Wednesday, 1 November 2017

Lancet Journal - Pollution the Global Burden of Guilt

Who has to bear the Global Burden Of Disease ?

This year the annual festival of Diwali in India is influencing the country’s social and geological climate long after it’s actual date of 19th  October 2017. After the Supreme Court of India had banned the sale of Diwali Crackers [1] [2] in the National Capital Region of Delhi, the topic was the subject of a lot of debate in India coupled with curiosity regarding the impact of the ban on the ambient air quality.
rottenmangoman Lancet Report pollution blog T.V. grab of typical news channels in India highlighting the increase in pollution levels after Diwali
Breaking News of Scaring News ?

Shortly after Diwali, the media started reporting some reduction in levels as compared to 2016, but cautioned that the levels were still high. The fact that the high pollutions levels were also attributable to the still weather, was not adequately highlighted  [3]. In fact when the region started experiencing favorable weather conditions, the air quality improved. At the same time the Center for Science and Environment [4] argued that the situation could have been worse without the Diwali crackers ban.

“There was a definite decline in burning of firecrackers because of the ban. But the high moisture content and calm winds on Friday (the day after Diwali) trapped pollutants, making some parts of Delhi more polluted than others,” – Central Pollution Control Board member-secretary A Sudhakar.

As if to reprimand the people in Delhi (NCR) of their obstinate behaviour, news of a “study published in the Lancet Journal” was reported by most media houses  [5][6]. By clubbing it in context of the rise in pollution levels after Diwali, it was indirectly implied that bursting Diwali Crackers may cause the death of millions of people in India.

This prompted me to actually read the Lancet Report so as to understand what the study was really all about.

The report of the Lancet Commission on pollution and health comments on data in 2015. It is a two-year project .More than 40 international health and environmental authors led by environmental scientist Philip Landrigan [7] were involved. Prominent authors from India include:

  •    Member of Parliament, Economist and politician (Indian National Congress), former Minister of State for Environment, Mr. Jairam Ramesh [8]
Interestingly, Prof.Khare was also part of the following study  [10] regarding the influence of odd–even car trial on fine and coarse particles in Delhi, which concluded:
 “Any further trial will need to be planned very carefully if an effect due to traffic alone is to be differentiated from the larger effect caused by changes in meteorology and especially wind direction.”

Other prominent Indian origin authors include :

  •    Bindu Lohani [11] - Head of Global Climate Change Practice, Formerly Vice President of Asean Development Bank [12](Knowledge Management and Sustainable Development),
  •    Karti Sandiliya [13] - Member of Advisory Board Madura Micro Finance Limited, Formerly, Country representative of Asean Development Bank.
  •     Gautam Yadama [14] - PhD, Dean and Professor at Boston College School of Social Work (BCSSW).
  •    Niladri Basu [15] - Associate Professor; Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, Canada.
In its introduction the report lists pollution as a major cause of concern both for global health and for the economy. It lists the major reasons for increase in pollution as :

  •        The uncontrolled growth of cities
  •        Rising demands for energy; increasing
  •        Mining, smelting, and deforestation
  •        The global spread of toxic chemicals
  •        Progressively heavier applications of insecticides and herbicides;
  •        An increasing use of petroleum-powered cars, trucks, and buses.
Despite blaming pollution for being linked to several deaths and diseases, it acknowledges, “there are still many gaps in information about pollution and its effects on health.”

The Lancet report consists of 5 chapters with specific recommendations for each chapter.

Chapter 1: The burden of disease attributable to pollution
These include more research on linkages between specific diseases and PM 2.5 air pollution as well as those caused by known and emerging chemicals

Chapter 2 : The economic cost of pollution and pollution related disease
It stresses the need to better quantifying costs of pollution on health as well as the non-health benefits of reducing pollution.

Chapter 3 : Pollution related disease, poverty and the Sustainable Development Goals
As per the Lancet report funding should be provided by international organizations to study the effects of pollution on underprivileged women and girls. International development programs should assist in protecting local communities from pollution and its detrimental effects.

