Air pollution should now be labelled as a “potentially modifiable” risk factor

It seems that the issue of air pollution is here to stay. Now, a study reported in The Lancet Planetary Health has attributed one in every eight deaths in India to air pollution, which is now believed to contribute to more disease burden than smoking. This study is the first comprehensive estimates of deaths, disease burden, and life expectancy reduction associated with air pollution in each state of India by the India State-Level Disease Burden Initiative.

India is home to about 18% of the world population, but it has a disproportionately high 26% of the global premature deaths and disease burden due to air pollution. Over half of the 12.4 lakh deaths in India attributable to air pollution in 2017 were in persons younger than 70 years.

The study further goes as far as saying that the average life expectancy in India would have been 1.7 years higher if the air pollution level were less than the minimal level causing health loss.

India has one of the highest annual average ambient particulate matter PM2.5 exposure levels in the world. While, the WHO recommended levels for PM 2.5 are less than10 μg/m³, the limit set by National Ambient Air Quality Standards of India is PM2.5 less than 40 μg/m³.

The WHO says that 14 of the 15 cities with the worst air pollution in the world are in India.

Last year, the annual population-weighted mean exposure to ambient particulate matter PM2.5 in India was 89.9 μg/m3. Around 77% of the population of India has been found exposed to annual population-weighted mean PM2.5 greater than 40 μg/m3. Delhi had the highest annual population-weighted mean PM2.5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India. All had mean values greater than 125 μg/m3. Of the 1.24 million deaths attributable to air pollution, more than half were people below 70 years.

Air pollution adds to the global burden of disease. Poor air quality has been shown to be associated with NCDs such as heart disease, asthma, COPD, cancer, making it a major public health problem of concern. It is not only associated with morbidity but also mortality due to these diseases. A study published only this month has shown a link between air pollution and increased risk for miscarriage.

Pollution is also a source of infection. Bioaerosols are among the environmental pollutants, which may be responsible for airborne disease transmission. Any negligent or malignant act likely to spread infection of disease dangerous to life is a punishable offence under sections 269 and 270, respectively, of the Indian Penal Code.

There is enough published evidence to now label air pollution as a major potentially modifiable risk factor, not only for chronic diseases but also as a precipitating factor for death due to acute disease events such as stroke, acute heart attack, acute bronchial asthma. 

As air potentially is a potentially modifiable risk factor, any attributed to it is a preventable death. And, any preventable death should be unacceptable.

Every death, which occurs in the setting of air pollution, should be audited and accounted for. There should be a column in the death certificate, which should state if the death was attributable to air pollution. This should be a policy.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA