"Combating Air Pollution Needs Cross-Sector Coordination"
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Air pollution is not just a visible gray layer that prevents people from seeing a clear sky or that causes the occasional cough. In certain conditions, common in a number of urban centers in Kazakhstan, it becomes a significant public health problem.
We interviewed Assel Mussabekova, who holds a PhD in Biology and is an international consultant in immunization and global health. Mussabekova looks at air pollution as a public health risk, which carries long-lasting consequences in a number of aspects of life, from respiratory and cardiovascular diseases to mental health and cognitive issues.
Mussabekova points to obstacles such as underdiagnosis, ignoring scientific evidence, and non-transparent data as the main roadblocks to acknowledging the full extent of air pollution’s impact on public health, which could then translate into actionable policies to address its negative consequences.
Assel Mussabekova. Photo by Zhanara Karimova (archive).
How do you define the impact of air pollution through the lens of public health?
Public health is everything that affects our health beyond the doctor’s office. And this is definitely the case of air pollution, because it affects our social, environmental, and political life.
In Kazakhstan, people often blame “bad medicine” when things go wrong, but in many cases the failure lies in public health, and air pollution is a classic example. Air pollution causes or enhances respiratory diseases, from chronic conditions such as asthma to COPD (chronic obstructive pulmonary disease), but also infectious respiratory illnesses like COVID‑19 or the seasonal flu.
Air pollution makes it worse, because particles in the air enter the lungs and the entire respiratory tract, causing chronic inflammation. This inflammation raises the risk of allergies, asthma, COPD, and also makes it harder for the body to fight off common infections. Because of air pollution, a flu that might normally last a week suddenly carries a higher risk of hospitalization, long‑term complications, or even death when layered onto already inflamed lungs.
“In Kazakhstan we still don’t understand what public health is.”Beyond the respiratory system, how does air pollution harm the body?
Scientific research has established a direct link between air pollution and cardiovascular diseases. Those same particles that cause chronic inflammation in the lungs also affect the heart functions, how hormones and metabolic systems behave. Over time, this can fuel atherosclerosis and other cardiovascular problems, increasing the risk of heart attacks and strokes.
Then we need to mention mental‑health effects. Take for example postpartum depression: A 2026 review in the Journal of Global Health, pooling data from over 400,000 women, showed that exposure to air pollution during the second trimester of pregnancy roughly quadruples the risk of postpartum depression.
Air pollution also affects children’s cognitive abilities. Studies that tried to control for other factors, such as season, temperature, holidays, family background, still found that schools with higher air‑pollution levels showed lower average grades. This is not just about students feeling tired or “in a bad mood”; the data point to real physiological changes, including neuroinflammation.
Research done in China, involving around 25,000 children, found that exposure to higher air pollution over several years significantly harmed cognitive performance. Short‑term exposure, say for a few weeks, is less damaging; the real harm comes from long‑term exposure. The longer a child breathes polluted air, the more their brain development can be compromised.
These findings are not always visible to policymakers because they come from large‑scale public‑health and epidemiological research, led often by richer countries that invest more in this kind of science.
How does air pollution relate to inequality?
In public health, the concept of “social determinants of health” captures how social conditions shape health outcomes. In the US and many other countries, there is a noticeable correlation between postal code and life expectancy. In Almaty [Kazakhstan’s largest city – V.], the pattern is similar: as you move to lower‑income neighborhoods, the air quality tends to be worse. In contrast, wealthier areas higher up towards the mountains usually have cleaner air and more access to green spaces.
This is not only about air; income, education, and healthcare access all play a role. But air pollution adds another layer of injustice: poorer people are more exposed and less able to buy air filters or move to cleaner areas. I come from Ekibastuz, a small city where there was a lot of pollution. My father died of lung cancer because he was working in the coal industry. And many of his colleagues also died of cancer, because nobody was paying for their treatment.
In order to make a change and hold the coal industry accountable, for example, we need to calculate and present these costs on paper so that governmental agencies understand it.
Power plants in Almaty. Photo by Zhanara Karimova.
