Exposure to air pollution in early pregnancy linked to miscarriage

Exposure to air pollution in early pregnancy linked to miscarriage

The adverse effects of air pollution on the lungs and heart are well-known and often spoken about.

Exposure to the toxic pollutants in the air can affect even the reproduction system.

A study conducted by the National Institutes of Health (NIH) has suggested that exposure to common air pollutants, such as ozone and fine particles, may increase the risk of early pregnancy loss.

The study published online November 16, 2017 in the journal Fertility and Sterility examined the effect of the exposure to ozone in 501 couples based on pollution levels in their residential communities. Ozone is a highly reactive form of oxygen that is a primary constituent of urban smog.

• Ninety-seven (28%) of the 343 couples who achieved pregnancy experienced an early pregnancy loss before 18 weeks.
• Couples with higher exposure to ozone had a 12% greater risk of suffering an early pregnancy loss.
• Couples exposed to particulate matter were 13% more likely to experience a loss.

Although the cause of pregnancy loss is not well understood, impaired fetal development due to increased inflammation of the placenta and oxidative stress has been suggested as a possible factor. Based on the findings of the study, pregnant women are advised to curtail outdoors activity when pollution levels are high and the air quality is of hazardous level.

(Source: NIH, November 16, 2017)

Air pollution increases the risk of diabetes

Air pollution increases the risk of diabetes

Dr KK Aggarwal
National President iMA

Air pollution has been dominating headlines in the past few days and has been at an all-time high in Delhi. The air quality in Delhi continues to remain in the severe category, with no respite.

There is increasing evidence for the role of environment in pathogenesis in many diseases with air pollution emerging as the largest environmental health risk globally. Exposure to the toxic air can affect the lungs, blood, vascular system, brain and the heart leading to significant adverse health effects and associated high overall morbidity and mortality.

Environmental pollution, with traffic associated pollutants, gaseous, nitrogen dioxide, especially high particulate matter PM 2.5 exposure, has been linked with risk of incident diabetes. Several studies have shown a positive association between long-term exposure to air pollution and increased risk of type 2 diabetes. Individuals who have prediabetes are especially vulnerable to the effects of air pollution.

According to the WHO, the air content of PM2.5 should be less than 10 μg/m3 but in India the levels are always more than 60 μg/m3 as 60 μg/m3 concentration has been accepted as normal in India. That means that an Indian is already six times more exposed to PM2.5. However, recently, extremely high levels of PM2.5, crossing 400, have been recorded. The risk of future diabetes associated with exposure to 10 μg/cu mm increase of PM2.5 ranges between 10 and 27% (Endocrine. 2016 Jan;51(1):32-7).

Any particulate matter of less than 2.5 µm in size can get absorbed from respiratory system, enter into the blood. The exact mechanisms as to how air pollution causes diabetes Air pollutants are hypothesized to exert their effects via impaired endothelial function, elevated systemic inflammation, mitochondrial dysfunction, and oxidative stress, all of which are hallmarks of type 2 diabetes (Trends Endocrinol Metab. 2015 Jul;26(7):384-94). Increased oxidative stress leads to insulin resistance, β-cell dysfunction, impaired glucose tolerance, and, ultimately, type 2 diabetes.

India has the second highest number of people living with diabetes 69.2 million with a prevalence of 8.7%. China has the highest number of people living with diabetes with 109 million cases of diabetes in the year 2015 and a prevalence of 10.6%.

This scenario calls for high priority action to minimize the air pollution to contain the rising incidence of type 2 diabetes in the country.

The responsibility towards this end lies with each one of us as it does with the government.

Controlling air pollution: Each one of us can make a difference

Controlling air pollution: Each one of us can make a difference

High air pollution in Delhi-NCR has recently dominated the front pages of newspapers, particularly since the last two days when the air quality worsened sharply to hazardous levels. Delhi-NCR continued to be enveloped by a thick smog due to the dangerously high levels of air pollutants leading to a state of public health emergency.

Air pollution is a recurring problem and the authorities undoubtedly need to implement measures to reduce particulate matter in the air. But, air pollution is mainly man-made and because it harms human health, it is of immediate concern to all.

Improving the air quality is a collective responsibility. Each one of us can do something every day to prevent or at least help control the air pollution levels and keep the environment healthy.

