The poisonous journey begins from the womb. When moms are uncovered to polluted air throughout being pregnant, the foetus is at critical danger. The danger blows up as a large illness burden for infants, youngsters and adolescents, and lasts a lifetime. The drawback has reached scary proportions within the Global South, with India bearing the infamy of accounting for 1 / 4 of the worldwide toddler deaths—inside a month of beginning.

Mounting native and international proof and well-decoded science outline the organic pathways by means of which pollu-tants enter our bodies and mutate organs. These estimates contemplate not simply lower-respiratory infections affecting youngsters but additionally a much wider set of well being impacts. And youngsters of poorer households are extra in danger.

Foetuses uncovered to toxins within the womb could have decrease probabilities of survival. Exposure to toxin additionally results in still-birth, preterm beginning and low birthweight. It predisposes foetuses to a variety of ailments later in life, together with endocrine and metabolic issues and diabetes. If air air pollution impacts the mom’s respiratory well being, oxygen and nutrient supply to the foetus could be diminished. Impaired lung growth in utero will increase the chance of airway ailments. Scientists clarify that particulate matter may cause maternal inflammatory response, scale back maternal immunity and enhance the chance of an infection and poor neurological growth. Babies born too small are extra susceptible and can’t deal with the chance of lower-respiratory infections, diarrhoeal ailments, mind injury and irritation, blood issues and jaundice.

In youngsters underneath the age of 5 years, exposures to polluted air pose grievous dangers. It impacts mind and neurological growth, lung operate and might trigger weight problems. Neurological issues embody consideration deficit hyperactivity, decrease intelligence and impaired neurodevelopment. Even at a decrease degree of publicity youngsters can develop lasting deficits in lung operate, making them susceptible to power lung illness in maturity, affecting their high quality of life.

Poor understanding of this proof breeds coverage complacency and scepticism. Powerful proof can be mounting on toddler deaths, acute respiratory an infection, stunting, childhood anaemia, allergic rhinitis and neurodevelopmental out-comes. Cohort teams of moms and infants have been tracked to search out hyperlink between publicity throughout being pregnant and low birthweight in households that use stable fuels for cooking.

Air air pollution and its impacts on youngsters are gravest violations of their proper to a habitable and viable future. This must be recognised. The National Clean Air Programme (NCAP) has to combine exposure-based well being proof for multi-sector motion. It has to make sure and monitor deep cuts in exposures from key sources of air pollution in all conditions, whereas bettering ambient air high quality and decreasing youngsters’s illness burden.

Declaring air pollution holidays in faculties throughout winter smog episodes isn’t the reply. The want is to make sure clear fuels to all households and business, zero-emissions automobiles, diminished dependence on vehicles, and a round economic system to shut the loop round waste streams to cease burning. Health adaptation plans in states and illness surveillance that the Union Ministry of Health and Family Welfare has initiated have to get stronger to tell NCAP. Clean air coverage has an obligation to guard youngsters from the poisonous danger.

Airborne risk

On November 3, as evening descended over Delhi, a whole lot of kids, coughing and gasping, thronged the out-patient division and emergency ward of Chacha Nehru Bal Chikitsalaya. Soon, the tremendous specialty paediatric gove-rnment hospital in east Delhi ran out of nebulisers and beds. Doctors on the hospital had been dreading the prospect for the reason that final week of October, when the typical air high quality within the nationwide capital remained in “very poor” class for six consecutive days earlier than plummeting to “severe” class on November 3, with the air high quality index (AQI) worth reaching a staggering/hazardous 468. AQI values over 100 are thought-about unhealthy.

Doctors within the nationwide capital and in adjoining areas are acquainted with this seasonal plague. As the area chokes on mud and smoke in winter yearly, hospitals obtain an exceptionally giant variety of sufferers with respiratory prob-lems.

In the primary two weeks of November, when the capital metropolis’s air high quality remained principally within the “severe” class, Down To Earth visited all the foremost hospitals to evaluate the impression on individuals’s well being. Ajay Shukla, director and medical super-intendent of Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia (ABVIMS-RML) Hospital, one of many nation’s premier hospitals run by the Union authorities, says the hospital data a 30 per cent rise in respiratory-related diseases throughout extreme air pollution days. On November 6, ABVIMS-RML opened a devoted weekly Pollution Out-Patient Department, a first-of-its-kind within the nation, to cater to sufferers affected by the impression of unhealthy air. Shukla says the initiative is to make sure that all of the pollution-related instances—from cough to eye an infection to headache—could be seen by the docs of various departments at one place. In Vallabhbhai Patel Chest Institute (VPCI), one other promi-nent hospital in north Delhi, hospital employees share a worrying knowledge: between November 2 and November 10, the hospital on common obtained 50 new instances of respiratory diseases each day.

