Written by: Muhammad Harist Syahirul A’en, Firdha Laila Amalia, Debby Paramitasari
Worsening air quality has become a prominent threat to human health in recent years, becoming a critical environmental issue that poses severe health risks globally. Climate change results in unpredictable weather, such as prolonged dry seasons and warmer temperatures, exacerbating air pollution. Since the last decade, worsening air pollution has started to rise as a global problem, with developing countries with rapid industrial activities experiencing the worst conditions, such as India and China. Indonesia, a country with robust development in several sectors going at once, is also facing similar problems. As a developing country with robust transportation and industrial activities, Indonesia poses a great risk of increasing air pollution levels and a worsening tropical climate, which is the effect of climate change. Jakarta, a city surrounded by industrial areas and centres of metropolitan activities with a high traffic burden, is not unfamiliar with the issue of air pollution. A 2019 IQAir study revealed Jakarta's average annual PM2.5 concentration was 49.4 µg/m³, with the most polluted months spanning from May to October, which falls into dry seasons. Based on air quality monitoring by IQAir, Jakarta has been identified as one of the most polluted cities globally several times, with an instance on August 13, 2023, recording a US AQI of 172 (unhealthy) and PM2.5 concentrations reaching 90.4 µg/m³ which exceeding the national ambience threshold level of 55 mg/m3 for 24-hour.
Air pollution is a term frequently used to describe outdoor air pollution. Air pollution is characterised by the introduction of substances into ambient air through natural or anthropogenic phenomena. The effect of poor air quality lies beyond immediate health concerns. Common sources of outdoor air pollution exposed to humans range from transportation to industrial activity and effects from transboundary pollution. Outdoor activity during exercise or commuting allows high pollution exposure, posing a risk, especially for vulnerable groups, including people aged 65 or older and children. Children's lower body height poses a greater risk of pollution than adults due to the nature of some pollutant particles that stream into the lower part of the air due to their weight, resulting in higher concentrations of pollution (UNICEF, n.d.). Apart from outdoor or ambient air pollution, indoor air pollution also contributes significantly to adverse health effects. Indoor air pollution mostly occurs in households. Household air pollution is generated by inefficient and polluting fuels and technologies in the house, including small particles that penetrate deep into the lungs. In poorly ventilated areas, fine particles can exceed the acceptable level up to 100 times higher. Exposure is particularly high among children and children who spend a long time indoors (WHO, 2023). Cooking and smoking are listed as the biggest contributors to indoor pollution. Children are at significant risk from pollution both indoors and outdoors. Commuting and outdoor activities in the playground or park and indoor cooking activities constantly expose children to air pollution. In the long run, fine particle exposure, combined with inappropriate ventilation, might have an immediate and long-term adverse effect on the children's health.
In 2022, WHO announced air quality standards of 15 µg/m³ for particulate matter (PM2.5), 40 µg/m³ for sulphur dioxide (SO2), and 25 µg/m³ for nitrogen dioxide (NO2) for 24-hour exposure. Exposure to concentration above the standard might pose serious health risks to humans. However, due to the circumstances of countries, setting the national standard to match the WHO standard is subject to multisector consideration. Exposure to harmful pollutants like PM2.5, NO2, and SO2 has been linked to various diseases. According to the WHO, air pollution contributes to approximately 4.2 million premature deaths yearly. In Indonesia, the Health Effects Institute reports that air pollution was responsible for over 123.000 premature deaths in 2020 alone.
One of the most vulnerable populations to air pollution is children, whose developing lungs and immune systems make them particularly susceptible to adverse effects. More than 700.000 deaths in children under five years were linked to air pollution in 2021, which contributes to 15% of all global deaths in children under five. Studies have shown that children exposed to polluted air experience increased rates of asthma, bronchitis, and pneumonia. In Jakarta, a study found that 45% of school-aged children suffer from respiratory problems related to air pollution. The effects of air pollution on health can be both acute and chronic.
Exposure can cause acute symptoms like coughing, wheezing, and shortness of breath in the short term. Long-term exposure, however, poses even greater risks of noncommunicable diseases (NCDs), including chronic respiratory diseases, cardiovascular issues, lung cancer, and developmental disorders (stunting) in children (Syuhada et al., 2023). Prolonged exposure to pollutants has also been linked to reduced cognitive development and dementia in later life (Chandra et al., 2022). The higher rates of NCDs will increase the disease burden, leading to productivity loss and increased healthcare expenditures. For instance, BPJS Kesehatan bears the burden of financing NCDs amounting to IDR 24.05 trillion, which will undoubtedly increase if air pollution issues are not addressed (Muhamad, 2023).
