air pollution and human health risk reduction: the case

17Air Pollution and Human HealthRisk Reduction: The Case Studyof Delhi Megacity, India

R. B. Singh and Aakriti Grover

17.1 Introduction

Health is determined by many factors such as theenvironmental surroundings, lifestyle, genetics anddietary habits. Human health and local climatic con-ditions have a complex relationship. As a result ofunplanned, unregulated and haphazard urban growthin Delhi, the associated micro and meso scale climaticchanges are imposing challenges to human health. Asa result, urban areas, the prime centers of develop-ment, are experiencing a significant rise in the burdenof diseases. This is largely in response to industrializa-tion, vehicularization, motorization and energy con-sumption (Chen and Kan, 2008).

The atmospheric composition of gases has beenaltered by industrial and vehicular growth. There arerising concentrations of oxides of nitrogen, sulphur andcarbon dioxide. Added to this, suspended particulatematter (SPM) and compounds such as benzene andozone (Knowlton et al., 2004) are increasing in concen-tration. There are multiple causes of respiratory prob-lems; a strong positive relationship has been establishedbetween respiratory illness and rising pollutant levels.Air pollutants have far-reaching damaging effect onhuman health including chronic heart and lung disease(Frumkin, 2002), asthma (Beggs and Bambricks, 2005;Magas et al., 2007), cancer (Bentham, 1992), minor eye,nose or skin irritations, allergy (Kim et al., 2015) andeven death (Lvovsky, 1998; Fang et al., 2013; Kimet al., 2015). However, there are variations and patternsin the trend of air pollution and disease occurrence.Also, the levels of vulnerabilities vary, particularly withrespect to gender and age, that are exposure and loca-tion dependent (Curtis et al., 2006).

It is reported that among the non-communicablediseases, cancer and cardiovascular diseases areleading causes of mortality in urban India, and expos-ure to poor air quality is one of the underlying reasons(World Health Organisation, 2016). It is alarming to

note that diseases of the respiratory system are thethird largest cause of all deaths in the country (Gov-ernment of India, 2010). The number of deaths fromdiseases of the respiratory system in Delhi increasedfrom 3,231 to 3,746 (2001–2010) (Government of NCTof Delhi, 2010).

The exposure to pollutants and immunity levels ofindividuals determine their state of health. Children andthe elderly constitute the most vulnerable groups. Besidesthis, children have lower breathing zone, small airways,developing lungs and immature immune systems thatmake them much more vulnerable to the effect of pollu-tants (Central Pollution Control Board, 2008). The eld-erly are also more susceptible than other age groups.There are, however, morbidity and mortality differentialswith respect to physical-biological-socio-economic status.

One conceptualization of the linkages between vari-ous aspects of health and environment can be describedusing system analysis (Gatzweiler et al., 2016). The levelof exposure and susceptibility to health risk is depend-ent on individual physical and biological factors(Figure 17.1).

Furthermore, mitigating and aggravating factorsproduce differential impacts. Combinations of individ-ual and physical environmental factors determine theseverity of impact, which ranges from minor illness todeath. The urban population is increasing at a fastrate, especially in developing countries, and thesegrowing cities are expected to have higher levels ofrisk and exposure to health hazards in the future (Beer,2001). Air pollution levels in Delhi were exceptionallyhigh in November 2016 (post Diwali celebration) suchthat the concentration of harmful gases remained sus-pended for a couple of days and as a result schoolswere closed for three days. This chapter aims (1) tounderstand the trend of air pollution in Delhi and (2)to analyze the impacts of air pollution on humanhealth.

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17.2 Study Area

The National Capital Territory (NCT) of Delhi is thenational capital of India and is the political, judicial andadministrative center of the country. The NCT of Delhiis located between 28� 24’ 17” and 28� 53’ 00” N and76� 50’ 24” and 77� 20’ 37” E. With an area of 1,483km2, it encompasses a total population of 16.7 million,97.5 per cent of which is urban (Directorate of CensusOperations, 2011). Delhi has a density of 11,297 per-sons/km2. For administrative purposes, Delhi is dividedinto nine districts and twenty-seven tehsils, or sub-districts. There are three statutory towns in the Delhiadministrative city: the Municipal Corporation of Delhi(MCD), New Delhi Municipal Council (NDMC) andDelhi Cantonment Board (DCB).Delhi experiences extreme climatic conditions due to

its inland location. The perennial River Yamuna is theonly major river in the city. Satellite data analyzed by

the Forest Department of India indicate 176.20 km2 ofthe area, which is 11.88 per cent of the total geograph-ical area of the city, is under forest cover (Forest Surveyof India, 2011). The total tree cover is 120 km2 viz.8.08 per cent of total area (Forest Survey of India, 2011).

