#EndAirPollution: For Blue Skies and Better Health in South Asia

00:00 Explainer video

01:05 Welcome

- Moderator: Subina Shrestha, News Correspondent

04:05 Opening remarks

- Martin Raiser, World Bank Vice President for South Asia

10:18 Panel discussion

- Ayesha Nasir, Founder, Scaryammi
- Pema Gyamtsho, Director General, ICIMOD
- Arvind Kumar, Founder and Managing Trustee, Lung Care Foundation
- Maria Neira, Director, Department of Environment, Climate Change and Health, WHO

54:11 Closing remarks

- Valerie Hickey, Global Director, Environment, Natural Resources and Blue Economy, the World Bank

[Music] 

[Subina Shrestha]
Good morning, good afternoon, and good evening to everyone around the world, whoever is here joining us live for this World Bank event for blue skies and better health in South Asia. September 7th is the International Day of Clean Air for Blue Skies. I'm Subina Shrestha, a filmmaker and a journalist from Nepal moderating this panel from sunny England, which is experiencing an Indian summer right now. What can I say? We have World Bank senior environmental specialist, Jostein Nygard, answering your questions on World Bank Live event page. So, if you have any burning questions, do reach out to Jostein and now let's all take deep breaths. But after that video, maybe you might be thinking, should we or should we not to breathe or not to breathe? That should never have been the question. And yet a quarter of the world's population, over 2 billion people, that's all of us in South Asia, are impacted by this daily struggle. The simple act of breathing for us is not that simple. Here we are, to discuss what air pollution is doing to our health and what we can do, stakeholders and partners to collectively work together towards a future where we no longer have to think before we take a deep breath. We have with us a panel of global and regional experts, including Dr. Arvind Kumar, Indian lung specialist or a clean lung advocate, seeing the damage done by rising air pollution levels firsthand in the lungs of his patients. He's been trying to get the attention of all stakeholders globally as he's doing here, right now. Dr. Pema Gyamtsho, so the director general of ICIMOD, the International Centre for Integrated Mountain Development based in Kathmandu. ICIMOD is a regional and intergovernmental learning and knowledge sharing center serving countries of the Hindu Kush Himalaya region, including Afghanistan, Bangladesh, Bhutan, China, India, Myanmar, and Pakistan. Ayesha Nasir, who is having an internet moment, and she will be joining us shortly.She's a founder of Scaryammi or Scary mums, Pakistan's largest and most engaged digital parenting platform. Its members are fast becoming most engaged in the battle against air pollution due to the rising concerns about the harms done to children's health and lung development. And Dr. Maria Neira, Director of Climate, Environment and Health at the World Health Organization hopefully is going to join us later in the second half of this program as she's in between airport transfers. But before we get started with this panel, I will turn you over to Dr. Martin Raiser, regional Vice President for South Asia for his opening remarks. Martin, over to you.

[Martin Raiser]
Thank you so much Subina, and welcome to everybody online from Washington DC which is terribly hot. It actually feels more like July than Indian summer, but I want to welcome you all today, and in particular, online audience in South Asia and around the world. And I want to say that we're really, really happy to be doing this event jointly with ICIMOD and WHO, two longstanding and excellent partners of ours in addressing the impact of air pollution and climate change in our region. You saw a video just now with some alarming statistics on the health impact of air pollution in South Asia. Let me just summarize some of the most salient facts. We have 2 million premature deaths annually in the region, and that makes the region the world's most affected by air pollution. On average, people in South Asia lose about five years of life expectancy due to air pollution through disability, premature deaths from lung disease and cancer, as well as cardiovascular disease and hypertension. This tremendous health toll not only exerts a huge human cost but has high economic implications too. We estimate that annual losses from reduced labor productivity and forgone output because people are sick, could be as high as 10% of the region's gross domestic product. And the same urban, domestic and industrial sources of air pollution, which are having these immediate health effects are also key drivers of climate change, which as I don't need to tell anybody in South Asia is profoundly affecting the region and our planet through extreme heat events, droughts, flooding, and other extreme weathers. Black carbon emitted by dirty cook stoves, brick kilns, and vehicles for instance, is exacerbating the melting of Himalayan glassiers as ICIMOD has, I think amply proven in many excellent pieces of research, which are the region's water storage tanks. And this puts downstream farmers at risk because they rely on regular water flow from the glacier melt to irrigate their fields in the dry season. So, the impact of air pollution and associated activities is multifaceted, and we really need to act now. Now, happily across the region, public awareness and demand for change have been growing steadily. Policymakers are increasingly aware of the health, climate and economic consequences of air pollution. Our new president, Ajay Banga has reinforced the World Bank's commitment to support poverty reduction on the livable planet. And that certainly for us in South Asia includes tackling air pollution. So, to accelerate progress, we've recently launched the Indo-Gangetic Plain and Himalayan Foothills Air Quality Management Program. That's a long word, but it's essentially an attempt to bring together all of the countries in the Indo-Gangetic Plain, Bangladesh, India, Nepal, and Pakistan to work together to reduce and ultimately eliminate the scourge of air pollution. We're making resources available to these four countries for national catalytic activities in two key areas. The first, to strengthen air quality monitoring, planning, governance and enforcement. And the second, to support air pollution abatement interventions targeted at the main sources of air pollution, including cleaner mobility, cleaner manufacturing, cleaner agriculture, and the reduction of burning of forests, agricultural residue and wastes. Internationally, we have evidence that air pollution can be reduced in less than a decade. London in the 1960s, Mexico City in the 2000s and more recently, several of the big cities in China, including Beijing, where I've spent four years before moving to Washington, have dramatically reduced air pollution in less than a decade. South Asia can emulate these achievements. Now, to accelerate progress at reasonable costs, regional cooperation will be key, and the reason is that air pollution does not respect borders and emissions from one country or municipality travel to neighboring territories. So, we have done some modeling and a lot of micro analysis, and it indicates that the costs of reducing air pollution fall by 45% if countries, states and cities work together to achieve better air quality. So, let me close by reassuring you that the World Bank will be with everybody committed to achieving cleaner and healthier air for the region. Let us do it together. With that, let me go back to you Subina and our panel of global and regional experts, and I'm really looking forward to hearing from all of them about the challenges, but also, the potential solutions in greater detail. Thank you very much for joining us.

