Air pollution: Asia’s deadliest public health crisis is not Covid

(Notably : India, Indonesia, Vietnam, China, Bangladesh)

As governments fail to curb the world’s worst air, millions are dying avoidable deaths

Bad air in New Delhi, India, in January: less than 8% of the world has safe air as defined by the World Health

Earth Day is an annual event held on April 22 to celebrate the environment and support environmental issues. By focusing on air pollution on this week’s cover story, Nikkei Asia is adding its voice to a global call — to world leaders, innovators, industry and investment leaders and influencers — to take concerted action and find better solutions to restore our planet.

Chiang Rai is among Thailand’s most glorious provinces, with its rolling hills, forests, elephant camps, sparkling waters and top-quality farm produce. At its northernmost point is the confluence of the mighty Mekong River, flowing down from China, and the smaller, winding Ruak River. These form the Golden Triangle where Thailand, Laos and Myanmar meet, infamous for its historical links to the opium trade.

Perched up on a ridge nearby, the Anantara Golden Triangle Resort is among a cluster of five-star properties that pander to moneyed hikers, elephant lovers and sightseers. During the week of April 12, however, only a handful of rooms were occupied. It is not Covid-19 keeping tourists away, but the annual dry-season haze that clouds the spectacular views.

Posted at the check-in desk are the latest PM2.5 readings, measuring the micrograms of minute deadly particles in the air. Sunday April 4 was another bad air day: the figure posted was close to 400 micrograms per cubic metre, nearly 40 times the level the World Health Organization deems safe.

“You almost feel like you are chewing the air,” said the husband of a Thai-speaking expatriate couple, checking in to an almost empty property.

Tourists wear masks in Chiang Mai Province, Thailand, in April 2019. For at least the past 15 years, the region has seen days with the highest PM2.5 readings in the world © AFP via Getty Images

The haze spreads across northern Thailand. For at least the past 15 years, neighbouring Chiang Mai Province has endured days with the highest PM2.5 readings in the world. Unlike many parts of Asia, the crisis in northern Thailand is not caused by belching power stations and factories, or cheap fuel and ancient vehicles. The problem comes from fires deliberately lit to burn forests and agricultural byproducts. Lung cancer and respiratory disease rates have soared.

Corn and rice farmers burn off residue. There is also unregulated burning of forest floors to facilitate the collection of wild mushrooms, demand for which is insatiable among China’s increasingly affluent middle class. Last year, air quality was even worse when disputes over national forests involved deliberate arson.

Pim Kemasingki, an environmental activist who edits online guide Citylife Chiang Mai, told Nikkei Asia that part of the problem was the basin-like landscape which traps smog — “a bit like a wok”, as she put it. “There is all this pressure that keeps the air here.”

Looking out of her window as she spoke, welcome early rains had partly cleared the air. Already, though, Pim could see smoke in the wet haze. “Farmers don’t have the wherewithal to change that practice,” she told Nikkei. It has been calculated that Thailand’s annual corn waste is the volume of 35 Mahanakhon Towers, a 77-storey skyscraper in Bangkok.

Jeff Hodson, a media trainer who worked in Chiang Mai in the 2000s, finally relocated to the US to escape the air pollution. “I didn’t want my kids breathing that crap,” he said. Most people have no such option, and the problem is festering.

Asia’s ‘airpocalypse’
Thailand’s verdant north, free of both industry and tourists, has somehow found itself at the epicentre of a global crisis.

The World Health Organization advises that a mean annual PM2.5 reading of 10 micrograms per cubic metre is safe, but less than 8 per cent of the world’s population has such clean air. And nowhere is more blighted than Asia. Of the world’s cities with the worst air pollution last year, ranked by Swiss air quality technology company IQAir, the top 148 are all in the Asia-Pacific region. Bawshar, Oman, ranking 149 on the PM2.5 list, was the first non-Asia-Pacific entry.

Thailand’s city of Chiang Rai, obscured by smoke from forest fires and crop-burning in 2019 © Getty Images

A study published in the journal Cardiovascular Research detailed the extent of the tragedy in 2015, the most recent year for which such detailed comparisons are available. The study put excess mortality attributable to ambient air pollution at nearly 8.8m globally, of which nearly 6.5m were in Asia. That makes it among the largest, if not the largest public health risk in the world — even larger than smoking, according to the study.

