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© Oxford University Press 2019 GeoFile, Series 37 Issue 3, April 2019 1

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Pollution and health: two case studies

By Rebecca Priest

SynopsisThere is a clear link between pollution and health. Both air pollution and water pollution are major causes of mortality and disease globally. Rapidly developing and industrialising countries, such as India, suffer from poor air quality and are seeing a rise in deaths from respiratory illnesses and cancers, which are both linked to outdoor air pollution.

The least developed countries in the world, such as Tanzania, are still struggling to provide universal access to clean drinking water and adequate sanitation which is influencing the mortality from treatable waterborne diseases, such as diarrhoea and cholera.

There are national and global responses to both health issues, which are attempting to increase knowledge on the link between pollution and health and reduce mortality from preventable disease caused by pollutants.

Key termsCarcinogenic, communicable, DALYs, disease vectors, epidemiological transition, NGOs, particulate matter.

Learning objectivesAfter working through this unit, you will be able to:

●● explain the link between pollution and health

●● explain the causes of air and water pollution

●● assess the impacts of air pollution on the health of

the population of India, and the impacts of water

pollution on the health of the population of Tanzania

●● explain the responses to health issues caused by air

and water pollution.

LinksExam board Link to specification

AQA

AS

A2

3.3.2 Contemporary urban environments

3.2.2.4 Air quality: particulate and photo-chemical pollution; Urban climate: pollution reduction policies

3.3.2.7 Other contemporary urban issues: atmospheric and water pollution page 21

Click here

3.3.2.9 Case studies: the nature and impact of physical environmental conditions page 22

Click here

3.2.3 Contemporary urban environments

3.2.3.4 Urban climate: pollution reduction policies

3.2.3.7 Other contemporary urban environmental issues: atmospheric and water pollution

3.2.3.9 Case studies : the nature and impact of physical and environmental conditions page 26

Click here

3.2.4 Population and the environment

3.2.4.3 Environment, health and well-being

Global paths of health; air quality and health; water quality and health page 27

Click here

Edexcel

AS

A2

Topic 3 Globalisation

3.4b Some communities in developing countries have experienced major environmental problems ..... which impact on people’s health and well-being page 34

Click here

Topic 3 Globalisation

3.4b (as above in AS) page 30

Click here

OCR

AS

A2

Topic 2.2 Disease dilemmas

2 Is there a link between disease and levels of economic development?

2a Case study of one country experiencing air pollution page 29

Click here

Topic 3.2 Disease dilemmas

2/2a (as above in AS) page 41

Click here

Eduqas 3.5 Weather and climate

3.5.6 Impacts of urban areas on air quality, including particulate pollution, photochemical smog and acid rain page 38

Click here

WJEC 4.4

Energy challenges and dilemmas

4.4.5 Problems associated with the extraction, transfer and use of energy: Environmental problems page 40

Click here

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GEOFILE

© Oxford University Press 2019 GeoFile, Series 37 Issue 3, April 2019 2

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the hydrological system from

domestic, industrial and agricultural

sources have resulted in a growing

proportion of water being unfit for

human consumption. Due to a lack

of basic sanitation or clean water

sources, around one in nine people

globally are consuming unsafe,

polluted water. As a result,

waterborne diseases, such as

cholera, cause around 1.5 million

deaths a year, and diarrhoeal

disease is the second biggest cause

of mortality under the age of five.

The provision of adequate

sanitation and clean water, and the

prevention of deaths from diseases,

is an important global challenge.

Air pollution and healthThe main source of air pollution is

the burning of fossil fuels for energy

and vehicle emissions. In 2016,

ambient (outdoor) air pollution was

estimated to have caused 4.2 million

the environment. Human activity is

responsible for high levels of

pollution entering and affecting the

quality of air, water and the land.

