Opinion Why we were scared of Covid, but don’t care about pollution

But air pollution is not a seasonal inconvenience. It is a year-round health problem that refuses to become a public-health priority.

The dual visibility problem

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 for us: Hidden in its origins and uncounted in its health effects.

Our primary year-round sources, including 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, making them more visible. 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 asthma, chronic obstructive pulmonary disease (COPD), and heart disease. Long-term PM 2.5 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 (AQLI 2025). Because it is only one among many NCD risk factors and cannot be controlled like salt or alcohol individually, it remains conveniently ignored.

Exposure everywhere, all the time

Exposure, the link between pollution and disease, is the hardest to assess. Unlike Covid, which can be avoided through distancing, air pollution in India is largely unavoidable. Nearly everyone breathes PM 2.5 far above the WHO’s 5 µg/m³ guideline throughout the year. To link it to an illness, what matters is the dose and duration, which is impossible to measure in patients to connect their symptoms directly to pollution.

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.

The missing ‘cause’

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 reality is often used as an excuse. We are wired to act on threats we can clearly count and responses that yield quick, measurable impacts, like with Covid.

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. Often such estimates are dismissed as “inconclusive” or “not Indian enough”. Meanwhile, methods have advanced substantially, integrating sophisticated models with satellite data, including multiple relevant indicators like wind speed, temperature, and land use patterns. Satellite data provide consistent and reliable information through open-source platforms. This enables exposure estimates at high spatial and temporal resolutions, overcoming the limitations of sparse or malfunctioning ground monitors to provide better health impact assessments. However, contention over data ownership can still delay acceptance and 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. The “small” percentages translate into thousands of deaths simply because of India’s population size. Cleaner-looking cities like Shimla and Bengaluru are also not immune; cities recording satisfactory levels (60 µg/m³) experienced nearly double the daily mortality increase (2.7 per cent), warranting strict control measures even in these cities.

Our health data

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. The quality and speed of disease intelligence remain suboptimal, diverting resources. 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 is a crucial tool that 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 and advisories.

Fragmented action, systemic blind spots

While strong central leadership and political will can accelerate progress, competing priorities, limited capacities, weak accountability, and the complexity of multi-sectoral engagement continue to slow reforms. The perceived lack of “authentic” Indian evidence becomes a convenient barrier to action planning, despite credible evidence. This forces administrators, city governments, and civil society groups to act independently, resulting in fragmented efforts and inefficient use of resources.

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