Pollution: Air, Water, Food, Oh My!

I’ve discussed many wellness topics on this health blog, but the major interest, by far, is pollution. Everyone in China is very concerned about the safety of the air they breathe and the food and drinks they put into their bodies. It’s easy to be overwhelmed by the seemingly constant food scandals and pollution spikes, but you actually have full control over your environment. You can limit your exposure to most of these risks, and you can thrive here as much as anywhere! Let’s now get into more details.


air pollution beijing chinaIn terms of health risks, there is accumulating research that air pollution causes both long-term and short-term risks, and children are considered more at long-term risk because their lungs are still developing. For girls, lungs nish developing at 18 years, while a boy’s lungs mature by their early 20’s. The American Academy of Pediatrics published an ocial position paper in 2004 detailing the health risks and recommending an aggressive community approach, led by pediatricians, to ensure children’s health. One of most concerning research findings is from the University of Southern California Children’s Health Study, following thousands of kids in smoggy Los Angeles over 9 years, from 4th to 12th grade. The results showed a worsening of lung function over those years of exposure in those children who had the most exposure to air pollution. In Los Angeles, the average annual Air Quality Index (AQI) is around 50, which is at least 2 times lower than most major metropolitan areas in China.

In order to minimize your risks, you rst must understand the data. That’s why many people monitor the Air Quality Index (AQI) from smartphone apps or dozens of websites. Until recently, the Chinese AQI assessed particulate matter of 10 microns (PM10), but growing research showed that the smaller particles, PM2.5, cause many more health effects. This is why China recently upgraded their system to monitor the more relevant PM2.5 with hourly reports in dozens of cities, and they are now ahead of many developing countries with their monitoring system.

When people must be outside on bad days (which I would say includes any AQI over 200), I recommend using a good protective mask; the key is to find a good mask. Officially certified “N95” commercial masks are the best. ”N95” means that the mask eliminates 95% of larger air particles; this theoretically would bring down an AQI day of 500 to a healthy 25 AQI. You can usually find good masks, especially made by 3M, in most major Chinese cities. Totobobo also manufactures comfortable and less awkward-looking masks made from transparent plastic. These can also be cut down to t the smaller faces of your children. Other well designed masks include Vogmask and I Can Breathe. Parents should know that Vogmask has just come out with a line of masks designed specifically for children’s smaller faces.

It’s important to remember that we all spend about 80-90% of our lifetime indoors, so it’s also good to protect your indoor air, which often has similar pollution levels as outside. Evidence suggests that indoor air purifier systems are very effective, whether it’s a stand-alone machine or built-in HVAC filters in your home vents and air conditioning units. Such machines, especially in bedrooms, are very effective in lowering indoor air pollution levels. Indoor plants also will help, but only slightly, and are no substitute for a good air purifier, especially in your child’s bedroom.


When it comes to the essentials of life, there isn’t anything more basic than water. We all require H2O every day of our lives and you wouldn’t last more than a few days without any water. OK, we get that, but as usual when living in China, we need to filter this basic concept through our gray-tinted glasses and ask which water is safe to drink?

My initial response is that you shouldn’t drink straight from the tap, as while many central water systems are clean, there may be heavy metals and bacteria collected in the piping along the way. But I would be saying this in almost any city in the world, so the same idea applies here. Actually, in New York City the tap water is famously clean, but even while living in San Francisco I always used a Brita table-top water filter and kept refilling it all day.

I think the same concept applies to the major cities in China: a recent Global Times headline, “Half of Tap Water Undrinkable,” certainly didn’t dissuade me from my caution. Several years ago, the Beijing Times exposed that half of Beijing’s bottled water jugs were counterfeit, using tap water or fake Watson’s stickers. Also, the water jugs you get delivered to your homes and offices may not be as safe as you think. One very concerning stat from a July 2011 survey in the China Daily showed that 31 water brands had failed inspection due to high levels of bacteria.

That’s why I recommend you use a water filtration system at home and avoid home water delivery. When I first came to China, we used a table-top lter for a several years, but we later upgraded to an installed water lter under the kitchen sink. You can read a lot of good consumer information about water filtration systems at www.consumersearch.com/water-filters/review.


