New Delhi: Grappling with one of the most severe global air pollution crises, the Union government has called on states and Union territories to work towards a robust public health response, including setting up special chest clinics in the 131 cities targeted for air quality improvement under the National Clean Air Programme (NCAP).
These chest clinics are to be set up at government health facilities in NCAP cities and must operate for at least two hours daily during periods of peak pollution, focusing on screening, risk communication, and providing standard care for air pollution-related cardio-pulmonary illnesses.
With the air quality in the severe category, the health and family welfare ministry has directed states to strengthen patient care services. This includes the Out-Patient Departments (OPDs); particularly in specialities like Respiratory Medicine and Cardiology, and increasing capacity in Emergency Departments (EDs) with ready access to essential medications, oxygen supplies, and nebulisers to address acute illnesses and chronic conditions affecting the respiratory, cardiovascular, and cerebrovascular systems.
“The purpose of the chest clinic is to screen and provide risk communication for air pollution-related cardio-pulmonary diseases. Among patients already suffering from cardio-pulmonary illnesses—establish possible causes (including air pollution) and confirm diagnosis; provide standard care to patients suffering from cardio-pulmonary illnesses; promote behaviour change and adoption of healthy practices to potential and diagnosed cases of air pollution-related cardio-pulmonary illnesses,” the advisory said.
The development assumes significance in the backdrop of a recent Lancet report that estimated air pollution contributes to around 1.7 million deaths in India annually. Furthermore, the directive mandates setting up a surveillance system under the National Programme on Climate Change and Human Health (NPCCHH), wherein designated hospitals must report daily air pollution-related illnesses for timely analysis and action.
Better response
The ministry of health and family welfare (MoHFW), through its updated Advisory on Air Pollution and Health, has directed state health authorities and departments to strengthen their response to the health challenge posed by the "poor to severe levels" of air quality frequently reached during the winter months.
MoHFW secretary Punya Salila Srivastava's communication stated the advisory material and action points intended to support "effective action at various levels" and serve as guidance for "awareness generation and health system response".
States and Union territories have been directed to ensure that health authorities regularly check and coordinate with Pollution Control Boards to obtain daily Air Quality Index (AQI) data. This data must be shared with all health facilities for both health-related purposes and for public dissemination.
For robust health system preparedness, the advisory stresses the development of district and city-level action plans for climate change and health under the NPCCHH, which specifically incorporate air pollution strategies.
The MoHFW also calls for the intensification of public awareness campaigns using all available channels—social media, posters, radio, and television—with locally translated messages during high-risk periods, such as the winter months, pre- and post-Diwali, and stubble burning days.
The directive is timely, as health experts across the National Capital Region (NCR) report a significant surge in patient visits. Prof Dr. Arvind Kumar, chairman of the Lung Transplant and Chest Surgery Department at Medanta, said that air pollution levels are as high as in any past year.
He observed that both healthy individuals and patients with pre-existing conditions have complaints such as a burning sensation in the nose and eyes, a sore throat, cough, and viral fever.
Dr. Kumar added that his colleagues in cardiology are also seeing a spike in patients reporting heart attacks and increased admissions, a consequence typically observed about 10 days after a period of intense pollution.
Health hazard
Prof Dr. Raj Kumar, a director at Delhi’s Vallabhbhai Patel Chest Institute, said that at this peak time, health complications and emergency visits for patients with respiratory illnesses increase.
The crisis is acutely visible in the Delhi-NCR region, where air pollution is heavily compounded by regional and local factors. The national capital's air quality has consistently oscillated between 'very poor' and 'severe' over the past week.
On Wednesday, the average AQI for Delhi is firmly in the 'severe' category, prompting the enforcement of Stage III of the Graded Response Action Plan (GRAP).
A significant contributor to hazardous air is stubble burning in neighbouring states, such as Punjab, Haryana, and Uttar Pradesh. While the daily contribution of farm fires varies based on wind direction, it can suddenly increase, with forecasts indicating that its share in Delhi’s PM2.5 levels can rise sharply when winds are unfavourable. The festival season also brings localized hazards; the burning of firecrackers during Diwali releases concentrated pollutants that severely aggravate health conditions.
In response to this public health emergency, sales of air purifiers in Delhi-NCR have surged dramatically, with some e-commerce platforms reporting a fivefold increase compared to typical days. This buying trend reflects a growing consumer consciousness about indoor air quality as an essential defence against the toxic outdoor environment.
Dr Anju Goel, associate director at the air quality division, The Energy and Resources Institute (Teri), said there is a lack of action on the ground. “There have been a lot of policies and regulations by different agencies of the state and central governments, but the implementation is not so strong, and this is the reason that air pollution has become a big issue every year during winter. We need to upgrade our PUC system with the latest technology and artificial intelligence. We need to strengthen the monitoring and evaluation system, bring in more transparency and accountability,” she said.