In this most populous country in the world, almost every citizen is exposed to deadly pollution while performing the most basic existential activity: breathing. And it adds to their disease burden. The notion that air pollution is a ‘big city problem’ is rapidly crumbling. Data indicates that smaller towns and industrial hubs are now at the frontline of India’s air pollution crisis. Rural areas are also reporting high levels of air pollution. Indians are indeed losing on life expectancy due to foul air. Delhi’s battle against air pollution, which led to landmark Supreme Court interventions, cleaner fuels and tighter vehicle emission standards. However, rising private vehicle ownership, congestion and dependence on polluting fuels are eroding these gains. Growing congestion also increases vehicular emissions, with studies showing pollution levels can be three to seven times higher in congested traffic than in free-flowing conditions. Right to clean air is about intergenerational equity. Traditionally, the health impacts of air pollution have been understood in terms of the relation between dose and response at an undifferentiated population scale. But over the years, more nuanced approaches have evolved to investigate the modifiers and specific impacts on groups differentiated by age, gender, socio-economic and nutritional status, and a range of other factors that define the vulnerabilities and underpin marginalisation. Evidence is stark on infant deaths during the first month of life due to lower respiratory infections; low birth weight and preterm births affected by air pollution (refer to preceding chapters). Foetal exposure to pollutants is on the rise, as many harmful substances can easily pass through the placenta. Children are especially at risk because their respiratory systems are still developing. Furthermore, their immature immune systems hinder their ability to cope with these exposures. There is mounting evidence from several studies in different regions indicating disproportionate impacts of air pollution on vulnerable groups. There is no absolute definition of a vulnerable population. Several attributes are considered to define vulnerability and susceptibility to air-pollution-related risks. These include age, gender, socio-economic inequalities, nutritional status, occupational exposures and geographical location that determine proximity of the communities to pollution sources. It is now quite widely understood that children, the elderly and women, especially pregnant women across all socioeconomic groups, and socially disadvantaged communities are disproportionately impacted by air pollution. It is necessary to understand the nature of these widely different risks. Air pollution was the second largest killer globally after blood pressure, recording a dubious tally of 8.1 million deaths in 2021. Of this, a staggering 2.6 million deaths occurred in South Asia alone. To this is added debilitating chronic diseases and a range of ill health. With a population over 1 billion, India recorded 2.1 million deaths, including 237,000 ozonepollution related deaths. Ozone levels have also increased in South Asia. In 2021, ozone was responsible for 56 per cent of all global ozone deaths reported in the region. The report further notes that the US, partly due to its sizable population, widespread ozone pollution and relatively high rates of Chronic Obstructive Pulmonary Disease (COPD), saw 14,000 deaths in 2021, higher than any other highincome country. Since 2010, the overall number of ozone-linked COPD deaths has risen by nearly 20 per cent. This is expected to increase as the population gets older. While South Asia, including India, continues to bear the biggest brunt of particulate pollution-related health impacts, the proportion of population experiencing high ozone exposures is also increasing in India, Nigeria, Pakistan, and Brazil. These countries have noted increases of more than 10 per cent in ambient ozone exposures in the last decade. With populations of over 1 billion each, India and China had recorded 2.1 million and 2.3 million deaths respectively, and together accounted for nearly 55 per cent of the total global disease burden from particulate matter. In 2021, nearly 50 per cent of all ozone-related COPD deaths were in India, followed by China and Bangladesh. The toxic journey begins in the womb. When mothers are exposed to polluted air during pregnancy, the foetus is at serious risk. The risk escalates into a massive disease burden for infants, children and adolescents, lasting a lifetime. The problem has reached alarming proportions in the Global South, with India bearing the infamy of accounting for a quarter of the global infant deaths— within the first month of birth. (
The Burning Question
