'Choked' By Air Pollution: An Invisible Consequence Of Climate Change

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"Choked: Life and Breath in the Age of Air Pollution" by Beth Gardiner (Allison Hagan/Here & Now)
"Choked: Life and Breath in the Age of Air Pollution" by Beth Gardiner (Allison Hagan/Here & Now)

This story is part of "Covering Climate Now," a week-long global initiative of over 250 news outlets.

On top of rising sea levels, intense hurricanes and massive wildfires, climate change is also making it harder for us to breathe.

The World Health Organization estimates that air pollution kills about 7 million people a year across the world, and climate change could make it much worse.

Air pollution and climate change are distinct issues, but they are also deeply connected, writes author Beth Gardiner in her book, “Choked: Life and Breath in the Age of Air Pollution

“They are both symptoms of the same thing, which is this unhealthy foundation we've built our modern world on: fossil fuels,” she says. “The causes of air pollution and climate change overlap to a very large degree. This is all the stuff that we're burning.”

Burning fossil fuels is not only causing climate change, Gardiner says it’s also killing millions of people by polluting the air we breathe.

“The flip side is that the things we need to be doing anyway — getting off fossil fuels in order to sort of try to ensure a stable climate — that those things will make people healthier and literally save lives right now,” she says.

Interview Highlights 

On the impact of burning coal at home in Poland 

“That was something that I saw very powerfully in Poland. It's not the only place where people do that, but that was the place that I chose to focus my coal chapter on. And what I saw there is that certainly, coal-fired power plants are not in any way compatible with clean air. And actually even more sort of egregious and horrible pollution source is coal that people are burning at home for heat. And that's because they tend to get a dirtier grade of coal, cheaper coal than is available to big energy companies. It's a sort of lower-tech system to just have like a furnace in your home. It burns at a lower temperature. So in Polish cities and in the Polish countryside, in the wintertime you just feel and see and smell this very, very heavy, thick, black smoke and it has a devastating effect on people's health.

“Having said that though Kraków is a city that is actually taking steps to change it. And when I was there a few years ago reporting on this ban that had just been passed on home burning of coal, it's now coming into effect this winter. I think it's likely to bring some relief to people there.”

On why burning wood is also harmful to the environment 

Author Beth Gardiner (Photo by Suzanne Plunkett)
Author Beth Gardiner (Photo by Suzanne Plunkett)

“That was something that really surprised me actually as I discovered it in the course of researching the book. I think, like many people, I had this notion of wood as sort of natural and a wood fire is cozy and lovely, and certainly it's not anything as pernicious as a fuel like coal might be. From a climate perspective, wood has been sort of talked about a lot and sold to people in recent years as kind of carbon-neutral, climate-friendly source of particularly heat. Those claims it turns out are very questionable when you start to look at them. Wood can be carbon neutral in the sense that if you replant the tree, you're recapturing the carbon that was released. But at the same time, the conditions to actually make that really be true are, you know, you'd almost need to be burning the wood under absolutely perfect conditions that rarely happen in the real world. And meanwhile, wood smoke is very very thick with these tiny pollution particles that are very very damaging to our health and that are linked to illnesses from strokes, heart attacks, dementia to premature birth and right up to premature death.”

On comparing levels of air pollution across the world

“I mean in some sense, when it comes to air pollution, we're all offenders and we're all victims. I mean we all use fuel, we all use energy for getting where we need to go and turning on the lights and all of that. And that's true whether you're in China or India or the United States. China and India are less developed countries. India obviously, much less developed than China, so they are in a phase of their development where they're dependent on much dirtier fuels.”

On high levels of air pollution in India and China 

“India is struggling with really devastating levels of air pollution. And obviously this has [an] impact on the climate as well because many of these fuels are also carbon emitters. But the human impact in India is really horrific. Upwards of a million and a half Indians die every year from the effects of air pollution. And I think India on the latest World Health Organization ranking had nine or 10 out of the 15 most polluted cities in the world. China, on the other hand, while still struggling with a really serious air quality problem is making some pretty serious progress. And there's been really significant declines, I think 40 percent or something like that, in the last eight or so years in Beijing, improvement in air quality.