In the 1970s, average daily levels of

air pollution were believed to be at

a level which did not pose a danger

to human health. Since then, as

concentrations of hazardous

particulate matter in the air have

increased, so has research into the

link between air pollution and

health. Particulate matter can enter

the lungs and the bloodstream,

impairing cardiovascular (the

heart and its blood vessels),

cerebrovascular (blood vessels in

the brain) and respiratory (lungs

and breathing) health. Air pollution

is now a major environmental

health issue and the World Health

Organisation (WHO) attributes air

pollution to 7 million deaths a year.

Water is essential to human life.

However, water pollutants entering

Pollution and health: two case studiesIs there a link between pollution and health?In December 1952, cold and

windless weather prevented the

natural dispersion of the airborne

pollutants which were rising from

the coal-burning factories and

power stations across London. This

famous Great Smog of London

caused major disruption due to

reduced visibility. In the weeks that

followed, however, government

reports began to link the smog,

which mainly consisted of sulphur

dioxide, to the death of around 6000

Londoners, and respiratory illnesses

and lung infections affecting around

100,000 more. These events raised

an interest in the link between

pollution and disease, and resulted

in the introduction of the Clean Air

Act in 1956 in an attempt to reduce

urban air pollution.

Pollution refers to the presence of

harmful materials, or pollutants, in

Figure 1 The number of DALYs per 100,000 (2013)

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Impacts of air pollution in IndiaThe high levels of air pollution are

having devastating impacts on

people’s health. In 2015, air

pollution was linked to the deaths

of over 1 million Indian people, the

most in any country. Respiratory

difficulties and asthma are 1.7 times

higher in Delhi than in the rural

areas of India, and lung function of

the urban residents is seriously

reduced. Indoor air pollution causes

around 2 million premature deaths

a year, with nearly half of those

deaths due to pneumonia. Women

and children are particularly at risk,

as they spend more time indoors.

Recent research has shown clear

links between air pollution and

higher rates of mortality from heart

disease, lung cancer, respiratory

tract infections, leukaemia,

tuberculosis and asthma.

Reducing mortality from air pollution in IndiaIndia’s air quality has worsened as

the country has developed

economically, and environmental

legislation has been unable to keep

up with the pace of industrial

growth. Whilst trying to cope

with the challenges of poverty,

population growth and

industrialisation, India has made

some attempts to improve its air

quality.

●● A draft National Clean Air

Programme (NCAP) has been

proposed. It outlines multiple

ways to reduce air pollution,

such as closing brick kilns, raising

parking fees in cities, stopping

hotels from using coal and

firewood, and banning garbage

burning.

●● A two-week ‘Clean Air

Campaign’ in February 2018

involved checking vehicle

Causes of air pollution in IndiaThere are four main sources of

hazardous pollutants in India:

1. Industry – many of the most

polluting industries (metals,

chemicals, compost and petrol)

do not abide by the regulations

in place to limit their emissions.

2. Motor vehicles – traffic

congestion is a problem in urban

areas due to volume of vehicles

and poor traffic sense. When

travelling slowly, vehicles burn

fuel more inefficiently and

pollute the air with carbon

monoxide and nitrogen

oxides.

3. Domestic – fuelwood and

biomass cakes are used for

cooking and heating on a chullah

cooking stove in the home, most

commonly in low-income

households. When burnt, they

release high levels of smoke

containing dangerous particulate

matter.

4. Power generation – India relies

on inefficient coal, oil and

natural gas-fired thermal power

plants which release harmful

substances into the air.

premature deaths worldwide, the

majority occurring in developing

countries. 91% of the world’s

population lives in areas where

hazardous particulate matter in the

air (mostly nitrogen dioxide and

sulphur dioxide) exceeds the WHO’s

limits, a major risk factor for

cardiovascular and respiratory

disease. In 2013, the WHO

confirmed that particulate matter in

air pollution is carcinogenic and

can increase the risk of lung and

bladder cancers. Whilst air pollution

is at hazardous levels in the majority

of countries across the world, the

number of DALYs (disability-

adjusted life years) lost due to air

pollution varies (Figure 1).

