Air Pollution Is a Health Emergency, and India Must Treat It Like One

Why does India continue to tackle air pollution reactively instead of taking sustained, proactive action?

Air pollution is a public health emergency. Its time it was treated like one.

(Photo: The Quint)

India mobilises incredibly quickly every year to prepare for and deal with a number of health crises. Heat waves result in government warnings and emergency cooling centres in cities. Vector-borne diseases such as dengue trigger public campaigns, field surveillance, and increased hospital preparedness.

Nationwide lockdowns, mask mandates, and real-time online dashboards offering near-up-to-the-minute information on reported cases and hospital capacity became the norm during the COVID-19 pandemic.

These examples illustrate that India faces several threats that have been recognised as emergencies demanding urgent and coordinated action.

Amid these responses, why does a public-health threat as omnipresent and constant as air pollution still not receive the attention and action it demands?

Doctors and public policy experts have been sounding the alarm for years.

Most recently, speaking at a seminar at AIIMS on combatting air pollution, Dr Anant Mohan, head of pulmonary medicine and sleep disorders at AIIMS (Delhi) said, “It's not just respiratory issues, other organs are now being affected. We’re seeing more life-threatening cases, a surge in both outpatient visits and emergency admissions, and many patients requiring ventilator support. This should be treated as a public-health emergency.”

Despite the enormous public-health, social, and economic burden of pollution, this crisis is still not treated as a medical emergency, and the response (year after year) remains limited to short-term, reactionary fixes.

The Hidden Toll of Air Pollution

A recent global report by the Global Burden of Disease, along with earlier reports by the World Health Organization, has shown that India has the highest burden of pollution-related health problems in the world.

Each year, millions of people die prematurely because of air pollution, largely from diseases of the respiratory and cardiovascular systems, such as asthma, Chronic Obstructive Pulmonary Disease (COPD), heart attacks and strokes.

For young people, breathing polluted air can stunt lung development, impair cognitive ability, trigger diabetes, and raise the risk of lifelong physical and mental health problems.

Pregnant women are at increased risk of miscarriage, preterm birth, and low birth weight when exposed to high levels of pollution. Such health problems have lasting implications, as they lead to a cycle of poverty and other social problems, with increased medical costs and loss of income for family members.

A recent report published in The Lancet in October found that air pollution from fossil fuel emissions alone claimed 1.72 million lives in India in 2022.

Indeed, despite clear evidence, India continues to address air pollution in a reactive, issue-by-issue manner rather than through proactive, sustained action.

Normalisation of a Chronic Crisis

Air pollution is still treated as an environmental or urban-planning problem, and not the public health emergency it is. It is baffling how normalised the recurring crisis has become.

Each winter, Delhi, Lucknow, and much of north-west India respond to smog with short-term fixes like smog guns, stay-indoors advisories, and mask distribution—measures that do little beyond offering momentary relief. Rising cases of respiratory illness are dismissed as “seasonal,” rather than recognised as clear warnings of a deepening public-health crisis.

Unlike heat waves, which lead to municipal cooling centers and city heat action plans, or mosquito-borne diseases, which lead to specific vector-control programs, the health effects related to pollution are naturalised as inevitable or as something that can only be addressed in a limited way.

Debates concerning emissions control remain at the policy level; business and industry leaders have long thought of economic development, community members often accept bad air as part of their daily lives.

Media outlets may report on pollution incidents, but they are seldom presented as emergencies that must be responded to immediately and with the scale and scope warranted by the disaster.

These disclaimers are rooted in a variety of manifold causes, including the fact that many pollutants are invisible and imperceptible, the noxious effects of long-term exposure to chronic pollution are insidious, and other conflicting priorities often take precedence over environmental and public health.

It is more politically palatable to urbanise and accept air pollution as a byproduct than to shift fixed mindsets and established industrial and infrastructure development practices.

Recognising Air Pollution as a Public Health Emergency

This problem also highlights the need for an enormous shift in attitude regarding air pollution in India.

Legal and policy frameworks must be established in India to categorise high levels of air pollution as a national health emergency.

Similar to the administrative processes and protocols that are set in motion during a pandemic or national disaster, categorising high levels of pollution as an emergency would help put into motion a number of linked responses.

