Indian Journal of Air Pollution Control Vol. IX No.

1 March 2009 pp127-129

Report on the Proceedings of the Workshop

“Air Pollution and human Health”
Held on 23rd Sept., 2008 at WWF-India Auditorium,
Lodi Estate, New Delhi

After the usual welcome of the delegates, Shri Rajesh of the Ministry of Environments and Forests
was requested to chair the proceeds of the day. He in his Inaugural Address dealt with the Health
Problems in the country. He informed that population and growth rate, population characteristics, age
distribution of populations, literacy rate, population below poverty line, birth and death rate, specific
mortality rates, fertility rates and life expectancy are the health related indicators. Discussing the
present status, he told that considerable improvement has taken place in terms of life expectancy and
reduction in mortality rate. Further, small pox has been eradicated and Guinea worm disease has been
eliminated.
Discussing the types of categories of diseases and their causes, he stated that the first category
of diseases, are communicable, maternal, peri-natal and nutritional. These diseases are responsible for
42.2% deaths and 50.3% DALYs. The burden of diseases of the second category is non-
communicable. These diseases are responsible for 47.9% deaths and 33.0% DALYs. The non-
communicable diseases are malignant Neoplasms, diabetes mellitus, Neuropsychiatric dis orders,
cardio-vascular diseases, respiratory diseases and digestive diseases. The burden of diseases of
category three is injuries. These are responsible for 9.9% deaths and 16.7% DALYs.
The data on reduction of the various diseases was then presented. It was informed that
Leprosy as on 31st December 2005 was reduced to 0.95 cases per 10,000 persons from 57/10,000 in
1981. Similary Kala Azar (Visceral Leishmaniasis), a disease which occurs due to the bite of infected
female sand fly, has been aimed to be eliminated by 2010. Information was also given about various
other diseases, their causes, and prevalence, as also the programmes launched by the Government of
India to eliminate or control them.
The first technical lecture was delivered by Prof. Mukesh Chandra of IIT, Kanpur. He
introduced the subject through a review of the ambient air quality criteria/standards. He showed that
as the plume advances on its journey after ejection from the stack, the impaction on the ground
surface is through a fall out of the pollutant particulates (aerosols) and gaseous emissions. All the
criteria pollutants (carcinogens) have threshold values beyond which they become highly hazardous.
The technique to select the pollutants that need air quality standards was then given for both criteria
pollutants and hazardous pollutants. A list of 15 pollutants was finally selected by the committee. A
review of the current levels of these pollutants, their current standards, the basis for the new standards
and associated risk was then presented. It was emphasized that pollutants having long term effect
should also have 24 hour standards along with annual standards. A review of the dose-response
relationship developed/published in India or elsewhere and by WHO was also given. He informed that
cost of implementation of the standards is formidably high in case we take the true / primary criteria
of the standards as human health only. Finally he presented the proposed standards fully justified by
the committee to be adopted for future use.
This introductory talk was followed by a presentation on a model study CHEMTOX by two
of Prof. Mukesh Chandra’s students. CHEMTOX is a soft ware related to chemical toxicity and risk
assessment. The model simulates concentrations of the contaminants and their metapolites in blood
and organs. It is a physiologically based pharmaco-kinetic (PBPK) model. It employs Monte Carlo
simulation and solves a specific set of differential and algebric equations and validates the data
available in the literature. The model as applicable for Lead – a Carcinogenic material whose
acceptable level in human blood is only 10 microlitre per deciliter – was described in detail giving all
relevant equations to characterize risk assessment. A case study of DDT/DDE was also presented.
These presentations were followed by a very lucid talk by Dr G.C. Khilnani of AIIMS on the
subject ‘Air Pollution and Human Health – Delhi Scene’. He started his talk by showing the
dirty/polluted environments around us. He also gave a scenic view of pollution generated after the
various accidents/incidents that have taken place during the 20th century. He reiterated a statement
made by WHO in 2002 wherein it is stated that free access to air of acceptable quality is a
fundamental human right. He made a revelation that motor vehicle emissions may be responsible for
twice as many deaths as from the motor vehicle accidents.
In his deliberations he described the various types of pollutants both of particulate nature and
gaseous. He informed that the most vulnerable groups of people with chronic respiratory & cardiac
diseases including asthma are due to the presence of fine particulates in the air, and under smog high
risk groups are infants & children, pregnant women, and elderly persons. The various sources for
these particulates are diesel trucks and buses, construction equipment, power plants, wood stoves,
wild fires and chemical reactions in the atmosphere. He also stated the various gaseous pollutants and
their health effects. He further stated that vehicles are the largest pollutants and amongst them trucks
and 2-wheelers are the highest emission sources with peak pollution in the morning fumigation period
and the evening transition time. He also described the phenomena of ozone formation and global
warming.
After all this general information, Dr Khilnani presented the various types of studies made
world-wide on long term and short term health effects due to pollution. He also related health effects
to the various types of air pollution indices used world wide.
To describe the Delhi Scene related to the pollution vis-à-vis health, he first narrated the
reasons for high air pollution in India and the estimated air pollution load in the major cities of India.
Analysing Delhi problem he stated that transport sector is the big culprit here. SPM in Delhi
frequently violates the air quality standards. He enumerated the various projects undertaken at AIIMS
related to air pollution and health effects. He stated that outdoor air pollution in a hospital like AIIMS
is related to the emergency visits made of the patients suffering from respiratory and cardiac diseases
in the various seasons or other pollution effects in the city. In the end he presented in detail the studies
made of the health effects due to IP Power Station.
Dr Khilnani’s talk was followed by another interesting talk by Dr Rajesh Kumar of the
School of Public Health, Chandigarh. His topic was ‘Air quality and Health’. He reported his studies
made at Mandi Gobindgarh and Ludhiana in Punjab. He mentioned that to maintain human health one
needs clean air, safe food, safe water, adequate housing, safe working place, safe streets and safe sex.
Air pollution is responsible for acute respiratory infections, chronic respiratory diseases, cardio-
vascular diseases, low birth weight and cataract.
The studies made at Mandi Gobindgarh were to establish a relationship between the extent of
air pollution and morbidity. Air quality in terms of SPM, SO2 & NOx was monitored twice a week by
using a High Volume Sampler during the years 1999 to 2001. Simultaneously survey of the health of
4000 adults was carried out. During the presentation of the results, it was reported that SPM had been
too high all through this survey.
The studies made at Ludhiana were in relation to air pollution and mortality. The period of
study was 2002 to 2004. Data of SPM collected at different sites was presented elucidating the effort
made to find an association of RSPM/Visibility with mortality. The observation made from these
results was that there was 1% rise in deaths for every 100 µg/m3 rise in RSPM and 2% rise in
mortality for every 1000 m decrease in visibility. The limitations in the study were amicably reported.
The next talk was made by Prof S.K. Chhabra of Vallabhbhai Patel Chest Institute, Delhi.
His topic was: ‘Health Effects of Outdoor Air Pollution: a Review and Indian Studies’. He initiated
his talk by presenting the SPM data in Delhi collected at various sites. He informed that the highest
SPM value was at Najafgarh (550 µg/m3), followed by Town Hall, Delhi, while the lowest was at Siri
Fort (350 µg/m3). Oxides of Nitrogen were the highest at Town Hall and that too above the prescribed
standard. Town Hall had also the highest value of SO2 pollution, however it was below the standard
limit at all the places. RSPM (PM10) was high enough (more than 300 units) during the years 2001 to
2005.
The effects of pollution were studied in terms of toxicological, epidemiological and controlled
human exposure. Peak expiratory flow (PEF) was found between 5.7 ± 3.2 and 11 ± 3.6 units. To see
the effect of these high values of PEF, studies were made of the relationship between ambient air
quality and rates of hospitalization due to acute respiratory (Asthma/COPD) and coronary
(angina/heart attacks) events at AIIMS, New Delhi. It was observed that SPM and RSPM had
significant positive correlation with the number of COPD cases. Studying morbidity it was reported
that higher morbidity has been noticed in subjects residing in areas with raised level of pollution.
Epidemiological studies were carried out through standardized respiratory symptoms questionnaire,