What’s perturbing is that the majority sufferers visiting the hospitals with respiratory illnesses are underneath 14 years. Ambavasan A, a senior resident physician on the emergency ward of ABVIMS-RML, says the hospital is flooded with youngsters with respira-tory issues, and their quantity and severity of the situation varies as per the air pollution degree. Medha Mittal, endocrinol-ogist at Chacha Nehru Bal Chikitsalaya, says, “Delhi’s air pollution is resulting in a rapid increase in respiratory illnesses among children.”

On November 2, when DTE visited Chacha Nehru Bal Chikitsalaya, three-year-old Vishal Prajapati lay nonetheless on a mattress in a crowded emergency ward. “We hospitalised him a week ago, after he developed symptoms of pneumonia, with high fe-ver, severe bouts of cough, shortness of breath and weakness,” Vishal’s mom tells DTE. “Since his birth, he develops respiratory problems as soon as the air pollution flares up, and has to be rushed to the hospital,” she provides.

One of the adjoining beds was shared by three youngsters, every with a nebuliser masks protecting the nostril and mouth to instantly ship remedy to the lungs to alleviate congestion and deal with respiratory infections. One of them was 10-month-old Yuven Thakur, who was for the primary time visiting the hospital due to respiratory difficulties. “Doctors say that my son has upper respiratory tract infection and severe air pollution is responsible for his condition,” says Yuven’s father Dipanshu Thakur.

“Children in the age group of two to five years are the worst victims of air pollution,” says Sanjeev Bagai, paediatrician and nephrologist in Delhi. “The proportion of children visiting the hospital with respiratory problems has increased since mid-October. Those who already have respiratory problems (for instance, asthma and bronchiectasis) have developed worsening of symptoms despite regular treatment,” S Ok Kabra, head of the paediatric division, All India Institute of Medical Sciences (AIIMS), Delhi, tells DTE.

Breathless from begin

There are causes youngsters are extra susceptible to air air pollution than adults. Since the respiratory system isn’t fully developed in youngsters, notably in newborns and infants, they breathe quicker than adults to make sure satisfactory provision of oxygen into the blood. Children even have excessive metabolic fee—the speed at which they dissipate vitality—and subsequently have the next oxygen demand, which in flip ends in greater respiratory fee than adults. Studies estimate that youngsters sometimes breathe 40 instances in a minute, which is greater than double the respiratory fee of adults. “As they breathe more air per body size and have smaller airways than adults, they are at an increased risk of developing respiratory diseases and exacerbation of asthma,” states a examine by researchers from Germany and the Czech Republic, printed in Urban Climate on June 4, 2022.

Of the numerous air pollution that youngsters breathe, the dreaded ones are superb inhalable particles (particulate matter with diameter lower than 2.5 micrometers or PM2.5) that originate from completely different native combustion sources equivalent to automobiles, industries and burning of waste, and are laced with toxins. Since these particles are smaller than the purple blood cells, research have established that they’ll go deep into the lungs, escape to the bloodstream and likewise breach the blood-brain barrier, with a whole lot of recognized and unknown well being results (extra on this later).

The German and Czech Republic researchers examined the potential variations of PM2.5 publicity between youngsters and adults in an city space and located that the focus of PM2.5 decreases with growing peak above floor. Since the breath ranges of kids are nearer to pollution emitted close to floor, it makes them extra susceptible to emis-sions by traffic-related exhausts and whirled up superb particles.

Arvind Kumar, chairperson of Institute for Chest Surgery-Chest Onco Surgery and Lung Transplantation, Medanta, Gurugram, and Founder of Lung Care Foundation, shares a couple of pictures of lungs with DTE to point out the impression of air air pollution on respiratory well being of these dwelling in areas with poor air high quality. “Healthy lungs look absolutely pink. However, we regularly see black deposits in the lungs of most non-smoker adults and children up to 14 years of age who come to us with respiratory illnesses. These black deposits cannot be removed and eventually damage the lungs,” says Kumar, including that youngsters are inhaling extra poisonous air than adults.

