Renu has it. Forty years old, living in Delhi that has just been declared the most polluted capital in the world, Renu has problem breathing. She sneezes. Her throat scratches. Her nose runs. From the moment her husband returns from work, the symptoms hit her. They spent a lot of money on tests and visits to experts. Renu is no great believer in coincidences. Until she consulted Dr Bharat Gopal, HoD of the Department of Respiratory Medicine at the Maharaja Agrasen Hospital, Delhi.
He diagnosed her condition as ‘chicken allergy’. Her husband owned a chicken farm. Though she had no direct contact with poultry, he would return from the farm with chicken hair, excreta and dead bird skin on his clothes that gave his wife allergy. Air pollution kills seven million people globally every year, of which four million die from indoor air pollution. A polluted city is a fatal city and indoor pollution is a bigger killer than lung disease. Reasons? Use of biofuels in cooking in villages. Smoking. Resins, waxes, polishing materials, cosmetics, and binders. Biological pollutants are dust mites, molds, pollen, and infectious agents in stagnant water, mattresses, carpets, and humidifiers.
India’s indoor pollution crisis is largely caused by using wrong cooking fuel. Three billion people don’t have access to clean fuel and cooking technology. In India, 49 percent of people use firewood to cook. The biomass lashback from fuel such as coal is deadly. The fallout is worst on women and children, since they spend longer time indoors. The World Health Organisation (WHO) notes indoor air pollution causes two million pre-mature deaths every year, of which 44 percent die of pneumonia, 54 percent of chronic obstructive pulmonary disease and 2 percent of lung cancer.
Dr KK Agarwal, Senior Medicine Consultant and President of Heart Care Foundation of India, smells a rat. Quite a few of us use perfumes, deodorants, nail paints and other cosmetics, without realising their effect on indoor pollution. “Fragrance often triggers respiratory problems and allergies,” he says. A patient of his, a young woman, had a persistent dry cough and cold. The tests didn’t offer any solutions. Ultimately, he zeroed in on a particular perfume she liked to wear before going out. “We ran a few specific allergy tests on her and found that she was allergic to it. She stopped using it and that was the end of the problem,” smiles Dr Agarwal.
Almost anything and everything in a house can lead to indoor pollution—from household cleaning agents, to wood, paints, building material, floor tiles and carpets. Lead, which is most commonly found in paints, can cause brain and nerve damage; an excess in the blood can also lead to kidney failure. Blame the Volatile Organic Compounds or VOCs—comprising carbon tetrachloride, ethylbenzene, benzene, trichloroethane, xylenes, toluene, trichloroethylene, styrene that shoot up gases and particles into the air.
There are two types of VOCs: aroma producing agents such as room fresheners, insect repellents, cleaning products, disinfectants, cosmetics and deodorants, dry-cleaned clothes, new furnishings, upholstery, carpeting, woodwork and paint. The other variety comes from furniture, pesticides and such. Smoke from tobacco, cooking oil and stoves are the major culprits behind pneumonia, bronchitis, cardiac diseases and in some cases, lung cancer. Dry-cleaned clothes pick up trichloroethylene and perchloroethylene—a form of VOC that is highly toxic.
“Biological agents such as fungus, viruses, bacteria, dust mites, not to mention TB and flu patients, cause indoor pollution,” says Dr Dipankar Saha, former additional director with the Central Pollution Control Board. City life comes with its own problems. Random household appliances such as water heaters, dryers, stationery, printers, fluid, glue, craft materials and office machines release different gases and fine particles. Humidity and the wrong temperature are responsible as well. If doctors and environmental stats are to be believed, it is as if we are trapped at home in an unknown hell; air conditioners drag in and circulate outdoor pollutants indoor, adds Dr Saha.