[Subina Shrestha]
Thank you ever so much, Martin. So, one thing I noticed while I was living in Kathmandu and I lived in Kathmandu for most of my life and I gave birth to my kids there, my daughter from infancy, had constant ear infection, coughing fits and chest infections. And from infancy to the age of eight, we were in and out of hospitals and the doctor said it was air pollution related. For the past three years I've been in the UK, and lo and behold, we haven't had that issue. And the other thing that happened, which really made me think about air pollution was that my non-smoker grandmother who hated the smell of cigarettes, well guess what? She died off besides old age. The doctor said it was lung cancer. Dr. Kumar, this question goes to you. You work with children and you have seen their lungs first-hand. It must be really hard. Can you tell us more about what you see? What is this polluted air doing to our children's lung? Was it random that young and old people are getting lung diseases at this rate? How bad is it? Sorry, you're muted.

[Arvind Kumar]
Thank you Subina, and my sincere thanks to World Bank for organizing this very, very important Zoom seminar on a topic which actually will determine the future of us and more importantly, the future of our children. Coming to your question, Subina, I'm a chest surgeon working in New Delhi, and I've been operating on people's chests for over 30 years now. So therefore, as a part of my surgery process, I've had the occasion to look at lungs of thousands of people over a 30 year period. And I have seen a sea change in the color of lungs of people. So, this air pollution and health, air pollution is primarily a health issue. You ask about the effect of children, but I would go a step back and I say the bad effect of air pollution does not wait for us to be born. It actually starts even before we are born. There is evidence now that mothers, pregnant mothers who are in polluted cities, when they breathe polluted air, the pollutants go to the fetus through the placenta and they cause damage ranging from congenital defects to intrauterine breath. And this is amply proof by international studies that it so happens. So, the damage starts within the fetus, within the uterus of the mother. When a child is born, the air that he or she breathes is the same ambient air. So, if your PM 2.5 is about 200, 250, which is the average in most of the cities in South Asia, that child is also breathing the same air, which is equal to 10, to 12 to 15 cigarettes. So, I dare say that in polluted cities, the newborns start smoking figuratively from the very first breath of their life. And that's why we see the impact on newborns, on toddlers, on children, and it goes into the adulthood, as you rightly said, your daughter used to get this problem. I see this every day in my practice in Delhi. Now, a nebulizer has become an ubiquitous part of every household which has children. When I was a child, I never heard this term nebulizer, but today, every child, when they start getting breathless, they then still say, “oh, I'm going to get nebulizer.” It's become so common here, and I think it's very dangerous. It's risky as they grow older, they get asthma, they get black deposits on lungs, there is a high incidence of cancers in children. And when we go into adulthood, there is tuberculosis, there is interstitial lung disease, and most importantly the dreaded lung cancer. Let me tell you that 30 years back when I started as lung cancer surgeon, I would see 95% of patients to be smokers. But today, 50% of my patients are so called non-smokers, I use the word so-called because I believe that in a polluted country there is no true non-smoker. Everybody is a smoker, but 50% of patients are non-smokers, so called. Why is this happening? Because of air pollution exposure. We are seeing it at a younger age in females as much as in males and in non-smokers. Other than that, everybody feels that pollution only affects the respiratory system. Well, Subina respiratory system is the entry point, but once it goes into lungs, it goes into the blood and from brain to toe, there is no organ system in the body. So, our central nervous system, cardiovascular system, including the heart and the blood vessels, the liver, the bones, the intestines, the reproductive system, there is no system in the body which is spared. And that's why we are seeing the high incidence of hypertension in children. We are seeing obesity in children, we are seeing diabetes in children, and there is scientific evidence now that all these are because of exposure to air pollution. So, if I was to summarize Subina, it starts affecting us even before we are born. Oh, thank you Subina for that message that I can take more time. I was trying to wind up in my five minutes allotted to me. I'm very particular about time. Thank you so much. So, what I want to convey, and this aspect, Subina unfortunately has not been conveyed. Until now, even doctors when I spoke to everybody looks at air pollution as an environmental issue “Oh yeah, it causes foggy air.” No, it's a pure health issue. It's ruining our health. It's ruining the health of our children. It starts impacting before we are born. It starts affecting from the very first breath, and the impact continues till the last breath.It causes lung diseases, it causes premature hypertension in children. It causes cerebral problems. There is now evidence that it reduces the IQ development, it reduces lung development, it causes childhood pneumonia and cancer, and it causes numerous other problems. The most dreaded, which I see, is very high increasing incidence of lung cancer. So overall, it's ruining our health, it's causing disease, it's causing disability, and it's causing large number of pre-mature deaths. It's a major cause of morbidity and mortality, and we must address this issue with the seriousness, which it deserves. Thank you. Over to Subina.

