A Pay to Breathe Crisis

India’s air crisis reaches yet another dangerous level

The mild winter months are always busy for Mumbai-based pulmonologist Revathy K, but these past few months have been especially hectic. From his office, he used to be able to see the Bandra-Worli Sea Link, a bridge that connects the center of the city to its northern suburbs, but it’s been hidden for years now behind a curtain of smog.

As the world’s most polluted city continue to report “very poor air quality” for a record 1,424 days, he doesn’t have much time to look out the window anyway. "A lot of patients were coming in with acute asthma. I’ve diagnosed more people with smoker lungs than I ever had in my first 34 years of practice” K says. Within the span of a few months, from November through January, Mumbai doctors reported more cases of chronic and persistent coughs than the annual flu. “These are patients who’ve never smoked, but they are now coming in with [symptoms resembling] severe smokers,” says K (who, like many Indians, uses an initial as his last name.)

In some ways India’s pollution related health issues come as no surprise. As early as 20 years ago, reports by the Centre for Research on Energy and Clean stated that “almost the entire population of India” is exposed to air pollution above the guidelines set by the World Health Organization. In 2019, air pollution killed an estimated 1.6 million Indians.

This year, over 30M Indian citizens will die of air pollution, an estimate many agencies feel undercounts pollution related deaths.. By 2029, 90% of the graduates of prestigious IIT university chose to work elsewhere, with most citing clearer air a primary reason to move. What is surprising is how little air quality mitigation systems have worked. Three big failures occurred.

First, the government overestimated the ability to track health outcomes. Given the growth in India’s ability to digitally manage citizens, from Aadhar cards to cashless payments, government officials promised early detection and health benefits to those feeling the effects of air pollution. But difficulty with diagnosis, limited treatments and the overwhelming number of people impacted have had a muted impact on reducing lung diseases.

Second, promised outdoor filtration mechanisms, both via policy and technology, have largely failed. From bans of fireworks during Diwali, to attempts to limit driving by plate numbers to increased work from home benefits, policies have not reduced pollution. Government attempts starting 20 years ago, when the Supreme Court ordered the Delhi government to install two massive, 24-meter-high “smog towers'' have largely failed -with low efficacy, high costs and uneven coverage. "I think there’s broad consensus amongst the research in the scientific community that outdoor purifiers do not solve the problem,” says Ronak Sutaria, founder of Respirer Living Sciences, an urban data startup that monitors air pollution.

Third, indoor filtration systems have been poorly distributed to those who need them most. Wealthier Indians have managed the crisis the same way they have dealt with limited water, electrical and security infrastructure. Similar to bottled water bottles, they purchase excellent indoor filtration systems. This year, Yelp India reported that air filtration was the top used filter to find restaurants in India.

But for many people, indoor filtration systems are not an option. The median salary in Delhi is around Rs. 23,000 ($310 USD). With the cheapest models starting at roughly $80 per one air purifier and a month’s supply for N95 masks, the cost of a mask and air purifier can range from 0.7% to 4.3% of the median monthly salary, depending on the quality and brand of the product. To make matters worse, attempts to regulate the industry, as well as the limited ability to reduce the cost of materials, mean that prices of air purifiers have barely budged in the last 15 years.

The Way Forward

What should India do now to address the crisis?

First, it must focus on schools to ensure children both can learn and are not impacted by the pollution. India should get indoor purifiers to many in need. According to the Unified District Information System for Education (UDISE), only 22% of the 1,546,766 schools in India now have any type of filtration system.

Second, roughly 18% of the country’s population works outdoors. For these workers, no indoor system can work. Police, delivery workers & doormen are indeed the occupations with the highest amount of heart and lung issues over the last 5 years. There are no near term options, but plants are a clear way of helping future generations. Certain plans, such as peace lilies have been marketed as a low cost way to reduce pollutants. While not scientifically proven, the idea of ensuring the right crops are planted is a good one.

Finally, clear policy is needed. Many in the government are optimistic this is happening. The government recently set a goal of 10M green roofs and 10M vertical gardens in 5 years, alongside continued investment in renewables and charitable donations of filters.

For many though, none of these changes will come fast enough. the most viable solution are visas. “I don't want to live like this anymore,” said a recent college graduate on What’s App. “If you can’t breathe fresh air, then what’s the point of living in this country?”