Everyone around the world shares the same right to a healthy environment. Indeed, during the United Nations General Assembly and the Climate Action Summit, leaders from governments and civil society, most notably youth leaders, reminded the world that the founding UN principle of justice applies to climate as much as any other issue facing humanity. Yet as physicians who specialize in treating people with lung disease, we were disappointed to see that principle was not honored through meaningful and decisive action at those meetings or at COP 25 in Madrid – this will have devastating consequences for the health and lives of billions of vulnerable people.
Preserving the environment and combating climate change is an imperative in its own right, but the pollutants that are causing climate change also cause death and disease. Poor air quality poses a threat across the life course, beginning in-utero and continuing as a significant cause of lung and heart disease in children and adults. We have seen firsthand the effects of poor air quality on our patients, young and old. In too many parts of the world, breath that should symbolize life and health brings harm instead.
People in Africa are already among the most vulnerable. According to the Global State of the Air report from the Health Effects Institute, nearly every person in Africa breathes air that exceeds health standards set by the World Health Organization. Between one quarter and one half of all deaths from heart disease, chronic lung disease, lung cancer and pneumonia in Africa are attributable to air pollution. And as air quality continues to decline, the resulting health impacts are offsetting the gains achieved by better control of diseases such as tuberculosis, malaria and HIV.
The UN’s commitments to gender equality and women’s health also demand attention to this issue. Women experience the highest exposures to household air pollution caused by cooking with polluting fuels such as wood, dung, charcoal or kerosene, often with their young children nearby. As a result, it’s not surprising that in Africa’s most populous countries, such as Nigeria and Ethiopia, 40-50% of the burden of chronic lung disease in women is caused by poor air quality, and more lung cancers are from breathing than from tobacco use.
By 2050, when 1.3 billion more people will be living in Africa, the scale of the problem - in the absence of targeted strategies to address continued increases in pollution and vulnerable populations - will get worse.
One myth promoted by many governments and self-interested industries is that air pollution is an inevitable consequence of development. Rapid economic development aided by access to cheap labor and subsidized fuels will certainly result in increased air pollution, but this is not the only pathway available and certainly isn’t the most desirable from a health or economic perspective. In fact, addressing air pollution by developing and enforcing policies to tackle leading sources of pollution, including household energy as well as industrial and vehicular emissions, will have a significant return on investment, with benefits to the public, lower costs to health and social systems, and measurable improvements to air quality and climate.
In contrast, failing to act urgently on climate-changing emissions will not just result in long-term risk to the planet; it will affect the health of millions, condemning generations to illness and lower life expectancy while hindering the sustainability of their environments.
The good news is that scalable, proven solutions to these problems are available. We’ve seen health improve in parts of the world where the air has been made cleaner through effective regulations on industrial pollution and vehicle emissions. For example, Nigeria has adopted standards for vehicles that other countries should follow to prevent much of Africa from becoming a dumping ground for old and dirty diesel-fueled cars and trucks. Access to clean household energy is also becoming more widespread in urban areas across the continent.
But significant gaps remain. There is an urgent and yet unmet need in Africa and elsewhere for better and more transparent air quality monitoring and reporting, increased engagement of civil society to demand safe healthy air, and accountability of governments and political leaders to exercise one of their most important responsibilities: preventing harm to their citizens.
Members of INSPIRE, a global coalition of health advocates and an initiative of Vital Strategies, are working to bring attention to this issue through our role as physicians charged with safeguarding human life. In our opinion, climate action commitments should aim first at reducing the world’s dependence on dirty solid fuels and the elimination of coal burning so that we can realize the near-term goal of improving air quality and health. Cleaning the air also makes good economic sense - lives are saved as soon as air quality improves.
Though the world’s largest greenhouse gas emitters - China, India and the United States - failed to commit to more aggressive climate plans at the Climate Action Summit, all hope is not lost. Approximately 70 countries did outline more aggressive plans and several wealthier nations announced more money for programs like the UN's Green Climate Fund. We urge countries and governments to follow their lead and prioritize actions to promote clean air to achieve health and climate co-benefits within their national plans to combat climate change. And, we want clinicians and civil society to hold them accountable.
In Africa and around the world, the issue is urgent, the need for action is great, and the stakes are high: nothing less than life and death.
Dr. Aschalew Worku, Assistant Professor of Medicine, Department of Medicine, Addis Ababa University School of Medicine/Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia and
Dr. Neil W. Schluger, Professor of Medicine, Epidemiology and Environmental Health Science, Columbia University and Senior Advisor for Science, Vital Strategies
This article is endorsed by members of Inspire: Health Advocates for Clean Air