Breathing Easy

Contributed by Dr. Vinuta Gopal
CEO Asar Social Impact Advisors
Member of the Clean Air Collective

Air pollution is one of the biggest public health threats to humankind today, and nowhere is this truer than in India, which accounts for the highest number of deaths from air pollution. The Global Alliance on Health and Pollution found that 15% of premature deaths around the world – amounting to 8.3 million – were from air pollution. India accounts for 2.3 million of these deaths, a 28% share. It is not surprising then that air pollution is the third-biggest health-related cause of death in India; shockingly, it even beats smoking, which ranks fourth. While COVID-19 is top of the public health agenda currently, air pollution could contribute to making sections of the population susceptible to increased severity of the illness, worse off.

The effects of air pollution are insidious.  Air pollution has long been associated with respiratory diseases like asthma and bronchitis. However, it can also cause cardiovascular diseases like heart failure, cardiac arrhythmia, coronary artery disease, and cerebrovascular disease, among others. Literature suggests that anywhere between 40 and 60 percent of premature deaths from air pollution are due to cardiovascular diseases.

Particulate matter (PM) is the most commonly known air pollutant that leads to cardiovascular disease. PM2.5 is the most dangerous as it is small enough to enter the respiratory passage and penetrate the alveoli. It can then enter the bloodstream and lead to potentially fatal cardiovascular diseases or, chronic comorbidities like hypertension that lead to an increase in disability-adjusted life years (DALY). In 2017, India accounted for 26% of the world’s air pollution related DALYs.

In India, close to 60% of the population uses solid fuels for household purposes, making them increasingly susceptible to health risks. Urban PM, however, is perhaps even more dangerous as industrial fumes, vehicular exhaust, and road dust make it a cocktail of chemicals that are significant contributors to cardiovascular diseases. The bigger danger is that there isn’t enough information to predict all potential complications that can arise out of prolonged exposure to these chemicals. The concentration of nanoparticles or PM0.1 in the air cannot be measured even though their increased surface area and ability to penetrate the bloodstream can lead to serious health issues. The fact that PM2.5 levels in 60% of Indian cities don’t meet National Ambient Air Quality Standards and that 21 of the 30 most polluted cities in the world are in India make the scenario extremely grim. What makes it far grimmer is the reluctance of authorities to acknowledge the seriousness of air pollution. India has one of the worst doctor-patient ratios in the world (1 doctor per 10,189 patients). This coupled with a 2018 study by IIT Bombay’s Health Effects Institute, which predicts annual deaths due to air pollution to triple by 2050 in a BAU scenario could lead to a serious overburdening of India’s already deficient healthcare infrastructure. India needs to treat air pollution as the gravest threat to public well-being and be on permanent red alert to ensure that the prediction does not come true.


Air pollution causes not only respiratory diseases but also cardiovascular disorders that can be fatal or significantly reduce the quality of life. The threat is far more severe in India as the most polluted country in the world. Global Alliance on Health and Pollution (GAHP) found that more than two-thirds of the adverse health impacts of pollution are Non-Communicable Diseases (NCDs). India’s health infrastructure is ill-equipped to deal with the dire predictions of rising deaths due to pollution. It is critical to treat the issue of tackling air pollution as a national priority to prevent a health emergency that the country cannot handle.