Diseases Caused by Air Pollution

Take a breather—something we do or suggest to others they do a few times a day to catch our breath after some exercise or to just take a break after some particularly stressful or hard activity. But what happens when the air that we inhale to relax or bring our body back into balance contains a lot more than oxygen?

Unfortunately, most of the air we breathe is polluted.

The horror stories about China’s pervasive air pollution which costs the life of more than one million people every year are shocking and show no signs of improvement. For weeks during early 2017, northern China has been covered in a thick toxic smog, considered as one of the worst episodes of air pollution the country has seen, affecting 460 million people [1].

But we should be under no illusions: air pollution is not just an issue for countries with a large industrial base fuelled with coal, such as China, or developing nations which don’t have the technology or know-how. It is a reality across the globe, including in Europe and North America.

Air quality today: billions of people breathe polluted air

It’s not Finland, with the cleanest recorded air in the world [2], but the United States, for all of its checkered stances on environmental issues, has been one of the world’s leaders in air pollution reduction, at least of particulate emissions from industry and vehicles.

Since the passage of the Clean Air Act in 1970, major air pollutant emissions have dropped dramatically and the total number of days with unhealthy air has dropped in 35 major cities by almost two-thirds since 2000 [3].

The loss of the steel market to Japan in those early years certainly contributed to cleaner air. One might argue that the cost of the mandatory best available pollution control technologies demanded by the US Environmental Protection Agency (EPA) under the authority of the Clean Air Act contributed to making the United States less competitive, but in balancing the cost of jobs in one sector or health, the invisible hand was given a nudge by governmental policy.

Globally, however, air pollution is still on the rise. The most recent World Health Organization (WHO) statistics show an 8 percent rise in outdoor pollution globally over the preceding five years.

The World Health Organization estimates that 9 out of 10 people in the world are breathing air containing high levels of pollutants [5]. And the World Bank, along with the Institute for Health Metrics and Evaluation released a report showing that diseases from air pollution caused one in ten deaths five years ago, in 2013 [6].

It’s not New Delhi, with the dirtiest recorded air in the world, but still Beijing has attracted an equal amount of ignominious attention, with photos of smoky cityscapes filled with bicycle riders in face masks. Against this backdrop of sand and smog, the world is wary of China’s pledges to clean up its environment.

China has a strong economy in clean energy solutions [7], but is it working hard enough to incorporate them [8]?

Beijing must contend with sandstorms it’s true, but this last Spring’s smogstorm covered an area of 1.5 million square miles and was one of 34 cities in northern China to issue smog alerts as curbs against manufacturing during the heating season were lifted and industrial activity resumed [9]. 

Just two weeks after Beijing reported that its air quality was better than it had been in five years, the government halted construction work in the city and issued an advisory against children and the elderly from going outside, recommending those who had to go out to wear face masks [10]. Not just paper face masks or bandanas, but respirator masks.

And they attribute seven million deaths annually to outdoor and indoor air pollution [12].

These are some staggering findings which we cannot afford to leave unaddressed. Indeed, in 2015, leaders from across the globe set a target within the Sustainable Development Goals to reduce the number of deaths and illnesses from air pollution by 2030. Associated with this commitment, in 2016 the WHO adopted a plan for accelerated action on air pollution and its causes.
 

Dangerous air pollutants: what causes outdoor air pollution?

The United States regulates six common air pollutants:

• Ozone
• Particulate matter
• Carbon monoxide
• Lead
• Sulfur dioxide
• Nitrogen dioxide

It also monitors 187 air pollutants known or suspected to cause cancer or other serious health issues. Well-known examples of these hazardous air pollutants are benzene, the vapor rising from gasoline, dry cleaning chemicals, and paint strippers.

#1 Ozone

The first CAP, or Criteria Air Pollutant is ozone. For simplicity sake, we will call it “bad ozone.”  Ozone is simply a gas made of three molecules of oxygen. 