As health threats go, air pollution and Covid-19 are apples and oranges. Massive public funds have been diverted to control the spread of the pandemic, while air pollution has gone mostly unaddressed through official inertia. But if annual deaths from smog per the study are played out to the present day, they total many multiples above the slightly-over 300,000 deaths recorded from Covid-19 last year in the region, according to aggregated data on

“Since air pollution is such a chronic problem in Asia, many in the region, including some politicians, have decided to live with it as a necessary cost in the pursuit of development, which it isn’t,” Kakuko Nagatani-Yoshida, the UN Environment Program regional co-ordinator for chemicals, waste and air quality in Bangkok, said.

High-emitting sectors like power, transport, construction, even agriculture, have served as the backbone in this growth, said Isabella Suarez, an analyst at the Center for Research on Energy and Clean Air. “With little to no adequate policies to control emissions, pollution from all these new and increasing sources accumulate. The result of that is why more and more cities are recording higher PM2.5 levels every year.”

Pollution deaths (Nikkei Asia)

Health authorities have been sounding the alarm about Asia’s air quality for years: China’s so-called airpocalypse began a decade of alarm about the health effects of pollution, but has slowly improved following stringent measures by Beijing. Meanwhile, Bangladesh, India and Pakistan replaced China to have the world’s worst air.

“The world has turned the corner on tobacco. Now it must do the same for the ‘new tobacco’ — the toxic air that billions breathe every day,” Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, wrote in the UK’s Guardian newspaper in 2018. “No one, rich or poor, can escape air pollution. It is a silent public health emergency.”

A Chinese worker at the Sahiwal coal power plant, owned by China’s state-owned Huaneng Shandong Rui Group, in Sahiwal, Pakistan © Bloomberg

Pollution has become less of an urban-only issue. Agricultural burning and forest fires are well recognised as a source of dangerous smog affecting many parts of Asia, compounding the industrial and transport air pollution that is a byproduct of Asia’s export-led economic growth.

Over the past few years, it has greatly worsened in secondary cities — Chiang Mai being among the best examples. Medical research shows that the effects on health are much more serious than previously thought, particularly for children, the elderly and expecting mothers.

UNEP’s Nagatani-Yoshida said one of the reasons Asia was more affected was population density. Indeed, three of the four most populous countries on Earth are in Asia — China, India and Indonesia. Their combined populations are 3.1bn — about 39.2 per cent of the world’s total.

Indonesia: firefighting

Although the lush Golden Triangle region of Thailand illustrates the shared nature of air pollution, it is Indonesia that most think of when it comes to transboundary pollution in south-east Asia.

Indonesia emits massive amounts of pollution from fires lit to clear land for plantations. In a report last year, Greenpeace, the environmental pressure group, said seven out of 10 member states of the Association of Southeast Asian Nations were affected by haze generated by fires in Indonesia, with Singapore and Malaysia the worst affected. The report was based on two decades of studies, and said the haze “causes wide-ranging health problems including lung conditions and cardiovascular diseases”.

Scientists at Harvard and Columbia universities in the US estimate that the 2015 haze caused about 100,000 premature deaths in Indonesia, Malaysia and Singapore. The World Bank assessed the economic damage to Indonesia alone at more than $16bn.

Mohammad Mahfud MD, Indonesia’s chief security minister, informed the cabinet in February that the total size of areas affected by forest and land fires last year was nearly 300,000 hectares — only 20 per cent of the area burnt in 2019. While that is a major improvement, it remains almost five times the size of Jakarta, the capital.

Greenpeace cited one study that found children exposed at a young age to smoke in Sumatra and Kalimantan produced “lower grades of completed schooling, lower scores in cognitive tests and slower physical growth than children who were not smoke-exposed”.

The situation was again extremely serious in 2019, when an estimated 1.6m hectares burnt and at least 900,000 people suffered respiratory problems. The economic damage to eight affected provinces was put at $5.2bn. The culprits are no secret: companies in the pulp and paper and palm oil industries. Small farmers also burn off forest and peatland.

