Millions breathe poison, but why public health isn’t political priority in India

“It feels terrible, I just don’t like it,” says Rubaab, an 8-year-old in New Delhi who has been using a nebuliser since he was a child.

He has croup, a wheezing cough that becomes nearly impossible to manage until he vomits. The symptoms worsen each time thick smog and pollution blanket Delhi NCR. And that happens every year around November. Rubaab can’t go outside to play. Not even in school, which closes when pollution levels soar. He is forced to stay indoors, hiding in the corners of his house where an air purifier hums non-stop. Rubaab’s experience is typical of most children in the capital city today.

Though the November smog in Delhi is just a decade-old phenomenon, its air remaining toxic all-year round has been a gradual slide. No one actually acted to prevent that.

Let’s look back 25 years. In a 1997 media interview, a Delhi resident in his 50s shared that black particles would come out when he washed his nose. A traffic police officer complained of persistent coughing, even while asleep, and many described the city as barely livable. Delhi’s story remains unchanged.

If Delhi, and other Indian cities, slowly turned into gas chambers, with air pollution behind 7 per cent of all daily deaths, why didn’t anyone take note? Why didn’t it become a political priority despite such a health emergency in India?

From the lack of public demand and political accountability to India being a “scarcity-model society” where people are convinced that the state cannot offer a higher quality of life, experts explain to India Today Digital why public health isn’t a national priority.

WHY DEBATES START AND END WITH POLLUTION EMERGENCY

Every November, as the national capital and its neighbouring regions are engulfed in toxic smog and air quality plunges to hazardous levels, active discussions spark both online and offline, often blaming the system. These debates persist for three to four weeks, with some politicians occasionally joining, and then fade.

The gravity of the current health crisis is such that it could have triggered mass protests in other societies and influenced poll outcomes, yet India remains largely unmoved. Despite its urgency, this critical issue is glaringly absent from the nation’s political discourse.

In its 2024 Lok Sabha election manifesto, the BJP introduced a two-page ‘Modi Ki Guarantee for Swasth Bharat’, focusing primarily on infrastructure development and baseline improvements — measures that are the bare minimum for a developing nation. Similarly, the Congress pledged better insurance coverage, hospital facilities, and an improved healthcare network. However, neither party offered a clear vision for a future where citizens no longer have to breathe toxic air.

In the run-up to the elections, Prime Minister Narendra Modi attended over 200 public events and rallies, while Rahul Gandhi participated in 107 programmes. However, neither they nor other leaders from their parties touched upon air pollution or the broader health crisis affiliated to it in their speeches.

So, why does people’s health find no space in political debates despite being as critical as inflation or unemployment? Why has there been no large-scale public demand to compel political action? TT Sreekumar, a political economist and professor at the English and Foreign Languages University (EFLU) in Hyderabad, observes, “CIvil society activism, which once raised awareness about such issues, has almost disappeared”.

He notes that the past decade has seen a decline in movements advocating for enviro-health causes. “Whatever happens now are sporadic outbursts, which do not evolve into strong, sustained movements,” Sreekumar tells India Today Digital. According to Sreekumar, regulatory measures on similar issues, for example, Coastal Zone Regulations or the Forest Act were outcomes of global civil society activism rather than political steps.

Legislative remedies for air pollution remain absent because they are not yet a forced public demand. “For the same reason, political parties continue to remain tight-lipped on health issues in larger discourse,” he says.

LACK OF POPULAR DEMAND ON HEALTH ISSUES MAKES POLITICIANS INDIFFERENT
Ajay Gudavarthy, an author and political theorist at JNU’s Centre for Political Studies, highlights the absence of civic sense, leading to a lack of public demand and political accountability. “There is absolutely no civic sense. Leave air pollution aside, during Covid, when bodies were floating in the Ganga, there was no response, no questioning from the public. The state does not see it as its responsibility,” he elaborates.

“Society does not care about or aspire to a quality life. Society is still stuck in subsistence ethics, content with having the bare minimum to carry on. Additionally, people are convinced that the state cannot offer a higher quality of life. It’s a scarcity-model society,” Gudavarthy observes.

He highlights a lack of “civic imagination”. “For that, society should view itself as citizens. From this sense of citizenry, civic imagination derives, and people start talking about rights. But currently, what we have is just communities, not citizens.”

According to him, with the lack of popular demand for change, regimes and political parties tend to remain indifferent. Gudavati also points to this as a consequence of representative democracy, where, “state and politicians focus on long-term measures but on immediate steps”.

“Health, for instance, requires long-term measures and policies, but today’s politics runs on a sense of intimacy,” he says.

The toxic smog, fuelled by agricultural fires, vehicular emissions, and other pollutants, that blankets the national capital is approximately 60 times higher than the World Health Organisation’s (WHO) safe limits. The concentration of particulate matter, capable of entering the bloodstream and causing significant health hazards, is at least seven times above the permissible maximum.

AIR POLLUTION BEHIND 7% OF DAILY DEATHS IN 10 CITIES: LANCET
According to The Lancet Planetary Health, air pollution contributes to over 7 per cent of daily deaths across 10 major Indian cities, with Delhi being the highest. Delhi records around 12,000 deaths annually due to PM2.5 exposure, accounting for 11.5 per cent of total deaths. Studies show life expectancy in Delhi is reduced by over 10 years due to air pollution.

On a national scale, air pollution is a leading cause of mortality, responsible for over 20 lakh annual deaths. A report by a US research team highlights that India’s 1.3 billion residents live in regions where annual average particulate pollution levels exceed WHO’s safe limit.

The Air Quality Life Index by the Energy Policy Institute at the University of Chicago (EPIC) estimates that approximately 51 crore people in north India–nearly 36 per cent of the country’s population–stand to lose 7.6 years of their lives on average if current pollution levels persist.

The air crisis places a heavy burden on hospitals in India. Mid-to-large hospitals in Indian cities report 200–300 daily patients in pulmonology departments, most of whom come from underprivileged backgrounds and cannot afford private healthcare.

For change to occur, India needs public awareness, political will, and a national-level policy. More than just policies, it requires a cultural shift where citizens demand accountability and aspire for quality healthcare. Without this, the country risks a silent health emergency, with dire consequences for generations to come.