<figure><img width="900" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d02ed9c7e80680e0a36a8jpeg.jpg" alt=""/><figcaption>Photo: NEPALI TIMES ARCHIVE</figcaption></figure><a href="https://www.nepalitimes.com/banner/how-weather-elevates-air-pollution-in-kathmandu/" target="_blank" rel="noopener noreferrer">Kathmandu’s air quality</a> has just got considerably worse, not just because of dirtier air, but because the World Health Organisation (WHO) has revised its Global Air Quality Guidelines, halving the recommended value for annual average pollution levels. Safe exposure to concentrations of harmful particles below 2.5 microns (PM2.5) in diameter every year has now been halved, meaning that many Kathmandu residents could be breathing much more <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener noreferrer">polluted air</a> than they throught.On 22 September the WHO updated its Air Quality Guidelines (AQG) such that annual mean concentrations of PM2 should not exceed 5 kg/m3 and NO2 not exceed 10 kg/m3. In addition, peak season mean 8-hr ozone concentration should not exceed 60 kg/m3. The 2005 guideline values for PM2 and NO2 were, 10kg/m3 and 40 kg/m3 respectively, with no recommendation for long-term suspended particles and ozone concentrations.Environmentalist Bhushan Tuladhar immediately took to twitter to respond to the new recommended standard for air quality: ‘The WHO just released its new air quality guidelines which have halved the guideline value for annual average PM2.5 in ambient air. This means Kathmandu, which had annual PM2.5 levels that were about five times higher than the WHO guidelines now have pollution levels that are 10 fold higher.’The new standards are ambitious and reflect the large impact of <a href="https://www.nepalitimes.com/editorial/polluted-politics/" target="_blank" rel="noopener noreferrer">air pollution</a> on public health, and experts hope that it will influence air quality policy across the globe. They recommend bold action to clean up the air at all levels and across all sectors such as transport, energy, industry, agriculture and residential.“Air pollution is a major global public health threat that causes a range of adverse health effects, even at the lowest observable concentrations. The updated guidelines offer a wake-up call, to reconsider current air quality legislation and regulations,” noted a joint statement released by the International Society for Environmental Epidemiology (ISEE) with the European Respiratory Society following the revised guidelines.It adds: “There is ample evidence to strongly support government action to reduce air pollution and address climate change simultaneously. But the most important message is that each reduction in the outdoor concentrations of key air pollutants brings health benefits to the surrounding population, even in places which already have low pollution concentrations.”Additionally, most jurisdictions with <a href="https://www.nepalitimes.com/here-now/solution-to-pollution/" target="_blank" rel="noopener noreferrer">clean air</a> regulations have relied on fixed limit values with little incentive to further reduce air pollution levels once compliance with the limit value is achieved. Given the evidence that health effects occur down to very low concentration levels, future clean air policies must include incentives for progressive lowering of exposures of the entire population, thereby improving health for all.The new <a href="https://www.nepalitimes.com/here-now/how-transboundary-haze-affects-nepal/" target="_blank" rel="noopener noreferrer">air quality</a> guidelines are not legally binding however but experts believe can represent a turning point in the way we approach air pollution globally, and in particular, South Asia where the air pollution levels are consistently high and the health burden is stark.“The new guidelines offer a benchmark for South Asian cities and countries to plan their air quality agenda. This will bring renewed interest in the topic and create an opportunity to push for stronger action,” says Pallavi Pant of Health Effects Institute based in Boston.She adds: “We know where we’d like to get to, and the real discussion now should be focused on the basket of strategies and sectors we need to address.”Air pollution, indoors and outdoors, accounted for some 12% of all death in 2019. Air pollution currently ranks fourth among major risk factors for global disease and mortality, only behind <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/" target="_blank" rel="noopener noreferrer">hypertension</a>, smoking and dietary factors.In terms of economic burden, the estimated global health-related external costs were $5 trillion in 2013 with an additional $225 billion in lost labour productivity as per the World Bank Group 2016.Here in Nepal, the new guidelines hardly made it to the news. Nepal doesn’t even have a minister for the environment because of a continued political stalemate.Successive governments in the recent past have made commitments to promote <a href="https://www.nepalitimes.com/here-now/cleaner-air-with-greener-buses/" target="_blank" rel="noopener noreferrer">electric vehicles and transport for clean air</a>, but they have done the opposite. Earlier this year in the budget, it reintroduced tax rebates. But only this week, Prime Minister Sher Bahadur Deuba’s government slashed taxes on the import of 10 or more diesel buses by new luxury hotels to 1%. It also cut by half the duty on petrol motorcycle assembly in Nepal.The Covid-19 pandemic and subsequent lockdowns over the last two years have shown people that the <a href="https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/" target="_blank" rel="noopener noreferrer">goal of clean air can be achieved</a>, and it has become even more crucial at this point where the coronavirus cases are going down, vaccinations have picked up and businesses are reopening for the Dasain-Tihar festive season.“There is no shortcut to clean air, we need long-term policies that target major sources including transportation, use of wood/animal dung for cooking and heating, brick kilns, coal power plants, industries and waste burning,” adds Pant ,who is from India.She adds: “Access to clean energy for all is one key policy that can help reduce the burden of air pollution. It is also useful to keep in mind that air pollution is a multi-sectoral problem, and we must engage not just technical experts but also legal and policy experts, economists, healthcare workers and others in developing solutions.In the short term, especially as we approach the winter season, the government should ensure the public that <a href="https://www.nepalitimes.com/here-now/open-air/" target="_blank" rel="noopener noreferrer">air quality data</a> is accessible and understandable. With this information, the public can avoid outdoor activities during hours when the pollution is at its peak and reduce the prevalence of allergies and immediate respiratory illness.

