India seeks clearer evidence of air pollution's health impact as smog worsens

The health ministry is introducing a nationwide reporting system to measure how air pollution affects people’s health. It requires hospitals with Chest clinics to screen patients, classify their illnesses and submit regular data. The goal is a clearer picture of respiratory and cardiovascular harm as air quality worsens.

Hospitals must keep daily patient records and use the WHO’s International Classification of Diseases codes. These codes distinguish asymptomatic exposure, symptoms and pollution-associated illnesses. Hospitals will send daily patient numbers to district and state authorities, which will share monthly reports with the National Centre for Disease Control.

The system also includes fortnightly reviews by the ministry and links Chest clinics with Ayushman Arogya Mandirs. ASHA workers will help follow high-risk patients. Better records could guide treatment and policy, but experts stress that surveillance must accompany coordinated pollution-control action.

Chest clinics are hospital-based services created under the National Programme on Climate Change and Human Health. They provide screening, diagnosis, management and counselling for air-pollution-related illnesses. The programme covers patients of all age groups and establishes clinics at district hospitals and medical college hospitals.

During the September-to-February period, participating hospitals must keep daily patient records and classify cases using WHO disease codes. They must screen for pollution-related illness, investigate possible causes, confirm diagnoses, and maintain supplies of essential equipment, drugs and consumables.

The clinics are also being connected with Ayushman Arogya Mandirs. This link allows ASHA workers to help follow high-risk patients after their hospital visits. Hospitals report patient numbers daily to district and state authorities, while states send consolidated information monthly to the NCDC. Fortnightly reviews will monitor progress.

Delhi-NCR faced rapidly worsening pollution during the period described. At 9:05am on 3 November, the region’s air quality index reached 332, placing it in the “very poor” category. Jahangirpuri recorded an even more dangerous reading of 452, classified as “severe.”

The deterioration was fast. The AQI rose from 117 on 31 October to 324 on 2 November. That sharp change prompted the Commission for Air Quality Management to invoke Stage II of the Graded Response Action Plan, or GRAP.

Stage II measures included mechanical sweeping, water sprinkling with dust suppressants and inspections of pollution hotspots. The figures show why health surveillance has become urgent. Experts also argue that enforcement must target pollution sources, including industries and other activities contributing to poor air quality.

The article links long-term exposure to polluted air with several serious health problems. These include stroke, cardiovascular disease, respiratory disease, lung cancer and a higher risk of premature death. The burden affects people across age groups, which is why the ministry’s screening programme is designed for all patients.

The effects can also appear quickly when pollution levels spike. Dr. Sowmya Swaminathan said hospitals see immediate increases in asthma, chronic obstructive pulmonary disease exacerbations and heart attacks. This shows that pollution can worsen existing illnesses while also contributing to severe health outcomes.

The health ministry wants Chest clinics to screen, diagnose, manage and counsel patients. Standardized records should make these effects easier to monitor. However, Swaminathan stressed that collecting clinic data is not enough. Pollution sources must also be reduced through coordinated, multi-year action.

A 2024 study published in The Lancet Planetary Health estimated that long-term exposure to fine particulate matter caused roughly 16.6 million deaths in India between 2009 and 2019. The estimate highlights the enormous national health burden associated with polluted air.

The study’s average was about 1.5 million deaths each year under WHO safety guidelines. These figures concern long-term exposure, rather than only the immediate effects seen during severe smog episodes. The article also links pollution with stroke, cardiovascular and respiratory diseases, lung cancer and premature death.

The estimate helps explain the ministry’s push for systematic health surveillance. Chest clinics and standardized WHO disease codes can produce more consistent records of pollution-related illness. Experts nevertheless caution that data collection alone cannot solve the problem. Reducing exposure requires coordinated action across the Indo-Gangetic airshed.

Determining pollution’s exact role in one patient’s illness is difficult because the same condition can have multiple possible causes. A patient may have symptoms or disease linked to pollution, but clinicians must still establish whether air pollution caused it, worsened it or occurred alongside other factors. The article identifies this as a clinical challenge without detailing every factor.

The new system addresses the problem by asking clinicians to record possible causes, including air pollution, and then confirm diagnoses. WHO’s disease codes will separate asymptomatic exposure, symptomatic cases and pollution-associated illnesses. This creates a more consistent record without claiming that every case has one clear cause.

Better data may help doctors and health authorities identify patterns over time. Still, the records will not replace clinical judgment. The ministry’s plan is therefore a tracking and diagnosis framework, while experts say stronger pollution control is also needed to prevent harm.

Reducing air pollution requires action across the Indo-Gangetic airshed because pollution is a regional problem rather than something contained within one city. Measures taken only by Delhi or one neighbouring state may leave major sources elsewhere untouched. That limits the effect of isolated local responses.

Dr. Sowmya Swaminathan called for coordinated, multi-year action covering transport, industry, dust, clean cooking fuel and stubble burning. These sources span communities and administrative boundaries. Cooperation is therefore needed alongside local enforcement, health surveillance and emergency measures such as GRAP.

The current response combines monitoring with some immediate controls. Delhi-NCR’s worsening AQI led to mechanical sweeping, water sprinkling with dust suppressants and hotspot inspections. Experts warn that such steps must be part of a broader regional strategy. Joint action could reduce exposure more effectively and prevent repeated pollution spikes.