The ozone layer frequently talked about – generally in the context of ‘the hole in the ozone layer’ and thinning of the ozone layer through the combustion of fossil fuels is in the Earth’s upper atmosphere. It is “good ozone” because it forms a layer that protects us from the sun’s strong ultraviolet rays.

The “bad ozone” that needs to be regulated is that same gas closer to the ground. It is formed when volatile organic compounds react with nitrogen oxides in the presence of sunlight. Ozone irritates the lungs at concentrations which are common in urban settings, particularly during the summer months.

You can easily recognize the orange-tinged smog one sees in urban areas when nitrogen oxides and volatile organic compounds, emissions from industrial facilities, chemical solvents, motor vehicle exhaust or gasoline vapors cook together in the sunlight.

Ground level ozone can make breathing difficult and harm vegetation as well.

#2 Particulate matter

The second pollutant is Particulate Matter. Also called particle pollution, it refers to tiny inhalable particles made up of hazardous chemicals and liquid droplets. 

Particulate matter is a complex mixture that may contain soot, smoke, metals, nitrates, sulphates, dust, water and tire rubber. Sources of particulate matter can be either direct emitters such as smoke from a fire, construction sites, or unpaved roads. Other particles form when sulfur dioxide and nitrogen oxides from power plants, industries or automobiles and sometimes ammonia from agricultural activities, react with each other. Ultraviolet rays contribute to the soup causing what is commonly called photochemical smog.  

The size of the particles is what determines what kind of health problems they may cause. The United States regulates inhalable particulate matter of 10 micrometers and smaller. It is generally considered that the finer the particle the longer it stays suspended in the air and the more hazardous it is as it easily absorbs into the bloodstream and can lodge deep in sensitive areas of the lungs, obstructing them.

Small particles (known as PM 2.5 or fine particulate matter) pose the greatest problems as they can penetrate deep into your lungs and some may even get into your bloodstream. To give an idea of the small size of these particles, forty of them would span the breadth of a typical piece of human hair. The number of 2.5 particulates in a cubic meter of air is the general measurement of particulate matter by governments across the world. Sand and large dust are larger than 10 micrometers and are not regulated. 

Particulate matter has not only been linked to lung cancer, it has also been associated with cardiovascular diseases. The small particles of air pollution can begin to irritate the lungs and blood vessels around the heart which over time aggravates or increases the process of disease in the arteries. It has been linked to irregular heartbeat, nonfatal heart attacks and premature deaths in those with lung or heart disease [13].

#3 Carbon monoxide

The third regulated pollutant is carbon monoxide. It is an odorless and colorless gas released when fossil fuels are burned. It is poisonous. It reduces the amount of oxygen in the bloodstream and sufficient oxygen is critical to the heart and the brain.

Outdoors, a high enough concentration can cause problems to those with a heart condition or even just to those exercising strenuously and needing a lot of oxygen. While waiting behind it at the traffic light, don’t breathe in the bus exhaust.

#4 Lead

The fourth “Criteria Air Pollutant” is lead. Lead in the air has many sources, most notably lead smelters. 

Lead exposure is detrimental to every organ of the body. It can cause brain damage, kidney malfunctions, reproductive issues, cardiovascular problems and its ingestion has even been linked to seizures, coma and death. 

Accordingly, it has been one of the most stringently regulated toxic chemicals. According to the US Environmental Protection Agency, lead in the air decreased 98 percent between 1980 and 2014 from removing lead from motor vehicle gasoline [14].

#5 Sulfur dioxide

The fifth regulated pollutant is sulfur dioxide, a common emission from power plants and other industrial facilities which can cause severe respiratory problems. Sulfur dioxide is a particular problem because it also forms into other sulfur oxides in the air which then become particulate matter in the sunshine.

#6 Nitrogen dioxide

Nitrogen dioxide is the sixth Criteria Air Pollutant. It is a highly reactive gas caused by burning fuel. The primary emission sources are power plants and motor vehicles.

