8 Pollution and Public Health
8 Pollution and Public Health
- Daniel K. Gardner
What Are the Major Health Consequences of Air, Water, and Soil Pollution?
When the smog settles in, coughing, wheezing, watering of the eyes, and shortness of breath are common, but these are relatively benign effects of air pollution. More serious respiratory problems associated with exposure to polluted air include asthma, bronchitis, pneumonia, and chronic obstructive pulmonary disease. It is now known, too, that long-term exposure to fine particulate matter (PM2.5) in polluted air results in an increased risk of lung cancer and cardiovascular disease.
Staying indoors is no guarantee of protection against pollutants. According to the Wall Street Journal, a report released in December 2015 based on a study of 160 office buildings in Beijing found that indoor air quality in 90% of the city’s offices is no better than the outdoor air quality.1 (The same study found that 75% of the PM2.5 in the outside air makes its way indoors.) Room air filters (costing $500 or more) have become the appliance of choice for affluent urban dwellers. On social media sites, netizens frequently discuss topics like whether it is better to open windows or keep them shut, at what times of day to allow outside air in, which air filters are most effective, and where to buy inexpensive PM2.5 monitors.
p. 106↵The air inside rural homes can be particularly toxic, as many villagers use low-quality, high-polluting, solid charcoal briquettes for heating and cooking. Despite a government subsidy program, beginning in 2004, to outfit rural homes with ventilating chimneys, many homes still lack them, so residents inhale the smoke from the burning coal, and the pollutants are deposited on the food.
Moreover, the coal used by the villagers in some regions of the country has a high content of fluorine, which is then released into the air or deposited on the food. Data from rural Shaanxi, for example, show that fluorine levels inside homes are up to 97 times the legal standard, leading to a high incidence of dental and skeletal fluorosis, which results in damaged and broken teeth and bones. In some regions the coal contains high levels of arsenic, which is released into the air when the coal is burned. Arsenic poisoning is linked to cancer and neurological disease as well as to digestive and urinary problems. Again in Shaanxi, a 2001–2003 study concluded that the coal burned there had five times the allowable level of arsenic, and in southern Guizhou province, 38,000 cases of arsenic poisoning related to coal have been confirmed.2
Exposure to China’s contaminated water presents a different range of health risks: typhoid, malaria, diarrhea, lead and mercury poisoning, intestinal parasites, and digestive cancers. Cases of typhoid, diarrhea, and intestinal parasites (e.g., schistosomiasis) are especially widespread in the warm region of south China. While the incidence of malaria has declined dramatically, from 24 million cases in the late 1970s to just tens of thousands today, it remains endemic in southern and central China, particularly in Yunnan and Hainan provinces. Digestive cancers—esophageal, liver, stomach, and bladder—have become the leading cause of death in rural China. Without ready access to piped water, villagers draw their drinking, cooking, and irrigation water directly from local streams, rivers, and lakes. Scientists believe that the metals, agrochemicals, pharmaceuticals, human and animal waste, p. 107↵and other pollutants in these water sources are largely responsible for the cancer blight spreading in China’s countryside.
Eating food grown in soil contaminated with heavy metals (e.g., cadmium, arsenic, mercury, and lead), petrochemicals, pesticides and fertilizers, and animal and human waste can likewise lead to digestive cancers—as well as to renal disease, osteoporosis, neurological damage, and a variety of other cancers.
Exposure to and contact with contaminated soil can lead to an assortment of human health problems. In one recent, widely publicized case, CCTV (China Central Television) reported that nearly 500 students at an elementary school in Changzhou (in Jiangsu province) had come down with illnesses ranging from bronchitis and eczema to lymphoma and leukemia; investigators suggested that the illnesses were linked to high concentrations of toxins found in the soil around the school, which had recently moved to a site near where three chemical plants used to operate.3
What Are “Cancer Villages”?
In February 2013 China’s Ministry of Environmental Protection issued a document stating, “In recent years, toxic and hazardous chemical pollution has caused many environmental disasters, cutting off drinking water supplies, and even leading to severe health and social problems such as the emergence of cancer villages.”4 This was the first admission ever by the Chinese government that “cancer villages” existed, although journalists and environmentalists had been writing and speaking about the phenomenon since 2001.
