Air pollution also remained the second leading risk factor after malnutrition in India as a whole, posing a significant and growing challenge to population health, said the report jointly prepared by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and Institute for Health Metrics and Evaluation (IHME).
While outdoor air pollution caused 6.4% of India’s total Disability Adjusted Life Years (DALY) (measure of overall disease burden, expressed as the number of years lost due to ill health, disability or early death) in 2016, household air pollution caused 4.8%.
State-wise, the DALY rate pattern for outdoor air pollution was highest in Haryana and Uttar Pradesh, followed by Punjab, Rajasthan, Bihar and West Bengal. Outdoor air pollution increased due to a variety of pollutants—from power production, industry, vehicles, construction to waste burning.
“This risk factor encompasses both outdoor air pollution from a variety of sources as well as household air pollution that mainly results from burning solid fuels in the home for cooking and heat," the report said.
“Combined, they make a substantial contribution to India’s burden of cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections. The contribution of air pollution to disease burden remained high in India between 1990 and 2016, with levels of exposure among the highest in the world. It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections," it said.
The summary exposure value of outdoor air pollution increased by 17% in India from 1990 to 2016 and the magnitude of this exposure was higher in the Empowered Action Group (EAG) states group as compared with the North-East and Other states groups. EAG states are socioeconomically backward such as Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh and Assam.
According to the report, progress has been made in India in reducing household air pollution from solid fuels, yet this remains a significant problem, particularly in the EAG states and Assam. For household air pollution, too, the DALY rate in 2016 was higher in the EAG states and Assam, with the highest rates in Rajasthan, Bihar and Uttar Pradesh.
“Concerted efforts are needed to curb the sources of this pollution, including power production, industry, vehicles, construction and open burning. Controlling air pollution has to be one of the highest priorities for improving the health of India’s population that would impact generations to come," the report recommended.
Last week air pollution levels touched “severe" and “emergency" levels in the Delhi-NCR region. Following that, the Environment Pollution (Prevention and Control) Authority (EPCA), which is tasked with implementation of the comprehensive pollution-tackling plan in Delhi-NCR cleared by Supreme Court last year, came out with a series of measures to control it. It had suggested measures like closure of brick kilns and stone crushers, intensification of public transport services, increase in the frequency of Delhi Metro services, intensification of mechanized road sweeping and sprinkling of water, continuation of the ban on use of generator sets in Delhi, immediate enhancement of parking fees by four times, ban on use of coal and firewood in hotels and eateries.
“The situation is grim with respiratory diseases such as asthma being more protracted due to the severely poor air quality. This is leading to longer recovery time, more dependence on steroids, antibiotics and inhalers. The situation will continue till the pollution levels are brought under control urgently," said Vivek Nangia, director and head of the department, pulmonology, Fortis Hospital.
The air pollution situation is worsening day by day. On Tuesday evening, the air quality index of Delhi-NCR was at 397 (very poor category)—nearly four times the satisfactory levels. The average levels of the two deadliest air pollution components—particulate matter (PM) 10 and PM2.5—across Delhi NCR on Tuesday was 347 (over three times the safe limit) and 397 (nearly seven times the safe limit), respectively.
“Air pollution triggers bronchospasm and chest congestion that can lead to infections including influenza and pneumonitis. The best treatment remains prevention. Apart from staying away from smoke, dust and all other trigger factors, vulnerable people should take vaccines at the start of the season. Two best vaccines for such purposes could be vaccine against influenza and vaccine against pneumococcal infections," Rajesh Gupta, consultant physician, Apollo Hospital, said.
The report has also shown that malnutrition is the largest risk factor in India and the burden of non-communicable diseases (NCD) are unabatedly increasing in India.
Anoop Misra, chairman, Fortis-C-DOC Centre for Diabetes, Metabolic Diseases and Endocrinology, and chairman, National Diabetes, Obesity and Cholesterol Foundation, said, “In health problems, India is suffering from double jeopardy; diseases related to under and over-nutrition. Also air pollution has become a major concern now. Those states where health transition is rapidly occurring (increase in heart disease, diabetes) are also most urbanised and mechanised. But such changes are dynamic, and will quickly march over to other states. In view of this, several National Control programs need not only strengthening but capacity building to tackle deluge of NCDs."