Air Quality and Human Health
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vi Contents
10 Fine
Particulate Matter-Related Disability-Adjusted
Life Years in Indian Union Territories ������������������������������������������ 135
N. Manojkumar, B. Srimuruganandam, and K. Krishnamurthi
11 Application
of Biomarkers in Assessing Human
Health Impacts of Air Pollution������������������������������������������������������ 145
Soumya Niyogi and Markus Hecker
12 Environmental
Emission from Coal-Fired
Power Plant and Control Technology�������������������������������������������� 163
Hridesh Agarwalla, Monalisa Gangopadhyay, R. Ebhin Masto,
Siddharth Bari, and Manish Kumar
13 Oxidative
Stress: The Particulate Linkage������������������������������������ 173
Suryasikha Samal and C. S. K. Mishra
14 The
Health Menace of Myriad Air Pollutants:
An Indian Perspective���������������������������������������������������������������������� 181
Priyadatta Satpathy, Monalin Mishra, Jyotishree Nath,
R. Boopathy, and Trupti Das
15 Strategic
Urban Air Quality Improvement:
Perspectives on Public Health�������������������������������������������������������� 203
Biswajit Patra, Surya Narayan Pradhan, and R. Paulraj
About the Editors
Pratap Kumar Padhy is a Professor and Head at the Department of Environmental
Studies, Institute of Science, Visva-Bharati, Santiniketan. Prof. Padhy is working on vari-
ous aspects of Air Pollution and Health. He has published many research papers in interna-
tionally refereed journals and several chapters in books. He has supervised 12 doctoral
students and 3 postdoctoral scholars. He has also undertaken four research projects, includ-
ing one international collaborative project. He was awarded the President of India Gold
Medal for General Proficiency from JNU from 1995 to 1996.
Soumya Niyogi is a Professor at the Biology & Toxicology Centre, University of
Saskatchewan Saskatoon, Canada. He is an Environmental Toxicologist with over 25 years
of research experience specializing in the toxicology of metals/metalloids and polyaro-
matic hydrocarbons (PAHs). He has published more than 80 peer-reviewed papers and
presented at more than 200 conferences. He has undertaken many sponsored research proj-
ects and supervised Ph.D. and M.Sc. students. He is an editorial board member in some
reputed journals and a frequent reviewer in many journals.
Pulak Kumar Patra is an Associate Professor at the Department of Environmental
Studies, Institute of Science, Visva-Bharati, Santiniketan. He has more than 20 years of
teaching and research experience in Environment Science. His research interests include
environmental geoscience, hydrogeochemistry, and medical geology. He has published
more than 50 research papers in journals and edited books. He has also authored three
books and edited two books. He has supervised eight Ph.D. students.
Markus Hecker is a Professor & Canada Research Chair at the School of Environment
and Sustainability, University of Saskatchewan. His research interest includes ecotoxicol-
ogy, endocrine disruption, environmental DNA, exposure and hazard characterization of
environmental contaminants, mechanistic toxicology, and toxicogenomics. He serves as
the editorial board member of many reputed journals. Markus has authored over 170 peer-
reviewed papers, review articles, editorials, and book chapters. He currently serves on the
board of directors of the Society of Toxicology and Chemistry (North America).
vii
Introduction
1
Pratap Kumar Padhy, Soumya Niyogi,
Pulak Kumar Patra, and Markus Hecker
1.1 Introduction knowledge of the harmful consequences of air
pollution on human health has grown many
Air quality and human health are closely linked. times. Pollution abatement technology has also
Two thousand five hundred years ago, progressed. Powerful techniques are now avail-
Hippocrates, the father of medicine, mentioned able for data collection and processing. Research
the critical role of the environment (especially in this field has grown enormously with the
the air we breathe and the water we drink) in our availability of much more data and the develop-
health (Balasubramanian et al. 2021). Following ment of data analysis methods. Air quality and
the eighteenth-century industrial revolution in human health science encompass a variety of
Europe, air quality deteriorated noticeably due disciplines, and a multidisciplinary approach is
to the rise of industrial and fireplace coal burn- needed to address this pressing global problem.
ing. The cause-effect relationship between air Air pollution and its health consequences are a
quality and human health was scientifically problem all around the globe. According to WHO
established. It led some countries to make laws data, 99% of the world’s population breathes air
for controlling emissions, with some success. that contains high levels of contaminants and
The tragedy of the great London smog in exceeds WHO guideline limits. While air pollu-
December 1952 woke the world to the repercus- tion has been improving in some regions, it is
sions of air pollution and paved the way for land- getting worse mostly in low- and middle-income
mark legislations such as the Clean Air Act nations including India. Rapid economic expan-
(Goodsite et al. 2021). Since then, scientific sion, fossil fuel-based energy generation, as well
as a lack of expertise and resources to combat
pollution are the main causes of higher levels of
air pollution in these countries.
