After having lived in New Delhi for six years, I remember the day in April 2015, when I finally realized that India’s air pollution crisis was my problem. I was in the car on my work commute from Gurgaon to Noida. The radio station’s English newscaster announced the World Health Organization had ranked New Delhi first in the world for the highest daily average air pollution levels.

The Hindi language newscast immediately followed, but did not even mention the air pollution news. I was shocked. I asked our Hindi-speaking driver if he understood what just happened, and explained to him that we just learned in English that we were living in the worst air in the world, but we were simply not given that news in Hindi.

I felt like we had been so ignorant about something so basic, our air. Even when WHO announced its official findings, only some of us were privy to the information.

Most news about air pollution levels and its associated health risks is shared inconsistently and inadequately. Reports are in English, in print or digital news, or via social media. Not everyone in northern India has the language capability, literacy, or Internet access required for this information to reach them.

India’s leaders do not effectively convey how serious air pollution is, to the Indian public or to visitors. Until they acknowledge that India has a major air pollution crisis, they cannot ensure the collective actions required to sustain solutions.

Air pollution in India is not a seasonal occurrence. It now affects every northern Indian city, every single day. Unlike many other concerns about living in northern India, every single person is at risk, just for breathing. International satellite imaging indicates that 600 million people, over half of India’s population, live in dirty air.

Constantly high air pollution levels are not just limited to New Delhi. Thirteen of the top 25 most polluted cities in the world are in northern India. These include Agra, Amritsar, and Jodhpur – places with millions of residents and many annual visitors.

India’s Air Quality Index, scaled from 0 to 500, is a composite measure of air pollution’s component particles, including the most harmful particle, PM2.5, which lodges into body organs, leading to inflammation, symptoms, and disease. Of note, Indian authorities declare the air unhealthy at higher PM2.5 levels (60 mcg/m3), compared to the U.S. (35 mcg/m3).

India defines air pollution at an AQI higher than 100. In northern India, daily average AQI levels exceed 150, indicating “Moderate” or worse air pollution. These winter days, typical daily AQI ranges from 200 to 300+, labeled “Severe” or “Very Severe.”

There are no “Good” air quality days in northern India.

Yet, very few people acquire AQI information, unless they access social media, and understand English, including potentially confusing terminology. Lacking AQI knowledge, people share daily misconceptions that the air “must be okay,” because it’s “sunny,” “colder,” “windy,” etc. The fact is the air is never clean. It is always polluted.

Why is this important to know, every day? Air pollution risk is cumulative. The longer you are in it, the greater your risk for getting sick. PM2.5 from any level of air pollution stays in the body, and exerts long-term harm.

Today, a baby born in a northern Indian city will not live a single day breathing clean air, unless her family moves away. Based on scientifically valid international and Indian studies, we know that, just from air pollution, this northern Indian child will grow up facing the following childhood risks:

1)      Poor lung growth and capacity;

2)      Brain damage and cognitive, developmental, and behavioral deficits;

3)      Respiratory symptoms including coughing, wheezing, and shortness of breath;

4)      Respiratory illnesses including bronchitis, pneumonia, and asthma.

Like her parents and grandparents already, as an adult she will accumulate the following additional risks:

1)      Lung diseases including chronic bronchitis and emphysema, as if she had smoked 2-4 packs of cigarettes per day.

2)      Whole-body chronic diseases, including a) infertility, b) diabetes, c) kidney disease, d) osteoporosis, e) cancer, and f) dementia.

She will suffer up to 6 productive life years lost, just due to air pollution-related disability. Ultimately, like an estimated 2.5 million people each year, she may die, simply from breathing dirty air.

We chose to leave New Delhi, in major part to protect our children from the air pollution. We may not live in India anymore, but we still need to support what is truly a fight for clean air in northern India.

The first step is to acknowledge the magnitude and seriousness of India’s air pollution crisis. Indian leaders must communicate across languages, literacy levels, and media access points, to ensure that all northern Indian residents and visitors understand air pollution levels, facts, and risks in their localities, every day.

(Gita Sinha, MD MPH, is a physician specialist in internal medicine and infectious diseases. She collaborates with partners in northern India to design and lead capacity-building and education projects in clinical medicine and public health. She was born and raised in the U.S. She received her MD from Stanford University, Internal Medicine residency at Brigham and Women’s Hospital/Harvard Medical School, and Infectious Diseases fellowship and MPH from Johns Hopkins University School of Medicine, where she is an adjunct assistant professor in Medicine/Infectious Diseases. She has worked and lived in New Delhi, Toronto, and the United States.)

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