In fact: New pollution-health study covers new ground but not enough

The Indian Express , Friday, December 25, 2015
Correspondent : Pritha Chatterjee
On Tuesday, AIIMS doctors announced that the institution would be part of the first large-scale study in India in nearly 18 years on links between respiratory and cardiovascular conditions and air quality in the Capital.

The lag of nearly two decades before a new study on air pollution and hospital admissions in Delhi is, to say the least, surprising. As the doctors said on Tuesday, health data helps influence policy decisions like nothing else. Had such data come sooner in Delhi, it might have triggered policy decisions to reverse the slide in air quality observed from the mid 2000s, especially with regard to particulates. The studies could have also provided evidence on the impact of policy decisions taken to improve air quality, including the use of CNG in public transport.

The earlier, landmark study was conducted by former AIIMS medicine department head Dr J N Pandey, from 1997-98. One of the first clinching studies in the country connecting health to air pollution, it was also one of the three Indian scientific studies mentioned by the Supreme Court in its judgment directing use of CNG in public transport in Delhi.

The new study, funded by the Indian Council of Medical Research (ICMR) and led by AIIMS, will include prominent disease areas, respiratory and cardiovascular, associated with air pollution in Delhi.

Apart from filling crucial gaps on new trends in health and air pollution, helping make comparison with pre-CNG times, the study beginning January 1 has a wider scope because of the involvement of two other institutes in it, Vallabhbhai Patel Chest Institute and Lady Hardinge Medical College. The effect on children, who were ignored in the previous study, is one of the crucial parts of the study. All clinicians now agree that children epitomise the health risks of air pollution. They present aggravated symptoms of existing diseases and also show a definite spike in emergency conditions when pollutants are high.

While there has been other research on pollution and health, the projects sanctioned were bogged down by long delays in publication.

A great example is a study to monitor schoolchildren in Delhi from government and private schools and compare their health with a control group of Uttarakhand children of the same age group, conducted by scientists of the Chittaranjan Cancer Institute in Kolkata. The study, which sought to see how children fared in the aftermath of CNG, was published in 2012, over six years after its submission in 2005-6. By then, its lead author had retired, and the data had already become redundant. The extension of this study is now awaiting publication, even as its co-author has also retired.

Dr SrikantNadadur, a US Embassy fellow posted in New Delhi for three months to study India’s air pollution and health research, told The Indian Express that there was a serious lack of any coordinated multi-centric effort to study the impact of air pollution on Delhi’s citizens. All global cities that have battled air pollution, including Los Angeles, London, Paris and Singapore, have had studies that covered both hospital admissions and air quality. Replicating the same in India should have been easy.

The ICMR study could now finally bridge that gap.

Scientists who are part of the 2016 study attribute some of the delays in multi-centric studies to ‘ethical clearances’ that institutions need to take and to the lack of a coordinating apex agency bringing all the scientists on this board. While the ICMR is expected to play the role of the coordinator now, the recent public debate surrounding air pollution, and raps from top courts have helped expedite clearances.

Another problem that has plagued all medical research in India, including on air pollution, is the lack of participation from the private sector. In contrast, in the US, private medical colleges such as Harvard, Yale and Johns Hopkins have been producing the bulk of research on air pollution and health, in coordination with the state environment regulatory authorities.

Many experts worry that considering the spiraling growth of the private sector in heathcare delivery in metros such as Delhi, and now increasingly in tier 2 and 3 cities, research that ignores findings from this bulk patient pool will be skewed.

Dr Pandey, who authored the 1997-98 study, says that one of his students who wanted to expand on his air pollution and hospital admissions study from private hospitals had been struggling for two years to get access to get raw data from private medical institutions.

The ICMR study will cover only three government institutions which, though apex centres for respiratory and paediatric diseases, omit the volume of Delhi’s population that seeks healthcare from the private sector. In addition, government institutions that still act as referral centres receive patients from across the country. To ensure they flush out data specific to Delhi will require an immense amount of screening from researchers, which will consume more time.

Unless private hospitals in India open up to data-sharing for research, getting scientifically representative data on how Delhi’s population is affected by air quality may still be a sketchy attempt at best. But if nothing else, it is a start.

 
SOURCE : http://indianexpress.com/article/explained/in-fact-new-pollution-health-study-covers-new-ground-but-not-enough/
 


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