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case history and examination by chest physicians and lung function tests (Spirometry/ Peak flow
recordings). It was found that nearly 25% residents of Delhi have chronic respiratory symptoms. A
marked increase in respiratory symptoms (43% in urban and 14% in rural) and sputum alveolar
macrophages were observed in urban children compared to rural children.
Ozone, another hazardous pollutant, irritates the respiratory system. These systems can last
for a few hours after exposure to ozone and may even become painful. Ozone reduces lung function.
It is difficult to breathe deeply and vigorously as one normally would when presence of ozone is
insignificant. It aggravates asthma. It influences and damages the lining of the lung. In sensitized
animals exposed to ozone, there was a greater increase in bronchial reactivity. Dietary
supplementation with vitamins E and C may have a protective role against allergen-ozone interaction.
The last talk was made by Dr Pragti Chhabra of the University College of Medical Sciences
and GTB Hospital, Delhi. The subject of her talk was Indoor Air Pollution and Childhood Lung
Diseases. In her talk she emphasized that indoor environment was more likely to cause
environmentally associated symptoms than outdoor environment since the proportion of time spent
indoors exceeds far more the time spent outdoors for most of the people. Further, concentration of
many pollutants indoors exceeds from those outdoors. She informed that significance of indoor air
pollution in child health has been recognized since 1980.
Causes of indoor air pollution are combustion, building materials, furnishings & chemical
products, pesticides, VOC, Radon, Mold, Mildew and Mites (biological), Biomass fuel, fuel use and
space heating. Environmental tobacco smoke is a major source of indoor air contamination. It has
been found that Indoor air pollution from household use of solid fuels causes about 35.7% of lower
respiratory infections.
Exposure assessment can be made by direct and indirect modes. In direct assessment, one
carries a personal monitor or there is a biomarker. In indirect assessment concentration of pollution of
the microenvironments where time is spent, and the amount of time spent in each microenvironment
should be known. In this case ALRI (Recall, Field Worker Surveillance and Physician Diagnosis) risk
factors, socio-economic status, parental education, breast feeding, nutritional status, environmental
tobacco smoke, crowding and immunization are the factors that are important. Risk is higher in
younger children. It can be also responsible for still birth.
A significant negative impact has been found with respect to environmental exposure to both
passive smoking and wood and kerosene invented cooking stoves. It is required to improve fuel and
combustion, impart health education, use improved stoves and clean fuel. In other words there is a
need for well-designed randomized intervention trials in the household.
This workshop was followed by Professor Nilay Choudhary Memorial Lecture, which was
delivered by a well-known environmentalist Ms Sunita Narian of CSE.

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