Ten Million a Year
David Wallace-Wells on polluted air
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Not all deaths are created equal. In February 2020, the world began to panic
about the novel coronavirus, which killed 2714 people that month. This
made the news. In the same month, around 800,000 people died from the
effects of air pollution. That didn’t. Novelty counts for a lot. At the start of
the pandemic, it was considered unseemly to make comparisons like these.
But comparing the value of human lives is one thing the machine of modern
civilisation does relentlessly, almost invariably to prioritise and absolve the
rich – when, for example, the global supply of Covid vaccines is apportioned
primarily to the highest-income countries, or when the cost of natural
disasters in Bangladesh is measured against the impact of sea-level rise on
Miami Beach real estate, or when Joe Biden’s onetime economic adviser
Lawrence Summers proposed that Africa, as a whole, was ‘vastly
underpolluted’, and suggested that ‘the economic logic behind dumping a
whole load of toxic waste in the lowest wage country is impeccable.’
In its first year, the pandemic did damage according to the opposite logic,
with the world’s wealthiest countries the worst hit. When people in those
countries tried to diminish the threat of the virus by comparing it to the flu,
the disease made a joke of them. But air pollution kills more than ten times
as many as the flu every single year, and we hear even less about it. In 2017,
a Lancet study put the figure at almost seven million a year, about two-
thirds from outside air pollution and one-third from indoor, household
pollution. More recent estimates run higher, with as many as 8.7 million
deaths every year attributable just to the outdoor particulate matter
produced from burning fossil fuels. Add on indoor pollution, and you get an
annual toll of more than ten million. That’s more than four times the official
worldwide death toll from Covid last year. It’s about twenty times as many as
the current annual deaths from war, murder and terrorism combined. Put
another way, air pollution kills twenty thousand on an average day, more
than have died in the aftermath of all the meltdowns in the history of nuclear
power: Chernobyl, Three Mile Island, Fukushima and all the others put
together. If the pandemic so terrified us that billions of us retreated into
panicked cocoons for months, what can explain or justify our blindness and
indifference towards the ten million lives ended each year by the repeated
inhalation of smog?
Ten million deaths a year is a hundred million a decade. The numbers are so
large that even the superlatives of disaster fail. They’re so large that they
strain credulity, perhaps partly because none of us can picture someone
dying in the street from air pollution and partly because it seems pathetically
old-fashioned for a doctor to advise a sojourn in healthier air. But the
chances are that you can’t picture a death from obesity or cigarette smoking
either, and yet you probably don’t doubt estimates of their toll on human
wellbeing, or think it wrong to call Louisiana’s River Parishes ‘Cancer Alley’ –
the presence of 150 petrochemical plants has made it an incontrovertibly
unhealthy place to live, with some communities registering cancer rates fifty
times the national average. Such areas are sometimes known as ‘sacrifice
zones’.
A single speck of black carbon, inhaled, won’t stop the heart or poison the
lungs, but over time, across populations, the effect is devastating. When we
talk about death we always want to see a murderer. When there isn’t one,
it’s a lot harder to call it a murder, rather than a tragedy or an act of God.
(‘You see one person run over in the street and you’ll never forget it,’ an
environmentalist observes in Choked: The Age of Air Pollution and the Fight
for a Cleaner Future.* Thousands dying from the effects of dirty air ‘will
never even faze you’.) But the central premise of any mortality model is that
everyone dies: the question is when, and whether a certain behaviour or
environmental factor hastened that end. And while none of these estimates
is meant to suggest a single cause of mortality, such as a gunshot wound or
a dose of poison in your morning tea, the calculus for air pollution is the
same as for obesity or smoking: take the problem away, and the number of
premature deaths will fall by many millions. According to new research, half
of these deaths, concentrated in the developing world, are the result of
consumption and fossil-fuel burning in the world’s richest countries.
The environmental historian Stephen Pyne calls our era the ‘pyrocene’, a
global regime of burning: coal and oil, agricultural land and forest, bush and
wetland, most of it planned. The Anthropocene, Pyne says, implies dominion
over nature. He prefers to emphasise the fact that, wherever you look, the
earth is in flames. The residue is carbon monoxide, nitrogen dioxide, ozone,
black carbon, sulphur dioxide, and the particularly toxic grouping of small
particulate matter known as PM2.5. Everything we burn, we breathe.