For example, informing the medical system, alerting vulnerable populations, and issuing directives to implement high-pollution control measures. It would also establish an unequivocal line of accountability from the central government to local urban authorities.

Challenging air pollution in India requires a proactive and pre-emptive approach.

In predictable peaking phenomena like stubble burning and winter smog, the government should consider pollution-control strategies such as placing a temporary ban on heavy vehicles or highly polluting industries.

Enhancements in healthcare system readiness would include training medical staff to identify health issues related to pollution early and preparing hospitals to cope with peaks in respiratory and chronic diseases.

Mass media campaigns should stress the controllable nature of air pollution, and the promotion of protective measures such as masks and air purifiers in workplaces, schools, and communities.

Equally important are strong, year-round enforcement mechanisms: legal penalties for polluters, regular compliance checks, and incentives for cleaner practices.

Finally, sustained public funding for pollution control, health-emergency preparedness, and new research is essential. These investments signal long-term accountability and a genuine commitment to public health.

Learning from Global Best Practices

There are success stories and good examples that some countries have displayed. The famous case of beijing stands out. Once known for some of the world’s worst urban smog, the city managed to drastically improve its air quality within a decade through a combination of sustained political will, strict enforcement, and heavy investment in cleaner infrastructure.

Pollution has been declared a health crisis in Paris, resulting in vehicle bans, reduced traffic, and greater promotion of public transport and cycling.

These examples show that large, densely populated cities (like Delhi) can reverse severe air-quality crises when pollution is treated as a public-health priority rather than an unavoidable cost of development.

India can draw lessons from these successes, but its solutions must be tailored to the specific needs and constraints of each city, balancing economic growth with public health.

Long-Term Strategies for Resilience

Air-quality considerations must be central to urban and industrial planning. This includes stronger vehicle and industrial emission norms, a faster push for electric mobility, and environmental measures such as expanding green spaces and restoring polluted sites.

Long-term reforms—like boosting renewables and improving public transport— can address pollution at its source and build more resilient cities.

At the core of this shift is a decisive transition away from coal and other fossil fuels toward clean energy such as solar, wind, and hydro. This can not only cut emissions sharply but also opens up new economic and employment opportunities in a more sustainable growth model.

The development of low-cost air purifiers, early warning technologies, and better devices to control air quality has become an essential investment in preparedness against large-scale toxic air exposure.

Also essential is the role that community and civil society participation play in exerting pressure from the ground up through local movements—movements that have historically driven change to secure proper policies. This includes air quality monitoring that empowers communities to demand and establish clean environments and to hold responsible policymakers accountable to act.

At its core, these forms of not reactive, but bold, systemic action will perhaps ensure that India need not always be working to avert an air quality crisis, but to live cleaner and healthier.

The Cost of Inaction

The cost of failing to confront this crisis is immense, and only set to get worse. The cycle feeds on itself: pollution drives climate change, while climate change — through erratic rainfall, extreme heat, and harsher winters — worsens pollution in return.

Air pollution is already one of India’s biggest killers, reducing life expectancy in some regions by several years.

Beyond its direct health impacts, air pollution carries a major “lost opportunity cost,” undermining family well-being and dragging down national productivity. Persistent pollution also hurts tourism, deters investment, and diminishes overall quality of life.

A 2020 study published in the Lancet Planetary Health found that air pollution resulted in an economic loss of approximately 1.4 percent of India's GDP in 2019. This loss, which is equivalent to about Rs 2,60,000 crore (US$36.8 billion), is due to lost output from premature deaths and illnesses caused by air pollution. 

India’s response reveals a troubling pattern: great powers often react only when a crisis is visible and immediate. But air pollution is the opposite — invisible, cumulative, and deadly. That makes it easier to ignore, yet far more dangerous.

Breaking this cycle will require a new mindset, broad public-policy reform, active engagement from the health sector, and sustained investment in protection and clean energy. It also requires political will (and public pressure) to treat clean air as a basic right, not a seasonal talking point.

The time to act is now, before more lives are lost to pollution, one of the biggest barriers to making India secure, prosperous, and resilient.

(Anjal Prakash is a Clinical Associate Professor (Research) at Bharti Institute of Public Policy, Indian School of Business (ISB). He teaches sustainability at ISB and has been contributing to IPCC reports, and is the Lead Author of the IPCC’s upcoming report on Cities and Climate Change. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)