Introduction

Pollution is defined as the introduction into the environment

of substances harmful to humans and other living organisms.
Pollutants are harmful solids, liquids, or gases produced in
higher than usual concentrations that reduce the quality of our
environment. Without a doubt, all of the aforementioned are
closely associated with climate change, and in the event of
danger, the consequences can be severe for mankind (2).
Climate changes and the effects of global planetary warming
seriously affect multiple ecosystems, causing problems such
as food safety issues, ice and iceberg melting, animal
extinction, and damage to plants (3, 4).

Human activities have an adverse effect on the environment

by polluting the water we drink, the air we breathe, and the
soil in which plants grow. Although the industrial revolution
was a great success in terms of technology, society, and the
provision of multiple services, it also introduced the
production of huge quantities of pollutants emitted into the air
that are harmful to human health. Without any doubt, the
global environmental pollution is considered an international
public health issue with multiple facets. Social, economic, and
legislative concerns and lifestyle habits are related to this
major problem. Clearly, urbanization and industrialization are
reaching unprecedented and upsetting proportions worldwide
in our era. Anthropogenic air pollution is one of the biggest
public health hazards worldwide, given that it accounts for
about 9 million deaths per year (1).

The air we breathe in is a precious commodity of life. We can

refuse to consume adulterated and polluted water and food for
a reasonable period of time, until we get the wholesome one.
However, when air is concerned we can’t afford to stop
breathing even for a minute, although we may know it to be
polluted. The quality of air we breathe, in is an important
element in the protection and promotion of our health. There
certainly exists a close relation between poor air and poor
health, as pollution of air results in breathing difficulties,
increased incidence of Asthma, Cancer and even death. Heavy
industrialization and increased transportation has polluted the
atmospheric air to such an extent that it is slowly loosing it’s
self cleaning capacity. Deteriorating air quality is posing
serious threats, of changing, even the composition of
atmosphere. Air is an invisible substance surrounding the
Earth and providing us all with the breathable oxygen and
performs a vital role in supporting life on Earth. But with the
passage of time the fresh and pure air is gradually getting
contaminated due to increase in air pollution. Air pollution is
the presence of one or more substance at a concentration
above their natural levels, with the potential to produce an
adverse effect.

Air pollution exposure is recognized as an important

contributor to premature mortality and morbidity globally.
Exposure to ambient particulate matter smaller than 2.5
microns in aerodynamic diameter (PM2.5) has been
associated with all-cause and non-accidental mortality,
cardiovascular and respiratory diseases, premature births and
birth defects, and neurocognitive deficits, among other
conditions. India is home to some of the most polluted cities
on the planet, the chief among them being Delhi. Ambient air
pollution (PM2.5) levels in Delhi routinely exceed World
Health Organization (WHO) guidelines and Indian National
Ambient Air Quality Standards (NAAQS) for safe levels of
daily exposure,contributing to a large and preventable burden
of diseases. While air quality has worsened in Delhi over the
last two decades, action to reduce emissions from polluting
sources has been scarce at best.

Global evidence indicates that ambient air pollution is a

major public health hazard, with harmful associations being
reported with respect to all-cause mortality (Di et al., 2017;
Samet et al., 2000; Zanobetti & Schwartz, 2009), cause-
specific mortality from cardiovascular (Dehbi et al., 2017;
Yap et al., 2019) and respiratory diseases (Mokoena et al.,
2019; Xue et al., 2018).
Globally, air pollution is a major environmental and health
crisis, contributing to millions of premature deaths annually
and significantly impacting human health and the
environment. Almost all of the global population (99%) is
exposed to air pollution levels exceeding WHO guidelines,
with the highest exposures in low- and middle-income
countries. Rising urbanisation, booming industrialisation, and
associated anthropogenic activities are the prime reasons that
lead to air pollutant emissions and poor air quality. It is
expected that by 2030, around 50% of the global population
will be residing in urban areas (Gurjar, Butler, Lawrence, et
al. 2008). More than 80% of population in urban areas is
exposed to emissions that exceed the standards set by World
Health Organization (WHO 2016). Air pollution is one of the
key global health and environmental concerns (Nagpure,
Gurjar, Kumar, et al. 2016) and has been ranked among the
top five global risk factors of mortality by the Health Effects
Institute (HEI 2019). According to HEI's report, particulate
matter (PM) pollution was considered the third important
cause of death in 2017 and this rate was found to be highest in
India. Air pollution was considered to cause over 1.1 million
premature deaths in 2017 in India (HEI 2019), of which 56%
was due to exposure to outdoor PM2.5 concentration and 44%
was attributed to household air pollution. As per WHO
(2016), one death out of nine in 2012 was attributed to air
pollution, of which around three million deaths were solely
due to outdoor air pollution.
The rising trends in population growth and the consequent
effects on air quality are evident in the Indian scenario. For
example, the megacities of Delhi, Mumbai, and Kolkata
combined holds a population exceeding 46 million (Gurjar,
Ravindra, and Nagpure 2016). Over the years, there has been
a massive-scale expansion in industries, population density,
anthropogenic activities, and the increased use of automobiles
has degraded the air quality in India (Gurjar and Lelieveld
2005). In the last few decades, the greenhouse gas (GHG)
emissions and other emissions resulting from anthropogenic
activities have increased drastically (Gurjar and Nagpure
2016).
As per WHO (2016) estimates, 10 out of the 20 most
populated cities in the world are in India. Based on the
concentrations of PM2.5 emissions, India was ranked the fifth
most polluted country by WHO (2019), in which 21 among
the top 30 polluted cities were in India. The Indian cities, on
average, exceeded the WHO threshold by an alarming 500%.
The consistent population growth has led to an excessive
strain on the energy consumption, thereby affecting the
environment and the air quality of the megacities (Gurjar and
Nagpure 2016). Kumar, Khare, Harrison, et al. (2015)
calculated the increase in the total energy demand for both
mobile and point sources and inferred that in Delhi, the
energy demand had grown by 57.16% from 2001 to 230,222
TJ in 2011. A subsequent rise in energy consumption can be
expected in the coming years, with no reliable sources
available for monitoring the rate of energy consumption.
The continuous degradation of ambient air quality in the
urban centres of India demands effective measures to curb air
pollution. Though various policy measures are being
introduced by the Government of India (GoI) to reduce the
vehicular and industrial emissions, the extent to which these
measures are implemented is questionable. The lack of
infrastructural facilities, inadequacy of financial resources to
implement advanced infrastructural innovations, difficulty in
relocation of the industries from the urban centres even after
mandatory court decisions, and above all, the behavioural
patterns among people in accepting the green solutions are
some of the crucial impediments on the road to environmental
protection that our country seems to be struggling to
overcome today.
Particulate Matter (PM) and Health

Studies have shown a relationship between particulate matter

(PM) and adverse health effects, focusing on either short-term
(acute) or long-term (chronic) PM exposure.

Particulate matter (PM) is usually formed in the atmosphere

as a result of chemical reactions between the different
pollutants. The penetration of particles is closely dependent on
their size (53). Particulate Matter (PM) was defined as a term
for particles by the United States Environmental Protection
Agency (54). Particulate matter (PM) pollution includes
particles with diameters of 10 micrometers (μm) or smaller,
called PM10, and extremely fine particles with diameters that
are generally 2.5 micrometers (μm) and smaller.

Particulate matter contains tiny liquid or solid droplets that

can be inhaled and cause serious health effects (55). Particles
<10 μm in diameter (PM10) after inhalation can invade the
lungs and even reach the bloodstream. Fine particles, PM2.5,
pose a greater risk to health
Particulate Matter (PM) is divided into four main categories
according to type and size Gas contaminants include PM in
aerial masses.
Particulate contaminants include contaminants such as smog,
soot, tobacco smoke, oil smoke, fly ash, and cement dust.

Biological Contaminants are microorganisms (bacteria,

viruses, fungi, mold, and bacterial spores), cat allergens,
house dust and allergens, and pollen.

Types of Dust include suspended atmospheric dust, settling

dust, and heavy dust.

Finally, another fact is that the half-lives of PM10 and PM2.5

particles in the atmosphere is extended due to their tiny
dimensions; this permits their long-lasting suspension in the
atmosphere and even their transfer and spread to distant
destinations where people and the environment may be
exposed to the same magnitude of pollution (53). They are
able to change the nutrient balance in watery ecosystems,
damage forests and crops, and acidify water bodies.

As stated, PM2.5, due to their tiny size, are causing more

serious health effects. These aforementioned fine particles are
the main cause of the “haze” formation in different
metropolitan areas (12, 13, 61).

Ozone Impact in the Atmosphere

Ozone (O3) is a gas formed from oxygen under high voltage
electric discharge (62). It is a strong oxidant, 52% stronger
than chlorine. It arises in the stratosphere, but it could also
arise following chain reactions of photochemical smog in the
troposphere (63).

Ozone can travel to distant areas from its initial source,

moving with air masses (64). It is surprising that ozone levels
over cities are low in contrast to the increased amounts
occuring in urban areas, which could become harmful for
cultures, forests, and vegetation (65) as it is reducing carbon
assimilation (66). Ozone reduces growth and yield (47, 48)
and affects the plant microflora due to its antimicrobial
capacity (67, 68). In this regard, ozone acts upon other natural
ecosystems, with microflora (69, 70) and animal species
changing their species composition (71). Ozone increases
DNA damage in epidermal keratinocytes and leads to
impaired cellular function (72).

Ground-level ozone (GLO) is generated through a chemical

reaction between oxides of nitrogen and VOCs emitted from
natural sources and/or following anthropogenic activities.

Ozone uptake usually occurs by inhalation. Ozone affects the

upper layers of the skin and the tear ducts (73). A study of
short-term exposure of mice to high levels of ozone showed
malondialdehyde formation in the upper skin (epidermis) but
also depletion in vitamins C and E. It is likely that ozone
levels are not interfering with the skin barrier function and
integrity to predispose to skin disease (74).

Due to the low water-solubility of ozone, inhaled ozone has

the capacity to penetrate deeply into the lungs (75).

Toxic effects induced by ozone are registered in urban areas

all over the world, causing biochemical, morphologic,
functional, and immunological disorders (76).

The European project (APHEA2) focuses on the acute effects

of ambient ozone concentrations on mortality (77). Daily
ozone concentrations compared to the daily number of deaths
were reported from different European cities for a 3-year
period. During the warm period of the year, an observed
increase in ozone concentration was associated with an
increase in the daily number of deaths (0.33%), in the number
of respiratory deaths (1.13%), and in the number of
cardiovascular deaths (0.45%). No effect was observed during
wintertime.

Carbon Monoxide (CO)

Carbon monoxide is produced by fossil fuel when combustion
is incomplete. The symptoms of poisoning due to inhaling
carbon monoxide include headache, dizziness, weakness,
nausea, vomiting, and, finally, loss of consciousness.

