Air pollution by oil giants is trapping impoverished communities into generations of injustice

South Durban, home to more than 250,000 people, has historically been a high pollution zone in South Africa. Despite the gradual reduction in traditional pollutants such as sulphur dioxide, others such as particulate matter and oxides of nitrogen continue to be elevated in the community. 

Typical of many such communities, established to serve as a labour pool to nearby industry, residents are at the margins of vulnerability as large numbers of people in these communities are unemployed or in low-income occupations. 

South Durban represents an example seen globally – and sharply exposed during the Covid-19 pandemic – of when multiple vectors of inequity and injustice converge into a perfect storm that influences health and further fuels a downward spiral of communities. The evidence for the social determinants of ill-health is convincing. Social determinants drive nutrition, education and residence. Residence, as seen in South Durban, the Vaal Triangle or the Highveld, is additionally a key determinant of exposure to pollutants. 

The evidence for adverse health outcomes and air pollution is well established. South Durban communities have contributed living case studies for this evidence base: researchers have documented pollutant-related impacts on acute lung outcomes, including symptoms, lung function and emergency health service use. 

Of concern is the evidence for neurocognitive effects related to exposure to pollutants such as metals and the polycyclic aromatic hydrocarbons: evidence is seen in children of loss in intelligence quotient (IQ) points, learning ability, attention span and concentration. Unfortunately, many of these outcomes are subtle at a population level, but potentially substantial at an individual level.

The findings that pollutant-related effects may begin their impacts on health in utero implies that the newborn is already disadvantaged at the time of birth. The adverse effect of pollutants on the organ development stage of the growing foetus, particularly on lungs, heart and brain, results in a child being born already compromised. 

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The work on infant lung function and neurocognitive assessments in newborns, followed up through later childhood, provides the evidence that those affected in the uterus before birth follow a different trajectory as they age, and these may then become the precursors of diseases in adulthood. Evidence that pollutants may have an epigenetic impact (changing of the genetic structure resulting in increased risk for an adverse outcome) in utero through to early childhood is increasing.

These epidemiological studies on air pollution and health outcomes indicate that effects are felt across a generation. The exposures experienced during pregnancy and consequences in the newborn and in early childhood compromises that child’s ability to achieve their full potential at school or in employment.

Coupled with the other social determinants, these youngsters can become trapped in the pollutant-poverty paradigm, preparing their communities for the next generation of similarly trapped young people. 

Research is emerging that a relationship exists between social determinants and air pollution, and the modification of health effects arising from dual exposure to these risk factors. This implies that the combined effects of exposure to these risk factors are greater than exposure to these factors individually. 

The Covid-19 pandemic provided a clear example of this, and because the outcomes were easily measurable (severe Covid-19 disease and Covid-19 deaths), and comparable (poorer, marginalised communities vs well-resourced ones), there was a vocal response with the media, non-governmental organisations and activists pressuring the government to act.