PUBLIC HEALTH EMERGENCIES IN NCT DUE TO AIR POLLUTION

ABSTRACT
The frequency and intensity of ambient air pollution are rising over time, which is
a major concern for public health. Approximately one in every nine fatalities
globally are attributed to it, making it the fifth most significant risk factor for
mortality. Air pollution is becoming more prevalent worldwide because of fast
industrialization, urbanisation, and population development. Smog and acid rain
are produced by it, along with respiratory illnesses, cancer, ozone layer thinning,
and global warming. ‘According to the World Health Organization's September
2011 urban air database, Delhi has surpassed the maximum PM10 limit of 198
μg/m3, which is nearly ten times higher than what is allowed’. Both indoor and
outdoor air pollution in Delhi has been linked to vehicle emissions and industrial
activity. Due to an increase in serious incidents in numerous cities across the globe
in recent years, air pollution has become an increasingly pressing issue. A serious
public health emergency is being caused by sudden and severe occurrences of air
pollution that are creating conditions akin to a disaster. To address the issue of air
pollution, it is imperative that we reconsider our course of action and adopt new,
ecologically friendly, sustainable technologies. It is imperative that state and local
planning processes incorporate immediate air pollution control.

Keywords: Human health, air pollution, Delhi, air quality, climate change,
disasters, and public health emergencies

INTRODUCTION
‘Air pollution is a complex mixture of harmful gases and aerosols and is the most
serious environmental concern among the scientific community. The
unprecedented growth in industrialization, urbanization, population, fossil fuel
consumption and ever-increasing transportation network are deteriorating the air
quality of the environment (Seinfeld and Pandis, 2016)’.
‘Air pollution has been described as one of the "great killers of our age" due to its
tremendous and severe health effects on humans (Sweileh et al., 2018)’.
Approximately 92% of people on Earth live in areas with subpar outdoor air
quality, according to estimates from the World Health Organisation (WHO).
Acknowledging air pollution in NCT is one of the primary preventable causes of
diseases and deaths worldwide, there is a correlation between air pollution and
several medical illnesses, including lung cancer, cardiovascular disease, stroke,
infertility, respiratory disorders, lung cancer, and cognitive decline and others.
Studies on the mortality and air pollution in Delhi have shown that there
was a positive correlation between air pollution and all-natural cause
mortality and morbidity.
‘It is reported that over 70-80% of air pollution in megacities in developing nations
is attributed to vehicular emissions caused by a large number of older vehicles
coupled with poor vehicle maintenance, inadequate road infrastructure and low
fuel quality (Gulia et al., 2015)’.
‘Re-suspension of road dust due to movement of traffic and tyre and brake wear
are also some of the significant sources of air pollution (Amato et al., 2014)’.
‘This activity contributes to 20% of Organic Carbon and Elemental Carbon out of
the total budget of emission from agricultural residue burning in the north-western
region of India (Bhuvaneshwari et al., 2019)’.
Air pollution in cities is becoming more severe, endangering both human health
and the environment due to rising vehicular traffic volumes and urban population
growth. Because urban areas have uneven distributions of ambient air pollution
concentrations, hot spots are mostly found in the centre of the city, at traffic
intersections, and on signalised roads.
Burning biomass is a significant contributing factor to the poorest air quality, along
with industrial and vehicle activities. Every year, a vast quantity of agro-wastes is
produced in an agricultural nation like India. Since there has been an unparalleled
rise in population, the quantity of these wastes has increased dramatically. Crop
wastes, such as woody stalks and cereal straws, are produced in huge quantities
every year. The crop residue is burned by farmers in the open field after harvest,
which pollutes the air.
OBJECTIVE
 To Identify the relationship between air pollution and public health
emergencies in NCT.
 Examine the major challenges encountered in reducing the effect of air
pollution on public health.
 To make recommendations for strategies to reduce the effect of pollutants
in the air on public health.
METHODOLOGY
Im using primary as well as secondary data.
  Literature riview: A review of latest existing literature on air pollution
and public health emergencies in NCT will be conducted.
 Data analysis: We will apply statistical techniques to analyse
quantitative data on air pollution levels and public health outcomes in
NCT.
AIR POLLUTION AS A DISATER
‘According to the United Nations International Strategy for Disaster Reduction
(UNISDR), a disaster is defined as a significant disruption of a community or
society's ability to function that involves extensive losses and impacts related to
people, property, the economy, or the environment, and that surpass the capacity of
the affected community or society to recover using its available resources’. It is
also known that inadequate risk management leads to disasters. As demonstrated
by the incidents involving chemicals, petrochemicals, and other industrial
accidents, life exposure to high concentrations of pollutants over brief periods of
time can have unanticipated social, environmental, and health effects.
‘Disasters involving extreme or sudden air pollution are causing an immediate
public health crisis leading to an increased pressure on stakeholders and agencies
to provide solutions to protect impacted communities during any such emergencies
(Chandrappa and Kulshrestha, 2016)’.
Air pollution can be the cause of disasters, and disasters can cause air pollution.
The environment and human health would suffer in both scenarios.

