Opinion | You Must Outrage Over Filthy Air More Than Once A Year

When we decided to move back to our country from California more than a decade ago, many of my friends, especially from the Indian diaspora, advised us to rethink our decision. “Look around. Are you absolutely sure?” asked a childhood friend whom I had gone to school with in the Delhi of the 1980s, but who had settled in the Bay Area, gesturing at the golden sunshine and clear blue skies, the smooth roads on which our children were cycling around, shrieking with joy, the acres of rolling greens of public parks around us and the white buildings at the far end—our local Palo Alto library, recreation centre, public pool, children's museum and zoo.

I shut my eyes, nodding mutinously. “I'm sure. Facilities aren't everything. I want my children to know who they are, their rich culture, heritage, their ethnic identity, their grandparents, cousins and extended family.” “So do I. Family visits once a year—and my kids are learning bharatnatyam, tabla and flute right here. And they go to after-school Hindi classes,” another friend exclaimed. She had managed to get Hindi included in the seven foreign languages taught after school. “Plus they can cycle to most of these places by themselves by the time they are teens.” “It's not the same, it's not immersive, experiential….organic. They are forced to toggle between two worlds,” I insisted, not even bringing up the difference between planned annual visits and meeting nani, dadi, maasi, bua and cousins at will.

“And you're willing to give up all civic amenities for that? Have you forgotten the dust, grime, pollution, and disease - not to mention the corruption, beginning from the petty to the sublime?” said another college friend sarcastically. She had recently got her citizenship after nearly a decade of living here. “Look, you're just months away from converting your Green Card to full citizenship. Why don't you wait another year, become a citizen and then return?” advised another reasonably. “That's what we did—and now we come and go as we please.”

Home And Denial

But between our idealism and our practical calculations, intertwined with our desire to raise our children in our homeland, we not just left, but also gave up our green card, which, as an Australian friend reminded me severely, “people risk their lives on boats in open seas' to get”. Delhi welcomed us with monsoon rains and mangos. We were home.

Fast forward a couple of years, in the winter of 2012, I found myself in denial about something other parents, mostly expats, were calling toxic air. Delhi's air pollution was sickening and killing us. It was much worse than Beijing's pollution, but less known. And that winter haze I used to call a fog was actually a poisonous smog that enveloped my city of birth and choice. It took me another two years, many conversations with air pollution experts, reading research papers, and searching the web to be thoroughly convinced that what we were breathing was dangerous to our health, that every breath compromised our health and that every newborn was a smoker. We had to do something to save our children and our parents.

Five Things We Don't Understand

Some of us banded together to bring awareness and advocate for clean air, making detailed presentations at schools, hospitals and residential areas, talking to children, parents, teachers and doctors, petitioning the courts and making individual changes from composting all kitchen waste to switching to public transport and EVs. In this 12-year journey—10 years of which I spent fighting for clean air—I've learnt more than I wanted to know about disease, disability and death due to air pollution. Ironically, my own mother passed away from lung cancer which her doctors said was triggered by air pollution. I've had to send my kids away sooner than I had planned, and, in the end, I myself became a pollution refugee. Here are the top five things that many still don't realise about this killer.

First, there are no safe levels of air pollution. Experts speak in one voice when they say this, whether it is the World Health Organisation, the National Institutes of Health, the American Journal of Respiratory and Critical Care Medicine or others. Episodic high pollution levels, like what happens during peak stubble burning or Diwali, may dramatically increase visits to hospital emergency rooms, but even relatively lower pollution levels cause disease, disability and death. Almost 1.7 million people die from air pollution each year, which is more than three times the deaths Covid-19 caused in one year, a disease the Indian government took seriously in its public messaging—something it has never done with equal intensity for pollution.

Second and equally important, air pollution is not a seasonal problem. It is an invisible, year-round problem in all of India that usually becomes more visible in the winter. On average, the country's pollution load is usually 10 times higher than the WHO guidelines all year through. It is just insanely—almost 50 times—higher in the winter months in north India, which leads to international headlines and increased attention. However, that doesn't alter the fact that year-round pollution levels are also high. Sadly, they have been normalised by over a billion people torn between helplessness, resignation and apathy.

Don't Blame North India Alone

Third, over 90% of India breathes dirty air, not just northern India or Delhi, though these regions are the most highly polluted. The Indo-Gangetic plain is home to 40% of India's population, which means more than 500 million people are sickened by just breathing. But Mumbai has shown us in three consecutive years that it can beat Delhi's AQI levels, last year even a month before Diwali. As for southern India, although its geography (high altitude) and weather (rain and wind) ensures most of its particulate matter is washed or blown away, Bengaluru had the dubious distinction of topping the State of Global Air's list of polluted cities for nitrous oxides in September 2023, followed by neighbouring Hyderabad. NOx exacerbates respiratory diseases, and a recent AIIMS study found it can lead to an increase in the number of emergency room visits by 53%. Another coastal city, Chennai, has had its moments, with AQI levels crossing Delhi levels. And if you thought that only urban India was suffering, not only does research show that pollution is increasing faster in southern and eastern India, it is also growing in rural areas, where indoor air pollution (caused by burning biomass for cooking and heating) already contributes nearly 30% of outdoor air pollution. 

Fourth, air pollution doesn't harm just the human respiratory system but damages every organ in the human body, especially the heart. Peer-reviewed journal Neurology's September issue published research that showed a strong and significant correlation between air pollutants and death from strokes. In fact, Bengaluru has the youngest population of heart patients. The city's Jayadeva Institute of Cardiovascular Science and Research treated 2,200 heart attacks of patients under 40 in two years, the youngest being 16 years old. These were mostly software professionals and auto/cab drivers who spent longer than an hour in traffic. But is sixteen any age to have a heart attack triggered by just the involuntary act of breathing?

There's No Going Back

None of this harm is short-term. It is long-term and irreversible, which means that you can only arrest it once you start breathing clean air (like when you stop smoking cigarettes). Those microscopic particles of PM2.5 that you're inhaling right now? They will remain in your body until you die. The University of Chicago has created an Air Quality of Life Index tool that calculates how much longer people of a certain region would live on average if that region met WHO guideline limits. A Delhi resident would live nearly 12 years longer, and a north India resident nearly seven years if the air they breathed met WHO guidelines.

Lastly, let me not even get started about how air pollution is a social inequity, this column just doesn't have enough words for that. But when you are working from home with your air purifier on a high pollution day, spare a thought for the waste-picker or construction worker who won't get her daily wage if she decides to protect her health and stay home, or the traffic policeman who stands among vehicular fumes at intersections directing traffic, or the autorickshaw driver who won't earn if he doesn't drive one day. These are also people who have less access to healthcare and are often malnourished. By now, we know air pollution is the greatest threat to human health globally, whose impact on life expectancy is comparable to that of smoking, more than three times that of alcohol use and unsafe water, six times that of HIV/AIDS, and 89 times that of conflict and terrorism.

India's air has been getting filthier over the years. Politicians bring up economic growth as the bogey when urged to act strongly and decisively on pollution. But there is a difference between growth and development - with the latter including a better quality of life through a focus on basic needs for all, healthcare, education and well-being. That is the kind of sustainable growth I'd like to see in my country, a place I chose to return to.

(Jyoti Pande Lavakare is the author of the grief memoir 'Breathing Here is Injurious to Your Health' and co-founder, Care for Air.)

Disclaimer: These are the personal opinions of the author