“I am happy to see research on environmental health getting the position in global health research it needs in times like these”
SIGHT Award 2020 of 100 000 Swedish kronor has been awarded to Ebba Malmqvist, Associate Professor at Division of Occupational and Environmental Medicine, Lund University, for her research on pollution and health with focus on pregnant women and children.
Text: Ulrica Segersten/Alex Farnsworth • Photo: Clea Bielecki
Congratulations on the award! How do you reconcile being a promising researcher in global health on the one hand and an environmental scientist on the other? How do these fields fit together?
“My ambition has always been to study developing countries and to work with global health issues. My path has been from environment to health, and not vice versa. Receiving the SIGHT Award 2020 is a testament to how environmental health issues can have an important impact in medical research,” says the award recipient.
Air pollution, or exposure to fine particles, is a major threat to health globally, especially in low-income countries and is one of the five most serious risk factors for premature death worldwide, accounting for 6.67 million deaths per year, according to the Global Burden of Disease Study (GBD 2019).
Proving the costs of climate and environmental health effects on society as a whole is a challenge for decision-makers anywhere, Malmqvist admits. Given that it may be easier to make this point to decision-makers in Sweden, it is not just a question of copy and pasting what works in Sweden into an Ethiopian context, for example. Studies must be national to gain traction, is Malmqvist’s belief.
Since 2016, Ebba Malmqvist’s research group has collected data and modelled air pollution levels in Adama, Ethiopia to produce maps of particle levels in different areas.
“The air in Adama is very polluted. Garbage is burned in the streets and people cook over open fires. The traffic situation is like going back 50 years in time. Many old and dirty trucks from Europe are shipped to Ethiopia (and to the rest of Africa) and drive straight through the city on the road between Djibouti and Addis Ababa. Although there is a ring road around Adama, it remains un-trafficked because it is subject to a toll. But if we can prove that the unhealthy truck traffic also creates costs, perhaps the decision-makers can rethink and remove the toll,” says Malmqvist.
Despite the obvious uncertainties surrounding the recent unrest in Ethiopia, Malmqvist still has high hopes in the government’s involvement in mitigating the negative side effects of air pollution on human health. For instance, aid organizations have expanded their scope of activities from poverty and hunger issues to collecting air quality measurements. Many more understand how important the climate is for health.
“Collaborations between NGOs and our research group in Ethiopia have grown enormously since 2016. Now we have also started measuring air quality in slum areas in India and Pakistan through new collaborations. For us, it is important that capacity building goes hand in hand with our research. In Ethiopia, we have a doctoral student on site who collaborates with three different universities. Our aim is to make ourselves redundant,” says Malmqvist.
Something that possibly will fuel more attention from decision makers is a model that NASA plans to implement in the next few years for air pollution around the world.
“But when I discovered that only high-income countries would be included in the NASA model, we suggested that Ethiopia should participate as well. We have now managed to get the various NGOs to pay for air pollution meters that will be set up in Adama. In 2022, NASA’s satellite will be set up to predict on-site air compounds. It is very exciting,” she says.
When Ebba Malmqvist’s research group completes the modeling of air pollution, it will be followed up by epidemiological studies.
There is a relatively new research field that tries to connect preeclamsia, a pregnancy disorder, with air quality and air compounds and the findings are remarkable. Women’s placentas have been mapped according to where the women live, and clear biological effects of air pollution have been discerned. Other studies have correlated a 70 percent increased risk of gestational diabetes with certain air compounds.
“A pregnant woman naturally has increased stress on her body, a larger blood volume and often more frequent breathing than normal. Taken together, this makes pregnant women more exposed to the effects of air pollution. This link between air pollution and pregnancy is also manifest in an increased risk of developing gestational diabetes. Additionally, it has also been shown that fetuses that have been exposed to higher air pollution levels than normal do not grow as much, due perhaps to the mother not feeling optimal, or that the really small particles reach the placenta and the fetus, which can thus affect growth,” says Malmqvist.
Given that Ethiopia has one of the highest mortality rates for preeclampsia, the most common cause of Ethiopian mothers dying, it is important to follow up the Swedish results on the spot.
“Mothers and their youngest children in Ethiopia are most exposed to air pollution because they tend to cook over an open fire while often carrying a child. It has been surprising to find such high levels of polluted air when cooking over an open fire,” says Malmqvist.
That global health, climate and the environment are closely linked has become even more apparent during the Covid-19 pandemic. Has the pandemic given you new insights into your own research?
“Our research group has actually been commissioned by the Public Health Agency of Sweden to investigate these connections. People are starting to realize how important urban planning and green environments are for human health generally. While we have clearly seen how air pollution has been reduced during the pandemic, we also don’t want to sacrifice our freedoms or close societies altogether either.”
According to Malmqvist, this pandemic can teach us lessons in the long-term reduction of air pollution, for example, or in evaluating other risk factors and human behaviour. Historically, many cities have developed their urban planning priorities after pandemics and natural disasters. And this pandemic will be no different. Cities such as Berlin and Paris, for example, have already redesigned their traffic patterns during the pandemic, adapting to fewer cars and creating more pedestrian and bicycle traffic.
“One thing we’ve learned is that we don’t need to commute to the same extent as we have in the past. A recent study in Barcelona showed how 90 percent of automobile commuters did not miss commuting, while those who commuted by bike did so because they wanted the daily exercise that getting to work provided.”
Malmqvist hopes that urban planners will shift their perspectives to include more human and natural parameters.
“When you consider what our cities actually look like today, the automobile has been the focus of urban planning for far too long. We must instead pivot towards building environments where people actually thrive and feel good,” she says.
Given what your environmental health research has shown so far, is there anything that makes you angry?
“Yes, I get annoyed when despite the results of the research, findings are often dismissed by decision makers because of short-term financial concerns,” says Malmqvist.
She mentions an example from her hometown of Lund, Sweden.
“When a schoolyard was due to close, city officials offered instead a platform above a heavily-trafficked bus stop to take its place. We’ve been doing research for over 12 years now on how bad air negatively affects health. And I mean, Lund is a university city – and yet they make such a decision! Children with impaired lung function and asthma cost money and suffering in the long run. Why is this so difficult to understand?” she growls.
When asked what makes her happy, Ebba Malmqvist takes a different tact:
“All the fantastic people I work with in research and on site in Ethiopia and India. They are so incredibly solution-oriented and good at solving impossible situations and have such a great attitude.”
And finally, what does it mean for you and your research to receive the SIGHT Award 2020?
“The prize is important to me personally, but above all I am happy to see research on environmental health getting the position in global health research it needs in times like these.”
”for research of key importance to reducing the harmful effects of air pollution, with a focus on the health of children and women in low- and middle-income countries.”
About the Laureate:
Ebba Malmqvist is Associate professor at Division of Occupational and Environmental Medicine, Lund University. Her research field concerns the impact of air pollution, with a focus on children and pregnant women. After a number of studies and many visits to Ethiopia, Ebba Malmqvist is especially interested in how to work with air pollution and health in a country already challenged in many other ways.
SIGHT Award 2020:
The prize was founded with support from the Einhorn Family Foundation 2017 and will be awarded the 25th of November during the online event, Global Health Night & SIGHT Award 2020 hosted by Stockholm School of Economics/ Mistra Center for Sustainable Markets (MISUM) in Stockholm.
In connection with the prize award ceremony a seminar for students will be held with a panel discussion about how the pandemic has reinforced social inequality and what measures are needed to create a more equal, fair and sustainable world after the pandemic, “Building Back Better”.
The decision on recipient of the SIGHT Award 2020 was made by the board of the Royal Swedish Academy of Sciences.