Breathing bad: A lung surgeon’s prescription for our air pollution

India, with its burgeoning urbanization, is grappling with a dire air quality crisis. Over 80% of our cities bear witness to recurring spells of hazardous air. The National Clean Air Programme (NCAP), launched in 2019, strives to combat this menace and had set an ambitious target of reducing PM2.5 pollution by 20-30% by 2024. In 2022, the NCAP aim was extended to 2026, by when it’s aiming for a 40% reduction in pollution levels from the 2017 levels. However, the battle against air pollution extends beyond governmental initiatives; it requires a collective, conscientious effort by each city, every policymaker and each citizen. As cities evolve, so must our strategies for combating the adverse health effects of pollution.

This surge in air pollution demands a paradigm shift in the approach taken by Urban Local Bodies (ULBs) to safeguard public health. While drawing inspiration from global initiatives, particularly London’s Air Quality Action Plan, the focus should be on tailoring these strategies to suit the unique challenges faced by Indian cities. The first and foremost is the need for accurate data. This would mean calling for city-wide air pollution monitoring infrastructure. Real-time sensor-based technology allows us to capture local nuances, identify pollution hotspots and enable prompt interventions.

In addition to the air-quality data, we need health-impact data for any meaningful intervention. This would be in the form of pollution and health vulnerability mapping and information on hotspots that are more prone to poor air quality and its adverse effects. That said, data without a strategy for action is of no use. So, authentic data must be coupled with action: for example, the development of a disease calendar using the environmental and health data that would empower cities to allocate resources optimally and safeguard vulnerable areas in specific months of the year.

Communication becomes the lynchpin in this battle. Transparent dissemination of real-time pollution and health data through various channels, from digital billboards and newspapers to social media platforms, fosters public engagement. The information disseminated on air quality should not be restricted to displaying AQI numbers; rather, it should be coupled with clear health advisories that make the numbers relatable to the public without letting a sense of apathy set in. Our air-quality messaging should shift from merely cautioning people against poor air quality to showcasing the benefits of clean air on good days and fostering behavioural changes through public health campaigns, like those against tobacco and covid.

Another much neglected and yet important piece of the puzzle is the need to upgrade our health centres for targeted services to ensure adequate care is provided to those who suffer from the adverse health impacts of air pollution. Hospitals and health centres should be prepared to respond to patients whose health is impacted by polluted air, our healthcare workforce should be educated to make sure they factor in the history of exposure to poor air, including levels of household or occupational risk, while diagnosing a disease and prescribing treatment. A remarkable example of this is the recent decision of Great Ormond Street Hospital in London to “look at home air pollution when diagnosing illnesses." Hospitals and other health facilities should be at the forefront of monitoring air quality and disseminating evidence-based information to the public. In this aspect, I am proud of the efforts taken by my own department at Medanta, Gurgaon. In 2022, we launched the Medanta Institute of Research and Advocacy for Clean Air and Health (MIRACAH) with the objective of working “towards advocacy, training and research on air pollution and health." Our belief is that any health infrastructure must not merely respond, but proactively protect citizens from the health hazards of the air we breathe.

Finally, we must address the root cause of poor air quality in our cities, and this means ensuring strict compliance with emission norms, be it for polluting industries, waste management or road vehicles. Importantly, we must avoid propagating false and end-of-pipeline solutions that often yield no results and are a huge burden on the public exchequer. Air pollution is not a technical problem that only needs smokestacks and tailpipes fixed, but a human health problem that needs a different perspective and approach to solutions.

The health of our cities hinges on decisive action. Cities must seize this opportunity to democratize data, engage communities and place health at the core of policy planning. As a lung surgeon on the front-lines, I implore our cities to breathe life into these strategies, not just as plans on paper, but as the blueprint for a breathable, vibrant future. The battle against air pollution is not just a policy matter; it is a fight for the very air that sustains our existence. Let us rise to the occasion, recognizing that each breath is a gift and safeguarding the air we share is a matter of collective responsibility. The time for action is now.