Mahatma Gandhi said, “You must be the change you wish to see in the world.”

Here is how each one of us can make a difference.

·         Walk or cycle for short distance commutes or to the neighborhood market.

·         Plan and combine all your errands (in one area or close by areas) for one trip.

·         Limit driving and carpool.

·         Use public transport, as much as possible, for longer distances.

·         If you have to use your vehicle, keep it well-maintained for efficient functioning with regular servicing to reduce harmful exhaust emissions and get pollution check done as required. Follow speed limits. Avoid buying diesel vehicle.

·         Avoid burning candles, dhoop or incense sticks at home or workplace.

·         Quitting smoking.

·         Plant more trees.

·         Limit the areas of bare soil by growing grass to reduce the amount of dust.

·         Sprinkle water on exposed soil or construction sites regularly to reduce generation of dust.

·         Wet mopping the floors at home or workplace.

·         Avoid organizing outdoor parties or any other events when AQI crosses 200.

·         Be a strong advocate for measures to control emission of air pollutants. Be active participants in activities to fight air pollution such as odd/even vehicle rule.

·         Follow all rules and laws as enforced by the state.

Air pollution causes millions of CKD cases globally each year

Air pollution causes millions of CKD cases globally each year

The estimated global burden of chronic kidney disease (CKD) attributable to air pollution (fine particulate matter (PM) less than 2.5 µm) is significant, amounting to more than 10.7 million cases per year.

The researchers used the Global Burden of Disease study methodologies to estimate the burden of CKD attributable to air pollution. Epidemiologic measures of the burden of CKD attributable to air pollution included years living with disability (YLD, meaning years living with kidney disease), years of life lost (YLL, meaning early death attributable to kidney disease), and disability-adjusted life years (DALY, a measure that combines the burden of living with the disease and the early death caused by the disease).

·         The global annual burden of incident CKD attributable to high PM2.5 levels was 10,784,514 (95% Uncertainty Interval: 7,821,109-13,857,623).

·         YLD, YLL, and DALYs of CKD attributable to high PM2.5 were 2,185,317 (1,418,442-

·         3,061,477), 7,897,941 (5,471,081-10,514,433), and 10,083,258 (7,064,399-13,323,685), respectively.

The study also found that burden of disease varies greatly by geography. India, along with Nigeria, Bangladesh and Pakistan had the high attributable burden of disease, exceeding 200 incident cases of CKD per 100,000 population.

India was also amongst the countries that reported highest DALYs that included Mexico, Central America, Southeast Asia and Northern Africa. DALYs per 100,000 were 366.71 (251.05, 498.01) in Nicaragua and 353.93 (260.05-449.24) in Mexico, compared to 44.59 (24.07-65.74) in the United States.

These findings were presented at the recently concluded ASN Kidney Week 2017 in New Orleans, Louisiana, USA.

Keeping BP, cholesterol, body weight, blood sugar within healthy limits, avoiding overuse of OTC painkillers, smoking, eating a healthy diet and exercising regularly are some of the ways to protect kidney health.

Air pollution has become a major threat to society today. Air pollution has been at an extremely high level, particularly in the Delhi-NCR region and continues to remain the ‘hazardous’ category.

Studies have shown that air pollution can damage the kidneys. A significant association between exposure to PM2.5 and risk of incident CKD, decrease in estimated glomerular filtration rate (eGFR)  and progression to end stage renal disease was reported online September 2, 2017 in the Journal of the American Society of Nephrology.

It’s now time perhaps to add air pollution (PM2.5) to the list of risk factors for chronic kidney disease and recommend avoiding or limiting air pollution exposure to the list of measures generally advised to prevent/delay chronic kidney disease.

It has become important to also note the air pollution levels in different areas in your city before venturing out to avoid exposure to pollution.

(Source: American Society of Nephrology News Release, November 4, 2017)

Air pollution at an all-time high in Delhi

Air pollution at an all-time high in Delhi

IMA strictly advises against exercising outdoors in the morning among other things

New Delhi, 04 November 2017: As per a recent study, air pollution has led to five lakh premature deaths across India. The weather conditions in the national capital are rapidly deteriorating and there is only one advise for those going for an early morning walk or run --- stay indoors. The reason is that air pollution is at an all-time high and the morning air can have drastic repercussions on one’s health. As per the IMA, exposure to this toxic air can affect the lungs, blood, vascular system, brain, heart, and even the reproduction system.

