The Invisible Crisis: Why We Need to Rethink Chronic Respiratory Disease
Featuring José Luis Castro, WHO Director General Special Envoy
When a child struggles to breathe, the world stops. It triggers an immediate, visceral instinct to help. Yet, when an adult suffers from Chronic Obstructive Pulmonary Disease (COPD), society often crosses the street. We meet their struggle with silence, or worse, judgment.
In this episode of Air Quality Matters, I sit down with José Luis Castro , the Director General Special Envoy for Chronic Respiratory Diseases at the World Health Organization. With over three decades of leadership in global health, Jose is now spearheading the WHO’s efforts to tackle the massive, yet often ignored, burden of asthma and COPD.
The Cinderella of Public Health
One of the most striking aspects of our conversation is the sheer scale of the disconnect between the data and public perception. Jose points out that chronic respiratory diseases claim roughly 3.5 million lives annually. To put that in perspective, that is a catastrophic loss of life occurring on a repeating loop, yet it barely registers in the global news cycle.
José describes these diseases as the "Cinderella of public health"—ignored and underfunded compared to cardiovascular disease or cancer. We discuss why this is the case, diving deep into the stigma that surrounds COPD. For too long, the narrative has been that this is a "smoker’s disease"—a consequence of lifestyle choices.
However, the reality José paints is far more complex and uncomfortable. While smoking is a factor, the blueprint for these diseases is often drawn decades earlier, dictated by the environments in which people live and work. We explore the concept of "environmental justice" and how air quality acts as a silent architect of long-term health, often injuring lungs long before the first cigarette is ever smoked.
The City is In Us
A profound moment in the episode centres on the physiological reality of our interaction with the built environment. We discuss the idea that "we are not in the city; the city is in us." The surface area of the human lung is roughly the size of a badminton court—a massive, open-access system designed to absorb.
This conversation challenges the listener to rethink the "contract" of shelter. If our buildings are allowing the ingress of pollutants that stunt the lung development of children—creating what we discuss as a "glass ceiling" for their future health potential—then the fundamental promise of the built environment is broken.
Why You Should Listen
This episode is not just a recitation of grim statistics; it is a masterclass in policy, advocacy, and the future of healthy buildings. José shares fascinating insights into:
The Economics of Breath: Why addressing respiratory health isn't just a medical expense but a massive economic lever regarding productivity and workforce retention.
The "Prisoner" Reality: A harrowing, humanising look at what life with advanced COPD actually looks like—a slow erosion of social contact and mobility that many in the built environment sector rarely see up close.
Silo-Busting: How the medical community and the engineering/building sector must stop working in parallel and start integrating their expertise.
José's optimism for the 2026 agenda and the momentum building behind global air quality initiatives is palpable. If you want to understand how high-level WHO policy translates into the realities of urban design and indoor air quality standards, this conversation is essential listening.
One Take: Making the Invisible Visible
The Economics of Air Quality Monitoring
In this week's One Take, we examine a fascinating working paper from the National Bureau of Economic Research (NBER) titled "Making the Invisible Visible." The researchers, Metcalf and Roth, ask a question that plagues everyone in our industry: If people could actually see the air they breathe, would they change their behaviour? And more importantly for the policymakers, is it worth the cost to help them see it?
The study focuses on a field experiment in London in which households were provided with high-quality air monitors. Half were blind (screens covered), and half were visible. The baseline data alone was startling, revealing a massive income gradient regarding indoor pollution exposure and proving that outdoor air quality is a poor predictor of indoor risk.
The Infinity ROI
But the real magic happened when the screens were turned on. The episode details how making pollution visible led to a significant drop in indoor PM2.5 levels during occupancy hours. Crucially, the study found that people didn't stop their lives—they didn't stop cooking or living—but they effectively managed the pollution spikes through ventilation behaviour.
For those of you constantly trying to justify the budget for monitoring technology or ventilation upgrades, the most compelling part of this summary is the economic analysis. The researchers calculated the "Marginal Value of Public Funds" for subsidising monitors. The result? Infinity.
Listen to the full One Take to understand exactly how that math works and why this paper suggests that the "deficit model" of information might actually hold true for air quality. It is a powerful argument for moving indoor air quality from a private luxury to a public health imperative.
MAKING THE INVISIBLE VISIBLE: THE IMPACT OF REVEALING INDOOR AIR POLLUTION ON BEHAVIOR AND WELFARE
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