P. K. Padhy (*) · P. K. Patra
The two most widely cited and regularly
Department of Environmental Studies, Visva-Bharati
University, Santiniketan, West Bengal, India updated estimates for the death toll from air pol-
e-mail:
[email protected] lution come from the World Health Organization
S. Niyogi (WHO) and the Institute of Health Metrics and
Department of Biology and Toxicology Centre, Evaluation’s Global Burden of Disease study
University of Saskatchewan, Saskatoon, SK, Canada (Roser 2021). Their latest estimation of air
M. Hecker pollution-induced annual deaths are 7 million
School of Environment and Sustainability and and 6.7 million respectively. However, there is no
Toxicology Centre, University of Saskatchewan,
consensus on these estimations. They also do not
Saskatoon, SK, Canada
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 1
P. K. Padhy et al. (eds.), Air Quality and Human Health,
https://doi.org/10.1007/978-981-97-1363-9_1
2 P. K. Padhy et al.
discriminate among the deaths caused by differ- sion into the atmosphere and its ultimate removal,
ent air pollutants. In general, more recent studies causes harm to a target, i.e. an ecosystem or
find a higher death toll than earlier studies. It is human health. The classical pollutants are sul-
not because of worsening air pollution, but due to phur dioxide (SO2), nitrogen oxides (NOx), car-
the fact that, recent scientific evidence suggests bon monoxide (CO), volatile organic compounds
that the health impacts of exposure to pollution (VOCs), and particulate matter (PM). Air pollu-
are more significant than previously thought. tion may be caused by natural processes or by
Research on the effects of air pollution is still in human activities. The largest source of natural air
its early stage. More scientific research is needed pollution is airborne dust in the world’s deserts.
to arrive at greater certainty. Traditionally, air A second major natural source is wildfire smoke
pollution was linked mainly to the respiratory in forests and grasslands. Additional natural
system and haematological health. Recent stud- sources are sea spray, pollen, and volcanoes. It is
ies provide evidence of a wide range of health possible to reduce natural air pollution to some
issues due to air pollution. The often-complex degree. It is certainly possible to reduce exposure
nature of air pollution due to its diverse chemical to it.
constituents makes it challenging to pinpoint the Anthropogenic sources of air pollution origi-
specific causes of health risks in exposed nate in a variety of human activities: the produc-
populations. tion of electricity in coal power plants; the
The nature of the air pollution problem varies burning of solid fuels (wood, charcoal, coal, crop
widely from country to country, also from one waste and dung) for cooking and heating in bil-
region to another within a country. It is not only lions of poor households; agriculture; industry;
dictated by the pollutants released or emitted into and road transport. These pollutions can be
the air from different sources, but also by the pre- reduced with policy measures and technological
vailing weather conditions. The range of pollut- innovations.
ants produced is also wide. Introducing new Quantitative information on the emission rate
methods of detecting and quantifying these pol- of air pollutants from different sources is vital for
lutants and establishing rural and urban air pollu- developing appropriate abatement strategies. The
tion networks to monitor regional and local best means of improving air quality is to identify
patterns has provided invaluable information that the major sources of both primary and the precur-
has been used to build up a profile of air pollutant sors of secondary pollutants. Emissions of air
problems. pollutants are estimated from knowledge of the
A better understanding of atmospheric chem- processes that form them. This is relatively
istry, new methods for pollutant monitoring, straightforward for some pollutants, as emissions
detailed epidemiology, and the use of controlled are mainly dependent on the composition of the
exposure studies to examine single and mixtures fuel. Information on fuel consumption and com-
of pollutants provide a firm framework against position and knowledge of the presence and type
which to devise new legislation to control this of pollution abatement technology is sufficient to
intractable problem. estimate emissions from many sources. For other
pollutants, emissions depend on combustion con-
ditions, such as temperature, pressure, and pollu-
1.2 Source and Nature of Air tion abatement technology, and are thus more
Pollutants difficult to estimate.
Annual emission inventories, a database of the
Air pollution comes from a wide variety of emissions of primary pollutants from all known
sources. A pollutant is usually understood to be a sources for a defined geographical area and year,
substance which, between the point of its emis- are being routinely compiled at the national level
1 Introduction 3
and increasingly at the urban level. National model’s predictions for current air quality, evalu-
emission inventories are used both within a coun- ate trends in air pollutant concentrations, and
try for prioritising pollution control measures and determine the effectiveness of the control strat-
internationally in negotiating pollution control egy once it is implemented. Another use of moni-
treaties. toring data is informing the public of air pollution
concentrations and, where necessary, providing
the basis for short-term remedial action.