Air Pollution Status in Delhi:

‘The Central and state governments collaborate in the administration of Delhi, also
known as the National Capital Territory of Delhi. It can house about 167.5 lakh
people (Indian Census, 2011)’.
Globally, metropolises are primarily responsible for environmental pollution, and
Delhi, India, is no exception.
‘In 1991–1994, a study on the effects of air pollution was conducted with funding
from the World Bank Development Research Group. The average Delhi total
suspended particulate (TSP) level during the study period was roughly five times
the annual average standard set by the World Health Organisation. Additionally,
during this period, 97% of the days when readings were taken saw total suspended
particulate levels in Delhi surpassing the WHO 24-hour standard’. The results of
the study indicate that, despite particulate matter's lower overall effect on non-
trauma deaths in Delhi compared to the US, deaths brought on by air pollution in
Delhi resulted in a greater loss of life years due to their earlier age.
‘Concerning deteriorating conditions, the Indian Ministry of Environment and
Forests examined Delhi's environmental status in a 1997 report. One of the study's
highlighted areas of concern was air pollution. An estimated 3000 metric tonnes of
air pollutants were released daily in Delhi, primarily from cars (67%), then from
thermal power plants that run on coal (12%). As observed by the Central Pollution
Control Board (CPCB), there was an increasing trend between 1989 and 1997’.
The fact that petrol was de-led and lead-handling manufacturing plants were
restricted seemed to be controlling the levels of particulate lead. Delhi, along with
other industrial centres, represents 12% of India's total air pollution due to its
largest cluster of small-scale industries.
In Delhi, one major source of air pollution is vehicular pollution. ‘As per the
Department of Transport, the Government of the National Capital Territory of
Delhi, the estimated vehicular population is over 3.4 million, with an annual
growth rate of 7%. There has been a noticeable decrease in comparison to the
1995–1996 levels of air pollution, even though this segment accounts for two
thirds of the total’.
When evaluating the quality of the air, the PM10 standard is commonly utilised.
Because these particles are small and can enter the lower respiratory tract, they are
most likely the cause of harmful health effects. ‘The World Health Organization's
Air Quality Guideline recommends an annual mean concentration of PM10 of 20
μg/m3, above which there is an increased risk of cardiopulmonary health effects’.
Exposure to PM10 poses significant health risks to humans, primarily affecting the
respiratory and breathing systems, cancer, and lung tissue damage. Individuals who
are elderly, have asthma, the flu, or suffer from chronic lung disease may be
severely affected by particulate matter. Delhi's PM10 levels were almost ten times
higher than the maximum allowed, at 198 μg/m3, ‘according to the World Health
Organization's urban air database released in September 2011. Delhi finished third,
one spot behind Kanpur and Ludhiana. Both outdoor and indoor air pollution in
Delhi has been linked to vehicle emissions and industrial activity.’
Effects of Air Pollution on Health

