Context

• Air pollution in India has shifted from a seasonal problem to a chronic, nationwide public health emergency.
• No longer confined to winter smog in the northern plains, toxic air now affects all regions, age groups, and organ systems.
• Persistent exposure is reshaping disease patterns, impairing childhood development, and silently shortening life expectancy.
• The crisis reflects deep-rooted structural failures and has become one of the most significant determinants of population health in India. 

Scale and Persistence of the Crisis

• India’s air quality problem is both widespread and severe. Of the 256 cities monitored in 2025, nearly 60% exceeded national PM2.5 standards.
• For most urban residents, breathing unhealthy air is routine rather than exceptional.
• The Indo-Gangetic Plain remains the epicentre, with Delhi recording seasonal PM2.5 levels of 107–130 µg/m³, far exceeding both India’s limit (60 µg/m³) and the WHO guideline (15 µg/m³).
• A major limitation in public understanding stems from India’s outdated Air Quality Index (AQI).
• The official AQI caps values at 500, masking extreme pollution episodes that often exceed this threshold.
• While international platforms routinely record values above 600 or even 1,000, Indian reporting collapses these into a single severe category.
• Outdated thresholds, limited monitoring, and the absence of an upper scale obscure risk perception and weaken policy urgency.

Existing Policies to Tackle Air Pollution and Their Limitations

• The Graded Response Action Plan (GRAP) is an emergency framework implemented in the National Capital Region to tackle severe air pollution through stage-wise restrictions based on AQI levels.
• Measures include curbs on construction activity, bans on diesel generators, vehicle restrictions, closure of schools, and suspension of polluting industrial operations as air quality worsens.
• However, GRAP is largely reactive and episodic, activated only after pollution reaches severe levels rather than preventing its build-up.
• Its effectiveness is further limited by weak enforcement, inconsistent inter-State coordination, economic disruptions, and its narrow geographic focus on NCR, while failing to address year-round structural sources of pollution or provide a long-term public health solution.

The Human Cost of Air Pollution: Years of Life Lost and Rising Mortality

• The human cost of polluted air is profound. Nearly 46% of Indians live in regions where air pollution significantly reduces life expectancy.
• In Delhi, current exposure corresponds to a loss of more than eight years of life, while losses across northern India range from 3.5 to 7 years.
• Mortality figures are equally alarming. Air pollution contributed to nearly two million deaths in 2023, primarily from cardiovascular disease, stroke, COPD, and diabetes.
• Notably, pollution-linked deaths have risen by 43% since 2000, highlighting the cumulative impact of long-term exposure. Air pollution now ranks among the deadliest, yet least visible, public health threats in the country.

Biological Pathways of Harm

• Cardiovascular damage
  • Elevated exposure is linked to hypertension, atherosclerosis, heart attacks, arrhythmias, and ischemic stroke, acting as a powerful accelerant in a population already burdened by heart disease.
• Respiratory Illness
  • Nearly 6% of Indian children have asthma, and even small increases in PM2.5 cause sharp rises in paediatric emergency visits.
  • Chronic exposure during childhood results in a 10–15% reduction in lung capacity, often persisting into adulthood.
  • Among adults, COPD, chronic bronchitis, and recurrent infections are increasingly common near roads, industries, and waste-burning sites.
• Neurological Harm
  • PM2.5 can cross the blood–brain barrier, triggering neuroinflammation and oxidative stress.
  • Exposure is linked to poorer academic performance, impaired memory, slower cognitive development, and a 35–49% higher risk of dementia per 10 µg/m³ increase.
  • Polluted air is increasingly recognised as a driver of accelerated brain ageing.
• Maternal and Neonatal Health
  • High exposure increases the risk of preterm birth, low birth weight, stillbirth, and neonatal mortality, with long-term consequences that deepen health inequities across generations.

Inequality and Misplaced Narratives

• Air pollution closely mirrors social and economic inequality.
• Low-income communities are disproportionately exposed due to proximity to highways, industrial clusters, construction zones, and landfills.
• Poor housing, reliance on biomass fuels, and limited healthcare access further heighten vulnerability. Children in these neighbourhoods face especially high exposure due to greater time spent outdoors.
• Public discourse often focuses on episodic contributors such as stubble burning or festival fireworks. While these intensify pollution, they are not the primary cause.
• Year-round structural sources, vehicular emissions, industrial activity, construction dust, informal waste burning, and household fuel use, drive baseline PM2.5 levels.
• Seasonal events merely exacerbate an already hazardous environment, diverting attention from systemic reform.

The Path Forward

• Towards a Health-Centred Policy Framework
  • Transport transformation: Large-scale electrification of buses, taxis, auto-rickshaws, and two-wheelers; shifting freight from diesel trucks to rail and electric fleets; real-world emissions monitoring; and low-emission zones and congestion pricing.
  • Industrial control: Strict enforcement of pollution-control technologies and a phased transition away from coal-based processes.
  • Construction regulation: Mandatory dust-suppression protocols, enclosure norms, and mechanised sweeping.
  • Waste management reform: Segregation at source, decentralised treatment, biomethanation, and scientific landfill remediation to eliminate open burning.
  • Health-system integration: District-level AQI-based advisories, lung-function testing in school health programmes, and screening for COPD and cognitive decline.
• Treat Clean Air as a Fundamental Right
  • Clean air must be recognised as a fundamental right essential to equitable growth and sustainable development.
  • Protecting this right requires policies anchored in science, driven by public health priorities, and executed with urgency.
  • Without decisive action, India risks consigning future generations to shorter lives, poorer health, and diminished potential, a cost no society can afford.

Conclusion

• India’s air pollution crisis is a systemic public health emergency that shortens lives, deepens inequality, and undermines national development.
• Scientific evidence clearly links toxic air to widespread cardiovascular, respiratory, neurological, and intergenerational harm, making incremental or seasonal responses inadequate.
• Recognising clean air as a fundamental right and acting with urgency through health-centred, science-driven policy is essential to safeguard present and future generations.