Asia emissions (Nikkei Asia)

Indonesia’s annual blazes were first taken seriously in 1997. The regional haze crisis spurred affected nations to draft the Asean Agreement on Transboundary Haze Pollution (AATHP) in 2002. Its purpose was “to prevent, monitor and mitigate land and forest fires to control transboundary haze pollution through concerted national efforts, regional and international co-operation”. In 2014, Indonesia became the last member state to ratify the agreement.

Even with Indonesia nominally on board, AATHP is a manifest failure. A road map on relevant regional co-operation was adopted in 2016. And in 2019, Asean environment ministers issued a statement reaffirming their commitment “to effectively implement [the agreement] and the road map . . . to achieve a haze-free Asean by 2020”. Multiple attempts by Nikkei to obtain comment from the Asean Secretariat in Jakarta on their inability to do so, and the ongoing pollution crisis, went unanswered.

Greenpeace blames the Asean code of non-interference in mutual affairs and consensus for the absence of progress. “In practice this means politeness, nonconfrontational approaches, behind-closed-door discussions, and informal and non-legalistic procedures,” Greenpeace said. “The AATHP itself does not even mandate Indonesia to accept international offers of firefighting assistance during transboundary haze crises, much to the frustration of Singapore and Malaysian leaders.”

Bangladesh: bricks in the wall
The daunting air pollution woes of Asean are, however, some way behind those of South Asia, home to much of the world’s filthiest air. With a population of more than 165m, Bangladesh is 15 times more densely packed than neighbouring Myanmar. According to the World Air Quality Index 2020, released in March by IQAir, the Swiss air-quality technology company, it is the most polluted country in the world, with an annual mean PM2.5 of 77.1 micrograms per cubic metre. Dhaka, meanwhile, is the world’s second most polluted capital.

One of the main culprits there is the brickmaking industry, with an estimated 7,000 kilns burning wood and coal. About 1,000 are around Dhaka. During the dry season, when the kilns are at their busiest, dust and smoke mingle with clouds of pollution rising from burning refuse and rickety transport. A thick, sulphurous fog blankets the city’s 21m people.

Environmentalist Abu Naser Khan said that one of its studies conducted with the Department of Environment found that the kilns were responsible for about 60 per cent of air pollution in Dhaka.

Ziaul Haque, director of air-quality management at the department, said the government had shut down about 560 kilns in the past five years but was fighting a losing battle. “It’s not that easy to stop their operations, because if we shut one, they tend to construct another within no time,” he said.

India and Pakistan: one thing in common
According to AQI 2020, Delhi pips Dhaka for the dubious distinction of being the world’s most polluted capital — for the third straight year. A measure of Delhi’s dire situation: in terms of PM2.5 levels, air quality actually improved by about 15 per cent from 2019 because of the nationwide lockdown against Covid-19, but even then remained the worst in the world.

Air pollution claimed an estimated 54,000 lives in the Indian capital in 2020, with related economic losses of $8.1bn — about 13 per cent of Delhi’s annual gross domestic product, according to a recent joint study by Greenpeace and IQAir. “Avoidable deaths” elsewhere last year included 25,000 in Mumbai and 12,000 in Bangalore.

Smog shrouds the India Gate in New Delhi in December 2018 © Kosaku Mimura

India is home to 22 of the world’s 30 most polluted cities. While, overall, it has managed improvements in recent years, air pollution “is still dangerously high”, according to the report. Delhi’s average annual concentration of PM2.5 was 84.1 micrograms per cubic metre of air, compared to 37.5 for Beijing, 20.9 for Seoul, 12.2 for Paris and 9.6 for London.

India and Pakistan share little amity, but a common problem in pollution. IQAir ranks Pakistan the world’s second-most polluted country and estimates that about 20 per cent of deaths are air pollution-related.

Malik Amin Aslam, the Pakistani minister for climate change, said that 40 per cent of the smog was because of vehicle emissions. He said other causes included industrial emissions and crop burning that happened around Lahore and across the border in India.

