India Leads the Way: A Health-Centered Strategy for Air Pollution

The Government of India has recently initiated unprecedented efforts to address the substantial national health burden attribu­ table to ambient and household air pollution. The key first step was the constitution by the Ministry of Health and Family Welfare (MHFW) of an expert committee on a ir pollution and health. This committee put together a landmark report (MHFW 2015) released earlier this year that outlined targeted actions aimed at providing the largest exposure reductions (and conse­ quent health benefits), instead of traditional approaches to air quality management. India's health ministry is perhaps the first among low­ and middle­ income countries to initiate steps that directly address air pollution as a national health concern. Discussions initiated through this process have led to a number of concrete policy actions consistent with these recommendations, the most recent of which is highlighted within the 2016–2017 budget just released by the government: a commitment of at least US$1.5 billion to address household air pollution by providing clean cooking gas to 50 million poor households in the next 3 years (MF 2016). This is an enor­ mous step forward in addressing household air pollution caused by polluting cookfuels. The impetus for the MHFW report came from recent assessments on the burden of disease that highlight the scale of air pollution– related health impacts (Lim et al. 2012, Forouzanfar et al. 2015) and the need to address dual burdens from ambient and household air pollution in the nation (Balakrishnan et al. 2014). Around 1.5 million premature deaths in India—deaths due to a range of acute and chronic health conditions—are attributable annually to the indoor and outdoor exposures of the population to air pollution (IHME 2015). This places air pollution near or at the top of the list of all known risk factors for ill health in the country, above high blood pressure, smoking, child and maternal malnutrition, and risk factors for diabetes (IHME 2015). Although management of the latter risks has long been part of national health programs managed by the MHFW, the report makes a compelling case for a major national cross­ ministerial effort directed at air pollution, to be spearheaded by the ministry. We describe here the salient recommendations of the report. The health burden from air pollution comes from outdoor exposures in both urban and rural areas as well as from within house­ holds. In fact, approximately 170 million households, primarily in rural areas, …