Black lungs—and a heart's struggle to beat right

Leading public health experts discussed evidence linking air pollution to cardiovascular diseases and cancer at the Centre for Policy Research on Wednesday, 20 December. Mr Bhargav Krishna, who manages the Centre for Environmental Health at the Public Health Foundation of India (PHFI), emphasised that air pollution is not just a Delhi-NCR problem: over 99% districts in India don’t meet the WHO’s standards for acceptable air quality.  Household sources contribute to both indoor and outdoor air pollution, and as a country, making the switch to LPG would require widespread behavioural change.

Contrary to popular belief, effects of air pollution aren't confined to respiratory issues—a large proportion of the burden of disease comes from strokes, heart attacks and other cardiovascular diseases. Air pollution is also the leading risk factor for Disability-Adjusted Life Year (DALY), a measure of lost productivity. DALYs attributable to air pollution are heavily distributed among the states of the Indo-Gangetic Plain, spanning most of northern India.

Prof. D. Prabhakaran, who heads the Centre for Control of Chronic Conditions at PHFI, further established the connection between cardiovascular diseases (CVD) and ambient air pollution. He stated that poor air quality increases risk of hypertension, diabetes, heart attack, stroke, peripheral artery disease and cardiac arrhythmia. It is a known endocrine disruptor, causing inflammation and metabolic abnormalities. Furthermore, Vitamin D deficiency may be linked to air pollution. The risk of death and disability related to cardiovascular disease is further compounded in people who already suffer from these diseases, increasing by as much as 25%.

Dr. Preet Dhillon, associate professor at PHFI’s Centre for Control of Chronic Conditions, gave an overview of the link between air pollution and cancer. For men and women, lung cancer is the most common type worldwide. Studies have consistently attributed lung cancer to air pollution—in terms of mechanism, and in both animals and humans. Outdoor air pollution, a group 1 carcinogen, triggers a cascade of events that result in tumour formation. Hormone-receptor-positive breast cancer has also been linked to nitrogen dioxide and PM2.5. Dr. Dhillon mentioned the methodological challenges with respect to studying cancer and air pollution, such as the typically long latency period for cancer outcomes and the need to study thousands of people.

Concluding the two-hour seminar, Prof. Prabhakaran spoke about the ‘uphill task’ of creating pollution-related awareness in the medical community—particularly among cardiologists—and addressing caveats in research. The panel agreed that instead of fatalism, the right approach to solving the air crisis would involve cost-effective solutions, setting time frames, holding authorities accountable, protecting vulnerable individuals and packaging all information in accessible formats.

Aakriti Bajaj
Aakriti briefly volunteered as Manager, Community Outreach at Care for Air. It was a dark, smoggy morning in New Delhi when she wrote to us, wanting to help. She soon became responsible for handling content and communication at CFA. Aakriti has a postgraduate diploma in Communication for Development from Xavier Institute of Communications, Mumbai, and a bachelor's degree in Mass Media and Mass Communication from Indraprastha College, University of Delhi. We wish her luck in her future air-pollution related ventures.

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