India Is Dying of Dirty Air, Yet Accountability Is Missing, Says Lancet Editor

India’s worsening air pollution crisis is claiming lives on a massive scale, yet political accountability and public pressure remain alarmingly weak, according to Richard Horton, editor-in-chief of the medical journal The Lancet. Horton has described the Indian government’s response to air pollution as deeply troubling, arguing that the larger failure lies not only with policymakers but also with the absence of sustained public outrage.

Speaking in an interview, Horton said it was baffling that India, despite being a vibrant and vocal democracy, has not mounted a stronger societal response to a public health emergency that is silently killing millions. He contrasted India’s situation with China, which introduced sweeping policy measures after years of hazardous smog in cities like Beijing.

Horton questioned why India’s electorate has not forced air pollution to the top of the political agenda. He argued that democratic systems rely on public pressure to drive reform, yet pollution-related deaths continue without triggering widespread demands for change. According to him, voters must hold leaders accountable when basic conditions for healthy living are not met.

Concerns over the economic cost of pollution are also growing. At a recent global forum, a leading economist warned that air pollution poses a greater threat to India’s economy than trade or tariff-related challenges. Citing data from the World Bank, she noted that air pollution caused an estimated 17 lakh deaths in India in 2022 alone, underscoring the scale of the crisis.

Multiple international assessments indicate that nearly the entire Indian population is exposed to unsafe levels of fine particulate matter, especially PM2.5, which is considered the most harmful air pollutant. These particles penetrate deep into the lungs and bloodstream, increasing the risk of heart disease, respiratory illnesses, and lung cancer. Large parts of northern India frequently experience air quality index levels exceeding 400 during winter months, while major urban centres rarely record air quality within safe limits for extended periods.

Horton believes the gradual nature of pollution-related deaths is a key reason accountability remains elusive. Unlike accidents or outbreaks that cause immediate fatalities, air pollution acts slowly. Health damage accumulates over months and years, making it harder for the public to link cause and effect or demand urgent action.

He explained that exposure today may only manifest as serious illness one or two years later, allowing policymakers to delay decisions without facing immediate consequences. This delayed impact, Horton argued, creates a dangerous gap between responsibility and response.

Drawing comparisons with China, Horton recalled how severe pollution once made daily life in Beijing almost unbearable. Faced with mounting public health risks, Chinese authorities shut down polluting industries, restricted vehicular movement, and enforced stringent environmental regulations. The results, he said, are now clearly visible in dramatically improved air quality.

Horton stressed that India faces a similar choice. Without decisive policy action and sustained public pressure, pollution will continue to erode public health, productivity, and quality of life. He argued that clean air should be treated as a non-negotiable public good rather than a distant environmental goal.

While the Indian government has maintained that there is no single conclusive national dataset linking pollution directly to mortality, health experts insist the broader evidence is overwhelming. For Horton, the real question is not whether pollution is deadly, but why a democratic society is tolerating its consequences without demanding change.