A public well being emergency

The hassle isn’t confined to Delhi. Doctors level to a steep rise in respiratory diseases amongst youngsters throughout the Indo-Gangetic area, the place air high quality stays within the “poor” class virtually all year long.

Air high quality evaluation of the previous one 12 months by Pune-based local weather know-how agency Respirer Living Sciences Pvt Ltd reveals that the Indo-Gangetic area has seven of the ten most polluted cities within the nation. In 2018, non-profit Climate Agenda studied 14 districts of Uttar Pradesh and located that small cities like Gorakhpur and Mau are extra polluted than the nationwide capital Delhi and state capital Lucknow. Air air pollution plagues rural areas as nicely and all the state is underneath a “health emergency”, states the report, titled “Air Kills”. An evaluation of Bihar’s air high quality within the winter season, from October 2022 to February 2023, by Delhi-based analysis and advocacy establishment Centre for Science and Environment (CSE) reveals that the PM2.5 ranges in at the least 10 cities within the state have been considerably worse than that of Delhi.

This is alarming. According to the Census of India, 2011, the Indo-Gangetic states—Punjab, Haryana, National Capital Territory of Delhi, Uttar Pradesh, West Bengal, Assam and Bihar—are house to virtually half of the kids (within the age group of 0-14 years) within the nation and two-thirds of under-five youngsters who’re most susceptible to air air pollution.

Mohan P George, scientist with CSE, says, “In the Indo-Gangetic region, a month-old infant with a weight of 4 kg and breathing 40 cycles a minute will inhale 184 microgram of PM2.5 a day.” George’s calculation relies on the annual av-erage of 100 microgram of PM2.5 degree within the area’s air.

The impression is palpable. At a nationwide convention, organised by the Indian Academy of Paediatrics in Kolkata in early November, pulmonologists identified that one in each two youngsters within the metropolitan metropolis suffers from respiratory issues triggered by air air pollution. “I treat children in northern fringe of city and can safely vouch that the number of pa-tients has increased several times in the past few decades, though the actual impact, both long- and short- term, is diffi-cult to be spelt out due to inadequate data,” says Subhamoy Mukherjee, a paediatric practising in Kolkata for greater than three many years.

Arup Halder, one other pulmonologist in Kolkata, says that first-generation bronchial asthma sufferers amongst youngsters are on the rise. “Earlier, asthma patients usually had a family history of the condition, but now a sizeable number of children seem to be developing asthma because of exposure to air pollution. The problem increases especially in the winter when the air quality worsens,” says Halder. He means that the faculties with morning shifts ought to begin a little bit late as a result of youngsters get uncovered to most air pollution throughout that interval.

In Bihar, there have been widespread stories of kids affected by respiratory infections, breathlessness and al-lergies, notably in the course of the winter months when the air high quality hits the bottom factors. Athar Ansari, professor, paediatric division at Nalanda Medical College and Hospital, a state government-run hospital in Patna, says that roughly a 3rd of kids and even some infants coming to the hospital endure from problem in respiration. “Manifestation of allergies is increasing among children due to air pollution,” Ansari says. Jayant Prakash, head of paediatrics division at Indira Gandhi Institute of Medical Sciences, Patna, says, “We have come across cases where newborns do not cry immediately after delivery and have difficulty breathing due to shortage of oxygen in their hyperactive airways because of pollution.”

Mounting proof

The impression of air air pollution on youngsters’s well being begins even earlier than they’re conceived. It begins by impairing the fertility of each women and men. Research reveals that publicity to air air pollution impacts ovarian reserve in ladies. The examine con-ducted on ladies in China confirmed that the extent of anti-müllerian hormone—a predictor of ovarian reserve—modified by -8.8 per cent, -2.1 per cent, -1.9 per cent and -4.5 per cent per 10 µg/m3 enhance in PM1, PM2.5, PM10 and nitrogen diox-ide (NO₂). “Theoretically, PM with smaller size and larger surface area volume ratio, e.g. PM with diameter ≤1 µm (PM1), is more likely to penetrate through the alveolar capillary barrier and then impact directly the ovarian function via blood circulation,” notes the paper printed in Environmental Research on February 1, 2023. Though the underlying mechanism of feminine fertility decline attributable to air pollution stays unclear, restricted proof speculates that oxidative stress and inflammatory response attributable to air air pollution could also be one essential pathway, the researchers say.

