Air Pollution: A Challenge to Public Health and Healthcare Systems

Abstract

Air pollution in Pakistan, and the region at large, has become one of the greatest environmental risks to health.
Three major cities of Pakistan, Lahore, Karachi, and Peshawar, have been declared the worst in the world for
their Air Quality Index and PM air pollution. The population residing in these cities is facing adverse health 2.5
effects. Children, with developing lungs and geriatric patients with chronic diseases are the worst affected. The
impact of short-term and long-term exposure to air pollution includes premature mortality, exacerbated
chronic heart and lung disease, lung cancer, decreased lung function in children as well as school absenteeism
and restricted activity days.¹ Hospitals and healthcare facilities are facing the increasing burden of a growing
number of hospitalizations and emergency department visits. Alarmingly, a recent global analysis from 116
countries has described an association between PM_2.5 and clinical antibiotic resistance.² The profound impact of air pollution has been seen recently in Lahore, where school and business closures have hindered the normal
functioning of society's education system and economic activities.

Air pollution ranks among Africa and Asia's top ten risk factors for disability-adjusted life-years (DALYs). The
combined effect of exposure to fine particles in ambient (outdoor) and household air pollution is associated
with 7 million premature deaths annually.¹ Globally, air pollution is the leading cause of death, killing 600,000
children under the age of 15 every year. Ambient air pollution is estimated to have caused 4.2 million premature
deaths worldwide; 89% of those deaths occurred in low- and middle-income countries, notably in Asia and
Western Pacific Regions.² In Pakistan, it has been estimated that the average lifespan is reduced by 3.9 years due to air pollution, whereas in Lahore, life expectancy is reduced by seven years.

The main sources of air pollution are industrial emissions, traffic-related pollutants, coal power plants, smoke
from brick kilns, crop burning, dust from construction sites, household biomass combustion, and indoor
pollutants from chemicals and tobacco. The toxic contaminants in the air include particulate matter (PM),
ozone (O₃ ), nitrogen dioxide (NO₂ ), carbon monoxide (CO), and carbon dioxide (CO₂ ). PM includes inhalable 
particles measuring 10 microns or less in size. PM₁₀ & PM_2.5 are proxy indicators for air pollution with the level of risk and adverse health effects varying with the size of the particles. Fine particulate matter of 2.5 microns or
less, including diesel-derived PM, is among the most dangerous airborne pollutants because of its small size
and ability to stay airborne longer. Burning fossil fuels, such as gasoline and coal, significantly contributes to air
pollution, releasing pollutants like nitrogen oxides and volatile organic compounds into the atmosphere. The
interaction of sunlight with nitrogen oxides and volatile organic compounds in the atmosphere creates ground-level ozone, a greenhouse gas and a principal constituent of smog.

Exposure to PM, lead, and the gaseous pollutants CO and SO₂ have reported pro-arrhythmic effects resulting in 
heart failure, ischemia, and atrial and ventricular arrhythmias.³ It is now widely recognized that PM is _2.5
associated with enhanced atherosclerosis development, premature aging of blood vessels, build-up of calcium
in the coronary artery, and blood coagulability.³ At ground level, ozone causes breathing difficulties, coughing,
throat irritation, asthma, and COPD. Ultra-fine PM can penetrate the bronchial epithelial barrier and enter the
bloodstream, causing systemic inflammatory changes and oxidative stress, leading to metabolic disorders,
dysbiosis, neurodegeneration, and dementia. Research has found links between air pollution exposure and
genetic and epigenetic changes that can be inherited across generations. Poor air quality is linked to immune
dysregulation, allergic rhinitis, allergic conjunctivitis, and other stronger allergic reactions.

Socially and economically marginalized vulnerable populations, outdoor workers, and professionals like
construction workers, athletes, and traffic wardens are more likely to be adversely affected by toxic air.
Increased air pollution during outdoor activities has brought into question the public health perspective
advocating outdoor exercise as a preventative measure for various health issues, from heart problems to
mental well-being.

The focus of COP28 held in December 2023 revolved around critical objectives such as reducing greenhouse gas
emissions. "Beginning of the end" of the fossil fuel era, the United Nations Climate Change Conference (COP 28)
signalled the need to move away from fossil fuels for the first time. However, a significant challenge arises for a
country like Pakistan, where the swift implementation of green technology is hindered by the substantial costs
associated with its adoption. The urgency of addressing climate change is apparent; however, the economic
constraints faced by Pakistan make the immediate achievement of fossil fuel reduction targets a complex and
formidable task.

Healthcare providers, public health workers, and academia should promote planetary health and advocate for
embracing individual responsibility in mitigating the impact of greenhouse gas emissions. A pressing need
exists for prioritizing public policies to safeguard individuals from air pollutant exposure, enforce stringent
regulations and penalties for polluters, promote sustainable practices, and invest in low-cost carbon sinks like
the urban green and blue spaces. Concerted efforts to address this crisis are paramount for our children's future survival.

Editor-in-Chief

How to cite this: Alamgir W, Shan H. Air Pollution: A Challenge to Public Health and Healthcare Systems. Life and Science. 2024; 5(1): 1-2. doi: http://doi.org/10.37185/LnS.1.1.594