Madrid, Spain – India’s Environment Secretary has said that he does not deny the link between air pollution and its health impacts – and affirmed that India needs to act on the issue because “even a single death” from poor air quality would be too much.

“Nobody denies that poor air quality causes morbidity and may also cause mortality. Certainly …it must be causing mortality,” said CK Mishra, Secretary of the Ministry of Environment, Forestry and Climate Change, in an interview with Health Policy Watch and two Indian media reprsentatives at the COP 25 Climate Conference, where Mishra was leading the Indian delegation in negotiations last week.

“I mean it may not be 7.5 [million deaths],” Mishra added, an apparent reference to  WHO estimates that there are 7 million deaths globally every year from air pollution, “It could be 2 it could be 5. …But the fact remains that there are numbers to be attended to.

“As far as the ministry is concerned, we are very conscious of the fact that it is leading to loss of human life and we need to correct this situation.”

Mishra made his remarks prior to Friday´s controversial and widely-quoted comments by Environment Minister Prakash Javadekar who declared before the Indian parliament that “No Indian study has shown pollution shortens life. Let us not create fear psychosis among people.”

But in the halls of the Madrid Climate Conference, where the Environment Ministry´s top civil servant was leading the Indian delegation in negotiations, Mishra sought to convey a more nuanced view of the Indian position to reporters.

“It’s common sense,” he said. “If you are breathing  bad air, it cannot cause good to your system….Irrespective of the reliability of the number… a number indicates a job to be done….”

While Mishra said that he was not trying to refute the link between air pollution and ill health – or even with mortality, he did say that more Indian-based studies would help nail down the exact numbers of people affected more clearly.

“We are not questioning the numbers. We are saying, let us get to know very closely how we get to that number. That also helps us find the causes.”

Javadekar’s statement roundly criticized 

Javadekar´s statement refuting the link between air pollution and health impacts was hotly contested by top WHO officials as well as some leading Indian medical experts. WHO has said that the evidence about reduced life expectancy among populations chronically exposed to air pollution is well-established globally, with evidence that recognizes no borders.

“No study shows Indians immune from air pollution: WHO responds to Prakash Javadekar,” said WHO´s Maria Neira, in a tweeted response on Friday. Neira, who leads the agency´s work on health, climate and environment, has become a vocal public advocate for national government action; but it is extremely rare for a WHO official to call out a single national government, or government official, by name.

“Air pollution is one of the biggest risk factors for health, especially impacting children and older people.  Reducing indoor and outdoor air pollution should be a high priority for governments and citizens,” said WHO’s Chief Scientist Soumya Swaminathan, herself a former head of the Indian Council of Medical Research (ICMR), in another tweet. While Swaminathan´s comments were not aimed directly at the Indian Minister, they highlighted a new study published just last week on the immediate health gains that have been realized from reducing air pollution levels in cities and regions around the world.

Indian researchers have indeed confirmed the fundamental linkage between  air pollution and ill health, Mishra acknowedged, referring to studies by the All India Institute of Medical Sciences [AIIMS] undertaken when he was Secretary of Ministry of Health and Family Welfare.

“AIIMS did some studies for us…and the established fact is vulnerable people are severely impacted by air pollution. Ok? The not so established fact is cause of death which is an academic exercise. ..this is an exercise that the Health Ministry is doing.

“As far as Environment Ministry is concerned, the concern is not numbers. The concern is why should even a single death happen because of air quality. That is the point I am making.”

He said, however, that studies ongoing at national level under the auspices of the Ministry of Health in collaboration with the Environment Ministry, would help to confirm the numbers of people impacted in India more precisely.

“Lots of studies are going on. They will have to be collated. The health mission will also give us some indication – the mission in collaboration with the Health Ministry that we launched six months ago. So, we are waiting.”

Estimating deaths attributable to air pollution risks is inherently more complex than counting the numbers of people who died from a particular disease, Mishra pointed out, although he acknowledged that what matters more, is to get a grip on the problem.

