If only breathing were optional

After suffering an intense "change of season" cough for several days and trying herbal remedies (hot water with ginger, lime and salt; bitter teaspoons of kalijira oil) without success, I finally went to the doctor. When I asked him if I should get a Covid test done, he laughed, as if to say, "You live in Dhaka and are surprised that you have a cough?"

In an online meeting, when an Indian colleague asked how I was, I replied, "I'd be fine if breathing were optional." 

Upon reflection, I added, "Which our governments seem to think it is, given how relaxed they are about air pollution." 

"True," he succinctly replied.

The coughing is now better, but persistent. When I lie down, I promptly started coughing again – those deep, rip-up-your-insides kinds of hacking coughs.

I would love to believe that I'm just having a severe reaction to dust, or that it's all normal seasonal illness, but the evidence suggests otherwise. While Dhaka did not (surprisingly) make it to the list of the five most polluted cities in the world in 2022, Bangladesh is one of the top five most polluted countries, and Dhaka's air is notoriously filthy. We all know this, and mostly we choose to ignore it and hope for the best. What's a little lung damage among friends?

But breathing in a cocktail of pollutants and dust does not only affect our lungs. Cigarettes destroy not just smokers' lungs but other organs as well, as the toxic chemicals in tobacco travel throughout the body. The same thing happens with air pollution, which also causes strokes, heart disease, and other non-communicable diseases in addition to chronic obstructive pulmonary disease (COPD) and lung cancer. Beyond making us sick, air pollution – indoor and outdoor – reportedly causes 6.7 million premature deaths in the world each year.

As if that weren't bad enough, small particles of pollutants can pass the blood-brain barrier and contribute to dementia. Think about this the next time you struggle to remember someone's name or where you left your glasses (on your head, dummy!).

So here's the thing about ambient air pollution: it's not a problem that can be solved through individual action. Sure, those who can afford it can live in less polluted environments, but given that 90 percent of the world's population now breathes dirty air, it's not entirely clear where one should migrate to. And even if the wealthy could escape, are we okay with subjecting everyone else to toxic air? Obviously, a problem of this magnitude requires some serious solutions. Where does one start?

One very simple measure would be a massive campaign educating people about how wrong it is to set up fires in the city. The burning of rubbish is a nightmare for those with particular susceptibility to polluted air. Many years ago, I fell dangerously ill due to hours of inhaling smoke, thanks to a fire someone had deliberately lit near our office. Such a campaign, of course, should be accompanied with strong enforcement and fines for non-compliance.

But that's only the beginning. A major source of air pollution is motorised vehicles. Various international organisations suggest reducing or removing motorised traffic in areas with high levels of air pollution, reducing or banning heavy vehicles in the city centre, and restricting the speed to 30 km/hour for all vehicles. They also suggest requiring the delivery of goods to shops by smaller vehicles (which, in Dhaka, could mean rickshaw vans). They suggest that cities could promote bicycle use and increase the number of "calm areas" such as parks and courtyards. Fortuitously, such measures, while aimed at air pollution, would also reduce noise pollution.

Many European cities institute car-free days when air pollution spikes. These car-free days are popular, with 62 percent of people in five major European cities supporting the idea of one car-free day a week, and replacing cars with walking, cycling, and clean air. According to Barbara Stoll, director of the Clean Cities Campaign, car-free days can "deliver a quick drop in toxic air pollution… Besides, they are a great way to demonstrate to the public what life can be like in cities when the roads are not dominated by cars."

A report from Barcelona's Public Health Agency (ASPB) found that the city's "superblocks" scheme – which transforms intersections in the most polluted urban areas into attractive plazas (thereby keeping motorised transport away from homes) – has resulted in a 25 percent decline in NO2 levels in some areas. Overall pollution and noise have declined significantly.

In other words, there are effective measures that government officials can take. But first of all, we must convince them that breathing isn't optional.

Debra Efroymson is the executive director of the Institute of Wellbeing, Bangladesh, and author of Beyond Apologies: Defining and Achieving an Economics of Wellbeing.