We have all experienced heartache at some point in our lives. It is usually the romantic, melancholic variety that writers and poets wax lyrical about, but this has nothing in common with that sharp pain in the chest which can take one’s breath away and require a headlong dash to the nearest emergency. The doctor there does not see the cute emoji we attach to lovelorn texts but rather clogged blood vessels and dysfunctional muscular tissue. This reality check usually comes as a rude shock to us.

In much the same way, we may romanticise the air that surrounds us all we want – the cool breeze in the summer that carries the sweet scent of jasmine or the dreamy fog in the winters that makes one want to snuggle in bed with a hot cup of tea – but in reality few of us realise how pernicious that breeze or fog is or what havoc it is wreaking on our bodies.

The truth is that we are breathing in poison with every breath we take and it is taking a terrible toll on our health. Here is how: in the short-term, exposures of a few hours or a few days can contribute to ear, nose and throat irritation. The irritation usually disappears with the removal of the pollutants. Those living in Lahore are familiar with these symptoms when these appear along with our annual smog season.

The misperception is that when the smog clears the air quality improves. Not really. The pollution level comes down and becomes invisible after the smog leaves but it still remains above danger levels. Such short-term exposure may also cause and aggravate lower-respiratory and chronic conditions such as allergies, asthma and bronchitis. In people with heart disease, it can lead to heart attacks, arrhythmias and even death.

However, the biggest impact comes from long-term exposure (that is, weeks, months and years) to air pollutants which increases a person’s chances of dying from heart disease, chronic respiratory diseases, lung infections, lung cancer and diabetes. This exposure can also cause other health problems including metabolic dysfunction, disorders of the central nervous system (including neurological and psychiatric diseases) and adverse pregnancy, and developmental outcomes (for example, preterm birth, low birth weight and restriction in the growth of foetus).

To put this in perspective, according to one estimate, Lahore only had two days in the whole of the year 2017 in which air quality was of acceptable standards. Other big cities face a similar situation but accurate data for them is not available. It would, therefore, be fair to say that the majority of our urban citizens are exposed to long-term air pollution.

So how does this translate for those of us living in Pakistan? The State of Global Air 2019 report has some scary statistics. It tells us that air pollution is the sixth leading risk factor for mortality in Pakistan, having caused more than 128,000 deaths in 2017 alone. An even more alarming fact is that we lose up to two years and eight months in life expectancy at birth due to exposure to bad quality air. And almost 100 per cent of our population lives in areas where harmful particulate matter in the air is above the least stringent air quality target set by the World Health Organisation. That means the problem is not just in the cities, it is also in our villages and even in our hill resorts where we thought we could breathe clean air.

We seem blissfully unaware that we have a serious public health emergency on our hands. The issue is often obfuscated by technical jargon on the types of pollution, the measurement indices and the desired target levels. How many people understand what PM2.5 is, or what a concentration of 58 μg/m3 as opposed to 35 μg/m3 means? How many know the difference between PM2.5, HAP (household air pollution) and ambient ozone levels? These terms, usually used for describing the issue of air pollution, make the knowledge of the air quality incomprehensible to general public.

And here lies the catch. We do not sufficiently understand the problem. The government, though admittedly more sympathetic to environmental concerns than previous administrations, does not seem adequately cognisant of the gravity of the issue. This is reflected in the lack of policy reforms and some outright paradoxical measures in the form of heavier reliance on coal-fired power plants and the persistent use of substandard transport fuel.

In the meantime, Pakistan has achieved second place on the list of top 10 countries with the highest mortality due to air pollution; China and India are tied for the first place. China, however, has shown that decisive government action can deliver results. With stringent policy measures, including the adoption of clean air technology and strict implementation of emission limit regulations, it has been able to turn the tide.
What will it take for our government to show the same level of commitment?

In a dire economic situation with ostensibly many critically important sectors competing for resources, it may seem convenient for the government to put this matter on the back burner. It is perhaps not so easy to make the connection that all other economic activities may become meaningless without a clean environment. More money for hospitals and schools or other infrastructure will not pay dividends if we continue to inhale poison and the lives of our citizens are cut short simply because they breathe.

In the absence, therefore, of a proactive government, the burden for action may fall on the citizens themselves. But for that citizens need to take ownership of their own environment and have access to information. Currently, apart from some committed civil society groups and individuals making a valiant effort to find alternative data sources, the available data on air quality is not only of doubtful accuracy, it is also confined within select government departments. It is being used neither to drive policy nor to educate the public.

If citizens were to take the lead, and the seeds of such a movement are there already, they could become involved in gathering and disseminating air quality data. With air quality monitoring technology becoming more accurate, accessible and affordable, such a ‘citizen science’ approach, which has been used in other countries to make an impact, could be adapted to Pakistan as well. This will have manifold benefits. First and foremost, it will provide the data that is needed for evidence-based planning. Secondly, by raising public awareness, it will motivate people to find local solutions.

They might understand how planting more trees, using public transport, carpooling, bicycling and not burning trash, especially plastics, can have an impact on air quality. They will be better able to protect the more vulnerable groups like pregnant women, children and the elderly during acute episodes of air pollution by keeping them indoor and using masks or air purifiers. They will be more amenable to complying with regulations that the government wants to promulgate but does not have the will and the capacity to enforce — like putting restrictions on burning crops, regulating vehicular emissions and reducing industrial pollution.

Lastly, they might feel more empowered to exert pressure on the government to take this issue seriously and make it a top policy priority. If the government feels it is being held accountable by an informed and aware electorate, it will be forced to act and deliver.

If we want to enjoy that sweet scent of jasmine carried on the summer breeze, this may be the best way forward.

Narmeen Hamid is a physician by training and has a master's in public health and a doctorate in social medicine from the United Kingdom.

This article was published in the Herald's May 2019 issue. To read more subscribe to the Herald in print.