Chapter 4 : Effective interventions against pollution - Priorities, solutions and benefits
Recommendations :
This chapter is the most important as it talks about actual methods and components for controlling pollution. This includes establishing robust systems for monitoring the environment and public health, accountability, having a program to manage chemicals, establishing and enforcing environmental laws as well as engaging with the private sector. The Lancet Report also recommends initiatives to encourage walking and cycling to reduce motorized transport. Most importantly the Lancet Report highlights the responsibility of the governments, foundations, international agencies, civil society , health professionals and interventions against pollution.

Chapter 5: Conclusion – the way forward
This chapter summarizes the various types of pollutions (air, water and soil) and the short, medium, long terms interventions and policy making required to control and counter it.

In the case of ambient air (outdoor) pollution, the interventions include identifying sources of key pollutants, installation of dust management and monitoring systems, mandating fuel quality and engine standards and other requirements for cleaner vehicles, incentivise use of electric/ hybrid vehicles, up-gradation and expansion of public transport fleets, and methods to reduce vehicle use.

The Lancet report talks about “Pollution related diseases”, with air pollution being the largest contributor. According to Wikipedia [16] , the following are the diseases linked to Outdoor air pollution :
Ischaemic Heart Disease(40%), stroke(40%), chronic obstructive pulmonary disease (COPD) (11%),lung cancer(6%), acute lower respiratory infections in children(3%). But curiously, the causative risk factors for the first two diseases are :
Stroke [18]                        :  the main risk factor for stroke is high blood pressureOther risk factors include tobacco smokingobesityhigh blood cholesteroldiabetes mellitus, previous TIA, and atrial fibrillation.

Air pollution does not figure anywhere in the list. In the case of Indoor air pollution, COPD, Chronic Obstructive Pulmonary Disease gets a 22% rating. The causative risk factors for COPD are :  

        COPD [19] : Tobacco smoking,with factors such as air pollution and genetics playing a smaller role. In the developing world, one of the common sources of air pollution is poorly vented heating and cooking fires.
While air pollution has been mentioned as a causative factor , it does not identify Diwali crackers or fireworks as the main agents of air pollution. For the sake of argument, if we assume that the information in Wikipedia has not been updated properly, we only need to go back to the Lancet study which lists in detail the causative factors for air pollution:
Fuel combustionfossil fuel combustion in high-income and middle-income countries and burning of biomass in low-income countriesaccounts for 85% of airborne particulate pollution and for almost all pollution by oxides of sulphur and nitrogen. Fuel combustion is also a major source of the greenhouse gases and short-lived climate pollutants that drive climate change."

It lists the main emitters of carbon dioxide :
  •        Electricity-generating plants,
  •        Chemical manufacturing facilities,
  •        Mining operations,
  •        Deforestation, and petroleum-powered vehicles.
  •        Coal is the world’s most polluting fossil fuel, and coal combustion is an important cause of both pollution and climate change.
The Lancet report further mentions that ambient air pollution, chemical pollution and soil pollution are on the rise. It lists the causative factors as follows :

  •        Industry,
  •        Mining,
  •        Electricity generation,
  •        Mechanised agriculture,
  •        Petroleum-powered vehicles
While the Lancet report clearly associates various factors such as cars and diesel generators for causing air pollution, it also admits, lack of data on how much the air pollution caused affects health – “In the case of fine-particulate air pollution, the shape of the exposureresponse association at both very low and very high exposure levels and the assumptions that underlie the integrated exposure response function used to estimate the relative risks of fine particulate (PM2.5) exposure in both the Global Burden of Disease (GBD) study and WHO analyses are not precisely known.