[Subina Shrestha]
Thank you so much, Dr. Kumar. I mean this is such a scary thing and a lot of citizens are very concerned. This question goes to Dr. Pema. I mean, you represent a regional and intergovernmental organization. How concerned are governments in the region? How much do they prioritize and have they really started to act upon it? Could you unmute yourself please?

[Pema Gyamtsho]
Yeah. Hey, can you hear me? Hey, thank you very much Subina, and thank you World Bank for organizing this webinar on this very, very important topic. After listening to Martin and Dr. Arvind Kumar, I was wondering why access to clean air is not at the same level as access to food and access to clean drinking water. Have not seen that her in our discourses or documentations. There is really a big need after listening to Dr. Arwin Kuer discourse, one could really appeal that this is a very, very serious issue and Dr. Martin Raiser has laid out the seriousness of the problem in this region that our lives are cut by at least five years in terms of our life expectancy. So probably, I would like to say we know that our countries in the region are also doing their best. They're taking measures now. There is a massive movement to clean energy transitions. For example, Bangladesh has set a target of generating 40% energy from renewable resources by 2041 and has plans to reach 30% of electric vehicle penetration by 2030. It has also adopted zigzag technology in firing brick kilns one of the main sources of pollutants in our region, and it has already achieved almost 80% by 2021. Bangladesh also has set a target to use 100% of known fire bricks in all government constructions by 2025. These are very, very encouraging. And also, as part of this nationally determined contribution. Bangladesh has plans to unconditionally reduce 3.39 million tons of CO2 emissions from road transport by 2030. Now, let's go to Bhutan. Bhutan is also part of the Indo-Gangetic Himalayan Foothill nexus. And while it doesn't pollute much, it is also at the receiving end of most of the pollution that drips across the borders. Bhutan has pleased to remain carbon neutral at all times, and it is constitutionally mandated to protect the forest cover and to maintain at least 60% of the forest cover at all times. Now, Bhutan has managed to switch to green electricity, almost all provided electricity, a hundred percent electrification in all the households already through hydroelectricity. So, it is however, also suffering from all the hills of air pollution like our neighboring countries. Bhutan is also placed to go for electric vehicles as early as possible by importing at least 1000 electric vehicles per year and replacing all the taxis and public passenger vehicles. Of course, we have heard from Dr. Martin the tremendous progress made by China. A few years ago, we used to listen to news about residents getting oxygen backs in Beijing, but now we don't see that. China has made tremendous progress and according to the report from this on the Air Quality Life Index from the Energy Policy Institute of the University of Chicago, China 20 years ago had some of the worst air quality in the world. But after 2013, it has managed to actually reduce air pollution by over 42%. And this report goes on to say that the Chinese citizen now can expect to leave 2.2 years longer. So, there's remarkable achievement and I think there's room for other member countries to learn from their good practices and policies. Now, India is also taking so many steps to reach reduce pollution. It has plans to produce 12,000 megawatts of energy through the development of solar parks and ultra mega solar power projects. I think you would've heard about that. India also intends to face our all-commercial fleets operated on fossil fuels and replace them with alternate fuels in every city and aims to reach 30% coverage by electric vehicles by 2013. Now, the government of India has also directed that all brick kilns should adopt this exact technology or vertical shock, all use piped natural gas for firing brick kilns. India's NDC, Indians will reduce the emission intensity of its GDP by 33% to 35% by 2030 from the 2005 level and increase the share of non-fossil fuel-based electricity to 40% by 2030. So over and above that, India has instituted the National Green Hydrogen Mission, and the National Clean Air Program, and is clearly on a better footing to address air pollution. Now, we come to Nepal, our host country. And so now you have already mentioned quite a lot. The situation about Nepal is also gearing up with a lot of initiatives on various forms to take away pollution. The national, actually, just to remind ourselves, the national annual average PM 2.5 has over around 50 micrograms per cubic meter, but on some days the air quality has been that we experienced up to 500 micrograms per cubic meter. So that is really, really bad. I'm sure Dr. Kumar would be shocked to hear that. Nepal has also plans to expand clean energy generation from hydropower. Hydropower plants up to 15,000 megawatts by the year 2030. So, Pakistan also we would've heard that has taken many, many initiatives. It has established electric systems, clean energy systems in about 7,000 villages. It has also transitioned to zigzag and clean technologies in this brick manufacturing sector. In provinces like Punjab, almost the entire brick industry is now switching over to zigzag and clean energy technology. In conclusion, I would like to say that all the countries in the region are very much aware now of the problems of air pollution and they're doing whatever they can. But I think the biggest requirement is investment, investment, investment. So investment for infrastructure, investment for capacity building of institutions, and also, technology transfer. If we can do that, I think the region is only close to have clean air blue skies. Thank you. Over to you Subina.

