When one thinks of air pollution in Kazakhstan, the image that pops to mind is the thick layer of smog that engulfs Almaty for about six months every year.In a recent academic article written for the International Journal of Chronic Obstructive Pulmonary Disease, researchers from Al-Farabi Kazakhstan National University showed that air pollution is a problem that extends beyond Almaty and could cause long-lasting respiratory effects on the population.Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality in the world.Vlast sat down with professor Denis Vinnikov, head of the environmental health lab at Al-Farabi Kazakhstan National University, to talk about the most recent scientific findings on air pollution in Kazakhstan.Photo: Zhanara Karimova.Let’s start by talking about the challenges of researching air pollution.What kind of questions are relevant? Air pollution combines health issues, administration, and policy.But also finance, policy, and socio-economic aspects.Researching air pollution is always a very complex task, because it involves a wide range of stakeholders.When doing health-related research in the field of air pollution, we face a lot of barriers, because when you find something, you have to fit it into the current socio-economic context and you also have to think about the consequences that it may entail.So you can look at mortality, or more widely at chronic and acute diseases, but in fact air pollution affects everything in the human body, from the lungs to mental health.At our lab, we focus on respiratory diseases.Importantly, we have to keep in mind that the issue is not only ambient or atmospheric air pollution.We need to also consider other factors, such as smoking and exposure to second-hand smoke, or indoor air pollution.And for each specific source there could be a set of specific policies.This particular study assesses the combined effect of smoking, workplace exposure to air pollution, and a past medical history of tuberculosis as predictors of the probability of getting COPD.What does it actually mean to get COPD? COPD is a progressive disease.Once it develops, you cannot do anything about it.You can only try to stop its progression, for example by quitting smoking.But the burden of COPD is tremendous, colossal.On a societal level, people tend to underestimate the burden of COPD.Several factors contribute to this: very poor access to high-quality spirometry in our country translates into underdiagnosis, which in turn undermines awareness.We estimate that underdiagnosis means that the reported cases are 17 times lower than the real number, which we find.That’s massive.In Kazakhstan's social context, I see that people do not appreciate health as the most important asset in their lives.But another, worrisome, systemic issue is poor financing of the medical services, which in turn is correlated with relatively low qualification of medical personnel.Add to this the low socioeconomic status of the population, and you have higher incidence of diseases and higher mortality.Photo courtesy of Denis Vinnikov.When it comes to air pollution sources, where do we begin?