Similarly, a examine in China on 33,876 males confirmed that publicity to PM2.5 and PM10 decreased complete and progressive sperm motility. The findings have been printed in JAMA Networks on February 17, 2022. If the kid is conceived in opposition to all odds, air air pollution can hinder their growth within the uterus as pollution can cross the placenta into the infant’s blood. In the examine printed within the Journal of Family and Reproductive Health in June 2017, the researchers from Iran have discovered an inverse relationship between the publicity to air air pollution within the first tri-mester of being pregnant and the load of placenta, which sustains the event of the foetus.

A complete evaluation of research, printed in The Lancet Planetary Health stories the presence of black carbon particles in twine blood which enter foetal liver, lungs and mind. The presence of the pollution continues to hurt the rising foetus a lot that it tends to extend the chance of preterm beginning. This, in flip, can enhance the probabilities of still-birth, low birthweight, underdeveloped lungs within the child, and loss of life of the infant throughout or shortly after beginning.

Sudhir Gupta, former chairperson of the division of gynaecology at Baba Raghav Das (BRD) Medical College, Go-rakhpur, explains how air air pollution impacts the event of foetus, “Due to pollution, pregnant women cannot get enough oxygen from the ambient air, which affects the natural development of the foetus. Furthermore, the higher the sulphur contents in the air, the greater the risk of miscarriage,” he says.

Bhupendra Sharma, chairperson of the paediat-rics division of BRD Medical College, says, “Air pollution can also lead to anaemia in expectant mothers, which greatly reduces the chance of delivering a healthy baby.”

If the kid survives the onslaught of pollution within the utero, a number of research present that the publicity earlier than and after beginning can impair their neurodevelopment expertise, equivalent to mental functioning, reminiscence and studying, consideration and execu-tive features, verbal language, numerical capability and motor and/or sensor motor features. “The pollutants that seem to represent the greatest risk are PM2.5, NO₂ and PAHs [polycyclic aromatic hydrocarbons],” states a evaluation of 30 analysis papers, printed in Neuroscience & Behavioral Reviews in May 2022.

Just like in adults, the kid’s blood stress is thought to shoot up because of publicity to air air pollution throughout pregnan-cy—greater the imply PM2.5 and black carbon publicity in the course of the third trimester, greater the new child’s systolic blood stress.

Exposure to air air pollution in utero may result in congenital coronary heart defects in youngsters, making survival troublesome. Lungs, too, usually are not spared from the onslaught. It has been noticed that greater the publicity to air air pollution throughout infancy, decrease the lung capability. Acute respiratory infections too appear to have an effect on youngsters who’re extra uncovered to PM2.5. A sur-vey of under-five youngsters signifies {that a} 10 µg/m3 enhance in PM2.5 was related to larger probabilities of contract-ing an an infection.

Gut well being too will get affected—pollution inhaled in the course of the first six months of life adversely have an effect on the composition of intestine microbes which might enhance danger of allergy symptoms, weight problems and diabetes, and even have an effect on mind growth. A 2020 examine printed in Gut Microbes states that these microbes and their by-products form urge for food, insulin sensitivity, im-munity, temper and cognition, and a poor mixture of microbes can depart the kid liable to bronchial asthma, sort 2 diabetes and different power diseases.

Exposure to air air pollution within the womb may change the protein exercise of the infant. For instance, pollution have been discovered to have an effect on cell processes equivalent to autophagy, “self-eating” of broken cells that often happens in response to emphasize, in response to a examine offered on the European Respiratory Society International Congress in Milan, Italy, on September 12, 2023. Exposure to greater NO₂ was linked to decreased ranges of SIRT1, a protein that performs a protecting function in stress resistance, irritation and ageing.

Evidence can be mounting across the impression of air pollution sources on well being. Studies in Europe have investigated the impression of vehicular emissions on youngster well being and impression on neuron growth alongside the highways. In 2013, a examine discovered correlation between early publicity to visitors air pollution and several other childhood cancers.

And as if to finish the circle of destruction, publicity to air air pollution additionally impacts the reproductive well being of ado-lescent women. Higher publicity to particulate matter in utero and all through childhood has been implicated within the early onset of menarche as a result of these particles appear to have endocrine-disrupting properties.