“Obviously, coal has powered [China’s] heavy industry that has turned Chinese manufacturing into such a powerful force globally. But what we have seen over the last few years is the government kind of starting to react to the fact that Chinese people, particularly the urban middle classes, have really been getting increasingly concerned and increasingly angry about the way that all this pollution is impacting their health. There started to be some response. The government's been imposing regional coal caps. It's always sort of a dance between jobs and economy and pollution, but there's been a real trajectory towards cleaner air and that has significant climate implications as well because China is on track to meet their carbon reduction pledges, which they made under the Paris climate agreement, well ahead of schedule. They had promised 2030 for beginning of plateauing of their carbon emissions, and they're likely to hit that more like the early 2020s.”

On if cities will become more polluted over time 

“Well you know it's a little bit hard to predict, I think, and it depends a lot on the choices that we make now. There are solutions. Air pollution is not in any way inevitable. It is not something that we just have to live with as a byproduct of sort of development and prosperity. And I think what you're starting to hear more and more now is a growing awareness of the need to move away from fossil fuels and towards cleaner fuels altogether: solar power, wind power, other renewable sources of energy. So I think that the coming together of those two sort-of pressing needs for better health and for trying to stabilize the climate do present a motivation to governments and businesses and individuals who are trying to confront both of these problems together.”

Book Excerpt: "Choked"

By Beth Gardiner

Inhale: The Meaning of a Breath

A human breath begins in the deepest reaches of the brain, where — far beneath consciousness — the body’s most basic and essential functions are regulated. Just above the point where the spine meets the skull, tiny receptors detect rising levels of carbon dioxide, then stimulate nearby clumps of neurons. Between 12 and 20 times a minute, perhaps 20,000 times a day, millions of times a year, over and over and over again from the first cry of birth until the very last moment of life, those neurons fire signals ordering the muscles of the diaphragm and rib cage to contract.

Message received, the dome-shaped diaphragm flattens, and the ribs move upward and out. As the chest cavity expands, the pressure within drops, drawing air through the nose and mouth. Down the back of the throat, over the voice box, it follows its path deeper and deeper into the body.

To the naked eye, the lungs are unremarkable hunks of spongy pink tissue. Only when they inflate, puffing up like balloons, but faster and more dramatically, does their uniqueness become apparent. In the stylized illustrations of medical textbooks, a lung looks like an upside-down tree, a symmetrical maze whose branches get smaller and smaller as they divide into more than a million tiny twigs.

It’s up close that the structure’s elegant intricacy comes into focus. Hunched over his microscope, the seventeenth-century Italian anatomist Marcello Malpighi was the first to get a glimpse. Until then, the best medical minds believed air mixed directly with blood inside the lung. What Malpighi discovered is now a biological commonplace, taught to middle schoolers: Inhaled air fills sacs that cluster at the airways’ ends like miniature bunches of grapes. There are some 300 million of these alveoli in a pair of lungs, and their surface area is often likened, in total, to the size of a tennis court. Separated from them by membranes one one-hundredth as thick as a hair, tiny capillaries carry blood low in oxygen and laden with carbon dioxide. The gases rush across the barrier, and oxygen molecules bind to hemoglobin, then whoosh toward the heart, ready to be delivered wherever they are needed.

Like so much about the body, a breath is at once astonishingly simple and magnificently complex, delicately balanced yet highly resilient. Unlike other essential functions, the beating of the heart or the peristalsis of digestion, breath can also be controlled by the conscious mind, when we laugh or speak or hold it in to dive underwater.

The lung, too, is a point of vulnerability. While it has its defenses—the mucus that traps some contaminants, the hairlike cilia that sweep away others—this is the place where the outside world makes its way into the very center of the body, barriers left far behind as the air and whatever it carries come within a whisper of the bloodstream.

Lacking microscopes and an understanding of air’s composition, the ancients struggled to grasp the hows and whys of a function they could plainly see was essential. Aristotle, a physician’s son, believed breathing released heat generated by the vital fires of the soul. It would take millennia to definitively correct such misconceptions, but there was one fact the philosopher and his contemporaries understood well: Our very existence depends upon air. “The last act when life comes to a close is the letting out of the breath,” wrote Aristotle. “And hence, its admission must have been the beginning.”


