EVERY year, the Global Initiative for Asthma decides on a theme for World Asthma Day. The organisation, which has increasing awareness on asthma as one of its main objectives, chose “Better Air, Better Breathing” as the theme for this year.
This theme is an acknowledgement of the fact that although asthma is often viewed as a condition affecting the individual, there are multiple external factors that need to be addressed to improve patient outcomes — in this case, the subject of air quality.
At its most basic level, asthma is a disease in which patients have hyper-reactive air passages. As individuals, you can control the condition with medicine and by avoiding triggers. Some triggers may be easy to avoid, such as the neighbour’s cat, but others are more difficult. In Malaysia, common triggers include cockroaches, dust mites, air conditioners, tobacco smoke and air pollution.
The latter two are arguably best addressed at a higher policy level. Tobacco smoke, which is essentially a form of air pollution, is best addressed by a holistic tobacco control policy that reduces the demand for tobacco as well as that of production, distribution, availability and supply. Tobacco is unique in that when used as intended, the consumer dies. Add the hundreds of millions of smokers worldwide and you get mass exhalation of thousands of chemicals that not only irritate the airways, but can cause coronary heart disease and emphysema.
There are local factors that contribute to poor air quality, such as traffic congestion, which can also be addressed by appropriate urban and developmental policies. Moving beyond, one can begin to appreciate the necessity for appropriate government policies when dealing with energy matters at a national level and the need for intergovernmental cooperation when addressing pollution at a global level.
One such issue that the world is struggling with is that of energy policy. Europe is committed to moving away from coal as a source of energy. Although the cheapest, coal is also the highest emitter of carbon dioxide. This contrasts with Japan, which is increasing its coal use following the recent safety concerns about their nuclear-derived energy sources.
The Energy Commission of Malaysia maintains a policy that prioritises affordability for the people. Almost 50 per cent of the total fuel mix in Peninsular Malaysia is from coal, with the commission aiming to increase this to two-thirds by 2025. On paper, this makes sense as coal is both cheap and abundant, but this comes with added environmental and health costs.
Government policies will not change if both the people and policymakers focus only on immediate financial costs. We tend to forget direct health-related financial costs of poor air quality, such as increased hospital admissions and use of medicine, as well as the indirect costs to the economy from loss of work productivity and days off from school, which affect working parents.
Poor air quality also affects children’s growth, robbing them of their full potential. And, we have not even touched on the cost to our environment and effect on climate change.
This illustrates the need to think beyond traditional silos when dealing with our health and the future. However, we have to start at a more basic level. Policies usually reflect society’s current thinking and, as such, education and awareness among the people need to be increased to induce a paradigm shift in our approach.
This brings us full circle back to the theme for this year’s World Asthma Day. As with any advocacy initiative, the goal is to create awareness and kick-start a discussion that will hopefully bear fruit. Although patients with asthma will undoubtedly have more short-term complications from poor air quality, the same issue affects all of us one way or another. It is high time we recognise clean air for what it is — a fundamental human right.
The writer is a consultant respiratory physician at Pantai Hospital Kuala Lumpur and co-founder of Asthma Malaysia, Malaysia’s first asthma
patient advocacy platform