A cancer village is a village where the incidence of cancer is abnormally high. There are now thought to be roughly 500 of them throughout China (Figure 8.1). Most are located in the eastern part of the country, along the major rivers—the Yellow, the Huai, and the Yangtze—and their tributaries, and there are a number in the south as well, in the Pearl River delta p. 108↵area. It is along these waterways that tens of thousands of tanneries, paper mills, chemical plants, textile factories, food manufacturers, and other industries have cropped up since the 1980s, releasing into the surrounding air, soil, and water a wide variety of pollutants that the villagers believe to be the cause of their cancer. Wastewater discharge into nearby water systems is the most common source of cancer, as villagers often draw their drinking and cooking water directly from these sources. That same wastewater can also seep into adjacent fields where crops are grown and livestock graze. Foodstuffs contaminated by the polluted water are thus another source of the cancer.
For almost two decades now villagers have been lodging complaints with government officials against factories they hold responsible for the spread of the disease. But officials have not been especially responsive, partly because these p. 109↵factories contribute to the local economy and partly because it is difficult to draw a causal connection between one particular factory (there may be many of them in the general vicinity spewing various chemicals into the stream or river) and the rash of cancer cases in the village. As Wu Yixu, a toxins campaigner for Greenpeace, noted, “You need to establish the fact that it’s a certain chemical that’s causing certain cancers, and this chemical is being discharged from this very factory.”5
Stricken villages suffer from more than the cancer alone. The toxins in the water and soil make their produce unfit for sale, thereby leaving the inhabitants without a livelihood. Poor and diseased, these villages desperately require aid. In recent years, nongovernmental organizations have been active in focusing the public’s and state’s attention on their plight (see Chapter 10). But it is unclear whether, in the end, the government will, or can, institute an effective, targeted remediation program for the hundreds of cancer villages.
What is clear is that the state thus far has been considerably more attentive to the problems associated with urban pollution. Cleaning up the cities has been the first line of attack in Beijing’s “war on pollution.” But even should the government aggressively take its war on pollution to the villages, the question is this: Will those factories and industries that are shuttered simply move their operations farther inland and set up shop elsewhere? That is, will the cancer-inducing pollution simply be outsourced to poorer “pollution havens” to the west?
Is Food Safety an Issue in China?
Food safety has become a serious concern. As we have seen, 71% of the respondents in the 2015 PEW survey said food safety was either a “very big problem” (32%) or a “moderately big problem” (39%). In 2008, just five years earlier, only 12% of the respondents had seen it as “very big problem.” High-profile scandals—melamine-laced infant formula in 2008, gutter oil p. 110↵in 2011, and the 40-year-old frozen meat in 2015—account for some of the mistrust on the part of the Chinese public.
But such sensational “additive” scandals aside, the public has become increasingly aware that food processing involves a series of steps, and that foodstuffs can become contaminated in any of the steps along the way. Improper application of agrochemicals, fertilizers, and pesticides can result in unsafe compounds in food products. Water used to grow the food can be contaminated with untreated sewage that enters the waterways from local villages, contributing to the transmission of foodborne diseases. Industrial pollutants—heavy metals and chemicals (e.g., cadmium, lead, iron, chromium)—in the water systems and soil can taint the food supply and pose a considerable hazard to human health. The water used in processing and preparing the food can transmit harmful microorganisms and chemical pollutants. It is such worries over the quality of food that help explain the growing popularity of organic farming and the preference, among those who can afford it, for purchasing foodstuffs that have been produced outside of the country.
The government has introduced important measures to safeguard the country’s food supply, most notably the 2009 Food Safety Law. But implementation of food-quality standards is challenging and progress has been slow—owing both to the lack of coordination among the national, provincial, and local government authorities and the enormous size of the country’s food industry. A Lancet study calculated that there are more than 450,000 food-production and food-processing companies in China, and that 350,000 are small operations with fewer than 10 employees.6
What Are Some Recent, Notable Health-Related Findings?
In 2014, 60% of China’s groundwater was found to be unsafe for drinking (or even touching).
On a scale of 0 to 500, with 300 to 500 representing hazardous air and above 500 representing “beyond index,” many p. 111↵cities in China, including Beijing, Shanghai, Harbin, Taiyuan, and Shijiazhuang, have recorded levels as high as 1,000, 40 times higher than the standard (25) deemed safe to breathe by the WHO.
