Today’s world’s rapid rate of population growth, industrialization, settlement practices and urbanization are causing several environmental problems. The energy required to meet these growing demands has come from fossil fuels combustion which releases greenhouse gases and air pollutants such as carbon monoxide, carbon dioxide, sulpher dioxide, particulate matters, lead compound and unburned carbon particles into atmosphere. Everywhere in the developed and developing world, outdoor air pollution is a major environmental condition leading to different health problems affecting everyone. According to World Health Organization (WHO) report of 2014, transportation sector is responsible for about 75 percent of air pollution. It degrades the quality of fresh air and causes about two million premature deaths and 6 percent of total lung cancers every year. It has now been a serious alarming issue across the globe. The increasing effects of air pollution on health cannot be taken lightly in South Asia because this region is inhabited by a quarter of world’s population and at the same time going through rapid urbanization, industrialization and economic growth. The air quality among the major cities of South Asia is deteriorating at alarming rates and has gotten worse over the last decades that has become one of the prominent cause of deaths by diseases related to air pollution. Global Burden of Diseases (GBD) reflects that air pollution is the sixth most dangerous killer in South Asia. Further this issue has been serious due to hazardous trans-boundary mobility of air pollution among the neighboring countries like Bangladesh, India, Pakistan and Sri Lanka from past several decades.
In Afghanistan, air pollution is killing the civilians as much as double rate than the war. Government report of 2008 shows one of the leading cause of pollution in Afghan is common practice of burning of tires and plastics by residents for warmth. As a result, the rancid air casts a yellow haze. Another cause is linked to pollution from means of transportation. The numbers of Car has grown 10 times more than Taliban era and most are foreign cast off that run with leaded fuel. The level of environmental pollution that Afghanistan is experiencing is rarely seen elsewhere. Annually, more than 3,000 people die in Kabul alone from diseases related to air pollution. According to World Bank report of 2010, in Kabul alone each year 6, 00,000 asthma attacks were reported with 2,287 deaths that are directly related to air pollution.
Similar to Afghanistan, air pollution is severe in Bangladesh, particularly in the big cities of Dhaka and Chittagong. Dhaka is the most vulnerable city due to its high level of automobile emission and population density. Bangladesh ranks 169th out of 178 by global air quality index in 2014. GBD 2010 shows that air pollution is second risk factor for cause of disease after tobacco smoking. World Bank states that 10 percent of respiratory infections and environmental related diseases in Bangladesh may be attributable to urban air pollution. The total burden of disease and mortality rates from respiratory infections in Bangladesh is higher in comparable to other South-East Asian countries Atmospheric lead emission is another issue in Bangladesh. About 50 tons of lead is emitted into atmosphere of Dhaka city annually and its density in dry season is about 463 monograms which is the highest in world.
GBD report also shows air pollution ranks 2nd risk factor for the burden of diseases in India. Air pollution causes 6, 20,000 premature deaths each year. According to the news of the Indian Express on 7th May 2014, Delhi is the most polluted city in the world. Hindustan times of 10th August 2015 quoted, out of 20 top polluted cities of the world, 13 are in India. Air pollution has reduced the life expectancy by 3.2 years for 660 million Indian residents of these cities including Delhi.
Air pollution alarming in Nepal as well. According to Yale University’s Environment Performance Index 2014, Nepal ranks 177th among the 178 countries rated for air quality. Throughout the nation, Kathmandu faces the worst sort of air pollution. The valley was safe to live in 1950s but the visibility of air quality has been decreasing since 1980s. In recent decades, air pollution in Kathmandu has worsened due to the rapid rise in the number of inferior quality vehicles on the traffic congested roads, as well as the unregulated locations of brick industries.
Likewise, in Pakistan, air pollution is rapidly causing environmental problem due to its accelerated growth of vehicles, industrialization and uncontrolled burning of solid waste including plastics. According to report on Pakistan Observer of 6th February 2014, air pollution in Lahore and Karachi is 20 times higher than WHO standards. A thick layer of smog covers Islamabad. Similarly, BBC news on 7th May 2014 reported level of particulate matter in Peshawar was 540 micrograms per cubic meter over a period of two months in 2010. Government report of 2006 shows, a total of 22,700 deaths including 700 children are caused by air pollution in Pakistan.
Although air pollution is a serious environmental issue in Sri Lanka, Bhutan and Maldives but in comparison to other South Asian nations its effect is in lesser extent. In Sri Lanka, it has become serious since 1998. In Bhutan, Maldives and Sri Lanka, diseases such as respiratory tract infection, asthma and acute bronchitis are leading causes of hospitalization. The trans-boundary mobility of air pollution from India and Pakistan is serious issue of Maldives since 1997 due to its low elevation location.
