In his 36 years as a thoracic surgeon, Dr. Arvind Kumar has heard and opened literally thousands of chests. According to him, the human lung, a pristine pink at birth, tells story of every breath Taken for life.
“For years, I could see the patterns of urban pollution as black deposits on lung tissue – a few spots here, larger stains there. Now it is everywhere,” Dr Kumar said from his office at Medanta Medicity Hospital, Gurugram. He is troubled by the terrible effects of air pollution on the lungs, and not just on people with lung diseases or the elderly. “The lungs of teenagers now look like the lungs of lifelong smokers. Pollution isn’t just in our cities – it’s inside us.”
This change in chest health is an invisible epidemic affecting millions of people across India, now underlined by the findings of the United Nations Environment Program (UNEP)’s 2024 Emissions Gap and Adaptation Gap Report. Emissions are rising around the world, but in few places as much as India. , up 6% from last year.
The data is clear: pollution is now much more than an environmental issue. This is a national health emergency.
An overlooked health crisis
India’s poor air quality has been silently affecting communities for decades, with deadly consequences. “Air pollution is the biggest environmental threat to health, even the leading cause of premature death in India,” said Dr Pallavi Pant of the Health Effects Institute.
According to their research, nearly 2 million people lost their lives in India in 2021 alone due to pollution-related diseases. Those most affected include pregnant women, children, the elderly and people already facing health challenges. “For these populations, the risk of respiratory infections, impaired lung function and even cardiovascular conditions due to pollution is devastating and far-reaching,” he said.
Exposure to air pollution can permanently impair lung development, leading to chronic respiratory problems and asthma in children. According to Dr. Pant, “These are not just minor inconveniences.” “This is a fundamental health crisis where children grow up with reduced health and quality of life throughout their lives.”
For them, the real tragedy is that the risk falls most heavily on the most vulnerable. “Those who have fewer resources are the most affected. They often live closest to pollution sources and lack the means to protect themselves. This is a crisis of health as well as inequality.”
Dr Soumya Swaminathan, former chief scientist of the World Health Organization (WHO) and chairperson of the MS Swaminathan Research Foundation, Chennai, said, “The effects of poor air quality are systemic. High pollution levels are linked to non-communicable diseases like high blood pressure, diabetes and stroke. We’re talking about lifelong health harms that are often invisible but devastating.
According to them, early and prolonged exposure to pollutants during critical times such as pregnancy and early childhood can put individuals at risk of lifelong diseases. “Children are growing up with a fundamentally compromised baseline for health,” he said.
a fragmented response
India launched National Clean Air Program (NCAP) in 2019 to reduce particulate matter pollution by 20–30% by 2024, before adjusting the target to a 40% reduction by 2026.
According to experts, there is a lot of scope for improvement in NCAP. “For many, NCAP has become a symbol of intent without effective action,” Dr Kumar said. “We have policies but we are faltering in implementation at the ground level.”
Dr Kumar argued that health should be the central focus of environmental policies while current efforts are “piecemeal and toothless”. He described the NCAP measures as a “band-aid solution” and called for stricter enforcement and a shift towards health-focused policies and grassroots action.
Dr Pant appreciated NCAP’s role in raising awareness and enhancing air quality monitoring, but also pointed out its shortcomings in sustained, source-specific emission reductions. Instead he suggested that a regional approach could allow for more targeted, impactful solutions. “NCAP requires localized strategies focused on specific emissions sources,” he said.
Dr. Swaminathan also urged NCAP to go beyond monitoring pollutants and focus on reducing emissions and prioritizing health outcomes. “NCAP’s goals need to directly integrate public health. Pollution control is not just about air quality. It’s about people’s lives,” she said. “The program must move from mere monitoring to actively reducing emissions and make health its primary focus.”
Vaibhav Chaturvedi, environmental economist at the Council on Energy, Environment and Water, stressed that NCAP’s goals are unrealistic if it does not move toward clean energy and reduce India’s dependence on fossil fuels. “For NCAP to be effective, we need structural change, especially in how we produce and consume energy,” he said.
Sophie Ghammi, a technical officer in WHO’s air quality and health unit, expressed confidence that the NCAP lacks the comprehensive, multi-sector approach needed to achieve meaningful progress. He also said there is a need to create policies that protect vulnerable populations who are disproportionately affected by air pollution.
