In a first, Maharashtra health dept initiates action plan to address Mumbai’s poor AQI

“Maintain statistics on air pollution-linked illnesses, compile data from healthcare facilities and cities for sharing with the National Programme on Climate Change and Human Health program division of NCDC. Identify AQI hotspots and high-density vulnerable population areas, ensuring access to essential healthcare services,” it reads.

The department has also directed convening of meetings for the District/City Task Force for Climate Change and Health, where they will provide guidance on priority action plans. They have also instructed the development of a District Action Plan on Climate Change and Health for districts and cities, with a dedicated section focusing on air pollution and health-related activities.

The decision comes days after The Indian Express as a part of its series — Death by Breath — exposed the absence of health advisories from the Brihanmumbai Municipal Corporation (BMC) despite city’s poor and very poor air quality index (AQI). Earlier, the BMC had announced plans for such advisories in its budget and in the Mumbai Air Pollution Mitigation Plan (MAPMP) to inform citizens during worsening air quality, similar to weather bureau bulletins during adverse climate conditions.

Subsequently, the Bombay High Court took note and urged the BMC and the state government to take action. The bench led by chief justice Devendra Kumar Upadhyaya noted, “Further we must note and what is crucial is that no steps have been taken to create/issue the necessary health advisories as also to raise awareness among the citizens so as to best safeguard themselves from deleterious levels of AQI presently prevailing in Mumbai. This factor needs immediate attention.”

The comprehensive Health Action Plan for districts and cities encompasses 14 critical elements.  The health department will document month-wise average statistics of diseases linked to air pollution and will make plans to connect air pollution data with disease information and find hotspots where people are at risk. The department will also make special healthcare plans for these areas.

Doctors have welcomed the move as a positive step. “It would serve as a transparent repository for citizens to better appreciate the harms associated with air pollution and see overall trends. This will hopefully lead to evidence-based lobbying for clean air,” said Dr Lancelot Pinto, epidemiologist and pulmonologist at Hinduja Hospital.

The medical community must reach a consensus on defining “air pollution-related illnesses”, establish guidelines and standardise reporting procedures, he said, adding, “We mobilised such data collection during Covid, do it regularly for TB… it would serve both citizens and policymakers to do the same for air pollution related illnesses.”

Every winter, hospitals in the state witness an increase in patients with asthma, COPD and bronchitis. However, the state health department does not officially record data on air pollution-related illnesses because these conditions are not required to be reported. In January, when The Indian Express raised this issue, the health department requested district health departments to submit reports, but no concrete action was taken.

Now, with the new directive, they will also document month-wise air pollution levels and identify vulnerable populations in these areas. The health department has classified vulnerable groups as consisting of children under five, the elderly, pregnant women, individuals with pre-existing respiratory and cardiovascular conditions, those in low socio-economic conditions, and occupational groups with prolonged pollution exposure.

The advisory includes health advice for the general population and those vulnerable to pollution, based on the AQI designed in collaboration with SAFAR and the Department of Environment. It will also address the integration of environment-friendly practices within healthcare institutions.

For the general population, the plan advises avoiding highly polluted areas and staying indoors during days with poor to severe AQI. It encourages the use of clean, smokeless fuel, discourages burning biomass, firecrackers, and open fires, and recommends wet mopping instead of sweeping or vacuum cleaning with High-Efficiency Particulate Air (HEPA) filters.

Ways to battle Mumbai’s rising air pollution

Advice for the general public:

• Avoid polluted areas: steer clear of congested roads, industrial sites, construction zones, coal plants, and brick kilns.
• Adjust outdoor plans by AQI; stay in on poor or severe air quality days.
• Skip outdoor activities during such days, keep doors and windows closed in the morning, and ventilate between 12 p.m. and 4 p.m.
• Avoid burning biomass; use clean fuels like gas or electricity. Opt for clean cookstoves if using biomass.
• Don’t burn firecrackers, open wood, leaves, crop residues, or waste.
• Refrain from smoking cigarettes, bidis, and related tobacco products.
• Avoid burning mosquito coils and incense sticks indoors.
• Choose wet mops over sweeping, or use a vacuum cleaner with a HEPA filter.
• Keep eyes washed with running water and do regular warm-water gargles.
• Seek medical help for breathlessness, giddiness, cough, chest pain, or eye irritation.

Advice for vulnerable population (patients with chronic pulmonary or cardiovascular conditions):

• Be vigilant in avoiding air pollution.
• Avoid strenuous activities during poor AQI levels.
• Monitor symptoms closely during air quality deterioration.
• Adhere to their doctor’s healthcare instructions.
• Maintain ready access to prescribed medications.
• Seek immediate medical help if symptoms worsen.

Optional measures:

• Choose N95/N99 masks with proper fit, replace after short use, and avoid ineffective alternatives like paper, handkerchiefs, scarves, or cloth.
• If using an air purifier, adhere to manufacturer instructions and maintain filters. Avoid ozone-generating purifiers, as they worsen indoor pollution. Use recirculation mode in air conditioners to minimise outside air exposure.