001, and even though I don’t have any respiratory problems, I found the air uncomfortable to breathe. So even though the Economist and other internationally-oriented media outlets occasionally weigh in on this problem, it seems to be accepted in too many places as a fact of life when it shouldn’t be.

By Martin Khor, Executive Director of the South Centre, Geneva. Originally published at The Star

What causes as many or more deaths in Malaysia as road accidents but has not been known to be such a dangerous killer?

Air pollution.

This “killer” is not as dramatic or visible as car crashes, but is even more dangerous as it penetrates and contaminates our vital organs, leading to serious diseases and thousands of death.

Outdoor air pollution caused 6,251 deaths in Malaysia in 2012, according to a recent report by the World Health Organisation.

The deaths were due to heart disease (3,630), stroke (1773), lung cancer (670), pulmonary disease (148) and lower respiratory disease (29).

In 2013, road accidents killed 7,129 people in Malaysia, slightly more than the outdoor air pollution figure for 2012.

But the WHO study does not include indoor or household air pollution, which may have harmed many more people. If the deaths from this were known and added, the total deaths caused by air pollution overall would almost certainly be higher than those caused by road accidents.

It is timely to get these new details on the serious health effects of air pollution.

Malaysians have been enduring the effects of the annual “haze” caused by burning in forest and agriculture areas in Indonesia. Memories of the misery this caused in 2015 are still fresh. Fortunately, the haze has been largely absent so far this year.

WHO estimates that 4.3 million die prematurely each year from indoor pollution, and 3.7 million from outdoor pollution.

And 92% of people in the world live in places that do not meet the WHO health standard for outdoor air quality.

The WHO report, Ambient air pollution: A global assessment for exposure and burden of disease, is based on satellite data and ground station monitors for more than 3,000 rural and urban locations.

The figures for Malaysia show that the country has a PM2.5 annual median concentration of 15 (ranging from 9 to 24) micrograms per cubic metre. This is 50% above the WHO’s guideline limit of 10.

By comparison, other Asian countries had the following air pollution levels: China (54), India (62), Thailand (25), Singapore (17) and Indonesia (14).

The PM2.5 level is the annual median concentration of particulate matter of a diameter less than 2.5 micrometres. PM2.5 includes pollutants such as sulphate, nitrates and black carbon, which penetrate deep into the lungs and in the cardiovascular system, posing the greatest health risks.

Due to the premature deaths, Malaysia also suffered 160,693 years of life lost in 2012, attributable to outdoor air pollution, according to the WHO report.

The adverse effects of this hidden killer have been growing fast (8% increase in deaths from 2008 to 2013). It was responsible for one out of every nine deaths (11.6% of the total) in the world in 2012, according to WHO. That makes it one of the top causes of deaths globally.

The air-pollution related deaths worldwide were due to ischaemic heart diseases and strokes (72%), chronic obstructive pulmonary disease or acute lower respiratory infections (14%) and lung cancer (14%) in 2012.

Ninety percent of the deaths are in developing countries and two out of three occur in our neighbourhood – the Southeast Asia and the Western Pacific regions.

Countering air pollution should thus be a top priority. What should be done? First, collect more details through improvements in monitoring air pollution and its effects.

Second, make the public more aware so they can take action to avoid being exposed.

Third, and most important, identify the causes of the pollution and take action to eliminate or reduce them.

Among the causes of outdoor air pollution are emissions from transport vehicles, coal-fired power plants, industrial factories, burning of wastes, and fires in forest and agricultural areas. Indoor pollution is mainly caused by the use of cooking fuels based on wood and coal.

Besides the direct effects on human health, air pollution is also a major cause of global warming, which in turn also affects health.

It is thus doubly important to tackle these causes. Actions should include the following:

Reduce vehicle emissions through better energy-efficiency and air-pollution standards for vehicles and control of private transport.

Give priority to public transport and promote clean transport such as railways, bicycles and walkways.

Phase out coal-powered plants, shift to clean modes of power, and promote renewable energy.

Impose strict air pollution controls in industry and phase in clean low-emissions technologies.

Phase out the use of wood and charcoal as household fuels, and replace them with safe and efficient stoves.

Reduce waste through recycling and reuse, introduce alternatives to open incineration of solid waste and stop the open burning of household wastes.

Stop the burning of forests, mangroves and in agriculture; this is the most important to prevent the South-east Asian “haze.”

Take measures so as to adhere to the WHO guidelines for outdoor and indoor air pollution.

Air pollution reduction measures should become part of wider health and environmental strategies and be given priority and resources in the country’s development plans.

The problem must also be given the global attention it deserves. Reducing air pollution is one of the targets of the United Nations Sustainable Development Goals. And in May 2016, the World Health Assembly for the first time adopted a four-point road map to tackle air pollution.

Air pollution reduction is crucial to tackling the world’s biggest health and environmental problems.

Though the serious environmental effects of air pollution are well known, we are only at the starting phase of understanding the huge health problem it causes.

While the actions needed are quite clear, getting them implemented will be an immense challenge, as the causes of air pollution are presently so much embedded in modern lifestyles and economic structures.