Concentration of PM 2.5 can cause tiny, hazardous particles to enter the lungs. This in turn can cause problems such as chronic obstructive pulmonary disorder and also impact lung functioning. The IMA has also advised strongly against running a marathon in this condition, as doing so can deposit about two tablespoons of toxic ash in the lungs.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Delhi has been experiencing high air pollution levels these past days. The air quality is particularly poor early in the morning, when pollution is extremely high. While this can be fatal for those with existing health issues such as asthma or cardiovascular ailments, it can also be detrimental to healthy individuals. Elderly people and children also form the high-risk category. As per a recent study, those living in the NCR are losing out on almost 6 years of life because of the dangerous air pollution levels.[2] If WHO standards were met in NCR, people would live 9 years longer. The IMA will be writing to the Hon’ble Delhi Chief Minister, Chief Justice Delhi High Court and the Chairperson, National Green Tribunal regarding urgent cancellation/postponing of the half marathon scheduled this month until there is significant improvement in the air quality.”

The Air Quality Index (AQI) in Delhi has ranged from “very unhealthy” to “hazardous” in the last couple of days itself. In many parts of the city, the levels have even crossed the 300 ‘danger’ mark.

Adding further, Dr Aggarwal, said, “The current level of pollution in Delhi can affect even an unborn child in the womb. A normal adult breathes about 6 litres of air per minute at rest, which increases to about 20 litres during physical activity. Given the alarming levels of pollution currently, this will only increase the amount of toxins in the lungs. Although one should ensure that exercise areas are at least 200 meters away from roads, construction sites, and smoke-emitting industry, even this cannot guarantee clean air.”

Here’s how different parts of the body are affected by air pollution.

• Toxic particles pass through blood vessel walls and affects blood flow. They can also lead to thrombosis.
• Toxins can lead to atherosclerosis reducing the diameter of blood vessels. This condition can also cause hypertension.
• Toxic air can lead to strokes and brain ischemia as also cognitive disorders and neuro-degenerative illnesses.
• Toxins in the air can adversely impact heart function and increase heart rhythm problems.
• Inhaling toxic air can make women prone to miscarriage, cause fetal growth problems, premature birth, and also low birth weight. 

Air pollution increases risk of heart disease by lowering the good cholesterol

Air pollution increases risk of heart disease by lowering the good cholesterol Air pollution is a reality today and has been a subject of much discussion recently. Several studies have demonstrated the association of poor air quality with diseases such as respiratory and heart diseases, global warming making it a major public health problem of concern. Yet another new study reported in the journal Arteriosclerosis, Thrombosis, and Vascular Biology has highlighted the increased risk of cardiovascular diseases due to traffic-related air pollution and proposed an explanation for the relationship between air pollution and cardiovascular disease. The study says that traffic-related air pollution may increase risk of developing heart diseases via its effects on the good high-density lipoprotein cholesterol (HDL-C). The study involving more than 6000 middle-aged and older adults in the United States found that people who live in areas with high levels of air pollution, especially traffic-related air pollution, have lower levels of the good HDL-C. Over a period of one year, those with higher exposure to black carbon, emitted from vehicles, had considerably lower levels of HDL-C compared to those with lower exposure to black carbon. Higher particulate matter exposure over three months was associated with a lower HDL particle number. Compared to men, women had much lower levels of HDL-C. Keep your total cholesterol lower than 160mg/dL. HDL is good cholesterol, keep it more than 40mg/dL. LDL is bad cholesterol and should be kept as low as possible; keep it lower than 80 mg/dL. A 1% rise in bad cholesterol increases the chances of heart attack by 2% and 1% reduction in good HDL-C reduces the chances of heart attack by 3%. (Source: AHA news release, April 13, 2017) Dr KK Aggarwal National President IMA & HCFI

