Lung diseases, facemasks and irritable eyes – a snapshot into the future of Pakistan without urgent air quality management programs.

The extensive smog experienced in Lahore in November 2016 kick-started a long overdue conversation about the importance of air quality in the country. As a result, a petition filed in the Lahore High Court led the Government of Punjab (GOP) and The Pakistan Environment Protection Agency (PEPA) being told to formulate an air pollution policy, which is currently underway.

A recent report by the State of Global Air states that while 92% of the world’s population lived in areas with unhealthy air in 2015, China, India, Pakistan and Bangladesh experience the most extreme concentrations of air pollution.

Air pollution is mostly measured and monitored in terms of ambient fine particulate matter (PM 2.5) and ozone concentrations in the atmosphere. PM 2.5 are airborne particles as small as 2.5 micrometers in aerodynamic diameter.

A project on the Global Burden of Disease (GBD) by the Institute of Health Metrics and Evaluation has reported exposure to PM 2.5 as the fifth largest factor contributing to global mortality. However, to address the rapidly increasing air pollution in the country, it is important to know the kind of air pollution that is present. “Punjab has 36 districts and PEPA has a total of one air quality monitor for the entire province, that too at the back of a pickup van in Rawalpindi,” says Ahmad Rafay Alam, Environmental Activist and Lawyer. “So if one wants to know the air quality of Lahore, the van will come down to the city and park somewhere for the day to measure it.”

Alam explains that usually for a city as big as Lahore, 10 to 15 air quality testing equipment would be required. These would be able to accurately tell how bad the air is, and what type of pollution is in the air because it is the type of pollution that tells you where it’s coming from. “We can blame the dust from industrial development and stop construction, only to find out it’s actually the automobiles that are causing it.”

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Population weighted ozone concentrations, a leading factor in air pollution has been on an increase as well. From 1990 to 2015, it has increased 7% globally. Increased ozone concentrations means an increase in ozone precursors such as nitrogen oxides, coupled with warmer temperatures.

The largest increase in the average population weighted ozone concentrations in the last 25 years has been experienced by China, India, Pakistan, Bangladesh and Brazil. In the US and the European Union, ozone concentrations have seen a decline due to air quality management programs.

Also, 84% of the rural population in Pakistan and 14% of the urban population uses solid fuels for cooking. In turn, 37% of the total deaths from ischaemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease and acute lower respiratory infections are attributable to household air pollution.

“Building codes need to be regulated in rural as well as urban areas,” says Syed Rizwan Mehboob, Prime Minister’s focal person on climate change. “By ensuring that houses have open air cooking areas, indoor pollution can be controlled.” He explains that green solutions need to be simplified and made economical for people to have alternative cleaner sources of energy.

A scientific research has found that long term exposure to ambient air pollution increases mortality and morbidity from cardiovascular and respiratory diseases and lung cancer, reducing life expectancy.

The diseases that are causally linked with exposure to ambient PM 2.5 are ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), lung cancer, and lower respiratory infections (LRI’s).

In 2015, 4.2 million deaths took place due to long term exposure to PM 2.5, accounting for 7.6% of global deaths. Pakistan currently has the 5th largest number of deaths because of PM 2.5 exposure and is ranked 6th in the world for the most number of deaths from COPD in 2015.

“Unless we have air quality testing equipment ready and available, not just in Lahore but in all 36 districts of the province, PEPA and the GOP is failing in its responsibility to be able to analyse and respond to the air quality threat,” says Alam.

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According to Mehmoob, the GOP has not formulated a policy on air pollution as yet as it is a long and complicated process.

“How do we convince farmers to stop their centuries old tradition of paddy burning because it’s harmful to the environment?” says Mehboob. “Policy making is not even the problem – the problem is strict enforcement and monitoring of the policies made which unfortunately is not possible overnight. We know there is an issue, and we are working on it.”

While the government has not been able to deal with the issue at hand timely and effectively, some concerned citizens have taken the matter in their own hands. Abid Omar, a Beijing based Pakistani has installed air quality monitors in Karachi, Lahore and Peshawar and tweets the measurements found on an hourly basis, in an attempt to create awareness of the looming dangers of air pollution nationwide.

Omar cites the example of Beijing where once data on air pollution was made available to the public, it forced the government to take action. “I’m trying to get the same thing to happen in Pakistan,” he says.

Regardless though, there is ample data now available both to the public and the government which highlights the dangers of air pollution in Pakistan.

However, it remains an obscure topic of conversation in the country. While a national policy that deals with all macro and micro factors will be a step in the right direction, a more pressing and immediate concern, is to recognize that severe air pollution, is now a reality in Pakistan.

This article originally appeared on MIT Tech Review Pakistan and has been reproduced with permission.