The number of vehicles per thousand populationwas estimated to be 253 in 1999–2000 and rose to 436 in2011–2012 (Planning Department of Delhi, 2013). Two-wheeled vehicles constitute the largest proportion(62.46 per cent) followed by cars and Jeeps (31.5 per cent).The road length in Delhi increased from 14,316 km(1980–1981) to 28,508 km (2000–2001) and reached32,663 km in 2011 (PlanningDepartment ofDelhi, 2013).

17.3 Data and Methods

The present research relies on various secondarysources of data on air pollution and health impacts.

Population Composition

MITIGATION FACTORS

Quality

AGGRAVATING FACTORS

Direct Health Impacts:Indirect Health Impacts:

Level of Exposure

Vulnerability and Risk

Mortality

Morbidity

RespiratoryRespiratory

TuberculosisSkin and eye infectionsInfectious diseases-

Pneumonia, InfluenzaLung disorders & cancer

lllness- Asthma.Bronchitis.

Death

Diseases of URT

Diseases of LRT

Diseases of ORD and minor infections

Heart disease & illness Tuberculosis of nervoussystem

LEVEL OF PHYSICAL HEALTH AND WELLLBEING

Inte

nsity

an

d s

eve

nty

of im

pact

Number of pepole affected

Medical TechnologyRegulationsEnforcementInfrastructureTransportAccess

Urbanization PatternLand Use

ClimateNatural EnvironmentEnergy use Spatio-temporal variations ofair quality

Figure 17.1 System analysis framework to conceptualize linkages between urban environment and level of physical health andwell-being.

224 R. B. Singh and Aakriti Grover


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The Pollution Control Board (PCB) under the Ministryof Environment and Forests is responsible for collectionof pollution data for all states and union territories ofIndia. The pollution recording stations are representa-tive of three categories on the basis of their function,that is, residential, industrial and traffic junctions. Allthe sites regularly monitor the SPM, respirable sus-pended particulate matter (RSPM), sulphur dioxide(SO2) and nitrogen dioxide (NO2) levels. SPM andRSPM are monitored every eight hours for twenty-fourhours, whereas SO2 and NO2 are monitored every fourhours. The CPCB provided the air pollutant data fornine stations, including JanakPuri, Nizamuddin, SiriFort, Sarojini Nagar, Pitampura and Town Hall, whichare residential sites, and Mayapuri, Shahdara andShahjada Bagh, which represent industrial areas, havebeen used to analyze the status of air pollution in thecity (Figure 17.2 and Table 17.1).

The spatio-temporal analysis of pollution data wascarried out after averaging the daily pollution recordsto monthly and annual averages. Trends in levels ofSPM, RSPM, SO2 and NO2 were analyzed (2001 to2011) with respect to the annual and monthly fluctu-ations and with respect to the nature of the station.

To examine the impact of pollutants on humanhealth, data on cause of mortality have been con-sidered. There are two major limitations to establish-ing a link between air pollution and health. Firstly,one may argue that a disease may be due to manyfactors and not only air pollution. On the other hand,the disease or illness tends to be aggravated as pollu-tion levels increase. Secondly, in the absence ofrespiratory illness data, the data on cause of mortalityare used.

Among the direct causes, diseases of the respiratorysystem are those most likely to arise from air pollutionand are divided into three parts: diseases of the upperrespiratory tract (URT), diseases of the lower respira-tory tract (LRT) and other respiratory system diseases(ORD) (Table 17.2). URT diseases have symptomsthat involve symptoms such as runny and stuffy nose,sinusitis, sore throat, wet cough, dry cough, cold head,fever, burning or red eyes. The LRT symptoms includewheezing, phlegm, shortness of breath, chest discomfortor pain.

