both an SLCP and a predominant public health concern for polluted cities and megacities across the world.
The 40‐year history of implementing CLRTAP and its protocols has been hailed as achievements that are ‘unparalleled’, and include the decoupling emissions and economic growth, cutting back certain air pollutants by 40–80%, recovering forest soils from acidification and avoiding some 600,000 premature deaths per year (UN News 2019b). But, there is a major global and regional disconnect in terms of addressing the linkages between air pollution and urban ill health for the rest of the world. The problem of PM air pollution impacts current and future generations living in developing countries of Asia and Africa at a scale vastly different from that experienced in Europe which successfully implemented one of the UN’s only regional air pollution protocols – the CLRTAP. The problem that needs to be addressed is that there are no similar regional protocols on air pollution that cover other regions of the world including South Asia where the scope and scale of the problem of air pollution is urgent, massive and brought to the fore by COVID related respiratory burdens of disease and death. The intrinsically linked PM air pollution and climate crises in countries like India – the third largest aggregate CO2 emitter but the 21st per capita CO2 emitter – is such that depending on the tenuous, incremental intergovernmental consensus‐driven outcomes can no longer suffice. The immediate sections provide context as to why the world’s largest environmental health risk – air pollution – intersects with access to clean energy for the poor and focuses on the need for integrated, localized NNSA inclusive action on air pollution, clean energy and climate actions.
1.3 Mapping the Scope of the World’s Largest Environmental Health Risk: Why Curbing Particulate Matter Air Pollution Matters for Millions of Lives
Poverty and socio‐economic marginalization have been evidenced as putting women, children and the elderly in a seriously disadvantaged position in terms of coping with adverse impacts of climate change (UNDP 2007; World Bank 2016). Back in 2014, the Fifth Assessment Report (AR5) of the IPCC identified three pathways by which climate change impacts on human health:
‘(1)Direct impacts, which relate primarily to changes in the frequency of extreme weather including heat, drought, and heavy rain;
(2)Effects mediated through natural systems, for example, disease vectors, water‐borne diseases, and air pollution; and
(3)Effects heavily mediated by human systems, for example, occupational impacts, undernutrition, and mental stress’ (IPCC 2014a, p. 716).
The IPCC finding that the health effects of climate change impact differentially and negatively on the global poor, including in the case of health risks associated with air pollution is categorically clear: ‘Climate change is an impediment to continued health improvements in many parts of the world. If economic growth does not benefit the poor, the health effects of climate change will be exacerbated. In addition to their implications for climate change, essentially all the important climate‐altering pollutants other than carbon dioxide (CO2) have near‐term health implications (very high confidence). In 2010, more than 7% of the global burden of disease was due to inhalation of these air pollutants (high confidence)’ (emphasis added, IPCC 2014a, p. 713). As referenced by AR5: ‘Put into terms of disability‐adjusted life years (DALYs), particle air pollution was responsible for about 190 million lost DALYs in 2010, or about 7.6% of all DALYs lost. This burden puts particle air pollution among the largest risk factors globally, far higher than any other environmental risk and rivaling or exceeding all of the five dozen risk factors examined, including malnutrition, smoking, high blood pressure, and alcohol’ (emphasis added, IPCC 2014a, p. 728).
The largest concentrations of the ‘energy poor’ (that is, people who are both poor and lack access to sustainable modern forms of energy) are currently in Sub‐Saharan Africa and South Asia where the direct use of solid biomass has been well‐documented to be widespread (Energy Policy: Srivastava et al. 2012). HAP resulting from the burning of solid fuels (wood, crop wastes, charcoal, coal and dung) imposes natural resource constraints and destroys the lives of women and children who spend more time in front of polluted hearths (Gordon et al. 2014). Heavy reliance on solid fuel use has been associated with acute lower respiratory infections, COPD, lung cancer and other illnesses at the household level, and burning biomass also impacts on local environments by contributing to deforestation and outdoor air pollution. Quaderi and Hurst’s summary findings and conclusions in ‘The Unmet Burden of COPD’ (2018) regarding COPD’s ‘under‐recognition and inequities’ being particularly grave for low and middle‐income countries is highlighted in Box 1.3. The authors pointed out that: ‘Those who have never smoked tobacco can still get COPD – think ‘biomass COPD’ and find that peak levels of PM10 in biomass‐using homes can be as high as 10,000 μg/m3, 200 times more than the standard in high‐income countries. PM2.5 are finer particles which penetrate deep into the lung and have the greatest health‐damaging potential” (Quaderi and Hurst 2018, p.2).
Box 1.3 Chronic obstructive pulmonary disease: under‐recognition and inequitable impacts on the poor.
‘COPD remains a growing but neglected global epidemic. It is under‐recognised, under‐diagnosed and under‐treated resulting in millions of people continuing to suffer from this preventable and treatable condition. The lower an individual’s socio‐economic position, the higher their risk of poor health: women and children living in severe poverty have the greatest exposures to HAP.
In the poorest countries, cooking with solid fuels can be the equivalent of smoking two packs of cigarettes a day. A 1‐year old would have accumulated a two pack year smoking history having never seen tobacco. Inaction to mitigate COPD therefore exacerbates health inequalities.
Climbing the “energy ladder” occurs gradually as most LMIC households use a combination of fuels. The poorest, at the bottom of the ladder, use crop waste or dung which is the most harmful when undergoing incomplete combustion. Those at the top of the ladder use electricity or natural gas. Increasing prosperity and development has a direct positive correlation with increasing use of cleaner and more efficient fuels for cooking.
The unmet global burden of COPD is a silent killer in LMICs. In conclusion, we suggest that given the high and rising global burden of COPD, a revolution in the diagnosis and management of COPD and exacerbations of COPD in LMICs must be an urgent priority’.
Source: emphasis added, Quaderi and Hurst (2018).
Box 1.4 excerpted from the WHO’s special report on climate change and human health lists key linkages between energy related air pollution, climate change and public health impacts.
Box 1.4 Strong linkages between climate change, air pollution and health.
The human activities that are destabilizing the Earth’s climate also contribute directly to ill health.
Burning fossil fuels for power, transport and industry is the main source of the carbon emissions that are driving climate change and a major contributor to health‐damaging air pollution, which every year kills over seven million people due to exposure inside and outside their homes.
Over 90% of the urban population of the world breathes air containing levels of outdoor air pollutants that exceed WHO’s guidelines.
Air pollution inside and outside the home is the second leading cause of deaths from non‐communicable diseases (NCDs) worldwide; it is responsible for 26% of deaths from ischaemic heart disease, 24% of those from strokes, 43% from chronic obstructive pulmonary