By Sunita Narain:

Our health is not on anybody’s agenda. Or, we just don’t seem to make
the connections between the growing burden of disease and the
deteriorating condition of our environment. We don’t really believe the
science, which tells us each passing day how toxins affect our bodies,
leading to high rates of both morbidity and mortality. It is true that
it is difficult to establish cause and effect, but we know more than
enough to say that air pollution is today a leading cause of both
disease and death in India and other parts of South Asia.

The Global Burden of Disease is an initiative involving WHO that tracks
the causes of disability-adjusted life years lost—the number of
productive years lost to diseases—and human death. In other words, it
assesses a large number of risk factors responsible for the global
burden of disease. Why are we ill? The initiative’s decadal 2010
assessment should make us angry.

In South Asia the top cause of disease and death is particulate
pollution—inside homes because of the poor quality cook stoves and
biomass fuel burnt by poor households, and outside homes because of
growing numbers of vehicles and use of dirty diesel fuel. What is more
worrying is that ambient and household-level air pollution has a
correlation with ischemic heart disease, stroke, lung cancer and lower
respiratory infections. According to this assessment, some 627,000
deaths in 2010 are attributable to ambient air pollution alone in India,
of which heart disease caused almost 50 per cent deaths and stroke and
hypertension another 25 per cent. In all, over 1.6 million deaths
happened in India because of indoor and outdoor air pollution in 2010,
finds the global assessment. It is not mocking numbers.

What is clear is that we have run out of air and time. Rural India
suffers badly because it still burns biomass for cooking its food.
Commercial fuel is expensive, while kerosene does not reach the very
people for whom it is subsidised. There is no option for the poor but to
burn leaves, twigs, wood or cow dung in inefficient chulhas in poorly
ventilated conditions. Women suffer the highest exposure to toxins,
which is equivalent to smoking many cigarettes every day. The answer is
to improve the combustion efficiency of the stove, the quality of
material being burnt and ventilation. But till date, government
programmes—and there have been many—have failed to get this done. As a
result, indoor air pollution is the top cause of morbidity and mortality
in India.

In fact, air does not differentiate between rich and poor; rural and
urban. Biomass burnt inside houses also contributes to ambient air
pollution; everyone in an airshed is affected.

Then pollution takes new forms which makes it difficult for us to find
protection even if we are rich and capable. The ground-level ozone is
found to be a key pollutant adding to the death burden in South Asia.
This is a gas, which is not necessarily found in the most polluted parts
of the city. Instead, it drifts away from the source of pollution to
greener and less congested regions. Thus, it hits and hurts even where
one cannot smell or see pollution.

All in all, this is bad news. This is when we know that half of India’s
urban population lives in cities where particulate pollution levels
exceed the standards considered safe. And as much as one-third of this
population breathes air having critical levels of particulate pollution,
which is considered to be extremely harmful. We are also running out of
“clean” places. Small and big cities are now enjoined in the pain of
pollution. Of the 180 cities monitored by different pollution control
agencies, only two—unknown cities in Kerala—meet the criteria of low
pollution. In other words, they have pollution levels 50 per cent below
the standard. Rest have foul air.

But we don’t make the connection. Current policies on containing air
pollution, particularly in cities, are regressive and border on the
criminal. We know that diesel particulates are indicted as known
carcinogens. Use of diesel in vehicles needs to be contained. We also
know that the price differential between petrol and diesel has pushed up
sales of inefficient SUV-type vehicles. This hurts oil companies and
kills us, literally. There has been pressure on government, mostly
fiscal, to contain the use of diesel in private vehicles.

So what does it do? It raises the price of diesel for retail buyers by
Rs 0.50 per litre. It also raises the price of diesel for bulk buyers by
Rs 10 per litre. What it does not explain is that bulk users of diesel
are mainly railways and public-sector bus transport agencies. Therefore,
what government does is deliberately hit the more efficient forms of
transport, which carry more people using less fuel. It also hits the
poor and not the rich who travel in cars.

Health is not on the agenda. That is pretty much clear.