China's Air Pollution: Masks, A Necessary Evil?

Air pollution is a serious issue in China, causing around 2 million deaths per year. It is caused by industry, transportation, coal power plants, and household solid fuel usage. To combat this, some people in China started wearing masks before the COVID-19 pandemic, particularly during periods of high pollution. However, it is a myth that masks have been mandatory in China for 18 years. In fact, mask-wearing was only made compulsory in certain cities in January and February 2020 to help curb the spread of COVID-19. Nevertheless, masks have been shown to be highly effective against air pollution, especially those with N95 certification, which can filter up to 95% of airborne particles.

Effectiveness of N95 masks against air pollution

Air pollution is a global issue that affects the health and well-being of millions of people worldwide. The World Health Organization (WHO) estimates that approximately 4.2 million premature deaths occur annually due to outdoor air pollution. The major contributors to air pollution are industry, transportation, coal power plants, and household solid fuel usage. As a result, many individuals have turned to protective measures such as face masks.

The N95 mask, also known as the N95 respirator, is a type of personal protective equipment (PPE) that has gained popularity due to its effectiveness in filtering out airborne particles, including bacteria and viruses. The 'N95' label stands for the mask's ability to filter out at least 95% of airborne particles larger than 0.3 microns. This includes particulate matter (PM2.5), which refers to fine particles with a diameter of less than 2.5 microns that can penetrate deep into the lungs and cause adverse health effects.

The effectiveness of N95 masks against air pollution has been supported by studies conducted in Beijing. These studies found that wearing an N95 respirator prevented the adverse effects of inhaling PM2.5 particulate matter. Specifically, wearing an N95 mask lowered mean arterial pressure and increased heart rate variability compared to not wearing a mask when exposed to air pollution.

However, it is important to note that N95 masks are primarily designed to filter out particulate matter, and they are less effective against gases commonly found in air pollution, such as nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3). Additionally, the breathability of N95 masks can be a concern, as they may cause discomfort during extended wear due to restricted airflow and heat and moisture buildup.

To ensure the effectiveness of N95 masks, it is crucial to achieve a good fit and seal against the wearer's face. Air should not leak in or out around the mask, and the wearer should follow proper usage guidelines, such as washing hands before putting on the mask. N95 masks are most effective when combined with other protective measures, such as social distancing.

In summary, N95 masks are highly effective at filtering out airborne particles associated with air pollution, especially when worn properly and in conjunction with other protective behaviors. However, their effectiveness is limited against certain gases present in air pollution, and breathability may be a concern for some users.

Air pollution in China: causes and health effects

Air pollution in China has emerged as a pressing issue in recent decades, causing widespread environmental and health problems. The country's rapid industrialization, population growth, and lax environmental oversight have led to excessive emissions of greenhouse gases and other pollutants, threatening both local and global well-being.

Causes of Air Pollution in China

China's rapid economic development and industrialization have resulted in a substantial increase in the demand for consumer goods, vehicles, and energy. This heightened demand has, in turn, led to a surge in the burning of fossil fuels, particularly coal, which is a primary source of energy in the country. The combustion of fossil fuels is a significant contributor to outdoor air pollution, filling the air with harmful fine particulate matter that poses risks to human health.

In addition to the burning of fossil fuels, other factors exacerbating air pollution in China include industrial activities, transportation, and coal power plants. The dense network of measurement stations and monitoring equipment in Chinese cities has consistently recorded high levels of air pollutants, with over 40% of major air pollutant concentrations exceeding Chinese standards in recent years.

Furthermore, indoor air pollution, often caused by household solid fuel usage and cooking with polluting fuels and technologies, poses another severe health hazard. The lack of proper ventilation and the use of inefficient or polluting technologies for cooking and heating contribute to poor air quality within homes, leading to respiratory and cardiovascular health issues.

Health Effects of Air Pollution in China

The health consequences of air pollution in China are dire and wide-ranging. Fine particles in polluted air penetrate deep into the lungs and cardiovascular system, causing a range of diseases, including stroke, heart disease, lung cancer, chronic obstructive pulmonary diseases, and respiratory infections. The Chinese Ministry of Health has identified industrial pollution as the leading cause of cancer in the country, with lung cancer being a significant concern.

According to various estimates, air pollution in China is responsible for a significant number of premature deaths annually. A 2007 World Bank report, in collaboration with China's national environmental agency, estimated that outdoor air pollution caused 350,000 to 400,000 premature deaths each year, while indoor pollution contributed to an additional 300,000 deaths. More recently, it was estimated that approximately 2 million deaths occur in China each year due to air pollution, with over 1 million attributed to ambient air pollution and another 1 million linked to household air pollution. The situation is particularly acute in northern China, where air pollution from fossil fuel burning, especially coal, has led to a reduction in life expectancy by an average of 5.5 years.

The health impacts of air pollution extend beyond mortality rates. The high levels of pollutants in the air affect the quality of life for many Chinese citizens, causing respiratory and cardiovascular issues, especially in vulnerable individuals such as children and those with pre-existing health conditions. Additionally, the pollution has spread internationally, with sulfur dioxide and nitrogen oxides falling as acid rain on neighboring countries like South Korea and Japan.