The affinity of carbon monoxide to hemoglobin is much

greater than that of oxygen. In this vein, serious poisoning
may occur in people exposed to high levels of carbon
monoxide for a long period of time. Due to the loss of oxygen
as a result of the competitive binding of carbon monoxide,
hypoxia, ischemia, and cardiovascular disease are observed.

Carbon monoxide affects the greenhouses gases that are

tightly connected to global warming and climate. This should
lead to an increase in soil and water temperatures, and
extreme weather conditions or storms may occur (68).

However, in laboratory and field experiments, it has been seen

to produce increased plant growth (78).

Nitrogen Oxide (NO2)

Nitrogen oxide is a traffic-related pollutant, as it is emitted
from automobile motor engines (79, 80). It is an irritant of the
respiratory system as it penetrates deep in the lung, inducing
respiratory diseases, coughing, wheezing, dyspnea,
bronchospasm, and even pulmonary edema when inhaled at
high levels. It seems that concentrations over 0.2 ppm produce
these adverse effects in humans, while concentrations higher
than 2.0 ppm affect T-lymphocytes, particularly the CD8+
cells and NK cells that produce our immune response (81).It
is reported that long-term exposure to high levels of nitrogen
dioxide can be responsible for chronic lung disease. Long-
term exposure to NO2 can impair the sense of smell (81).

However, systems other than respiratory ones can be involved,

as symptoms such as eye, throat, and nose irritation have been
registered (81).

High levels of nitrogen dioxide are deleterious to crops and

vegetation, as they have been observed to reduce crop yield
and plant growth efficiency. Moreover, NO2 can reduce
visibility and discolor fabrics (81).

Sulfur Dioxide (SO2)

Sulfur dioxide is a harmful gas that is emitted mainly from
fossil fuel consumption or industrial activities. The annual
standard for SO2 is 0.03 ppm (82). It affects human, animal,
and plant life. Susceptible people as those with lung disease,
old people, and children, who present a higher risk of damage.
The major health problems associated with sulfur dioxide
emissions in industrialized areas are respiratory irritation,
bronchitis, mucus production, and bronchospasm, as it is a
sensory irritant and penetrates deep into the lung converted
into bisulfite and interacting with sensory receptors, causing
bronchoconstriction. Moreover, skin redness, damage to the
eyes (lacrimation and corneal opacity) and mucous
membranes, and worsening of pre-existing cardiovascular
disease have been observed (81).

Environmental adverse effects, such as acidification of soil

and acid rain, seem to be associated with sulfur dioxide
emissions (83).

Lead
Lead is a heavy metal used in different industrial plants and
emitted from some petrol motor engines, batteries, radiators,
waste incinerators, and waste waters (84).

Moreover, major sources of lead pollution in the air are

metals, ore, and piston-engine aircraft. Lead poisoning is a
threat to public health due to its deleterious effects upon
humans, animals, and the environment, especially in the
developing countries.

Exposure to lead can occur through inhalation, ingestion, and

dermal absorption. Trans- placental transport of lead was also
reported, as lead passes through the placenta unencumbered
(85). The younger the fetus is, the more harmful the toxic
effects. Lead toxicity affects the fetal nervous system; edema
or swelling of the brain is observed (86). Lead, when inhaled,
accumulates in the blood, soft tissue, liver, lung, bones, and
cardiovascular, nervous, and reproductive systems. Moreover,
loss of concentration and memory, as well as muscle and joint
pain, were observed in adults (85, 86).

Children and newborns (87) are extremely susceptible even to

minimal doses of lead, as it is a neurotoxicant and causes
learning disabilities, impairment of memory, hyperactivity,
and even mental retardation.

Elevated amounts of lead in the environment are harmful to

plants and crop growth. Neurological effects are observed in
vertebrates and animals in association with high lead levels
(88).

Polycyclic Aromatic Hydrocarbons(PAHs)

The distribution of PAHs is ubiquitous in the environment, as
the atmosphere is the most important means of their dispersal.
They are found in coal and in tar sediments. Moreover, they
are generated through incomplete combustion of organic
matter as in the cases of forest fires, incineration, and engines
(89). PAH compounds, such as benzopyrene, acenaphthylene,
anthracene, and fluoranthene are recognized as toxic,
mutagenic, and carcinogenic substances. They are an
important risk factor for lung cancer (89).

Volatile Organic Compounds(VOCs)

Volatile organic compounds (VOCs), such as toluene,
benzene, ethylbenzene, and xylene (90), have been found to
be associated with cancer in humans (91). The use of new
products and materials has actually resulted in increased
concentrations of VOCs. VOCs pollute indoor air (90) and
may have adverse effects on human health (91). Short-term
and long-term adverse effects on human health are observed.
VOCs are responsible for indoor air smells. Short-term
exposure is found to cause irritation of eyes, nose, throat, and
mucosal membranes, while those of long duration exposure
include toxic reactions (92). Predictable assessment of the
toxic effects of complex VOC mixtures is difficult to estimate,
as these pollutants can have synergic, antagonistic, or
indifferent effects (91, 93).

Dioxins
Dioxins originate from industrial processes but also come
from natural processes, such as forest fires and volcanic
eruptions. They accumulate in foods such as meat and dairy
products, fish and shellfish, and especially in the fatty tissue
of animals (94).

Short-period exhibition to high dioxin concentrations may

result in dark spots and lesions on the skin (94). Long-term
exposure to dioxins can cause developmental problems,
impairment of the immune, endocrine and nervous systems,
reproductive infertility, and cancer (94).
Without any doubt, fossil fuel consumption is responsible for
a sizeable part of air contamination. This contamination may
be anthropogenic, as in agricultural and industrial processes or
transportation, while contamination from natural sources is
also possible. Interestingly, it is of note that the air quality
standards established through the European Air Quality
Directive are somewhat looser than the WHO guidelines,
which are stricter (95).
Effect of Air Pollution on Health
The most common air pollutants are ground-level ozone and
Particulates Matter (PM). Air pollution is distinguished into
two main types:

Outdoor pollution is the ambient air pollution.

Indoor pollution is the pollution generated by household

combustion of fuels.

People exposed to high concentrations of air pollutants

experience disease symptoms and states of greater and lesser
seriousness. These effects are grouped into short- and long-
term effects affecting health.
Susceptible populations that need to be aware of health
protection measures include old people, children, and people
with diabetes and predisposing heart or lung disease,
especially asthma.

As extensively stated previously, according to a recent

epidemiological study from Harvard School of Public Health,
the relative magnitudes of the short- and long-term effects
have not been completely clarified (57) due to the different
epidemiological methodologies and to the exposure errors.
New models are proposed for assessing short- and long-term
human exposure data more successfully (57). Thus, in the
present section, we report the more common short- and long-
term health effects but also general concerns for both types of
effects, as these effects are often dependent on environmental
conditions, dose, and individual susceptibility.

Short-term effects are temporary and range from simple

discomfort, such as irritation of the eyes, nose, skin, throat,
wheezing, coughing and chest tightness, and breathing
difficulties, to more serious states, such as asthma,
pneumonia, bronchitis, and lung and heart problems. Short-
term exposure to air pollution can also cause headaches,
nausea, and dizziness.

These problems can be aggravated by extended long-term

exposure to the pollutants, which is harmful to the
neurological, reproductive, and respiratory systems and causes
cancer and even, rarely, deaths.

The long-term effects are chronic, lasting for years or the

whole life and can even lead to death. Furthermore, the
toxicity of several air pollutants may also induce a variety of
cancers in the long term (96).

As stated already, respiratory disorders are closely associated

with the inhalation of air pollutants. These pollutants will
invade through the airways and will accumulate at the cells.
Damage to target cells should be related to the pollutant
component involved and its source and dose. Health effects
are also closely dependent on country, area, season, and time.
An extended exposure duration to the pollutant should incline
to long-term health effects in relation also to the above
factors.

Particulate Matter (PMs), dust, benzene, and O3 cause serious

damage to the respiratory system (97). Moreover, there is a
supplementary risk in case of existing respiratory disease such
as asthma (98). Long-term effects are more frequent in people
with a predisposing disease state. When the trachea is
contaminated by pollutants, voice alterations may be
remarked after acute exposure. Chronic obstructive
pulmonary disease (COPD) may be induced following air
pollution, increasing morbidity and mortality (99). Long-term
effects from traffic, industrial air pollution, and combustion of
fuels are the major factors for COPD risk (99).

Multiple cardiovascular effects have been observed after

exposure to air pollutants (100). Changes occurred in blood
cells after long-term exposure may affect cardiac
functionality. Coronary arteriosclerosis was reported
following long-term exposure to traffic emissions (101), while
short-term exposure is related to hypertension, stroke,
myocardial infracts, and heart insufficiency. Ventricle
hypertrophy is reported to occur in humans after long-time
exposure to nitrogen oxide (NO2) (102, 103).

Neurological effects have been observed in adults and

children after extended-term exposure to air pollutants.

Psychological problems relate dto AQI

Psychological complications, autism, retinopathy, fetal

growth, and low birth weight seem to be related to long-term
air pollution (83). The etiologic agent of the
neurodegenerative diseases (Alzheimer's and Parkinson's) is
not yet known, although it is believed that extended exposure
to air pollution seems to be a factor. Specifically, pesticides
and metals are cited as etiological factors, together with diet.
The mechanisms in the development of neurodegenerative
disease include oxidative stress, protein aggregation,
inflammation, and mitochondrial impairment in neurons (104)

Health Impacts:
A Air pollution has various health effects. The health of
susceptible and sensitive individuals can be impacted even on
low air pollution days. Short-term exposure to air pollutants is
closely related to COPD (Chronic Obstructive Pulmonary
Disease), cough, shortness of breath, wheezing, asthma,
respiratory disease, and high rates of hospitalization (a
measurement of morbidity).

The long-term effects associated with air pollution are chronic

asthma, pulmonary insufficiency, cardiovascular diseases, and
cardiovascular mortality. According to a Swedish cohort
study, diabetes seems to be induced after long-term air
pollution exposure (5). Moreover, air pollution seems to have
various malign health effects in early human life, such as
respiratory, cardiovascular, mental, and perinatal disorders (3),
leading to infant mortality or chronic disease in adult age (6).
National reports have mentioned the increased risk of
morbidity and mortality (1). These studies were conducted in
many places around the world and show a correlation between
daily ranges of particulate matter (PM) concentration and
daily mortality. Climate shifts and global planetary warming
(3) could aggravate the situation. Besides, increased
hospitalization (an index of morbidity) has been registered
among the elderly and susceptible individuals for specific
reasons. Fine and ultrafine particulate matter seems to be
associated with more serious illnesses (6), as it can invade the
deepest parts of the airways and more easily reach the
bloodstream.

Air pollution mainly affects those living in large urban areas,

where road emissions contribute the most to the degradation
of air quality. There is also a danger of industrial accidents,
where the spread of a toxic fog can be fatal to the populations
of the surrounding areas. The dispersion of pollutants is
determined by many parameters, most notably atmospheric
stability and wind (6).