Once in the air nitrogen dioxide readily forms both particulate matter and ozone, wreaking havoc on the respiratory system. Roll up your window when that delivery truck clambers by, spewing black smoke.

And indoor air pollution?

And that’s just outside. In the home, the air quality is even more dismal for the three billion people still relying on kerosene, wood, coal or whatever fuel they can acquire for cooking, heating and light [15]. 

Incomplete combustion of unprocessed coal can release arsenic, lead and mercury.

Health problems caused by air pollution

How does air pollution harm you?  Well, it depends on what you are breathing. 

Take a look at the list of air pollutants regulated by the United States. These originate primarily from industry, power plants and car emissions. If you live next to a polluting factory, a coal-generated power plant or next to the freeway, these are your culprits.

Add to that any chemicals you are exposed to in your workplace and any volatile organic compounds you are exposed to regularly outside of work, like paint thinner, household cleaning products and dry cleaning solvents, and tobacco smoke if you have a smoker in the house or live in Europe.  

More culprits causing health problems. If you are poor [18] or live in a developing country with limited air quality regulations or are one of the three billion who do not have access to clean energy sources [19], you are more likely to be subject to poor air quality than those more privileged than you.

Asthma and chronic obstructive pulmonary disorders

Air pollution is responsible for chronic obstructive pulmonary disease and increases the risks for acute respiratory infections.

Chronic obstructive pulmonary disease (COPD) is mostly linked to exposure to tobacco smoke, however, in lower income countries the disease is attributed mainly to the use of biomass and coal for cooking, heating and other household needs. With 3 billion people worldwide following such practices, this is an important consideration.

Over 20 million people in the U.S., including six million children, suffer from asthma, a condition in which your airways narrow and swell and produce extra mucus, making it difficult to breathe [20]. 

What makes children particularly vulnerable is the fact that they tend to breathe through their mouth, bypassing the filtering effects of the nasal passages; they also have a large lung surface area relative to their weight and inhale relatively more air, compared to adults.

Chronic obstructive pulmonary disorders also involve restricted airflow, inflammation and breathing difficulties, but generally occur later in life, have a less favorable prognosis, do not respond to anti-inflammatory treatment and generally result in a progressive decline in lung function [21]. 

Two common chronic obstructive pulmonary diseases are emphysema and chronic bronchitis.

Cancers

The International Agency for Research on Cancer classifies particulate matter as a carcinogen, and now after reviewing more than 1000 scientific papers from studies on five continents, has decided to group individual air contaminants on the carcinogen list into one, classifying outdoor air pollution itself as a carcinogen, and not only declaring that outdoor air pollution causes lung cancer, but that it is also linked to bladder cancer [22].

Lung cancer begins with an irritation of the airways and uncontrolled abnormal cell growth. It involves a persistent cough, sometimes of blood, that gets worse over time, constant chest pain, difficulty breathing, repeated episodes of pneumonia or bronchitis, weight loss and fatigue [23].

Sustained exposure to fine particulate matter has been linked to liver, breast and pancreatic cancers as well as leukemia, a blood cancer [24]. 

Exposure to asbestos can cause mesothelioma, a rare, aggressive cancer with a poor prognosis that develops in the lining of the lungs, abdomen or heart [25].

Cystic fibrosis

Not surprisingly, air pollution exacerbates cystic fibrosis, a genetic disease involving a buildup of mucous in the lungs that traps bacteria and leads to infections, extensive lung damage and eventually respiratory failure. 

And now a study reports that air pollution increases the risk that young children with cystic fibrosis will develop the methicillin-resistant bacteria Staphylococcus aureus, or MRSA [26].

Chronic cardiovascular problems

Long-term exposure to fine particulate matter and nitrogen oxides can cause inflammatory effects on the heart as well over time, prematurely aging blood vessels and causing chronic cardiovascular problems including heart disease, stroke, high blood pressure and cardiovascular diseases [27]. 

