Amid deteriorating air quality in Mumbai and the rest of Maharashtra, the state health department has issued an advisory on air pollution and an action plan to be implemented by the city and district administration. The health department has said that the health of citizens may be impacted following the deteriorating air quality due to air pollution and dust during November and February, especially in the winter season. Since November the air quality has deteriorated and the air quality index has crossed 200 in various cities in the state. In view of the health hazards, the health department in an advisory has suggested the city and district administration create awareness among the citizens and take necessary steps.
The Health Action Plan for districts/cities will include
i. Documentation of month-wise average air pollution levels recorded in districts/cities
ii. Documentation of the vulnerable population in districts/cities.
iii. List of operational agencies and stakeholders in districts/cities
related to air pollution and associated illnesses.
iv. List of available healthcare infrastructure and services
available districts/cities for air pollution-associated
v. Documentation of month-wise average statistics of diseases
related to air pollution for districts/cities.
vi. Strategies to integrate air pollution data with disease surveillance data.
vii. Details of hot spots based on pollution levels and population vulnerability,and plan for appropriate healthcare services in hot spot localities.
viii. Roles and responsibilities identified for stakeholders in districts/cities.
ix. Standard procedures for operational coordination among local government and stakeholders.
x. Identified risk reduction activities in districts/cities.
xi. List of available resources to handle air pollution and health
related issues by Taluka
xii. Details of planned awareness and capacity
building activities(IEC, advisories, training).
xiii. Details of plans to make healthcare institutions environment friendly
xiv. Details of responsibilities of healthcare facilities towards a. Data surveillance
b. Response to address increase burden of illness
c. Logistics required at health care facilities
d. Preparedness of health personnel
e. Develop operational communication channel
f. Promote clean air by controlling waste incineration, use of diesel generators,use of vehicles non-compliant to vehicle emission standards
In addition, the department has stressed the need to generate awareness to prevent unhealthy effects of Air Pollution.
• General Population:
0Reduce risk from exposure to air pollutants by followings-
o Avoid places with high pollution like roads with slow & heavy traffic, areas near polluting industries, construction-demolition sites, coal based
power plants and brick kilns etc.
o Reschedule outdoor activities as per AQI level, and remain indoors ondays with poor to severe AQI.
o On days with poor to severe AQI, avoid outdoor morning and late evening walk, run, jog and physical exercise. Do not open external doors and
windows during morning and late evening hours, may ventilate ifnecessary between 12 p.m. to 4 p.m. in afternoon.
0Avoid burning biomass such as wood, coal, animal dung, kerosene. Use clean smokeless fuels (gas or electricity) for cooking and heating purposes.If using biomass, use clean cook stoves.
o Avoid burning firecrackers.
o Avoid burning in open any form of wood, leaves, crop residues, and
o Do not smoke cigarettes, bidis and related tobacco products.
o Avoid burning mosquito coils and incense sticks in closed premises.
o Practice wet mopping instead of sweeping or vacuum cleaning inside homes. If you choose to use a vacuum cleaner, use those which have a HighEfficiency Particulate Air (HEPA) filter.
o Keep washing your eyes with running water regularly and do regular gargling with warm water.
o Consult the nearest doctor in case of breathlessness, giddiness, cough,chest discomfort or pain, irritation in eyes (red or watery).
o As a “no-regret” strategy, a healthy diet, with fruit and vegetables rich in antioxidants, and adequate amount of hydration by drinking water is advocated.
Vulnerable Population – additional measures
0 Patients with underlying medical conditions such as chronic pulmonary or cardiovascular problems etc. should
o Be more careful to avoid exposure to air pollution.
o Avoid any strenuous activity if AQI levels are poorer
o Keep a check on exacerbations of symptoms during poorer AQI levels
o Properly follow personal doctor’s instructions on healthcare.
o Keep their prescribed medications readily available.
o Seek immediate medical advice if symptoms worsen.
The advisory has listed the people that may be considered vulnerable to health consequences of air pollution –
1. Age group – Individuals who are under five aged children and in old age. 2.Pregnant Women-Exposure during pregnancy may have consequences for
child in womb.
3. Predisposed health or medical conditions – Those with pre- existing illnesses of respiratory and cardiovascular systems etc. are at high risk.
4. Low socio-economic conditions – Those with poor nutritional status and those living in conditions of poor housing, using fossil
fuels for cooking, heating and lighting purposes have high risk. 5.Occupational group – Those with possibility of prolonged exposures
such as traffic policemen, traffic volunteers, construction workers, road sweepers, rickshaw pullers, auto-rickshaw drivers, roadside vendors, and others working outdoors in polluted settings
are at high risk. Women burning biomass for cooking, and sweeping dust are vulnerable on account of their household work.
The health impacts of air pollution depend on the level of pollution exposure duration.The individuals’ vulnerability to the health impacts of pollution can also differ based on demographic factors and predisposing health conditions.
Short-term high-level exposures can result in acute health reactions such as irritation to eyes,nose, and throat, along with coughing, wheezing, chest
discomfort and acute upper respiratory infections. Vulnerable groups can experience more severe effects such as lower respiratory tract inflammation and infection, exacerbation of asthma, bronchitis or exacerbation of illnesses such as chronic obstructive pulmonary disease, ischemic heart disease, and cerebrovascular stroke. Long term exposures to even lower levels of pollution can result in chronic illnesses of respiratory and cardiovascular systems, lung cancer and premature death.
1. Surveillance and Monitoring:
Sentinel surveillance of acute illnesses attributed to air pollution in the 17 cities across the state. Record and monitor acute respiratory or coronary events at emergency units of sentinel hospitals of each city.
Monitor this against daily AQI levels reported for the cities. Document and maintain statistics of illnesses and their mortality known to be related to air pollution. Statistics should be compiled by healthcare facilities and by cities and to share with NPCCHH programme division at NCDC at email: [email protected] OR [email protected]
Identify the hot spots by AQI levels and density of vulnerable populations and ensure adequate access for them to essential healthcare services.
Meeting of District/City Task Force for Climate Change and Health who would provide technical guidance to Nodal officers in air pollution related health services in developing the action plan as a priority.
Develop District Action Plan on Climate Change and Health, including sub-plans for Districts/Cities, which also has a section on air pollution and health related activities
Air pollution is the contamination of indoor or outdoor air by a range of gasses and solid particles that modify the natural characteristics of air we breathe. Key health harmful pollutants include particulate matter (PM2.5 and PM10), carbon monoxide (CO), ozone (O3), black carbon (BC), sulfur dioxide and nitrogen oxides (NO). Air pollution is often not visible to the naked eye as the sizes of the pollutants are smaller than the human eye can detect.
What are major sources of Air Pollution:
Ambient (outdoor) air pollution is caused by factors such as vehicular exhaust, roaddust, construction dust, burning of garbage, burning of agricultural crop residues, industrial emissions, fossil fuel fired thermal power plants and brick kilns, burning of biomass in households, burning of firecrackers etc.
Household air pollution is caused by burning biomass such as wood, coal, dung, kerosene in chulhas or fireplaces for cooking and heating purposes. Indoor air pollution is caused by burning mosquito coils, incense sticks, cigarettes, bidis, use of sprays, solvents, and fumes from chemicals used in building interiors etc.
Air Quality Index (AQI) is a tool based on ambient concentration values of air pollutants and is categorized as Good, Satisfactory, Moderately polluted, Poor, Very Poor, and Severe. Worsening of Air Quality Index especially when in range of ‘poor to severe’ in an area may result in increase in morbidity and mortality among the exposed people.
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