In developing countries (7), the problem is more serious due

to overpopulation and uncontrolled urbanization along with
the development of industrialization. This leads to poor air
quality, especially in countries with social disparities and a
lack of information on sustainable management of the
environment. The use of fuels such as wood fuel or solid fuel
for domestic needs due to low incomes exposes people to bad-
quality, polluted air at home. It is of note that three billion
people around the world are using the above sources of energy
for their daily heating and cooking needs (8). In developing
countries, the women of the household seem to carry the
highest risk for disease development due to their longer
duration exposure to the indoor air pollution (8, 9). Due to its
fast industrial development and overpopulation, China is one
of the Asian countries confronting serious air pollution
problems (10, 11). The lung cancer mortality observed in
China is associated with fine particles (12). As stated already,
long-term exposure is associated with deleterious effects on
the cardiovascular system (3, 5). However, it is interesting to
note that cardiovascular diseases have mostly been observed
in developed and high-income countries rather than in the
developing low-income countries exposed highly to air
pollution (13). Extreme air pollution is recorded in India,
where the air quality reaches hazardous levels. New Delhi is
one of the more polluted cities in India. Flights in and out of
New Delhi International Airport are often canceled due to the
reduced visibility associated with air pollution. Pollution is
occurring both in urban and rural areas in India due to the fast
industrialization, urbanization, and rise in use of motorcycle
transportation. Nevertheless, biomass combustion associated
with heating and cooking needs and practices is a major
source of household air pollution in India and in Nepal (14,
15). There is spatial heterogeneity in India, as areas with
diverse climatological conditions and population and
education levels generate different indoor air qualities, with
higher PM2.5 observed in North Indian states (557–601
μg/m3) compared to the Southern States (183–214 μg/m3)
(16, 17). The cold climate of the North Indian areas may be
the main reason for this, as longer periods at home and more
heating are necessary compared to in the tropical climate of
Southern India. Household air pollution in India is associated
with major health effects, especially in women and young
children, who stay indoors for longer periods. Chronic
obstructive respiratory disease (CORD) and lung cancer are
mostly observed in women, while acute lower respiratory
disease is seen in young children under 5 years of age (18).

Accumulation of air pollution, especially sulfur dioxide and

smoke, reaching 1,500 mg/m3, resulted in an increase in the
number of deaths (4,000 deaths) in December 1952 in London
and in 1963 in New York City (400 deaths) (19). An
association of pollution with mortality was reported on the
basis of monitoring of outdoor pollution in six US
metropolitan cities (20). In every case, it seems that mortality
was closely related to the levels of fine, inhalable, and sulfate
particles more than with the levels of total particulate
pollution, aerosol acidity, sulfur dioxide, or nitrogen dioxide
(20).

Furthermore, extremely high levels of pollution are reported

in Mexico City and Rio de Janeiro, followed by Milan,
Ankara, Melbourne, Tokyo, and Moscow (19).
air pollution is a leading cause of premature death, second
only to high blood pressure, with air pollution shortening
average lifespan by 1 year and 8 months.
In 2021, air pollution contributed to 8.1 million deaths
globally, with non-communicable diseases like heart disease,
stroke, and lung cancer accounting for nearly 90% of the
disease burden.
Ambient particulate matter air pollution was the leading Level
4 risk factor for DALYs (Disability-Adjusted Life Years)
among all environmental and occupational risks in 2021.
Over 700,000 deaths in children under 5 were linked to air
pollution in 2021, representing 15% of all global deaths in this
age group.
Air pollution shortens average life expectancy by 2.2 years
worldwide.

Outdoor air pollution is a major environmental health problem

affecting everyone in low-, middle-, and high-income
countries. Ambient (outdoor) air pollution in both cities and
rural areas was estimated to cause 4.2 million premature
deaths worldwide per year in 2019; this mortality is due to
exposure to fine particulate matter, which causes
cardiovascular and respiratory disease, and cancers.

WHO estimates that in 2019, some 68% of outdoor air

pollution related premature deaths were due to ischaemic
heart disease and stroke, 14% were due to chronic obstructive
pulmonary disease, 14% were due to acute lower respiratory
infections, and 4% of deaths were due to lung cancers. People
living in low- and middle-income countries disproportionately
experience the burden of outdoor air pollution with 89% (of
the 4.2 million premature deaths) occurring in these areas. The
greatest burden is found in the WHO South-East Asia and
Western Pacific Regions. The latest burden estimates reflect
the significant role air pollution plays in cardiovascular illness
and death.

Air pollution in India

Global evidence indicates that ambient air pollution is a major

public health hazard, with harmful associations being reported
with respect to all-cause mortality (Di et al., 2017; Samet et
al., 2000; Zanobetti & Schwartz, 2009), cause-specific
mortality from cardiovascular (Dehbi et al., 2017; Yap et al.,
2019) and respiratory diseases (Mokoena et al., 2019; Xue et
al., 2018).
Air pollution exposure is a major and growing risk factor for
ill health and premature death in India, with the 2017 sub-
national burden of disease estimates for India stating that over
670,000 premature deaths annually are attributable to ambient
PM2.5 exposures (particles smaller than 2.5 microns in size).
With a rapidly growing transport fleet, vast availability and
usage of highly polluting coal, and increasing migration to
major urban centres, India is home to 21 of the 30 most
polluted cities globally (World Health Organization, 2014).
Additionally, the wide prevalence and continued use of solid
fuels for cooking and heating in many parts of rural and peri-
urban India, contributes not only to high levels of household
air pollution exposure, but also to the ambient air pollution
loading (Balakrishnan et al., 2019; Krishna et al., 2017).
While large parts of India currently experience air pollution
(specifically PM2.5) beyond levels considered safe for daily
and annual exposure by the WHO (10 and 25 µg/m3
respectively), Delhi has received particular media and policy
attention over the years (World Health Organization, 2014)
given its special status as the capital of the nation. A variety of
point (e.g., power plants, industry), line (e.g., traffic
emissions), and diffused sources (e.g., construction dust, trash
burning) contribute to a large and mixed particulate matter
load in the city, differing often by season. This mixed load
also ensures that action to curb any one source alone is
insignificant in reducing overall exposures. As a result, annual
average exposures to PM2.5 in Delhi exceeded 130 µg/m3 in
2016, having grown steadily over the previous 7 years, with
large spatial and temporal variations (Mandal et al., 2020).
Seasonal factors, high emissions
related to fireworks combustion during religious events and
periodic crop-stubble burning also contribute to extremes of
PM2.5 in the winter which can sometimes breach
1000µg/m3(McCall, 2019).
Over the years, a growing and significant body of work has
documented the health effects of exposure to PM2.5 both in
household and ambient settings, with a focus more on chronic
longer-term exposures (Balakrishnan, Krishna, et al., 2015).
High levels of PM exposures in the short (Cropper et al.,
1997; Maji et al., 2017; Rajarathnam et al., 2011) and long-
term have been shown to have health effects in India as well,
with PM exposure a key risk factor for the burden of disease
in the country (Balakrishnan et al., 2019; Krishna et al.,
2017). However, there is limited evidence on the short-term
effects of PM2.5 on mortality and morbidity in India, with
only one time-series study conducted till date anywhere in the
country documenting the effect on daily mortality (Gordon et
al., 2018; Singh et al., 2019).This lack of evidence of the
short-term impact, and more importantly the impact on
mortality, is cited regularly by policymakers as a reason for
inaction. While air pollution impacts human health in very
similar ways across different parts of the world, the need for
local evidence that is grounded in measured and not modelled
data remains salient, especially in alleviating concerns
(legitimate or otherwise) of those in policymaking circles.
Policy change on air pollution has also been stymied as a
result of push-back from policymakers for a variety of
reasons, and has not been helped by poorly designed studies,
the results of which have often been miscommunicated to the
public by the media.
Driving effective policy change on air pollution will require a
considered approach that fills in the knowledge gaps in
epidemiological evidence and buttresses that with an effective
framework for translation and communication to all relevant
stakeholders. Through this project I aimed to do both of those
things by first studying the effect of shortterm exposures to
PM2.5 on daily mortality in Delhi. I then aimed to translate
and communicate the findings of my work directly with
relevant stakeholders through appropriate fora and means
sequentially. This work has direct implications on the policy
direction that environmental regulators need to take moving
forward, and to that end, effective communication can ensure
that the right messages get through.

Globally, air pollution is a silent killer. The air pollution levels

in India are among the highest in the world, posing a heavy
threat to the country's health and economy. All of India’s 1.4
billion people are exposed to unhealthy levels of ambient PM
2.5 – the most harmful pollutant - emanating from multiple
sources. These small particulates with a diameter of less than
2.5 microns, is about one-thirtieth the width of a human hair.
Exposure to PM 2.5 can cause such deadly illnesses as lung
cancer, stroke, and heart disease. 1.67 million deaths were
attributable to air pollution in India in 2019, accounting for
17.8% of the total deaths in the country. The health impacts of
pollution also represent a heavy cost to the economy. Lost
output from premature deaths and morbidity attributable to air
pollution accounted for economic losses of US$28.8 billion
and $8 billion, respectively, in India in 2019. This total loss of
$36.8 billion was 1.36% of India's gross domestic product
(GDP).
PM 2.5 comes from a variety of sources. Some of the most
common sources include emissions from burning fossil fuels
such as coal or oil and biomass such as wood, charcoal, or
crop residues. PM 2.5 can also come from windblown dust,
including natural dust as well as dust from construction sites,
roads, and industrial plants.

Over half of PM 2.5 emissions in India are formed in

“secondary” way in the upper atmosphere when different
types of gaseous pollutants from one area such as ammonia
(NH3), mix with other gaseous pollutants like sulfur dioxide
(SO2), and nitrogen oxides (NOx) from another place.
Agriculture, industry, power plants, households, and transport
all contribute significantly to the formation of secondary PM
2.5. This secondary form spreads farther and wider than
primary PM2.5 and travels across states, cities, and crosses
jurisdictional borders.

