Opinion: The safe air decade

Professor Guy Marks, President of the International Union Against Tuberculosis and Lung Disease, believes that lessons learnt during the Covid-19 pandemic should not be forgotten if we are to make our atmosphere safer for everyone to breathe. 

Although air is invisible, ever-present and vital to our existence, safe air is taken for granted. However, in an era of climate change, pandemics, and urban growth, everyone has been forced to acknowledge the hazardous nature of unsafe air.

Such recognition has been lacking for many years. Until the World Health Organization (WHO) updated the Global Air Quality Guidelines in September 2021, the guidelines had not been updated since 2005. This is just one example of the lack of emphasis placed on safe air.

Air pollution is a major global public health threat that causes a range of adverse health effects, even at relatively low or moderate concentrations . It is time to recognise current and emergent airborne threats.

We need to learn from COVID-19 by making our air safe from all airborne threats to health. As with many global health problems, the danger of unsafe air is greater in low- and middle-income countries and comes in many forms:

• Infectious agents, such as COVID-19, tuberculosis and other respiratory infections
• Man-made pollutants, such as emissions from industry, from cars, trucks and buses, and from coal- and gas-fired power stations
• Smoke from forest fires, agricultural burning and other fires
• Other biological hazards, such as airborne pollen and fungal fragments, that are may trigger for allergic symptoms and epidemics of fatal asthma during thunderstorms
• Workplace hazards causing asthma, silicosis, “black lung”, asbestosis and other serious lung diseases

Unsafe air is a greater risk in low- and middle-income countries due to the reliance on diesel engines, coal fired power stations, domestic fuel burning for cooking and heating and agricultural burning.

The catastrophic consequences of unsafe air are starkly evident: not only in massive loss of life due to the airborne spread of air pollution and other airborne hazards in cities, but also the huge economic costs of failure to control this hazard. This problem is global. It has impacts on industry and workers, homes and families, children, the elderly, health care organisations and environment agencies.

The crisis of global warming lends even greater urgency and complexity to the problem of unsafe air and the need to find solutions.

We need evidence-based interventions and policies that will ultimately protect human health from diverse airborne threats and, in doing so, promote environmental justice and sustain economic and social well-being across the global.

Without safe air we cannot hope to eradicate the airborne transmission of deadly infectious diseases, including COVID-19, tuberculosis and other respiratory diseases. Tuberculosis (TB) is preventable and curable, yet it remains a leading cause of deaths globally – an estimated 1.5 million people died of TB in 2020.

Professor Guy Marks is President of the International Union Against Tuberculosis and Lung Disease

The Union joined over a hundred other lung health partners in urging nations to implement ambitious clean air policies immediately in order to protect global health.

There is ample evidence to strongly support government action to reduce air pollution and address climate change simultaneously. The Union urges nations to commit to ambitious air quality and emission reduction policies around the world.

We must drive discovery, innovation, development, and implementation equivalent to that which followed from John Snow’s discovery of the link between unclean water and cholera in the mid-19th century.

Now, many of us take clean water for granted thanks to engineering, chemical and biological solutions driven by demand for sanitation. While human health was the driving force, the solutions were developed and implemented outside the health sector.

This requires us to take a multidisciplinary and collaborative approach between physical chemistry, engineering, building and urban design, law, data science, psychology, social sciences and many others.

The next decade must be the decade of safe air.

The International Union Against Tuberculosis and Lung Disease (The Union) is a global scientific, technical and membership organisation committed to creating a healthier world for all, free of tuberculosis and lung disease.

 Established in 1920, The Union strives to end suffering due to tuberculosis and lung diseases, old and new, by advancing better prevention and care. They seek to achieve this by the generation, dissemination and implementation of knowledge into policy and practice. Ensuring that no-one is left behind, people are treated equally and there is a focus on vulnerable and marginalised populations and communities.

Images:  Engin Akyurt (Top) / Nick Fewings (Middle)