The impact of air pollution on respiratory processes and the related morbidity
have been the subject of numerous studies conducted in Delhi. Out of all of
them, the Central Pollution Control Board's 2008 study was the most thorough,
finding strong correlations with every pertinent adverse health outcome. West
Bengali rural control population data was compared with the findings.
Compared to rural controls, India's capital had a 1.7-fold higher prevalence of
respiratory symptoms (in the last three months) (P < 0.001). In Delhi, 40.3% of
the population had reduced lung function, compared to only 20.1% in the
control group.
Delhi had more sputum samples with different cytological changes and more
airway epithelial cell metaplasia and dysplasia. Furthermore, it was noted that
Delhi experienced higher non-respiratory effects in comparison to the rural
controls. It was discovered that there was a positive correlation between the
level of respirable suspended particulate matter (PM10) in ambient air and the
prevalence of hypertension in Delhi, which was 36% compared to 9.5% in the
controls. Chronic headache, irritated eyes, and irritated skin were all much more
common in Delhi.
There is a link between respiratory morbidity and air pollution, according to
several other community-based studies. Indoor air pollution and respiratory
morbidity have been linked in numerous studies. A number of these studies
have focused on respiratory morbidity in children. Other studies on children
have shown similar links between ambient airborne particulate matter and
ADHD. Two examples of these associations are those between lower mean haze
scores, a proxy for UV-B radiation reaching the ground, and lower serum
concentrations of vitamin D metabolites, and between vehicular air pollution
and elevated blood lead levels, a potential risk factor for children's abnormal
mental development.
According to studies examining the overall effect of weather patterns on air
pollution, winter reduced both indoor and outdoor air quality. They also found
that the onset of winter corresponded directly with a rise in hospital admissions
for patients with chronic obstructive pulmonary disease.
It was rather uncommon to find studies that objectively attempted to link
outdoor air pollution levels to detrimental health effects after measuring the
levels directly. Nonetheless, some research that measured air pollution levels
discovered a link between them and incidents involving health.
According to a time-series study conducted in Delhi, the mortality rate from all
natural causes rose as air pollution levels rose. In a different study, there was a
more consistent correlation between respiratory admissions and gaseous
pollutants, even though their level was below what was allowed. An increase in
air pollution levels was linked to a rise in emergency department visits for acute
coronary events, asthma, and chronic obstructive pulmonary disease, according
to a hospital-based study.
CASE STUDY
‘For TSP, the standard RR values provided by WHO are used. Nevertheless,
since TSP data are unavailable for some Delhi districts, suspended particulate
matter (SPM) concentration has been used in its place.’
As per the USEPA (U.S. EPA, 2014), particulate matter with an aerodynamic
diameter of no more than 30 μm is classified as SPM, which is commonly used
as a substitute for TSP despite TSP having a relatively coarse size range.
The population density and ambient air pollution levels are the main factors
influencing the methodology mentioned above. ‘Numbers pertaining to the
population from the Indian Census (Census of India, 2011). Three criteria
pollutants—SO2, NO2, and SPM—have ambient air concentrations that are
monitored and estimated by the Central Pollution Control Board (CPCB),
located in Delhi’. The information is an annual average concentration and
comes from CPCB. The earlier research used the mean ambient level from nine
monitoring stations to estimate the health risk for the entire Delhi NCT. This
study uses district-level ambient air pollution concentration data to calculate the
health risks for each district in Delhi's National Capital Territory. The NCT of
Delhi is divided into nine districts. To calculate each district's health risk
estimates, the concentration data of the
Fig1. An excessive number of cases involving total mortality.
Fig2. an excessive number of deaths from cardiovascular disease.
Fig3. An excessive amount of respiratory mortality cases.
Fig4. an excessive amount of COPD hospital admission cases.