A study in Jakarta even showed that the annual economic cost of health impact attributable to air pollution reached approximately USD 2943.42 million (Syuhada et al., 2023). Addressing air pollution is crucial for safeguarding public health and a critical economic and social priority to ensure a healthier and more productive future generation, especially for vulnerable populations like children.
Air pollution-related diseases pose a significant health threat, especially to children, requiring a multi-faceted approach for effective mitigation. In Indonesia, tackling these diseases involves improving air quality monitoring, implementing stricter environmental regulations, and raising public awareness. The government has introduced policies such as the National Action Plan for Greenhouse Gas Emissions Reduction and PROPER (Program Penilaian Peringkat Kinerja Perusahaan dalam Pengelolaan Lingkungan Hidup) to reduce emissions from industrial sources and promote sustainable practices (BRIN, 2024; KLHK, 2021).
To combat the impact on children, Indonesia has also implemented the Clean Air Programme and the Adiwiyata Programme in schools to educate students about pollution and encourage eco-friendly practices. However, a more actionable strategy for reducing air pollution's impact on children should be taken. For instance, improving indoor air quality can be attained by promoting the use of air purifiers, installing exhaust fans to improve ventilation, prohibiting smoking indoors, and using cleaner fuel for cooking. While most of the action for improving indoor air quality could be done individually, outdoor air quality faces more complex issues. While using public transportation and enhancing green spaces might improve ambient air quality, more factors are considered, such as weather and worsening climate problems.
Mitigative actions should be considered more to lessen children's exposure to air pollution. Robust air quality monitoring systems should be implemented, and sufficient early warning systems should be provided to improve mitigation actions and to help recommend citizens, especially when conducting outdoor activities. Recommendations on mask usage for outdoor activities and advice prohibiting outdoor activities or opening windows when the air quality passes a certain level could be examples of proper integration in utilising monitoring results for mitigation actions through early warning systems. Due to the nature of children's activities, monitoring air quality in education facilities, playgrounds, and residential areas is advisable. At the policy level, besides the aforementioned government programs, which heavily focus on emissions and air pollution, the government should enforce air quality standards monitoring on public spaces and enhance health surveillance systems to track pollution levels and associated health outcomes. Regular data tracking on children's respiratory problems and other air pollution-related diseases would help analyse the causal effects of air quality levels on children and provide data for formulating accurate precautions. Education on air pollution for parents and facilities frequented by children, such as schools and daycare, should also be provided. Multisectoral collaboration is required to address this issue, and collaborating with international bodies, non-governmental organisations, research institutions, healthcare providers, educational practitioners, and civil society groups to adopt best practices is essential. By fostering partnerships between policymakers, healthcare providers, and communities, the air pollution problems can be tackled more effectively and protect vulnerable populations, particularly children, from adverse health effects.
References
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Chandra, M., Rai, C. B., Kumari, N., Sandhu, V. K., Chandra, K., Krishna, M., Kota, S. H., Anand, K. S., & Oudin, A. (2022). Air Pollution and Cognitive Impairment across the Life Course in Humans: A Systematic Review with Specific Focus on Income Level of Study Area. International Journal of Environmental Research and Public Health, 19(3), 1405. https://doi.org/10.3390/ijerph19031405
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Muhamad, N. (2023, March 7). BPJS Kesehatan Kucurkan Rp24 Triliun untuk Penyakit Katastropik pada 2022. https://databoks.katadata.co.id/datapublish/2023/07/03/bpjs-kesehatan-kucurkan-rp24-triliun-untuk-penyakit-katastropik-pada-2022
Syuhada, G., Akbar, A., Hardiawan, D., Pun, V., Darmawan, A., Heryati, S. H. A., Siregar, A. Y. M., Kusuma, R. R., Driejana, R., Ingole, V., Kass, D., & Mehta, S. (2023). Impacts of air pollution on health and cost of illness in Jakarta, Indonesia. International Journal of Environmental Research and Public Health, 20(4), 2916. https://doi.org/10.3390/ijerph20042916
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WHO. (2022, December 19). Ambient (outdoor) air pollution. https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health
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