Delhi girl Sonia’s problem was puppy love. She persuaded her parents to get her a dog and spent most of her time with it. But her joy was short-lived. Within a month, cough, breathlessness, tiredness and other asthma symptoms cropped up. “After thorough investigation we realised that she was allergic to dog hair,” explains Dr R S Mishra, Medicine Consultant at Max Super Speciality Hospital, Saket, Delhi. “Every month we get a couple of patients whose pets are causing allergies and respiratory problems,” he adds.
The Danger zone
People spend on an average around 70-90 percent of their lifespan indoors—home, school, office, restaurant, mall, cinema hall or at other such places. A study by the Environmental Protection Agency (EPA) indicates that in America, 93 percent of people spend their life indoors. Another study by the US Environmental Protection Agency reveals that indoor pollution is about five times more dangerous than outdoor pollution. Awareness has led to the air purifier market in Delhi growing from just `75 crore in 2015 to around `500 crore in 2018. The air quality monitoring market is predicted to surpass $4.5 billion by 2025 due to excessive presence of chemical pollutants such as carbon dioxide, carbon monoxides, formaldehydes, VOCs, ozone, etc. in the vicinity of residential, commercial, institutional, and industrial buildings.
Builders are changing the look of Delhi colonies, buying cheap at this time when the real estate market is stressed, and expanding the floors. As a result ‘poor ventilation’ is another direct cause for indoor pollution. This is more true at the work place. Signs are poor concentration, fatigue and sleepiness. Cause: rise in CO2 levels within the office premises.
Recently, a study conducted by the India Pollution Control Association (IPCA)across 13 buildings in Delhi found that CO2 levels were steeper than the permissible limit in many corporate offices. The study, conducted between January and September, also reveals that the air in these buildings was loaded not only with VOC, CO2, but also with viruses, bacteria, pollen and plant fibre. “We found that these biological particles were twice the safety level,” says Radha Goyal, Deputy Director, IPCA. “Most of these buildings have central air conditioning, because of which the windows and doors are kept completely sealed. They are never opened. This leads to the concentration of gases and higher levels of CO2,” she adds.
An Old War
Delhi has done it yet again. According to the latest data compiled in the IQAir AirVisual 2018 World Air Quality Report, prepared in collaboration with Greenpeace Southeast Asia, Delhi is at the top of the most polluted capitals across the world. Not just that, India also boasts of 15 of the 20 most polluted cities in the world. The Delhi-NCR region is the worst-affected. Gurugram and Ghaziabad have topped the list of the most polluted cities, followed by Faridabad, Bhiwadi and Noida. In fact, there are only three non-India cities in the top 10: Faisalabad and Lahore in Pakistan at number three and 10, respectively; and Hotan in China at number eight. Greenpeace predicts grimly that air pollution will take an estimated seven million lives globally next year, while costing the world’s economy nearly $225 billion.
The report measures air quality in terms of PM2.5 data as aggregated through the IQAir AirVisual platform in 2018. The report is based on air quality data collected in 2018 from public monitoring sources in real-time. “These sources include government monitoring networks as well as validated data from air quality monitors operated by private individuals and organisations,” the report states. Of the over 3,000 cities in the survey, 64 percent exceeded the WHO’s annual exposure guideline for fine particulate matter.
The Government of National Capital Territory of Delhi has flagged off initiatives to drive transition to electric mobility and fight air pollution caused by vehicular emissions. It recently earmarked `100 crore for electric vehicles (EVs) in the annual budget for 2019-20. Charging stations are being planned at public areas such as government offices, metro stations in Dwarka, market places such as Sarojini Nagar and others, in an effort to boost the move towards EVs.
The government has also approved deployment of 1,000 low-floor electric buses. Uttar Pradesh, Himachal Pradesh, Maharashtra, Karnataka, Kerala, and Tamil Nadu have earlier introduced electric buses in their public transport fleet to concur with the Central government’s mission of increasing electric mobility among people. The Centre plans to make at least 30 percent of the total vehicle traffic in India electric by 2030.