[Subina Shrestha]
Thank you very much. Ayesha, I'm going to go to you now. I love the name Scaryammi. As a dazy mother myself, I can totally empathize with the name and what you're getting at. Just as a background, Ayesha told me that the platform initially shared a dazy silent parenting, which has its own unique quirks. Can you please tell me a little bit more about the motivations behind Scaryammi and the actions that you have taken on air pollutions and what you've achieved because you have achieved quite a lot.

[Ayesha Nasir]
Yes, thank you. Thank you so much for having me, and thank you to the World Bank for organizing this. So, I was in Pakistan. We were stuck in a very unique situation where especially in the Punjab, we don't really have the environmental minister, the climate minister, embracing the enormity of this challenge. In 2019, the climate minister went on record saying that smog and air pollution is just a conspiracy. So, when you are faced with such a situation, it was really up to the mothers to kind of take action. And the reason mothers began getting involved is because right before Covid-19, so 2017, 16 and 18, we began seeing a huge increase in the number of children who were being admitted to government hospitals and private hospitals for chest infections, for asthma, for upper respiratory tract infections. And there were increased numbers of children who could no longer go to school because their health condition just wouldn't allow it because breathing problems was on the rise, asthma, all these infections were on the rise. So that's when a lot of mothers began talking to me about “What can we do? What can be done in this session? Can we maybe talk to the schools?” At that time, I got together mothers under the initiative called Ammis Against Smog, and instead of going to the Ministry, Climate Change Ministry, they were really not even convinced that this was a problem. We went to the education ministry, which was a unique approach we took, which paid off. The education minister, when we showed him the numbers, the figures got doctors on board, got activists on board, and he realized the enormity for the first time ever in the history of Pakistan. I don't know what the other countries, in 2018, the first ever smog legislation was passed whereby a lot of things were done. Like for example, outdoor sports were stopped in the crucial months of October to December. Air purifiers were mandated, masks were mandated, smog sessions were mandated. And so, I personally conducted about 119 sessions educating mothers about what is smog and what do you do? So that was the motivation. The motivation was that our children were falling sick and we were able to find a loophole with the Ministry of Education. So that Ammis legislation was historic in what it achieved. Hello, Subina?

[Subina Shrestha]
Thank you. I thought you were going to continue with… 

[Ayesha Nasir]
I can talk about this for as long as you want. I just wanted to be mindful of time. So just to update, so this happened back in 2018 and then we were putting into play mandatory carpooling and also, mandatory Euro 5 compliant fields and all these things. And then Covid-19 happened, which really, really sidelined our efforts and hijacked it because all the ministries are like, “What are you talking about? We are trying to just keep the country alive.” So that is, I don't know if other efforts in other countries were affected, but in Pakistan, Covid-19 and then the political instability and inflation and dollar repeat devaluation of all kind of pushed air pollution to the site. But I'm hoping this year to really galvanize the government once again to start where we stopped.

[Subina Shrestha]
Thank you so much. I'm sure it's going to be with the amount that you've already managed to achieve. I'm sure you'll manage more and it's going to be quite exciting to see what you will end up doing. Trust. I'm now going to go to Dr. Maria. Thank you so much for being with us right after landing and with all your busy schedule. Thanks. Thanks so much. Can you give us a brief summary of the global context of health impacts from air pollution and why are the air pollution levels in South Asia, in particular, so concerning, why should we be so concerned?