Yogurt Helps Weight LossIn a number of recent Chinese polls, food safety is currently the number one major health concern. How could it not be? Every few weeks it seems we read about a new food scandal, or even worse, the recurrence of an old scandal. It might be yet another “gutter oil” crackdown; exploding watermelons; illegal clenbuterol found in pork; etc. The most well-known food safety scandal, by far, involved contaminated infant formula in 2008, which killed 6 children and sickened 300,000 others, many with permanent kidney disease. Unfortunately, since then this melamine chemical has been rediscovered in a few dairy products, and thus all of China remains justifiably wary of the entire dairy industry.

If you have a newborn baby, the healthiest milk in any country remains breast milk, so it would be best to breast feed for as long as possible. Otherwise, most doctors I know recommend only buying infant formulas imported from other countries, from the most reputable brands, as well as
from the most famous stores. I would definitely not recommend getting formula or anything of consequence from Taobao, as the counterfeit industry is very large. For grown-ups, if you don’t trust regular milk products, give soy milk a try—it has better nutritional value and is easier to digest for many.

For fruits and vegetables—an essential part of everyone’s diet—again the main issue is trust: do you know exactly where they come from? If you buy your produce direct from an organic farm, and you’re comfortable with the farm’s practices, then you should be safe. However for most of us this is an impractical or expensive option, so I prefer to buy organics as often as possible from the large hypermarkets such as Carrefour, Metro, Walmart, Tesco and Auchan. I prefer organics not so much for the taste and quality, but more for their quality chain of production, traceability and oversight by multiple governmental agencies. In other words, you have a much better chance of getting healthy and safe produce from a heavily monitored farm than elsewhere. You should be wary of getting produce grown on small farms, where pesticide, growth hormone and other chemical rates are enormous, not to mention very high rates of water pollution runoff.

No matter where you buy your produce, it remains crucial to wash them all very well, especially the leafy greens. If you do not prepare food at home yourself, it is important you educate whoever does, not only on proper food washing, but also simple hygiene such as correct hand washing or not mixing raw meats and veggies on the same cutting tables. There’s a program from the World Health Organization called the “Five keys to food safety” which I really like; they have many handouts in multiple languages which you can print out.

Of all food groups, I am most uncomfortable with seafood in China. A diet rich in fish is beneficial for all ages, as fatty fishes are filled with nutritious omega 3, a crucial element for a child’s brain, as well as an adult’s heart. But finding any safe fish in China is a serious issue, as many local rivers and waterways are seriously polluted. As usual, always buy the freshest seafood from a popular market; try to avoid smaller seafood restaurants with slow turnover; or spend a little bit more for imported frozen fish (Alaskan or Norwegian salmon, for example). As for meats, again I recommend organic meats at larger markets, mostly again because they have their own, independent supply chains, traceability and stricter government oversight.

When eating out, the unfortunate truth is that the smallest mom-and-pop restaurants and street vendors simply may not have the money to offer the safest or freshest foods, nor is the hygiene in the kitchen as reliable. Also, you should look for the mandatory restaurant ratings that are commonly found inside the front entrance. If it is not an A or B rating (Beijing) or a green happy face (Shanghai), perhaps you should reconsider eating there.

To sum up, we all need to be more careful in order to ensure safe food for our families. But with a little extra knowledge, we can thrive just fine.


1. American Academy of Pediatrics: www.pediatrics.org/cgi/content/full/114/6/1699
2. China Xiaokang: http://xkzz.chinaxiaokang.com/xkzz3/newsview.asp?id=6079
3. “Half of tap water undrinkable.” Global Times. www.globaltimes.cn/NEWS/tabid/99/ID/708496/Half-of-tap-waterundrinkable.
4. My Health Beijing: www.myhealthbeijing.com/pollution/
5. “Questions remain over safety of bottled water.” China Daily. www.chinadaily.com.cn/cndy/2011-08/16/content_13119459.htm
6. WHO: www.who.int/foodsafety/consumer/5keys/en/index.html

Originally printed in my hospital’s Health Matters magazine, Autumn 2013 issue. Click here for all issues.

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