17.4 Results and Discussion

17.4.1 Trends in Air PollutionAnnual mean levels of SO2 indicate that it has beenmostly below the prescribed limit (50μg/m3) during themonitored period (Figure 17.3a). Power sector andthermal power plants are the main sources of SO2; someresearchers have also listed the transport sector as asource (Chelani and Devotta, 2007; Datta et al.,2010). Hence, the low concentrations of SO2 may bedue to the policies requiring the use of higher quality ofdiesel and compressed natural gas (CNG) in publicvehicles. Goyal et al. (2006) also point out similartrends in SO2. The levels of NO2, on the other hand,

Table 17.1 Permissible Limits and Sources for SelectedPollutants

Pollutants

Annual meanconcentrationrange (μg/m3)

24-Hour meanconcentration range(μg/m3)

SO2 50 80NO2 40 80RSPM 60 100SPM 40 60

Source: Annual Mean Concentration Range given byNational ambient air quality, 2009 guidelines adopted fromCPCB, 2012.

76°50'0"E

Janak Puri (R)

Nizamuddin (R)

Pilampura (R)

Sarojini Nagar (R)

Siri Fort (R)

Town Hall (R)

Siri FortSiri Fort

ITOITOJanak PuriJanak Puri

MayapuriMayapuri

Sarojini NagarSarojini NagarNizamuddinNizamuddin

Shahjada BaghShahjada Bagh

PitampuraPitampura

Town HallTown Hall

ShahdaraShahdara

Siri Fort

ITOJanak Puri

Mayapuri

Sarojini NagarNizamuddin

Shahjada Bagh

Pitampura

Town Hall

Shahdara

NN

Shahdara (I)

Mayapuri (I)

Shahzada Bagh (I)

ITO (TJ)

77°0'0"E 77°10'0"E 77°20'0"E

28°3

0'0

"N2

8°4

0'0

"N2

8°5

0'0

"N

28°3

0'0

"N2

8°4

0'0

"N2

8°5

0'0

"N76°50'0"E 77°0'0"E 77°10'0"E 77°20'0"E

Figure 17.2 Location and nature of air quality monitoringstations in Delhi (background image is Landsat TM 5). Thegreen symbol represents residential sites, red represents industrialsites and black represents traffic junction. (Source: CPCB, 2012;background image is taken from earthexplorer.usgs.gov.).For the color version, please refer to the plate section.

Air Pollution and Human Health Risk Reduction: The Case Study of Delhi Megacity, India 225


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Table 17.2 Classification of Causes of Death Due to Air Pollution

Diseases of the respiratory system

Majorclassification

Diseases of the upper respiratory tract(URT)

Diseases of the lower respiratory tract(LRT)

Other respiratory systemdiseases (ORD)

Disease Acute pharyngitis and acute tonsilitis Acute Bronchitis and acutebronchiolitis

Influenza

Acute laryngistis and trachetis Bronchitis, chronic and unspecifiedemphysema

Pneumonia

Acute upper respiratory infections Asthma PleurisyOther diseases of URT Other lower respiratory disorders All other diseases of the

respiratory system

Source: Compiled from Government of NCT of Delhi, 2001, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012

0

5

10

15

20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Sul

phur

dio

xide

(in

µg/m

3 ) (a)

(b)

020406080

100120

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Nitr

ogen

dio

xide

(in

µg/m

3 )

Pitampura Sarojini Nagar Town Hall Nizamuddin JanakpuriSiri Fort Shahdara Shahzada Bagh Mayapuri

Pitampura Sarojini Nagar Town HallNizamuddin Janakpuri Siri FortShahdara Shahzada Bagh Mayapuri

Figure 17.3 Annual trend of major pollutants in Delhi, 2001–2011. a. SO2, b. NO2, c. SPM and d. RSPM. The figure is preparedby the author using Central Pollution Control Board (CPCB) daily pollutant level data.Note: RSPM data not available until 2003; x-axis represents years and y-axis represent pollutant levels in µg/m3. For the colorversion, please refer to the plate section.



