Mint Explainer | Delhi pollution crisis deepens: Can India’s health system adapt?
While the Centre has mandated the establishment of chest clinics in government health facilities and medical colleges to tackle rising health issues, the country still needs a long-term plan to address air pollution itself.
MUMBAI : India’s national capital has seen two citizen-led protests in November over the government's inaction to address dangerously worsening air quality.
Health experts have declared the winter air pollution in New Delhi a public health emergency, urging strict and long-term solutions similar to those taken to curb the covid-19 outbreak.
Mint examines the measures in place to tackle air pollution-linked health risks, and what more could be done.
How bad is the situation?
Air quality in the National Capital Region and in neighbouring cities across Punjab, Haryana, and Uttar Pradesh has been deteriorating since October—an annual phenomenon driven by factors such as stubble burning, firecracker use, and vehicular emissions, and exacerbated by low wind speeds, winter temperature inversions, and the region’s topography.
This year as well, hospitals started reporting a significant rise in the number of people visiting outpatient departments as air quality worsened. On 18 November, doctors at Delhi's All India Institute of Medical Sciences (AIIMS) said in a seminar that they had observed a 10-15% increase in respiratory cases across the departments of pulmonary medicine, respiratory medicine, and ophthalmology since Diwali, celebrated on 20 October.
Fortis Hospital, Gurugram, saw a 20% increase in air pollution-linked OPD footfall, while respiratory disease-related hospitalisation jumped 10% post-Diwali, Dr Manoj Kumar Goel, principal director and unit head of pulmonology and sleep medicine, told Mint.
While Delhi is at the centre of the storm, the problem is far more widespread: 13 of the world’s 20 most polluted cities are in India. According to a recent Lancet study, the country recorded 1.72 million deaths from outdoor air pollution in 2022—up 38% since 2010.
What do health experts think?
Dr Anant Mohan, head of pulmonary medicines and sleep disorders at AIIMS-Delhi, termed the situation a “public health emergency", called for state agencies to take “drastic steps". Masks and purifiers offer limited protection, he said, adding that the city needs “real, long-term solutions".
While people with pre-existing conditions, including chronic obstructive pulmonary disease (COPD) or heart disease, are more prone to flare-ups, healthy people are also falling sick, according to doctors at AIIMS.
“There is an increased risk of infection in the lungs, like pneumonia, sinusitis, bronchitis, respiratory failure, and asthma, which may require hospitalization," said Dr Goel, adding that children and pregnant women are particularly vulnerable to risks.
Common symptoms of air pollution-related ailments include wheezing, coughing, breathlessness, burning eyes, and skin irritation.
Is there an adaptation plan?
The Ministry of Health and Family Welfare launched the National Programme on Climate Change and Human Health (NPCCHH) in 2019, aiming to strengthen the country’s healthcare system to handle cases linked to climate change.
Under the NPCCHH, a health adaptation plan for diseases due to air pollution was released in 2021. The document provides a framework for states and Union territories to tackle air pollution-related illnesses by defining the roles of key stakeholders and outlining strategies to address challenges.
It includes identifying air pollution hotspots and vulnerable areas; mapping healthcare infrastructure and establishing priority-based surveillance; allocating appropriate resources to public health facilities; training healthcare workers; issuing timely health alerts; and coordinating with key stakeholders in non-health sectors.
An updated health ministry advisory in 2024 recommended that state and district health departments establish systems to access daily air quality data and share it with healthcare facilities, increase awareness campaigns, train medical staff and community workers and enhance surveillance. It urges healthcare facilities to prepare by bolstering essential equipment, including emergency medicines, oxygen, ventilators, diagnostics, beds, and referral mechanisms.
What’s being done?
Last week, in the wake of rising cases, the Centre issued an updated advisory, mandating the setting up of chest clinics in government health facilities and medical colleges, dedicated to screening, treatment, and follow-up of cardiopulmonary illnesses linked to air pollution. These clinics are expected to identify risk factors, confirm diagnoses, and provide long-term care for patients suffering from respiratory and heart diseases aggravated by air pollution.
During the peak air pollution months (September to March), the clinics are expected to function for at least two hours daily. The Centre has also directed states to record cases, and all health centres and district hospitals have been asked to ensure adequate medical supplies, as well as trained staff. Private hospitals, such as Fortis, have extended their OPD hours as cases surge.
What more could be done?
These are reactionary measures, designed to address the fallout. Citizens and health advocates demand long-term interventions to curb air pollution and accountability.
Wellness influencer Luke Coutinho's plea on 24 October in the Supreme Court sought to declare air pollution a national public health emergency. It highlighted that the National Clean Air Programme (NCAP) launched in 2019 has not met its objectives and sought a direction to make NCAP targets binding with “statutory force, including clear timelines, measurable indicators, and enforceable penalties for non-compliance".
The top court on 18 November refused to entertain the plea but allowed the petitioner to file an intervention plea in a pending case filed by environmentalist M.C. Mehta on the subject.
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