Zeroing in on the Cause
Apart from fatal biofuel use in villages, urban India’s living and working spaces are unsafe, too. The US National Cancer Institute says that kitchen counter tops, basements and storage places are sources of radon gas, which is the second leading cause of lung cancer in America. Recently, a study conducted by Delhi University’s Environmental Science Department on 900 people from different social sections over five years indicated that both high and low-level income groups suffered from respiratory problems. In the former, indoor pollution levels rose in the evenings caused by faulty cooking methods, poor ventilation, et al. In the latter strata, it was higher in the mornings and nights because of chemicals and air conditioning.
The perennial culprit—stubble burning—has repercussions on health inside the house too. A study by US-based International Food Policy Research Institute (IFPRI) and partner institutes states that its economic cost for Punjab, Haryana and Delhi is around `2 lakh crore a year. Experts say it elevates the risk of lung cancer, stroke, heart attack and respiratory diseases, including asthma, among all age groups. The report identifies some of the major sources or causes of ambient air pollution. “Industries, households, cars, and trucks emit complex mixtures of air pollutants, many of which are harmful to health. Of all these pollutants, fine particulate matter has the greatest effect on human health,” it says. “Most fine particulate matter comes from fuel combustion, both from mobile sources such as vehicles and from stationary sources such as power plants, industry, households, agriculture or biomass burning,” the report adds.
To lower indoor pollution may not be child’s play, but it isn’t rocket science either. The first and foremost thing needed is proper ventilation across all buildings. Good ventilation lowers moisture and CO2 levels and also brings down concentration of VOC within the premises. “It is unfortunate that most of us do not even think about proper ventilation while designing residential and commercial structures,” says Mukesh Khare, professor of Civil Engineering in IIT, Delhi. In 2017, a Ministry of Environment and Forests committee under his chairmanship established the parameters to check indoor air pollution and formulated guidelines to control it. “We need to start ‘occupancy level surveys’ in malls, schools and hospitals to monitor and control indoor air pollution. Most importantly, we need to create awareness about keeping indoor air clean,” Khare says.
People should be taught alternate methods of cleaning the house and use environmentally friendly products, explains Dr Saha. Keeping indoor plants that release oxygen at night is a rising awareness trend in cities. As executive director of Greenpeace South East Asia, Yeb Sano, said in a statement, “Air pollution steals our livelihoods and our futures, but we can change that. In addition to human lives lost, there’s an estimated global cost of $225 billion in lost labour and trillions in medical costs. This has enormous impacts, on our health and on our wallets.”Home is where the heart is. It is also where the lungs are.
Home Toxic Home
In India, of 0.2 billion people using fuel for cooking, 49 percent use firewood, 8.9 percent use cow dung cakes, 1.5 percent use coal, lignite, or charcoal, 2.9 percent use kerosene, and 0.5 percent adopt other means. Only 28.6 percent use liquefied petroleum gas (LPG), 0.1 percent electricity, 0.4 percent biogas. Each year, close to four million people die pre-maturely from illness attributable to household air pollution.
It causes non-communicable diseases including stroke, ischaemic heart disease, chronic obstructive pulmonary disease and lung cancer. Close to half the deaths due to pneumonia among children under five years are caused by particulate matter (soot) inhaled from household air pollution. It is also a risk factor for acute lower respiratory infections in adults, and contributes to 28 percent of all adult deaths to pneumonia.
Twelve percent of all pre-mature deaths due to stroke can be attributed to the daily exposure to household air pollution arising from cooking with solid fuels and kerosene. Approximately 17 percent of pre-mature lung cancer deaths in adults are attributable to exposure to carcinogens from household air pollution caused by cooking with kerosene or solid fuels like wood, charcoal or coal. The risk for women is higher, due to their role in food preparation.
More generally, small particulate matter and other pollutants in indoor smoke inflame the airways and lungs, impairing immune response and reducing the oxygen-carrying capacity of the blood. There is also evidence of links between household air pollution and low birth weight, tuberculosis, cataract, nasopharyngeal and laryngeal cancers.