[Maria Neira]
Thank you. And it's really an immense pleasure to be with you and an honor because everybody around this table such a role. I'm looking at my friend Dr. Kumar, who did an amazing job with his famous lungs that we are using everywhere to convince people, the moms, the moms for fighting for the clean air, and of course, the colleagues from the World Bank organizing this and the others around this table. Thank you very much. Things have been changing. The global situation is, let's put the figures on the table. I think we all know this horrible figure of 7 million premature deaths. If you look at your region in Asia, IT will be two million. But in addition to the death, which is already horribly dramatic, we need to keep in mind that we are talking about chronic diseases and we are talking about chronic diseases that will take a lot of the quality of life and the cost for the health systems as well. So, several things. The WHO considered this as one of the biggest public health emergencies we are facing right now. It’s affecting, as you well know, every organ in our body. And the most dramatic thing is that every day, every single day, we have new scientific evidence, papers published demonstrating even more and more damage caused by the exposure to this air pollution, these pollutants that are produced. Several things. One, in few weeks now we are going to COP28. Air pollution and climate are very, very much overlapping. I am sure I don't need to explain you why we need to all look at reducing emissions as one way to reduce the negative consequences of climate change. But at the same time, one of the immense very good benefits will be the reduce reduction of air pollution. Second, we need to have a look, a very careful look at legislation. Maybe the air quality guidelines of WHO can go as far as, at least I know that mandatory is legally binding is maybe a dream, but at least making sure that the governments will be very serious about that. Third, mayors can be our first and very important supporters on this fight against air pollution. And of course, all the interventions on industry on there and pushing for this transition to clean sources of energy, pushing for a better planning and design of our urban environments will be very good. And of course, we need to keep doing evidence monitoring. We need to make sure that everybody has a way to monitor the quality of the air they breathe every day. And by doing that, understanding the health consequences, the economic consequences, and of course putting a lot of pressure on their politicians. We are moving. It's true. But this is still something that in terms of non-communicable diseases, for instance, we need to reach out more to the community of non-communicable diseases, join forces as the AIDS community or the tobacco community. Tobacco against tobacco community did years ago. This is the biggest battle of public health because on tobacco we had one enemy, which is very strong, but one, but here the conflict of interest and the different commercial sectors that will be involved are many. But if we use the health argument, I think we are going to win on all of that. Or at least, I'm very, very much convinced. One scoop, if you allow me. To celebrate a cleaner day, you will be the first one to hear officially that next year in October in Ghana, we will have the second global conference on air pollution and health. And of course, your role is absolutely fundamental. We need to join forces because the conference will be exclusively about solutions and why we have obstacles and what are the ways to go around those obstacles. What is the financing we need? And on that, I'm sure the World Bank will be extremely helpful and we need to create a big global fund to fight with air pollution. Just landed, but I will stop here, as the previous speaker, I could go for four hours, but I want to hear from others. This is so exciting. Thank you so much.

[Subina Shrestha]
We are going to come back to you again and I hope this kind of massive Goliath is going to be won over. Now, we've heard from all the speakers, air pollution harms us, it impacts us physically and mentally right from the beginning, before we are born. It is a slow poison. And yet this is not a health sector problem. It's not a problem that the health sector alone can solve. It's not a sector that environmental alone can solve. We all know that it needs an intersectoral and intergovernmental coordination. And then there is, of course, as Maria just said, there's a question of markets. Priorities have to be set. So, say you are a decision maker or say an advisor to the prime minister or a minister of transportation or industry or energy, and you have to work with limited budgets. What would be the first practical and achievable actions that you would take? So, these are some of the questions that I'm just going to throw to you. And if you can just be brief within a couple of minutes, two or three minutes, that'd be great. My first question goes to Dr. Kumar, what actions would you advise to ministers in South Asia to prioritize in the fight against air pollutions? I mean, we are at the doorstep of G 20 as well. I mean, maybe throw a suggestion for them as well.

[Arvind Kumar]
Yeah, thank you, Subina. The first thing I would do is to convince them that it's as major and challenging a health problem as Covid-19 was because every year air pollution is killing more people than Covid-19 killed in its entire period. So, we need to, and the world needs to respond to air pollution in the same way that we responded to Covid-19. That's the first thing I would tell them. Covid-19 caused death immediately, directly. Air pollution causes slow death, indirect death, and hence does not get the attention we need to clarify this myth. That's the first thing I would do. And then there are five requests I'll make to that minister to do himself or to talk to his ministers quickly, starting from the lowest hanging fruit in India. And I'm sure it must be same in Pakistan, Bangladesh, Nepal. Construction sites and roadside dust is a major addition to particulate matter and it's the lowest hanging fruit, which can be sorted by addressing with the municipal corporations of the respective cities. One thing, I will ensure that they take care of the test. Number two, burning, whether it is double burning in our agriculture sector, it is not of garbage burning, which happens in millions of streets across the country. Brick manufacturing, Dr. Pema mentioned about zigzag, but most of the places they still don't. I would enforce that these burnings, which add to the fumes, they are reduced or removed. Number three, I'll address the transport sector, reduce the number of vehicles, educate people to reduce the number of kilometers run per vehicles and shift to EVs as fast as possible. Number four, I'll address the energy sector. Let's work to reduce the demand. Number two, let’s put electrostatic precipitators in the existing coal plants, and then move lock, stock and barrel to fossil fuel free cleaner energy based plants. And lastly, political will. Political will, political will. So, this is DBTEP, dust burning transport sector, energy sector, political bill, DBTEP. Thank you. I finished in three minutes.

