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March 2002
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This month public health issues became policy for once. The Supreme Court in its judgement on moving public vehicles to compressed natural gas (CNG) in Delhi made it clear that the concern of the court in passing various orders on combating air pollution has been only one, "namely to protect the health of the people."

Unusual also was that scientific research was considered to decide policy. I call this unusual because a key failure in our country is that government decision-making and policy setting is never based on recent scientific evidence. But this time the court looked at studies from the US to Kolkata to understand the impact of air toxins on human health.

A key consideration was the recent study published in the Journal of American Medical Association (JAMA) on tiny particles. The JAMA study – an amazing epidemiological journey – taking 16 years, covering 116 cities and research on 500,000 people presents stunning evidence that exposure to fine particles leads to lung cancer and other related diseases and deaths. According to the study a mere increase of 10 microgramme per cubic metre (µg/cum) of fine particles – smaller than 2.5 microns or PM 2.5 – can increase the risk of lung cancer by 8 per cent, cardiopulmonary deaths by 6 per cent and all deaths by 4 per cent.

Co-author Arden Pope, who has been working on particulates and pollution for many years now, says that the findings of this study provide the strongest evidence to date that long-term exposure to air pollution is an important risk factor for cardiopulmonary and lung cancer mortality.Consider also that the US annual average standard for fine particulates is 15 µg/cum while in India the annual average standard for

PM 10 is 60 µg/cum and most cities, where this pollutant is monitored, record anywhere between 100-200 µg/cum on an average in a year. What then would be the risk of breathing air in our cities?

In the JAMA study, analysis was based on data collected by the American Cancer Society, which is working on a massive study involving over 1.2 million adults to look at cancer prevention. I believe this is all about what we should be doing in our country – working with medical professionals to study exposure and impact studies on vulnerable populations – children, women and people living in polluted areas. Such studies give us confidence in knowing what needs to be done and then policy prescription can follow. This is good research and good politics.

The judges also discussed studies, however limited, done by Indian medical professionals – by H Paramesh of the Bangalore based Lakeside Medical Centre on 20,000 children under the age of 18 years which shows that asthma incidence increased from 9 per cent in 1979, to 29.5 per cent in 1999. By J N Pande of the All India Institute of Medical Sciences, by S K Chhabra of the Vallabhai Patel Chest Institute and by the Chittaranjan National Cancer Institute and Environmental Biology Laboratory of the Department of Zoology of Kolkata University. All showing similar trends of growing risk.

The court then concluded that the increase in respiratory diseases, especially in children should normally be a cause of concern for any responsible government. But, the wise judges say, "children do not agitate or hold rallies and, therefore, their sound is not heard and the only concern of government appears to be to protect the financial health of polluters, including oil companies, at the cost of public health."

Need I say anymore?

— Sunita Narain
Director

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