Tuesday, September 15, 2015

Choking to death whilst deliberating income inequality and health

Subramaniam and Kawachi's (2004) meta-analysis and research into the strength of association between income inequality and health is at best inconclusive. In their paper, they say the relationship between the two is furthermore confounded by factors such as individual income, education, regional effects and potential lag effects.

Having lived in southern China for nearly two decades, I am not one to be easily sickened by bad air. During all those years, I was perhaps affected three or four times and each time, it took me around a month to get over a night cough.

But this week, plantation fires in Indonesia started deliberately by Big Business to slash and burn for the next planting season has blanketed Singapore and parts of Malaysia and Indonesia with a deadly, choking haze. The pollution index shot to as high as 250 PSI (pollution standard index), which is in the "very unhealthy" range. This means even healthy persons are advised to avoid prolonged outdoor activities while the elderly, pregnant mothers, children and people with underlying chronic heart and lung conditions are to avoid the outdoors entirely.

This cocktail of polluted air is deadly because it contains the following pollutants - sulphur dioxide (SO2), particulate matter (PM10) and fine particulate matter (PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). Of these, respirable suspended particulates are especially worrying.

What is a respirable suspended particulate?

Imagine the circumference or cross-section of the human hair. Now, a particulate matter of 10 microns, or PM10, would be a tiny dot inside this cross-section of the human hair -- just like the tip of your little finger within the circumference of your waist. That is how small a particulate measuring 10 microns is. So a particulate measuring 2.5 microns, or  PM2.5, is even smaller.

Suspended in the air, they are so fine that once you breathe them in, they lodge deep in your lungs pretty much forever, causing asthma, chronic bronchitis, even premature death in people with heart or lung disease. Prolonged exposure is known to cause stunting in lung growth in children.

As I sat at home reading Subramaniam and Kawachi's paper, I could smell the acrid burn of the Indonesian forests and feel a dull pain on both sides of my head. I slept that night with the air purifier on and woke up fine the next morning. Then I thought of my parents. I rang them and said I would pass them the air purifier. As I carried the machine to my parents' home that evening, I wondered how many people in this country would own this electrical appliance, which no longer is a luxury, but a need.

And even though Subramaniam and Kawachi think that income inequality does not have a conclusive association with health, do we really want to wait for what the experts find out next before we get one of these air purifiers?

Coming back to the CCA, when will we shake off this terrible, unmovable structural evil that Big Business has imposed on our part of the world? Year after year, and thanks to the culture of money-making, it has refused to listen and neither have the Indonesian and Singapore governments the agentic political will nor ability to put a stop to this. What can the little people do apart from buying air purifiers, which of course go to enrich Big Business once more?

References:

Subramanian, S. V., & Kawachi, I. (2004). Income inequality and health: what have we learned so far?. Epidemiologic reviews, 26(1), 78-91.
Uphoff, E. P., Cabieses, B., Wright, J., & Pickett, K. E. (2015). International prevalence rates of asthma and allergy are associated with income inequality. Journal of Allergy and Clinical Immunology.

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