Urgent need to address air pollution through Private Public Partnership: IMA

Urgent need to address air pollution through Private Public Partnership: IMA International Meet on Combating Air Pollution commences to take place on March 10-11thin New Delhi Globally, an estimated 24% of the burden of disease and 23% of all deaths can be attributed to environmental factors. New Delhi, March 10, 2017: The International Meet on combating air pollution will be held in Delhi in on March 10 & 11 2017 to address the global burden of air pollution. The environment is the most important social determinant of health, causing morbidity and mortality in a given population. Further, globally, non-communicable diseases (NCDs) deaths, attributable to air pollution, are amounting to 8.2 million of the total 12.6 million deaths. The Global Burden of Disease (2010) data showed that household air pollution was ranked at the 3rd position and ambient air pollution at the 9th position among the leading risk factors that contribute to morbidity and disability adjusted life years (DALYs). Air pollution has witnessed a dramatic upsurge since the last two years, in 2015 the Annual PM 2.5 level of Delhi was 220 pg/m3 while the safe levels for PM according to the WHO's air quality guidelines are 20 μg/m3 (annual mean) for PM10 and 10 μg/m3 (annual mean) for PM2.5. Shri Anil Madhav Dave, Hon’ble Minister of Environment, Forest & Climate Change, Government of India applauded the initiative and said, “The strategy for pollution control should involve reinforced measures at three main levels- tackling of the pollutants, controlling the pollution at source and identifying polluted areas. A holistic strategy will be an optimal combination of these three steps”. “Dr Ketan Desai, President, World Medical Association, added, “There is a urgent need for body like Indian Medical Association and other CMAAO countries to address the problem of air pollution in India with the objectives of creating awareness on the burden of health effects of air pollution, discussing main sources of air pollution in India (source apportioning), facilitating the mitigation of the health impacts of air pollution through private public partnership and finally examining preparedness and capacities of respective ministry to address the problem of air pollution emanating from development driven activities”. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) and Dr RN Tandon – Honorary Secretary General IMA, stated that, “NCDs, such as cardiovascular diseases including stroke, cancers and chronic respiratory disease, now claim nearly two-thirds of the total deaths caused by unhealthy environments. Air pollution needs to be addressed in right earnest. Air Pollution is the leading cause of mortality and disability in Indian settings and there is a need to reduce sources of emissions, improve access to clean fuel and raise public awareness on health effects of air pollution. Inefficient cooking methods using solid fuels like wood, charcoal, coal, dung, crop wastes lead to indoor air pollution especially in houses that are poorly ventilated. Indoor air pollution leads to not only health effects but also has adverse social and environmental effects.” Clearly, it is a major public health issue; the following data may help emphasize: • Each 10 mcg/m3 increase in PM 2.5 levels can increase the chances of death from heart disease by 1.76 times and each decrease in PM 2.5 levels by 10 mcg/m3 life can increase life expectancy by 0.77 year. • For every increase of 10 μg/m3 in PM10, the lung cancer rate rises by 22% and for PM 2.5 by 36%. • Asthma is linked to high NO2 levels and bronchitis is linked to high levels of SO2. A PM <2.5 reduction of 6.8 mcg/m3 can decrease asthma prevalence by 15.4% and a median reduction in NO2 of 4.9 parts per billion can decrease asthma prevalence by 10 percent. • By reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre (μg/m), air pollution-related deaths could be reduced by roughly 15%. There is emerging evidence which suggests that household air pollution in developing countries may also increase the risk conditions such as: low birth-weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer and cervical cancer. Dr Yoshitake Yokokura, President of JMA and President-elect of WMA and Dr Mari Michinaga, Executive Board Member of JMA and Secretary General of CMAAO, in a joint statement said, “Exposure to poor quality air is now an inescapable part of urban life throughout the globe. Air pollution is no longer just a public nuisance but a grave health problem and a threat to many environmentally sensitive areas areas on the worldwide. Clearly, everyone stands to benefit from an international collaboration in this regard”. Shri Ajay Narayan Jha, Secretary, IAS, Ministry of Environment, Forests & Climate change, Govt. of India further said, “We have come a long way in our fight for cleaner air, despite major setbacks. However, there is still a long way ahead and the goal can only be achieved through continuous dedicated efforts of the pollution control agencies, commitment of the polluters and due participation of public.” Shri Chandrakar Bharti, IAS Secretary, Environment, GNCTD added, “India is the first country, to have provided a provision for environmental protection in its constitution. The constitution casts a duty on the State for taking steps for protection and improvement of the environment and also makes obligatory on every citizen of India to protect and improve the natural environment. It is time for us to revisit these moral duties.” Several distinguished dignitaries will be present including Dr. A B Akolkar Member Secretary, CPCB, GoI,Dr. Ravi Wankhedkar, National President (Elect), IMA; Dr A Marthanda Pillai, Past National President, IMA and Dr P K Sharma, MOH, NDMC. The following measures might go a long way in the fight against air pollution: • Understand the concept of Reduce, Reuse and Recycle: Do not throw away items that are of no use to you. In-fact reuse them for some other purpose. For e.g. you can use old jars to store cereals or pulses. • Emphasis on clean energy resources: Clean energy technologies like solar, wind and geothermal are on high these days. Governments of various countries have been providing grants to consumers who are interested in installing solar panels for their home. This will go a long way to curb air pollution. • Use energy efficient devices: CFL lights consume less electricity as against their counterparts. They live longer, consume less electricity, lower electricity bills and also help you to reduce pollution by consuming less energy.

