Source: Incidence of Primary Lung Cancer in India, Lung Cancer in India and Lung Care Foundation Study
 
The increasing numbers of non-smokers now suffering from lung cancer, is another ‘disturbing trend’ that points to factors beyond smoking tobacco as being the primary cause.
 
Of the total 150 patients surveyed, 50% or 74 were non-smokers (meaning they had never smoked in their life). The proportion of non-smokers rose to 70% amongst the younger age category (i.e less than 50 years old).
 
Amongst the reasons given in the study for non-smokers contracting lung cancer were exposure to radiation and asbestos and occupational hazards attached to mining, in addition to environmental factors such as heavy air pollution.
 

A comparison of images of healthy and diseased lungs. Of 150 lung cancer patients surveyed in Sir Ganga Ram Hospital, New Delhi, 74 were non-smokers.
 
The air-pollution link
 
Lower numbers of patients suffering from squamous cell carcinoma (59) compared to adeno carcinoma (80) are a further indication of the link between increasing lung cancer and polluted air.
 
“Typically smoking used to cause squamous cell carcinoma, but we now see an increase in women and younger people with mostly adeno carcinoma and this shows their cases are not related to smoking, but pollution,” said Kumar.
 
 
Adeno carcinoma (AC) is the most common form of cancer amongst non-smokers and increasing levels of ambient PM 2.5 have been proven to be associated with increasing incidence of AC, according to this 2016 paper in the European Respiratory Journal.
 
High 24-hour average levels of PM 2.5 is now a year-round problem for the national capital, with residents experiencing zero days of good quality air between March-May 2018, IndiaSpend reported in June 2018.
 
Prevention and solutions
 
Increased levels of lung cancer amongst the 20-30 age group and high prevalence of the ardeno carcinogenic pathology point towards a looming epidemic, the study warned. Late detection and misdiagnosis as tuberculosis are further adding to the situation.
 
However, prevention and early detection is possible. Currently 70-80% of patients are diagnosed at stage III and IV, and health professionals are calling for more screening and diagnosis to take place at stage I instead.
 
A cancer’s ‘stage’ refers to its size and the extent to which it has spread, and it helps determine the level of treatment. At stage I, the cancer is between 3-4 cm, growing up to 5 cm at stage 2. From stage 3, the cancer begins to spread to the lymph nodes (important for immune response function) and at stage 4, the cancer may be present in both lungs or have had spread to other organs in the body.
 
A reduction in air pollution levels is also a key point of action for health campaigners, who hope additional data on health risks will activate policymakers into looking at the issue more closely.
 
“We hope studies like this will help us in going to the government and convincing them this is a public health emergency,” said Kumar. “But we are also focusing on people, making this a people’s movement–if people become conscious about their health and demand clean air as matter of right, then this will become a priority area for the government.”
 
The decision on whether to ban firecrackers–which emit PM 2.5 and contribute to heavy levels of pollutants in the air–during Diwali was heard in the Supreme Court on World Lung Cancer Day, August 1, 2018. Images of black lung in a non-smoker and lung cancer patient at Sir Ganga Ram Hospital, Delhi, where shown by Kumar in order to show how even young lungs have the appearance of a smoker’s.
 

The image of a black lung in a non-smoker and lung cancer patient at Sir Ganga Ram Hospital, Delhi, shows how even young lungs have the appearance of a smoker’s.
 
Opposition to the ban was heard from firecracker manufacturers who believe the impact on air quality and lung health is not as severe as is made out, positing that the car and construction industries should also bear responsibility for their emissions. The case is now listed for concluding arguments on August 8, 2018.
 
Over the Diwali weekend of 2016, India’s air quality was among the world’s worst and between 40% and 100% worse in five north Indian cities than at the same time the preceding year, an IndiaSpend analysis of national data and our #Breathe network of sensors showed in November 2016.
 
(Sanghera, a graduate of King’s College London, is an intern with IndiaSpend.)

Curtesy: India Spend
 

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The union environment ministry is planning to bring down air pollution in around 100 cities nationwide–exceeding national air pollution standards–by 50% in the next five years through the National Clean Air Programme (NCAP).
 
NCAP includes expansion of monitoring network, conducting air pollution health impact studies, setting up of air information systems, certification of monitoring institutes, air quality forecasting systems, awareness and capacity building drives.
 
The Centre’s list includes three cities from Telangana, five from Andhra Pradesh, one from Tamil Nadu and four from Karnataka. In comparison, 10 cities in Telangana, 15 in Andhra Pradesh, four in Tamil Nadu and 10 in Karnataka reported annual levels of PM 10–tiny airborne particles seven times finer than human hair–exceeding national standards (60 micrograms per cubic metre, or µg/m³) in 2015 and 2016, according to this January 2018 analysis by Greenpeace-India, an advocacy, based on data obtained from state pollution control boards using right to information applications.
 