Pakistan has significant reserves of low-grade coal, but in 2016 had only one coal-fired power station. The China-Pakistan Economic Corridor, a $50bn flagship component in China’s Belt and Road Initiative, includes 10 coal-powered stations worth $10.8bn. Half are already operating, but the two planned for Muzaffargarh and Rahim have been scrapped. Prime minister Imran Khan announced a moratorium on further coal-fired power plants at the Climate Ambition Summit in December.

“In Pakistan, the use of dirty fuels in vehicles exacerbates air pollution,” Ahmad Rafay Alam, an environmental lawyer in Lahore and Yale World Fellow, said. Going forward, the federal government has ordered that only Euro-V standard fuels can be imported.

Elsewhere, banks have announced policies to end financing for coal-powered plants. Yet non-profits remain sceptical of efforts — notably by Japanese megabanks like Mizuho Financial Group, Sumitomo Mitsui Group and Mitsubishi UFJ Financial Group — and point out loopholes, including the fact that they continue to fund oil and gas-powered projects.

Others argue that this is still a necessary evil. “The 100 per cent renewables scenario is not a credible scenario,” said Michelle Manook, chief executive of the World Coal Association, which represents global coal miners and users. Renewable energy required investment in storage systems, she pointed out, and other unsolved technical and cost hurdles.

Asia carbon capitals (Nikkei Asia)

Burning crop residue is also a growing problem. Punjab is the only province to have formulated a policy on account of exceptionally heavy pollution and the threat of legal action by affected parties. To mitigate the pollution crisis, the government has set a target for electric vehicles to contribute 30 per cent of all vehicle sales by 2030. But Alam said the fuel import and electric-vehicle policies only existed on paper: “The government has not taken practical steps to implement them.”

Vietnam: the price of growth
GlobalData expects Vietnam to be the fastest-growing economy in Asean in 2021 with real GDP growth of 8.5 per cent, but it comes with unprecedented awareness of the environmental toll. When Q & Me market researchers recently surveyed nearly 800 people between the ages of 18 and 49, 79 per cent cited air pollution as their greatest environmental concern, and 84 per cent said environmental issues had become a bigger issue in 2020.

“Vietnam suffers an estimated $10.8bn to $13.2bn worth of economic loss due to ambient air pollution each year, or equivalent to 5 per cent of gross domestic product, according to official data,” the English-language VnExpress International reported in March. The Global Alliance on Health and Pollution estimates that Vietnam had 50,232 deaths because of air pollution in 2017.

PM2.5 levels around Hanoi and Ho Chi Minh City reached particularly high levels in November and December. The Ministry of Natural Resources and Environment instructed local authorities to install more air monitoring systems, and in January outgoing prime minister Nguyen Xuan Phuc issued a directive on air pollution control. The government recommended that people close windows, wear masks outdoors and administer saline nasal washes to the young and elderly.

Motorcyclists in Hanoi, Vietnam, in 2019. In a recent survey, 79 per cent of respondents cited air pollution as their greatest environmental concern © EPA=時事
Vietnam’s human rights activists have led the charge on environmental issues, mainly using Facebook. This has led to arrests and, in one case, asylum in the US. Authorities faced rare public protests in 2015 against air pollution and ash generated by the Vinh Tan 2 thermal power plant in Binh Thuan Province.

China: drastic measures
China has taken the most authoritarian approach to cleaning up. Last year, President Xi Jinping announced China’s target to be carbon neutral by 2060, and his government has been cracking down. January saw a rare public reprimand of state actors when the National Energy Administration was admonished by the Ministry of Ecology and Environment for negligence in controlling coal production.

Coal burning particularly affects China’s north-east. Ministry inspectors found 121 coal mines in three provinces had exceeded approved production by a combined 30 per cent. “Some NEA comrades thought securing supply was the most important part of their job, and that overemphasising environmental protection would increase production costs,” the ministry said, giving the NEA a month to rectify matters. “They fell short of expectations.”

IQAir ranked China’s air 14th dirtiest among 106 countries in its 2020 world air quality report, but it is going in the right direction. China reduced its PM2.5 level from 41.2 micrograms per cubic metre in 2018 to 34.7 last year — still three times more than the WHO’s advised mean level.

