Green Circle World Environment Day Issue

Understanding Perspectives of Doctors on Air Pollution

Every year June 5th is celebrated as World Environment Day where the United Nations Environment Programme (UNEP) organizes events on a common theme throughout the world to encourage awareness and action for the protection of the environment. This year’s theme happens to be ‘Air Pollution’ which itself speaks about the enormity of the problem at hand.

Air pollution is a silent and invisible killer which has devastating impacts on health causing diseases such as stroke, heart disease, lung cancer, chronic obstructive pulmonary disease, respiratory infections, among others. According to the World Health Organisation (WHO), more than 7 million premature deaths happen every year as a result of exposure to air pollution.

While the issue of air pollution has, in the last few years started to gain significance, managing the effects of air pollution and its associated risks on human health has been a formidable challenge for both policy makers and health professionals. Even though there is evidence base on the linkages between air pollution and its effects on health, there is not much awareness about the same. There is, therefore, an urgent need to engage the public and in doing so, the health professionals in the advocacy process towards achieving a cleaner environment. It is imperative that we understand perspectives of doctors on the health impacts of air pollution and how they can advocate for sustainable, cleaner energy practices.

For this reason, we at Public Health Foundation of India (PHFI) and Centre for Chronic Disease Control (CCDC), undertook a research study aimed at understanding and communicating to the health community, the prevalence of air pollution as a risk factor and the importance of effective communication and outreach to their patients. While the primary objective of this study is to create awareness around air pollution amongst the first responders, doctors in this case, and make them the voice of change, it also aims to facilitate a greater presence of the health rationale in the design and implementation of policies.

Some of the key findings which emerged from interviewing doctors during the course of this study are:

Understanding of ‘air pollution’

While there is some awareness about air pollution and its impacts on health, the knowledge about the topic is not much. It also does not feature very high in terms of priority or is not a topic of conversation which garners much interest within the community of doctors. Not many respondents were able to reflect on the incidences of pollution to correlate those with episodes of increase in patient footfall. There is also a common misconception, that air pollution is a Delhi-centric problem which seems to stem from the greater degree of emphasis on the issue by the media in Delhi.

Training in air pollution and associated health risks

Most doctors reported that the topic of ‘air pollution’ was not a part of their medical curriculum in any detail. Even though it was a topic in the respiratory medicine and social and preventive medicine curriculum, it was not taught in great detail. Given that air pollution has become a serious threat to life, especially in India, be it formal conferences or events or informal meetings of doctors, it does not feature in any conversations. Newspapers and television are the main sources of learning about air pollution.

Practice of environmental history taking

Most respondents stated history taking as an important part of their practice, including socio-economic background of patients and their environmental surroundings. This was true for pulmonologists and pediatricians who could relate with the issue of air pollution in their practice (for example, rising instances of childhood asthma). Cardiologists, however, had the most difficult time associating air pollution as a health risk factor in their practice and also did not spend much time on asking questions about the patient’s exposure to environmental health hazards.

Linking existing data on exposure to air pollution with health impacts

While pulmonologists and pediatricians corroborate with evidence linking air pollution with adverse impacts on health especially diseases such as COPD, lung disease, asthma and respiratory tract infections, other respondents suggest lack of sufficient data to effectively link exposure to air pollution as a serious risk factor over other factors such as smoking. Doctors across the country believe that there is need for more research studies in India in order to strengthen the evidence base linking air pollution and its impact on the cardiovascular system, among others.

Doctors as ‘drivers of change’ in policy

While doctors across categories recognize the harmful effects of air pollution, they believe that they themselves cannot make much of a difference. Almost all respondents interviewed pressed for more action from the government. Most suggested that diesel vehicles be phased out and more solar or electric powered vehicles be promoted. They believe that if the government enforces laws more stringently, it would make people more aware of and take steps to combat air pollution.

Even though the last few years have seen a significant and very visible rise in the levels of air pollution, leading to a sharp increase in the number of people suffering from the ill effects of air pollution, the response to this has been almost inconsequential. Medical associations and health practitioners can become powerful mediums for raising awareness and in translating scientific information to policymakers and to the public in general. Once the medical fraternity is itself more aware of the problem at hand and the mitigation measures, they can be advocates of change to raise awareness as well as dialogue with the government and policymakers to influence decision making for cleaner, healthy air for all.

Written by, Vidushi Bahuguna (Public Health Foundation of India/Centre for Chronic Disease Control)

Water Stress and Impacts on Public Health

The issue of water stress and poor sanitation in India

About 600 million people in India already face high to extreme water stress according to the latest Composite Water Index of 2018 released by Niti Aayog. The index also indicates that India stands at 120th position among 122 countries in the water quality index, with nearly 70% of water being contaminated. According to the estimates of World Bank, around 163 million Indians lack access to safe water and about 210 million lack access to improved sanitation. Due to lack of stringent regulations, industrial and domestic waste water is discharged in rivers, canals and underground water sources. The Composite Water Index of 2018 also highlights that around three-fourth of the households in the country do not have drinking water at their premise. Only about 10% of the generated waste water in India gets treated and the remaining untreated gets discharged as it is into surface water bodies. Thus making water pollution a major problem in India that is impacting the availability of clean water and sanitation practices.