1.3 Air Pollution Monitoring Satellite-based sensors are increasingly being
used to monitor the air quality. Geographic
Any estimation of the public health impact of air Information System (GIS)-based land use regres-
pollution exposure must depend heavily upon sion models are becoming popular to estimate
estimates of air pollutant concentrations. Such long-term exposure where monitor density is
estimates may be derived either by measurement insufficient (Adams and Kanaroglou 2016).
or by numerical modelling and are often a combi- These models incorporate land use information
nation of the two. Measurements of air pollutant to provide additional knowledge about emission
concentrations are customarily carried out at source potential to improve spatial variation
fixed-site monitoring stations. The number of modelling.
measuring stations and their networking has Where there are several measures of varying
increased many fold. Still, they are concentrated cost and ease of implementation, pollution con-
in urban areas. Model predictions are used to trol authorities need to know which measure, or
interpolate or provide data for areas where moni- combination of measures, will be most cost-
toring data are lacking. Meteorological informa- effective in improving air quality to the desired
tion is vital for such modelling. Weather, air level. Thus, emission control approaches for
quality, and health watch warning systems may managing air quality better require a proper
all be supported by meteorological modelling, understanding of the fate and transport of pollut-
which also serves as the foundation for real-time ants. Many simulation models are now available
air quality forecasts. for visualising/predicting the effectiveness of the
Provided the boundary conditions of the measures in different situations.
model are known, i.e. the concentrations of air Measurements of air pollutant concentrations
pollution entering the model domain from out- are best considered in the context of the entire air
side, then a well-conceived model should be quality management process. The major forces
capable of predicting both annual average and driving air pollution control and the policies and
short-term concentrations within the urban area. measures through which that air pollution control
Monitoring still has an important role to play is achieved can be represented in the flow chart
since monitoring data will be used to validate the (Fig. 1.1) as proposed by Harrison (1999).
4 P. K. Padhy et al.
AIR QUALITY AIR QUALITY AIR QUALITY
DATA ASSESSMENT STANDARDS
SOURCE NUMERICAL
METEOROLOGICAL
EMISSIONS AIR QUALITY
DATA
INVENTORY MODEL
AIR POLLUTION
SOURCE EMISSION
CONTROL
STANDARDS
STRATEGY
Fig. 1.1 Key components of an air quality management Jonathan M. Samet, Hillel S. Koren, Robert L. Maynard
strategy. (Source: Harrison, R.M., 1999, Measurements of editors Air Pollution and Health, Academic Press, 1999)
Concentrations of Air Pollutants In Stephen T. Holgate, (Reprinted with permission from Elsevier)
1.4 Air Pollution Meteorology An essential category of air pollutants con-
and Atmospheric Chemistry sists of substances not emitted into the atmo-
sphere in any significant quantity but formed by
Air pollution arises from the competition between chemical reactions. These latter pollutants are
emission processes, which increase pollutant termed secondary pollutants to distinguish them
concentrations, and dispersion and advection from the primary or emitted pollutants. Nitrogen
processes in the atmosphere, which reduce them. dioxide (NO2), ozone (O3), and suspended par-
Weather and climate are critical in the relation- ticulate matter are three major secondary pollu-
ship between air pollution and health. tion problems with potential public health
Atmospheric stability controls the extent to impacts in urban and industrialised population
which pollutants may be dispersed and diffused, centres worldwide. The distinction between pri-
while wind transports and disperses pollutants. mary and secondary pollutants is vital for under-
Meteorological modelling may provide the basis standing air pollution and devising pollution
for real-time air quality forecasting and health abatement strategies. There is a proportional
watch warning systems. Because people can be relationship between emissions and ambient
sensitive to both weather and air pollution, par- concentrations for primary pollutants. However,
ticular weather and air quality configurations for a secondary pollutant, reducing emissions of
may engender distinct health outcomes. the precursor does not lead to a proportionate
Unravelling these complex interactive effects is a reduction in its ambient concentration. In some
challenge. The exact nature of the synergistic circumstances, reducing precursor emissions
impacts of weather extremes and harsh air quality may lead to increased concentrations of some
conditions on health is firmly established. pollutants. This is most notable in the case of
1 Introduction 5
urban ozone, where reducing local emissions of ing research activity and a drive by both national
nitrogen oxides can lead to an increase in local governments and international organisations.