“The NCAP is a start, but a whole-of-society approach that spans sectors and prioritizes vulnerable people is needed,” he said.
economic and social costs
“Not only are people losing their lives due to poor air quality; “This is causing loss of livelihoods,” Gami said.
Dr. Swaminathan also called air pollution an economic crisis with the potential to increase health care costs and reduce productivity (through loss of work and school days). “Poor air quality leads to increased hospitalizations and health care costs, increasing the financial burden on families and the health system,” he said.
According to Dr. Swaminathan, vulnerable, low-income communities bear the greatest burden: “The poorest are most at risk, yet least equipped to mitigate these impacts” – a situation that is particularly vulnerable to the impacts of climate change. Reminds me of. “The burden of pollution-related non-communicable diseases continues to increase” while climate-related challenges such as heat waves are exacerbating health and productivity losses.
Dr Kumar’s ‘My Solution to Pollution’ campaign, under his Foundation and Doctors for Clean Air initiative, encourages communities to take small but meaningful actions. “People cannot wait for government solutions alone,” he said. “If 1.4 billion people committed to small actions like reducing idling cars or limiting garbage burning outside schools, we could reduce local pollution loads substantially.”
A pilot program to prevent idling vehicles near school zones showed improvements in air quality, a potential model for broader change. “If each of us does our part, we can reduce pollution at the grassroots level.”
clean energy alert
Despite growing public awareness, India’s heavy dependence on fossil fuels remains a significant barrier to change. While the government promotes electric vehicles, Dr Kumar warned that their benefits would be limited if their batteries were charged with coal-fired electricity. He argued that sweeping changes to energy infrastructure are needed, including a complete transition away from coal.
“We’re tackling the wrong end of the problem,” said Chaturvedi, the environmental economist. “We are focusing on the symptoms – dust suppression, controlling stubble burning – but not the root cause, which is our dependence on fossil fuels and inadequate clean energy infrastructure.”
“True progress in air quality will require a pivot from coal to renewables, as well as a strong national investment in sustainable infrastructure.”
Dr Pant also pointed out that people in rural areas are largely dependent on biomass and they also need access to clean energy. “For many rural families, wood and cow dung are the only affordable options for cooking fuel,” he said. He said the health impact of household pollution, especially for women and children, is as important as urban air quality.
Policy Reforms, Public Accountability
Experts said it may be important for NCAP to adopt a regional approach rather than assuming that one size fits all. Dr. Pant suggested that local targets could allow diverse regions of India to address their most pressing pollution sources – industrial emissions, agricultural combustion, or urban vehicle congestion – differently. “Air pollution is very complex. By prioritizing interventions at the state and local level, we can tailor strategies where they are needed most,” she said.
Second, while experts have mixed reactions to listing pollution as a cause of death on death certificates, Dr Kumar said this explicit acknowledgment could increase public awareness. “When you add pollution to a death certificate, you are showing people a cause-and-effect link in their lives,” he says. Dr. Swaminathan agrees: “Having an official link to death records could encourage more serious health and policy actions against pollution.”
He also proposed establishing a regulatory body similar to the US Environmental Protection Agency to enforce environmental standards and integrate interdisciplinary policy making. “India lacks a comprehensive body to regulate air, water and other pollutants that threaten public health,” he said. Dr Pant echoed his point, saying, “A unified regulatory body can streamline and strengthen India’s fragmented environmental policies.”
But Dr Kumar was wary of bureaucratic hurdles: “We don’t need more agencies; We need stronger enforcement.”
towards a permanent solution
The UNEP report calls for systemic change in the transport, energy and health sectors to effectively curb pollution. Experts agreed that public health, climate mitigation and community engagement should be prioritized in a national clean air strategy. For Dr Kumar, the urgency cannot be overstated. “The pollution is in our lungs now, and it’s not going to go away on its own. “Every breath we take is a reminder of how much needs to change.”
“This is not just about the environment,” Dr Pant said: “This is about the right of every person in this country to breathe without fear.”
India stands at a crossroads and its choices today will determine the health of generations to come. As Ghammi said, “Investing in clean air today is investing in India’s economic and social future.”
Vijay Shankar Balakrishnan is a freelance journalist based in Ludwigshafen am Rhine, Germany.
published – November 22, 2024 07:49 am IST
