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Michael J. Stephen is an associate professor at Thomas Jefferson University in Philadelphia, director of the Adult Cystic Fibrosis Center and the author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs.

The case of Lisedi, an 18-month-old South African girl, first brought home to me the connection between climate change and lung medicine. It was 2009, and I was rotating through the Red Cross War Memorial Children’s Hospital in Cape Town. She came in very sick with pneumonia, and passed away within two days despite good antibiotics.

I asked the senior physician if we knew the exact bacteria, and he scoffed at me: “It could have been one of 10. But it doesn’t matter. It was the air she was breathing that killed her. The bacteria, the pneumonia, is just a symptom of the disease.”

The disease the doctor was talking about was the toxic mixture of poor lung health, air quality and climate change. Living in a township, Lisedi was likely exposed to significant indoor and outdoor pollution, and being so young her airways were more permeable to particles and damage. This is what allowed the bacteria into her lungs that led to her death.

This is also the reason the World Health Organization tells us respiratory infections attributable to air pollution and second-hand smoke are the leading killer of children under 5, causing some 570,000 deaths a year worldwide. Canada is familiar with this association from the SARS-1 crisis, where it was estimated higher levels of pollution caused higher fatality from the virus. This will also surely be true for COVID-19.

Air pollution and climate change are intimately intertwined, with both feeding into the other in a vicious negative cycle. Pollution not only harms us, but also poisons trees and traps more harmful global warming gasses. Global climate change in turn has led to worsening wildfires in the American West, Australia and the Amazon rain forest.

These wildfires are the exact reason why the United States has had a decline in air quality in the past three years, where in 2020, according to the American Lung Association, 45 per cent of the population is now exposed to toxic air on a yearly basis, which is up from 38 per cent in 2017. Climate change has also led to a large increase in vegetation and allergens along with higher levels of humidity and higher ozone days.

The data worldwide are even more sobering, with 91 per cent of the world’s population exposed every year to unhealthy levels of air pollution. According to the WHO, this leads to 4.2 million premature deaths each year from outdoor air pollution, with another 3.8 million coming from indoor air pollution. These are owing to associated lung diseases such as COPD, but also heart and neurological disease. Air pollution causes total body inflammation and affliction.

Canada, on the whole, is a bright spot for air quality in the world. A 2019 report ranked it the ninth most healthy country for air quality out of 98. Since control measures were put into effect in 1970, there have been dramatic decreases in particle pollution and pollution from noxious gasses such as carbon monoxide.

The devil, though, is often in the details. A real-time map of air pollution in Canada on Feb. 2 showed five cities, four in Alberta, over the 100 index threshold of outdoor air pollution, indicating a light polluted atmosphere with a recommendation that children and seniors curtail outdoor exercises. How many people living in those five cities had that information?

Canada will not likely be able to maintain this quality air for long as our atmosphere is communal on both small and large scales. Nutrient dust from the Sahara feeds the Amazon rain forest, and the Gobi Desert supplies the trees in Yosemite in an opposite jet stream. Toxins and carbon dioxide produced in China to make all of our goods will more sooner than later be affecting everybody on the planet. As the climate changes, air pollution will get worse, and vice-versa. Our lung health will not just suffer, but also our heart, brains and bones.

If there’s a silver lining, there is solid research that cleaning up our air leads to dramatic and immediate improvements in lung function and health. In the 1980s, a steel mill closed in Utah for the year, and child admissions for lung diseases dropped to 23 from 78. Over the 1990s in Los Angeles, it was shown that cleaning up the air led to significant increases in children’s lung function.

The solutions to climate change and pollution are out there. Getting onto renewable energies and lowering carbon dioxide output will be a big part of this. During COVID-19 we saw how the Earth can heal itself as pictures circulated of dolphins frolicking in the Venice canals in the absence of human activity. With a worldwide effort, Canada could stay safe both from toxic air and also lethal changes in the environment.

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