[Subina Shrestha]
DBTEP, everyone shall remember that DBTEP and this question, Dr. Ayesha, as you're a doctor, as a mother and a civil society activist, what advice do you have for the government on actions to prioritize? Because you have actually made a significant progress and you could also perhaps suggest other activists from other countries. How do they learn from your group?

[Ayesha Nasir]
Well, firstly, I would try and convince the climate minister to listen to the mothers of the country because they seem to know a little bit more about air pollution. But jokes aside, the first thing. So, my response to Dr. Arvind is AMMI, A-M-M-I, with A being awareness, because I feel, especially in Pakistan, they're really amongst the political, in and amongst the politicians and the government officials. There's very little awareness for what this is like. I still hear comments from people in power like, “this is not an issue” or “this is an issue for the rich,” or “this is a conspiracy,” it’s something that has publicly been said by climate ministers and environmental officials in the country. So, obviously A will be the first, that awareness, so that once and for all the government realizes, and the bureaucrats, they just need to be educated and made aware that this is really a real issue that's affecting the lives. The second would be for M, it's definitely more car sharing. So, when we did analysis and when you look at the statistics of urban cities in Pakistan, the highest levels of smog are also in school months. And the highest times are pickup and drop off times of schools. A very simple solution is simply for schools to impose more car shares, more bus shares. Right now, if one car, one student is the norm, and with 40,000 private schools per city, you can imagine the numbers that it's leading to. And the third would be more imposition of the Euro 5 compliant fuels. So, the government in Pakistan did try, it was a half, it was a feeble effort. They've tried to impose cleaner fuels, they've tried to put embargoes on Euro 2 compliant fuels. But those are not… 

Subina Shrestha]
I think we have… we are losing Ayesha. I think there, we've lost Ayesha, but I think we kind of got the idea. Are we back? Yeah… 

[Ayesha Nasir]
Sorry, I was saying something.

[Subina Shrestha]
No, we lost you in the middle and you were talking about the Euro compliancy.

[Ayesha Nasir]
Yeah, so I said more of a political will to ensure that we have cleaner fuels. So, the government did try in Pakistan, both at the federal level and provincial level to impose Euro 5 compliance to put an embargo on Euro 2 fuels. But that really, really hasn't happened. And that's, I feel, one of the biggest issues. And the last would really be an intent to… the most affected in Pakistan are the children. And it's really sad. And overall, I feel like Dr. Arvind was saying, the children being born today, the moms who are pregnant, the children who are under five, research has shown that they're losing 10 years of their lives. If your child, I have two kids under five. For me, it's also a personal battle. Those children are losing 10 years. So, one thing that we are trying to lobby to the schools, which is really an intent to restructure the school year so that summers are not off because in Pakistan, the small months, the worst months are October to March. We are trying to restructure, the holidays are moved to the winter summers, maybe different schools give holidays at different times. So, not everybody has summers off and not everybody has winters off. So really… 

[Subina Shrestha] 
I think we've lost… 

[Ayesha Nasir]
…solution. But I say this to everything in Pakistan, the solution are educated moms.

[Subina Shrestha]
Thank you very much, Ayesha. I think like Ayesha said, everyone can organize. And there was a question that how can citizens be encouraged to be more involved in reducing air pollution? And that's exactly what Ayesha and her team are doing. And you've just heard what can be done. Martin earlier said that air pollution knows no border between countries and states. And this has also been proven by studies. Now, Dr. Pema, can you tell us more about cross border and regional actions and solutions that need immediate action?