Page 14 of the Lancet report states, “PM 2.5 is the best studied form of air pollution and is linked to a wide range of diseases in several organ systems. “ It references 2 publications to substantiate this. One is from Global Burden of Disease study and the second one interestingly is a joint policy statement from the European Respiratory Society and American Thoracic Society: what constitutes an adverse health effect of air pollution? [20]
“As discussed, we do not attempt to provide an exact definition or fixed list of health impacts that are, or are not, adverse. Instead, we propose a number of generalizable considerations”, with examples, to evaluate whether or not an effect is adverse. We aim to provide guidance for evaluation of effects that may be identified in the future, not just the ones seen “under the lamppost” of today’s knowledge. How we evaluate whether the literature supports an assessment of adversity is key to our discussion of guidelines. There cannot be precise numerical criteria, as broad clinical knowledge and scientific judgments, which can change over time, must be factors in determining adversity. The WHO has provided one practical framework, categorising evidence of adversity according to benchmarks. The first is that single, not (yet) verified observations by themselves only indicate a need for further research, while the benchmark of adversity is the availability of clear verified evidence for clinical or pathological change.”

The statement in it’s conclusion says, “The authors of this statement have recognised and discussed substantial new areas of human health effects from air pollution, choosing the [21] [22] 
study (Published in the Lancet) as a starting point for the identification of health effects to be considered adverse when convincingly associated with exposure to air pollution.”

This effectively shows that the Lancet Report and the ERS/ATS statements are basing their facts on claims not yet verified and stress upon a need for further research.

The Lancet report strongly disputes postulates of the Kuznets hypothesis which has been extended to environmental economics- That early stage economies and pollutions grow together.
The Lancet report also encourages the merging of Environment and Health Ministries in various countries so as to be able to better understand the influence of pollution on public health.
It advocates promotion of a circular economy [23]based on the three fundamental principles of reducing non- renewable resources, improving resource produces and designing out pollution, greenhouse gas emissions and deadly constituents.
Most importantly the Lancet report identifies the opposition of “powerful vesting interests” as a “perennial barrier” to managing and reducing pollution, specially industrial, vehicular and chemical.
It mentions the fact that budgets for foreign aid from various agencies, private humanitarians, and major institutions have not included significant funding for restriction of industrial, mining and transport-related pollution.
Finally the Lancet report also suggests cost effective and proven approaches and methodologies to control and reduce pollution which could be incorporated both at the country and city level.
References to India
Interestingly on page 12, the Lancet Report notes that “Among the world’s 10 most populous countries in 2015, the largest increases in numbers of pollution-related deaths were seen in India and Bangladesh, as reported by the Health Effects Institute [24]. A major sponsor of Heath Effects Institute is the automobiles industry [25] .

On page 13, the Lancet report states that In 2015, the highest numbers of deaths due to pollution occurred in southeast Asia (3.2 million deaths) which includes India. The report makes this claim on the basis of its own published article[26] authored by GBD 2015 Risk Factors Collaborators, sponsored by The Bill and Melinda Gates Foundation[27][28]. The Los Angeles Times has revealed the Bill and Melinda Gates Foundation has made millions of dollars each year from companies blamed for many of the same social and health problems the foundation seeks to address.

Some of the Indian authors who have collaborated for this article include, Prof Lalit Dandona[29], Rakhi Dandona [30], S Goenka and G A Kumar[31]  - all from the Public Health Foundation of India, New Delhi [32][33]. The founding Chairman of this organization is
Rajat Gupta [34], the same person served a 2 year term in a federal prison for insider trading and advisor to Bill and Melinda Gates foundation. The Public Health Foundation had been had been barred from receiving foreign funds in India [35] by the Home Ministry for “allegedly violating provisions of the FCRA by “diverting” foreign funds for purposes other than intended for”.
Out of these four contributors, at least 3 appear to be related to the Wellcome Trust, United Kingdom.
Several authors of this article declare interest of other sources of income and affiliations as mentioned on page 62 of the article.

On page 29 the Lancet report provides the example of environmental injustice where mineral and metals extraction facilities have been excessively located in the tribal regions of central and northeast India, where almost 70 million tribal people were living in extreme poverty. It claims they are subjected to polluted air, water, and soil on account of these facilities. It refers to a  landmark case linking the mining industry in the tribal belt to environmental injustice, where the Indian Supreme Court observed that the fundamental rights of citizens, guaranteed by the Constitution, included the right of enjoyment of pollution-free water and air for full enjoyment of life.”