Air pollution increases risk of childhood obesity and diabetes

Air pollution increases risk of childhood obesity and diabetes There is increasing evidence for the role of environment in pathogenesis in many diseases. Children below 5 years of age and adults older than 50 years are most at risk. A global assessment of the burden of disease from environmental risks by the WHO has shown that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. The harmful effects of air pollution on respiratory health are well-known to us and well-established. Air pollution has been linked to many non communicable diseases such as cardiovascular diseases, obesity, cancers and type 2 diabetes. A new study has again underscored the dire need for a healthier environment. This study has suggested that exposure to ambient air pollution may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function. The study reported in the January 2017 issue of the journal Diabetes investigated whether exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter (PM 2.5) had adverse effects on longitudinal measures of insulin sensitivity, β-cell function, and obesity in children at high risk for developing diabetes. Although this was not a cause and effect study, an association between air pollution and risk of obesity and type 2 diabetes in children was observed in the study. • Higher NO2 and PM2.5 were associated with a faster decline as well as a lower insulin sensitivity at age 18 independent of adiposity. • NO2 exposure negatively affected β-cell function evidenced by a faster decline in disposition index (DI) and a lower DI at age 18. • Higher NO2 and PM2.5 exposures over follow-up were also associated with a higher BMI at age 18. (Source: WHO, Diabetes 2017 Jan; db161416. https://doi.org/10.2337/db16-1416) Dr KK Aggarwal National President IMA & HCFI