Air pollution in IndiaNew Delhi, India, is the most

polluted city in the world

(Figure 2). Concentrations of the

most dangerous airborne

particulate matter (PM2.5) are

between 15 and 32 times higher

than the WHO guidelines and are

predicted to increase (Figure 3).

Rural indoor air pollution is also a

major problem due to people’s

reliance on burning wood for fuel

inside their homes.

Figure 2 In thick smog, a Delhi Transportation Corporation bus in Old DelhiSource:  Richard Sowersby/Alamy Stock Photo

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Water pollution and healthWaterborne diseases such as

diarrhoea, cholera, dysentery,

typhoid, schistosomiasis and polio

can be spread through a country’s

water supply. Globally, 842,000

people die each year from

preventable diarrhoea. The

pathogens can enter the water

supply through contact with

untreated sewage. In countries

without adequate sanitation,

human defecation in rivers and

lakes pollutes the drinking water

supply with bacteria. Globally,

2 billion people drink from a

source which is contaminated

with human waste. In the tropics,

stagnant water also attracts

disease vectors such as the

anopheles mosquito, which

spreads malaria.

Water pollution in TanzaniaAlthough Tanzania has a rapidly

growing economy, uneven

development across rural and urban

areas means that access to clean

water and sanitation is still poor for

much of the population. The

waterborne disease, cholera, is a

particular problem. People who

drink water contaminated with the

Vibrio cholerae bacterium develop

diarrhoea and severe dehydration,

which can quickly lead to death if

left untreated.

Causes of water pollution in TanzaniaAround 40% of the population of

Tanzania do not have access to safe

water, and around two-thirds do

not have access to improved

sanitation (Figure 4). Most of the

rural population relies on

groundwater wells which are often

located next to toxic drainage

systems which pollute the

the second Kyoto Protocol in 2013,

which commits them to reduce

harmful emissions to at least 18%

below 1990 levels. In 2016, 195

countries signed the Paris

Agreement, which aims to keep the

increase in global average

temperature to below 2°C above

pre-industrial levels.

Each signing country must

determine a plan and report on its

progress towards the Agreement’s

aim. For example, Norway will ban

the sale of petrol and diesel cars by

2025. In 2017 however, President

Trump, announced his intention to

withdraw the USA from the

agreement in 2020.

In 2015, the WHO produced a draft

road map to enhance the global

response to the link between air

pollution and ill-health. The

four-year plan aims to expand

knowledge on the link between

air pollution and health and to

improve monitoring and

reporting.

pollution, inspecting power

plants and raising awareness of

how to avoid indoor air

pollution.

●● Cities such as Nagpur and

Bengaluru are encouraging the

use of electric vehicles through

tax incentives and lower fares for

electric buses.

●● An emphasis is being put on

improved education and

increasing awareness about

avoiding indoor air pollution,

such as improving ventilation

and retrofitting cooking stoves to

make them more fuel efficient

and less smoky.

Global solutions to air pollutionThere are a number of international

agreements which are aimed at

cutting down on emissions to

mitigate climate change, which will

also have benefits for human

health. 38 developed countries,

including those of the EU, signed

Figure 3 Ambient air pollution (for the majority of India, PM 2.5 is above the WHO guidelines of 10 µ/m3)Source: The Times of India

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groundwater through leaks. The

alternative surface water is often

polluted with bacteria or human

waste. The spread of waterborne

disease is also influenced by poor

personal hygiene and lack of hand

washing, particularly among food

vendors in larger cities.

Impacts of water pollution in Tanzania

●● 32,098 cases of cholera including

532 deaths being reported since

the beginning of the most recent

cholera outbreak in August 2015.

Between January 2018 and July

2018, the number of cases was

double that of the same period

for the previous year.