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indicate an increasing trend and are well above thepermissible limit of 40μg/m3 (Figure 17.3b). A substan-tial rise in the vehicular fleet is considered the majorcause for this increase. The rise of NO2 is a threat toenvironmental and human health as the reactions ofNOX in the presence of sunlight produce ground levelozone that is dangerous to human health (Lo and Quat-trochi, 2003).

The SPM and RSPM levels are seen to increasemarkedly during the monitored period (Figure 17.3cand d). Incomplete combustion from industries andvehicles is a major source of particulates of a range ofsizes. Natural sources including dust from unpavedroads or roadsides combined with particular meteoro-logical conditions add to the load. Other anthropo-genic sources include agricultural fields, constructionsites, refuse burning etc. These are a menace to humanhealth and well-being including physical, social andmental conditions. In the process of rapid urbaniza-tion and the increased demand for intra- and inter-citymovement, human activities produce large quantitiesof particles of complex structure.

The annual temporal analysis of SPM and RSPMdemonstrates a rising trend (permissible limits forSPM and RSPM are 40 and 60μg/m3, respectively).The particulates constitute a prominent share of thepollutant load of the city and, hence, may have pro-found effects on the lungs, respiratory tract and circula-tory systems.

Because of variations in temperature, rainfall, humid-ity, wind direction and other climatic factors, the levelsof pollutants in Delhi vary between seasons. There arevariations in the level of increase of NO2 betweenseasons. The winter months are associated with max-imum concentrations, which gradually decrease inspring and summer to reach lowest values during therainy season (Figure 17.4a).

RSPM is one of the most dangerous components forhuman health. The RSPM levels are markedly low inthe rainy season (Figure 17.4b) because of the settlingof minute particles under the influence of rainfall andhigh humidity. The highest RSPM levels are found inthe winter, when they are very much above the pre-scribed limits (60μg/m3). Similar findings are cited in

(c)

0

200

400

600

800

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SP

M (i

n µg

/m3 )


0

100

200

300

400

2004 2005 2006 2007 2008 2009 2010 2011

RS

PM

(in

µg/m

3 )


(d)

Figure 17.3 (cont.)



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detailed research by CPCB (2006). The SPM levels arealso high in all seasons except the rainy season. Thecontributing factors of high SPM are incomplete com-bustion in vehicles and construction works. The peakwinter and summer seasons have maximum SPM(Figure 17.4b). In the former, the air is stable and thereis less mixing in the atmosphere that contributes tohigh SPM levels. On the other hand, in the latterseason, towards spring and summer, pollen and dry-ness of the air are responsible for the SPM content.Shandilya et al. (2006) indicate that the finer particlesstick together or deposit on surfaces easily and rapidlyin the rainy season, leading to cleaner air duringmonsoons.

17.4.2 Vehicular Growth as a Major Factor InfluencingAir Quality of Delhi

While Delhi contains 1.4 per cent of India’s population,it accounts for 7 per cent of total vehicular load of thecountry. According to Das and Parikh (2004) Delhi wasthe fourth most polluted city in the world, and thedominant contributor sector to air pollution was thetransport sector, as illustrated by the strong correlationbetween population and GDP growth, motor vehiclenumbers and pollution increase.The total number of vehicles in Delhi increased from

1.92 million (1991) to 5.32 million (2010). Private motorcars have rapidly proliferated in the city, now a total of1.46 million (2010), up from a mere 0.42 million (1991)(Figure 17.5). There is high dependency on privatevehicles for transportation, which is clearly reflected

by the increasing proportion of private cars to totalvehicle composition. While in 1991, 22.2 per cent ofthe total vehicular load was of private cars, this hadrisen to 27.4 per cent in 2010.

17.4.3 Impact of Air Pollution on Human HealthThe cause of deaths due to illness can be influenced bymultiple factors including heredity, lifestyle, exposurelevel, occupation, dietary habits among others. Dis-eases may be acquired or inherited and may be aggra-vated by, for example, environmental conditions. Inorder to avoid these complexities, the immediaterecorded cause of mortality is considered here as abase for establishing the degree of correlation withpollution and health. This takes into account the factthat the immediate surroundings have a profoundimpact on health in the sense of both developing adisease and aggravating the conditions that activate ahereditary illness.

