The World Health Organization (WHO) is holding its first global conference on the link between air pollution and health, the first ever global conference on the topic, aiming to find a solution to prevent the seven million deaths caused by air pollution every year. Several studies have established clear links between air pollution and health outcomes and have underlined how air pollution has become silent a public health emergency or a ‘new tobacco’. But what is too often ignored in the debate is the link between air pollution, health and socio-economic inequalities.
Does air pollution affect rich and poor equally?
Both outdoor (ambient) and indoor (household) air pollution cause multiple respiratory and cardiovascular diseases, and affect practically all countries in the world and all parts of society. However, some people in some countries, particularly those with lower social-economic status in developing countries, are more vulnerable to the impacts of air pollution. They often face higher exposure to pollution due to their living and working conditions. Some of the highest air pollution exposures are inflicted on those who make their living on the streets, including street vendors, waste collectors, traffic police or rickshaw drivers. They lack access to proper nutrition and medical services, which further constrains their ability to adapt to hazardous pollution. They often do not have sufficient knowledge or information on pollution and protection, and even if they do, many cannot afford expensive air masks and indoor purifiers.
Moreover, they do not have the option to escape the polluted areas by ‘quitting the city’ (through holidays or migrating to other countries), as many rich people do nowadays. These are not new insights – a study on Delhi (2011) identified that low-income residents bear the brunt of the city’s toxic air as levels of particulate matter tend to be higher in the city’s poorer neighbourhoods.
People often believe that once the air pollution is mitigated, these problems will no longer exist. Unfortunately, there are signs that poorly designed mitigation policies which do not consider socio-economic issues further exacerbate inequalities. Reducing severe air pollution requires a comprehensive technical and political-economic transition in key areas of industrial production, urban transportation, and a wide range of social services. Such transition often requires various policy and social interventions.
We undertook a pilot study in Beijing and Delhi in 2017, supported by the Sussex Sustainability Research Programme, which sought to understand the social inequalities related to the toxic urban environment, particularly their protective capabilities and lack of participation in political processes and social practices. The study revealed that in Beijing some of the policy interventions designed to mitigate air pollution further exacerbated social inequalities as people of lower socio-economic status were often excluded from their design and implementation.
As a result, the burden and costs of reducing air pollution were unfairly distributed to disadvantaged groups, who were eventually required to sacrifice their welfare (jobs, education, and even lives) for pollution reduction. For example, in December 2017, some rural residents around Beijing were freezing to death due to their bulk coal heating system at home being cut off as a result of Chinese government’s initiatives to reduce the capital’s winter pollution level. In the case of Delhi, the city continues to grapple with air pollution year after year, peaking in the winters, triggering a severe health crises in the national capital. However, most of the mitigation measures either are limited to technical fixes or appropriate for people who can afford them. Prescriptions as living indoors, wearing masks do not apply to those who work on the streets or are casual labourers who cannot afford these ‘luxuries’.
The politics of air pollution
The fight against air pollution is not just a technological issue, but a social-economic and social-political challenge because of its unbalanced social impacts on different population groups such as children, senior citizens and poor and marginalised people who either have limited adaptive or affordable capacity. It is also about the contestations of interests between economic development and environmental sustainability, between urban and rural divides, between those who demand cleaner air and those who are pay a big price for it.
These disproportionate impacts and political trade-offs associated with air pollution are typical manifestations of social inequalities analysed in detail in the 2016 World Social Science Report, which was co-directed by IDS Director Melissa Leach and John Gaventa. Social inequalities are defined as differences or imbalances in the functioning of education, health, justice and social protection systems, and inextricably interact with both economic and ecological inequalities.
Air pollution – a truly global issue beyond the North-South divide
In 2016, according the WHO statistics, 4.2 million premature were deaths caused by outdoor air pollution each year. About 90 per cent of those premature deaths occurred in low- and middle-income countries and 50 per cent of these are in India and China alone. As more developing countries follow in China and India’s footsteps and accelerate their urbanisation and industrialisation processes, the problem of air pollution will become truly global.
This is not only a developing country issue. Research in developed countries like the US, the UK and Canada shows similar disparities among people with various gender, age and ethnic groups. In the UK, the case of Ella Kissi-Debrah who lived 25 metres from London’s South Circular Road – a notorious pollution “hotspot” – is the first case in the UK linking urban air pollution to the death of a child. She experienced three years of asthmatic seizures and hospital stays before her death in February 2013. During that time, local air pollution levels breached EU and UK limits, legally binding parameters that must not be exceeded. According to a UK government report published in 2018, poor air quality has been classified as the largest environmental risk to public health in the UK and Defra is now consulting on the Clean Air Strategy 2018 that aims to reducing roadside nitrogen dioxide concentrations in the UK.
Given the global situation, the WHO conference is timely, but much more needs to be done to understand the widespread and complex connections between urban air pollution and social inequality – their manifestations, magnitude, deep rooted structural causes, and potential remedies – in order to prevent the millions of premature deaths that are caused every year by our toxic environment.