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Dirty Kathmandu air gets dirtier

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06f59c7e80680e0a5f92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The past year-and-half since the Covid-19 outbreak, Nepal’s limited health resources all had a singular focus. But now that the second wave is waning and the lockdown has been eased, hospitals are once again flooded with patients with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">diabetes</a>, cardiovascular diseases and kidney ailments.Many of these patients had left these conditions untreated, and doctors say nursing them back to health will be more complicated. One of the most common disorders is hypertension or high blood pressure, which has become an epidemic.Hypertension is a silent killer and one of the most common causes of chronic conditions like <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener noreferrer">kidney damage</a> that are often too costly to treat for the majority of Nepalis. Now, mental stress due to Covid has also added to the problem.“Hypertension makes up for the majority of patients in hospitals these days now that the lockdown has been relaxed,” says cardiologist Prakash Regmi. “Also worrying is that many of these are new patients coming in due to Covid-related stress, a large number of people who had their blood pressure under control previously after treatment are also relapsing.”To be sure, Nepal has been seeing a dramatic rise in hypertension patients even before the pandemic – some of them in their teens and 20s. <a href="https://www.hindawi.com/journals/ijhy/2021/6610649/" target="_blank" rel="noopener noreferrer">A paper published in March</a> in the International Journal of Hypertension, shows that since 2000, the hypertension rate in Nepal has been increasing at 3.5% per decade, and 44.7% of Nepali men will be suffering from hypertension by 2025.The study also found that high blood pressure is disproportionately affecting men, the elderly, those without formal education, and those who reside in urban areas, and seems to be most common in Gandaki Province.Worldwide, an estimated 1.13 billion people have hypertension, and it is responsible for 9.4 million deaths globally every year. In 2015, 1 in 4 men and 1 in 5 women had elevated blood pressure.In Nepal, close to one-third of the adult population has some form of hypertension, but in urban centres the figure is as high as 40%, with 25% in rural areas suffering from it.There is no specific cause of hypertension, but its biggest risk factor is high sodium intake. A survey in 2020 revealed that on average, the mean dietary <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.13813#:~:text=Overall%2C%20estimated%20mean%20salt%20intake,d%20(SD%20%C2%B1%204.7)." target="_blank" rel="noopener noreferrer">salt intake of a Nepali</a> per day is 13.3 mg. Most of the world consumes double the WHO recommended 5g of daily salt intake, increasing the risk of heart disease and strokes, which kills some 3 million people annually worldwide.“Traditionally Nepalis have a preference for salty food, but now with higher consumption of processed and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">junk food</a>, our salt intake has grown,” says public health expert Aruna Uprety, adding that the sodium content in packaged foods is often much higher than what companies claim.In May WHO (World Health Organisation) released a new set of <a href="https://www.who.int/news-room/events/detail/2021/05/05/default-calendar/launch-event-who-global-sodium-benchmarks-for-different-food-categories" target="_blank" rel="noopener noreferrer">global benchmarks for sodium levels</a> that will act as a guide for countries and industry to reduce sodium content in more than 60 categories of processed foods, in line with the global target of reducing salt intake by 30% and hypertension by 25%, both by 2025.Another prominent risk factor is mental stress and lack of physical exercise, both of which have been exacerbated with people staying at home for months and under the uncertainty of the pandemic. Family history of hypertension also plays a significant role in an individual developing high blood pressure, as does smoking and drinking alcohol.Undetected hypertension, and non-medication to control it, can lead to other disorders like stroke, heart disease, kidney failure, etc.Despite the huge burden of the disease on public health and the economy, treatment of hypertension is ill-managed. Patients are never diagnosed because often times there are no prior symptoms.And of the 50% who are diagnosed with high blood pressure, half ignore their condition and get no treatment. Of the remaining, 25% do get some kind of treatment but half of them again do not follow-up or take the correct dose of medication.