Air pollution is getting worse. After declining by 24 percent between 2009 and 2016, the amount of particulate matter in our air increased by 5 percent between 2016 and 2018. (Some particulate matter you can see. Some you can’t. The dirty specks and droplets of particulate matter are produced when we burn wood, for example. But it’s also formed in the air through the chemical reactions of pollutants emitted by industrial plants and cars and trucks.)

Even this rise, researchers have found, led to 9,700 premature deaths in 2018.

Worldwide, writes Beth Gardiner in her new book, “Choked: Life and Breath in the Age of Air Pollution” (The University of Chicago Press, 2019), air pollution prematurely kills 7 million people every year.

In fact, she writes, “A powerful body of evidence now links air pollution to a long and growing list of health woes, including heart attacks, strokes, birth defects, many kinds of cancer, dementia, diabetes and Parkinson’s disease.”

She wonders, “Is air pollution an inevitable part of modern life? What would it look like to do things differently, to build a cleaner, healthier world?”

To write “Choked,” named by The Guardian as one of the best books of 2019, Gardiner traveled from her home in the “diesel stew” of London to India, Poland, Germany, China and back to America, where she grew up, exploring the sources of air pollution, the impacts on people’s health and wealth and the steps taken — and needing to be taken — to make progress.

“Cleaner air,” she concludes, “is not an impossible dream.”

A conversation with Gardiner has been edited and condensed for clarity.

Allyn West: So, I’ll start by confessing something I probably shouldn’t. My 4-year-old daughter lives right now in a rural town in Kentucky. Thinking of her little lungs here in Houston, where we had nearly a month of ozone action days already in 2019, I let a heartbreaking question creep in, sometimes, that maybe it’s not in her best interest to live here with me. You wrote something similar about your own daughter in London. This uncertainty about what, exactly, air pollution is doing to our bodies, and when, and how, stuck out to me. As you write, “It’s a strange, and very modern, kind of anxiety.” How do you deal with it?

Beth Gardiner: I wrestle with that a lot. London’s air quality is even worse than Houston’s. I have a now-12-year-old daughter. Having reported the book, I am very well acquainted with the science about what air pollution does to all of our bodies.

Children are particularly vulnerable, because their lungs are still growing, and they can be stuntedby air pollution. That’s something we have known for a long time, from the USC Children’s Health Study, and there’s been recent research confirming it again.

But for all of that, we still live in London. My daughter walks to school, along some pretty busy roads. The science says that increases her exposure.

In the global perspective, compared to Delhi, Beijing, eastern Europe, cities like London and Houston have exponentially better air quality. So the risks we are talking about are nothing compared with what parents in India or Pakistan have to deal with.

But I don’t feel that the answer is we all just leave the polluted cities. It’s possible to have cities that don’t give us heart attacks and dementia. My family is in London because this is where our jobs are. We can’t move easily. And a lot of people can’t afford to leave.

It would be better to have cleaner cities than to have to run for the hills to protect our kids’ health. Our cities can be so much better. There’s so much we can do, in terms of better public transportation and tougher regulation on industry and the other forms of pollution we’re living with.

AW: The cost of air pollution is often expressed in global death tolls. But air pollution compromises our quality of life in many ways. There’s the stress of that anxiety you discussed. The costs of health care. Afternoons when children are warned from playing outside and stuck in front of a television. What, for you, has been one of the most poignant illustrations of the ways air pollution compromises the quality of our lives?

BG: Short of premature death, there’s a tremendous amount of illness associated with air pollution. That makes an impact in terms of missed school days and missed work days when parents have to take their kids to the doctor or the ER.

And it exacts a terrible toll in anxiety, worry and grief. A woman I know, a journalist, moved from the U.S. back home to India, so her kids could get to know the culture there and spend time with their grandparents.

But then after they got there, her mom, who had never smoked, developed lung cancer and died. And of course every death has huge ripple effects on everyone who grieves for that person.

In Poland, I met parents who bring their kids straight home from school and don’t let them play outside on the playgrounds. A geriatrician told me he often advises his patients to stay indoors. That has a cost for his patients, older people who like to take walks and see friends, and they become isolated when they have to stay inside.

In London, I worry about the pollution every day. Not just worry. It makes me so angry. In Europe, there’s this diesel smell that hits you whenever you’re near a road, even a pretty quiet one. It’s all these diesel cars that are violating the emissions limits. Even now, four years after the VW cheating scandal came to light, governments are still letting manufacturers get away with selling cars that shatter the rules.

And I understand what the health effects are. So it makes me upset every time I smell it. It leaves this awful taste in your mouth. When I meet my daughter on her way home from school, I get home and brush my teeth — you feel this layer of grit. Sometimes, it makes me headache-y or light-headed.

