AIR POLLUTION, RESPIRATORY DISEASES, AND OUR STEPS TO ADDRESS

By: Erni, Adhella Menur

Breathing is a vital right for every living creature, and good air quality is essential for environmental survival and sustainability. Concerns over air pollution levels continue to grow, as over 95% of the world’s population breathes polluted air. Air pollution is described as a ‘silent public health emergency’ and ‘the new tobacco’ by Dr. Tedros Ghebreyesus, the World Health Organization’s General Director, during the first WHO Global Conference on Air Pollution and Health. It adversely affects our lives, impacting health, society, and the economy. Therefore, understanding air pollution and its impact on health is crucial for society to create a better quality of life.

What is air pollution?
Air pollution is a condition where the air is contaminated with chemical, biological, and physical sub-stances, negatively affecting living creatures and the environment.1 Often seen as a cloud causing hazy air, commonly known as smog (a combination of ‘smoke’ and ‘fog’), air pollution is assessed through air quality monitoring. This involves measuring the concentration of hazardous substances in an area’s air over a certain period. The higher the pollution levels, the worse the air quality and the greater the impact on health.

What is the source of air pollution?

Most air pollution is man-made, originating from anthropogenic sources such as factory emissions, households, motorcycles, cars, planes, etc. Second-hand cigarette smoke is also considered a form of air pollution. Natural sources, like smoke from wildfires or volcano eruptions, also contribute to air pollution. The WHO releases air quality guidelines, prioritizing six types of air pollutants based on their significant health impact and defining their Air Quality Guideline (AQG) levels².

How safe is our breathing air?

According to a WHO statement, 99% of the world’s population breathes air that falls below the standardized quality, containing pollutants exceeding AQG levels. From 2010 to 2019, around 6,743 human settlements in 117 countries were monitored for their annual mean concentration of PM2.5, PM10, and NO2 in the air. The results revealed that only 10% of the population in these settlements were exposed to annual mean levels of PM2.5 and PM10 below the AQG level, predominantly in high-income countries of America and Europe³.

Air quality in high-income countries has improved over the past decade. However, in low- and middle-income countries, pollutant concentrations still exceed the WHO threshold due to overpopulation, economic growth, and urbanization, which increase the burning of fossil fuels2. In the Eastern Mediterranean and South-East Asia regions, PM10 levels were recorded at approximately six to eight times greater than the AQG level, with none of the countries in these regions meeting the AQG standard for PM annual mean concentration.

As part of the South-East Asia region, Indonesia also experiences high pollution levels. The air quality deteriorated drastically during the 1998-2016 period, as PM2.5 concentration increased by 171%, making Indonesia one of the twenty most polluted countries globally. In subsequent years, PM2.5 concentrations tended to stabilize with minimal changes4. The level of PM2.5 rose again after wildfires in the Kalimantan and Sumatra areas in 2019, reaching a concentration value of 51.7µg/m³. Recent data recorded that the level of PM2.5 decreased over the last three years, with a concentration value of around 30.4 µg/m3 in 20225. However, this concentration is still far above the AQG level for PM annual mean concentration defined by the WHO. Long-term exposure to such unhealthy air, even at low pollutant levels, is known to cause adverse health outcomes. Residents in Jakarta, the capital of Indonesia, face a daily onslaught of smog. Data from the Swiss air quality technology company IQAir shows that Jakarta has consistently ranked among the ten most polluted cities globally since May 2023. The lack of atmospheric moisture during the dry season, combined with high emissions from factories, coal-fired power plants, and traffic congestion, results in dangerously high pollution levels.

How does air pollution impact our health?

Polluted air contains hazardous substances that lead to health and environmental consequences. In 2019, air pollution was estimated to cause 6.67 million deaths worldwide, becoming the fourth leading risk factor after hypertension, tobacco smoking, and unhealthy diets. Exposure to fine particulate matter (PM2.5) is a significant factor in respiratory and cardiovascular diseases. Long-term exposure to ambient PM2.5 pollution contributed to 62% of all air pollution-related deaths, approximately 4.14 million, in 2019. Generally, short-term exposure to pollutants can cause intoxication, acute respiratory diseases, or trigger existing conditions like asthma. Many parents have reported their children’s health issues, which general practitioners and pediatricians confirm with the increasing number of acute respiratory infections and asthma attacks during periods of worsened air pollution. Long-term exposure to air pollution is linked to chronic obstructive pulmonary disease (COPD), lower-respiratory infections (e.g., pneumonia), lung cancer, ischemic heart disease (IHD), stroke, type 2 diabetes mellitus, adverse birth outcomes (e.g., preterm birth, low birth weight), neurocognitive disorders (e.g., Alzhei-mer’s), and other effects (e.g., chronic kidney diseases)6. Additionally, the University of Chicago’s Energy Policy Institute (EPIC) recently reported that rising air pollution could reduce life expectancy by more than five years per person in South Asia.

