“Air Pollution and Child Health: Prescribing Clean Air”, a new World Health Organisation report, says that 98% of children under the age of five from countries such as India are exposed to toxic air. Acute Respiratory Infections — which are the leading cause of death among children under five, and claiming the lives of approximately 2,400 children a day — accounted for approximately 16% of the 5.6 million under-five deaths, killing around 880,000 children in 2016. Most victims are less than two years old.

A report by Save the Children (“Fighting for Breath”) showed that pneumonia kills two children in this age group every minute — more than malaria, diarrhoea and measles combined. More than 80% of victims have weakened immune systems caused by malnutrition or insufficient breastfeeding and unable to fight the infection. For countries with high levels of toxicity in the air, delivering on the pledge of the UN’s Sustainable Development Goals (SDGs) will require an unrelenting focus on the most disadvantaged children. Children born into poverty, and also those living in the hardest-to-reach places, and facing discrimination are the ones who face the greatest risks.

Air pollution is a ‘major risk factor for pneumonia. The sources of pollution vary across and within countries. Outdoor air pollution, which is associated with emissions from factories, the burning of rubbish and coal, and traffic, is a growing concern. Children living in urban slum environments often face high levels of exposure to these sources of pollution. Indoor air pollution is a major contributor of respiratory infection in many high-burden pneumonia countries, where the burning of biomass for cooking, heating and lighting are the common sources of pollution’.

According to the International Energy Agency’s Energy Access Outlook 2017 report, over 63% of households in India use biomass energy sources. Tackling household air pollution that is a major source of pneumonia infections is another priority.

In 2016, pneumonia was the leading cause for under-five deaths in India, and more than 25 million children under the age of two were found not immunised with pneumococcal conjugate vaccine. The “Fighting for Breath” report says that globally, a million children are dying from pneumonia annually, even though it can be treated with antibiotics costing as little as ₹26.

While the Indian government has taken several steps to improve the health of children, India continues to top the world ranking in the number of deaths due to the disease burden. The number of unvaccinated children in the 0-2 age range in developing countries is estimated to be at around 170 million, with India dominating. Research shows that that the association between pneumonia and air pollutant exposure is particularly strong during the first year of life. It is a well known that exclusive breastfeeding in the first six months acts as an effective vaccine and continued breastfeeding with the gradual introduction of complementary food is another risk-reducer.

Defeating pneumonia necessitates multi-sectoral action plans. Concerted action by the government, backed by civil society, corporates and communities can help save children’s lives, but we need to move fast. Looking at the threat that bad air is posing, it is imperative for the government to develop comprehensive national guidelines and multi-sectoral convergent action plans and ensure adequate resourcin. The complexity of interventionsplaces a premium on coordinated policy responses.

India has made remarkable progress. The Partnership for Maternal, Newborn and Child Health summit is to be hosted by India in December and this should hopefully bring rigour to commitments made under the SDGs vision 2030.

Pneumonia leaves desperately vulnerable children struggling, parents coping with anxiety and, all too often, the grief and trauma that comes with the loss. It is indefensible that we allow so many young lives to be destroyed by diseases when we have the knowledge and the resources to defeat them.

Bidisha Pillai is CEO, Save the Children

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