History of mask-wearing in China

The history of mask-wearing in China is a fascinating one that combines cultural traditions, public health concerns, and evolving social norms.

Traditional Chinese Masks

Chinese masks have a long history, dating back around 3,500 years. Initially, they were used in shamanistic practices and religious healing rituals. Over time, their use expanded to include exorcism, funeral rites, and celebrations of major life events such as births and weddings. Traditional Chinese masks are often associated with scaring away evil spirits and celebrating various cultural events. The colour of the mask symbolises certain characteristics, such as red for courage and bravery, yellow for evil, and green for violent characters.

Air Pollution in China

China has been facing an alarming rate of air pollution, which has severely impacted the health and quality of life of its citizens. Air pollution leads to exposure to fine particles that penetrate the lungs and cardiovascular system, causing serious health issues including stroke, heart disease, and respiratory infections. While China has made some progress in addressing this issue, it still contributes to approximately 2 million deaths annually. As a result, masks have become a common sight in China, with many residents opting to wear them to protect themselves from the harmful effects of air pollution. The N95 respirator mask, in particular, has been recommended by experts as it can filter out 95% of airborne particles and provide protection against the adverse health effects of air pollution.

COVID-19 Pandemic

The COVID-19 pandemic further emphasised the importance of mask-wearing in China. The country implemented strict measures, including mandatory face mask-wearing, which contributed to its success in controlling the spread of the virus. During this time, studies also emerged highlighting the impact of prolonged mask-wearing on the nasal microbial composition of young adults in Shanghai, China. These studies found significant alterations in the nasal microbiota of individuals who wore masks for extended periods.

Social Acceptance and Collectivism

Unlike in Western cultures, where mask-wearing was often viewed with suspicion or as a sign of sickness, Asian societies, including China, have generally embraced mask-wearing as a social norm. This shift can be partly attributed to the SARS pandemic in 2003, which normalised the practice across Asia. In China, mask-wearing became indicative of collectivist values, where individuals prioritised the protection of others by hiding their faces to prevent the spread of germs. This sense of solidarity and mutual reassurance contributed to the widespread acceptance of masks in Chinese society.

Government-issued measures to combat air pollution

Air pollution in China has been a cause of concern, leading to about 2 million deaths per year. The major contributors to air pollution are industry, transportation, coal power plants, and household solid fuel usage. The Chinese government has implemented various measures to combat this issue.

In 2013, China introduced the Airborne Pollution Prevention and Control Action Plan, backed by a $277 billion investment from the central government. This plan aimed to reduce fine particulate matter, known as PM2.5, in the air, which can have harmful health effects. The government also targeted ground-level ozone pollution, a highly irritating gas created by volatile organic compounds (VOCs) reacting with nitrogen oxides from vehicles.

To reduce pollution from vehicles, large cities like Shanghai, Shenzhen, and Guangzhou restricted the number of cars on the road and started transitioning to all-electric bus fleets. The government also called for increasing freight cargo transport by rail and water by 2025 to reduce road transport pollution. Additionally, China set targets to reduce coal consumption in various regions, including the Beijing-Tianjin-Hebei area and the Yangtze River Delta, by 2025.

China has also focused on afforestation and reforestation programs, investing over $100 billion in initiatives like the Great Green Wall, planting more than 35 billion trees across 12 provinces. These efforts have contributed to significant improvements in air quality, with PM2.5 levels in Beijing reduced by 33% between 2013 and 2017.

Furthermore, the Shandong Province approved funding to remove heavy-polluting vehicles from its roads, and the government prohibited new coal-fired power plants while shutting down older plants in highly polluted regions. The draft amendment to the Environmental Protection Law proposed greater responsibility for governments at all levels to improve the environment and prevent pollution, with environmental protection work becoming a criterion for evaluating the performance of departments and officials.

Behavioural changes to protect against air pollution

Behavioural changes can be an effective way to protect oneself against air pollution. While air pollution remains at an alarming rate in China, causing about 2 million deaths per year, there are ways to combat its adverse effects.

One way to protect oneself from air pollution is to wear a mask. In Asia, masks have been worn to protect against air pollution, even before the COVID-19 pandemic. The N95 mask is preferred by experts as it is certified to trap 95% of particles 0.3 microns in size, which are much smaller than PM2.5 (fine particulate matter with a diameter of less than 2.5 microns, which is very harmful to health). The N95 mask should be worn when the Air Quality Index (AQI) exceeds 200, especially for those with respiratory problems.

Other behavioural changes can be implemented within the home to reduce exposure to air pollution. For example, increasing ventilation is a positive action that can be taken, as opposed to traditional advice such as remaining indoors and keeping activity levels low. Behavioural change interventions can also be implemented, such as changing where fires are burned, how fuels are dried and kindled, and how windows are opened and closed. These strategies have been shown to reduce indoor air pollution exposure by 20%-98% in laboratory settings and 31%-94% in field settings.

Access to accurate information about pollution levels is another important factor in behavioural changes. In China, a program that increased awareness of pollution levels resulted in a noticeable increase in articles about air pollution and a surge in mobile phone apps providing users with air pollution data. This led to behavioural changes such as the purchase of air purifiers, which had meaningful health effects. It is estimated that access to pollution information reduced premature deaths attributable to air pollution exposure by nearly 7%.

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