Apart from disorders of the respiratory system, airpollution may cause harm to eyes, skin, lungs and otherrespiratory organs. In extreme cases it may lead tomortality from respiratory illness and cancer. Air pollu-tion may also worsen the circulatory system, making itmore vulnerable to failure.

SPM may cause pneumoconiosis, restrictive lungdisease, asthma and cancer. Cropper et al. (1997),using the mortality data obtained from NDMC,established that there is a positive relationshipbetween particulate pollution and daily non-traumaticdeaths from respiratory and cardiovascular problems.

Figure 17.4 Monthly average of (a) SO2, NO2 (b) RSPM, SPM.



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Similarly, Firdaus (2010) concluded that there is highcorrelation between SPM and health consequences.Using primary survey data, he found chronic respira-tory symptoms and airway diseases among residentsof high-pollution areas.

RSPM is released from industries, combustion offossil fuels, vehicle exhausts and is known to causerespiratory illnesses such as chronic bronchitis andasthma, heart disease etc. Agarwal et al. (2006) suggestthat SPM and RSPM have a direct bearing on the

Figure 17.5 Growth of vehicles inDelhi, 1991–2015 (source: compiledfrom Firdaus and Ahmad, 2011;Transportation Department, 2005).

Table 17.3 Total Deaths from Disease from URT, LRT and ORD in Delhi

Cause of death 2001 2004 2005 2006 2007 2008 2009 2010 2011

Diseases of URT 49 243 48 9 43 17 21 499 653Diseases of LRT 1,108 695 1,043 1,089 922 949 1,088 598 886ORD 2,074 1,350 1,678 1,218 1,500 1,730 2,006 2,649 2,403

Source: Based on data from Government of NCT of Delhi, 2001, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011

Table 17.4 Area, Population and Mortality Details of Different Regions, Delhi

Area (2001) (per cent)* Population (2001)*Density (2001)(persons/km2)*

Total institutional deaths(2001–2011)**

MCD 94 1,34,23,227 (97%) 9,607 4,16,094NDMC 3 3,02,363 (2%) 7,074 2,02,529DCB 3 1,24,917 (1%) 2,907 14,496Urban 62 NA 13,957 NARural 38 NA 1,692 NA

Sources: *Directorate of Economics and Statistics, 2014; **Directorate of Economics and Statistics, 2014. Compiled fromGovernment of NCT of Delhi, 2001, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011



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number of chronic obstructive airway/pulmonary dis-ease (COPD) cases in Delhi. The extensive study byRizwan et al. (2013) reflects on the associated morbiditydue to air pollution. Dry cough, wheezing, breathless-ness and chest discomfort are notable health problemsin the city. In the same study, hypertension was also

found to be positively correlated with RSPM, and Delhiis associated with significantly higher levels of chronicheadache, eye irritation and skin irritation. Delhi alsoshowed statistically significant increases in varioustypes of lung function deficits. Oxides of nitrogen gen-erated from power plants, electric utility boilers and

Table 17.5 Deaths from Respiratory Illness by Region in Delhi, 2001–2012

Statutory towns and rural areas

Direct health effects

Respiratory diseases

Pneumonia Influenza Bronchitis and asthma Whooping cough

MCD 6,441 2,588 5,330 300NDMC 6,592 74 3,687 2DCB 550 3 403 0Rural 623 115 566 41

Total figures do not include data for 2002 and 2003.Source: Based on data from Government of NCT of Delhi, 2001, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012

Pneumonia44%

Influenza18%

Bronchitis andasthma

36%

Whooping cough2%

(a) (b)

(c) (d)

Pneumonia64%

Influenza1%

Bronchitisand asthma

35%

Whooping cough0%

Pneumonia58%

Influenza0%


42%

Whooping cough0%

Pneumonia46%

Influenza9%


41%

Whooping cough4%

Figure 17.6 Regionwise direct andindirect causes of death, Delhi (in percent) in (a) MCD, (b) NDMC, (c) DCBand (d) rural areas.Note: does not include data for 2002and 2003.(Source: Based on data fromGovernment of NCT of Delhi, 2001,2004, 2005, 2006, 2007, 2008, 2009,2010, 2011, 2012).