Hundreds of millions of people live and breathe in cities permanently
clouded by airborne toxic events. In November, the authorities in Delhi
closed schools and colleges indefinitely, suspended construction work, and
shuttered half of the local coal plants after an episode of ‘toxic smog’ and an
order from the Indian Supreme Court to institute emergency measures to
combat it. The smog wasn’t new; the response was. Throughout the city,
particulate matter hangs around in offices, lobbies and private homes, even
those with air purifiers. It often gets so thick that it interferes with air travel.
More remarkably, it has interrupted train travel, the smog making it
impossible for drivers to see the tracks. Taxi drivers have filtration systems
to process the particulates that sneak in. Pedestrians can’t escape it, which
is one reason that, on especially smoggy days, living in Delhi is the
equivalent of smoking several packets of cigarettes. The city has the highest
rates of respiratory illness in the world, and 60 per cent of inhabitants
diagnosed with COPD – chronic obstructive pulmonary disease – aren’t even
smokers.
Across India as a whole, where more than a million people die from air
pollution each year, exposure to small particulate matter has been estimated
at five times the World Health Organisation’s longtime ‘safe’ level – defined
as ten micrograms per cubic metre of air. This year the WHO set a new
standard, at half the old level. Under the old threshold, 90 per cent of the
world’s population were breathing dangerously polluted air; under the new
threshold the figure is closer to 99 per cent. Of the world’s fourteen most
polluted metropolises, only one (Hotan in China) is outside India. Of the 336
cities that come next on the list, 184 are in China. But this isn’t to say that air
pollution is a problem in just two countries. Globally, it causes one death in
five.
Here is just a partial list of the things, short of death rates, we know are
affected by air pollution. GDP, with a 10 per cent increase in pollution
reducing output by almost a full percentage point, according to an OECD
report last year. Cognitive performance, with a study showing that cutting
Chinese pollution to the standards required in the US would improve the
average student’s ranking in verbal tests by 26 per cent and in maths by 13
per cent. In Los Angeles, after $700 air purifiers were installed in schools,
student performance improved almost as much as it would if class sizes
were reduced by a third. Heart disease is more common in polluted air, as
are many types of cancer, and acute and chronic respiratory diseases like
asthma, and strokes. The incidence of Alzheimer’s can triple: in Choked,
Beth Gardiner cites a study which found early markers of Alzheimer’s in 40
per cent of autopsies conducted on those in high-pollution areas and in
none of those outside them. Rates of other sorts of dementia increase too,
as does Parkinson’s. Air pollution has also been linked to mental illness of all
kinds – with a recent paper in the British Journal of Psychiatry showing that
even small increases in local pollution raise the need for treatment by a third
and for hospitalisation by a fifth – and to worse memory, attention and
vocabulary, as well as ADHD and autism spectrum disorders. Pollution has
been shown to damage the development of neurons in the brain, and
proximity to a coal plant can deform a baby’s DNA in the womb. It even
accelerates the degeneration of the eyesight.
A high pollution level in the year a baby is born has been shown to result in
reduced earnings and labour force participation at the age of thirty. The
relationship of pollution to premature births and low birth weight is so strong
that the introduction of the automatic toll system E-ZPass in American cities
reduced both problems in areas close to toll plazas (by 10.8 per cent and
11.8 per cent respectively), by cutting down on the exhaust expelled when
cars have to queue. Extremely premature births, another study found, were
80 per cent more likely when mothers lived in areas of heavy traffic. Women
breathing exhaust fumes during pregnancy gave birth to children with
higher rates of paediatric leukaemia, kidney cancer, eye tumours and
malignancies in the ovaries and testes. Infant death rates increased in line
with pollution levels, as did heart malformations. And those breathing dirtier
air in childhood exhibited significantly higher rates of self-harm in
adulthood, with an increase of just five micrograms of small particulates a
day associated, in 1.4 million people in Denmark, with a 42 per cent rise in
violence towards oneself. Depression in teenagers quadruples; suicide
becomes more common too.
