Smoke, smoke everywhere, not a puff to breathe

The air around us has been riddled with so much of dirt that it is increasingly becoming unfit for consumption. And yet we cannot survive if we do not breathe. The theme of the 44th Union World Conference on Lung Health organised by the International Union Against Tuberculosis and Lung Disease (The Union) held recently in Paris was very apt - 'Shared air, safe air?'

Is this air which we share, breathable? Well it seems not and the experts at the conference gave a clarion call to governments and people alike to take urgent action before we choke on what is meant to be life giving. According to the WHO indoor air pollution and outdoor air pollution are estimated to cause respectively approximately 2 million and 1.3 million deaths worldwide per year.

The conference saw some interesting talks on air pollution being a serious global public health concern. While outdoor air pollution is caused by nature (bush fires, dust storms, volcanic eruptions) and human beings (traffic fumes, industrial effluents, cigarette and other forms of smoke) human activity (like use of solid fuel cook stoves and smoking) alone seems to be responsible for indoor air pollution. Nearly 3 billion people worldwide rely on solid fuels for cooking that emit carbon monoxide and other pollutants at levels much higher than safe limits. Inhaling solid fuel smoke has been said to be associated with acute respiratory infections in children, chronic obstructive pulmonary disease in women and lung cancer in women exposed to coal smoke. And although asthma too is related to various sources of indoor air pollution and made worse by outdoor air pollution, yet, as Professor Ross Anderson, Member of the World Health Organization (WHO) Scientific Advisory Committee, conceded, there is no convincing evidence to prove that air pollution causes asthma in children or adults.

The other bigger killer is tobacco/cigarette smoke. Dr Tara Singh Bam, Technical Advisor on Tobacco Control at The Union, passionately stated that tobacco smoking is major contributor indoor air pollution and that we cannot create a healthy indoor environment unless we ban smoking. He reiterated that tobacco smoke is a human carcinogen and that Second Hand Smoke (SHS) is a killer. It kills more than 600,000 people every year, 75% whom are women and children. Ventilation cannot eliminate the risk of SHS in enclosed environments. He shared the data confirming that the measured PM2.5 (particulate matter with aerodynamic diameter smaller than 2.5 µm) level over a period of 45 minutes in Café City, a smoking restaurant in Mandalay was well above the WHO permissible limit of 25 μg/m3 and 8 times higher than that in Café Corner (a non-smoking restaurant). PM2.5 levels in bars in Scotland reduced by about 90% in 2006 after a smoking ban was imposed. Chronic exposure to particulate matter contributes to the risk of developing cardiovascular and respiratory diseases, as well as of lung cancer.

Dr Bam said that, “There is no risk free level of SHS exposure. Even a brief exposure is dangerous. There have been many studies from different parts of the world all conveying the same message—we must ban smoking completely, with no smoking rooms, to have clean indoor air.”

Dr Ehsan Latif, Director Tobacco Control at The Union was worried that except for Turkey, there has been not been any significant decrease in tobacco consumption. So countries will not only have to have robust anti- tobacco policies in place but also ensure their strict implementation, which unfortunately is not happening in India (and elsewhere too).

Dr Rana J Singh, Technical Advisor, The Union South East Asia, blamed the tobacco industry for undermining public health efforts in India and said that full implementation of Article 5.3 of the FCTC by the government is the first step to de-normalize tobacco industry and ensure that governments do not compromise public health . 

Emmanuelle Beguinot  representing an NGO in France ‘the French National Committee For Tobacco Control’ said that while smoking prevalence in the European region at 31% is highest amongst all other regions, France too has a high level of tobacco consumption with roughly 33% of the population being smokers. 73,000 people in France die every year from tobacco related causes and it is estimated that in 2014 more French women will die of lung cancer than by breast cancer. She was concerned that although France had ratified the FCTC (Framework Convention on Tobacco Control) in 2004 tobacco control policies seemed to be failing in France due to lack of coordination and sustainable strategies; lack of political will; and close association between tobacco industry and government.

Air pollution, both indoors and outdoors, is a major environmental health problem affecting all of us. An aware individual is an empowered individual. By helping reduce air pollution levels, we can help reduce the global burden of disease from respiratory infections, heart disease, and lung cancer. Of course individual efforts will just not be enough. There has to be concerted action by public authorities at the national, regional and international levels.

Shobha Shukla, Citizen News Service - CNS 
November 2013
(The author is supported by the Lilly MDR TB Partnership to provide conference coverage from the 44th Union World Conference on Lung Health)