Clearing the air

THE morning after we landed in London three weeks ago, my nine-year-old and I went out for a walk post-breakfast. Out of nowhere, she said “Baba, I can breathe here.” I looked at her: she had a big smile on her face.

She was not making a political or ideological statement; she was just making a statement of fact about the air. Living in Lahore, over the last two to three years we had gotten her used to wearing a mask all the time when outside. In London, I could see her face when we were walking that morning.

I checked the Air Quality Index for London right after her remark: it was 20. I checked what the AQI in Lahore was at the time: it was 140. As I write this article, the AQI in London is 55 and around 150 in Lahore. The average AQI for Lahore last year was around 170. We had many days when the AQI was in the 200-300 range. For London, it was 42 in 2024 and 45 in 2025.

Despite the fact that my daughter had to wear a mask whenever she was out in the open in Lahore, she still had to take medication containing montelukast sodium, which is commonly used for allergies and managing respiratory issues like asthma. It has been more of a friend to her over the last few years — a period in which she has been far sicker than in the first five to six years of her life — than any of her classmates. This was also the case with other children in her class and school. A paediatrician told me that children in Pakistan seemed to be living on this particular medicine — at least much more than on chocolates or other sweets. School absences on account of sickness have risen as well.

We have yet to see a major sustained effort to reduce air pollution in the country.

There is no dearth of evidence regarding the deleterious impact of air pollution on human health. In children, lung development as well as brain and cognitive development, are impacted. In adults, sustained exposure to air pollution increases the risk of heart disease, blood pressure, strokes, dementia, chronic obstructive pulmonary disease and other respiratory issues. In some places, hospitals gear up for surges in the number of patients coming in with specific complaints (heart attacks in the elderly, etc) if the air quality is poor and has been poor for some time. Long-term exposure to air pollution has a significant impact on the health and longevity of all, but it has a more serious impact on children as their capacities are still developing.

London had come a long way from the days of the London smog. But it was still not enough. So, in 2019, despite widespread scepticism and stiff opposition from many quarters, the mayor of London sanctioned the implementation of the Ultra Low Emission Zone (ULEZ) programme. It was eventually expanded to all London boroughs. Under the programme, vehicles had to meet stricter emission guidelines or pay stiff fines.

Since it raised costs for vehicle users and owners, it was not popular but a recent five-year study has shown the significant impact it has had on children’s health. According to the study, ULEZ is strongly associated with accelerated and restored lung function growth in children. The study compared children in London with children in Luton. Both had comparable air quality rules to start with, but Luton did not come under ULEZ. At the start of the study, London’s children had significantly smaller lungs than their peers in Luton. But over five years, children in London caught up with those in Luton and the proportion of children with clinically impaired lung function dropped by five per cent.

A separate study showed that over 2019-2024, deaths linked to toxic air fell by about 40pc alongside a 41pc drop in nitrogen dioxide in London. Scepticism about ULEZ has gone down. There are a number of British cities that are now implementing or contemplating the implementation of similar programmes. The mayor of London recently said that the implementation of ULEZ was the hardest decision he had to make as mayor but the results have shown it was needed and that the children of London were reaping the rewards now.

Heating systems in Sofia — the capital of Bulgaria — were very dependent on coal and wood burning. These are being replaced as part of a citywide clean air programme, which includes a subsidy for low-income groups. Results already show an approximately 20pc reduction in the emission of harmful particulates. It is not just cities in rich countries that have done this or are doing it.

London, Paris and Barcelona may be good examples of what can be done in just a few years, but it is cities in the not-so-rich countries that are also cleaning up the air or have plans to do so, because the cost of inaction is far too high. Bogotá — the capital of Colombia — is doing more work in this area. It has cut air pollution by about 24pc since 2018. The Kenyan capital of Nairobi passed an air quality law in 2022 that commits to cutting harmful emission by half by 2035. Hundreds of cities are embarking on the journey to clean up the environment.

There is a lot of discussion of these issues in Pakistan whenever we have a season of high AQI numbers and schools are closed and emergency action is taken to address pollution. But we have not seen major medium- to long-term initiatives to take us to a place where the lungs and brains are not impacted by pollutants in the air, and where medication is not our children’s best friend. Though resolute and comprehensive action requires significant state buy-in and commitment, we also need a lot of citizen action to motivate and push the state. On both fronts, we need much more work and attention.

The writer is a senior research fellow at the Institute of Development and Economic Alternatives and an associate professor of economics at Lums.

Published in Dawn, August 28th, 2026