By Dr. Ankush K. Bansal
The United Nations Climate Action Summit was held in New York at the United Nations Headquarters on September 21-22, 2019. This weekend prefaced the high-level meetings by heads of state and government officials from around the world that started on September 23. Representatives from governmental and non-governmental organizations from around the world attended.
One of the tracks was on air pollution, entitled, “Climate Action for Health: Cut Emissions, Clean Our Air, and Save Lives,” moderated by Lucia Ruiz Ostoic, the Minister of Environment for Peru. There was also a special appearance, speech, and plea by Dr. Tedros Ghebreyesus, Director-General of the World Health Organization (WHO).
An informative and sobering presentation, a call to action, was given by Dr. Arvind Kumar, a leading pulmonologist in New Delhi, India. New Delhi has one of the highest levels of air pollution globally, a fact that I can personally attest to, with PM2.5 levels consistently many times over the maximum safe limit. In 2018, the average PM2.5 level was 14.3 times over the safe limit. This was equivalent to smoking 6.5 cigarettes per day. In fact, a teenager living his/her whole life in the Delhi Metropolitan Area (DMA) had the level of pollution and particulate matter in his/her lungs as a lifelong smoker, even if this teenager never smoked a single cigarette. Furthermore, from 1988 to 2018, the rate of lung cancer among non-smokers in the DMA rose from 10% to 50%, with the average age of diagnosis dropping from 50-60 to 30-40, even factoring in earlier diagnosis during this same time period, and an increase in diagnosis in women rising from almost non-existent to 40%.
The most sobering statistic for populations is that based on previous studies, breathing polluted air was equivalent to smoking at a rate of 22 mcg/m3 of pollutants, equal to 1 cigarette. This included newborns and children, in whom exposure has been found to result in neuroinflammation and reduced cognitive development. In adults, it increases the risk of stroke by at least 5 times. Additionally, air pollution results in infertility, miscarriage, preterm and low-birth-weight infants, and congenital abnormalities. Up to 7 million premature deaths per year worldwide have been attributed to air pollution according to the WHO. This is why reducing air pollution and mitigating its effects is so critical and emergent.
Leaders from government and non-governmental organizations provided examples of solutions, trials, and collaborations to tackle this. While the DMA may be one of the most extreme examples in the world, air pollution affects all of us. The mayors of Accra and Seville; the Ministers of Health, Environment/Climate, or Energy from the United Arab Emirates, Finland, and Norway; the European Union Commissioner for Environment; and the Directors of Healthcare Without Harm and the Clean Air Fund made presentations on work being done. Cities in Spain and in South America are working together to reduce air pollution by redesigning cities through decentralization of services, increasing bicycle and pedestrian lanes with improvement in access to social, occupational, and retail services through decentralization.
Furthermore, some cities are utilizing pollution sensors with less expensive versions being developed so that the population can be notified accordingly. While these measures will result in some improvement in local pollution levels and future city planning/development, the causes of air pollution on a larger scale need to be addressed fully and urgently. Here, the national ministers provided examples of how their governments are committed to solutions. However, no specific examples beyond voluntary international agreements were provided. Partially because of this, the Clean Air Fund was created and was formally introduced to the world in the subsequent days at the United Nations to bring awareness and encourage pressure on governments to act.
It is of note that recent research has shown that air pollution, particularly among the wealthiest nations, is increasing, contrary to what scientific consensus strongly recommends occur as soon as possible. For example, in the United States, in 2018, there were an additional 10,000 deaths attributed to air pollution, specifically PM2.5 pollution, compared to 2 years prior. This was after a decline to almost half from 2000 levels. Even if the increase in wildfires in the western United States during the preceding 3 years were considered, the rise in air pollution is still remarkable.
Therefore, as physicians who encounter the effects of climate change regularly, including air pollution, it is our responsibility to advocate for our patients’ health to our respective governments. Decentralization, pedestrian and bicycle-friendly cities, and pollution sensors are a start but even as the mayors and ministers present at the Summit stated, it is not enough or comprehensive.
Ankush K. Bansal, MD, FACP, FACPM, SFHM is an Associate Member and Representative to the General Assembly of the World Medical Association, a PSR Florida board member, Co-Chair and Co-Founder of Florida Clinicians for Climate Action, and Co-Chair and Co-Founder of the Palm Beach Chapter of the Climate Reality Project.