How is air pollution potentially linked to respiratory diseases?

Respiratory diseases are strongly associated with air pollution, which leads to high mortality and morbidity rates among other health consequences. State of Global Air data indicates that air pollution contributed to deaths from COPD, respiratory tract infections, and cancer by 40%, 30%, and 19%, respectively.

Several studies have demonstrated the impact of pollut-ed air on the human respiratory system. Air pollutants alter cellular responses in respiratory cells through four mechanisms ^7-8:

1. Inducing inflammation responses of respiratory tract cells.
2. Impairing macrophage function in pathogen clearance.
3. Altering cellular receptors for pathogen binding.
4. Modulating commensal bacteria within the respiratory tract.

What steps can be taken to address air pollution?

Addressing air pollution needs strong commitment, effort, and consistency from the individual level to stakeholders and policymakers. To effectively address the issue, it is crucial to apply sustainable measures in collaboration with research-based information. Investments supporting affordable and sustainable access to clean energy must be campaigned. Air pollution legislation must be harmonized and updated, and policymakers should decide on designing comprehensive environmental and health protection tools.

As the main source of pollutants is generated by anthropogenic activity, we are responsible for making wise decisions in daily life to reduce air pollution. We can strive to change our way of life to improve the quality of the air we breathe by taking the following simple steps:

• Limit vehicles use by taking public transportation, cycling, or walking to move from one place to another. Choosing to use electric vehicles is an alternative to reducing the number of pollutants produced by fuel combustion.
• Save the energy by using the electronic devices wisely. Turn it off whenever the devices are not in use.
• Use renewable energy to provide power, starting from the house. Choose clean energy to cook. Stop burning wood to heat/ cook inside the home.
• Minimize the amount of waste we produce every day. Be responsible with our wastes by sorting, recycling, and composting but never burning the trash.
• Plant and care for trees. Trees filter pollutants and absorb carbon dioxide. Trees also release oxygen into the atmosphere and help cool our homes.
• Monitor the air pollution level daily. Take necessary precautions such as using proper masks, avoiding high-traffic areas, limiting outdoor activities, especially when the air quality is not healthy or in vulnerable conditions, and consuming healthy food rich in antioxidants.
• Keep raising awareness about the dangers of air pollution.

It will be tiring and take time, but a brighter and cleaner future for the next generation and our earth is worth fighting for.

References:

1. World Health Organization. Air Pollution. Available online: https://www.who.int/health-topics/air-pollution (accessed on 10 November 2023).
2. World Health Organization. 2021. WHO Global Air Quality Guidelines: Particulate Matter (PM2.5 and PM10), Ozone, Nitro-gen Dioxide, Sulphur Dioxide and Carbon Monoxide. Geneva: World Health Organization. p74-142.
3. World Health Organization. 2023. WHO Ambient Air Quality Database, 2022 Update: Status Report. Geneva: World Health Organization. p9-15.
4. Greenstone, Michael, Qing (Claire) Fan. 2019. Indonesia’s Worsening Air Quality and its Impact on Life Expectancy. Chica-go: Air Quality Life Index.
5. IQAir. World’s Most Polluted Countries & Regions. Available online: https://www.iqair.com/world-most-polluted-countries (accessed on 10 November 2023).
6. Health Effect Institute. 2020. State of Global Air 2020, A Special Report on Global Exposure to Air Pollution and Its Health Impact. Boston, MA: Health Effect Institute.
7. Monoson, Alexys, et al. 2023. Air Pollution and Respiratory Infections: The Past, Present, and Future. Toxicological Sciences. Volume 192, Issue 1.
8. Bălă, Gabriel-Petrică et al. 2021. Air Pollution Exposure-the (In)visible Risk Factor for Respiratory Diseases. Environmental Science and Pollution Research International. Volume 28,16: p19615-19628