In 2012 the Institute for Health Metrics and Evaluation released the influential Global Burden of Disease Study 2010, which found that in 2010 alone 1.2 million people in China died prematurely from exposure to “ambient particulate matter pollution” and 1.1 million people died prematurely from exposure to “household air pollution from solid fuels.” A later assessment by Berkeley Earth concluded that 1.6 million people in China died annually (4,400 each day) from health problems related to outdoor air pollution. Still another study, done this time by the Max Planck Institute and published in Nature in 2015, put the number of annual premature deaths from ambient air pollution in China at 1.4 million.7 According to research by Teng Fei, a professor at Tsinghua University, the particulate matter emitted by coal combustion alone was responsible for 670,000 premature deaths in 2012.8
In the past 30 years, the death rate from lung cancer in China has increased 465%. Most of the increase, according to medical studies, is due to exposure to air pollution. A 2015 Greenpeace–Beijing University study of the mainland’s 31 municipalities and provincial capitals found that in 2013 people were as likely to die from breathing the air as from smoking cigarettes. Of every 100,000 deaths, 90 were attributable to PM2.5.9 In 2013, the WHO’s International Agency for Research on Cancer announced that because there is “sufficient evidence that exposure to outdoor air pollution causes lung cancer,” it is now classifying both outdoor air pollution and PM2.5 as “carcinogenic to humans.”
In 2013, an international team of researchers published an influential study showing that because north China over the years 1981–2000 was more dependent on coal than the south (for heating during the winter), particulate matter levels there were significantly higher; and as a consequence, the life p. 112↵expectancy of people living in the north was a stunning 5.5 fewer years than their counterparts in the south.10
A Duke University study in 2016 found that rats exposed to Beijing’s polluted air had a much higher risk for obesity and diabetes than rats not exposed to the air. After only 19 days, the exposed rats had 50% higher LDL cholesterol, 46% higher triglycerides, and 97% higher total cholesterol; their insulin resistance level, a precursor to type 2 diabetes, was also higher. After 8 weeks of exposure, male rats were 18% heavier and female rats 10% heavier than their counterparts breathing clean air. “If translated and verified in humans, these findings will support the urgent need to reduce air pollution, given the growing burden of obesity in today’s highly polluted world,” said Junfeng Zhang, the lead author of the study.11
In the city of Guiyu in Guangdong province, the e-waste capital of China, the melting of lead solder off circuit boards has resulted in an epidemic of lead poisoning. Over 80% of the children there have tested positive for the harmful disease.
In May 2013, officials in Guangzhou, one of China’s largest and most prosperous cities, informed the public that 44% of rice samples sold throughout the city contained dangerous levels of the metal cadmium.
He Dongxian, an associate professor at China Agricultural University, said her studies show that when thick smog settles over Beijing, so much sunlight is blocked that plant photosynthesis is slowed and crop growth is stunted. She concluded that, on a larger scale, photosynthesis-impeding smog could reduce the nation’s food supply, warning that if the air pollution continues or intensifies, China’s agriculture would face conditions “somewhat similar to a nuclear winter.”12
What Measures Do China’s Residents Take to Protect Themselves from the Health Effects of Pollution?
The first thing many residents in China do when they awaken is to consult one of the many air-quality index apps available p. 113↵on mobile devices. For some, the air-quality reading helps determine what they do that day. Will they leave the house? Will they let their kids play outside? Will they bike to work or take another mode of transportation? Will they jog? Will they swim outdoors or indoors? Will they wear a facemask?
Increasingly, residents own room air filters and run them when pollution levels are high. High-end residential and commercial builders have installed whole-building filtration systems to attract potential buyers. Likewise, high-end car manufacturers tout the benefits of innovative air-filtration systems in reducing the particulate matter in the cabin of the car. The chairman of Geely, Volvo’s parent company, stated in an interview on Chinese television, “Volvo’s interior air quality system provides you with an air quality inside the car as good as that of Northern Europe while the outside is as bad as that of Beijing.”13 Affluent parents are sending their children to schools that have built $5 million inflatable domes that enclose the playgrounds and filter the air.
Boiling drinking water is a standard practice throughout China, whether in the cities or the countryside. Boiling vaporizes the microorganisms in polluted water but does not affect the toxic metal content. Because water drawn directly from streams, rivers, and lakes tends to have an especially high content of chemicals and heavy metals, those who drink it are especially vulnerable to toxic buildup in the body. Water drawn from the tap (72% of the country’s drinking water) has typically gone through a process that filters out most of the microbial matter but is less effective in removing the heavy metals. People can install water-filtering systems in their homes (usually attached directly to the tap); they can install water-storage tanks and subscribe to a water-delivery service; or they can purchase bottled water at the local convenience store or the supermarket. All of this is costly and does not completely eliminate the risk: people have been told by the government that 50% of Beijing’s bottled water is counterfeit, simply drawn from the tap.
p. 114↵In a country where water scarcity is already at a critical point, the prospect of a more affluent China turning in greater numbers to bottled water is unwelcome. Production of bottled water is energy- and water-intensive: three extra bottles of water and a quarter-bottle of oil are required to produce one bottle of drinking water. Already China has surpassed the United States as the world’s leading consumer of bottled water (15% of the bottled water worldwide). In 1997, China consumed 2.8 million cubic meters of bottled water; in 2013, that number was 39.5 million. And in the last five years, sales of bottled water have doubled.