ozone concentrations. It demonstrates clearly that inhaled particles
Patterns of atmospheric aerosols have changed can profoundly impact physiology and biochem-
enormously since coal burning was widespread, istry, and it is therefore unsurprising that epide-
and the particles were mainly coal-derived carbo- miological studies show significant impacts of
naceous particles associated with sulphuric acid PM exposure. The methodology and approach
and other irritant compounds. In terms of the pre- used in standard setting depend very much on the
sentation in the air of potentially polluting enti- nature of the pollutant, and this is brought out
ties to the human body, the numbers of particles clearly by case studies of individual pollutants.
are, therefore, several orders of magnitude The focus is on how epidemiological evidence
smaller than the number of molecules of other can be used to evaluate the risk from particulate
pollutants in the air simultaneously. Therefore, matter exposure.
the individual particles’ structure and composi- Personal exposure depends on many factors
tion are crucial in understanding the mechanism(s) such as activity patterns, microenvironmental liv-
by which particles produce adverse health effects. ing conditions, deposition, clearance, retention
The significance of evolving patterns of particu- and disposition of the particular matter, and the
late and gaseous pollution, particularly for human mechanisms of damage and repair.
health, is a major challenge for atmospheric and The current understanding of the health effects
medical science. of air pollutants, especially of particulate matters
(PM), is limited. Most of the epidemiological
evidence linking adverse health effects to PM
1.5 Exposure Assessment exposure is not conclusive. The cellular and
molecular mechanisms by which PM and other
Accurate estimates of human exposure to inhaled air pollutants prompt toxic effects in humans are
air pollutants are necessary for a realistic yet to be fully understood. Biochemical and
appraisal of the risks these pollutants pose and to molecular biomarker assessments can provide
design and implement strategies to control and important insights into the cellular perturbations
limit those risks (Monn 2001). Except in occupa- that lead to the onset of adverse health effects
tional settings, such estimates are usually based during chronic exposure to air pollutants. The
on measurements of pollutant concentrations out- advent of next-generation, systems biology
side (ambient) air, recorded with outdoor fixed- molecular techniques (e.g. omics technologies)
site monitoring. For non-carcinogenic air provides exciting new avenues to study the effects
pollutants, much of our knowledge of public of air pollution on human health.
health impacts is derived from community-based
epidemiological studies which relate health out-
comes to concentrations of air pollution mea- 1.6 Designing of the Book
sured at fixed-point outdoor monitoring stations.
Exposure-response relationships derived from With contributions from well-known experts
such studies can readily be combined with other from diverse research fields (environmental sci-
outdoor fixed point concentration measurements ence, toxicology, geology, public health science,
and used in a predictive manner to estimate pub- biology, physics, chemistry, and geospatial tech-
lic health impacts of air pollution exposure. nology), the book deliberates on the health risks
Therefore, routine outdoor measurements, of air pollution and explores its control and miti-
instead of personal exposure assessments, have a gation strategies. The recent developments and
crucial role in evaluating the health effects of air challenges in diverse aspects of air quality and
pollution (Sexton and Ryan 1988). This has been human health, starting from air pollution moni-
a very active field in recent years, with burgeon- toring, identification of the source, especially in
6 P. K. Padhy et al.
aerosols, specific health issues to biomarkers, Chapter 11 critically examines the recent
and management issues, are discussed in the fol- progress in developing and using both targeted
lowing 14 chapters. and non-target biomarker approaches to assess
The second chapter summarises the existing the impacts of air pollution on human health.
Global Burden of Disease Study (GBD) studies Recent developments in ‘omics’ biotechnologies
and presents a roadmap for the way forward. The and AI tools have revolutionised the way we can
authors suggest India should invest resources to probe entire biological systems, allowing for the
systematically collate health data, design cohorts, identification and development of novel and rel-
and improve exposure assessment to generate evant biomarkers which will support human
exposure-response functions. Lab-based studies health risk assessment of air pollution.
and biomarker analysis can help detect early indi- Chapter 12 deals with air pollutants from power
cations of air pollution health impacts. plants and briefly describes their sources and their
Over the years, remote sensing combined with impact on human health. Best available technolo-
geographic information systems known as geo- gies (BAT) and best environmental practices
spatial technology-based assessment of air qual- (BEP) to manage different pollutants are also dis-
ity has emerged as a popular tool wherein air cussed. Oxidative stress, inflammation and subse-
quality standards can be studied across ample quent genotoxic processes are the predominant
space (regional units and global scales) and time drivers of adverse health outcomes such as pulmo-
scales. The third paper presents a cross-sectional nary and cardiovascular diseases and cancer asso-
descriptive bibliometric analysis of publications ciated with air pollution. The oxidative damage
on geospatial technology-based air quality caused by PM-induced toxicity and its impact on
assessment. Air particulate medical geology is various organ systems is discussed in Chap. 13.