Besides the emission from several sources, the seasonality and land structure of that particular place also determine how long it will be polluted. Cities with the shape of a bowel in topography are highly polluted for long term than the open areas. The best example is Kathmandu and Kabul where pollutants are only accumulated in high level but due the shape there is a restriction to the exhale of air and the outflow of pollutants accordingly. Air flow starts only in afternoon hours and during morning and evening, high concentration of pollutants in air reflects hazardous to walk and breathe.
Winter haze in the skies of Bangladesh, India and Nepal is one of the best examples related to seasonality and air pollution. Anthropogenic sources mostly coal-fueled power plants of India and China, air borne particles released from combustion of wood and forest fires, emissions from vehicles and factories, and burning of biomass to generate energy form Asian brown cloud. High and low dose effects of this cloud indicate alarming to health consequences. The high dose causes chronic bronchitis, pulmonary edema, emphysema, cancer and even death while eye, nose and throat irritations are caused by low doses. A study in 2002 shows nearly two million people die each year, in India alone, from conditions related to the brown cloud.
One of the persistent problems living in South Asian cities is the poor air quality and health risks. More people die and are admitted to hospital. More number of people died from smoggy days than hypothermia during winter season. Air pollution seriously affects the respiratory tract and causes headaches, high blood pressure, eye and throat irritation, wheezing, shortness to breathe, lung damage, bronchitis, cough, chest pain, impaired fetal development and premature mortality, neurological disorders, brain damage, anemia and cancer. Lead pollution causes the hypertension, damages to kidneys and also affects to the central nervous system that adversely affects to the mental faculty of children.
Pollution as a whole is serious issue of 21st century due to which air is unfit to breathe, water is unfit to drink and land is unfit to cultivate. Among them air pollution is key concern of modern world and it is both a global and regional issue. It has become more serious in urban region of South Asia. Children and elderly people are highly vulnerable groups mostly in megacities. Now it’s time for all nations to think seriously about the impacts of pollution to health of their citizens and ponder upon how to maintain fresh air and healthier environment to inhabit. But this off course is not an easy task. All countries are in developing stage, increasing industries, automobiles, urbanization etc. Still there is environmental debate between west and Asian nations where western countries have been blaming to Asia for this pollution and forcing to stop the release of pollutants. But the response is different form Asian side, they blame the western world for polluting the environment during the industrial development in their respective countries. Asian nations now claim the 21st century as Asian era in terms of development and has turned deaf ear to the preaching of western world in this regard. No government wants to stop development. It is continuous process and there is no limit. Now, it’s difficult to answer, when we will have healthier, pollution free, disease free environment to live? This question can be answered in terms of some extent but is practically difficult to answer. The best way is to think alternate source of energy and research based policy implementation which can reduce the air pollution borne mortality.
Nowadays, although the small scale studies about impacts of air pollution on public health are increasing in South Asian countries but due to limitations of national level epidemiological studies, assessment of health impact of air pollution in South Asian population rely to a large extent on extrapolation of the results of Western studies, which involve considerable uncertainties. It is very difficult to address this overwhelming issue of air pollution either in single way. It is a multi-dimensional issue. Each pollutant is unique in its combination and effect. Moreover, all pollutants do not have similar disease severity. Therefore, it is essential to know about the relationship of exposure and effect on human health. While addressing this issue, the pollutant with highest burden should be prioritized to address first. Again, this task is also not easy. There must be air ambient air quality data at least in highly polluted cities and government must have good record of daily surveillance and mortality database. The modeling works clear us about the impact of individual pollutant responsible for particular disease. This will help government to make national policy to and effective implementation leading to gradual reduction of the amount of pollutants from atmosphere. In addition to these activities, plantation, awareness program, media broadcasting etc. are also prioritized for a short term mitigation of air pollutants. Particularly, we can see even within a nation excluding the government role, countless organizations have been working in air pollution and every year billion of fund is invested, but remarkable change is generally not visible This is probably because organizations only works on current situation and very rarely plan to work on long-term research based policy implementation model. Formulation of such model needs good pollutant and surveillance database as well as expertise in environmental epidemiology and statistics.
In conclusion, air pollution has become a serious health burden for South Asian countries and particularly in big cities. It is essential to promote actions for the improvement of air quality. It is regional issue and no one country especially in this poor and diversified region of South Asia can tackle this on its own. National action in this regards seem to be insufficient. Lack of financial support, skilled and trained manpower, technology, surveillance and ambient air quality database are further limits. For that reason, regional integration to combat the issue of air pollution is current demand of South Asia that help to find out surveillance based impact of air pollution first and reduce the risk factors and mitigate the diseases and deaths along with the research based policy implementation later on.
(The author is pursuing PhD in Environmental Epidemiology, Sungkyunkwan University, Republic of Korea. He can be reached at firstname.lastname@example.org.)