[Pema Gyamtsho]
Thank you, Subina. I think now it is a given fact that pollution is transboundary. It doesn't stop at our borders. The source of the pollution could be thousands of miles away, but the impact could be felt elsewhere. So, we really need an airshed management approach, just like we do watershed. Airshed management approach is that is what now the Bank and ICIMOD are embarking up on to address this severe air pollution in the Indo-Gangetic Plain and Himalayan Foothills. Now, there is a lot of need. I think one of the major sources of air pollution in the cities is of course transport. In Kathmandu we have thousands of motorcycles, for example, and thousands of taxis and so on. So, there needs to be a lot more investment in the public transport sector using clean energy. And I think that would really solve a lot of air pollution issues. But in the mountains, we should not forget the indoor air pollution. People still use fuel or even animal dung, right? Dungs for cooking. So, Nepal has actually an ambitious plan of supplying about half a million electric cooktops, and for those kinds of things you need in investment. Now, already we have some good experience in terms of sharing good practices and in the brick kiln that I shared, we have linked brick sector, the private sector of Nepal with Pakistan. And there was this business-to-business learning. And now this is being taken to the other countries, Bangladesh and as well as in India. The other area that we are now embarking upon is really to bring the countries together to discuss. So, we have managed in the past, also, to bring, for example, the two Punjab together in a webinar to discuss about the task boundary air pollution and find out solutions, the source, identifying the source, and also, how we can tackle the pollution head source. And it needs a combined effort. So, there's a lot of need to increase data collection, increase the monitoring ability, and also to exchange good practices. The Bank and we have been successful in organizing a workshop last year where we brought the countries together, the regional countries together and endorse their roadmap. Now, this roadmap clearly spells out what is needed to cooperate in monitoring the air quality. And it also talks about how we can share good practices and policies by holding annual science policy dialogue among the member countries of the Indo-Gangetic Plain and Himalayan Foothills. Now, ICIMOD has been actively engaged in setting up monitoring stations in at least four countries, in Bhutan, Bangladesh, Pakistan, and Nepal. Hopefully, we'll be able to also work together with our government partners to not only set this up, but also assist in continuing the monitoring program monitoring. This is something that we need to continue. Also, we are in the process of enhancing regional cooperation by working towards the formation of Hindu Kush Himalayan council. Now, this is something that we have been doing in the last two and a half years. We have been working on coming up with a mechanism to enhance regional cooperation because one country cannot solve this issue, solve this problem alone. So, if you want to have blue skies, clean air, all the whole Indo-Gangetic Plain and Himalayan Foothills, these countries need to come together. And all of us, I think have a very important role to play. I'll stop here, Subina. Thank you.

[Subina Shrestha]
Thank you, Dr. Pema, and good luck for all your work and bringing all these countries together. Dr. Maria, do we still have Dr. Maria?

[Maria Neira]
Yes, here I am.

[Subina Shrestha]
Yes, excellent. You've served in the government of your home country in Spain, and in WHO you interact regularly with leaders from all over the world looking from Europe to South Asia region. What lessons do you see for them as the most important first step?

[Maria Neira]
I think if you allow me, I will endorse all the measures that have been recommended by the previous speakers. Can you hear me?

[Subina Shrestha]
Yes. I'll re endorse… 

[Maria Neira]
Yes, I'll re endorse, just adapting maybe each of them to the different realities of the countries. But all of the previous measures describe it are absolutely a hundred percent important. But Dr. Kumar mentioned the importance of the political will. And if we want to convince a politician, we want to give them something in return. So, since we are playing with slogans here, I will go for a slogan, going to politician in telling them, zero pollution equals multiple votes for you. And I will tell them how they can optimize this reduction on their air pollution, on gaining the support of their citizens and eventually for them to vote them. I will tell them a very simple scenario with data, making sure that they will understand what their quality standards that they have in the country, or the lack of air quality standard, means so many lives, how many lives they could save. And we can help them to maybe communicate that back to the population, for them to have a good image. Obviously, if it's true, if they are reducing the levels of pollution, not just for a greenwash in terms of air pollution. So, we need to have politicians on our side and for that we need to convince them that air pollution is affecting our health dramatically. But they can be good leaders if they apply certain measures, and we will help them to go around the lack of popularity that certain measures will have by giving back to the citizens the very good positive impacts that we are having on their health. And I think another important measure I will do, and this is from my experience in Spain when I was at the government, is calling for a national task force and bringing to that task force all the medical associations and professionals, pediatricians, respiratory societies, all of them and say, “Okay, help me to put in place certain measures that you think will be useful and I need to use your voice as well on television and other media to advertise about that.” Bring in the private sector as well and kind of challenging them and say, “Okay, you are part of the problem, but you need to be a very strong part of the solution as well.” And of course, all the measures around sustainable transport. I think if you bring to the table those in charge of transporting, obviously, the transition to clean sources of energy is one of the biggest, biggest ones. But you need to bring the society. Moms convince, nobody will stop them. I mean the day we have all the moms behind, this is irreversible and we'll move mountains for sure, over.

[Subina Shrestha]
Yeah, just leave it all to the mothers to move it forward and to all of you guys. I think we will have a chance to have one question. And the question is, how can South Asian countries balance economic growth with environmental protection to ensure long-term sustainability? And this is a question that everyone throws all the time, like economics versus environment sustainability, and where does health fit into this? Maybe Dr. Pema, would you like to answer this?