●● 70% of Tanzania’s health

expenditure is directed towards

treating preventable,

communicable diseases caused

by poor water, sanitation and

hygiene.

●● Absences from school or work due

to illness from diarrhoeal disease is

costing the Tanzanian economy

US$1.6 million each year.

Reducing mortality from water pollution in TanzaniaA number of NGOs (non-

governmental organisations) are

working to improve access to clean

water. Cholera is easily treatable by

oral rehydration solution (ORS). In

Tanzania, there is a lack of access to

ORS and education on the

symptoms and treatment of cholera,

which raises mortality rates.

UNICEF is working to control

cholera epidemics through the

construction of toilets and by

increasing the number of trained

healthcare professionals in the

worst affected areas. Another

important aspect of reducing

mortality is to increase community

education and awareness of good

hygiene practices, through school

meetings and in the local media.

UNICEF is helping to close down

restaurants which do not abide by

regulations to prevent the

contamination of food.

The semi-autonomous island of

Zanzibar, where 30% of the

population have no access to clean

and safe water, has implemented a

10-year cholera elimination plan,

aiming to end deaths from cholera

by 2027 through mass vaccinations

and improving sanitation facilities.

The government on the Tanzanian

mainland has an ambitious goal to

provide 24 million people with

clean water and half of all

households with toilets by 2020

with the help of NGO, WaterAid.

Global solutions to water pollutionThe United Nations Sustainable

Development Goal 6 has the aim of

ensuring access to water and

sanitation for all by 2030. This

target involves ending open

defecation and improving drinking

water quality by reducing water

pollution. In 2017, the WHO’s

Global Task Force on Cholera

Control announced a strategy,

‘Ending Cholera: A roadmap to

2030’, which aims to reduce

cholera deaths worldwide by 90%.

However, climate change,

population growth, urbanisation

and industrialisation will increase

the number of countries living in

water-stressed areas, and create

further challenges for the provision

of safe water and the prevention of

the spread of waterborne disease.

ConclusionPollution has an impact on

health at all stages of economic

development. Abdel Omran’s

model of the epidemiological transition shows the relationship

between development and the

prevalence of different types

of disease. In less developed

countries, communicable diseases

are more prevalent. Cholera is a

more common cause of death in

countries in the earlier stages of

epidemiological transition, as

they are more likely to be unable

to provide good sanitation and

uncontaminated drinking water

to its population. As a country

develops, man-made diseases

become more common causes of

death, including those caused by

air pollution. More industrialised

countries will discharge waste

products from industry and

transport into the air and water

sources, causing a greater

incidence of respiratory illnesses

and cancers. This means that

pollution affects health in both

the early and later stages of

epidemiological transition.

Figure 4 Women with inadequate facilities in their homes use a river to wash clothes and collect drinking water, increasing their risk of contracting waterborne diseasesSource: Charlotte Thege/Alamy Stock Photo

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Learning checkpoint

When reading through this unit you should consider the following questions:

1. What are the causes of air pollution in India?

2. What are the impacts of air pollution on health in India?

3. What are the causes of water pollution in Tanzania? Explain each one clearly.

4. What are the impacts of water pollution on health in Tanzania? Consider impacts on people and the economy.

5. What are the main strategies to deal with diseases caused by air and water pollution? Briefly discuss examples.

6. What is the link between pollution, health and development?

Focus questions

1. Referring to examples, evaluate the impacts of pollution on health.

2. Assess the extent to which economic causes are the most influential for mortality from air and water pollution.

3. Assess the extent to which the impacts of air pollution on health can be mitigated against.

4. Essay: Evaluate how the impact of NGOs on the prevention and treatment of diseases is linked to water pollution. Research examples to illustrate your points.

Web linksWHO air pollution website

Click here

WHO air pollution in India

Click here

India’s National Clean Air Programme (NCAP)

Click here

WaterAid in TanzaniaClick here

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