“All in all only about 10% of hypertension patients get proper treatment in Nepal. Lack of proper health monitoring system, as well as misconceptions about life-long medications, hasn’t helped,” says cardiologist Prakash Regmi. “This often leads to a point where treatment is either too expensive, or even unmanageable.”Hypertension is first and foremost a lifestyle disease with strong ties to a possible failure of crucial organs in the human body. Its prevention and control are heavily dependent on an <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">individual’s choice of diet</a>.A state-sponsored robust awareness campaign to focus on preventive measures and a strong healthcare system are urgently needed to reduce the epidemic of hypertension.Says public health expert Aruna Uprety: “Mandatory blood pressure check-ups for certain age groups at fixed intervals is a good place to start. It goes a long way in reducing the cost of the disease and human lives.”Stages of hypertension<ul style="font-weight: 400;"><li>Normal: Less than 120/80 mm Hg</li> 	<li>Prehypertension (Elevated): Systolic between 120-129 and diastolic less than 80</li> 	<li>Stage 1 (Moderate): Systolic between 130-139 or diastolic between 80-89</li> 	<li>Stage 2 (Severe): Systolic at least 140 or diastolic at least 90 mm Hg</li> 	<li>Hypertensive crisis: Systolic over 180 and/or diastolic over 120</li></ul>Types of hypertension<ul style="font-weight: 400;"><li>Primary or essential: Most common high blood pressure among adults. No specific cause but risk factors include diet, age, physical activity and genetics.</li> 	<li>Secondary: Up to 10% of hypertension is secondary. Most often caused by another medical condition or the use of certain medicines.</li></ul>Risk factors<ul style="font-weight: 400;"><li>High salt/sodium intake</li></ul>WHO recommendation: 5gm/day<ul style="font-weight: 400;"><li>Mental stress</li> 	<li>Lack of physical exercise</li></ul>WHO recommendation: at least 150–300 minutes of moderate-intensity aerobic physical activity<ul style="font-weight: 400;"><li>Family history of high blood pressure</li></ul>

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Why do so many Nepalis have high blood pressure?

<figure><img width="1500" height="814" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccad79c7e80680e08bb8ejpeg.jpg" alt=""/><figcaption>Dogs huddle for warmth at a fireplace in Janakpur.</figcaption></figure>Just as it has every winter, the cold wave in Nepal’s Tarai has had a devastating impact on the livelihood of its people, but local governments have provided little to no support to the neediest. As a result, even in this day and age, <a href="https://www.nepalitimes.com/opinion/12-full-opinion/is-the-nepal-tarai-prepared-for-winter/" target="_blank" rel="noopener noreferrer">Nepalis still die from the cold</a>.There are indications that the ground fog that covers the Indo-Gengetic plains that includes the Tarai is getting thicker and lasts longer because of a combination of moisture in the air due to the spread of irrigation and <a href="https://www.nepalitimes.com/banner/breathing-is-hazardous-to-health/" target="_blank" rel="noopener noreferrer">pollution</a>. Water droplets stick to soot particles, and even the sun cannot burn the smog off during the day. “Only those who can afford it wear warm clothes here. Our children run around in hand me downs, and sometimes without one, even in winter,” says Lalmati Devi of Birganj. “We have had no income because of the lockdown, so we couldn’t buy warm clothes.” <img width="1500" height="843" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccad99c7e80680e08bb8fjpeg.jpg" alt=""><figure><img width="1500" height="812" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccadc9c7e80680e08bb90jpeg.jpg" alt=""><figcaption>Fog-bound Birganj, where the sun did not shine for days during the cold wave this month.</figcaption></figure>In Nepalganj 500km away to the west, passengers at the airport wait for days on end for flights, which are cancelled or delayed due to poor visibility. It is the same story in Dhangadi, Simra, Biratnagar and Bhadrapur.“We have visibility of only 10-20 metres right now, it is too low to operate flights. This has been the case here for the past few days,” says Prem Nath Thakur, head of the Nepalganj Airport.  Even a decade ago, the winter fog used to clear by afternoon. But in recent years it stays for days on end, sometimes for a week or more. People are trying to cope, but cannot seem to stay warm.“When humidity is over 95% and visibility is below 1km, water droplets are suspended in the atmosphere or near the earth’s surface, like a thick cloud that touches the ground,” explains Archana Shrestha of the Department of Hydrology and Meteorology. “It is only at ground level, but it is persistent and doesn’t allow the sun to warm the ground, leading to a cold wave.” <figure><img width="1500" height="776" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccadf9c7e80680e08bb91jpeg.jpg" alt=""><figcaption>Planes grounded at Nepalganj airport due to poor visibility this week.