Pakistan's Public Health Emergency: Taking on Smog

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Calling on Pakistan's medical professionals, scientists and researchers to sign this petition for protecting our air and public health through implementing appropriate emergency measures

Petition on the “Public Health Emergency” in Punjab and all of Pakistan

TO: Secretary, Department of Specialized Healthcare & Medical Education, Punjab; Secretary, Primary and Secondary Healthcare Department, Punjab; Secretary, Environment Protection Department, Punjab; Lahore District Health Authority; World Health Organization, Pakistan; Minister of Climate Change

The Pakistani public has become aware of the impact of the worsening air quality crisis over the past three years, with the onset of the annual ‘smog season’ beginning in October. We, as medical professionals, the scientific community, and related persons, are witness to the fact that thousands of families show symptoms of the worst respiratory diseases, as well as increased heart failures, during this time of the year. We insist that the government, particularly the Departments of Primary and Secondary Healthcare, Environmental Protection and Specialized Healthcare & Medical Education implement legally mandated measures to prevent the release of pollutants in the air and to safeguard the health of the public. 

The suffering is huge and the healthcare costs are almost entirely borne by the tax-paying public as well as by industry, which loses money due to sick-based absences. Less than 1% of GDP is spent on health in Pakistan, and even less on preventative health measures, creating severe decline in public health facilities.

This constitutes a public health emergency, as concentration of pollutants remain unsafe and continue to worsen, while public health infrastructure is weakened. 

Evidence of the negative health impact of air pollution is overwhelming. Based on its Commission on Pollution and Health research, the prestigious medical journal The Lancet characterises air pollution as a major health hazard. It estimates that 7 million premature deaths are caused annually by air pollution. The 2015 Global Burden of Disease Study finds that exposure to outdoor fine particulate matter (PM) is the fifth leading risk factor for death worldwide. The Science Academies of Brazil, Germany, South Africa, and the USA, and the US National Academy of Medicine, have found that the pollutants of greatest health concern are fine airborne particulates produced by combustion of fossil fuels and biomass. They link particulate air pollution to heart disease, stroke, chronic obstructive lung disease, lung cancer, premature birth, dementia, and adverse effects on brain development

Globally, air pollution by fine particulate matter is heavily concentrated in South and South East Asia.

In Lahore, beyond the clear visual and health evidence, we are aware from the data received from multiple air monitors, that the city exhibits some of the worst PM 2.5 measures in the world - up to the Hazardous Level - and it is frequently named as the MOST air-polluted city in the world. Yet, to date, the Punjab Primary and Secondary Healthcare Department has absolutely no program for mitigating air pollution-based diseases across the province, and, despite the Report of the Smog Commission constituted by the Lahore High Court, we see no evidence that the Federal Ministries or Provincial Departments and other institutions of the state are coordinating an effective response mechanism to the Public Health Emergency caused by smog and the broader air quality crisis plaguing much of the entire country. 

As professionals of the medical and scientific disciplines, we are deeply concerned that meaningful measures be adopted immediately to stop the premature deaths and needless suffering as a result of polluting our air. 

The following measures detailed by the Report of the Commission on Smog 2018 must be implemented, as this is the law.

- The Specialized Healthcare & Medical Education Department must study the health effects of air pollution in the Province to generate and publicise its data and findings. Such data will be critical in formulating effective policies to reduce the impact of air pollution on public health. 

- The Specialized Healthcare & Medical Education Department as well as District Health Authorities should be involved in developing health emergency responses at the district level. The Government of Punjab must replicate the health emergency measures, whenever and wherever required, at district level. 

- A public awareness campaign is to be initiated by the Provincial Government in aid of District Health Authorities (and local government), which should include daily reports and real time air quality conditions and radio broadcast of this data.  

- Medical schools, hospitals and practitioners and the public must be promptly educated through seminars and other forms of public engagement, especially on risks for pregnant women, the elderly and children.

The Punjab Clean Air Action Plan recommends the passage of a specific Punjab Clean Air Act to define emission and demarcate areas for cleanup

In addition, we urge the government to immediately undertake the following specific measures, many of which are common in other parts of the world.

- Declare Smog Days when the average PM 2.5 level exceeds Unhealthy Levels of above 35.4 μg/m3 and the Air Quality Index exceeds 151. During this time children are to be kept home from school, and parks are closed, as these concentrations of pollutants in the air constitute a Public Health Emergency. 

- Distribute free PM 2.5 quality masks to all school children and elderly and to all traffic constables and sanitary workers. 

- Follow-up on the Advisory for Smog Awareness issued to the Principals of public schools in Punjab on Oct 18, 2019 as to whether the recommended measures are being followed. Similar directive to be issued to Private Schools. 

- Mandate school buses, odd-even days, and carpooling for all children travelling more than 1 km to school.

- Identify hot spots (where the concentration of PM 2.5 is highest) and institute strict controls on the volume of traffic and vehicular emissions passing through.

- Implement and enforce safe vehicular fuel standards immediately.

- Expand the public transport infrastructure by providing adequate, reliable and affordable clean-energy buses and vans on all major routes in the city. 

- Implement strict ban on the burning of garbage, crop stubble, and other hazardous materials. Institute proper waste management measures in the district and village level as well as city, including in Cantonment areas.  

- Shut down industrial units operating without emission control equipment, violating applicable PEQS, or using substandard fuels, while providing alternative employment for workers. 

- Close down coal-fired plants and transition to cleaner energy sources as a medium to long-term strategy, within 2-3 years.  

- Increase the Health Budget of all relevant bodies, with the recognition that the money saved from having better health will more than compensate for the costs of preventive care. 

- Increase the number of beds in public hospitals for all air pollution-related diseases, and subsidize the costs of such healthcare across the board. 

- Strengthen Pakistan’s public health institutions, empower medical experts and researchers and provide free care for all in need.

Through the successful implementation of these measures we will relieve some of the suffering borne by the population, who, in our duty as professionals, we are here to serve.