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‘Health is the trigger for action to protect the environment. It is also clear that the first assault of environmental degradation is on our bodies. It is this that needs to be understood better so that we can make the (necessary) decisions to correct the growth path such that it does not take this toll. But we don’t. The reason is that we really do not know what is happening to our health and how that is linked to the environment. We not only do not know, we don’t care.’ These are the opening lines in an extremely important, and timely, publication by the Centre for Science and Environment, Body Burden 2015: State of India’s Health.

The CSE team traces the ‘conspiracy of silence’ and consequent (in)action to the lack of communication between health practitioners and environmental researchers. In addition, there is a tendency to focus almost exclusively on the technical questions, and foreground expert opinion, thereby possibly missing out on the interconnections and thus, the larger picture. Alongside impeding comprehension, such an approach also constrains debate about possible responses to essentially matters of management while eschewing engagement with the politics governing the choices we make.

This publication highlights the challenge of the ‘double health burden’ – the simultaneous impact of traditional diseases like malaria and diarrhoea and modern ones like cancer and diabetes – in substantial measure a consequence of the growing incidence of toxicity in our air, water, and soil. Unfortunately, we do not, as yet, adequately understand the ways in which shifts in environment affect us. Hardly surprising that there is so little consensus even among ‘experts’ about what is happening and thus what might be done to reduce the negative impacts. What complicates matters further is that each choice carries differential implications for different sections of society, making the task of consensus building that much more difficult.

Take, for instance, the challenge of air pollution, a problem currently obsessing key decision makers, possibly because Delhi, the national capital, has recently crowned as the world’s most polluted city. Literally choked by the toxic smog that engulfs the city every winter, the state government has proposed a range of drastic measures to combat what has correctly been identified as a health emergency, the terrifying increase in the incidence/intensity of respiratory diseases, particularly affecting those most vulnerable – children, elderly, the sick and malnourished.

This belated focus on a critical health concern cannot but be welcomed, more so because issues of ill-health so rarely animate public discourse. It is ironic that not too far back pollution was seen by both our politicians and envoronmentalists as essentially a problem affecting rich countries. (Remember the famous quote: Poverty is the greatest pollutant.) It is, however, disappointing that a complex issue has been reduced, at least in the media debate, to one of controlling vehicular pollution, and within that, to reducing the number of private cars. Seemingly forgotten in the process are the many other contributors to atmospheric toxicity – polluting industry and thermal power stations, the practice of burning crop residues on our farms and garbage, the reliance on dung and firewood as domestic fuel, and the dust released by construction activity.

It is now well-recognized that air pollution – external and internal – is a leading cause of chronic illnesses and premature death, claiming close to a million lives/year. The conundrum is not about the need to act but about what aspects to prioritize and what measures to deploy, given not only constraints of resources and technology but also of administrative ability and political feasibility. Less acknowledged is the state of our knowledge about the efficacy of proposed solutions. For instance, in the absence of reliable data about the extent and causes of air pollution, there is a chance that we may choose to tackle a less critical problem or worse, add to it.

The state government had commissioned a study of Delhi’s air pollution by IIT, Kanpur; the report, though submitted some months back, has yet to be placed in the public domain. Why? Similarly, at the moment, there is little clarity about the vehicular restrictions proposed regarding what categories are to be covered and what exempted. All this raises doubt about the seriousness and intent behind the announcement.

We do need to reduce the burden of cars/vehicles on our roads and reasons other than their impact on air quality. What mix of strategies we choose – fiscal or administrative – will have major consequences on the way we imagine urban planning, mobility, lifestyles, as also what products we value. Such crucial decisions cannot be left only to experts but need a larger and continuing debate on our preferred futures. Issues of health, though undoubtedly technical, are also intrinsically political.

Harsh Sethi