Opinion | Air pollution and child health: Time to act is now!

According to a World Health Organization (WHO) report, every day around 93 per cent of the world’s children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk.

Both outdoor and household air pollution is a threat to health across the globe.

More than 40 per cent of the world’s population is exposed to high levels of household air pollution from mainly cooking with polluting technologies and fuels.

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Air pollution was the 4th leading risk factor for early death worldwide in 2019 (State of Global Air 2020). Air pollution is estimated to have contributed to 6.67 million deaths worldwide in 2019.

The air quantity index (AQI) is a way to measure air pollution levels. It takes into account five chief pollutants, including PM10 and PM2.5. More than half of the Indian population gets exposed to PM2·5 greater than the annual limit recommended by the National Ambient Air Quality Standard. Lancet study estimates that 8.8 per cent of under-5 deaths in India could be attributed to air pollution in 2017.

According to the 2019 World Air Quality Report, India is home to 21 of the 30 most polluted cities in the world, where air quality can be as much as ten times over the safe limits of air pollution recommended by WHO.

Why are children at higher risk?

Children are more susceptible than adults to air pollution as their lungs, brains and immune systems are still developing and their respiratory tracks are more permeable. Children also breathe more air per kilogram of body weight, so their exposure to air pollution is much greater than adults.

What are the effects of air pollution on children’s health and development?

Air pollution is one of the leading threats to child health, accounting for almost one in 10 deaths in children under five years of age. Air pollution can also cause asthma, childhood cancers, chronic diseases, poor lung function, pneumonia and other types of acute lower respiratory infection.

Together, household air pollution from cooking and ambient (outside) air pollution cause more than 50 per cent of acute lower respiratory infections in children under 5 years of age in low- and middle-income countries.

Every third child in Delhi has impaired lungs due to the high level of pollutants that are present in the city's air.

A study from Bangladesh found a pneumonia incidence among children under 5 increased by 3.2 per cent for every PM2.5 increase of 10 micrograms per cubic meter of air -- a standard measure in air pollution analysis.

Pregnant women exposed to polluted air are more likely to give birth prematurely and have small, low birth-weight children.

Air pollution accounts for 20 per cent of newborn deaths worldwide, most related to complications of low birth weight and preterm birth. Of neonatal deaths attributable to air pollution, nearly two-thirds are related to household air pollution.

A recent study from India revealed a negative impact of exposure to air pollution during the first trimester of pregnancy on child growth indicators. Prolonged exposure to polluted air also negatively impacts neurodevelopment in children. Air pollution affects children's learning process by exacerbating respiratory illnesses, fatigue, school absenteeism and attention problems.

The relationship of air pollution and covid pandemic on child health is interesting. Lockdowns resulted in a temporary reduction in air pollution levels but the situation has become worse again after lifting of covid restrictions. There is also evidence that air pollution may increase the risk of covid infection by affecting the body’s immunity.

Government’s Response

Several factors have been identified for polluted air, namely- Industrial emissions, automobile emissions, stubble burning, construction and demolition activities, use of unsafe fuels for cooking etc.

India has taken several steps at the central and state level to control pollution and improve air quality—be it the use of CNG, the odd-even measures in Delhi, the Pradhan Mantri Ujjwala Yojana for clean fuel, or the National Clean Air Programme.

National Clean Air Programme (NCAP) is a long-term, time-bound, national-level strategy to tackle the air pollution problem across the country in a comprehensive manner.

In addition to the COVID-19 pandemic, NACP implementation has faced a number of challenges. The program also focussed on 122 big cities only. A parliamentary committee too has acknowledged the lack of air pollution data from smaller cities and towns and the need for more transparency in the monitoring of NACP.

A large scale survey study from India found a homogenous effect of air pollution on child health in both NACP and non-NACP cities.

Save the Children’s Role

Save the Children advocates for the need for clean air, through participation in Multisectoral convergence meetings at the national and state levels on child health- where air pollution is also part of discussions.

The organisation advocates and works for ensuring a safe environment, especially in schools and anganwadis.

Save the Children with partners have supported the Ministry of Health & Family Welfare, Government of India in drafting Childhood Pneumonia Management guidelines that include reduction of air pollution as a key preventive intervention.

Way Forward

With the recent announcement by Prime Minister Narendra Modi that India aims to achieve net-zero carbon emission by 2070, the time to act is now.

The right combination of political will, appropriate implementation, and a strong compliance mechanism from both the government and private sector are required to move forward.