In fact, a broad scientific consensus has emerged around the basic methods for calculating deaths from air pollution. Based upon those methods, Indian mortality estimates were released just last year in The Lancet in a study co-sponsored by the ICMR. That study found some 1.24 million people died prematurely in India in 2017 due to air pollution, including 670,000 deaths from outdoor exposures and 480,000 from household air pollution.

But Mishra still contends that the methods used to make such assessments are not yet formalized. “Is there a coherent system, which is internationally accepted, to put a number on mortality caused by air pollution is the question? If that is there, no issues,” he said.

“Diseases are recognizable, identifiable causes. X died of tuberculosis” Mishra noted. “Now that death of the tuberculosis patient could have been hastened because of bad air.  There is a cause-effect…[but as for the] exact estimates of the number of people who died from air pollution [that is] more difficult to calculate.

“Having said that, there is no harm in accepting them and working on them, instead of disputing them,” said Mishra referring to the prevailing expert estimates. His more nuanced views seemed to reflect growing recognition of the gravity of air pollution’s health impacts in some government circles, even if top politicians still seek to play it down.

India Will Improve Air Quality In Coming Years

In the interview, including journalists from The Telegraph India and India Climate Dialogue, Mishra also expressed confidence that within the coming few years, India will make big advances on air quality.

“I would like to dispel this belief that we have not seized this opportunity [to act]. India is very much there, and air pollution is a major concern. But let me tell you that it is not just Delhi or a couple of cities in India. This is a global issue and this issue arises from several things, including the fact that there are meteorological factors which are impacting it.

“Notwithstanding all that, the commitment is that over the next five years or so we will bring about a reduction of 30%, in terms of the particulate matter and the pollutants. We have already done about 15% reduction and we are steadily moving.

“We have a commitment to clean the air. Even if it causes no mortality no morbidity, we still need to do it….”

Mishra said, however, that WHO and other international agencies concerned with India´s air pollution problem should factor in the complexities that must be faced.

“One thing that I would like to emphasize is, that air quality and issues of air pollution, do not have a switch on-switch off solution or technology. It takes time. Efforts are on, resources are being put in, and I think every year it´s improving and by the end of another 4 years or so, we should have a much cleaner air – in the entire Indo-Gangetic plain which incidentally is the only problem area for India. It is a small portion of a big country like India.

“…And yes of course it is about morbidity. I do not know how much of a direct connect you have to mortality in terms of counting numbers. But anyway, be that as it may, it is a commitment of the Indian government. And the Swachh Bharat (Clean India) mission of the Prime Minister – the entire switching over to cleaner fuels… e-vehicles…they are all part of the strategy.”

As for the contribution of rice stub burning in Punjab and other neighboring states to Delhi´s chronic winter air pollution crises, a major focus of media attention this year, Mishra said the focus on crop burning may be “slightly disproportionate to the kind of problem that it poses.

“But be that as it may, there are two solutions we have come up with. Last year and this year, we have tried on what it is known as the in-situ solution of mulching the straw in the ground.

“At the same time, there are private sector players as well as public sector players, which are strongly looking at ex- situ solutions, which include using that straw and the biomass for power generation, for gasification, for bio-ethanol, and many other purposes. So that experiment is going on, and I think over the next couple of years, we are going to see a huge improvement, including some changes in crop patterns as well.

He also praised Delhi officials for playing a strong role to confront the air pollution emergency that has wracked the city over the past month, where levels of small particles at times rose higher than the measurement limits of monitoring equipment.

“The municipal bodies have to really, really come forward to take it up. The kind of work they [in Delhi] have done this year, if they continue to do it for the next two years, we will have much cleaner air. They have really, really responded well this year.”

In the broader climate arena, Mishra also said India intends to take a stronger leadership role in the stalled negotiations – even if that has not been explicitly stated.

“You don´t take a leadership role, by announcing that your leadership. You take a leadership role by your actions, by what are you doing. And the globe watches you very carefully. So when I say India is going to take a leadership role, it is two-fold. “A – India is slowly becoming the voice of many countries which have this problem and are trying to solve it and B – In our own field, in reduction of emissions, we want to lead the rest of the world.”

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Priti Patniak contributed to the research and reporting of this story.

Image Credits: E Fletcher/HP-Watch, @DYFIDELHI.