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Efforts to reduce air pollution around the world have yielded tangible but tenuous gains

Choked: Life and Breath in the Age of Air Pollution

Beth Gardiner
University of Chicago Press
237 pp.
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Extreme air pollution episodes provide stark evidence that the presence of harmful compounds in the air can contribute to serious adverse human health effects. “Killer smogs”—such as those seen in Meuse Valley, Belgium, in 1930; in Donora, Pennsylvania, in 1948; and in London, England, in 1952—emphasize the broader ramifications of air pollution, which not only causes disease and death but can have economic consequences as well.

In the mid-20th century, there was some loss of faith in the classical economic doctrine of laissez-faire—at least as it related to heavily polluting industrial and other activities. At this time, there was growing acceptance that society has an opportunity, even an obligation, to take public policy actions that protect air quality and human health. In the United States, historic public policy actions included the passing of the 1970 Clean Air Act, the implementation of science-based national ambient air quality standards, and the establishment of the Environmental Protection Agency—all with substantial public and bipartisan political support.

Over the past several decades, research has indicated that even moderate levels of air pollution can contribute to increased risk of disease and death. This research also demonstrates that improvements in air quality in the United States and elsewhere have had enormous health benefits. These include reductions in respiratory and cardiovascular disease and death and increases in life expectancy and quality of life.
Air pollution, however, continues to be a major contributor to the global burden of disease—especially in highly polluted countries.

Estimates suggest that it contributes to as many as 4 million to 9 million human deaths per year globally. Beth Gardiner’s remarkable book, Choked, reports on air pollution’s pervasive and pernicious effects on the health and well-being of individuals, families, and nations throughout the world.

Gardiner is not a historian or a scientist but a skilled journalist who deeply understands and cares about these issues. She acknowledges that individuals can take responsible action to address the problem of air pollution. We might choose, for example, to use clean cars and to bike or walk when possible. For Gardiner, “this book, this writing, is an action…. it’s the only thing I know how to do.” She is frustrated, however: Individual action is not enough. Solving air pollution problems requires substantive public policy actions.

It is hard to tell whether Gardiner is optimistic, pessimistic, or just realistic. As she documents the massive air pollution dilemmas in India and China, she reports efforts in China that appear to be making some early progress. These include widespread monitoring of air pollution, increased public awareness of exposure and health effects, and adoption of a nationwide action plan to reduce pollution from coal-fired power plants and polluting industries.

Gardiner also applauds successful public policy initiatives to improve air quality in the United States but notes that these gains are tenuous. She worries that we are at risk of taking our hard-fought-for cleaner air and improved health for granted and that we are allowing science-based clean air policies to be dismantled. “Those who care about the planet’s future are right to despair at Trump’s rejection of science,” she laments.

Although Choked focuses on the benefits of clean air for human health, Gardiner also notes that reducing air pollution from fossil fuel combustion contributes to solving the challenge of global climate change. Because fossil fuel combustion sources are primary contributors to both greenhouse gases and to primary and secondary air pollutants that are directly harmful to human health, control of these sources can contribute to improving and protecting human health as well as mitigating greenhouse effects.

Ultimately, Choked is “a book about choices”: What kind of air do we want to breathe, and what kind of world do we want to live in? The decision to prioritize clean air is among our most important economic, scientific, and public policy choices. It is, after all, more than just a positive environmental amenity; it is an economic good that contributes to improved human health, human capital, and the overall well-being of human lives.

Choked is a plea to make responsible choices, individually and collectively, regarding how we pollute or don’t pollute our air. It is an important book. I recommend it to all who care about the air they breathe

About the author

The reviewer is at the Department of Economics, Brigham Young University, Provo, UT 84602, USA.