Water safety concerns, thus, are inexorably leading to a crisis of water security. China Water Risk, a nongovernmental organization based in Hong Kong, has done some outstanding work highlighting the problems surrounding the consumption and production of bottled water in China.14
As we have seen, the Chinese people are increasingly concerned about the safety of their food and have been turning to organically raised crops and meat. China is now the fourth largest consumer of organic products in the world. Urban farming has also become popular: city dwellers have begun converting their balconies and rooftops into gardens for growing their own green beans, tomatoes, cabbage, eggplants, herbs, and so on. Observers note that in the big cities, imported-food stores have proliferated; while as recently as 5 to 10 years ago they catered largely to foreigners, today they are filled with Chinese patrons. These recent changes are all attributable to worries over food safety.
In recent years, there has been a steady retreat of urbanites moving from large cities to smaller towns and villages—where the sky is bluer and the water clearer—in places like Yunnan province in southwestern China. Surveys indicate that the rich especially are eager to move. Emigrating abroad is increasingly popular: a 2014 survey by Hurun Reports found that 64% of Chinese millionaires have already emigrated to other countries or are eager to do so. Two of the most frequent reasons p. 115↵cited for leaving or wishing to leave were pollution and food safety (though I suspect that protecting their wealth is at least as strong a factor).15
Does Pollution Affect Different Populations Differently?
The study of how different populations in China are affected by environmental pollution is in its early stages and needs further study. Preliminary research, however, indicates the following.
Rural dwellers have far less access to filtered tap water than urban dwellers, and their surface water has a much higher content of heavy metals and chemicals. Experts believe that enforcement of water standards has been much less rigorous in rural areas than in urban areas, because (1) rural populations have been less environmentally demanding and (2) rural officials have been slower to impose regulations that might hurt the local economy. This helps explain the “cancer village” phenomenon and the high incidence of diarrheal diseases and waterborne parasites in villages. It also explains why digestive cancers are more frequent in the countryside and why lung cancer, from exposure to air pollution, is more common in the cities.
There is a marked disparity between rural and urban areas in the availability of medical professionals and hospital care. In cities there are three physicians for every 1,000 people, but in rural areas there is just one.16 In cities there are 6.24 inpatient beds for every 1,000 people, but in rural areas there are just 2.80.17
The hukou registration system, instituted in the 1950s to limit migration from countryside to city, is another source of environmental inequality. In the hukou system, each individual in China is given either a rural residency card or an urban residency card. In the past 30 years, rural residents have moved to the cities in large numbers because of job opportunities, especially in construction work and factories. However, while they p. 116↵may work and reside in cities, they are not entitled to the same employment, educational, health, and social welfare benefits provided to those who have an urban hukou. They live as “migrant workers,” a decided subclass of the urban population in China. Even though they are a subclass, the migrants number over 250 million, almost, but not quite, the entire population of the United States. Studies have shown that they tend to live on the urban fringes, in cheaper places where heavily polluting industries and power plants are more likely to be located; thus, the migrants are more susceptible to the harmful effects of air and water pollution.18
Similarly, well-off Chinese generally suffer less from the ill effects of pollution than the poor. They can more readily afford health care—doctor visits, hospital stays, and medications. They can equip their homes and workplaces with air-filtration devices. They can live in neighborhoods farther away from coal-fired power plants, incinerators, and landfills. And their jobs are typically white collar, in offices, rather than outdoors on construction sites or farms or indoors in bleak factories. They are more likely to heat their stoves and homes with electricity rather than with solid coal briquettes or wood. And they can afford to send their children to schools where the quality of the air and water is safeguarded.
The old and the young are especially susceptible to some of the hazards of environmental pollution. For instance, preliminary studies indicate that people over 50 are considerably more likely than any other group to die prematurely from respiratory and cardiovascular diseases associated with air pollution. Older women living in areas with excessive levels of PM2.5 may be more likely to experience cognitive decline and to develop dementia.19
Children, because they spend more time outdoors and because their immune systems are still undeveloped, are especially vulnerable to asthma and acute respiratory disease. Evidence also indicates that air pollution compromises the p. 117↵neurocognitive development of children.20 Finally, while diarrhea is a common disease throughout China, the morbidity and mortality rates for children under five years old are particularly high, as they are in most low-income and middle-income countries.21