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vehicle emission may cause airway resistance, chesttightness, lung and eye irritation and viral infections.Jayaraman and Nidhi (2008) correlated the daily countof patient data in the respiratory unit of one hospital andatmospheric levels of ozone, NO2 and RSPM. Theresults reveal a significant impact of air pollution factorson all age groups for all variables. In another study,Nidhi and Jayaraman (2007) also state that gaseous

pollutants such as SO2 and NO2, in spite of being mostlyat low levels, have significant impact on human health.

The deaths from URT significantly increased from9 in 2006 to 653 in 2011. On the other hand, LRTdiseases have fluctuated with a minimum of 598 deathsin 2010 and a maximum of 1,108 deaths in 2001. ORDhas always been the largest contributor of respiratoryrelated mortality (Table 17.3).

y = 57.921x + 325.53R2= 0.5297

y = 61.345x – 78.6R2= 0.3739

y = 59.491x + 205.8R2= 0.6215

–200

0

200

400

600

800

1000

1200(a)

(b)

2001 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pneumonia InfluenzaBronchitis and asthma Linear (Pneumonia)Linear (Influenza) Linear (Bronchitis and asthma)

y = 5 .5273x + 628.8R2= 0.0053

y = 126.12x – 324.93R2= 0.7503

–400–200

0200400600800

1000120014001600

2001 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pneumonia InfluenzaBronchitis and asthma Linear (Pneumonia)Linear (Bronchitis and asthma)

Figure 17.7 Trend analysis of deaths from respiratory diseases per region of Delhi (a) MCD, (b) NDMC, (c) DCB and(d) rural areas.Note: does not include data for 2002 and 2003; x-axis represents number of deaths and y-axis represents year.(Source: Based on data from Government of NCT of Delhi, 2001, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012).



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17.4.4 Spatial Analysis of Impact of Air Pollution onHuman Health in Delhi

The urban area of Delhi is administered by three agen-cies, i.e., NDMC, MCD and DCB (Table 17.4).The MCD occupies both the maximum area (94 percent) and maximum population (97 per cent in 2001) in

Delhi and proportionally accounts for the highestnumber of deaths. The DCB is geographically thesmallest region and counts for just 3 per cent of thearea, 1 percent of the population and the lowest popu-lation density (2,907 persons/km2). The spatial analy-sis of mortality from diseases caused due to air

y = 12.467x – 2.8889R2= 0.7212

y = 2.8167x – 2.3056R2= 0.491

y = 6.2333x + 21.611R2= 0.4361

0

20

40

60

80

100

120

140

(d)

2001 2004 2005 2006 2007 2008 2009 2010 2011

Pneumonia InfluenzaBronchitis and asthma Linear (Pneumonia)Linear (Influenza) Linear (Bronchitis and asthma)

y = 9.8x – 14R2= 0.4732

y = 2.3x + 43.278R2= 0.1038

–20

(c)

0

20

40

60

80

100

120

2001 2004 2005 2006 2007 2008 2009 2010 2011

Pneumonia InfluenzaBronchitis and asthma Linear (Pneumonia)Linear (Bronchitis and asthma)

Figure 17.7 (cont.)



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76°50'0"E

28°5

0'0

"N2

8°4

0'0

"N2

8°3

0'0

"N

76°50'0"E 77°0'0"E 77°10'0"E 77°20'0"E 28°2

0'0

"N2

8°3

0'0

"N2

8°4

0'0

"N2

8°5

0'0

"N

77°0'0"E 77°10'0"E

MCD

NDMC

RURAL

9

140

12001000800600400200

0

100y = 1.793x + 45.13

R2= 0.086

y = 5.527x + 628.8

R2= 0.0051200

1000

800

600400200

0

80

60

40

20

0

20

01

20

04

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20

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y = 10.62x + 3.866

R2= 0.681

y = 57.92x + 325.5

R2= 0.529

12010080604040

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4.5 0 9

Kilometers

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DCB

N

77°20'0"E Figure 17.8 Spatio-temporal trend ofmortality from pneumonia in regions ofDelhi, 2001–2012.Note: does not include data for2002 and 2003; x-axis representsnumber of deaths and y-axisrepresent year.(Source: Based on data fromGovernment of NCT of Delhi, 2001,2004, 2005, 2006, 2007, 2008, 2009,2010, 2011, 2012).

