Is there a nurse in the 'House'?
The world will breathe easier with Biden and Harris — literally
When I was growing up, my parents would take my sisters and me to South India to visit relatives and experience the beautiful and bustling world they grew up in. Hours after landing in Chennai, I remember blowing my nose, the mucous already darkened from just a few hours of being in the city.
When I visit India now, I sheepishly reflect on my childhood ignorance. The air is impossible to ignore; it hangs like a thinly veiled cloud. 14 of the 20 most polluted cities in the world are in India. I see women holding the edge of their saris over their faces to protect their noses. I am acutely aware that my uncle, who has chronic lung disease, has to wear a mask outdoors because his lungs are easily aggravated by the polluted air he breathes.
On the other side of the world, it's the same story with different characters. A patient of mine, an elderly Black man from Washington, DC, recently told me something that reminded me of my uncle's plight. My patient lives near a highway, and for years, he has preferred to stay indoors because the traffic-related air pollution affects his breathing. Thousands of miles apart, a common issue affects the health of two vulnerable individuals: poor air quality.
Air pollution due to fuel combustion includes the release of fine particulate matter, known as PM2.5. Once we inhale it, it travels through the airway and settles into the tiny air sacs called alveoli of the lungs. Here, the particulate matter causes inflammation leading to breathing complications in patients with obstructive lung disease, such as asthma. When an ultrafine particulate matter is inhaled, the particles are so tiny they can travel from the alveoli of the lungs into the capillaries, entering the bloodstream and leading to an increased risk of heart disease. The effects of air pollution manifest beyond our lungs and our heart. It is a detriment to our neurologic function and is associated with adverse pregnancy outcomes.
Globally, the World Health Organization estimates that nine out of ten people breathe polluted air. Air pollution is responsible for seven million premature deaths worldwide, and more than 90 percent of these deaths occur in low and middle-income countries, mostly in Asia and Africa.
Each one of those seven million deaths is a person. Most of them are names I will never know, faces I will never see. But some of the people I do meet - they are in our proverbial backyard. This global crisis is affecting people like my patient in Washington, D.C. and all over the country. According to the "State of the Air" 2020 Report by the American Lung Association, nearly 150 million Americans, representing 45.8 percent of the population, live in counties with unhealthy ozone or particle pollution. This is a 20 percent increase in the number of Americans compared to the 2017 report, which covers the years 2013-2015.
Poor air quality is one of the gravest examples of environmental injustice both globally and in the United States. In the United States, Black and Hispanic Americans disproportionately inhale air polluted with PM2.5, and the actions of non-Hispanic whites disproportionately cause that pollution. Because air pollution can lead to health complications like heart and lung disease, this "pollution burden" puts the health of those who live in vulnerable communities at the mercy of the actions of others. These communities are denied the fundamental right to breathe clean air, and in doing so, are faced with an invisible threat that endangers their health.
In the United States, the current guideline for PM2.5 exposure, which recommends an annual standard not exceeding an average of 12 μg per cubic meter, is inadequate to protect public health. Scientists are pushing for stricter regulations, but instead of listening, the Trump administration is reversing an environmental policy that can make air pollution worse, such as weakening auto fuel efficiency standards, relaxing air pollution regulations for some waste coal plants, and undermining standards that regulate mercury and limit the release of over 80 toxic air pollutants from coal-fired plants.
Presidential nominee Joe Biden's commitment to clean air and addressing the climate crisis has gone through a much-needed evolution due to push from climate advocacy groups, now earning him support from environmental groups, including the Natural Resources Defense Council and the League of Conservation Voters. Vice Presidential nominee Kamala Harris, who was a co-sponsor of the Green New Deal in the Senate, has introduced the Climate Equity Act, which is designed to address environmental injustice and develop policies that will protect affected communities. To be sure, environmental groups are pushing for more forceful action on the fossil fuel industry, and they should continue to do so. But together, Biden and Harris have the most ambitious climate platform of any presidential ticket in our history.
Clean air is not a prescription I can write, but I can fight for it- and you can too. As air pollution and city congestion approach pre-pandemic levels in many parts of the world, we can use our votes as instruments of change for the seven million people who die locally and globally due to air pollution. The impact of this election resonates far beyond our borders. Each of us has the potential to improve public health by electing an administration who will be environmental leaders in the United States and rally a global movement. The most effective way to fight for clean air is to vote this November. And maybe, when I revisit India, the only thing my nose will encounter is the smell of mangoes.
Neelu Tummala is an ENT physician and a clinical assistant professor of surgery at George Washington University School of Medicine and Health Sciences.