another emerging field of research focusing on Chapter 14 provides a broad overview of the
atmospheric particle cycles and their complex major components of air pollution, their sources
pathways to assess their health risks. The fourth and modes of transportation, concentration in dif-
chapter dealing with this field priorities two ferent regions of India, reaction mechanisms, and
research areas: the use of interfacial sciences health effects, along with the major gap areas.
tools for quantitative assessment of in situ sur- The last chapter (Chap. 15) explains the avail-
face, chemical, and mineralogical characteristics able management strategies for air pollution.
of atmospheric particulates; and to understand Emission control through public policy formula-
what role trace elements play at the level of cells tion has been instrumental in reducing particulate
in living things. Chapter 5 stresses the i mportance air pollutant load. Innovative technological inter-
of land-use regression models that air quality ventions can help to moderate its adverse health
data from limited monitoring stations using pre- effect.
dictor variables usually obtained through geo- Thus, we hope the book provides an up-to-
graphic information systems (GIS). date overview of the modern methods and tools
Chapter 6 deals with the toxicity of particulate used in air quality monitoring and human health
pollutants, especially the emerging pollutants risk assessment. It addresses all aspects of air
microplastics and their impact on mitochondrial quality, covering indoor-outdoor air pollution;
health. Chapters 7 and 10 are based on case stud- gaseous and particulate pollutants; characterisa-
ies from India on trends of air pollutants and their tion of source and pathways of air pollutants; and
health effects. Though the overall trend of pollut- the modelling and assessment of health risks
ants has seen a gradual decline, the health effects (respiratory, epidemiological and toxicological)
of air pollution in India are in a grave situation. with regional and global perspectives. It also
The pattern and trend of the burden of disease addresses air quality management issues. The
due to particulate matter in the world and India lucid explanation of the role of oxidative stress
are presented in Chap. 8. Chapter 9 provides a mechanisms and molecular biomarkers (genom-
detailed overview of various health effects caused ics, proteomics) may be considered as inputs into
by outdoor air pollution. the development of cancer therapeutics.
1 Introduction 7
Along with providing a scientific basis for air Manag. 2016;168:133–41. https://doi.org/10.1016/j.
pollution, this book will help readers appreciate jenvman.2015.12.012.
Balasubramanian S, Domingo NGG, Hunt ND, Gittlin
the environmental determinants of public health M, Colgan KK, Marshall JD, Robinson AL, Azevedo
and apply research evidence to improve the qual- IML, Thakrar SK, Clark MA, Tessum CW, Adams
ity of life. It also delineates future research initia- PJ, Pandisand SN, Hill JD. The food we eat, the air
tives and policy actions needed to protect human we breathe: a review of the fine particulate matter-
induced air quality health impacts of the global food
health from air pollution, locally and globally. system. Environ Res Lett. 2021;16:103004. https://
The book will be of great educational value doi.org/10.1088/1748-9326/ac065f.
and is recommended for consultation and teach- Goodsite ME, Johnson MS, Hertel O, editors. Air pollu-
ing. The multidisciplinary nature of the book and tion sources, statistics and health effects. New York,
NY: Springer; 2021. 531 p.
the wide range of issues covered may provide the Harrison RM. Measurements of concentrations of air
reader with access to up-to-date information on pollutants. In: Holgate ST, Samet JM, Koren HS,
all matters relating to ambient air pollution. It Maynard RL, editors. Air pollution and health, vol.
will therefore, be helpful to those interested in 1999. New York: Academic Press; 1999. p. 63–81.
https://doi.org/10.1016/B978-012352335-8/50080-6.
monitoring air pollution and those wishing to ISBN 9780123523358.
know more about its impact on indices of human Monn C. Exposure assessment of air pollutants: a review
health. on spatial heterogeneity and indoor/outdoor/personal
exposure to suspended particulate matter, nitrogen
dioxide and ozone. Atmos Environ. 2001;35:1–32.
Roser M. Data review: how many people die from air pol-
References lution? Our world in data; 2021.
Sexton K, Ryan PB. Assessment of human exposure to
Adams MD, Kanaroglou PS. Mapping real-time air air pollution: methods, measurements, and models. In:
pollution health risk for environmental manage- Watson AY, Bates RR, Kennedy D, editors. Air pollu-
ment: combining mobile and stationary air pollution tion, the automobile, and public health. Washington,
monitoring with neural network models. J Environ DC: National Academies Press (US); 1988.
