Like clockwork, the NCR has slipped into the same cycle of neglect, retreating indoors, wearing masks infrequently, and hoping the pollution disappears. But air pollution is not a seasonal inconvenience. It is a year-round health problem that refuses to become a public-health priority. Action on air pollution remains stuck between “environmental” and “biological” realms due to its primary source, fossil fuel combustion. As a health hazard, pollution presents a dual visibility challenge — its origins are hidden and its health effects cannot be enumerated.
Coal power plants, industrial clusters, diesel fleets and brick kilns operate out of sight, continuously releasing particulate matter (PM) and toxic gases, which shape the baseline emissions that every city breathes. Despite rapid growth in renewables, coal still powers over 74 per cent of India’s electricity generation. In North India, cold temperatures and local terrain trap pollutants close to the ground. AQI values help us measure concentrations, but not toxicity or local health risk.
On the health side, air pollution does not cause a single dramatic, easily identifiable disease. Irritation and inflammation from short-term exposure can mimic seasonal coughs, colds, and infections, and exacerbate respiratory and heart diseases. Long-term PM2.5 exposure not only extends non-communicable diseases (NCD) but is now linked to new-onset hypertension, diabetes, neurological changes in healthy individuals, and rising lung cancer in non-smokers and a reduction in life expectancy by up to eight years in northern India. Because it is only one among many NCD risk factors and cannot be controlled like salt or alcohol individually, it remains ignored.
Exposure is the hardest to assess. Unlike Covid, which can be avoided through distancing, air pollution in India is largely unavoidable. Nearly everyone breathes PM2.5 far above the WHO’s 5 µg/m³ guideline. To link it to an illness, what matters is the dose and duration, which is impossible to measure in patients.
Pollutants, as non-living particles, lack antigens and do not replicate like bacteria or viruses. So, our immune system cannot build antibodies or memory to make us “immune”. As such, vaccines or medicines that can be deployed en masse during health emergencies do not exist for pollution. Because pollution affects multiple organs and systems, it is not possible to precisely quantify the extent to which polluted air causes any specific illness or death in an individual. This is often used as an excuse. What we can measure are disease burdens and trends in the population. The State of Global Air 2025 report estimated over two million pollution-attributable deaths in India in 2023. However, contention over data ownership can still delay action. Recent nationwide and multi-city studies in The Lancet Planetary Health have shown that for every 10 µg/m³ increase in PM2.5, annual mortality rises by 8.6 per cent and daily mortality by 1.4 per cent.
India’s health data remains scarce and underutilised. A significant barrier is the uneven adoption of Electronic Health Records (EHR). Unlike the mature EHR systems in Western countries, which enable query-based surveillance and near-real-time analysis, our public health surveillance operates independently of EHRs and relies heavily on manual data entry. This deprives the health sector of the decisive role it should play in holding other sectors accountable for population health, whether in air pollution, climate change or development projects.
The National Outdoor Air and Disease Surveillance tracks daily aggregates of respiratory emergencies and admissions from selected tertiary hospitals in cities under the National Clean Air Programme. However, in its early stage, it captures only acute respiratory illnesses, lacks advanced analytical capabilities, and has yet to generate credible evidence. Ironically, the very institutions that warn citizens about pollution do not consistently report cases to the national system. These limitations weaken its ability to estimate thresholds or issue health-impact-based early warnings.
Together, these gaps create a serious disconnect between the sectors that generate pollution, regulate it, monitor health impacts, and the public. We then rely on reactive afterthoughts like artificial rain, water cannons, more monitors, or antioxidant foods, while accumulating serious health damage year after year, drowning in the smog of our own consumption, and remaining blind to systemic gaps.
The writer is former senior consultant, National Programme on Climate Change and Human Health, National Centre for Disease Control
