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healthcare | IST

Even newborns in Delhi and Gurgaon are ‘smoking’ 15-20 cigarettes a day due to pollution, says Dr Arvind Kumar

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On the occasion of World Environment Day, CNBC-TV18's Manisha Natarajan spoke to Dr Arvind Kumar, the founder of Lung Foundation of India.  He speaks about how over the last 30 years, the lungs of children as young as 10 and 12 are covered in black spots, like smokers' lungs.

Air pollution in India is a growing public concern, and the city of Delhi is the most polluted of all metros in the country.
There are various health hazards of breathing this polluted air, such as asthma, burning eyes, but there's one thing that scares us all — lung cancer. New research showed that breathing polluted air can affect your brain and cognitive abilities.
On the occasion of World Environment Day, CNBC-TV18's Manisha Natarajan spoke to Dr Arvind Kumar, the founder of Lung Foundation of India.  He speaks about how over the last 30 years, the lungs of children as young as 10 and 12 are covered in black spots, like smokers' lungs.
Here are edited excerpts:
Q: We have met the vulnerable foot soldiers of Delhi – The traffic policemen and Safai Karmacharis. They are given these thin black cloth masks by the government, which they believe are enough protection for them from air pollution and particulate matter. Do these masks offer any protection at all?
A: No, these cloth masks which are often worn by the safai karmacharis or the traffic policemen on the road, they have no protection at all. It is just a cosmetic kind of a thing which is there.
Q: So whether they tie a handkerchief or a cloth mask is the same?
A: Both are equally useless.
There are two things in the pollution. One is the particulate matter (PM) and the other is gaseous matter. Gaseous you cannot prevent by any means. There is no pore size which will prevent the gas molecules from going. You can protect the particulate matters from going if you use what is called N95 mask which has pores of such small size that almost 95 percent of the particulate matter is trapped and checked by the mask.
However, the catch is that you have to have a fresh mask, it should not be torn, and it has to be properly fitting on the face so that there is no space at the side. So all the air that you are breathing must pass through the mask, otherwise, if you just put it and it is loose, and 50 percent of the air volume that you are taking is coming from sides, then your protection is that much less, and it has to be worn all the time.
The problem with this mask is that the whole size is so small that when you exhale, there is some amount of resistance which this poses and not all the air passes out and some air remains inside which you rebreathe. So there is a certain amount of rebreathing that happens, one. Two, when you inhale and exhale, there is some amount of resistance. So your work of breathing increases and if you wear it, for a long time, it gives a sense of breathlessness. I have seen that after half an hour or so, people tend to remove it and put it in front of their neck.
Q: So masks are not really a solution. We are living in a deathly gas chamber; that is the reality of Delhi.  Today if you look at the Air Quality Index (AQI), earlier at least summers we used to have some moderate to reasonably good quality air days. However, today, in the peak of summer, most of Delhi and Gurgaon is in poor to severe air quality.
A: Most of Delhi and Gurgaon is smoking 15-20 cigarettes every day including newborns.
Q: You set up this lung care foundation because you noticed a definite change in the colour of lungs of patients you were operating on. Can you explain what is happening to all our lungs right now?
A: As a chest surgeon, I have been operating on lungs since 1988. So, 1988 to 2012 I was at All India Institute where a lot of patients used to be from outside Delhi and at that time smokers would be having black lungs, but non-smokers mostly would have pink lungs. However, over the years I was noticing that the amount of pink is decreasing and the area of black spots is increasing.
The major change I noticed when I moved to Gangaram Hospital where mostly we cater to Delhi’s population, I started noticing most of the people having black spots on their lungs and teenagers also I saw having black spots. Now, imagine somebody at the age of 12-13 has black spots on the lungs, what will happen to him by the time he is 30-40?
Q: Why don’t you just spell out what the health hazards of breathing this polluted air are. Lung cancer is a big thing everybody is scared of. There are breathing issues, asthma, burning eyes, but there is so much more. Now there is research to show that it can affect your brain and cognitive abilities.
A: I will summarize it in one sentence, in Delhi at least, I may extend it to most of the parts in India, breathing kills.
Q: So just the fact that you are breathing, you are going towards death?
A: You are moving closer to death. Although breathing is supposed to keep you alive, actually breathing the toxic air is taking you closer to death. I will give you the reasons when you take these toxins in, the brunt of the attack is of course borne by the lungs which trap all these material and they get the damage because of the trap. However, the fact is that a lot of this material gets absorbed into the blood and goes to all the organs in the body from head to toe and this affects everyone from the fetus in the mother’s womb to the elderly.
The worst affected is the fetus. When these chemicals go into the mother’s blood and therefore into the fetus, the newly developing fetus, if you have these chemicals reaching there in the first trimester which is the organ forming stage, you can have defects. Later on, when it is a growth phase, their growth gets affected. So you have stunted growth, you have premature deaths, you have a premature delivery, and these children have a lot of breathing problems post-op. So a newborn in Delhi becomes a smoker from the time he is born because he is breathing the same.
So, if your PM 2.5 is 250, it is equal to about 10-12 cigarettes and a newborn is breathing the same air that you and I are breathing. So we have newborn smokers. That is the reason by the time these children are reaching the age of 30, I am noticing them to be developing lung cancer because they have been smokers for 30 years.
The lung is not the only organ when this gets absorbed, it goes to the brain, and you have stunted brain development. It has proved beyond doubt in studies from various parts of the world that you have stunted lung development, you have a higher incidence of childhood cancers, and this is the commonest cause of death in children under five. So exposure to air pollution is the commonest cause of death in children under five.
So many of them die of pneumonia; when they grow up, they develop cancers, and when they become adults, now it is being attributed as one of the causes of obesity. It is attributed now as one of the causes for an increased incidence of diabetes, premature hypertension, heart diseases, brain stroke and even reproductive abnormalities including decreased reproductive functions.
Q: You set this lung care foundation, now we have a new minister for environment, the government has a National Clean Air Program, it is talking about reducing pollutant in the next five years by 20-25 percent, but there is no implementation mechanism. You have been speaking to health ministers, you have been in touch with the environment ministers in the past and now you have a new government.  What would your message to them be?
A: This is as a doctor, especially as a chest doctor who sees these patients every day and is pained by the volumes that are going to be there in the next ten years. I can see almost an epidemic of chest diseases including lung cancer happening in India in the next decade.
Q: It is going to be a heavy economic cost?
A: Huge not heavy, huge economic cost. This is almost a public health emergency and this demands real serious emergency measures.
I am not at all suggesting that the government has not taken measures, the government has been taking measures. The National Clean Air Action Plan is an example. However, what I would say is, on one hand, you have the gravity of the situation and on the other hand, you have the measures that have been taken, I think there is a huge mismatch, disconnect.
The gravity of the situation is such that very serious, time-bound, result oriented, result ensuring actions have to be taken. If you just leave it to people saying we request you to reduce your emissions by 20 percent, nobody listens to request in India. You have to ensure, you have no choice, but to do it. If you don’t do it, we will die.
Q: The head constable was telling me why are diesel cars are still running on the road and he was right he is standing there was 16 hours and you have diesel cars running on the road?
A: If you look at the health of the Delhi policeman, especially the traffic people, pathetic.