One consequence of the COVID-19 pandemic has been a dramatic drop in air pollution. Empty roads and closed factories have made breathing while cycling in our towns and cities much easier during these grim times. Nevertheless, although this phenomenon clearly should not be described as a benefit, hopefully it will trigger greater interest in air pollution.
As Beth Gardiner eloquently argues, the facts are not new. The Great Smog of 1952 killed around 12 000 Londoners and led directly to the 1956 Clean Air Act. In the US, the Clean Air Act was passed in 1970 following a bipartisan effort in the US Congress and a realpolitik decision by the now-maligned President Richard Nixon, who in fact established the Environmental Protection Agency, EPA.
That almost appears a golden age when compared with the current incumbent of the White House, who, shortly after arriving in post, appointed ‘top EPA officials bent on eviscerating the agency’.
Scientific evidence on the direct effect of air pollution is more recent: in 1993, Dockery and colleagues published a landmark study in the NEJM on the association between air pollution and mortality in six US cities. Nevertheless, that was over 25 years ago, and Gardiner highlights a body of subsequent research. Why therefore is this public health problem not taken more seriously? Why as GPs do we correctly talk to our patients about smoking, but rarely about the air pollution in their communities?
Gardiner is well placed to ask the question, having been raised near the New Jersey Turnpike — made famous by Bruce Springsteen in his song ‘State Trooper’ — and a ‘notorious traffic choke point’. Later in life she moved to London, and her book is peppered with concerns about the effect of air pollution on her daughter’s health: ‘London’s pollution is just one piece of a health disaster playing out across Europe, belying the continent’s reputation for environmental progressivism.’
And to underline the European problem, she describes a visit to Poland, which is similar to 1950s Britain in its dependence on coal, and as a country is ‘home to more than two-thirds of Europe’s 50 most polluted citizens’.
But one European scandal trumps all, and that is diesel. Governments across the continent have incentivised the fuel, to the extent that sales of diesel cars in the UK rose from 14% in 2000 to over 50% by 2014. And when the extent of the crisis caused by excessive emission of nitrogen oxides was understood, the German carmaker Volkswagen resorted to inserting devices in 11 million cars to mask the emissions during tests — the now infamous Dieselgate scandal.
Air pollution of course is a greater curse for the poor and disaffected, and Gardiner’s empathy for these populations runs through the book. In a chapter on Delhi, which she describes as ‘air pollution’s ground zero’, she contrasts a high-tech business centre, or ‘bubble’, created by an Indian entrepreneur to keep out the seething pollution, with the toxic reality for the vast majority of the population, and especially the ‘invisible havoc it is wreaking on these children, the little ones napping inches from traffic’.
Unusually for the environmental genre, the second part of her book is hopeful, and is a testament to individuals, who against vast odds have brought about considerable change. One of these is Mary Nichols, who as head of California’s Air Resources Board, tackled air pollution in the state, and especially in Los Angeles, which had given birth to a noxious form of photochemical air pollution, smog.
In China, Gardiner profiles individuals such as Chai Jing, a journalist, who have taken considerable personal risks to expose the air pollution crisis. Echoing what we have seen with COVID-19 in China, Gardiner writes that ‘air pollution used to be sensitive, until it grew impossible to deny and the government finally decided to do something about it’.
Politics is therefore at the heart of the problem of air pollution, and nowhere more so than the question, ‘To who belongs the city?’, as Gardiner titles a chapter about Berlin’s rebirth as an environmentally focused city, ‘to orient itself around the needs of human beings rather than of the huge hunks of metal that hog the roads’.
Tackling air pollution will mean that all of us — GPs included — will have to wean ourselves off our motor vehicle addiction.
- © British Journal of General Practice 2020