Delhi’s foul air: Alarm bells for India’s health

Patralekha Chatterjee

Does Delhi’s winter of discontent, its headline-grabbing smog, really matter? Should someone living thousands of kilometres away, in another part of the country, care about the troubles of India’s capital as we choke and as our children grapple with severe respiratory diseases and get used to spending more and more time indoors?
The answer, in my view, is an unequivocal yes. Because, while Delhi’s air quality is particularly bad right now, we are not the only ones breathing poisonous air. Allahabad, Kanpur, Firozabad and Lucknow, to name just four, are among the most polluted cities in the world. More to the point – the indifference of the political class to the plight of Delhiites is symptomatic of a much larger malaise – according low priority to the health of ordinary Indians.
Delhi’s foul air is not a new problem. We know what the reasons are; we also know the solutions. Other cities like Beijing, grappling with poisonous air, have put in place time-bound measures to improve the situation. Here, in stark contrast, we have been watching blame games and a political slugfest between chief ministers. A Union minister, who is also a medical doctor, has declared that while air pollution was certainly harmful, “to attribute any death to a cause like pollution may be too much”. Unfortunately, however, that is not what public health advocates in India and around the world are saying.
Nothing is taken seriously unless you can put a figure to it. So, let us talk the money talk surrounding just one key reason behind Delhi’s current woes. A recent report in a national newspaper noted that this season’s stubble-burning in northern and northwestern India, believed to be hugely responsible for the current smog looming over Delhi, could have been avoided if the Centre and the states concerned had agreed on a formula to share the burden of a new financial incentive package to deter farmers from burning their crops. The tab was Rs 3,000 crores. But alas, the states and the Centre could not agree on who would pay for what and the plan has remained just that, the last time that I checked.
What is Rs 3,000 crores? A simple Google search threw up some interesting findings. The 210-metre-high statue of Chhatrapati Shivaji Maharaj, expected to come up off the Mumbai coastline by 2020, is likely to cost roughly that figure, according to current estimates. India is developing its first unmanned combat aircraft, under the ambitious project Ghatak, and the government has allocated Rs 3,000 crores to develop the drones or Unmanned Aerial Vehicles (UAVs), which can deliver bombs and missiles.
Clearly, there is a cost to everything we do. Equally, there is a cost to what we don’t do. Nowhere is this more evident than in health, which goes beyond just the impact of air pollution.
This week, the release of the first-ever “Health of the Nation” state-level disease burden study put together by the Indian Council of Medical Research (ICMR), the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME), a global health research institute, in collaboration with the health and family welfare ministry, has thrown up some disturbing findings which have serious implications for India’s future and aspirations.
The report shows that while Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand, Bihar and others deemed socio-economically backward in many respects and clubbed under “Empowered Action Group” are still waging a battle against child and maternal malnutrition and persistent infectious diseases, other states which are more “developed” with higher GDP also have serious health problems in the form of non-communicable or lifestyle diseases. In fact, every Indian state now has a higher burden from non-communicable diseases and injuries than from infectious diseases, the extent of which varies widely between the states. Kerala, Goa, and Tamil Nadu have been found to have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases. This trend is present but much lower in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan.
The basic point in the scientific findings which have also been published in the Lancet, a globally-renowned medical journal, is simply this: India just can’t afford to be complacent about the health of its citizens as it faces a dual burden. While the old problems of maternal and child health and communicable diseases persist in many states, lifestyle or non-communicable diseases such as heart diseases, cancer, diabetes, etc are on the rise, and accounted for 55.4 per cent of the country’s disease burden in 2016, up from 30.5 per cent in 1990.
What does this mean? There is a lot of talk about premature deaths due to various diseases and how many Indians go bankrupt paying for their medical care. But let me flag another chilling concept, mentioned in the study. This is YLD, or Years Lived with Disability, a measure that takes into account the number of individuals suffering from disability, which, in this context, means non-fatal poor health as a result of disease or injury and also the severity of this disability. Here is just one figure that leapt out at me – the contribution of YLDs to the total disease burden increased in India from 17 per cent in 1990 to 33 per cent in 2016. Most of this was due to non-communicable diseases but iron deficiency anaemia was also a leading cause in many states, accounting for 11 per cent of disability in India in 2016.
These are not mere numbers. They have moral, ethical and economic consequences.
When India wants to do something, it has shown time and again that it can. One needs to look at how India successfully battled polio, once considered an impossible feat. Now is the time to put health of ordinary Indians on the front burner, on top of the political agenda.
Prime Minister Narendra Modi’s flagship campaign Swachchh Bharat Abhiyan would not quite live up to its name if the air, water, soil of this country continued to be poisonous, taking the toll of the health of millions of its citizens.