[Pema Gyamtsho]
I think in a nutshell, this tool does not have to be competitive. I think it's complimentary and has to go hand in hand. The very fact that many of our countries are now investing big time in clean energy is a very positive step forward. So, hopefully, we should be able to make better use of these clean energies together with technologies to move towards cleaner air, and also, that means cleaner environment or better environment if you like. I do not see these two as competing sectors, but really complimentary to each other. So, by improving the air quality, we improve the environment as well as the economy. And by improving the economy and environment, we are also purifying the air, actually, we have better air. That is my take on this. Thank you.

[Subina Shrestha]
Dr. Kumar, would you like to add something on this?

[Arvind Kumar]
Yeah. First, I would just add to what Dr. Maria very powerfully and very accurately said that when we go to politicians, we have to go to them with some slogan. So, I would suggest giving a slogan to them. Pollution control will help you in polling. If we just tell them pollution control will help you in polling, if it can go into their head, I think actions will follow.

[Subina Shrestha]
Excellent. Thank you all so much. I am going to take this. We are at 13:55 my time, which is 8 55 DC. I'm going to ask Valerie Hickey, Global Director of Environment, and Natural Resources and Blue Economy at the World Bank to give her closing remarks, and perhaps, talk a little bit more about what she has heard and some of her thoughts about today.

[Valerie Hickey]
Thank you so much. Thank you so much Subina. And I have to say, it has been an incredibly humbling experience to listen to everybody this morning. Your voices are so powerful and so authentic, coming, as they do, from the trenches of this war on dirty air. And it is a war. The stakes are that high. We've all talked about these stakes. Martin started and there's three numbers that really struck in my head, 2 million people dead every year. And that's just talking about lives lost. The quality of life, as Dr. Maria said, are the shocking examples of sickness that Dr. Kumar gave us. It means that it's not just the people who are dead, it's the people who are living lives of misery because of air pollution. It's the number five. Everybody across South Asia having five fewer years with family and friends because of air pollution, many of them after long lives spent working incredibly hard, hoping that they can have a happy retirement, having five years less, but that's not okay. And 10% of GDP lost. Think about the misery that spreads, the food insecurity, lost jobs, lost opportunity. So, the stakes are incredibly high. But what was also so powerful, I thought what I heard this morning is one other number and that's the number 10. 10 years is all it takes. We've seen those examples in real life cities, like Los Angeles and the United States or Mexico City, Beijing, cities that have been able to clean their air in less than 10 years. And that's the hope we have to stick to in this terrible, terrible war on dirty air. And there were four keys I heard to winning this war. The first one, and Dr. Maria, you said it so well, is the importance of data. We need to understand the scale of the problem. We need to understand where the problem is coming from and we need to hold everybody accountable so that we can make better personal decisions, better policy actions, and see how that affects the amount of dirty air. We also, the second thing I heard very clearly from everybody, was the importance of policies and not just national policies or local policies, cross-border policies. We need to make sure that sectors and companies and communities adopt better practices and better technology. And they're incentivized to do it. They're mandated to do it through better policy. And they're penalized when they don't do it. The stakes are too high. We also heard, Dr. Pema, you said it so brilliantly, we need investment, investment, investment. We need more money and rest assured that the World Bank stands ready to invest our financing to fight this war. And then finally, Dr. Kumar, you went toe to toe with Dr. Pema in terms of the fourth and probably most important thing that's needed to win this war, which is political will, political will, political will. So Subina on this International Clean air Day, knowing that we cannot have a world without poverty in a world that's choking on dirty air, dirty air, wanting nobody else to have the kind of experience you've had where your daughter lost a happy childhood to air pollution, and you lost your grandmother to air pollution. Not wanting, like Dr. Kumar said, nebulizers to be as common as kettles in everybody's homes. We need to increase advocacy, do what's being done by those strong and scary moms like Ayesha. And we have to accelerate investment for action so that no later than 2033, in 10 years, everybody across South Asia, whether they're living in cities, in suburbs or in rural communities, whether they're rich or poor, everyone will have access to blue skies and better health. Thank you, Subina.

[Subina Shrestha]
Thank you very much Valerie. And thank you everyone, Dr. Maria, Dr. Pema, Ayesha, Dr. Arvind, for this enlightening conversation. Thank you, Martin and Valerie, for your opening and closing remarks. A special shout out to all of you working behind the scenes and to all of you who have tuned in through World Bank Live and Facebook Live and Twitter Live. I hope you have all enjoyed this as much as I have and learned as much as I've had. Thank you, World Bank for having me. Have a good day, a good evening, and a good night to all of you. Thank you.

[Arvind Kumar]
Bye.

[Subina Shrestha]
Bye-Bye.

[Music]