The air pollution challenge in India is therefore inherently

multi-sectoral and multi-jurisdictional, requiring an “airshed”
approach. An airshed can be defined as a region that shares a
common flow of air, which may become uniformly polluted
and stagnant. Air quality within an airshed will largely depend
on pollution sources within it. Because the formation of
secondary particles and the transporting of primary and
secondary particles take place over large geographic areas,
airsheds can extend over several hundred kilometers, well
beyond the boundaries of cities. India, therefore, needs to look
beyond its cities and take action at the sub-national level for
effective air pollution control strategies and apply new set of
tools for airshed-based management. Standardizing tools
across India is important so control strategies and relevant
data sets can be linked.
One of our era's greatest scourges is air pollution, on account
not only of its impact on climate change but also its impact on
public and individual health due to increasing morbidity and
mortality. There are many pollutants that are major factors in
disease in humans. Among them, Particulate Matter (PM),
particles of variable but very small diameter, penetrate the
respiratory system via inhalation, causing respiratory and
cardiovascular diseases, reproductive and central nervous
system dysfunctions, and cancer. Despite the fact that ozone
in the stratosphere plays a protective role against ultraviolet
irradiation, it is harmful when in high concentration at ground
level, also affecting the respiratory and cardiovascular system.
Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic
Compounds (VOCs), dioxins, and polycyclic aromatic
hydrocarbons (PAHs) are all considered air pollutants that are
harmful to humans. Carbon monoxide can even provoke
direct poisoning when breathed in at high levels. Heavy
metals such as lead, when absorbed into the human body, can
lead to direct poisoning or chronic intoxication, depending on
exposure. Diseases occurring from the aforementioned
substances include principally respiratory problems such as
Chronic Obstructive Pulmonary Disease (COPD), asthma,
bronchiolitis, and also lung cancer, cardiovascular events,
central nervous system dysfunctions, and cutaneous diseases.
Last but not least, climate change resulting from
environmental pollution affects the geographical distribution
of many infectious diseases, as do natural disasters. The only
way to tackle this problem is through public awareness
coupled with a multidisciplinary approach by scientific
experts; national and international organizations must address
the emergence of this threat and propose sustainable solutions.
Air pollution in Delhi
Delhi’s air has recently become a focal point of public
discourse in which the city’s present is being debated with the
tropes of its status as the most polluted city in the world, its
inhabitants as living in prognosis, overcrowding and
congestion, and a ‘cocktail of causes’. Based on these, the
city’s future is being negotiated by different actors to provide
different prescriptions- the current state government has
responded by introducing the odd-even car rationing policy to
reduce vehicular pollution (said to be the most offending),
restriction on no. of trucks plying inside the city, and a future
scheme to vacuum Delhi’s streets; the national government
has set multiple air quality monitoring systems and indices
(most recent being the National Air Quality Index); the
judiciary and the civil society has been instrumental in
charting this discourse in popular media . Moreover,
conversations on air purifiers (both technological and natural),
and air purifying masks as personal interventions are also
present. However, Delhi’s Air was also contested in urban
politics in the 1990s, with an activist judiciary which led to
closure and relocation of polluting industries outside Delhi,
adoption of Euro emission standards, and conversion of all
autorickshaws into CNG-actions criticized in academic
literature and social activists as ‘middle-class
environmentalism’(Baviskar, 2003) According to World
Population Review, Delhi, the National Capital Territory
(NCT) of India, is the densely populated metropolitan city
with a large influx of population from other states of India. As
per the last Census carried out in 2011, population of Delhi
was 16.7 million [2] and estimated 2016 population of 18.6
million. In recent years, rapid industrialisation and
urbanisation posed detrimental effect on environment.
Problem of air pollution is increasingly getting more serious.
Increasing levels of pollutants in air is causing extreme health
disorder. It directly affects a population of millions who are
suffering from shortness of breath, eye irritation to chronic
respiratory disorders, pneumonia, acute asthma etc [3] [4].
Causes of Air Pollution
Some major causes of air pollution are discussed below.
Industrial exhaust
Emission of harmful gases such as SO2 and NOx from
thermal power plants of Rajghat, Badarpur, Indraprastha and
other industrial regions adds to the major pollutants of the
Delhi air pollution.
Vehicular emission
Traffic congestion and vehicular emission contributes majorly
to degrading the Delhi air quality. The data accessed from the
transport department of Delhi government up to 31-Dec 2016
puts the total number of registered vehicles to 1, 01,06,791.
The largest number of the registered vehicles in thecity are
motor cycles and scooters , numbering 63,40,136 . These are
considered to be major contributors towards air pollution [2].
Agricultural stubble burning in Punjab and Haryana .Farmers
of Punjab and Haryana burning their ricecrop stubble to
quickly prepare their field for rabi crop wheat [5].
Construction and demolition
Continuous construction and demolition contributing to
increased level of dust-borne particulate matters in the air and
are, therefore, considered hazardous
Other factors
Some factors that may indirectly involve in worsening air
quality are over -population, road dust, diwali cracker smoke
etc.

Type of pollutants in ambient air

The major concentration of pollutants in the Delhi air is:-
1. Particulate Matter, RSPM and SPM (PM2.5 and PM10):
The principle source of particulate matter in Delhi is
vehicular emissions, particularly from heavy motor diesel
vehicle, kerb-side dust, thermal power plants, industrial
and residential combustion processes. Respirable suspended
particulate matter (PM2.5) is considered to be more
hazardous to human health than PM10. The average limit of
PM2.5 pollution is 60 microgram per cubic meter but
all the areas of Delhi have the level of PM 2.5 exceeding 300
microgram per cubic meter [7].
2. Nitrogen Oxide (NOx): Oxides of Nitrogen are produced
during industrial combustion processes and primarily as
vehicular exhaust. NOx levels are highest in urban areas as it
is related to traffic. It is an important ingredient in
generation of photochemical smog which envelops the urban
air with haze like blanket. It has harmful effects such
as wide-range of respiratory problems in adults and children.
3. Sulphur Dioxide (SO2): It is formed mostly by burning of
fossil fuels particularly from thermal power plant. This
Nidhi Sharma et al. / Procedia Computer Science 132 (2018)
1077–10851079
Nidhi Sharma et al. / Procedia Computer Science 00 (2018)
000–000 3
pollutant is the reason for acid rain and has adverse effects on
lung functions.
4. Benzene: The main sources of benzene are from vehicle
exhaust and other industrial processes since it is an
industrial solvent. Benzene is a component of crude oil and
petrol. Apart from vehicle exhaust, evaporation from
petrol filling stations can raise benzene levels [7].
5. Ozone (O3): Formed by chemical reaction of volatile
organic compounds and nitrogen dioxide in the presence of
sunlight, so level of ozone is generally higher in the summer.
Ground level ozone also contributes in formation of
photochemical smog.
6. Toluene: Toluene is another industrial volatile solvent
whose short term exposure causes irritation of eyes and
the respiratory tract. The substance is a known carcinogen and
affects the central nervous system also.
7. Carbon Monoxide (CO): CO is a toxic air pollutant which
is produced by incomplete combustion of carbon-
containing fuels. Vehicle deceleration and idling vehicle
engines are one of its main causes.

1.3. Study Area

Delhi has been considered for the study whose geographical
regions are shown in figure 1. Delhi is one of the mostpolluted
cities in the world according to World Health Organization
(WHO) 2016 [8]. The level of the airborne particulate matter-
PM2.5 is very high in Delhi. Also, PM 10 levels is the highest
among the 11 mega cities of the world having more than 14
million habitants (2011 to 2015). PM is considered to be the
most harmful pollutants tohealth [8].
There are 20 air monitoring stations at present in Delhi
located at different locations. Different areas of Delhi
havebeen selected for the study: Anand Vihar, Shadipur, DTU,
Dwarka. As a representative sample, Anand Vihar(AV) and
Shadipur, due to their high population density and heavy
vehicular movement are represented and shown in the
results.
 Fig.1. Map of
Delhi [9]
2. Related Work
India’s scenario of air pollution

A study in the Lancet Planet Health journal shows that, in

2019, an estimated 1.67 million deaths in India were
attributable to pollution, and one out of 10 deaths were caused
by ambient particulate matter (PM) pollution. The study
categorises the deaths attributable to ambient PM, household,
and ambient ozone pollution.
Globally, air pollution poses significant challenges, with over
seven million deaths attributed to it annually1 . Its effects are
particularly severe in low- and middleincome countries like
India. Air quality in India, both ambient and household, is
significantly influenced by geographical variability and
seasonal weather patterns. Key pollutants such as particulate
matter (PM), oxides of nitrogen (NOx ), ammonia (NH3 ),
sulphur dioxide (SO2 ), and non-methane volatile organic
compounds (NMVOCs) are predominantly emitted from
transport, industrial processes, farming, energy generation and
domestic fuel use for cooking and heating2-4. Alarmingly,
pollution levels in India are often much higher (overall annual
geographic mean of PM2.5 in India increased from 27 µg/m3
in 1998 to 44µg/m3 in 2022)5 than the World Health
Organization’s recommended levels6 , particularly during the
winter season in cities and harvesting periods in rural areas of
the northern Indian States. Rapid industrialization,
urbanization, climate change, crop burning, and and
population growth have further diversified and intensified
pollution sources. This editorial will briefly explore the
sources of air pollution in India, its effects on health and the
environment, government efforts to address it, technological
mitigation strategies, public awareness and engagement,
challenges faced, successful intervention case studies, and the
future outlook for tackling this critical issue.
Sources of air pollution in India
Air pollution sources in India vary widely across geographical
regions, including natural (pollen grains, desert dust, mineral
dust, etc.) and anthropogenic sources. Some of the primary
anthropogenic sources are: (i) Industrial emissions: many
factories and manufacturing units, such as cement factories
and brick kiln industries, release harmful atmospheric
pollutants, such as particulate matter (PM), sulphur dioxide
(SO2 ), and oxides of nitrogen (NOx ); (ii) Vehicular
emissions: Vehicles in India increased from 128 million to 326
million from 2010 to 20207 , and significantly contribute to
air pollution by exhausting fumes containing NOx , CO and
volatile organic compounds (VOCs); (iii) Agricultural
activities: Crop residue burning, in particular, releases large
amounts of toxic smoke into the air, leading to a phenomenon
known as crop burning pollution along with small rural
industries such as jaggery plants using unprocessed biomass
for energy; (iv) Domestic fuel: About 60 per cent of Indian
population use solid fuels for cooking and heating, and is a
primary source of household air pollution (HAP), particularly
in rural areas8 . Burning biomass fuels such as wood, dung,
and crop residues releases pollutants that not only impact
HAP but also contribute to outdoor pollution when emitted
into the atmosphere; (v) Indoor sources: Indoor Air Pollution
(IAP) poses significant health risk to individuals of all ages,
particularly young children, elderly and those with pre-
existing health conditions. In urban areas, people spend over
70 per cent of their time indoors, with an additional 20-30 per
cent spent in enclosed environments such as schools,
workplaces, shops, and transport. IAP comprises a wide range
of physical (e.g., damp), biological (allergens, mould, and
airborne respiratory pathogens), and chemical agents9 . Their
sources are varied and include water ingress, pets, building
materials, furniture and furnishings, smoking, paints,
varnishes, glues, cleaning products, air fresheners, deodorants,
perfumes, pesticides, fungicides, burning mosquito coils, and
candle or incense burning. The extent of IAP exposure largely
depends on structural factors like a building’s ventilation and
insulation, proximity to important sources of ambient air
pollution, such as busy roads or polluting industries,
crowding, and personal behaviours, including smoking, pet
ownership, and using various chemicals for cleaning.
EFFECTS OF AIR POLLUTION
The Global Burden of Diseases study estimates that air
pollution attributed to 1.67 million (0.98M from AAP and
0.6M from HAP) deaths in India in 2019, accounting for 17.8
per cent of total deathsin the country10. While the deaths due
to HAP decreased by 64 per cent from 2010 to 2020, deaths
attributed to Ambient Air Pollution (AAP) increased by 115
per cent10. Although specific mechanisms of harm are not
fully understood, substantial evidence indicates that even low-
level exposure to air pollution adversely affects cardiovascular
and respiratory health. Exposure during pregnancy and
childhood is linked to an increased risk of asthma and
impaired lung development, potentially leading to long-term
respiratory issues and lower life expectancy10,11. Children,
older people and individuals with preexisting multi-
morbidities such as cardiovascular or respiratory conditions
are also particularly vulnerable to the effects of air
pollution12. Daily exposure to PM has been associated with
increased hospitalization and mortality due to acute
exacerbations of heart disease, chronic obstructive pulmonary
disease (COPD), and asthma. Furthermore, data from high-
income countries shows that long-term exposure to air
pollution increases the risks of developing lung cancer, heart
disease, diabetes, stroke and dementia13. Beyond its health
impacts, air pollution has significant environmental
consequences and economic implications, particularly in
countries like India. With over 45 per cent of the population in
2022 engaged in agriculture14, the detrimental effects on
agricultural productivity are enormous. Air-borne pollutants
can cause acid rain and smog formation, damaging
ecosystems, including forests, water bodies and wildlife
habitats. The economic costs associated with air pollution are
substantial, including healthcare expenses, lost productivity
due to illness and damage to infrastructure and crops. Poor air
quality can discourage foreign investment and reduce tourism,
hindering a country’s overall economic development.
Challenges in addressing air pollution Combating air pollution
is a complex task requiring many stakeholders’ sincere and
coordinated efforts.
Challenges in addressing air pollution Combating