NEW DELHI
The presented data demonstrates a discernible upward trend in more mortality
and morbidity resulting from air pollution in New Delhi, India, from 1991 to
2010. The excess number of COPD-related hospital admissions, respiratory
deaths, cardiovascular deaths, and overall deaths has increased over time.
Particulate matter (PM) was identified by the study's authors as the primary
pollutant in charge of this rise in mortality and morbidity. Nevertheless, they
also noted a slight rise in overall mortality in 2005 and 2006 because of NOX
pollution.
These results imply that air pollution is a serious public health issue in New
Delhi and is negatively affecting people's health. To safeguard the public's
health, the study's authors demand immediate action to lower New Delhi's air
pollution levels.
Specific findings
 There was an excess of cases, with 126 cases of total mortality in 2010
compared to 81 cases in 1991.
 From 27 cases of cardiovascular mortality in 1991 to 42 cases in 2010,
there was an excess of cases.
 In 1991, there were 13 cases of respiratory mortality; by 2010, there were
20 cases.
 In 1991, there were 116 cases of COPD-related hospital admissions; by
2010, there were 179 cases.
 The primary pollutant accountable for the rise in both mortality and
morbidity rates was particulate matter.
 There was a slight rise in overall mortality in 2005 and 2006 because of
NOX pollution.
Implications
The study's findings suggest that New Delhi's air pollution problem is a
significant public health concern that is having a detrimental impact on people's
health. The authors of the study urge prompt action to reduce air pollution in
New Delhi to protect public health.
To be more precise, policies and initiatives to lower emissions from
automobiles, businesses, and other sources of air pollution should be put in
place by the Indian government and the government of Delhi. Along with other
ways to lessen people's exposure to air pollution, they should also invest in
public transport.
CENTRAL DELHI
The excess number of cases for COPD-related hospital admissions,
cardiovascular, respiratory, and overall deaths do not appear to be trending.
Nonetheless, the year 1991 saw the greatest excess number of cases for both
mortality and morbidity, most likely because of the year's higher pollution
concentration. The years 1993, 2006, and 2008 saw the largest increases in
mortality and morbidity, while the years 1994 to 1997 and 2001 to 2005 saw a
declining trend. This suggests that the implementation of clean fuel technology
(CNG) and EURO standards may have improved the air quality in Central
Delhi.
Particulate matter (SPM) is the main pollutant in Central Delhi that is
responsible for an excess of overall mortality, cardiovascular mortality,
respiratory mortality, and hospital admissions due to COPD. Only a small
portion of cases are caused by NOX pollution, and cases in 1991 are only
caused by SO2 pollution.
Specific findings:
 There does not seem to be a trend in the excess number of cases for
hospital admissions due to COPD, cardiovascular, respiratory, or overall
deaths.
 The year 1991 saw the greatest excess number of cases in terms of both
mortality and morbidity.
 The three years with the highest increases in mortality and morbidity
were 1993, 2006, and 2008.
 There is a noticeable downward trend from 1994 to 1997 and from 2001
to 2005.
 Particulate matter (SPM) is the main pollutant in Central Delhi that is
responsible for an excess of overall mortality, cardiovascular mortality,
respiratory mortality, and hospital admissions due to COPD.
 Only a small portion of cases are caused by NOX pollution, and cases in
1991 are only caused by SO2 pollution.
Implications:
The findings of this study show that air pollution is still a major public health
concern in Central Delhi, notwithstanding some recent improvements. The
Indian government, along with the government of Delhi, ought to persist in
executing policies and initiatives aimed at curbing emissions originating from
automobiles, industries, and additional sources of air pollution. Along with
other ways to lessen people's exposure to air pollution, they should also invest
in public transport.
It's crucial to remember that the study only examined information from 1991 to
2010. It would be interesting to see how, in the last ten years, Central Delhi's
health outcomes and air quality have changed.
NORTH DELHI
Figures 1c, 2c, 3c, and 4c illustrate the excess cases of mortality and morbidity
that occurred in the North Delhi district between 1991 and 2010. The numbers
show a negative slope from 1991 to 1997 and an upward trend from 1997 to
2002. In 2003, there is a sharp decline in the excess number of deaths and
morbidities, and this pattern holds true until 2005. The greatest excess number
of cases for all mortalities and morbidities occurred between 2006 and 2010.
The growth in North Delhi's infrastructure and population in recent years could
be attributed to this.
Particulate matter (SPM) is the main pollutant responsible for the
disproportionately high rates of hospital admissions due to COPD,
cardiovascular mortality, overall mortality, and respiratory mortality in North
Delhi. In 1991, SO2 pollution was the only cause of cases; NOX pollution
accounted for only a small portion of cases.
Specific findings:
 Between 1991 and 1997, the excess number of cases of morbidity and
mortality sloped downward.
 There has been an upward trend in the excess number of cases of
morbidity and mortality from 1997 to 2002.
 The excess number of deaths and morbidities abruptly declines in 2003,
and this pattern continues through 2005.
 The greatest excess number of cases for all mortalities and morbidities
occurred between 2006 and 2010.
 Particulate matter (SPM) is the main pollutant responsible for the
disproportionately high rates of hospital admissions due to COPD,
cardiovascular mortality, overall mortality, and respiratory mortality in
North Delhi.
 Only a small portion of cases are caused by NOX pollution, and cases in
1991 are only caused by SO2 pollution.
Implications:
The study's conclusions imply that one of North Delhi's main public health
issues is air pollution. Policies and initiatives should be put in place by the
Indian government as well as the government of Delhi to lower emissions from
cars, factories, and other sources of air pollution. Along with other ways to
lessen people's exposure to air pollution, they should also invest in public
transport.
It's crucial to remember that the study only examined information from 1991 to
2010. It would be interesting to see how, in the last ten years, North Delhi's
health outcomes and air quality have changed.
Apart from the ramifications, the government ought to contemplate the
subsequent actions to tackle the problem of air pollution in North Delhi:
 Encourage the use of clean energy and energy-saving techniques.
 To assist in filtering air pollution, plant trees and other vegetation.
 Create campaigns to educate the public about the dangers of air pollution
and how to avoid exposure.
 Ensure that environmental regulations are more strictly enforced.
EAST DELHI
From 1991 to 2010, the East Delhi district had an excess of cases of deaths and
morbidities, as shown in Figures 1d, 2d, 3d, and 4d. From 1991 to 1996, there
was an increasing trend in the figures, but in 1997, there was a decrease. From
1998 to 2010, the excess number of cases then increased once more.