International Meet on Combating Air Pollution on March 10-11, 2017 in New Delhi

International Meet on Combating Air Pollution on March 10-11, 2017 in New Delhi Urgent need to address air pollution through Private Public Partnership Environment is the most important social determinant of health, causing morbidity and mortality in a given population. The WHO’s comprehensive global assessment of the burden of disease from environmental risks reveals that globally, an estimated 24% of the burden of disease and 23% of all deaths can be attributed to environmental factors. Further, globally, non-communicable diseases (NCDs) deaths, attributable to air pollution, are amounting to 8.2 million of the total 12.6 million death. NCDs, such as cardiovascular diseases including stroke, cancers and chronic respiratory disease, now claim nearly two-thirds of the total deaths caused by unhealthy environments. The Global Burden of Disease (2010) data showed that household air pollution was ranked at the 3rd position and ambient air pollution at the 9th position among the leading risk factors that contribute to morbidity and Disability-adjusted life years (DALYs). Household and ambient air pollution are the leading risk factors contributing to burden of disease in India. Household air pollution contributed to nearly 3.5 million deaths and a loss of 3.5% DALYs globally (2010). Ambient air pollution contributed to another 3.1 million deaths and 3.1% DALYs. The ambient ozone pollution had a lower effect than the above and led to 0.2 million deaths and 0.2% DALYs in 2010. Cognizant of the fact that air pollution needs to be addressed in right earnest, a Steering Committee was constituted, by the Ministry of Health & Family Welfare (MoHFW), Govt. of India in 2014, with members drawn from both health and non-health sectors. The report of this Committee, released in December 2015, has been able to shift the historical ‘urban air pollution centric focus’ to the ‘burning of biomass fuel across rural and periurban pockets in India’. According to the Institute of Health Metrics and Evaluation (IHME), air pollution was found to be the leading cause of mortality and disability in India. In Indian settings there is need reducing sources of emissions, improving access to clean fuel and raising public awareness on health effects of air pollution. Major risk factors are household and ambient air pollution contributing to burden of disease in India. • Household air pollution is caused by solid fuels like wood, charcoal, coal, dung, crop wastes are being used by over 3 billion people for cooking at home. These inefficient cooking methods lead to indoor air pollution especially in houses that are poorly ventilated. • Indoor air pollution not only has adverse health effects but also has adverse social and environmental effects. • Household energy and Poverty: Poor households are unable to afford LPG and other cleaner fuels and reliance on inefficient fuels reduces the time they could spare for income generating activities and education. As a result, a vicious cycle of poverty leading to use of inefficient fuels and these in turn contributing to poverty starts • Gender issues: In most of the cases, women carry out the household chores and hence are the major sufferers of indoor air pollution. • Environmental impact and climate change: Reliance on wood for fuel leads to deforestation and consequent loss of habitat and diversity. The simple biomass and other fuels are inefficient and incomplete combustion takes place. The pollutants like black carbon and methane that are produced as a result of incomplete combustion leads to climate change. Major health effects of indoor air pollution include acute lower respiratory infections, chronic obstructive pulmonary disease (COPD), lung cancer, cardiovascular disease, burns Emerging evidence suggests that household air pollution in developing countries may also increase the risk conditions such as: low birth weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer and cervical cancer. Considerable evidence suggests that exposure to air pollution leads to adverse respiratory outcomes. Perinatal exposure to air pollution can impair organogenesis and can lead to long term complications. Exposure to air pollution during pregnancy has also been linked to decreased lung function in infancy and childhood, increased respiratory symptoms, and the development of childhood asthma. The WHO’s Ambient Air Pollution database for 2016, showed that the levels of PM10 and PM 2.5 in Delhi are way above the normal levels. The annual PM 10 level was found to be 229 μg/m3 and that of PM 2.5 was found to be 112 μg/m3. In a study conducted at Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India by Garg Suneela et al in 2016, a total of 3019 individuals were screened through spirometry. Of these, 34.35% were found to have lung impairment. Almost 32.5% of the individuals screened were from the age group of 41-50 years. More than half of the subjects (57.6%) had been living in Delhi for more than 20 years. Initiatives taken by the government for combating the problem of air pollution • Stringent regulations, development of environmental standards, control of vehicular pollution, spatial environmental planning including industrial estates and preparation of zoning atlas. • Use public mode of transportation: Encourage people to use more and more public modes of transportation to reduce pollution. Use of carpooling. The odd/even rule wherein cars with odd-numbered registration plates would ply on odd dates and those with even-numbered registration plates would do so on even dates. • Conserve energy: Switch off fans and lights when you are going out. Large amount of fossil fuels are burnt to produce electricity. Ban on burning of waste and fine on emission of construction dust • Understand the concept of Reduce, Reuse and Recycle: Do not throw away items that are of no use to you. Reuse them for some other purpose. For e.g. you can use old jars to store cereals or pulses. • Emphasis on clean energy resources: Clean energy technologies like solar, wind and geothermal are on high these days. Governments of various countries have been providing grants to consumers who are interested in installing solar panels for their home. This will go a long way to curb air pollution. • Use energy efficient devices: CFL lights consume less electricity as against their counterparts. They live longer, consume less electricity, lower electricity bills and also help you to reduce pollution by consuming less energy. • So there is a urgent need for body like Indian Medical Association (IMA) and other CMAAO countries to address the problem of air pollution in India with the objectives of • Creating awareness on the burden of health effects of air pollution • Discussing main sources of air pollution in India (source apportioning) • Facilitate mitigating the health impacts of air pollution through private public partnership. • Examine preparedness and capacities of respective ministry to address the problem of air pollution emanating from development driven activities. Dr KK Aggarwal National President IMA & HCFI (Contributions from Dr R N Tandon HSG IMA and Dr Ajay Kumar, Advisor CMAAO)