Air pollution is a complex task requiring many stakeholders’

sincere and coordinated efforts. Some challenges that hinder
air pollution control in India15 are: (i) Lack of enforcement:
Inadequate enforcement of environmental regulations, leading
to non-compliance by industries, vehicle owners, and other
polluting entities. India lacks stringent air pollution standards,
relying on country specific guidelines, which are way higher
than WHO recommended guidelines; (ii) Rapid urbanization:
urbanization in India has resulted in increased pollution levels
due to higher energy consumption, vehicular traffic, and
industrial activities concentrated in urban centres, posing a
significant challenge to air quality management; (iii) Socio-
economic factors: poverty, lack of access to clean energy
sources, and inadequate infrastructure in rural areas contribute
to the persistence of HAP and AAP in India, exacerbating the
air pollution problem15.
Government initiatives to combat air pollution

The scale of air pollution in many countries, including India,

is huge, requiring a collaborative effort from the government,
industries, civil societies, and the general public. The Indian
government has initiated several measures to combat and
reduce HAP and has developed some policies and regulations
that are likely beneficial if implemented. The Indian
government launched the National Clean Air Program
(NCAP) in 2019 to combat air pollution comprehensively. The
programme aimed to formulate a plan to reduce PM
concentrations by 20-30 per cent by 2024 through source
apportionment studies in 102 cities nationwide16. The
Government of India has formulated various policies and
regulations to control air pollution, including emission
standards for industries and vehicles, restrictions on crop
burning, and measures to promote cleaner fuels and renewable
energy sources. Transitioning to renewable energy sources
such as solar, wind, and hydropower can help reduce reliance
on fossil fuels and lower greenhouse gas emissions, mitigating
air pollution and combating climate change. India has an
ambitious target of getting 500 GW of energy from renewable
sources by 2030. As of March 2024, it has already achieved
190 GW, with targets likely to be met ahead of schedule15,17.
In 2015, India launched the Air Quality Index (AQI) tool
([Link] to communicate air quality levels to the
public in an easily understandable format. AQI monitoring
and reporting is currently established in 34 of 36 States and
Union Territories18. The primary aim is to raise awareness
about air pollution and its health impacts, encouraging
individuals to take preventive actions. Educating the public
about the causes and consequences of air pollution and
advocating for policy changes and sustainable solutions are
essential in raising awareness and fostering a collective effort
to combat this environmental challenge. Several technological
advancements have enabled citizens and industries to find
solutions to minimize air-borne pollutants released into the
atmosphere or protect vulnerable individuals. In the short
term, when AAP or HAP cannot be lowered, susceptible
individuals are advised to use air purifiers equipped with
HEPA (high efficiency particulate air) filters and activated
carbon to improve indoor air. Individuals can play a crucial
role in reducing air pollution by adopting sustainable practices
such as avoiding burning domestic waste in their gardens,
carpooling, using public transportation, conserving energy,
and supporting clean air initiatives in their communities.
Similarly, adopting electric vehicles (EVs) and hydrogen fuel
as alternatives to traditional gasoline two-stroke and diesel
vehicles can significantly reduce vehicular emissions in urban
areas. However, infrastructure upgrades are necessary to meet
the demand of the large population.
Other initiatives Several cities in India have successfully
implemented initiatives to reduce air pollution, such as
introducing cleaner fuel standards, promoting public
transportation, and establishing air quality monitoring systems
to track pollution levels and inform policy decisions. Learning
from other countries that have effectively tackled air pollution
through a combination of stringent regulations, technological
innovations, public awareness campaigns, and international
collaborations to address transboundary pollution issues, India
can adopt a similar multi-faceted approach. To address air
pollution effectively, India must adopt comprehensive
strategies, including stricter enforcement of environmental
regulations, investment in clean technologies, promoting
sustainable urban planning, and public participation in
pollution control efforts. The long-term strategy should focus
on transitioning to cleaner energy sources, improving public
transportation infrastructure, enhancing green spaces in urban
areas, and fostering a culture of environmental stewardship in
the population. Unconventional approaches to combat air
pollution The air pollution problem is too big for any single
sector or government to address alone. It requires a concerted
effort from all stakeholders to utilize innovative SMART
(Specific, Measurable, Achievable, Relevant, and Time-
Bound) solutions. Out-of-thebox thinking to prioritize novel
ideas might lead to impactful and sustainable interventions to
address air pollution, improve public health, and drive
positive change. Given India’s vastness and diversity, one-
sizefits-all solutions might be impractical; local solutions with
active community participation are essential. Some
unconventional approaches could be: (i) Community-led air
quality monitoring: Empowering local communities to
monitor air quality in their neighbourhoods using low-cost
sensors and mobile apps, which can then be used to advocate
for policy changes and implement interventions; (ii) Green
infrastructure initiatives: Vertical gardens, green roofs, and
urban forests to help absorb pollutants and improve air quality
in urban areas; (iii) Art and awareness campaigns:
Collaborating with local artists and influencers to create
engaging campaigns that raise awareness about health impacts
of air pollution and the importance of taking action; (iv)
Mobile health clinics: Setting up mobile health clinics in
highly polluted areas to provide healthcare services and
screenings for various health outcomes such as respiratory
illnesses, as well as education on prevention and management;
(v) Innovative clean cooking solutions: Solar cookers, biogas
stoves, and efficient biomass pellet-based cookstoves, to
reduce indoor air pollution and improve health outcomes; (vi)
Policy advocacy through data visualization: Presenting air
quality data in a compelling and easy-to-understand way,
advocating for stronger environmental regulations and
enforcement; (vii) School-based education programmes:
Developing interactive educational programmes for schools
that teach students about the sources and effects of air
pollution, as well as practical steps they can take to reduce
their exposure; and (viii) Corporate partnerships for clean air
initiatives: Collaborating with businesses to implement
projects that improve air quality in exchange for recognition
and branding opportunities, fostering a sense of corporate
social responsibility. In conclusion, air pollution is a complex
and pervasive problem in India that demands urgent and
coordinated efforts from the government, industry, civil
society, and individuals to mitigate its adverse effects on
public health and the environment. By implementing effective
policies, embracing clean technologies, raising public
awareness, and fostering a culture of sustainability, India can
work towards a cleaner and healthier future for its citizens. All
stakeholders must take responsibility, actively reducing air
pollution, and ensure that the air we breathe is safe for us as
well as for future generations. Active participation, innovative
thinking, and sustained stakeholder commitment are crucial
for achieving this goal.

Delhi’s Senario New Delhi, the capital of India, has been

recognised as the most polluted capital city all over the
world1. As the second largest city in the world and its fast
growth of economy and urbanization, this severe air quality
problem is threatening the public health of ~33 million
citizens in New Delhi. Fine particulate matter is the most
dominant pollutant in New Delhi2,3,4, and is estimated to be
responsible for about 10,000 premature deaths per annual3,5.
The up-to-date World Health Organization (WHO) Ambient
Air quality database reported the annual average of fine
particulate matter mass concentration of 121 µg/m3 in New
Delhi, which is 24 times higher than the suggested healthy
level by the WHO air quality guideline1.

This severe air pollution problem in New Delhi has captured

wide attentions from the scientists all over the world. Vast of
short-term comprehensive/intensive observations6,7,8 and
long-term regular monitoring networks, for example Central
Pollution Control Board (CPCB)9 and SAFAR10,11
networks, have been developed in recent year to better
understand the air pollution and to suggest for mitigation
strategies12,13. Using the CPCB network observations, ref. 5
reported the record-high hourly concentration of fine
particulate matter in New Delhi of up to 1676 µg/m3 during
Diwali Festival under an unfavourite stable meteorological
condition, this is 70% higher compare to the worst record in
Beijing, China1
For a decade, Delhi has regularly held the dishonourable title
of being the world’s most polluted city, with other Indian
cities close behind. A recent study calculated that the 30
million people living in and around the capital could have
almost 12 years taken off their lives due to its catastrophic
health impacts.
The air pollution in Delhi, the capital territory of India, was
found to be the worst of any major city in the world in an
August 2022 survey of 7,000 world cities by the US-based
Health Effects Institute.[2] The air pollution in Delhi also
affects the surrounding districts.[3][4] Air pollution in India is
estimated to kill about 2 million people every year and is the
fifth largest killer in India. India has the world's highest death
rate from chronic respiratory diseases and asthma, according
to the World Health Organization.
In Delhi, poor air quality has irreversibly damaged the lungs
of 2.2 million children.
On 25 November 2019, the Supreme Court of India made a
statement on pollution in Delhi, saying "Delhi has become
worse than narak (hell)".[5] Supreme Court Justice Arun
Mishra remarked that it is "better to get explosives, (and) kill
everyone."[6] During the COVID-19 pandemic lockdown in
India, the air quality in Delhi significantly improved.[7][8]
The air quality index (AQI) in Delhi generally falls within the
Satisfactory (51–100) and Moderate (101–200) ranges
between March and September, and then drastically
deteriorates to Poor (201–300), Severe (301–400), or
Hazardous (401–500+) levels between October and February
due to various factors including the burning of effigies during
Vijayadashami, the bursting of firecrackers during Diwali,
thermal power plants in the National Capital Region,[11]
stubble burning,[12][13] road dust, vehicle pollution and cold
weather.[14][15][16]
In November 2016, in an event known as the "Great Smog of
Delhi", the air pollution spiked far beyond acceptable levels.
The levels of PM2.5 and PM 10 particulate matter hit 999
micrograms per cubic meter, well above their respective 24-
hour peak limits of 15 and 60 micrograms per cubic metre.
[17]

According to Bloomberg, 16.7 lakh (1,670,000) people died

due to polluted air in India in 2019. According to data released
by the Ministry of Environment, Forest and Climate Change
in 2022, the Air Quality Index in Delhi stood at over 200 for
at least half the year.[18]

Animal agriculture also contributes to Delhi's pollution

problem, as smog and other harmful particles have been
produced by farmers burning their crops in other states since
the 1980s.