The primary pollutant accountable for the disproportionately high rates of

overall mortality, cardiovascular mortality, respiratory mortality, and hospital
admissions resulting from COPD in East Delhi is particulate matter (SPM). In
2004, 2005, and 2006, a minor portion of cases were caused by NOX pollution.
There is not an excessive number of cases in East Delhi, and this is not due to
SO2 pollution.
Specific findings:
 in 1991 and 1996, there was an excess of cases of deaths and morbidities;
however, in 1997, there was a decline in these cases.
 From 1998 to 2010, the excess number of cases then rose once more.
 In East Delhi, SPM is the primary pollutant that is to blame for the
disproportionately high rates of cardiovascular, respiratory, and overall
mortality as well as hospital admissions brought on by COPD.
 In 2004, 2005, and 2006, a minor portion of cases were caused by NOX
pollution.
  There is not an excessive number of cases in East Delhi, and this is not
due to SO2 pollution.
Implications
The results of this investigation indicate that East Delhi's air pollution poses a
serious threat to public health. Policies and initiatives should be put in place by
the Indian government as well as the government of Delhi to lower emissions
from cars, factories, and other sources of air pollution. Along with other ways to
lessen people's exposure to air pollution, they should also invest in public
transport.
Apart from the consequences, the government ought to contemplate the
subsequent actions to tackle the problem of air pollution in East Delhi:
 Encourage the use of clean energy and energy-saving techniques.
 To assist in filtering air pollution, plant trees and other vegetation.
 Create campaigns to educate the public about the dangers of air pollution
and how to avoid exposure.
 Boost the implementation of environmental regulations.
CONCLUSION
The health risks associated with air pollution in different districts of Delhi, a
megacity, were estimated using the Risk of Mortality/Morbidity due to Air
Pollution (Ri–MAP) model. According to the model, in NCT Delhi in 1991,
there were 12 809 excess hospital admissions for COPD, 3 413 excess cases of
cardiovascular mortality, 1 302 excess cases of respiratory mortality, and 8 945
excess cases of total mortality. In 2010, these figures increased by 100% to 18
229, 6 374, 2 701, and 26 525, respectively.
In districts like Delhi Central, North Delhi, East Delhi, Southwest Delhi,
Northeast Delhi, and West Delhi with high transportation traffic, the effects of
the introduction of CNG and the phase-out of polluting vehicles were evident.
The district of New Delhi exhibited the least excess of mortality/morbidity
cases, potentially attributable to its smaller population.
Increased levels of particulate matter (SPM) and nitrogen oxides (NOX) in the
surrounding air were the cause of the excess mortality and morbidity in different
parts of Delhi.
Delhi's air pollution is a serious public health issue that contributes significantly
to the city's annual hospital admissions and fatalities. The city's air pollution
levels should be drastically reduced by the government, for example, by
encouraging the use of clean energy sources and energy-saving techniques,
planting trees and other vegetation, and creating public awareness campaigns
about the dangers of air pollution.
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