Impacts of Air Pollution on Human
Health: Present Status in India 2
and Future Directions
Pallavi Joshi, Ekta Chaudhary, and Sagnik Dey
2.1 Introduction and exposure (Martin et al. 2019). A higher pro-
portion of solid fuel use for domestic purposes
Over the years, an extensive body of scientific evi- results in high household exposure in LMICs.
dence established the negative health effects asso- This, in turn, increases the risk of exposure mis-
ciated with exposure to polluted air, using various classification in health burden estimates. Patchy
epidemiological study designs. The Global Burden health data in LMICs make the health burden
of Disease (GBD) study evolved a uniform frame- estimates more uncertain.
work to assess and track the long-term effects of The GBD study addressed these critical gaps
exposure to air pollution across the globe. Based using geospatial modelling and other relevant
on the GBD assessment (GBD 2019 Risk Factors techniques and developed exposure-response
Collaborators 2020), air pollution exposure is functions for ischemic heart disease (IHD),
ranked fourth on the list of risks globally causing chronic obstructive pulmonary disease (COPD),
disability-adjusted life years (DALY) and mortal- acute lower and upper respiratory tract infections
ity (GBD 2019 Risk Factors Collaborators 2020). (ARI), stroke, diabetes, and neonatal deficiencies
The GBD study revealed that low- and middle- such as preterm birth and low birth weight by
income countries (LMICs) experience a dispro- compiling cohort studies from around the world
portionate burden of air pollution-related health (Burnett et al. 2014, 2018). The evolution of
burden compared to high-income countries. exposure-response functions and their applica-
LMICs face multiple challenges in managing air tions in estimating excess mortality risks has
quality and associated health burdens. The been summarized in Burnett and Cohen (2020).
ground-based monitoring in LMICs is highly In terms of air pollutants, exposure metrics con-
inadequate for mapping regional-scale air quality sider the ambient fine particulate matter (PM2.5),
household PM2.5, and ambient ozone.
India, home to 1.4 billion population, has one
P. Joshi · E. Chaudhary
Centre for Atmospheric Sciences, IIT Delhi, of the highest PM2.5 exposure globally (Cohen
New Delhi, India et al. 2017). Air pollution is ranked second after
S. Dey (*) maternal and child malnutrition and was esti-
Centre for Atmospheric Sciences, IIT Delhi, mated to cause 1.67 million (95% uncertainty
New Delhi, India interval, UI: 1.42–1.92) deaths in 2019 in India,
Arun Duggal Centre of Excellence for Research in causing a loss of up to 1.36% of the gross domes-
Climate Change and Air Pollution (CERCA), IIT tic product (Pandey et al. 2021). In addition to the
Delhi, New Delhi, India GBD study, where mortality and morbidity
e-mail:
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P. K. Padhy et al. (eds.), Air Quality and Human Health,
https://doi.org/10.1007/978-981-97-1363-9_2
10 P. Joshi et al.
b urden was estimated at state levels, numerous 2013; Sehgal et al. 2015; Kesavachandran et al.
studies were carried out in the last few decades in2015; Cohen et al. 2017; Haque and Singh 2017).
India to understand the health impacts emanating Short-term exposure and related health effects
from air pollution exposures, using indigenous are measured at weekly/hourly/daily temporal
health data and standard epidemiological study scale, whereas long-term exposure and health
designs. This chapter summarizes the current effects are captured over monthly or annual
state-of-the-art knowledge of air pollution health scales. (Beverland et al. 2012). The short-term
impacts in India, outlines the critical challenges,exposures manifest in acute illnesses or episodes
and shows the ways forward to accelerate India’s such as exacerbation of asthma, breathing trou-
progress to meet the United Nations’ Sustainable bles, and cardiovascular disease (CVD) condi-
Development Goal (SDG) 3 of promoting healthy tions such as ischemia, arrhythmias, and cardiac
lives and well-being. failure. The short-term effects are recorded in
terms of emergency hospital visits, hospitaliza-
tions, and even fatal outcomes generally in finer
2.2 Air Pollution Health Effects temporal windows (Kumar et al. 2004; Gupta
and Epidemiological Study 2008; Patankar and Trivedi 2011; Maji et al.
Designs 2015, 2018). The longer duration and more
intense exposures are exhibited in terms of
The assessment of any health endpoints in rela- chronic and disabling conditions such as compro-
tion to air pollution exposure relies on data from mised lung/heart function, tuberculosis, cough/
health institutions or civic bodies responsible for wheezing, allergies, cardiovascular complaints,
the collation of vital statistics. The most common and even premature deaths (Kumar and Foster
methods to estimate the occurrence of health out- 2007; Guttikunda and Jawahar 2012; Guttikunda
comes in environmental research are based on the and Goel 2013; Ghosh and Mukherji 2014;
events in which (1) the subjects have sought med- Tobollik et al. 2015; Gawande et al. 2016; Rajak
ical attention (e.g., emergency hospital visits or and Chattopadhyay 2020).