An initiative that is being considered to address air pollution

is a 1,600 km long and 5 km wide green ecological corridor
along the Aravalli Range from Gujarat to Delhi connecting to
the Sivalik Hills range. This would involve the planting of
1.35 billion (135 crore) new native trees over 10 years to
combat pollution.[19] In December 2019, IIT Bombay, in
partnership with the McKelvey School of Engineering of
Washington University in St. Louis, launched the Aerosol and
Air Quality Research Facility to study air pollution in India.
[20]

The Delhi government announced in November 2021 that it

would be shutting all schools and government offices[21] for
a week due to the severe air pollution. The government told
the Supreme Court that it was confident and prepared for a
complete lockdown.[22] The Supreme Court asked authorities
in the NCR region to consider remote work policies for
employees. When the air quality in Delhi on 18 November
2021 slipped into the "severe" category with an AQI of 362,
the Supreme Court of India reprimanded the central and state
governments and asked them to take strict measures to reduce
pollution in Delhi and the NCR region.[23]

In November 2023, New Delhi was suffering from

particularly high levels of air pollution. 38% of this
years[when?] pollution has been caused by stubble burning a
practice where stubble left after harvesting rice is burnt to
clear fields.[24]

On November 18, 2024, Delhi recorded its worst air quality of

the season, with a 24-hour AQI reading of 491, classified as
"severe plus." This level, as reported by India's pollution
control authority, indicates hazardous conditions with
significant health impacts, particularly for vulnerable
populations. The reading marks the highest AQI level for
Delhi in 2024.[25]

Air quality index (AQI), according to the Central Pollution

Control Board (CPCB), is a measure of the concentration of
eight pollutants — particulate matter (PM)10, PM2.5,
nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon
monoxide (CO), ozone (O3), ammonia (NH3), and lead (Pb)
— in the air at a monitoring location. A sub-index is
calculated for each of these pollutants (not all may be
measured at every station); and the worst among them is the
AQI for that location. So, AQI transforms complex air quality
data into an index we can understand.
Delhi is perhaps going to become, if it has not already, an
uninhabitable city for two different reasons. In winters
(October-February), pollution levels peak, while during
summers (April-June), the heat waves are unbearable, both
affecting Delhi’s poor disproportionately. This piece concerns
itself with air pollution. This article will focus on the PM2.5
in particular because it dominates the AQI reading in Delhi
and is quite dangerous as it is likely to travel to the deeper
parts of the lungs owing to its extremely small size, the largest
of which is 30 times thinner than human hair.

An extensive 2023 report prepared by IIT Kanpur, IIT Delhi,

TERI New Delhi, and Airshed Kanpur shows that, even
during winter months, when sources of pollution external to
Delhi are at their peak, half of the PM2.5 levels can be
apportioned to Delhi itself (Chart 3).

Studies on air pollution in India

Though various studies have addressed the issue of air

pollution and its impacts on urban Indian cities, most of these
studies are limited to specific cities and do not necessarily
give a complete picture of the situation. Some of the
highlights of these studies are discussed in the following
paragraphs.
Pandey and Venkataraman (2014) evaluated the effects of
emissions from various modes of transport in India. Their
study inferred that on-road transportation contributed over
97% of the estimated emissions in India, when compared to
other modes of transport, such as railways, waterways, and
airways. Gurjar, Ravindra, and Nagpure (2016) did a
comprehensive study on various anthropogenic emission
sources in Indian megacities, such as Delhi, Mumbai, and
Kolkata. The global impact of urban pollution is also
discussed in their study. Upadhyay, Dey, Chowdhury, et al.
(2018) evaluated the major anthropogenic sources of PM2.5
and the potential benefits to human health, if sufficient control
measures are applied to curb emissions. A recent study by Jat,
Gurjar, and Lowe (2021) examined the extent of pollution
during the winter months in India. The study used a WRF-
Chem model, that is, Weather Research and Forecasting
(WRF) coupled with chemistry, to evaluate the concentrations
of pollutants, such as PM2.5, oxides of sulphur (SOX), oxides
of nitrogen (NOX), black and organic carbons, and non-
methane volatile organic carbons (NMVOCs) that were
identified for the winter months. The various sources of air
pollution can be classified into seven major sources and the
consequent effects are discussed in this article.
Studies indicate a strong link between air pollution, including
poor Air Quality Index (AQI), and mental health in India, with
higher AQI levels associated with increased symptoms of
depression, anxiety, and stress. Prolonged exposure to
pollutants has been linked to increased mental health
disorders, including pollution anxiety.
Air pollution is a big problem for both the environment and
public health. We know that breathing polluted air can cause
lung and heart diseases. However, recent studies have found
an even deeper impact. Mental Health Impacts of Air
Pollution, leading to anxiety, depression, and memory
problems.

This is especially dangerous for vulnerable groups like

children, older adults, and low-income communities. They
often breathe in more pollution and have fewer resources to
get help. One shocking fact is that pollution has been linked to
higher suicide rates, especially in places with long-term poor
air quality. This makes it even more important to take action
now. Impact on Mental Health
Air pollution, including tiny particles like PM2.5, nitrogen
dioxide (NO₂), and ozone (O₃), can enter the bloodstream
and reach the brain. As a result, it can cause inflammation,
which may lead to mental health problems. Over time, long-
term exposure to pollution can increase stress and anxiety.
This is especially true for people living in cities, where
pollution levels are high. Furthermore, polluted air can lower
the quality of life by making it harder to spend time outdoors
and disrupting sleep. This, in turn, may lead to depression and
other mental health issues.

Evidence from Studies

Several studies support Mental Health Impacts of Air
Pollution:

A 2017 study from the University of Washington, published in

Health & Place (Association Between Ambient Air Pollution
and Psychological Distress) found that people living in areas
with higher PM2.5 levels experienced more stress and anxiety.
In 2016, researchers at Harvard T.H. Chan School of Public
Health, Long-term Exposure to Fine Particulate Matter and
Incidence of Dementia discovered that long-term exposure to
air pollution can make memory and thinking skills decline
faster in older adults.
A 2022 study by Carleton et al. (Air Quality and Suicide)
found that when PM2.5 levels increased by 10 μg/m³, suicide
rates went up by 0.4%, especially in rural areas.
Scientists are still studying how Mental Health Impacts of Air
Pollution, but they have some ideas:

Inflammation and Cell Damage: Tiny pollution particles

(PM2.5) can enter the lungs, reach the blood, and cause
inflammation. This can lead to mood problems like depression
and anxiety. Pollution can also damage brain cells, which may
lead to memory loss over time.
Brain Chemical Imbalance: Air pollution may affect important
brain chemicals like serotonin and dopamine, which control
mood and emotions. This could increase the risk of
depression, anxiety, and even serious mental health conditions
like schizophrenia.
Low Oxygen Levels (Hypoxia): Breathing in polluted air for a
long time can lower oxygen levels in the blood. This can
make it harder for the brain to work properly, leading to
memory problems and mood changes.
Increased Stress: Constant exposure to polluted air can put the
body in a state of stress, raising cortisol (the stress hormone).
Over time, this can cause anxiety, trouble sleeping, and
depression.
These effects show that air pollution harms the brain in many
ways, both directly and indirectly, making mental health a
growing concern. Detailed Evidence from Research
Several studies provide compelling evidence for the link
between air pollution and mental health:

1. University of Washington Study (2017):

A study published in Health & Place (Association Between
Ambient Air Pollution and Psychological Distress), looked at
data from over 60,000 adults to understand the link between
air pollution and mental health. The results showed that higher
levels of tiny air particles (PM2.5) were linked to increased
stress and anxiety.

For example, people living in highly polluted areas (21 μg/m³)

had 17% higher distress levels compared to those in cleaner
areas (5 μg/m³). Even more surprising, every 5 μg/m³ increase
in pollution had the same negative effect on mental well-being
as losing 1.5 years of education. This was true even after
considering other factors like unemployment and chronic
illnesses.

2. Harvard T.H. Chan School of Public Health Study (2016):

A study published in Environmental Health Perspectives
(Long-term Exposure to Fine Particulate Matter and Incidence
of Dementia), examined the long-term effects of air pollution
on brain health. It found that prolonged exposure to fine
particulate matter (PM2.5) increases the risk of dementia in
older adults.

For every 10 μg/m³ increase in PM2.5 levels, the risk of

dementia rose by 16%. This suggests that air pollution may
speed up cognitive decline, affecting memory, decision-
making, and overall mental processing abilities.

3. JAMA Neurology Study (2019, misreferenced as 2018):

A study published in JAMA Neurology (Association Between
Long-term Exposure to Fine Particulate Matter and Incidence
of Dementia) found that long-term exposure to air pollution
can speed up mental decline in older adults. This effect was
especially noticeable in areas with high levels of fine
particulate matter (PM).
The research suggests that prolonged exposure to pollution
may increase the risk of neurodegenerative diseases like
Alzheimer’s and Parkinson’s, making brain health a growing
concern in polluted regions.

4. NBER Working Paper (2022):

A study by Carleton, Heyes, and Siberian (Air Quality and
Suicide) found that a 10 μg/m³ increase in annual PM2.5
levels is linked to a 0.4% rise in the annual suicide rate. This
effect was especially noticeable in rural areas, suggesting that
air pollution-related stress and inflammation may contribute
to severe mental health outcomes.

5. Systematic Review (2022):

A study published in Neurotoxicology by Zundel et al. (Air
pollution, depressive and anxiety disorders, and brain effects),
reviewed over 100 studies on air pollution and mental health.
The findings were clear—air pollution is strongly linked to
higher risks of depression, anxiety, and even changes in the
brain. In fact, 73% of the studies showed that people living in
polluted areas had more mental health problems.

These studies also show that air pollution affects mental

health in many ways. It can cause stress, emotional struggles,
and, in severe cases, even lead to higher suicide rates. Most
importantly, long-term exposure to pollution seems to have
the worst effects, making it crucial to take action.