Stock market returns are lower on days with higher air pollution, a study
found this year. Surgical outcomes are worse. Crime goes up with increased
particulate concentrations, especially violent crime: a 10 per cent reduction
in pollution, researchers at Colorado State University found, could reduce
the cost of crime in the US by $1.4 billion a year. When there’s more smog in
the air, chess players make more mistakes, and bigger ones. Politicians
speak more simplistically, and baseball umpires make more bad calls.
In 2019, a comprehensive global review by the Forum of International
Respiratory Societies found that air pollution damages every organ, indeed
virtually every cell, in the body. Nanoparticles of pollution have been found
inside the brainstems of even the very young. But you don’t have to wait
until birth to see the effects of breathing particulate matter. The impact
begins in the womb, damaging the development of lungs and shortening
future lives. In 2019, a small-scale study at Hasselt University found
particles of black carbon in every single placenta examined, including those
from mothers who lived in areas where the air was thought to be clean, with
thousands of particles found in every cubic millimetre. For those who worry
about microplastics in the flesh of fish, this is a yet more invasive category
of intrusion. Of course, there are also microplastics in the air. They’ve been
found in placentas too.
That everything is worse in the presence of pollution means that everything
should be better in its absence. And, as best we can tell, it is. According to
the National Resources Defence Council, the US Clean Air Act of 1970 is still
saving 370,000 American lives every year – more than would have been
saved last year had the pandemic never arrived. According to the NRDC, a
single piece of legislation delivers annual economic benefits of more than $3
trillion, 32 times the cost of enacting it – benefits distributed
disproportionately to the poor and marginalised. The American experience
provides the basis for self-justifying indifference to pollution: according to
what’s often called the ‘environmental Kuznets curve’, development makes
countries dirtier before they get cleaner. This is wishful thinking, implying
that pollution is an inevitable consequence of development, which can’t
conceivably be achieved cleanly; and that it is in a way consensual, as if
taking a job expresses a willingness to choke all the way to work. It also
suggests that the effect is temporary, since societies at a certain level of
wealth will refuse to put up with heavy pollution. But if more than 90 per
cent of the planet’s population have lived for years in places with
dangerously polluted air, 90 per cent also live where renewable energy is
cheaper than dirty. This one fact renders the ‘economic bargain’ of air
pollution, if it could ever be said to be credible, no better than an alibi.
In London, the gains over a single lifetime have been striking. ‘On Friday, 5
December 1952 my dad left work in South London, stepped out into the
darkness and realised this was not going to be an ordinary journey home,’
Gary Fuller writes in The Invisible Killer: The Rising Global Threat of Air
Pollution – and How We Can Fight Back (2018). ‘The fog was exceptionally
thick. It was as if the world around him had vanished.’ He had to feel his way
along the kerb all the way home.’ Throughout the city, visibility was reduced
to just a yard, Tim Smedley writes in Clearing the Air: The Beginning and the
End of Air Pollution.† ‘People couldn’t even see their own feet. Blinded
commuters stepped off bridges into the icy Thames and from railway
platforms into the path of oncoming trains.’ The smoke stuck to windscreens
‘like paint, forcing drivers to abandon their vehicles’. In 1952, the fog was
estimated to have killed four thousand people in London, though later
estimates tripled the figure; the rate of death was higher than in the cholera
epidemic of 1866. The hospitals were overwhelmed. Four years later the
Clean Air Act was introduced, and in relatively short order the pea-soupers
that had given the city a permanent-seeming identity – reflected in the
works of Dickens, Monet and Conan Doyle – came to an end.
In China, particulate pollution has been cut by a third since 2013, when the
state declared ‘war’ on it. In the 1990s, when Mexico City was more polluted
than Delhi, 80 per cent of 10 and 11-year-olds asked the colour of the sky
responded ‘grey’, Smedley writes; only 10 per cent said ‘blue’. Today the city
only just ranks in the list of the world’s thousand most polluted cities, with
air as clean as the Northern French town of Roubaix, terminus of the famous
cycle race.