outpatient visits, or hospital admissions), (2) The type of epidemiological study designs is
death events recorded by civic bodies and certi- extremely crucial for accurate assessment of air
fied by medical professionals, with or without pollution-related health risks. Their selection pri-
cause of death, (3) self-reported or bio-monitored marily depends on exposure and health data and
health irregularities and illnesses recorded in determining factors for the results, their synthe-
small/large scale health surveys. The use of med- sis, interpretation, and policy use. There are mul-
ical record data, however, has inherent limita- tiple analysis methods used in air pollution health
tions, such as recording errors, variability in studies, ranging from case-crossover, case-
medical coding, lack of information on the onset/ control, time-series, Bayesian epidemiological
duration of events, and biases due to varied studies, and cohort designs to examine associa-
health-seeking behaviour. These limitations tions between pollutant exposures and health out-
impact the accuracy of the health outcome assess- comes of interest. Generally, the case-crossover
ments and introduce bias in the estimation air and time-series studies utilize local and fine-scale
pollution-related health consequences or any temporal exposure data. They are generally good
other risk factor. The alternatives to surpass the at assessing the effects of regional pollutants that
above limitations are by way of bio-monitoring/ exhibit greater spatial homogeneity.
human tissue sampling, which is expensive and It is important to highlight that time-series
only viable for a very small sample population studies using exposure and health data resolved
and is not realistic at a population scale. at fine spatial scales like zip code level show
The existing body of epidemiological research modestly stronger associations (Joshi et al. 2021).
records health effects from both long- and short- Such studies mainly focus on the short-term and
term exposure to ambient air pollution (Liu et al. acute effects of exposure to ambient air pollution.
2 Impacts of Air Pollution on Human Health: Present Status in India and Future Directions 11
Cross-sectional studies utilizing improved spa- level (TMEL), population, and its age distribu-
tially resolved health and exposure data rely on tion (RRs vary with age for some diseases), and
ecological assessments and can provide critical background disease rates from all possible risk
evidence of association in the absence of cohort factors. The GBD India study compiled the data
studies. On the other hand, there are cohort-based for the period of 1990 onwards and tracked the
studies, where a group of subjects is followed, progress in air pollution health burden
and subsequent health evaluations are conducted (Balakrishnan et al. 2019). Figure 2.1 shows the
to determine participants’ exposure characteris- state-level DALY rate attributable to air pollution
tics driven by temporal and spatial variations in (normalized to 100,000 population) from the
exposure, retrospectively or prospectively. The GBD India study 2019. The data revealed a large
advantage of cohort studies is that they are capa- disparity in DALY rates attributable to air pollu-
ble of establishing true causal effects but expen- tion in 2019, ranging from 1664 (95% UI: 1347–
sive in terms of logistics and financial resources. 2042) in Arunachal Pradesh to 5002 (95% UI:
4227–5848) in Uttar Pradesh. For ambient PM2.5
exposure, the lowest DALY rate was found for
2.3 GBD India Study Arunachal Pradesh (593, 95% UI: 389–823),
while the highest rate was found for Uttar Pradesh
Health burden attributable to air pollution (3106, 95% UI: 2387–3824). For household
depends on three factors—relative risk (RR) of a PM2.5, the DALY rate varied from 19 (95% UI:
disease corresponding to an exposure level com- 9–37) in Delhi to 2513 (95% UI: 1769–3228) in
pared to the theoretically minimum exposure Chhattisgarh.
Fig. 2.1 DALYs
attributable to air
pollution, covering both
sexes and all age groups
in India, 2019. (Data
source: https://vizhub.
healthdata.org/
gbd-compare/)
12 P. Joshi et al.
The temporal changes in the mortality rates graphically diverse regions will not result in the
attributable to ambient and household air pollu- same health benefit. For example, the change in
tion (Fig. 2.2) further revealed that the age- ambient PM2.5-related mortality burden in
standardized death rates resulting from India, for the period 2000–2015 is depicted in
household level PM2.5 decreased by 72.3% from Fig. 2.3. However, if the other factors remained
215.5 in 1990 to 59.6 in 2019. During the same unaltered and the exposure only changed, the
time, the death rates attributable to ambient air pollution burden would have increased only
PM2.5 rose by 57.5% from 60.7 in 1990 to 95.6 in by 17.4%. The population rise contributed to
2019. A large share of DALYs, around 39.5% of 33.6% of the increase in burden alone, and the
the total DALYs, were due to lung diseases, shift of the age structure towards older age con-
including COPD (22.7%) and ARI (15.5%). Out tributed to another 14.5% increase in the bur-
of the rest, about 38.6% of the total was CVDs, den. This was partially compensated by the
including IHD (24.9%) and stroke (13.7%), reduction of the burden by 14.2% due to an
neonatal deficiencies (14.5%), diabetes mellitus overall reduction in baseline mortality. The net
(5.5%), and cataracts (1.5%). Across the total result is an increase in air pollution-linked mor-
DALY burden attributable to all risk factors, air tality burden by 47.9% between 2000 and 2015
pollution was responsible for 11.5%, out of (Chowdhury et al. 2020). Such analysis implies
which 6.7%, 4.5%, and 0.7% could be attributed that the air pollution health burden can be
to ambient-household PM2.5 and ozone expo- reduced further by accelerating the reduction of
sure, respectively. In 2017, air pollution-related baseline mortality by improving the healthcare
losses in life expectancy were estimated at 0.9 infrastructure.