China only really began to address air pollution seriously in 2013, when coal satisfied two-thirds of its power needs. China now leads the world in solar power development and has dramatically reduced its cost to the world. Its electric vehicle and battery sectors are also world leaders, but not all its solutions are environmentally friendly. China has promoted hydropower as an alternative, raising serious environmental concerns in south-east Asia where it has dammed countless rivers, including the Mekong.

The Forbidden City in Beijing, shrouded in smog in 2018 © Kosaku Mimura
Drastic measures in recent years included relocating old polluting factories. Early last year, 46 in Hebei Province near Beijing were ordered out as part of a three-year drive to reduce industrial pollution, particularly from the manufacture of steel, cement and glass.

Cambodia: ‘alarming’ decline
For decades, Cambodia remained environmentally pristine — a result of war and genocide. The civil war there only finally wound down in the late 1990s. Now more prosperous, Cambodia is very belatedly tackling its bad air. It was only in 2017 that the environment ministry installed a PM2.5 meter, so records started in 2018. Another 16 devices have been installed in Phnom Penh, and 26 in the provinces. A mobile testing van was added in October.

Early last year, prime minister Hun Sen ordered extra efforts to combat pollution after PM2.5 spiked to over 60 micrograms per cubic metre. In December, the environment ministry noted an “alarming” decline in air quality and ordered local authorities to clamp down on forest fires, illegal burning of refuse and agricultural waste, particularly the rice stubble left after harvest.

Chea Nara, the director of the ministry’s department of air quality and noise management, said that efforts to curb pollution had helped to keep levels mostly below the ministry’s standard of 50 micrograms per cubic metre for 24-hour periods, and 25 micrograms per cubic metre for the yearly average. The country still faces challenges controlling air pollution, he said, noting his inexperienced staff and limited equipment. “Overlapping or unclear responsibilities between the Royal Government of Cambodia and relevant agencies, and resource, manpower and financial constraints lead to incomplete and ineffective enforcement of laws and regulations,” he said.

In February, after the rice harvest, a government official told the Phnom Penh Post that 3,000 burning sites had been identified, mostly set by farmers eliminating stubble. There is also a serious deforestation problem because of land clearance, yet the government persists in claiming that large, well-organised illegal logging operations do not operate in Cambodia. Recent data from the University of Maryland tells another story in supposedly protected areas. That includes Prey Lang, one of south-east Asia’s last lowland evergreen forests, which in 2020 had one of its worst years on record.

Particulate matter size (Nikkei Asia)

Kicking the can
Such serious delayed effects of air pollution may be among the reasons governments in Asia have been kicking the can down the road for so long. Back in Chiang Mai, Pim said she had been battling the problem for 15 years.

“I have spoken to people in government in Bangkok, and they have said it is not this government’s problem,” Pim said. “The real problem will come in 30 years’ time, they say. It really needs some decisive moves by people who have power. Right now, we have a lot of activists and a lot of voices, but no power.”

That is bad news for the region. “It needs the government to get behind it — real commitment,” said Pim. She added that government policies could be used to encourage farmers to make soil-enriching biochar from residue, and create a market for it. “Farmers can then supplement their income making it rather than burning,” she said.

But there is a glimmer of hope in the increasing public recognition that there is a problem. Despite years of pressure on the government, it took a court order this month to force the National Environmental Board to declare the northern tip of Thailand — Chiang Mai, Chiang Rai, Lamphun and Mae Hong Son Provinces — a pollution control zone. “It came out of nowhere, and it’s a step in the right direction holding authorities accountable for not protecting our lives,” said Pim.

The rains have mercifully come early to Thailand this year, so it may not be until next year that the official inertia is tested. In the meantime, everybody will carry on holding their breath.

Additional reporting by Adnan Aamir in Karachi, Akane Okutsu in Tokyo, Faisal Mahmud in Dhaka, Erwida Maulia in Jakarta, CK Tan in Shanghai, Kiran Sharma in Delhi, Shaun Turton in Phnom Penh, and Kim Dung Tong in Ho Chi Minh City

A version of this article was first published by Nikkei Asia on April 21 2021. ©2021 Nikkei Inc. All rights reserved


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