Because of global urbanization, the number of people exposed to catastrophic levels of pollution is growing exponentially.

Way back in 1662, John Evelyn, a brilliant Englishman known for his detailed diaries, wrote a lament about the effects of coal-burning on the city of London. His work was called Fumifugium, or the Inconvenience of the Aer and Smoak of London Dissipated. In it, he described an infernal scene of pollution, air filled with "Columns and Clouds of Smoake" emitted by small industries and residences that burned coal for fuel:

That hellish and dismal cloud of sea coal [means] that the inhabitants breathe nothing but an impure and thick mist, accompanied by a fuliginous and filthy vapour, which render them obnoxious to a thousand inconveniences, corrupting the lungs and disordering the entire habit of their bodies…

Those who repair to London, no sooner enter into it, but they find a universal alteration in their Bodies, which are either dryed up or enflam’d, the humours being exasperated and made apt to putrefie, their sensories and perspiration so exceedingly stopp’d, with the losse of Appetite, and a kind of general stupefaction, succeeded with such Cathars and Distillations, as do never, or very rarely quit them….

I found this quotation in the 2003 book When Smoke Ran Like Water, by epidemiologist and environmental advocate Devra Davis. In it, Davis looks back at several historic pollution events and their disastrous effect on human health – and at how these phenomena were often ignored or even actively covered up by the people in charge at the time. The book is informed by a sad personal knowledge. Many members of Davis's family suffered lasting health effects from the 1948 killer smog in the steel town of Donora, Pennsylvania, which left at least 20 dead and dozens more injured.

As Davis points out, John Evelyn was ahead of his time when writing about how London’s notoriously filthy air affected the well-being of its residents. It wasn’t until nearly 300 years later, after what became known as the Great Smog of 1952, that the government began to address the problem in a systematic way.

For four days, between December 5th and 9th, due to a quirk of the weather pattern, the city was entombed in a dense, toxic fog. People were still burning coal for fuel, and low-grade coal at that, because of wartime austerity. A temperature inversion trapped the smoke from the city’s fires, creating a black cloud in which people could barely find their way down even the most familiar streets. Some tried to shield themselves – film footage from the time shows even dogs being fitted with masks – but most people simply went about their business. It was a city, after all, famous for its fog and smoke – and, as Evelyn wrote, for the noxious effect that these had on human health.

But 1952’s fog was far worse than any other in memory. This one killed people quickly enough that it couldn’t be ignored, although we will never know just how many died. In the same week of the previous year, 1,852 people had died in London; in 1952, that number was 4,703. And the deaths didn’t stop when the weather changed and the fog lifted. Davis and her colleagues analyzed data from the next several months and found that “about 13,000 more people died between December and March than one would have predicted from historical averages.” Many of them succumbed to pneumonia. The government, she writes, tried to blame a bad flu season. Her detailed analysis found that explanation simply did not pan out.

Four years after the killer fog struck London, the United Kingdom passed its Clean Air Act. At the same time, and the air of the city grew noticeably cleaner very quickly. London no longer suffers from killer fogs. The episode has passed into history, to be brought out at anniversaries for remembrance.

But in the last few months, we have had several reminders that history, when it comes to urban air pollution, is anything but ended. And in each case, the hazardous levels of pollution have been exacerbated by economic and political conditions, putting millions upon millions of urban resident at risk of death and severe health problems.

Last December, some 60 years after London’s killer fog, Tehran was hit with what has become an annually worsening smog event – pollution so thick this year that authorities closed schools, universities, banks, and government offices in an attempt to decrease the haze. People were warned to stay inside to avoid the smog, which contained sulfur dioxide, lead, and benzene. The New York Times reported that state radio warned it was “suicide” to venture outdoors. At one point, the health minister advised the city’s 12 million residents to get out of the city altogether.

According to the Times, one of the reasons the air in Tehran is getting worse is the type of gasoline that is being used – an Iranian formulation that has been concocted since U.S. sanctions made it impossible to import refined gasoline. The number of cars in the city has also been mushrooming in recent years, despite government policies to discourage driving. Many of the vehicles on the road are older, with outdated and ineffective emissions systems.

This winter in Athens, people have been burning wood for warmth because they cannot afford austerity taxes imposed on heating oil. The result has been a blanket of smoke that hangs over the city on cold nights, prompting the Athens Medical Association to call for immediate action:

"We can't wait any longer," it said in a statement. "We have enough cancers in our country. The cost of treating people sickened from the effects of the smog will be much greater than that of [fully] subsidizing natural gas and heating oil."

And in Beijing last month, the city’s already infamous levels of air pollution hit unheard-of highs, going literally off the charts. The air-quality index reading at the U.S. Embassy there went to 755. To put that into context, anything over 300 in the U.S. is considered “extremely rare.”

It wasn’t always rare. As Alexis Madrigal pointed out last, Pittsburgh air used to be as foul as anything you encounter in Beijing.

What’s troubling is that because of global urbanization trends, the numbers of people exposed to these catastrophic levels of pollution are growing exponentially. So, too, are the early deaths and lifelong disabilities that come with both chronic and acute exposure to this type of toxic atmosphere.

But because of political pressures of various types, it is going to be very hard for some of the governments in question to take the kind of meaningful action that will save lives.

In the United States, 22 years passed between the killer smog that hit Donora in 1948 and the passage of the Clean Air Act in 1970. Devra Davis writes that even in this country, we still have not completely absorbed the lessons of Donora and similar events:

Our knowledge of the health consequences of both local and global pollution is more detailed and accurate than it has ever been. We are now in a position to make informed choices as a society about what risks we will accept and how much we’re willing to pay to change them. Some have argued that a dirty world is the unavoidable cost of economic growth. People who have a vested interest in not changing the causes of pollution will too often use this claptrap as an excuse for doing nothing and learning nothing.

In Beijing, pollution is the product of the engines of prosperity that no one wants to slow. In Athens, it is the result of austerity measures that have been sold as Europe’s only hope for economic survival. In Tehran, the foul air is made worse by a political standoff with the U.S. that is rooted in generations of animosity.

The residents of all three cities are at the mercy of tangled political and economic forces that consistently leave public health at the bottom of the priority list. Sixty years after the killer fog lifted in London, people are dying preventable deaths and suffering life-changing illnesses, simply because they must breathe the air of the cities where they live.

Top image: A bird flies through the polluted sky of Tehran. (Morteza Nikoubazl/Reuters)

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