It can also show more immediate results.

For example, those already struggling with heart disease can experience immediate trouble when air pollutants cause plaque in a blood vessel to rupture, triggering a heart attack [28]. 

The risk of adverse inflammatory effects is markedly greater in the elderly and those with diabetes, obesity, hypertension [29].

Birth defects and autism

Air pollution has been linked to birth defects, both from exposure of the mother to polluted air around the time of conception [30] and due to poor sperm quality of the father from exposure to air pollution containing toxic heavy metals and polycyclic aromatic hydrocarbons [31]. 

A recent Harvard study concluded that children whose mothers are exposed to high levels of  fine particulate matter in their third trimester of pregnancy have up to twice the risk of developing autism [32].  While this study has been widely attacked, the final word from the US National Institute of Health validates its findings [33], finding a ‘compelling causal connection between air pollution and autism spectrum disorders.’

Brain inflammations

Air pollution is known to cause inflammation in the brain and neural system too [34].  

A recent seminal study in Greater Los Angeles demonstrated a strong correlation between air pollution and teen delinquent behavior, showing that antisocial behaviors were triggered by inflammation in the brain.

How can air pollution be prevented?

To answer this, we need to examine the man-made sources of air pollution. 

The primary contributors are:

• motor vehicles which burn of fossil fuels
• agricultural activities releasing ammonia gas
• factory exhaust
• mining operations
• indoor air pollutants [35]

*The latter includes not only improper combustion of fossil fuels, but the ubiquitous use of toxic household products ranging from paint fumes to your furniture polish aerosol or air freshener.

Motor vehicles

• Drive less.
• Take public transportation.
• If none, participate in creating it. Look to new capital projects and upgrades in current transportation which do not utilize fossil fuels.
• Share rides. 
• Bicycle or walk when feasible.
• Drive an eco-friendly vehicle: a hybrid or a fully electric one.

Agriculture

Agricultural activities which emit large quantities of ammonia that is a catalyst for smog. The agriculture industry is strong and fighting wholeheartedly against the regulation of ammonia [36]. 

But at the individual level you can:

• Buy locally rather than supporting agribusiness. Demand creates the market.
• Educate the community to the benefits of eating fresh, sustainable grown local food.

Manufacturing exhaust

Much of manufacturing is devoted to unnecessary consumer goods, so here is what you can do:  

• Consume less. 
• Insist that your government compel industries to utilize the best technologies imaginable to control emissions.

Mining and construction

Mining operations and construction projects that emit large amounts of dust. With a large-scale move away from fossil fuels and unnecessary consumer goods, mining operations can be largely unnecessary. 

But for those that continue, enforce restrictions that minimize the dust, such as alternative extraction techniques and only performing the operations on wet days. 

Construction projects can often be blockaded from the general public if required. In this situation, of course worker safety must be heightened.

Indoor air pollution

Help provide access to clean technologies for cooking, heating and lighting to the three billion without. Educate people to the hazards of using fossil fuels in the home as well as the toxic household chemicals routinely used in most homes.

It is clear that air pollution can really damage our health. But decisive action to eliminate air pollution can yield results quickly and substantially improve our quality of life. For example, WHO guidelines indicate that reducing annual average particulate matter concentrations to the WHO guideline levels could already reduce air pollution-related deaths by around 15 percent.

We also need our governments to adhere to commonly agreed standards, such as the EU’s National Emissions Ceiling Directive which sets maximum limits for air pollutants, as well as to take stringent action when industries, such as the automobile industry misinform consumers about emissions as was the case with Dieselgate and the 2015 Volkswagen emissions scandal.

A lot of environmental charities and NGOs, such as Friends of the Earth or Client Earth, are working hard to improve air quality around the world.

Help support their activities – it will be a breath of fresh air!