Air Pollution Is Just As Harmful as Alcohol. Where's the Surgeon General's Advisory? | Opinion

Many Americans will be wrapping up their Dry January challenges this week, and with the recent surgeon general advisory linking alcohol consumption with an increased risk of at least seven types of cancer, the health-conscious among us now have clear guidance about the harms of drinking on our bodies.

As a primary care physician, I applaud what would have been a difficult and unpopular decision for the former surgeon general to make. Hopefully, the soon-to-be affixed alcohol warning labels translate to fewer deaths and lower health care costs for Americans over time, just as warning labels on cigarette packages augmented other tobacco control strategies to reduce smoking.

However, there is another toxin in our environment that merits the same level of national concern. It's a substance that Americans are exposed to on a regular basis, regardless of age. While most of us who consume alcohol have consented to it, this toxin doesn't afford the same opportunity because it exists in the air we breathe. This substance is air pollution in the form of fine particulate matter (known as PM2.5).

Fine particle pollution can be found in indoor and outdoor air in both urban and rural areas. Most PM2.5 in cities comes from car and truck tailpipes, coal power plants, industry, and the burning of organic matter like leaves and wood.  Wildfires, like the recent tragic events in Los Angeles, release a great deal of PM2.5 (along with dozens of other toxins) and are increasing in frequency and intensity due, in large part, to climate change. Because of their miniscule size, fine particles can remain suspended in air for days and be carried hundreds of miles away by wind.

As former Surgeon General Dr. Vivek Murthy's advisory clearly states, alcohol contributes to cancer in multiple ways. Air pollution harms us through many of the same mechanisms such as inflammation, immune modulation, and damage to our DNA. Fine particulate matter can also bypass the natural defenses of our respiratory tract, gaining access to the deep recesses of our lungs where gas exchange occurs. Here, it can carry other toxins into our bloodstream, damaging many different organ systems. Through these mechanisms, fine particles not only increase our risk of cancer, but also contribute to other systemic conditions, including infections like COVID-19.

Dr. Murthy's advisory attributed 741,000 cancer cases to alcohol worldwide in 2020. Fine particle pollution likely led to 265,267 lung cancer deaths worldwide just a few years prior in 2017. And lung cancer is just one of many types it is linked to (breast, prostate, and digestive tract cancers including colon are others). Inhaling fine particle pollution can also lead to heart attacks, arrhythmias, strokes, and over time, dementia along with adverse birth outcomes.

Americans aren't the only ones breathing in fine particle pollution. According to the World Health Organization, approximately 99 percent of the Earth's population breathes air that exceeds safe air quality limits. The health and economic consequences of these numbers are grave, given that several studies also show significant increases in mortality associated with incremental increases in PM2.5 concentration. Children are particularly vulnerable because they breathe more and tend to spend more time outside. Since they are still developing, air pollution damage can result in illnesses that persist into adulthood.

To be sure, reducing alcohol consumption at a societal level is easier to regulate than air pollution. Fine particle pollution comes from multiple sources and many of them are tied to how we get to work or the manufacturing of products our society relies upon. Achieving significant reductions in ambient fine particulate matter will take years to attain and require a multifocal approach.

Yet, hope lies in the form of policies that are already working. Some of these include setting stricter emission standards for cars, trucks, and corporate entities, promoting renewable energy sources like wind and solar, and regulating agricultural burning. As a primary care physician, I am partial to pollution-reduction policies that support creating safe bike lanes, expanding public transportation, and implementing urban greening initiatives because of the myriad health co-benefits these carry in the form of physical exercise and improved mental health. Clear messaging about the harms of fine particulate matter pollution would support such policies and supply affected communities with the evidence they need to mobilize action campaigns to protect themselves.

Surgeon general's warnings are designed not only to share clear information about health risks, but also to induce action, including policy efforts. Over the next few weeks, a new surgeon general will be confirmed, but the office will continue to carry the same weight.  An advisory about fine particle air pollution from the highest-ranking physician in the United States would be a powerful tool in helping policymakers and communities better protect the health of current and future generations for years to come.

Sheetal Khedkar Rao, MS, MD, is an internal medicine physician and assistant professor of clinical medicine at the University of Illinois, Chicago. She is on the Board of Illinois Clinicians for Climate Action and a Public Voices Fellow with the OpEd Project.

The views expressed in this article are the writer's own.