Vijayawada in Andhra Pradesh exceeded the annual PM 10 standard levels by 68%. Bidar and Tumkur in Karnataka exceeded the levels by 88% and 144%, respectively.
 
Tamil Nadu’s Thoothukudi and Telangana’s Kothur exceeded the annual PM 10 standard levels by 200% and 78%.
 

Source: Data from state pollution control boards, compiled by Greenpeace India in this analysis; *Maximum of annual average PM 10 levels in 2015 and 2016
 
All these cities need city-specific action plans to fight air pollution.
 
For now, Delhi’s Graded Response Action is the only available programme in India to combat pollution. It entails a number of actions to be taken as soon as the air quality plunges, such as stopping garbage burning, not allowing trucks to enter the city, shutting down power plants, and closing brick kilns and stone crushers, IndiaSpend reported on December 22, 2017.
 
How bad is south India’s air pollution problem: The tale of two metros
 
In a bid to shift the limelight from over the National Capital Region (NCR) to southern parts of the country–which are also suffering from bad air quality–independent researchers used two separate methods for monitoring air quality in Chennai and Bengaluru.
 
While the researchers deployed roof-top air quality monitoring stations in five locations across Chennai, Bengaluru was monitored for pollution levels on seven arterial roads during peak traffic hours.
 
The Bengaluru experiment showed instant results of high air pollution exposure, ranging between 100 and 200 µg/m³ for PM 2.5, and between 300 and 850 µg/m³ for PM 10.
 

Source: Bengaluru’s Rising Air Crisis, Study, 2018
 
“The safety limits for particulate pollutants are available for 24-hour and annual averages only, therefore, one cannot directly say how unsafe the instant values are in comparison to the regulatory norms,” said a statement by Co Media Lab, a community radio, and Climate Trends, an advocacy, supporters of the report.
 
However, studies have shown that even brief exposures to high air pollution result in premature deaths, as IndiaSpend reported on January 19, 2018.
 
PM 2.5 levels up to 60 µg/m³ (annual average) and 40 µg/m³ (24 hour average) are considered safe, while for PM 10 levels up to 100 µg/m³ (24 hour average) and 60 µg/m³ (annual average) are considered safe, according to Indian national standards.
 
To calculate the bad air a person is exposed to during peak hours in Bengaluru’s busiest routes, researchers installed small air quality monitoring units in autos armed with a GPS tracker to locate various junctions and sensitive areas at which pollution spikes have taken place. The exercise was done for seven days during February 5-15, 2018.
 
Other than recording high instant values, the averages observed over the four-hour auto rides carried out in two parts during the study also consistently generated averages above 200 µg/m³.
 
“[This] indicates that very poor air quality levels prevail for several hours every day owing to traffic congestion,” said the statement.
 
“There is a high incidence of heart attacks among the auto and cab drivers in the city as they spend long hours in slow moving traffic,” said Rahul Patil, a cardiologist at Bengaluru-based Jayadeva Hospital.
 
Residents of Bengaluru should become more aware of the rising pollution crisis and not walk and cycle on or near busy roads as the benefits might not outweigh the risks, he added.
 
The report also looked at the annual averages of air quality data from the Karnataka State Pollution Control Board.
 
The PM 2.5 values have exceeded national safe standards by 3% to 45% during 2016-17, while PM 10 exceeded the standards by 30% to 120%, the analysis showed.
 

Source: Karnataka State Pollution Control Board
 
Chennai’s air was not any better. During a nearly month-long air quality monitoring exercise in the city, 80% days saw 24- hour averages exceeding the national standards, according to this statement jointly released by advocacies Chennai-based Human Lung Foundation, The Other Media, Health Energy Initiative and Mumbai-based Urban Sciences.
 
None of the days had particulate levels within the more stringent World Health Organization (WHO) standards of 25 µg/m³, the statement said.
 
“All locations recorded hazardous levels (above 180 µg/m³) of PM 2.5 on 13 January (2018), the day of Bhogi festival (first day of four days pongal festival),” it added. That was three times more than the national standard and about seven times more than the WHO limits.
 
Large-scale citizen-efforts in air-quality monitoring, like Chennai, are needed to ​bring about awareness at an individual level as well as to provide a mechanism for data-driven dialogues between citizens and policy makers, Ronak Sutaria, founder, Urban Sciences, told IndiaSpend.
 