76°50'0"E

28°3

0'0

"N28°4

0'0

"N28°5

0'0

"N

2012

2012

2012

2012

9 4.5

100y = 6.618x + 20.2

R2= 0.542

y = 10.01x – 14.8R2= 0.563

y = 59.49x + 205.8R2= 0.621

y = 126.1x – 324.9R2= 0.750

80604020

RURAL

NDMC

MCD

DCB

N

150

1000800

600400200

0

100

50

0

00

0

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9 18

Kilometers

–500–50

2011

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77°0'0"E 77°10'0"E 77°20'0"E

28°2

0'0

"N28°3

0'0

"N28°4

0'0

"N28°5

0'0

"N

77°20'0"E77°10'0"E77°0'0"E76°50'0"E Figure 17.9 Spatio-temporal trend ofmortality from bronchitis and asthmain regions of Delhi, 2001–2012.Note: does not include data for2002 and 2003; x-axis representsnumber of deaths and y-axisrepresents year.(Source: Based on data fromGovernment of NCT of Delhi, 2001,2004, 2005, 2006, 2007, 2008, 2009,2010, 2011, 2012).


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pollution is done with respect to MCD, NDMC andDCB. Among the direct health effects, i.e., respiratoryrelated mortality, maximum deaths are due to pneu-monia and followed by bronchitis and asthma andinfluenza (Table 17.5).Further, the regionwise trend analysis of four major

diseases of the respiratory system from 2001 to 2012reveals that bronchitis and asthma have observed max-imum rise (Figure 17.6). The mortality from respiratorysystem diseases such as bronchitis and asthma andpneumonia has increased in MCD, NDMC and DCBsince 2001 (Figure 17.7a,b,c).The spatio-temporal analysis was done for three

urban regions controlled by MCD, NDMC and DCBand for rural Delhi (Figures 17.8 and 17.9). The studyreveals that deaths due to pneumonia, asthma andbronchitis have been increasing in the study area, how-ever, there are spatial variations in the magnitude ofchange. In general, the deaths due to asthma and bron-chitis have experienced a sharper increase than thedeaths caused by pneumonia.The second most important causes of death are bron-

chitis and asthma. The spatial analysis of mortalityfrom bronchitis and asthma reveals an increase in allregions. NDMC was associated with the strongest levelsof increase followed by MCD and DCB, suggesting thedire need for stricter and more effective policies toimprove urban health.

17.5 Conclusion and Recommendations

The urban atmosphere of Delhi is deteriorating as aresult of a rise in air pollution. The relationshipbetween air pollution levels and various parametersassociated with human health in Delhi suggests thatPM exerts the strongest negative influence. Delhi has alarge, increasing population and these rising healthrisks pose a substantial threat to the sustainablegrowth of the city.For more sustainable growth of the national capital,

there needs to be a focus on the entire complex ofelements affecting physical human health and well-being, but it is clearly most important that pollutantlevels be controlled. Green technology and cleaner fuelsmust be used.There should be stringent implementation of the rules

regarding the pollution norms of vehicles and industries(small, medium and large). Maintaining a clean envir-onment in the city requires the establishment of a green

belt. Cleaner fuels and very efficient diesel and petrolvehicles are required. In addition, the governmentshould allocate additional funds for the developmentof heath facilities, including public hospitals. Further-more, afforestation programmes, car pooling and use ofpublic transport should be encouraged, as these canoffer improvements in air quality and, accordingly,health.

Acknowledgements

We acknowledge the reviewers for valuable commentsand suggestions for the improvement of this researchpaper. Thanks are also due to Dr. D. D. Basu fromCSE; Dr. Chintan Chaudhary, Consultant at Safdar-jung Hospital, Delhi for fruitful discussions. We aredeeply grateful to Dr. Sanjeev Agarwal and Dr. San-geeta from the Central Pollution Control Board forproviding the pollution data for Delhi.

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