India’s personal proof

Health specialists in India are already producing proof to implicate air air pollution within the excessive mortality and poor well being of kids within the nation.

In November, the Collaboration for Air Pollution and Health Effect Research, India (CAPHER India), a nationwide analysis community centered on air air pollution and well being results steered by AIIMS New Delhi and the Indian Institute of Technology (IIT) Delhi, has launched a coverage transient, which says air air pollution is the third main danger issue for deaths in under-five youngsters within the nation. For youngsters underneath 14 years, it’s the second main danger issue for deaths. Since 2010, Delhi, Punjab and Haryana have seen the best share of deaths in under-five youngsters associated to outside PM2.5 exposures, esti-mates the coverage transient which has reviewed key Indian research on the problem.

One of the research printed in April 2022 in Science of the Total Environment gives proof that PM2.5 impacts toddler mortality primarily by means of neonatal mortality. Another examine factors in direction of a hyperlink between air air pollution and stunt-ing. The examine by Germany’s Heidelberg University and France’s University of Rennes, printed within the Journal of Envi-ronmental Economics and Management in May 2022, estimates that the odds of stunted and severely stunted chil-dren in India would drop by 10.4 and 5.17 share factors, respectively, if common air pollution ranges have been diminished to World Health Organization-recommended ranges.

A big-scale examine by the Population Council, New Delhi and the International Development Department, University of Birmingham, UK, printed within the journal BMJ Global Health in July 2020, confirms that the publicity to PM10 not solely impacts youngsters but additionally pregnant ladies leading to untimely beginning. This indicated that the chance of new child mor-tality elevated by 6 per cent for each 10-unit enhance in PM10 ranges.

A current examine discovered a big correlation between the chemical parts of PM2.5 and low birthweight, anae-mia and acute respiratory infections in under-five youngsters. The examine “Cumulative effect of PM2.5 components is larger than the effect of PM2.5 mass on child health in India”, printed in Nature on October 31, 2023, confirmed that for each 10 µg/m3 enhance in PM2.5 publicity, the prevalence of anaemia, acute respiratory an infection and low birthweight in-creased by 10 per cent, 11 per cent and 5 per cent amongst youngsters underneath 5 in India. PM2.5 is a mix of varied parts with completely different sources and toxicities.

The examine confirmed the cumulative impact of PM2.5 parts—ammonia (NO3-), superb ammonium (NH4+), elemental carbon (EC) and natural carbon (OC)—to be bigger than the impact of PM2.5 mass on youngster well being in India. Another Delhi-based examine, printed in April 2022, has additionally established a hyperlink be-tween acute publicity to PM2.5 chemical species and mortality throughout winters. “There might be differences in the meth-ods of studies and study design, including time series, cross-sectional, exposure based health outcomes and many more. However, an interesting fact is that in both these studies NO3 showed the highest impact,” says Ekta Chowdhary, researcher and writer of the Nature examine.

Yet one other space of investigation is childhood most cancers. While there’s sufficient proof to point out that publicity to air air pollution can result in most cancers in adults, this correlation isn’t studied adequately in youngsters. There is sufficient proof to point out that publicity to air air pollution can result in most cancers in youngsters. Studies have recognized air pollution equivalent to benzene, NOx and particulate matter as culprits in childhood Non-Hodgkins Lymphoma, a sort of most cancers that begins within the lymphatic system which is a part of the physique’s immune system. A examine printed in January 2023 in Nature discovered an affiliation between publicity to PM2.5 degree and danger of acute lymphoblastic leukaemia amongst youngsters, which is a most cancers of blood and bone marrow. But this correlation isn’t studied adequately in India.

The newest out there knowledge by the National Cancer Registry Programme is just from 2012 to 2016. But it reveals a pat-tern. The proportion of childhood cancers relative to cancers in all age teams in numerous cities diverse between 0.7 per cent and three.7 per cent. Delhi was the worst affected amongst locations with a most cancers registry—the nation had 28 Population Based Cancer Registries between these years. Here, as many as 203.1 boys per million are affected by all of the broad sorts of cancers in comparison with simply 12.2 per million in Pasighat in Arunachal Pradesh. Patiala’s most cancers registry reported 121.2 instances per million boys. Mum-bai, which too is dealing with a air pollution problem, stood at tenth place. In case of women within the age group of 0-14, the quantity is 125.4 per million in Delhi in comparison with 12.1 in East Khasi Hills District. Patiala stood at ninth place with 74 instances per million.