(0.8–1.1) and 0.7 (0.6–0.8) for ambient and In addition to the GBD study, there are a host
household PM2.5, respectively (Balakrishnan of epidemiological studies in India which utilized
et al. 2019). pre-existing exposure-risk functions for various
The GBD India study demonstrated that the pollutants and health endpoints. The majority of
health burden and exposure are not linearly these studies utilize curated software like the Air
proportional. Therefore, an improvement in air Q/Air Q+ developed by the WHO European
quality by the same margin in socio-demo- Centre for Environment Health, Bilthoven
Fig. 2.2 Age-standardized death rates attributable to air pollution, India 2000–2019. (Data Source: GBD
(https://vizhub.healthdata.org/gbd-compare/))
2 Impacts of Air Pollution on Human Health: Present Status in India and Future Directions 13
Fig. 2.3 The relative
changes in mortality 50
burden attributable to
ambient PM2.5 exposure 40
Population
in India between 2000
and 2015 and the 30
Exposure
changes in burden due to
% Change
the changes in specific 20 Age Structure
factors. (The statistics Baseline
are taken from 10
Mortality
Chowdhury et al. 2020,
0
Creative Commons
Attribution BY 4.0) Burden
-10
-20
Division. Such software packages are based on gaseous pollutants (Maji 2017a; Afgan and
the Risk of Mortality/Morbidity due to the Air Patidar 2020). Another study in Nagpur used the
Pollution (RiMAP) model, modelled to estimate same model to establish a long-term association
air pollutant impact on a defined population (two decades) between COPD risk and PM expo-
group in a given region and time point. The sure. Similar studies incorporating multicity anal-
underlying approach to any risk assessment for yses have found this excess mortality and
human impact is population attributable factor morbidity to be on an increasing trend over the
(PAF), the fraction of excess morbidity or mortal- years (Maji et al. 2016). The model has also been
ity in a given population due to atmospheric pol- put to use to establish a strong association between
lutants, calculated using a pre-existing risk the excess cases of COPD hospital admissions
function for exposure and excess health risk, fac- correlated with PM2.5 exposures (Manojkumar
toring in for the possible confounding factors in and Srimuruganandam 2021). Trend analysis in
that association (Maji et al. 2016). The advantage most studies showed peak particulate matter
of using these packages is that they serve as tools impacts during post-monsoon and winter seasons
for quick analysis to support policymaking for air (Sasmitaa et al. 2022; Kumar and Middey 2022).
quality management. The other advantages are
that they are versatile and capable of estimating
air pollution exposures at short (i.e., daily) and 2.4 Cohort Studies
long (i.e., yearly) temporal scales for various
health endpoints and list of pollutants and for The number of epidemiological studies causally
even sources like household air pollution. The linking air quality and health is very limited in
risk functions based on non-indigenous studies India. The Tamil Nadu Air Pollution and Health
and data, however, pose a question of true appli- Effects (TAPHE) cohort study conducted by
cability for the Indian demography (Sacks et al. Balakrishnan et al. (2015) investigated the impact
2020). of fine particulate matter (PM2.5) exposure in a
Given these limitations, such simple tools have rural-urban regional setting. The study finding
repeatedly been used on Indian city-level data to revealed that an increment of 10 μg/m3 in PM2.5
demonstrate the health and economic impact of exposure during the gestation period was associ-
poor air quality. Studies based in Mumbai and ated with a 4 g (CI: 1.08–6.76) decrease in birth-
Delhi found excess all-cause mortality, respira- weight and subsequently led to a 2% increase in the
tory and cardiovascular mortality, also hospital low birth-weight prevalence (OR: 1.02; CI: 1.00–
admissions due to COPD and CVD to be more 1.04) (Balakrishnan et al. 2018). Another cohort—
strongly associated with PM10, and PM2.5 than Ambient and Indoor Air Pollution in Pregnancy on
