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Cities must take measures to protect their young residents from air pollution—now.

If you knew your child’s health was being endangered by the place you live, what would you do? This isn’t just about how your kid feels today. We’re talking about a situation in which there is extensive scientific proof the city you live in is increasing your kid’s chances of one day having permanently reduced lung function, premature cardiovascular disease, even cancer. Would you get out of town?

That was the question raised in a New York Times op-ed over the weekend. Gardiner Harris tells the story of his son, Bram, who was eight years old when Harris got the choice job of Times South Asia correspondent, based in New Delhi. The Indian capital happens to be the most polluted city in the world, with particulate air pollution readings routinely double those of Beijing, which has gotten much more attention for its pervasive smog. (For some international perspective: The smoggiest day in Beijing is about seven times worse than the smoggiest day in Los Angeles, the U.S. city with the worst air pollution.)

Before long, Bram was suffering frightening asthma attacks, one of which landed him in the hospital for a week. Harris and his wife debated whether their son and his brother should remain in such a threatening environment, ultimately opting to keep the kids there. Things seemed to be better until, two years later, Bram endured another breathing crisis precipitated by someone burning something toxic in the neighborhood. Then the family finally left for Washington, D.C. There, Bram hopes, “My asthma will go away.”

Harris’s professional and personal dilemma sheds light on a particular subculture of expatriate Europeans and Americans living in heavily polluted Indian and Chinese cities to take advantage of opportunities in the fast-growing economies of those nations. It’s a choice that raises eyebrows among those who know the facts. One Indian pollution researcher who moved his own children to the western coastal state of Goa told Harris: “If you have the option to live elsewhere, you should not raise children in Delhi.”

If you have the option. Those are the key words. While Harris and people like him—entrepreneurs, businessmen, bankers, and media types, expatriate or no—often do have the choice to leave the most polluted places, tens of millions of people living in cities such as Delhi do not. In fact, as opportunities for subsistence in the countryside dry up, terribly polluted megacities around the world exert a strong pull on rural populations with few options in a rapidly transforming global economy.

Last year, the World Health Organization released air quality data from 1,600 cities in 91 countries around the globe. Just 12 percent of the people covered by the survey live in cities that comply with WHO standards for outdoor air pollution. Fully half live in cities where the pollutants in the air exceed WHO standards by 2.5 times or more. (Many cities in Africa and the Middle East do not monitor air pollution in a way that conforms with WHO standards, meaning the toll is likely even greater than this report suggests.) Outdoor air pollution was responsible for as many as 3.7 million deaths around the world in 2012. That’s a one-year toll.

We all know more and more people are moving to cities, including Delhi, whose population has increased by nearly a million in just the last two years. As Harris notes in his article, 4.4 million of the more than 18 million people who live in Delhi are school-age children, and a 2010 study showed that just under half are likely growing into adulthood with irreversible lung damage. The conclusions of that study, according to the Indian Express, were largely ignored by policymakers.

The ongoing exposure of tens of millions of the world’s children to damaging levels of air pollution amounts to a public health experiment on a massive scale. What will happen as those who breathed such polluted air begin to get older? What about children exposed in utero? What will the burden be on nations that have failed to confront the crisis now, in terms of health-care costs and reduced productivity? What is the toll on the families who, unlike Harris’s, cannot afford treatment—much less to move their children to safer places—and must watch as they struggle for every breath?

The WHO report suggests a number of policies that could begin to reverse the pollution trend: reducing industrial emissions; mandating cleaner fuels for trucks and other heavy vehicles; emphasizing walking, biking, and transit as urban transportation modes; moving to cleaner power generation; requiring more energy-efficient buildings; and reducing or eliminating incineration as a mode of waste disposal.

The results of cleaner air are real and measurable, as a study of children in Southern California has shown. That research looked at kids in five of the region’s most polluted cities, comparing children aged 11-15 during the 1990s to the same cohort from 2007 to 2011, after California had implemented stringent air quality regulations. The number of kids with dramatically reduced lung function went down by four percentage points, from 7.9 to 3.6. Their lung growth over the four-year study period improved by 10 percent.

“This study shows that California’s tough diesel and other air quality regulations protect children,” a state official told the Los Angeles Times.

That’s what all parents want to do, of course: protect their kids. A handful, like Gardiner Harris, can choose to do so by removing them altogether from places where the air simply isn’t safe to breathe. But the vast majority don’t have that option, and are reliant on larger forces to keep their children safe. “We cannot buy clean air in a bottle, but cities can adopt measures that will clean the air and save the lives of their people,” said WHO’s Dr. Carlos Dora in a statement. The choice to do so should be clear.

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