A Silent Public Health Crisis in India

About Author: With a fresh, digital approach to solving climate change, Mahesh Ramanujam convenes a coalition of leaders in both sustainability and technology. As a global thought leader, he is an authority on the intersection of climate, sustainability, business, and financial transformation – and works tirelessly to progress society toward net zero through cross-sector decarbonization strategies, seamless ESG compliance, and an economy unreliant on greenhouse gases.

For too long, air pollution in India has been viewed primarily as an environmental issue rather than a public health crisis. However, mounting evidence makes it clear that the air we breathe is straining healthcare systems, crippling economies, and making even the most basic aspects of urban life like commuting, working, and simply stepping outside a gamble with long-term health consequences.

In 2019, air pollution was linked to 1.67 million deaths in India, and exposure to high levels of PM₂.₅ has been shown to reduce life expectancy by up to eight years in some regions. The economic impact is equally significant, with an estimated $36.8 billion lost annually due to healthcare costs and reduced productivity. And at the heart of this crisis is an uncomfortable truth: our built environment is failing us. 

Cities that were once designed to be engines of prosperity have now become breeding grounds for respiratory illnesses, cardiovascular diseases, and cognitive impairments. Rather than sheltering and protecting us, the very  very places we live and work are accelerating our exposure to harmful pollutants.

But if our buildings and cities are part of the problem, they can also be part of the solution. As such, recognizing their causal relationship with air quality as an interconnected, fundamental determinant of public health is the crucial first step to making this transformational change.

Rethinking Infrastructure as a Public Health Imperative

Traditionally, discussions about air pollution solutions have focused on vehicular emissions, industrial output, and crop burning. While these remain critical fronts in the fight for cleaner air, they overlook an equally powerful intervention: the way we design, construct, and operate our buildings.

The vast majority of Indians spend more than 90% of their time indoors. Yet, indoor air quality in homes, offices, schools, and hospitals often remains an afterthought in policy conversations. While the COVID-19 pandemic revealed that without good ventilation pushing pollutants outside, or diluting them with cleaner air, indoor air pollution and subsequent health complications for building occupants can pile up, managing indoor air quality remains tricky. This is not only because indoor air is more reactive due to limited airflow and the ripe environment for harmful chemical reactions, but also because different rooms have different uses, pollutants, and capacity for effective ventilation. And despite evidence that indoor pollution levels can be two to five times higher than outdoor levels in poorly ventilated buildings, we continue to perpetuate this silent but curable  crisis — a crisis with workers, students, and families inhaling a toxic cocktail of VOCs (volatile organic compounds), fine particulate matter, and other pollutants.

“India’s air pollution crisis has already stolen years from millions of lives. Without urgent intervention, it will steal millions more.”

While the technology to address this problem already exists, widespread adoption remains sluggish. High-efficiency particulate air (HEPA) filters, electrostatic purifiers, and dedicated outdoor air systems (DOAS) have been proven to cut indoor air pollution significantly. Smart sensors powered by AI and machine learning can track real-time air quality and autonomously adjust ventilation and filtration systems. We can and must act on the data from studies revealing that green buildings incorporating these technologies can reduce Sick Building Syndrome symptoms, lower absenteeism, and improve cognitive performance, which are all key indicators of public health and economic productivity.

India’s air quality policies, including the National Clean Air Programme (NCAP), have largely overlooked indoor air quality as a regulatory priority. Most urban construction still follows outdated norms that prioritize cost savings over long-term health benefits. But with systemic incentives such as tax breaks for green-certified buildings, mandatory indoor air quality benchmarks in the National Building Code, and performance-based subsidies for air filtration systems, India can opt to  build structures that alleviate rather than entrench its pollution crisis.

Net Zero Buildings as the Future of Urban Health

The concept of net zero buildings is often framed in the context of climate resilience. But their potential as public health tools is just as compelling. A well-designed net zero building does not merely reduce its carbon footprint; it also prioritizes indoor air quality, thermal comfort, and occupant well-being as core design principles.

Research comparing conventional buildings with environmentally optimized or sustainably designed structures has consistently shown lower levels of indoor air pollutants such as PM₂.₅ and PM₁₀. All of these structures recorded reduced incidence of respiratory illnesses and allergic reactions among occupants and fewer cases of Sick Building Syndrome and associated productivity losses.

Perhaps the most compelling case study comes from Delhi, where Kamal Meattle, an entrepreneur diagnosed with severe lung impairment, transformed his office into a clean-air haven by integrating plant-based filtration systems and optimized ventilation. The results were profound: a 34% drop in respiratory illnesses among occupants, a significant reduction in air-pollution-related medical symptoms, and a model for how urban spaces can be reimagined as health-protective environments rather than risk factors.

However, for India to scale these solutions, we must start by recognizing that when we scale the adoption of green buildings — and particularly those with a focus on transforming indoor air quality — we’re not just making individual spaces better. We’re raising the standard of living for entire communities. We can do this by dismantling key net zero building barriers such as high upfront costs, fragmented regulatory standards, and a lack of skilled professionals trained in health-centric building design. In addition, we can implement at scale emerging indoor air quality technologies like ultraviolet photocatalysis (UV-PCO), biophilic design that includes city trees and living walls functioning as natural air filters and circulation boosters, and AI that analyzes data and optimizes indoor air quality settings in real time.

The Role of Policymakers: A Health-First Approach to Urban Development

India stands at a crossroads. We can either continue treating air pollution as a seasonal crisis with reactive measures like temporary bans and fines or embed public health into the core of urban planning, or we can embrace a systemic shift, including integrating health-driven policies into building regulations and infrastructure investments. 

In addition to leveraging smart building technologies such as AI-powered air sensors and predictive analytics, updating the National Building Code with mandatory indoor air quality thresholds, and introducing financial incentives such as green bonds, tax rebates, and blended finance models, we need education on a collective scale. Public awareness remains a critical gap; large-scale educational campaigns can help individuals recognize the direct link between air quality and long-term health, empowering them to demand better housing, schools, and workplaces. A comprehensive, health-first approach would accelerate the adoption of healthier buildings without overburdening developers.  

Way Forward

India’s air pollution crisis has already stolen years from millions of lives. Without urgent intervention, it will steal millions more.

But if we abandon reactionary leadership for deliberate, systemic transformation, the buildings we construct today can determine a promising public health trajectory for the next generation. The fact is that better building leads to better lives — and if we seize this moment, if we recognize net zero buildings as frontline public health tools and integrate air quality into every level of urban planning, we can turn the tide today and take that foundational step toward a healthier India and world.

*The views shared by the author are his own.

**This article was first published in the May 2025 edition of BioVoice eMagazine.