Why are Kazakhstan’s institutions not getting on top of the problem fast enough?
In Kazakhstan, the National Center of Public Health is nominally responsible for overseeing both infectious and non‑communicable diseases, including those linked to air pollution. In theory, it could either commission local studies or extrapolate existing research, calculate the cost of inaction, and then present this to the ministry of health, which would in turn brief the ministry of finance and the ministry of energy. This kind of inter‑sectoral coordination is how public health policy works in many countries.
In Kazakhstan, however, this mutli-sectoral coordination is lacking. The NCPH may post warnings on Instagram or print flyers about air pollution, but it does not bring about policy changes.
And you’ve mentioned that there is also a disconnect between scientific discoveries that are being made internationally and what is being taught at local universities?
That’s right. At medical universities here, public health is often taught as old‑style epidemiology, with a focus on infectious diseases, rather than as a policy, communication, and behavioral discipline. Today’s public health professionals need to hone skills closer to marketing and behavioral science: they must understand how people make decisions, how to frame risks, and how to design incentives.
Another structural issue in education is over access to research and how it is used. Many universities in Kazakhstan produce high‑quality, data‑driven studies on air pollution, but those findings are not integrated into official policy documents. The government does not lack data; it lacks the will to validate and openly use that data.
This is yet another sign that in Kazakhstan we still don’t understand what public health is.
Illustration by Daniyar Mussirov.
People’s behavior is traditionally resistant to transition and changes. How can we address this in order to promote better habits and awareness of air pollution?
It’s no use having air‑quality standards if industries and households ignore them. In Kazakhstan, indoor temperatures in winter exceed 25°C, which is uncomfortable, energy‑intensive, and creates large indoor‑outdoor temperature differences that irritate the respiratory tract. Even if we passed a new law to cap indoor temperatures, it would not work; we need broad-based changes in behavior.
If people could obtain information and skills, ensure they have affordable alternatives, and finally provide both positive and negative incentives, it would make a difference. Capability, opportunity, and motivation interact to change behavior, that is the principle behind the COM-B model.
What other steps can we take to push for change?
Public health specialists, civil society, and citizens can raise a number of issues with the government.
First, we need to better validate data. When independent research shows higher levels of air pollution than are reflected in official figures, it needs to be acknowledged.
Second, we should make air quality data open and transparent. The government should publish real‑time measurements, allow public access to raw data, and remove discrepancies between Kazhydromet and scientific studies.
Third, we need to establish a responsible, coordinating body at the inter‑sectoral level, possibly at the level of a deputy Prime Minister, to oversee air‑quality issues.
Fourth, it would be helpful if government planning models took into account the cost of inaction, both in terms of health and economic losses.
Fifth, air pollution should be elevated as an issue beyond the ministry of health alone, so that education, transport, and energy ministries as well as local‑government institutions all have to work together to tackle the problem.
For example, the ministry of health should tell the ministry of education that if current rates of pollution continue, children’s cognitive performance and GPAs will fall, and this will harm the country’s human capital. Similar messages could be crafted for the ministries of tourism, sports, and labor.
But given the issue of underdiagnosis, how can the situation change?
Underdiagnosis is a persistent problem, especially of chronic respiratory diseases such as COPD. Part of the reason is that the system does not reward reporting. With vaccines‑preventable diseases, such as measles, a “yellow card” system is used: every diagnosis must be reported, and special surveillance is put in place. This creates strong incentives to monitor and act.
A similar reporting scheme could be introduced for diseases known to be linked to air pollution. Health‑care workers could be required to flag asthma, COPD, and certain cardiovascular issues in high‑pollution areas, triggering more detailed monitoring and follow‑up.
At present, clinicians in Kazakhstan may underreport because they fear being punished or because they believe the system will not respond. Changing this culture requires both technical tools — standardized reporting forms and digital systems — and political will: the state must signal that transparency about pollution‑related illness is a priority, not a liability.
By combining open data, better diagnosis, inter‑sectoral coordination, and behavioral incentives, Kazakhstan can begin to treat air pollution not as an abstract environmental issue, but as a central public‑health and social‑justice challenge.
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