On page 30 the Lancet report refers to numerous cities in India and China where the average annual concentrations of PM 2.5 pollution is greater than 100 μg/m3, and more than 50% of global deaths due to ambient air pollution in 2015 happened in India and China.

On page 33, while commenting on partial successes in reducing pollution from cook-stoves, the Lancet Report Notes that the Indian National Program on Improved Chulha stoves, which operated from about 1984 to 2001, was reported to have had little effect on fuel efficiency nationally, and in reducing long-term exposure to smoke.

On Page 34, under cleaner fuels and indoor air, the report mentions the “The Indian liquefied petroleum gas programme” 2016, where India set a goal of providing access to liquefied petroleum gas to 50 million additional poor families in 3 years through the national oil companies.

Criticisms of the Lancet Commission on Pollution and Health:

  •    According to Marc Jeuland [36], associate professor with the Sanford School of Public Policy and the Duke Global Health Institute at Duke University, more concrete substantiation [37] for the claims of the report as to how specific policies might lead to economic gains is required. “Policy makers will often find it difficult to take action, and this report thus only goes part way in making the case for action.” He warned against extrapolating from the United States statistics on the economic benefits of pollution control, since the effects of pollution are different across locations.
  •    He also noted discrepancies (possible overlaps) as to the health effects of pollution specially if someone might be experiencing health problems on account of both air and water contamination.

Conclusion :

The study published in the Lancet Medical Journal is well written by experts in the field and needs to be read and taken seriously. The study also acknowledges the need to gather more substantive data. Notwithstanding the criticisms and the dubious nature of some of the sponsors of such studies and reference material, the fight against pollution must proceed in the right direction.

Pollution needs to be curbed.The best Diwali Gift to India would be to have the recommendations of the “Lancet Report” implemented
It can't be done by simply banning Diwali crackers. or pimping the sale of air purifiers and gas masks.
As winter proceeds and the weather gets stiller, the PM 2.5 levels are likely to increase.

The media should use this opportunity to contribute to reducing pollution. They need to take up a leadership role and target and expose the institutions really responsible, to take actionable measures, instead of using the Lancet Report to establish the burden of guilt on the common man 

What is unfortunate but noteworthy is that not one of the international banks or philanthropists or “Charities” have sponsored even one advertisement in Indian Media Channels to raise awareness on programs to fight pollution.

Somewhere along the path to fighting pollution, the vested powerful polluting industries appear to have (for now) successfully deflected the real corrective measures such as reducing Traffic Related Air Pollution (TRAP)

The Supreme Court judgement is a welcome step in understanding the exact extent of pollution caused by Diwali crackers. However, legislations which are based on polluter-pays principles may be the need of the hour.

One of the key statements of the Lancet report is “Pollution disproportionately kills the poor and the vulnerable.”

A lot of work is being done by the Government, the NGOs and activists as well as Lawyers and Courts to curb pollution. It would be rather unfortunate and myopic to see the entire narrative of India’s fight against pollution reduced to holding the common man responsible for pollution and disease.




  1. Most media and Governments fail to effectively control pollution since the polluter companies are their bread and butter

  2. Polkution is a global killer. Instead of camoflaging it , we must take tough and effective measures to counter it. The Lancet report is right - developing economies do not mean more pollution. Currently India is being used as a dumping ground by foreign companies

  3. Very thorough article blog by rottenmangoman on Lancet report. It seems he has read the fine print and took the trouble to bring it to our knowledge

  4. It is Indian culture to live as one with the environment. Also, so many people were cooking with woodburning prior to gas. But they weren't reported to die of PM 2.5. How Come?

  5. Well said @rottenmangoman.Pollution can only be truly curbed by taking on the powerful vested intrests. But Indian media is too chicken to take on corporates

  6. Politicians and Multinational companies have formed a nexus to pollute this planet beyond repair

  7. @rottenmangoman it looks like you have taken a lot of pain to READ the lancet report unlike the #FakeNews media houses who simply copy paste the press notes emailed to them. Good work