Connection between Air Pollution and Mental Health In a

recent systematic review of over 100 studies, Zundel and
colleagues 26 found that humans and animals exposed to
polluted air which exceeds the average levels of air pollution
present more mental health and behavioural concerns. The
primary author of the review, Clara G. Zundel stated in a
World Economic Forum Report 27 that humans exposed to
polluted air tend to experience changes in the brain regions
that govern emotions such as amygdala, hippocampus, and the
prefrontal cortex. These individuals are more likely to develop
anxious and depressive symptoms in comparison to the
individuals who inhale less polluted and cleaner air. Exposure
to significant high levels of air pollution could prove
dangerous for children and adolescents as they are in a
sensitive period of brain development. According to research,
28 children and adolescents breathing polluted air could
display depressive symptoms and be at a high risk for suicidal
behaviours. The same research also observed structural and
functional changes in the brain region through neuroimaging
techniques. Data reported from China stated that standard
deviation by 1 for increase in the particulate matter according
to the accepted level of PM2.5 concentration in the air tends
to increase the chances of developing psychiatric illness
(comprising depression) by 6.67% in individuals which is
equivalent to a medical expense of approximately 22.88
billion dollars. 29 This data holds important implications as
majority of the global population resides in regions which
have PM2.5 concentration levels much higher than
permissible limits defined by the WHO guidelines.
Rationale of the study The study was carried out recognizing
the need to study the possible links between mental health
(Depression, anxiety, and well-being) and air pollution of
individuals residing in the capital given the high levels of Air
Quality Index in Delhi-NCR. The study was initiated to
understand the possible psychological concerns faced by
individuals who breathe polluted air with a much higher PM
2.5 level than permissible by the WHO Guidelines. Literature
shows a strong correlation between breathing polluted air and
deterioration of physical health. There is a need of research to
understand the possible psychological pathways leading to
compromised mental health (if any) due to the alarming levels
of air pollution. Materials and Method Aim of the study The
study aimed at exploring the possible links between mental
health (depression, anxiety, and well-being) and high levels of
air pollution for individuals residing in Delhi-NCR.
Objectives • To understand whether individuals who reside in
regions with high Air Quality Index (AQI) levels tend to
experience depression, anxiety, and compromised wellbeing. •
To explore the cognitive appraisals of individuals residing in
Delhi-NCR about the state of air pollution and study the
possible links between their cognitions, emotional states, and
mental health challenges (if any) through semistructured
interviews.
With pollution rising in the environment, a number of studies
have been conducted which show direct and indirect impact of
pollutants on mental well-being. The stress of physical issues
like respiratory problems, sleep disturbances, the haze in air
cutting of light which impacts neurotransmitters secretion in
brain and direct biological impact of pollutants on nervous
system are some of the underlying pathogenesis. This has
shown to increase incidence of anxiety, depression and
personality disorders along with lowered stress tolerance.”
Toxic air pollutants cause harm to the respiratory organs as
well as affect mental health by increasing anxiety and
depression. Air pollution refers to any physical, chemical, or
biological change in the air that may be contaminated due to
harmful gases, dust and smoke which affects plants, animals
and humans drastically, according to the World Health
Organisation. These air pollutants can cause serious
neurocognitive effects—ranging from behavioral variations to
neurodegenerative disorders—that ultimately can have
devastating effects on mental health. Pollution particles can
cross fHigh amounts of air pollution can lead to tissue and
blood vessel inflammation, which can have detrimental
psychological impacts and even send some individuals into
despair or make them impulsive. Anxiety and modifications in
mood, cognition, and behaviour are examples of the
psychiatric symptoms that can result from the psychological
and toxic impacts of air pollution. Air pollutants are
associated with an increase in psychiatric hospitalizations,
emergency calls and behavioural changes as well as a decline
in psychological wellbeing.”

Highlighting that numerous hazardous contaminants obstruct

the nervous system's ability to grow and operate normally as
an adult, he said, “Even while symptoms are frequently subtle
or slow to appear, they can serve as a more accurate predictor
of hazardous consequences than statistics on death or cancer
rates. Psychological health may be indirectly impacted by
other physiological symptoms of air pollution, such as asthma.
Multiple chemical sensitivity and the sick building syndrome
are mental and toxicologic diseases, respectively to mitigate
the effects of environmental stress.”rom the lung to the blood
and, in some cases, travel up the axon of the olfactory nerve
into the brain.” "Due to their ease of entry into the
bloodstream and ability to readily pass through the body to the
brain, particles equal to or less than 2.5 microns in diameter
offer an extremely significant danger. Carbon Monoxide,
Sulphur Oxides (SOx), and Nitrogen Oxides (NOx), in
addition to PM 2.5 and below, can irritate blood vessels and
result in neuro-inflammation by rupturing the blood-brain
barrier, a thin, sensitive membrane that shields the brain from
toxins. Anxiety, sadness, Impulsive Control Disorder (ICD),
Alzheimer's disease, Parkinson's disease, schizophrenia, and
bipolar disorder can all be brought on by toxic compounds in
the brain. If possible, stay indoors. While you go outside,
wear a mask. Avoid congested areas by taking the public
transit instead.
Air pollution is responsible for millions of premature deaths
and lost years of healthy life annually around the globe [1].
According to the World Health Organization (WHO), over
90% of the global population is exposed to toxic air pollution
[1]. Most commonly, air pollution affects human health and is
associated with respiratory and cardiovascular diseases
[1,2,3,4]. However, as of recent years, more research is
emerging considering the effects on mental health. More
attention has been paid to understanding whether air quality
relates to emotional and psychological well-being and the
complexity of the brain. Mental health is a fast-growing cause
of morbidity and a leading cause of disability among young
people worldwide [5,6]. People with mental health disorders
have poorer social outcomes than the general population in
several areas of life. Yet, environmental health issues brought
by continuous improvement of people’s life quality and
development via industrialization and urbanization have
affected the lives of residents [7,8]. Recent research showed
that air pollution is associated with suicide, increased drug
usage, self-harm, work incapacity and lower productivity,
memory impairment, poor mood, annoyance, lower physical
activity, poor sleep, schizophrenia, depression, anxiety, and
stress among various ages in the urban area, especially
amongst the vulnerable population [6,9,10,11,12,13,14].
Certain pollutants, such as PM, can penetrate the lung’s small
airways and alveoli, entering the bloodstream and activating
multiple pathophysiological mechanisms, potentially causing
neuroinflammation and oxidative stress [9,10,11]. The brain is
susceptible to environmental factors due to high metabolic
demands, environmental inflammation, and oxidative stress
[11,12,13,14]. Oxidative stress results from an imbalance
between free radicals and antioxidants in the body, leading to
cellular damage [11,15,16] that can affect neural pathways
involved in mood regulation [13,15,17,18], even if the
pollution levels are not exceedingly high [19].
Epidemiological evidence of air pollution and adult mental
health problems is still limited and tends to be mainly
concentrated on analyzing the effects on more susceptible
populations, such as children, pregnant women, and the
elderly. The purpose of this scoping review is to examine the
existing literature and explore the methods used by
researchers to determine the air pollution effects on mental
health, mainly focusing on stress, anxiety, and depression
symptoms. This scoping review focused on PM—a complex,
heterogeneous mixture of natural and anthropogenic sources
[30,31]. PM2.5, also known as fine particulate (<2.5 µm), is
responsible for the most significant proportion of air
pollution’s health impact, especially for premature deaths
[1,32]. The review investigates various scientific
methodologies used to analyze the exposure of PM (ultrafine
(UFT) (<0.1 µm), PM2.5, PM10 (also known as course
particulate, <10 µm) exposure to adults’ (18–69 years) mental
health (depression, anxiety, and stress) in publications
between 2010 and 2024. The review excludes vulnerable
populations, such as the elderly and children, to derive
standardized findings broadly applicable to the general adult
population. Mental health alone can be analyzed using
different strategies and tools, including medical analyses and
psychological scales, involving cohorts. This paper aims to
determine the most preferred and sound ways of collecting
data for the study to find the relationship between mental
health and air pollution, essentially welcoming more
opportunities for other research, air pollution reduction, and
mental health awareness intervention strategies. Addressing
air pollution and mental health in countries can reduce the
burden of mortality and morbidity and contribute towards
greater knowledge sharing and community development.
Air pollution is considered to be a major risk factor for asthma
and depression. Air pollution includes smoke, gases, and dust
particles. Both indoor and outdoor pollution pose a major
public health threat as exposure to pollutants such as ozone
(O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon
monoxide (CO), and particulate matter [PM ≤10 and 2.5μ⁢m in
aerodynamic diameter (PM10 and PM2.5, respectively)], have
been found to induce asthma symptoms and exacerbations, to
increase hospitalizations, and to decrease lung function in
patients with asthma.13 Mechanistic studies have shown that
exposure to air pollution can cause neuroinflammation,
oxidative stress in the brain, and cerebrovascular damage,
which may lead to the onset of depression.14 There is
evidence that long-term exposure (≥30d, >6 months) to fine
PM (PM2.5), NO2, SO2, and CO is significantly associated
with an augmented risk of depression.15,16 Even short-term
exposure (<30d) to air pollution has been found to be
associated with an increased risk of depression.15 A study
conducted by Cho et al. revealed that short-term exposure to
air pollutants significantly increased the risk of depressive
episodes among individuals with preexisting asthma.17
Air pollution in Delhi is a growing concern that affects more
than just our physical health. While most people focus on the
respiratory and cardiovascular problems caused by Delhi's
toxic air, its effects on mental health are often overlooked.
Research increasingly shows that prolonged exposure to
polluted air can exacerbate mental health issues, leading to
conditions like anxiety, depression, and cognitive decline.

Delhi’s air quality, especially during the winter months and

festive seasons like Diwali, is notorious for spiking to
hazardous levels.
How Does Pollution Affect Mental Health?
Air pollution mental health in Delhi is an emerging concern
that needs more attention. Prolonged exposure to polluted air
has been linked to increased rates of mental health disorders,
including:

Anxiety: Constant exposure to poor air quality can lead to

pollution anxiety. People living in polluted areas worry about
their health, contributing to chronic anxiety. This
phenomenon, often termed "pollution anxiety Delhi," is
particularly prevalent among people living in areas like South
Extension and Lajpat Nagar, where pollution levels are
constantly high.
Depression: Studies show a significant correlation between air
pollution and depression. Pollutants affect the brain's
chemistry, disrupting the release of neurotransmitters like
serotonin and dopamine, which are vital for maintaining
mental balance.

Cognitive Decline: Air pollution can lead to long-term

cognitive issues, such as memory problems, slower cognitive
response times, and even early onset dementia. This makes it
particularly concerning for the elderly living in high-pollution
areas of the city.
Pollution Anxiety in Delhi: A Growing Concern
What Is Pollution Anxiety?
"Pollution anxiety" is the term used to describe the stress and
fear that stems from constant exposure to high levels of air
pollution. This is particularly relevant in Delhi, where air
quality often reaches hazardous levels. Many people avoid
outdoor activities, limit social interactions, and develop an
overwhelming sense of worry about their health. For residents
of busy areas like Connaught Place, the daily exposure to
toxic air can lead to mental health conditions that need
professional attention.

Pollution anxiety in Delhi is not just limited to physical

symptoms like headaches or shortness of breath but also
emotional symptoms like stress, irritability, and even panic
attacks.

Environmental Stress and Its Mental Health Impact

How Environmental Stress Affects Residents of Delhi
Environmental stress refers to the strain caused by living in
polluted environments. In Delhi, this type of stress has
escalated due to constant exposure to harmful air.
Environmental stress not only worsens anxiety and depression
but also leads to chronic fatigue, emotional burnout, and
irritability.