That those gains are so large doesn’t mean there aren’t much bigger ones
to reap. In China, more than a million people still die each year from air
pollution. In Africa, another million. In London, Gardiner estimates, 9500,
about 20 per cent of the city’s total deaths, despite the apparent success of
the Ultra Low Emission Zone. The Twitter account @CleanAirLondon has
begun to tally deaths attributable to pollution by area in real time. About
two-thirds of the population of the UK, Smedley calculates, are living with
pollution above the legal limit set by the EU, and millions of British children
are going to school in dangerously dirty air.
The World Bank estimates that as much as 6 per cent of global GDP is lost
to pollution and puts the annual loss at $8.1 trillion. Last year, Drew Shindell
of Duke University, an expert on pollution impact, appeared before the US
House Committee on Oversight and Reform. By further cleaning up
America’s air over the next fifty years, Shindell’s research shows, the
country could prevent 4.5 million premature deaths, 1.4 million
hospitalisations, 1.7 million cases of dementia and 300 million lost work
days. The result, he calculated, would be $700 billion a year in net benefits,
‘far more than the cost of the energy transition’. In other words, a total
decarbonisation of the US economy would pay for itself through public
health gains alone. The American Environmental Protection Agency has an
official measure for the value of a single human life: $7 million in 2006
dollars. If you take that number seriously, the annual value of saving the
350,000 lives a year lost to pollution would be $2.45 trillion.
Globally, air pollution cuts life expectancy by almost two years. The average
inhabitant of Delhi would live 9.7 years longer were it not for air pollution.
The figure is 8.5 years across the Indo-Gangetic plains, where 500 million
people live. Cutting air pollution to the WHO standard would add 5.9 years
of life expectancy to 1.38 billion Indians, 5.4 years to 164.7 million
Bangladeshis and 3.9 years to 220 million Pakistanis. Annually, 349,000
stillbirths and miscarriages in South Asia can be attributed to air pollution,
and 116,000 infants die from its effects in their first month.
These numbers demand that we reorder our picture of the world we live in,
recalculating the brutality of the present. It becomes plain that clean air and
clean water and human health should be restored to the centre of the
environmental crusade – rather than at the margins, where they’ve been
relegated as the movement has coalesced around the necessary project of
addressing climate change through decarbonisation. (As a side benefit,
clean air and clean water tend to be much more popular with voters than
climate-focused environmental policies.) The long timescale of global
warming has often made it hard to mobilise a majority against damage that
may occur decades, or even generations, in the future. That timescale no
longer looks quite so distended, after the last few years of serial disaster –
fire, storm and flood – but air pollution provides an even more urgent motive
for change: millions are dying, right now, because of it, and because
particulate pollution dissipates much more quickly than carbon dioxide in
the atmosphere, abating that pollution would save lives swiftly. Carbon
hangs in the air for centuries if we don’t remove it; local pollution abates
almost as soon as the match is extinguished.
There’s a further incentive for individual governments to prioritise the
addressing of pollution. The benefits of decarbonisation – chiefly that it
limits temperature rise – are distributed globally, which in practice means
that local actors wait and see how quickly others are moving before moving
themselves. Air pollution changes the calculus: for one thing, it’s actually
under the control of local and national governments. It’s also a significant
burden on public health, which if alleviated offers immediate benefits every
government should want to seize.
A final implication of numbers as large as ten million deaths a year is that,
certainly in terms of human mortality and probably in terms of human
suffering, over the next few decades the toll of air pollution from the burning
of fossil fuels will be greater than all the other impacts of climate change
combined, at least as we currently quantify them. Global warming will of
course deliver punishing and transformative impacts well below the
threshold of mortality: flooding, drought, crop failure; poverty and forced
migration and possibly state collapse; hurricanes and wildfire of
unprecedented intensity. But as brutal as these may be, they don’t add up to
anywhere near ten million deaths a year – or even one million – unless you
add to most models the effects of improbable feedback loops (large-scale
release of methane from melting permafrost in the northern latitudes, for
instance) or widespread civilisational collapse.
Warming may well destabilise societies: it’s certainly not out of the question.