</figcaption></figure>The cold kills people. Either because of hypothermia, or indirectly through smoke inhalation inside the home as people try to keep warm. The problem lies in the lack of awareness about indoor air pollution, ventilation, insulation and as well as inappropriate architecture. Winter fog is getting thicker and lasts longer every passing year because of open agricultural burning, industrial emissions, <a href="https://www.nepalitimes.com/here-now/how-transboundary-haze-affects-nepal/" target="_blank" rel="noopener noreferrer">transboundary pollution</a>, wildfires and smog.The cold wave on 21 January reduced the maximum temperature in Nepalganj to 14°C whereas it was 19.3°C in Jumla, which is at an altitude of 2,500m in the mountains.The first recorded cold wave in the Tarai occurred in 1998. At that time, the difference between the minimum and maximum temperature was a mere 1.3°C, meaning the temperature was constant throughout the day. The longest cold wave recorded was in 2002/03 when it continued from 26 December to 27 January without any sunshine. Prior to this, a cold wave in the plains lasted from 15 December 1997 to 15 January 1998.This year, the cold wave has hit the Tarai in short spells but they were no less menacing, particularly in central Nepal where they were longer and denser. In Mahottari, the fog was so thick people could hardly see a metre away. Families huddle inside their homes, and do not venture out unless there is an emergency. But like all other disasters, the poor are disproportionately affected by the cold wave. <img width="1500" height="983" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101156/636ccae29c7e80680e08bb92jpeg.jpg" alt="">"People with means have homes, warm clothes and heaters, they can even employ others if they are unable to work because of the cold," says Tula Narayan Shah (pictured right) of Nepal Madhes Foundation. "But even among the poor, women and Dalit in the Tarai are hit the hardest." The <a href="https://www.nepalitimes.com/banner/unsung-heroes-of-nepals-tiger-recovery/" target="_blank" rel="noopener noreferrer">Musahar community</a> in this Province 2 district have homes built with public housing programs but with no roofs. Families do not have warm clothing or electricity. “It has been two years since we paid for the roof but we are still waiting, government does not listen to us,” says a local resident, Biraj Majhi.Oftentimes, people burn straw in order to warm themselves from the cold. There are fatalities every year from fires. Nine people have died in house fires this winter alone. But these aren’t listed as deaths caused by the cold wave. Open burning to keep warm also <a href="https://www.nepalitimes.com/latest/kathmandu-air-pollution-hits-record-high/" target="_blank" rel="noopener noreferrer">degrades air quality</a> further.Bheri hospital in Nepalganj is often crowded with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">hypertension patients</a> and those having difficulty breathing in the winter season.“Generally, blood pressure increases during winter, even of those who have it under control, other chronic illnesses are also more pronounced and people need a higher doses of their medications,” explains cardiologist Krishna Prasad Adhikari. “There is also an increased risk of heart attacks as morning chill leads to spasms and narrowing of blood vessels. Covid has added to the risk.”The cold wave also affects agriculture. Crops wilt without the sun, and insects infest the vegetable patches. Moreover, due to <a href="https://archive.nepalitimes.com/page/crushing-tale-of-Chure" target="_blank" rel="noopener noreferrer">increased deforestation in the Chure</a>, wild animals have moved down the plains, destroying crops as they search for food. But farmers are unable to stand guard during a cold wave and are forced to send their produce to the market before they have fully ripened.https://www.youtube.com/watch?v=b4CUcKlj3XU&amp;feature=youtu.beEven by moderate estimates, cold spells affect at least 125,000 households in the Tarai every year and these numbers are increasing. The Cold Wave Contingency Action Plan has estimated that 50,000 people from 5,000 households in Saptari (where 19 people died of cold three years ago) would be affected this year. Another 30,000 and 6,500 households in Dang and Bardia.Cold waves are listed as a disaster in Nepal now, and the District Disaster Management Committee has a plan to reduce its impact. Says Krishna Bahadur Katuwal, former Chief District Officer of Mahottarai: “No citizen should suffer from the cold wave or die from it. We are ready to respond and we have made arrangements through municipalities to distribute warm clothes, blankets and bedding.”But in most places, such support is yet to reach the neediest of the bunch. “The CDO came for inspection a month ago, the help hasn’t reached us yet,” says Ramprit Sada of Kaira in Mahottari.Adds Lalmati Devi of Birganj: “We haven’t received anything from the municipality, this is a Dalit neighbourhood. Our children just burn the cow dung to keep warm.”Based on Episode 7 of Saglo Samaj, a tv magazine program produced by Himalmedia which is broadcast every Monday, at 8:30 pm on Dish Home Channel 130.

Nepalis still dying of cold

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