I didn’t think much about the meaning or mechanics of breath when I was growing up. Until I was five, I lived in Fort Lee, New Jersey, in an apartment building overlooking the entrance to the George Washington Bridge. It was, and still is, a notorious traffic choke point, where the New Jersey Turnpike and a tangle of other highways merge into one. Suburbanites commuting to offices in New York sit bumper to bumper with trucks rolling north along the I-95 East Coast corridor, waiting to cross into the city. This was the early 1970s, the dawn of environmental consciousness, a time when American cars were exponentially dirtier than today, their fuel tainted with lead, sulfur, and other dangerous toxins. Along with my peers — the Jennifers, Davids, and Lisas who lived in the building too — I breathed it all in as we ran and jumped in the concrete playground out back.

Years later, in my twenties, I watched crosstown buses lurch by a few stories below my Manhattan apartment, heading into and out of Central Park. When I cleaned, the soot that coated the windowsill blackened big wads of paper towels. It took several goings-over, and a lot of soapy spray, to get the paint on the sill white again.

At 30, I moved to London with the charming Brit who’d stolen my heart. For 18 years, more than half of them with our chatty, energetic daughter, we’ve breathed the diesel fumes that foul the city’s air. London’s pollution is just one piece of a health disaster playing out across Europe, belying the continent’s reputation for environmental progressivism. I can smell the exhaust when I’m out running errands, meeting a friend for coffee, or walking Anna to school, clouds of it billowing into our faces. After a few minutes on a busy road, I often have a mild headache.

For a long time, I saw that awful air as just an annoyance. But as I’ve come to understand pollution’s profound effects on the human body, it’s grown into something more: the focus of nagging worry, a fear for my daughter’s well-being, and my own.

I try my best to protect her, of course. But I can’t change the air that surrounds us, nor wish away our city’s diesel mess. So I find myself veering from anxiety to anger. Landing sometimes, too, at a willful blocking out of the danger, as a parent’s urge to shield a vulnerable child tugs against the reality of an individual’s powerlessness in the face of larger forces. It’s that back-and-forth pull of emotions that set me on the path to writing this book.

What I’ve found since is that the taint my family and I breathe is only one strand of a far bigger story. Around the world, from Fort Lee to Frankfurt, Karachi to California, dirty air causes 7 million early deaths annually, more than AIDS, diabetes, and traffic accidents combined, making it the single biggest environmental threat to health. More than 40 percent of Americans breathe unhealthy levels of pollution. In Britain, air pollution is second only to smoking as a health risk, causing as many as a fifth of all deaths in my adopted hometown. Across Europe, it kills more than 15 times as many people as car crashes. Nothing is as elemental, as essential to human life, as the air we breathe. Yet around the world, in rich countries and poor ones, it is quietly poisoning us.

It’s not just the obvious ailments like asthma and bronchitis. Over the past decade and a half, scientists’ understanding of air pollution’s harms has advanced rapidly, and a powerful body of evidence now links it to a long and growing list of health woes, including heart attacks, strokes, birth defects, many kinds of cancer, dementia, diabetes, and Parkinson’s disease.

Not far from where I grew up, and many years later, researchers took advantage of the natural experiment created when highways in New Jersey and Pennsylvania replaced the old- fashioned tollbooths where we used to hand cash to an attendant or toss coins into a basket with the high-tech kind that charge the fee electronically as you zoom past. The switchover dramatically reduced backups at the collection points, and the researchers found rates of premature birth dropped by about 9 percent for pregnant women within a mile and a quarter radius of where the old booths had been. While that change was positive, it made clear the disturbing link between the highway exhaust so many of us breathe and a pregnancy outcome that can have lifelong consequences for babies born early.

I’m lucky enough to have been in good health all my life. And when, sooner or later, illness comes along, I won’t know whether the pollution I’ve taken in over the years has had anything to do with it, or if I should, instead, blame my sweet tooth, my lifelong preference for a good book over a brisk run, or a malevolent gene buried somewhere in my DNA, beyond anyone’s control.

None of us can. And that invisibility is a strange feature of this crisis. “You see one person run over in the street and you’ll never forget it,” observed a Los Angeles environmentalist I met. But thousands dying from the effects of dirty air “will never even faze you.” He was right. When smokers succumb, they know their own actions, and those of the tobacco companies that fed their habit, helped bring about their illness. But, in a world powered by fossil fuels, we all travel from place to place, use electricity, heat our homes, and few of us fully grasp the effects.