But the damage done by air pollution isn’t hypothetical, and it’s happening
at a much bigger scale. According to the WHO, extreme heat killed at least
166,000 people around the world between 1998 and 2017 – 8700 a year. Air
pollution killed about a thousand times more. Other estimates are higher,
but even the highest – the Lancet’s half a million heat-related deaths per
year – is just a twentieth of the toll of air pollution. Earlier this year,
Madagascar was said to be on the brink of the world’s first ‘climate famine’,
with 30,000 on the verge of starvation. In the same country, Unicef
estimates, more than 40,000 already die each year from the effects of air
pollution. The Climate Impact Lab recently published a comprehensive
accounting of the ‘global mortality consequences for climate change’. The
lab, a consortium of environmental scientists and economists from a wide
range of US institutions, is known for being at the alarm-raising vanguard of
the serious research on the effects of warming. Their highest estimate for
the end of this century – assuming an implausibly high emissions scenario
called RCP8.5 – was for an annual death toll from climate change of 73
deaths per 100,000 people. Today, air pollution is killing up to 126 per
100,000. In a more plausible scenario, the report projects fewer than 20
deaths per 100,000.
Perhaps, like me, you have spent the last five years in a state of panic about
climate change. Perhaps it has inflamed your politics, and your sense of self.
It should. The world is already warmer than it has ever been in the history of
human civilisation. We have already exceeded the narrow temperature
window which gave rise to everything we know as agriculture and society
and politics and culture. The last time there was as much carbon in the
atmosphere as there is today, temperatures weren’t 1.2°C warmer than the
pre-industrial base level, as they are now, but about 3°C, with forests
growing in the Antarctic and sea levels twenty metres higher.
The climate is changing ten times faster than ever before in a planetary
history that includes mass extinctions which wiped out more than 90 per
cent of life on Earth. Half of that damage has been done in the last 25 years,
since the publication of Al Gore’s first book on global warming and the
formation of the UN’s Intergovernmental Panel on Climate Change – in other
words, with the full knowledge of the scientific community and the effective
consent of global political leaders. A quarter of the change has taken place
since Barack Obama was elected president, having hubristically proclaimed
that ‘this was the moment when the rise of the oceans began to slow and
our planet began to heal.’ Just a few years later, he bragged to an audience
in Texas that ‘suddenly, America is the biggest oil producer. That was me,
people.’
In 2018 an IPCC report declared that giving the planet a good chance of
staying below 2°C of warming and avoiding the catastrophic effects that
would bring – island nations have called it genocide; African climate
ambassadors ‘certain death’ for the continent – would require a 45 per cent
reduction in emissions this decade. The report suggested that such a rapid
timeline would require a global World War Two-scale mobilisation beginning
the following year, 2019. Instead, emissions went up, and will be up again, it
appears, in 2021, after a brief dip during the pandemic.
An IPCC report released in August also noted that air pollution has limited
the level of warming, to the extent that if it were removed global
temperatures would be half a degree higher than they are now. The reason:
aerosols reflect sunlight back into space and therefore hold temperature
rise below the level our carbon concentrations alone would dictate. Some
estimates of the cooling effect run even higher: the climate scientist James
Hansen believes the rate of global warming could double as aerosols
decline. Cutting air pollution probably won’t produce a sudden temperature
spike, because the transition would be gradual, but we would probably
already be close to the 2°C threshold if we weren’t also producing enough
particulate matter to kill ten million people a year.
If we fail to keep the rise below 2°C, we may see what used to be once in a
century floods happening every single year; major cities in South Asia and
the Middle East experiencing ‘lethal’ heat for two hundred or more days a
year; the total loss of the planet’s coral reefs, which provide food, income
and coastal protection to a half a billion people; and possibly irreversible
acceleration of sea-level rise as a result of the melting of the Arctic ice
sheets. And the climate may be more sensitive to our carbon perturbations
than median estimates predict: a doubling of carbon concentrations from
the pre-industrial average produces anything from two degrees of warming
to six, depending on the model. At three degrees, a quarter of potential
global GDP could be wiped out; in many equatorial regions there would be
no hope of economic growth at all. At four degrees, crop yields could drop
dramatically, and parts of the world might be hit by up to six climate-driven
natural disasters at once.