Living in bustling areas like South Extension and Lajpat

Nagar, where air pollution is unavoidable, can make
individuals more vulnerable to the harmful effects of
environmental stress. This type of mental strain can manifest
as difficulty concentrating, mood swings, and even a lack of
motivation to engage in daily activities.

Vulnerable Groups
Certain groups are more at risk for air pollution's mental
health effects, including:
Children: Prolonged exposure to air pollution can stunt
cognitive development, making kids in Delhi more susceptible
to learning difficulties and attention disorders.

Elderly: Older adults may experience worsened cognitive

decline and heightened symptoms of depression due to
pollution.

People with Pre-existing Conditions: Individuals already

struggling with anxiety, depression, or respiratory issues are
more likely to experience a worsening of symptoms due to the
impact of pollution on mental health.

Coping with Pollution-Related Mental Health Issues

Practical Strategies for Managing Pollution Anxiety
If you’re dealing with pollution anxiety in Delhi, it’s
important to take steps to mitigate its impact on your mental
well-being. Here are some strategies that can help:

Stay Indoors: Avoid outdoor activities during peak pollution

times, typically in the early morning and late evening.

Use Air Purifiers: Invest in high-quality air purifiers to

improve indoor air quality. This is particularly important in
heavily polluted areas like Lajpat Nagar and Connaught Place.
Practice Breathing Exercises: Mindful breathing exercises can
help alleviate the physical and mental symptoms of pollution
anxiety.

Seek Professional Help: If pollution anxiety or environmental

stress in Delhi is affecting your daily life, reach out to
professionals.

Studies indicate a strong link between air pollution, including

poor Air Quality Index (AQI), and mental health in India, with
higher AQI levels associated with increased symptoms of
depression, anxiety, and stress. Prolonged exposure to
pollutants has been linked to increased mental health
disorders, including pollution anxiety.
Here's a more detailed look at the research:
Evidence of Correlation:
Numerous studies, including one reviewed by Zundel et al. in
Neurotoxicology, have found a strong correlation between air
pollution and mental health problems. For example, a scoping
review found that 27 out of 29 studies indicated a negative
impact of air pollution on mental health, with higher AQI
levels linked to increased symptoms of depression, anxiety,
and stress.
Specific Mental Health Impacts:
Research suggests that air pollution can contribute to:
Anxiety: Constant exposure to poor air quality can lead to
pollution anxiety, where individuals worry about their health
due to pollution levels, contributing to chronic anxiety.
Depression: Prolonged exposure to pollutants has been linked
to increased rates of depression, potentially due to various
factors like respiratory problems, sleep disturbances, and the
direct impact of pollutants on the nervous system.
Other Mental Health Issues: Some studies suggest that air
pollution may also contribute to the development or
exacerbation of other mental health conditions, such as
personality disorders and even changes in the brain.
Research in India:
Studies have been conducted in Indian cities like Delhi,
investigating the link between air pollution and mental health.
For example, research in Delhi found that nearly 45% of
respondents reported feeling helpless and stressed due to
winter air pollution.
Underlying Mechanisms:
The mechanisms through which air pollution affects mental
health are still being studied, but some possible pathways
include:
Physiological Effects: Air pollutants can cause inflammation
and oxidative stress, which can affect brain function and
contribute to mental health problems.
Psychological Effects: The stress of dealing with respiratory
problems, sleep disturbances, and the haze in the air can also
contribute to mental health issues.
Social Effects: Exposure to pollution can also have social
implications, such as the potential for increased isolation or
social avoidance due to health concerns.
Studies suggest a strong link between poor Air Quality Index
(AQI) and negative mental health outcomes, including
increased risk of depression, anxiety, and even certain
psychiatric disorders. Specifically, exposure to higher levels
of pollutants like PM2.5 and PM10 has been associated with
increased symptoms of these conditions.
Here's a more detailed look at the research:
Increased Risk of Mental Health Disorders:
Research indicates that living in areas with poor air quality
may be associated with a higher risk of developing mental
health disorders, including depression, anxiety, bipolar
disorder, schizophrenia, and personality disorders.
Higher Visits to Mental Health Services:
Studies have shown that visits to mental health service centers
are higher on days with increased particulate matter (PM)
pollution, suggesting a connection between air pollution and
mental health.
Suicide Rates:
Some studies suggest a correlation between higher levels of
pollutants like NO2, O3, PM, and SO2 and suicide rates,
highlighting the potential impact of air pollution on suicidal
behaviors.
Children and Mental Health:
Research indicates that children growing up in areas with
higher air pollution may be more susceptible to depression
later in life.
Brain Changes:
Studies suggest that air pollution can negatively affect brain
function, potentially leading to changes that contribute to
mental health issues.
Long-Term Effects:
Current research suggests that prolonged exposure to high
levels of air pollution can have long-term mental health
effects, including reduced mental capacity, increased
cognitive decline, and increased stress, anxiety, and
depression.
Mechanisms:
Some studies suggest that air pollutants, particularly
particulate matter, can induce inflammation and oxidative
stress in the brain, potentially contributing to the onset of
depression.
Specific Pollutants:
Research has identified specific pollutants like PM2.5 and
PM10 as being associated with negative mental health
outcomes, particularly depression.
Studies show that poor air quality, as indicated by high AQI
levels, negatively impacts various aspects of quality of life,
including health, mental well-being, and even lifespan. These
effects are particularly pronounced in vulnerable populations
like children, the elderly, and those with pre-existing
respiratory or cardiovascular conditions.
Specific Impacts:
Physical Health:
Poor air quality can exacerbate respiratory issues like asthma
and COPD, increase the risk of heart attacks and strokes, and
contribute to various chronic diseases. Studies have shown
that air pollution significantly increases the probability of
chronic lung disease, heart disease, and self-rated poor health.
Mental Health:
Exposure to air pollution has been linked to increased risk of
mental health disorders like depression and anxiety. A study in
the U.S. and Denmark found a significant association between
air pollution and increased risk of psychiatric disorders,
including depression, schizophrenia, and personality
disorders.
Cognitive Function:
Emerging research suggests that long-term exposure to air
pollution may affect cognitive function.
Lifespan:
Studies indicate that air pollution can shorten lifespan, with an
average reduction of 1.8 years worldwide.
Social Relationships:
Exposure to air pollution can negatively impact social
relationships, as highlighted in a study examining the effects
of acute and brief exposure on quality of life.
Health-Seeking Behavior and Medical Expenses:
The National Institutes of Health (NIH) study found that high
AQI levels significantly increased health-seeking behavior
and medical expenses, with the effects varying depending on
the severity of pollution.

Buteyko breathing aims to reduce minute volume and thus to normalise

carbon dioxide (CO2) levels. Those who practice Buteyko breathing suggest
that hyperventilation and hypocapnia drive much, if not all, of the
pathophysiology of asthma. As such Buteyko breathing ‐ which aims to
reduce minute volume and raises CO2 levels ‐ could reverse or alleviate
asthmatic symptoms (Bowler 1998; Cooper 2003). The technique was named
after the Ukrainian doctor, Konstantin Buteyko, who first developed the
techniques during the 1950s. The technique was named after the Ukrainian
doctor, Konstantin Buteyko, who first developed the techniques during the
1950s.

he benefits of Buteyko breathing include enhanced breath

control, which helps to prevent breathlessness and promote
proper breathing patterns. It’s used to manage and improve a
variety of conditions, including asthma, anxiety, and sleep
concerns.
Buteyko breathing teaches you to breathe more gently and less rapidly.
You’ll learn to breathe slower and deeper, which balances your breathing
rhythms.

It involves exercises that teach you to hold your breath and refrain from
breathing. It’s said that over time the breathing technique will become a
natural part of your daily life.

Preparation
1. Sit on the floor or on a chair.
2. Elongate your spine to maintain an upright posture.
3. Relax your respiration muscles.
4. Breathe normally for a few minutes.

The Control Pause

1. After a relaxed exhale, hold your breath.
2. Use your index finger and thumb to plug your nose.
3. Retain your breath until you feel the urge to breathe, which may include an
involuntary movement of your diaphragm, and then inhale.
4. Breathe normally for at least 10 seconds.
5. Repeat several times.

The Maximum Pause

1. After a relaxed exhale, hold your breath.
2. Use your index finger and thumb to plug your nose.
3. Retain your breath for as long as possible, which is usually twice the length
of time of the Control Pause.
4. Once you’ve reached the point of moderate discomfort, inhale.
 5. Breathe normally for at least 10 seconds.
6. Repeat several times.

Tips for beginners

 When practicing Buteyko breathing, always breathe in and out
through your nose.
 If at any time you experience anxiety, shortness of breath, or intense
discomfort, discontinue the practice and breathe normally.
 As you progress, you may be able to hold your breath for longer
periods. Over time, you may be able to hold the Control Pause for 1
minute and the Maximum Pause for 2 minutes.
Dr. Konstantin Buteyko is the developer of the fundamentally
new, drug free therapy for bronchial asthma, well known
today as The Buteyko Method. He is the Ukrainian born
medical scientist and medical practitioner who discovered that
the main cause of bronchospasm in bronchial asthma is CO2
deficiency in alveolar air, resulting from hyperventilation and
low metabolic activity. He demonstrated that hyperventilation
is the main element in the etiology and pathogenesis of
asthma.
The understanding and knowledge of this mechanism was the basis for
the development of the Buteyko Method, which reverses not only asthma
but also all other hyperventilation related diseases often associated with
asthma, such as bronchitis, coughing, allergy, rhinitis, high blood
pressure etc., [3].
With asthma, excess breathing has 4 primary effects, according to the
Buteyko Institute of Breathing and Health in Australia.
 1-
Carbon dioxide levels decrease. Since higher levels of carbon
dioxide signal smooth muscle to relax and dilate, low levels can
cause the smooth muscle around the bronchioles (tubes that carry
air into and out of the lungs) to spasm, resulting in chest tightness
and difficulty in exhaling.
  2-
Oxygen is released from the blood more slowly, causing
breathlessness.
 3-
Mast cells, immune-system components found in connective tissue,
become overly sensitive to perceived allergens and release large
amounts of histamine, which causes inflammation.
 4-
Airways dry out and become inflamed, encouraging mucus
formation [4].
Buteyko breathing, developed in the 1950s by Ukrainian doctor Konstantin Buteyko, is a
breathing technique that involves taking deep breaths through the nose to improve health. The
method utilizes the diaphragm when breathing, leading to fuller breaths and the body getting
the proper amount of oxygen.

The breathing technique is designed to stop people from taking shallow chest breaths, which
can lead to reduced oxygen levels and the overproduction of carbon dioxide. In many cases,
Buteyko breathing can help manage asthma and respiratory issues in addition to other
potential health benefits. Today, the technique is considered pseudoscience in many circles,
and it is not an accepted complementary therapy for any condition, including asthma