Air Pollution Kills as Many People as Cigarettes
Originally published on October 8, 2019 by Neha Pathak M.D. on WebMD.
When she turned 62 in 2012, Latifa Moosajee and her husband decided to downsize from their home in small-town Georgia. They moved into a brand-new townhouse in the commercial heart of Atlanta. “It was my dream home … close to my daughter’s family.”
Moosajee was excited to spend more time with her grandchildren and lead an active life in the city. But the very first year in her new home, she began to wheeze and have trouble breathing. At first, she tried allergy pills, thinking it was just a rough ragweed season. Over the next 5 years, she had longer and longer stretches of wheezing with trouble breathing, and she needed more and more medicines. She started short-acting inhalers, then long-acting inhalers, and eventually needed steroids just to keep her airways open.
The winters were the toughest. “For months at a time I had no energy … I could barely breathe,” Moosajee said. Her lung doctor ruled out the usual suspects. She had no history of lung disease. She didn’t smoke. No one around her smoked. She hadn’t changed her diet or started using new products in her home.
The only times she had similar problems were on her rare trips to India, which has some of the highest pollution levels in the world.
Figuring that out helped her zero in on the gridlocked street outside her window in Atlanta. “The cars pack the road from morning to night; only the evening would be clear.” Moosajee and her doctor began to suspect the polluted air she was breathing in for years was taking a toll on her health.
Are We Are All Smokers?
Muller cautions that he is not suggesting that breathing in air pollution is actually the same as smoking a cigarette. It’s more like a mathematic illustration of how both can cause similar harms over a while.
Yet research shows that the health risks from cigarette smoking and air pollution are similar. A recent study found that breathing air with mild increases in air pollution levels over 10 years caused the same type of lung damage seen after 29 years of smoking a pack of cigarettes a day.
What Are We Inhaling?
Cigarette smokers breathe in over 7,000 chemicals whenever they light up, and at least 69 of these are known to cause cancer.
The makeup of air pollution is very different and depends on where we live. In the U.S., pollution from fossil fuels is the biggest killer, with models estimating close to 200,000 deaths a year. From cars to power plants, burning fossil fuels like gas and coal releases many dangerous pollutants into the air. Every time we start our engines, cancer-causing toxins like benzene, along with dangerous gases and particles, fill the air. Whenever coal is burned, dangerous fine particles, mercury, lead, and other heavy metals spread through the sky. Even natural events like wildfires can damage our health, sending particles and hazardous gases far into the air.
What Happens When We Inhale?
In the short term, spikes in air pollution can worsen medical problems like asthma and heart disease. Over the long term, even low-level exposures considered acceptable by the Environmental Protection Agency (EPA) can play a role in developing lung and heart diseases. More and more research now finds links to damage in virtually every organ in our bodies, from our brains to our bones.
Dean Schraufnagel, MD, a University of Illinois at Chicago pulmonologist and director of the Forum of International Respiratory Societies, helps people make the connection between “the steady stream of ‘low-dose’ pollution” we inhale and the medical problems that can come years down the line.
“Air pollution really is a silent killer … By the time people have the lung cancer or the heart disease, they think … ‘oh, that’s bad luck or bad genes’; they don’t realize that air pollution over many years also may have played a role.”
Young children and older adults face the highest risks because their body’s defenses are less robust than healthy adults. For children, the damage can start even before they are born. Air pollution can cause early birth and low birth weight, putting babies at risk of lifelong health problems.
After birth, children face more risks from air pollution because their organs are still developing. They also inhale higher amounts of pollutants because they tend to spend more time outside, breathe faster than adults, and breathe more through their mouths. The nostrils are much better at keeping pollutants out of the body than the mouth.
Breathing in polluted air during a time of critical development can also damage the brains of young children, affecting how they think and feel. Polluted air has been linked with autism, lower intelligence, attention problems, and a higher risk of mental health problems like anxiety.
Most of us are not aware of the pollutants we are breathing in. Even fewer are paying attention to the long-term health risks of air pollution.
In the U.S., air monitoring stations collect data on pollutants like particulate matter and ozone so people can be alerted when levels are higher than what is considered acceptable. But these monitors don’t provide neighborhood-level information and may not catch “hot spots” where people like Moosajee live. This is quite true for people living on busy roads. Even on alert days, people who don’t have symptoms may not think they should heed the warnings.
Two young app developers in Paris want to change that.
Amaury Martiny came across Muller’s air pollution-to-cigarette calculation about a year ago and describes it as an “aha” moment.
Martiny and designer Marcelo Coelho created a free app using Muller’s formula and PM2.5 data from hundreds of air quality data stations in cities all around the world. When the app is open, it finds your phone, finds the closest air monitor data for PM2.5, and converts it into the “equivalent” number of health-damaging cigarettes. They found that many of their U.S. downloads happened during the California wildfires in 2018, when the app would have shown a staggering 45 cigarettes per day in the area of the wildfire.
Martiny and Coelho stress that their “main goal is to raise awareness about the risk of air pollution … What was amazing about the equation was it transformed this very abstract scientific notion of PM2.5 to something that was really tangible to basically everybody … Everybody knows the effect a cigarette can have on your body.” And everyone knows that there aren’t “safe levels” for cigarette smoking.
Why Don’t We Cut Back?
- Plans to roll back fuel efficiency standards for cars and trucks
- Repeal of the Clean Power Plan and replacement with a rule that may increase emissions
- Changes to how the EPA measures benefits to human health when cutting down on pollution from toxic air pollutants, including mercury and PM2.5
According to experts, all of these changes will likely lead to a reversal of the progress in reducing air pollution and preventing related deaths.
What Happens When We Quit?
Though levels of air pollution are better in most communities in the U.S. than other places in the world, we can still do more to reduce our risk of long-term health problems. “The only thing that makes sense based on the evidence is that we should continue to try to reduce our exposure to air pollution … It doesn’t come without effort, and it doesn’t come without vigilance,” says Pope.
Some of what we know about the health benefits of cleaner air comes from “natural experiments,” where researchers study what happens to people in areas after pollution levels come down, like when large factories shut down or traffic routes change. Most of these studies show improvements to health quickly.
After coal and oil power plants closed in California, there were fewer preterm births in neighboring communities. New electronic tolls (E-ZPass) in New Jersey and Pennsylvania reduced traffic congestion from idling cars, improved birth weights, and lowered early births for mothers living less than 1.5 miles from toll plazas. When air pollution was controlled during the Olympics in Beijing, birth weights for babies in the area improved. And when traffic was rerouted during the Olympics in Atlanta, there were fewer ER visits and hospitalizations for asthma for local children.
How Can We Protect Ourselves?
The best way to reduce the risk of health problems is to avoid breathing in polluted air. This is especially true for pregnant women, babies, children, older adults, and those with chronic medical problems. But it’s hard to do if you live in high-traffic areas or close to polluting factories.
Facemasks, specifically those called respirators masks, can filter particle pollution if worn the right way. The main problem is that people have to buy the right mask and wear it with an airtight seal; otherwise, it won’t filter out harmful pollution. Also, most masks don’t filter out certain toxic gases and can still allow harmful lung irritation.