These monitoring efforts are also essential in light of the inadequate monitoring capacities of monitoring stations deployed the the state pollution control boards, experts believe.
 
“State air quality monitoring stations are collecting [only] regulatory grade air quality data. That is what they are designed to do,” added Sutaria, also the architect of IndiaSpend’s #Breathe project.
 
(Tripathi is a principal correspondent with IndiaSpend.)

Courtesy: India Spend
 

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National capital Delhi has the worst air in the country, said the report, Airpocalypse, released by Greenpeace India, an advocacy.At a time when India is already slipping to meet the renewable targets the budget 2018 overall allocations to the ministry of new and renewable energy (MNRE) has declined by 326 crore or 6% from last year’s Rs 5473 crore.
 
Of India’s 280 cities/towns where air quality is monitored, none met the World Health Organization’s (WHO) safe levels of PM 10–20 μg/m³–the report said.
 
The Indian annual safe level for PM 10–airborne particles seven times finer than a human hair that can sicken or kill people by entering their lungs–is three times more lenient at 60 μg/m³.

 Source: Greenpeace India; Data for 2015-16
 
To prove air pollution is not limited to Delhi, the report analysed air quality data of 280 cities with a population of 630 million–53% of the total population of the country.
 
Of them, 550 million–9 of every 10 Indians–live in areas exceeding the national standard for PM 10, found the report.
 
Similarly, every three out of 10 Indians live in areas where air pollution levels are more than twice the stipulated standards, said the report.
 
“Apart from this, 580 million Indians live in districts with no air quality data available,” the report said.
 
“Only 16% of the population inhabiting the districts (where air quality is being monitored) have real-time air quality data available,” said Sunil Dahiya, senior campaigner, Greenpeace India, and an author of the report. “This portrays how inhumanly we are responding to the national health crisis in front of us.”
 
Even the manual data collected for 300 cities and towns are not shared in a timely manner and in a format which can be accessed and understood easily by general public, he added.
 
The data used for the report was obtained from multiple sources–the National Air Monitoring Programme, Right to Information (RTI) responses from State Pollution Control Boards and annual reports, along with the websites of various state pollution bodies.
 
Delhi worst hit, at five times permissible standards of pollution
 
Ranking of cities based on their annual average of PM10 levels reveal that Delhi is the most polluted city at 290 μg/m3—close to five times the national standard. It is followed by Faridabad, Bhiwadi and Patna with annual averages that are 272 μg/m3, 262 μg/m3 and 261 μg/m3 respectively.
 
Dehradun in Uttrakhand was an unexpected entrant in the list of 10 worst cities, with an annual average of 238 μg/m3.
 
The annual average PM 10 levels for the 20 most polluted cities ranges between 290 μg/m3 and 195 μg/m3.
 

Source: Greenpeace India; Data for 2015-16
 
Most of the top polluted cities are spread across the Indo-Gangetic basin with southern cities being slightly better off, said the report. However, cities in the south also need a focused and time-bound action plan to achieve WHO standards, it added.
 
Less than 20% cities comply with air quality standard
 
“The fact that less than 20% Indian cities are complying with the national, or CPCB [Central Pollution Control Board], standards sadly points to the lack of workable, robust and timely action plans so far,” said Dahiya.
 
Delhi’s Graded Response Action is the only available programme in India to combat pollution. It entails a number of actions to be taken as soon as the air quality plunges. These include putting a stop on garbage burning, not allowing trucks to enter the city, shutting down power plants, and closing brick kilns and stone crushers, IndiaSpend reported on December 22, 2017.
 
The government is planning to launch a National Clean Air Programme (NCAP) “as a medium term national level strategy to tackle the increasing air pollution problem across the country in a comprehensive manner”, according to a January 5, 2018 Lok Sabha reply .
 
Can the national programme be the answer?
 
NCAP entails evolving an effective ambient air quality monitoring network across the country besides ensuring a comprehensive management plan for prevention, control and abatement of air pollution.
 
“The NCAP focuses on collaborative and participatory approach covering all sources of pollution and coordination between relevant Central Ministries, State Governments, local bodies and other stakeholders” said the reply.
 
The NCAP has not been made public yet.
 
The Greenpeace report has made some recommendations to make the NCAP more effective. First, it needs comprehensive, systematic and time-bound plans with fixed accountabilities. Second, it needs to be made public soon so it can draw the participation of the general public and all layers of the government.
 
A continuous ambient air quality monitoring mechanism across the country with real time data sharing capabilities, stricter enforcement of laws for pollution control, and incentivising use of electric vehicles are the other suggestions on air pollution control.
 
(Tripathi is a principal correspondent with IndiaSpend.)

Courtesy: India Spend
 

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