What Are We Breathing?

By Tyrone G. Bristol, MD, MPH, FAAP

When it comes to the air quality in Chinese metropolises like Beijing, Shanghai and Guangzhou, there are things we know and many things we don't! Yes, sometimes we wake up to a hazy sky, thick with choking air and wonder if we dare go outside. But fair is fair, we can't deny that pleasant evenings of clear blue sky, light air and easy respirations happen too. So, is the air ok to breathe or not? Well, it depends…

According to the World Health Organization (WHO), clean air is considered to be a basic requirement of human health and well-being. However, air pollution continues to pose a significant threat to health worldwide. More than 2 million premature deaths occur each year that can be directly attributed to the effects of outdoor and indoor air pollution. More than half of those affected by this degree of pollution live in developing countries such as China.

In parts of the Asia Pacific region – such as New Zealand, Australia and Singapore – 5% of the population uses solid fuels, compared to over 80% in China. Despite this staggering statistic, much has been done to improve the air quality in China over the last few years. For example, a 10% reduction in the total discharge of major pollutants by 2010 is just one of the many goals that China has set.

The effects of pollution and poor air quality on human health are complex. Generally speaking, air pollution directly affects the body's respiratory and cardiovascular systems. However, recognizing the complexities, the WHO emphasizes that reactions to air pollutants depend on the type and degree of exposure as well as the individual's age and health. In short, air pollution can affect people in different ways.

In China, suspended particulate matter from construction, fuel emissions and combustion has the biggest impact on health. As is the case with many developing countries, suspended particles in outdoor urban areas of Shanghai and Beijing, for example, are much higher than that recommended by the WHO. Indoor pollutants such as tobacco smoke, biological sources like pollen, mites, molds and pet allergens, emissions from indoor materials such as organic compounds, lead and various synthetic chemicals, and finally combustion emissions are also a major health concern.

We cannot control the general quality of the air, but we can try to avoid excess exposure to pollutants. Modern urban life can cause us to remain indoors more than out, so decreasing the amount of dust mites and mold indoors can result in important health benefits. Avoiding tobacco smoke, both first and second-hand, is another easy tip to follow. Children or adults with mild asthma can have severe reactions to smoke exposure of any kind. Air purifiers can also help if poor indoor air quality is causing respiratory problems.

For numerous reasons, outdoor air quality varies from day to day (e.g. smoggy one day and clear the next). One simple step you can take is to try and limit outdoor activities during "smoggy" or heavily polluted days. While looking out the window is a good indication of pollution levels, you can also visit http://english.mep.gov.cn, the website of the China Ministry of Environmental Protection, which lists daily air quality measurements and other such information. This site also keeps historical data, which is good if you are unsure or worried about past exposure on a particular day.

The reality is that exposure to air pollutants is largely beyond the control of individuals. However, conscientious decisions about the use of transportation and the types of appliances being purchased and used can give us some control over "our air." Making a few small adjustments on our part can significantly improve the air we breathe.


Tyrone G. Bristol, MD, MPH, FAAP
Chief Medical Officer, Pediatrician
Shanghai United Family Hospital & Clinics