Air pollution and health in India: A review of the current evidence and opportunities for the future

Air pollution is a major and growing risk factor for ill health in India, contributing significantly to the country’s burden of disease. As per the Global Burden of Disease comparative risk assessment for 2015, air pollution exposure contributes to approximately 1.8 million premature deaths and 49 million disability adjusted life-years (DALYs) lost, ranking it among the top risk factors for ill health in India. Home to 10 of the top 20 cities with the highest annual average levels of PM2.5 as per the WHO Urban Ambient Air Quality Database (2016), and with several studies showing a worsening trend over time it is safe to say that rapid urbanization and industrial development have adversely affected urban air quality due to vehicular and industrial emissions. Simultaneously, over two-thirds of rural Indians caught in the ‘chulha trap’ use biomass fuels such as wood, dung or coal to satisfy their cooking and heating needs, resulting in smoke-filled homes and extremely high levels of exposure especially to women and children. Rural and urban India are both affected by poor air quality. There is, however, heterogeneity in sources and pollutant profiles. For instance, use of cooking fuels varies between urban and rural households, vehicular density is vastly different in cities and villages, and differing climatology and geography across India affects regional and seasonal levels of ambient air pollution. Air pollution has been termed a democratizing force but it is far from that, as it propagates existing environmental injustices. Studies have shown that children and the elderly are particularly vulnerable to air pollution exposure. Air pollution exposure has shown to slow lung development in children , affect cognitive development , and has resulted in high levels of mortality from respiratory infections . The elderly are more likely to develop chronic respiratory and cardiac illnesses as a result of long-term exposure, and are more susceptible to heart attacks and strokes during episodic high pollution events. Vulnerable also are those of a lower socio-economic status, with studies showing they are more susceptible to insults from air pollution exposure for a variety of reasons including occupation, housing, cooking fuel use, the common link being poverty While environment, health and development are frequently pitted in adversarial roles in the discourse on economic growth, published evidence argues that they are very much in consonance. A study published by the World Bank in 2016 revealed that air pollution cost India approximately 8% of its GDP or $560 billion in 2013, as a result of lost productivity due to premature mortality and morbidity. This study, while a great first step, failed to capture the healthcare costs of treating air pollution-induced illnesses, which if factored in, could produce a far larger number.