All these impacts, even if unleashed, probably won’t surpass present-day air
pollution in terms of human mortality for a very long time. Reducing fossil
fuel pollution won’t solve the problem. Last year, wildfires accounted for
more than half of the air pollution in the western United States – meaning
that more particulate matter from burning forests infiltrated the lungs of
Americans living in those states than from all other human and industrial
activity combined. By the middle of the century, the extent of those fires is
expected to double, at the very least, with each tree burned releasing
carbon just as coal does, along with particulate matter. The worst air quality
in the world is now routinely registered in California, and although these
record-setting events typically last only a few days, it is already the case
that the smoke from last year’s fires can be held responsible for five
thousand additional pre-term births in the state. Globally, the world’s wildfire
smoke delivers only a fraction of air pollution, but the fraction is growing.
The 2021 fires are still smouldering, and wildfire emissions from this year
have reached 4.7 billion tons of carbon, not far off the 5.1 billion produced
last year by the US, which is the world’s second biggest emitter.
Fire is eternal in the American west, of course, but when climate sceptics
point to evidence of ancient megafires, they neglect to mention that at the
time there weren’t forty million people living in California. In the entire 20th
century, there were only five fires that burned more than 100,000 acres. In
2020, there were eleven such fires – one blaze, the August Complex fire in
Mendocino, which burned more than a million acres, seemed to demand a
new term, ‘gigafire’, to describe it. Each of these fires has produced an
unprecedented amount of smoke, so much of it that the fires create their
own weather systems – pyrocumulus clouds, fire tornadoes and lightning
storms, the lightning sometimes travelling miles from the central point of
ignition, and sparking more fire where it lands, producing yet more smoke.
In some ways fear of smoke is more logical than fear of fire. In many parts of
California, you can be confident your house won’t burn down. The chances
are that you can evade the flames of even rampant wildfire. But smoke can’t
be quarantined. This summer in the resort community of Lake Tahoe –
where the Air Quality Index, which describes 51 on its scale as ‘hazardous’,
hit 700 – those trapped inside during oppressive weeks of smoke finally fled
their vacation homes. Poisoned air reached as far as the East Coast of the
US, where more deaths are caused every year by western wildfires than in
the west itself, and across the Atlantic to Europe, where around the
Mediterranean unprecedented fires were already burning, forcing
evacuations from resort hotels.
The story is global, the world wrapped in smoke. In British Columbia, more
carbon is now unleashed each year from forest fires than from all other
sources. In Australia, where bushfires are an enduring feature of both
landscape and legend, 46 million acres burned in the 2019-20 season – ten
times the record-setting California season that would follow, and enough to
kill, it was estimated, more than a billion animals. The smoke in Sydney
Harbour was so thick ferries couldn’t navigate it, and the particulates so
dense that fire alarms were triggered in office buildings, the sensors
concluding that there had to be flames nearby. In Siberia, where ‘zombie
fires’ now burn regularly through the Arctic winter, carbon released from
forests in flames regularly sends heavy smoke across the North Pole to the
other side of the planet.
And then there’s South America, where 30 per cent of the Pantanal, the
world’s largest tropical wetland, was lost to fire in a single year – 2020. In the
Amazon, so much land is burned to clear trees for farming that the fires
release three times as much carbon as all other forms of emission in Brazil –
enough to make the rainforest itself, if it were a country, the world’s fifth
largest emitter, and to turn the celebrated ‘carbon sink’, which might aid in
our fight against warming, into a net source of global carbon. In theory, the
burning could be halted, and it may at least be slowed if Lula succeeds
Bolsonaro and returns to Brazil’s presidency next year. But the longer-term
decline of the rainforest may lie outside the reach of national policy, as
current global emissions trajectories suggest an irreversible tipping point for
the region by the 2040s: less forest and more grass, less new growth and
more new dying, more heat and therefore more fire. The Amazon has long
been called ‘the lungs of the planet’. It may soon become a bellows.
Everything we burn, we breathe."
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