High demand- limited supply

Demand for clean and safe water is increasing whereas the access is getting more difficult. As per the World Economic Forum, by 2030 the demand for water will double its supply. The Central Pollution Control Board's analysis of water quality monitoring results from 1995 to 2009 had indicated microbial contamination as the predominant form of pollution in surface water bodies in India which has been attributed to two main reasons. First, the municipal authorities are unable to treat the ever increasing load of municipal sewage due to which it is ending up contaminating water bodies. Second, the receiving water bodies themselves do not have adequate water available for dilution. This severely limits safe water availability for both human as well as ecosystem consumption through surface water sources.

Due to the lack of availability of clean surface water resources, populations are relying more on the ground water sources. Development and urbanization causes an increase in the built-up area leaving less area as permeable land that is able to recharge the groundwater table. In addition to this, lack of municipal water supply for increased population causes households, particularly in rapidly developing multi-story apartments, to set up their own tube wells to extract groundwater to meet their needs which has caused decline in groundwater table over a long period of time. The situation has worsened due to the uncertain arrival of monsoon. Transformation from small settlements to cities or urban agglomerations is accompanied by infrastructural changes in water and sanitation. Another big challenge faced by the Indian urban water supply system is the lack of finance as most of urban local bodies/municipalities have to depend on the state government to get investment in water supply system. They do not have enough sources for revenue generation at their level to maintain water supply infrastructure.

How does water crisis impact public health?

Microbial pollution in water is significantly responsible for high disease burden in India. World Bank estimates that 21% of communicable diseases in India are linked to unsafe water and more than 500 children under the age of five die each day from diarrhea in the country. Major pathogenic organisms responsible for waterborne diseases and associated illness in India include bacteria (E. coli, Shigella, V cholera), viruses (Hepatitis A, Polio Virus, Rota Virus) and parasites (E. histolytica, Giardia). According to the data presented to Lok Sabha in 2018, diarrhoea caused 6,514 deaths between 2013-2017 in India.

Poor health due to inadequate sanitation practices impose economic burden in countries. In 2016 IndiaSpend reported that India loses 73 million working days due to water-borne diseases. A study conducted by the Water and Sanitation Programme (WSP) in 2010, estimated that inadequate sanitation causes India 'considerable economic losses', equivalent to 6.4 per cent of India's gross domestic product (GDP) in 2006 (US$53.8 billion). Management of wastewater and availability of clean water to populations in order to meet their demands has become an imperative of our cities today. Considering water is a State subject, management of these predominantly lies within the domain of States.

Written by, Ananya Tewari ((Public Health Foundation of India/Centre for Chronic Disease Control)

World Environment Day Mask Challenge at PHFI

Nine out of ten people worldwide are exposed to levels of air pollutants that exceed World Health Organization safety levels. This year, World Environment Day draws attention to the particularly pressing environmental and health concern of Air Pollution. In order to raise awareness and encourage action to protect our environment, United Nations Environment Programme has issued the Mask Challenge. The challenge employs Face masks as a symbol to advocate for clean air.

The Centre for Environmental Health at Public Health Foundation of India hosted the Mask Challenge on June 3.

Together, the participants took on the #Mask Challenge at PHFI and:-

  • Designed and created their own air pollution Mask at the #WED Desk
  • Take a pledge to #BeatAirPollution
  • Shared their action/commitment to combat air pollution

Be a part of UNEP's World Environment Day Mask Challenge, create your own mask and tweet it with the hashtag #BeatAirPollution with an action or commitment you wish to take to combat air pollution.

Upcoming Events & Latest News from GGHH

GGHH Asia Conference 2019- Singapore

Health Care Without Harm -Asia, GGHH and Khoo Teck Puat Hospital (Singapore) are pleased to host the 2019 GGHH Asian Conference.

“Towards sustainable, climate-resilient Asian healthcare”

October 8-10, 2019 in Singapore

Call for proposals deadline extended to June 15th

Please visit the conference site to register.

GGHH 2018 Annual Report

The beginning of 2018 saw GGHH celebrating its biggest milestone in the history of the network: 1,000 institutional members. An important and inspiring moment for GGHH, it served as a broader indicator that sustainable health care is moving into the mainstream in all corners of the world. This accomplishment launched a year highlighted by expansion, evolution and exciting ambitions that are redefining what truly sustainable, climate-smart health care can be.

The 2018 Annual Report features the achievements of the network and members from around the world and showcases exciting programs and initiatives integrating with and mobilizing GGHH.

Click here to Download the GGHH 2018 Annual Report

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Photo credits: Pexels: Free Stock Photos

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