Tackle air pollution diseases: India enforces climate change plan in its new advisory to states

The Centre has issued an updated advisory to all states and Union territories asking them to ensure chest clinics in government health facilities and medical colleges under its National Programme on Climate Change and Human Health (NPCCHH) to tackle air pollution-related diseases.

During the peak air pollution months (usually from September to March), the clinics are expected to function for a fixed duration of at least two hours daily.

Issuing instructions for immediate action, the Union health ministry has sent 33-page guidelines to the states and Union territories stating that cases of respiratory and cardiac diseases tend to rise due to pollution and therefore, hospitals must maintain special preparedness.

These chest clinics can be established at community health centres, district hospitals, and medical colleges in urban areas, covering all such facilities in cities under National Clean Air Programme (NCAP) initially.

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They will screen the patients for risk factors, confirm diagnosis, give treatment and long-term care to patients suffering from respiratory and heart diseases aggravated due to pollution, the advisory said.

The ministry also asked the facilities to maintain records of these patients through state or national level digital tools such as (Integrated Health Information Platform) IHIP. A register of individuals identified as being at high risk is to be maintained, and details of the high-risk individuals may also be shared with the respective blocks for community-based follow-up through ASHA, ANM, and CHO.

The advisory called for training of doctors and staffs to manage respiratory and cardiovascular cases strengthening support to manage cases attributed to air pollution.

These clinics should also promote behaviour change and adoption of healthy practices to potential and diagnosed cases of air pollution-related cardio-pulmonary illnesses.

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In a letter to the chief secretaries, Union health secretary Punya Salila Srivastava said during the winter months, air quality in several regions across the country frequently reaches poor to severe levels, posing a significant health challenge.

“Together, we can work towards a healthier, cleaner and more resilient ecosystem,” she said.

The advisory stated that children particularly under 5 years, elderly, pregnant women, patients with asthma or heart diseases, those from low socio-economic conditions having poor nutritional status and belonging to outdoor working groups are at the highest risk.

The ministry also advised healthcare facilities to ensure adequate medicines, oxygen cylinders, nebulizers, ventilators, and hospital beds, sketchers, Wheelchairs, and ambulances and have proper referral mechanisms in place.

Health departments including healthcare facilities have been asked to strictly monitor daily AQI levels during such high air pollution days or months as reported from pollution control boards States have been asked to minimise pollution by mitigating or reducing from sources such as construction sites and burning of wastes, crop residues, plastics, bottles and food wrappers etc.

Construction workers should be provided with masks or personal protection to safeguard against the inhalation of fine particulate matter (PM2.5), dust, and odours.

Regular use of water sprinkling or fine sprays from nozzles should be adopted to suppress dust at the site, preventing its resuspension into the air.

There should also be regular health check-ups and training sessions for construction workers and their duties should be rotated to minimize extended exposure to high-dust environments.

The advisory also listed precautions and avoidance of outdoor activities in schools if AQI levels is poor and above.

It suggested schools to limit outdoor activities during days of higher pollution levels, staying indoors during break sessions and minimizing outdoor exposure and avoiding physical activities like running, jogging, playing,school activities, functions, celebrations and even birthday celebrations.

Medical officials and staffs at school should be sensitised on air pollution related health issues and ways to manage such cases for support also from nearby emergency health facilities if required.

School health authorities, head, teachers and parents have been asked to develop mechanisms to create awareness and motivate in adopting better practices among students to mitigate and adapt to air pollution.

The advisory stated that children should be awarded by organising activities and events on air pollution at school level.

The health impacts of air pollution depend on the level of pollution and exposure duration. The individuals’ vulnerability to the health impacts of pollution can also differ based on demographic factors and predisposing health conditions, the document said.

Short-term high-level exposures can result in acute health reactions with involvement of various human organs and patients may present with certain suggestive symptoms like irritation of eyes, nose, throat and skin. cough, breathing difficulty, wheezing, chest discomfort, chest pain, headache, giddiness, limb weakness, facial deviation etc.

Vulnerable groups can experience more severe effects such as lower respiratory tract inflammation and infection, exacerbation of asthma, bronchitis or exacerbation of chronic illnesses such as chronic obstructive pulmonary disease (respiratory system), ischemic heart diseases (CVS), and cerebrovascular strokes (CNS) etc.

Long term exposure to even lower level of air pollution can result in chronic illnesses of respiratory and cardiovascular systems, lung cancer and premature deaths. .