So, there are a lot of smaller quality-of-life impacts, beyond the headline numbers.

AW: Air pollution is an ambient problem. It doesn’t always appear to be a problem, though, in Houston, save for explosions. It’s hard to see. As you’ve toured the world trying to see the problem, what are some of the most striking visuals you’ve encountered that make the invisible visible?

BG: In London, you can’t see it either. And that’s a big part of the political dynamic around air pollution.

The Clean Air Act is almost becoming a victim of its own success, because 40 years ago, you really could see the smog in American cities. Today, you don’t notice it. And the public support for regulation and measures to deal with it isn’t there in the same way it once was.

In general, the visuals aren’t really visuals, unless you’re talking about India, China, Mongolia or Poland, where you see thick black smoke in the sky.

But I’m a journalist and a writer. When I started to understand some of the science, the numbers around air pollution, that’s why I wrote this book. I really felt like this was an important story, and one that wasn’t getting coverage that matched the amount of impact it has on people’s lives.

If anything else was killing the same number of people, if there was an epidemic, or war, or act of terrorism, killing 500,000 people in Europe, 100,000 in the U.S., that would be nonstop news. Air pollution does it in this way that’s invisible. We know deaths are happening that wouldn’t if the air was cleaner, but you can almost never connect the cause in any individual case.

One exception to that: In London, there’s a mother who’s trying to get air pollution written on her daughter’s death certificate.

Ella Kissi-Debrah died in 2013. She was 9 years old. She lived right off a busy road, the South Circular, a ring road around London. She had a severe form of asthma. She was sick on and off for years with asthma attacks, but no doctor ever said anything about air pollution as a trigger.

After Ella died, a British scientist did an evaluation. Ella had had something like 30 hospitalizations, and the scientist, Dr. Stephen Holgate, found somewhere around 28 of them were correlated with air pollution spikes in their neighborhood.

Ella’s mother, Rosamund, who was a secondary school teacher and is now running for Parliament, wants air pollution written on the death certificate as a contributing factor. There had been an official inquest into Ella's death, and petitioning to get a new one opened was a huge legal process.

She was supported by the attorney general, and now the case will be re-examined. I feel like we hear these numbers — 9,000 Londoners every year — but one child, one face, is so much more powerful than any number.

So that's one way of making the invisible visible. There’s something about air pollution being written in black and white on a legal document, if she wins this case, that it contributed to Ella’s death, this one little girl’s death, that’s powerful legally, morally, ethically, politically.

It begs for a response, some kind of action, because you then also have to ask whether other children are dying from air pollution. Which of course they are.

AW: You write that government is the only institution large enough to push back hard enough to clean our air. That’s why moves proposed by the current presidential administration, to slash vehicle emissions standards or allow even more flaring and venting of methane, can seem so frustrating. What are some regulatory wins, or even promising initiatives, that you’ve learned about?

BG: In the U.S., we don’t think of ourselves as being successful with environmental issues. But the story of the Clean Air Act is one of slow, steady progress that has accumulated into tremendous success. There are studies showing that that progress has saved millions of lives and trillions of dollars. And that the benefits have been dozens of times the cost.

It’s one of the most consequential pieces of legislation in modern American history.

But it’s invisible. No one wakes up and thinks how grateful they are to some lawmaker they’ve never heard of because the air is cleaner than it would have been. We just don’t work that way. That’s just now how politics works.

So, now, we’re seeing very aggressive rollbacks at the Environmental Protection Agency in terms of regulations. But there’s also this brain drain, this shrinking of expertise.

I was surprised to learn that Europe’s air quality is significantly worse than the U.S.’s., in part because Europe does not have an EPA equivalent that is resourced not just with money but with scientific and technical expertise.

And Europe's enforcement failures are a real cautionary tale for us, because what’s happening now at the EPA is the evisceration of its enforcement capability. And what I think is potentially even more consequential is the attack on its science.

Science has been the pillar of the Clean Air Act, the pillar of the EPA. It has never been a perfect agency, but it has delivered so many health protections.

The Trump administration is seeking to attack and undermine huge, widely respected scientific studies. They’re weaponizing the language of science to attack actual science. That’s very dangerous. The consequences are long-lasting. We’re used to denialism around climate science, but now we’re seeing it around air pollution science, as well. How do you get back to where you were?

Because what I saw in all the places I traveled to as I reported this book is that the one force actually capable of delivering clean air is government regulation and government action.

Individuals do not have the power to demand that a power plant install better scrubbers. We don’t have the power to force Volkswagen to follow the law and make its cars comply with the rules. We don’t even have the power to make our neighbors stop burning wood in their fireplaces or stoves.

The place where we put that power is our government.

West is a senior communications specialist for the Environmental Defense Fund. You can follow him on Instagram and Twitter @allynwest.

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