Dr. Karan Thakur
15th November 2017
Much of North India has been caught in the throes of a major public health emergency with a quantum increase in air pollution. The quality of the air and its toxic constituents have led to calls from all sections to take urgent action to address this issue. Air pollution has emerged as a significant challenge to the health and well-being of citizens, more so of developing countries, over the past decade.
With the emergence of this new public health challenge, a paradigm change in public policy making is needed at the earliest.
The 2017 Lancet Commission on pollution and health, along with the Icahn School of Medicine at Mount Sinai and the Global Alliance on Health and Pollution, noted that in 2015, pollution as a whole accounted for 9 million premature deaths worldwide. Pollution accounts for 16% of global deaths and this alarming number is expected to rise in the years ahead.
Most significantly, the report highlights that nearly 92% of pollution related deaths occur in low-income and middle-income countries, with children facing the brunt of this. Clearly, rapid, unhindered and unregulated industrialisation and ‘development’ has led to a public health catastrophe which threatens the economic, social and health wellbeing of our citizenry and future generations.
India itself has faced multiple health challenges over the past decades.
With the control of communicable diseases, came the rise of non-communicable diseases which account for over 60% of deaths in India. The Lancet Commission notes that, ‘non-communicable diseases account for most of the total burden of disease due to pollution - approximately 71%.’
Going forth, for its continuing growth and prosperity, the apodeictic fact remains that India needs to add pollution to its list of public health challenges. However, given the recognised threat that pollution has posed to the health of India over the past decade, why has so little been done on the health policy front to tackle this threat?
One primary reason for this has been the lack of convergence in policy making for as-yet considered unrelated subjects. For example, the Ministry of Housing & Urban Development’s policy making on building codes and standards have little inputs from the Ministry of Health.
Urban centres are witnessing liberalised floor area ratios and redevelopment that have increased air pollution within residential clusters in most large cities. The impact of this ‘modifiable’ exudation of pollutants could have been avoided with better planning and thought. Construction related pollutants are today considered the main culprit in poor air quality in urban centres.
Similarly, the town planning, industrial zoning and transport policy making do not keep health impacts as front and centre to the policy formulation process. While industrial policy has seen stringent controls on limiting the geographic proxymity vis-a-vis residential populations, city and urban planning have not adequately kept up.
Health policy making itself has not factored the entire gamut of determinants of health in its policy formulation. Further, health should find more prominence in the primary education curriculum of the country to make a meaningful impact and bring change through a more reformist outlook amongst the next generation.
Within this, the cause, impact and cessation strategies to curb pollution must be mandatory in school curriculums in India. It is heartening to note that many schools have now inculcated sustainable development as part of their curriculum. This needs to be further expanded to include more profound and finer subjects around health, pollution and sanitation.
Health policy itself cannot impact pollution to bring about the scale of change which is needed today. However, its impact can most be felt when health impact becomes a requisite and quantifiable metric in policy making as a whole.
Additionally, the Ministry of Health must initiate and fund research on the impact of air pollution on health. The controversy that erupted post the publication of the Lancet report, witnessed much debate, but very little substance and evidence available to the government at hand to counter, support or provide an alternative narrative on the subject.
Integrating health into policy making, mainstreaming health into education curriculum and enhancing research on the impact of pollution are clear actionables that need to see the light of day.
Ironically, a light that most of north India is longing to see in the days ahead.