WHO report

Half of all deaths due to acute lower respiratory infections, which include pneumonia and influenza, in children below five years is caused by exposure to high air pollution levels in lowand middle-income countries, estimates WHO.

Across the world, at least 600,000 children died from acute lower respiratory infections caused by air pollution in 2016.

India also has one of the highest morbidity and mortality rates: at least 50 deaths for every 100,000 children due to such infections.

Globally, premature birth is the only other factor that kills more children below five years than acute respiratory infections. In the African region, however, acute respiratory infections are the leading cause of death of children in that age group.

When asked about the details of the methodology for the country-wise mortality figures, WHO said the sources to assess PM2.5 exposure was scientific modelling, ground measurements (provided by the likes of the Central Pollution Control Board in India) and satellite data. The methodology to assess risks associated with PM2.5 exposure is the one used in the Global Burden of Disease, a study on health impacts from various sources.

WHO has also put together a list of health effects that children may be facing from air pollution, taking into account significant research studies published in the past 10 years and inputs from experts around the world.

Poor birth outcomes like low birth weight and a rise in preterm births and stillbirths due to the mother’s exposure to high air pollution levels have been mentioned in past research.

WHO’S review has established that air pollution can also lead to behavioural disorders such as autism spectrum disorders and attention deficit hyperactivity disorder; adverse metabolic outcomes such as obesity and insulin resistance; occurrence of otitis media (an inflammatory disease of the middle ear); and higher risk of retinoblastoma (cancer of retina) and leukaemia (blood cancer) in children.

The report says that there is substantial evidence that exposure to road traffic-related air pollution or diesel exhaust is associated with childhood leukaemia.

Authors of the study have listed why children are the most vulnerable to air pollution exposure and the various pathways through which air pollution affects their health — which include inhalation and ingestion of pollution particles.

As children breathe at twice the rate that adults do, they inhale larger amounts of air pollutants. Pollution particles are also moved through the respiratory system faster, allowing them to reach the lungs, the alveoli and the bloodstream more rapidly, according to the study.

Children are also more physically active than adults; so their ventilation is even greater. They are closer to the ground, where pollution concentrations are higher. Certain pollutants (small enough to penetrate the alveolar wall) inhaled by a pregnant mother can enter her bloodstream and then cross the pla- cental barrier and reach the foetus, and, in turn, affect the baby’s growth and development.

Children are also exposed to pollutants through mother’s milk. Pollutants from industrial sources, such as pesticides, fossil fuels, chemical by-products, flame retardants, heavy metals and volatile organic compounds, can enter the mother’s circulation by inhalation or, more commonly, ingestion before being passed into breast milk, the report says. For example, polycyclic aromatic hydrocarbons (PAHS), a toxic and carcinogenic compound, have been reported at high levels in breast milk samples in the Mediterranean.

WHO finds a strong correlation between poverty and exposure to air pollution. Children in low-income communities suffer disproportionately higher effects of air pollution. “Poverty causes people to rely on polluting energy sources for their basic needs, and poverty compounds the health risks associated with their use. Poverty also limits people’s capacity to improve the environment in which they raise their children,” the report says. Female children are worst affected, and more girls than boys die premature due to air pollution in India, says WHO data.

Dr SK Chhabra, head of department (pulmonary, sleep and critical care medicine) at Primus Super Speciality Hospital, is not surprised with the WHO findings. He led a study last year at the Vallabhbhai Patel Chest Institute, which found that children in Delhi have a far lower lung capacity and lung growth rate compared to children of the same age in the United States.

“We have already reported that lung growth rate among Indian children is retarded. Nutritional deficiencies, protein and vitamin D deficiencies only compound the problem. Our experience shows that children under five are more impacted by indoor air pollution because of biomass burning within the house.”

Dr Rahul Nagpal, paediatric consultant with Fortis hospital, said: “The first impact of air pollution is seen on the respiratory system. We see a lot of allergies, infections and prolonged cough and slow response to conventional medication. Otitis media is linked to respiratory disease. The nose and ear are both affected by pollution. The infections significantly go up during this season. Till now about 50% of the hospitalisation cases till now were dengue related now almost all are linked to respiratory infections.” for micro, small and medium enterprises said.

Congress leader and former finance minister P Chidambaram accused the BJP of polarising people on the issue ahead of the Lok Sabha polls. “Every five years before elections, the BJP tries to polarise views on Ram Mandir. Congress’s position is that the matter is before the Supreme Court and everyone should wait until the top court decides... I don’t think we should jump the gun,” he said.

The Ayodhya dispute has slowly returned to the political centre stage over the past few months. Earlier this month, Rashtriya Swayamsevak Sangh (RSS) chief Mohan Bhagwat called for a law for the construction of the temple. On Sunday, Uttar Pradesh deputy chief minister said no one would want a structure named after Mughal emperor Babur in Ayodhya. The Vishwa Hindu Parishad, an affiliate of the RSS, said it would lobby with lawmakers from several political parties during Parliament’s winter session to push for a legislation for the construction of a Ram temple.

BJP ally Shiv Sena, which has also been pushing for the construction of the temple in recent weeks, said the courts won’t do anything in the matter. “We are not paying attention to what the Supreme Court verdict (on Ram Temple issue) is and what date it gives (for the verdict). We don’t want to pay attention. The court won’t do anything in the Ram temple matter,” party leader Sanjay Raut said in Mumbai.

Triloki Nath Pandey, who represents Ram Lalla, said the top court’s decision was unfortunate. “Now, the Centre must bring an ordinance and frame a law for construction of Ram Mandir i n Ayodhya.” But another Hindu litigant, the Nirmohi Akhada, said they will wait for the court’s judgment.

Senior counsel for the Muslim litigants, Zafaryab Jilani, said they wanted the top court to give them a patient hearing before passing a verdict. “It is not for us to condemn or welcome the order,” he said.

Last month, the apex court declined to reconsider its observations in a 1994 judgment that a mosque was not integral to Islam — an issue which had arisen during the hearing of the Ayodhya land dispute. In a 2:1 verdict, a three-judge bench headed by then chief justice Dipak Misra had said the civil suit would be decided on the basis of evidence and the previous verdict had no relevance to the matter.

Sanjay Kumar, director of the Delhi-based Centre for the Study of Developing Societies, said the SC decision will prove to be an advantage for the BJP.

“The BJP too would not like to go to polls in the shadow of a vicious atmosphere, so a delay on the issue will help them to keep the hopes alive. They will be able to go to people with the assurance that something positive is being done and if they are questioned on the delay, they can say that their hands are tied because the issue is in court,” he said.