The knowledge from India’s National Cancer Registry Programme reveals that Delhi is badly affected by leukaemia too—as many as 84.2 boys per million, between the ages of 0-14 are affected in comparison with simply 7.3 per million in Meghalaya. For women, this quantity stands at 47.2 instances per million, the second-highest after Imphal West sistrict in Manipur, in comparison with simply 4.9 per million in Cachar district of Assam. In case of lymphomas, the quantity stands at 30.7 per million for boys in Delhi, a lot decrease than the two.3 per million instances seen in Meghalaya. For women, Delhi has the third highest instances of lymphomas which stand at 10 per million. The report additionally reveals that among the many Asian international locations studied for boys, Delhi has the best instances per million adopted by China’s Jianmeng. In case of women, Delhi has the sixth highest variety of instances. For all international locations included within the examine, Delhi has the sixth highest variety of most cancers instances for boys and tenth highest in case of women.

Insidious hyperlink

There is an insidious hyperlink between outside and family air air pollution. The 2015 report of the Steering Committee on Air Pollution and Health underneath Union Ministry of Health and Family Welfare estimates that family air air pollution can con-tribute as much as 25-30 per cent of outside air air pollution in India.

Several epidemiological research can be found in India on the impact of family air air pollution. The first ever “mother–child” cohort examine was carried out by Kalpana Balakrishnan and her crew of Sri Ram Medical College, Chennai. They adopted the cohort over time to research the hyperlink between publicity to PM2.5 throughout being pregnant and low birthweight in an built-in rural-urban setting. This reveals {that a} 10 µg/cum enhance in publicity to PM2.5 throughout being pregnant can lower birthweight by 4 g, result in a 2 per cent in-crease within the prevalence of low birthweight and trigger 70 g lower in birthweight in households utilizing stable fuels.

However, in response to a worldwide examine “Global, regional, and national burden of ambient and household PM2.5-related neonatal disorders, 1990–2019”, printed in March 2023, the worldwide neonatal issues burden attributable to family PM2.5 has decreased by 38.35 per cent prior to now 30 years. This is especially because of lower within the family PM2.5-related neonatal issues burden which decreased by 52.33 per cent in the course of the interval, in response to the examine printed in Ecotoxicology and Environmental Safety in March 2023.

According to “State of Global Air/2019” report of the Institute for Health Metrics and Evaluation (IHME), a analysis insti-tute within the US, India has diminished its proportion of households cooking with stable fuels from 76 per cent in 2005 to 60 per cent in 2017 because of improved entry to liquefied petroleum gasoline. Yet stable gasoline use stays excessive among the many decrease earnings teams. This nonetheless accounts for about two-thirds of the PM2.5-related neonatal illness bur-den. In truth, India together with Pakistan, Nigeria and Ethiopia account for about 50 per cent of the whole variety of neonatal issues attributable to family PM2.5.

Globally, mixed publicity to outside and family particulate matter air pollution is estimated to have contributed to almost 500,000 toddler deaths of their first month of life. Around 116,000 or 23 per cent of those newborns have been in India, in response to the current estimates in IHME’s “State of Global Air/2020” report. This means one in all each fourth new child deaths because of air air pollution was in India. In truth, the country-level evaluation of the loss of life burden because of air air pollution reveals {that a} new child dies within the nation from well being considerations related to air air pollution as soon as each 5 minutes.

Plethora of native and international proof, thus, builds the case for pressing motion to manage air air pollution. Despite the mounting proof, individuals usually don’t perceive how air air pollution triggers well being circumstances that result in loss of life and sickness. This was evident when a nine-year-old lady Ella Kissi Debrah died because of acute bronchial asthma assault in south London in 2013 and her mom moved the court docket difficult that air air pollution was chargeable for her youngster’s loss of life. The incident finally led to the landmark judgement and coroner’s report in 2020 that made Ella the primary particular person on this planet to have air air pollution cited as a explanation for loss of life.

Kalpana Balakrishnan factors out, “Gaps in evidence never close in science. There is already enough evidence on ex-posures to rest the case. Also remember, absence of evidence is not the evidence of absence. There is already enough for us to act urgently.”

This was first printed within the 1-15 December, 2023 print version of Down To Earth