The gains that come when air gets cleaner are similarly difficult to see. There’s no doubt reducing pollution saves lives. But those whose years are lengthened, and those who love them, never know it. Emergency room visits are averted and health care dollars stay in pockets, but the line connecting car or power plant regulations with the size of medical budgets isn’t easy to make out.

Once I’d grasped the dimensions of this hiding-in-plain-sight threat, I wanted to see, up close, how it was playing out around the world. And why. Is air pollution an inevitable part of modern life, something we must resign ourselves to living with? Or are there more malign forces at work, too, keeping us wedded to the old, dirty ways of doing things when better alternatives exist? And, most importantly, what would it look like to do things differently, to build a cleaner, healthier world? Has anyone done it, or tried? And how can we get from here to there?

By way of looking for answers, this book tells the story—the stories—of air pollution, and of the people I met whose lives are shaped by it. In the United States, thanks to decades of gradually tightening regulation, air is far cleaner than it once was. But that improvement— now at risk as the rules that brought it about come under assault—has failed to keep up with the science, which tells us more clearly with each new study that even relatively low pollution levels do real damage. Around the world, in fast-growing South Asia and China, in Europe’s coal-burning east and its diesel-dependent west, in Cairo and Johannesburg and Lagos, the problem is much worse.

In Part 1, “Holding Our Breath,” our itinerary includes Delhi, pollution’s ground zero, where a mother has nightmares about what’s happening inside her children’s lungs, and an eccentric businessman builds himself a clean-air bubble. I’ll show you around London, my window onto the consequences of Europe’s disastrous embrace of diesel. Poland’s story is the story of coal; we’ll meet men hoisting bags of it into their cars and watch an old woman trudge to the basement to scoop some into her furnace. In California’s parched and poor San Joaquin Valley, migraines and wheezing shatter preconceptions that this is just an urban problem. We see there, too, that while dirty air affects everyone who breathes it, some suffer more than others, so this issue is infused with questions of race, class, and fairness.

The news is not all bad. Part 2, “Coming Up for Air,” finds progress and hope—past, present, and future; grinding and swift; tiny glimmers and potentially seismic shifts. From the still-unfolding story of one of America’s most powerful and important laws, the Clean Air Act — and the friendship that, across party lines, helped to birth it — to China’s world-changing push to find a healthier path. And a search, on the streets of Berlin, for ways to put the needs of human beings before those of the cars that dominate so many of our cities.

Of course, there is action and progress in the polluted places, and still plenty fouling the air of the improving ones. My hope is that these chapters’ global reach will demonstrate both the scale of the problem and the very real opportunity we have to solve it.

In many ways, this is a book about choices. About how we choose the kind of world we want to live in. And about the complexities of an age in which the things that have changed our lives for the better also bring consequences that are harder to see.

Cleaner air, it turns out, is not an impossible dream. We know how to get there, and doing so would bring enormous health benefits, on a par in some places with slashing sugar consumption or getting everybody up off the couch.

And understanding pollution’s hidden dangers holds an even greater power. The overarching challenge of our time, of course, is climate change. But despite the floods and droughts and storms, its risks can still feel abstract and distant, a calculus of parts per million high in the atmosphere, or glaciers melting thousands of miles away. Dirty air, on the other hand—caused by our heedless burning of the very same oil, gas, and coal that are warming the planet—is wreaking its damage in the here and now. Those fuels are woven into the fabric of our societies, and weaning ourselves from them won’t be quick or easy. But once we recognize the toll they are taking, not just on the habitats of polar bears but on our hearts and lungs and those of our children and parents, I hope we’ll see more clearly that a different future is within our grasp.

Excerpted from "Choked: Life and Breath in the Age of Air Pollution" by Beth Gardiner. Copyright © 2019 of The University of Chicago Press. Republished with permission of publisher.

Francesca Paris produced and edited this interview for broadcast with Todd Mundt. Samantha Raphelson adapted it for the web. 

This segment aired on September 19, 2019.


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Before coming to WBUR to co-host Here & Now, Jeremy Hobson hosted the Marketplace Morning Report, a daily business news program with an audience of more than six million.



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