Environmental challenges such as air pollution, water contamination, and waste management are not just ecological issues; they are deeply intertwined with public health crises, particularly for individuals with chronic conditions. In India, where the air quality index often crosses hazardous levels and access to clean water remains a struggle, the health impacts are both severe and under-researched.
These environmental crises not only impact the general population but disproportionately harm vulnerable groups, including those with chronic illnesses. While the government acknowledges the problem, systemic action and comprehensive data remain lacking, leaving many to grapple with worsening health conditions.
In light of these challenges, we recently spoke with Dr. Urvashi Prasad, Former Director at Niti Aayog and a public health professional, writer, and cancer survivor.
Having navigated the dual battle of chronic illness and Delhi’s toxic air, Urvashi brings unique insights into the intersection of environmental pollution, health, and policy. Through her experiences and expertise, she highlights the urgent need for robust action to address these escalating crises.
Q: Today, when we talk about environmental issues such as waste management, air pollution, and water crisis, how do you think they impact people with chronic health conditions?
Urvashi: Environmental pollution plays a significant role in both the development and worsening of acute and chronic health conditions. Emerging research highlights air pollution, food contamination, and water pollution as major contributors to these issues. While extensive evidence exists globally, research in India is still catching up. The government recently stated in a Parliamentary response that there is no “concrete evidence” linking air pollution to specific illnesses, but this largely reflects the inadequacy of official systems to collect and analyze such data.
It’s true that diseases like cancer are multifactorial, making it difficult to attribute them to a single cause. However, evidence can and must be generated systematically. For example, studies already suggest that rising cases of lung cancer in non-smokers are often linked to air pollution. I can personally attest to this: as someone who developed lung cancer despite being a young, fit, non-smoker, a doctor at AIIMS confirmed that they are seeing an increasing number of such cases, with air pollution identified as a significant factor.
While anecdotal evidence from doctors in panels and conferences is valuable, it’s insufficient. We need this information to be documented and shared systematically. It took decades to establish the link between smoking and cancer. Similarly, with the sophisticated tools available today, we need to start generating robust data that leaves no room for whataboutery or blame-shifting between governments. The medical community, too, has a critical role to play by putting out strong, unified statements to emphasize the urgency of addressing air pollution.
For individuals with chronic health conditions, extreme air pollution exacerbates vulnerabilities, triggering infections and worsening existing health issues. Delhi’s extreme AQI levels, which sometimes exceed the scale’s cap of 500 and have reportedly reached 1600, are a case in point. Such conditions demand immediate action, as the health impacts are undeniable and growing by the day.
Q: Being a cancer survivor, what has been your experience of dealing with Delhi's toxic air? How has this problem evolved for you over the years?
Urvashi: Over the years, dealing with Delhi’s toxic air has been increasingly challenging. Air pollution often goes unnoticed until a major event brings it into focus. Despite my background in public health, I initially treated it like many others—business as usual. Most residents don’t take even basic precautions, such as wearing masks, during severe pollution levels. This year, with AQI levels off the charts, I had to take additional measures like wearing an N95 mask and using a personal air ionizer.
As we approach the smog season, I’ve become more cautious. The seriousness of air pollution becomes apparent when directly affected, which is why I actively speak out, urging people to take it seriously. However, government statements claiming a lack of evidence linking pollution to health issues perpetuate complacency. This dismissive attitude is reflected politically, where air pollution rarely becomes an election issue.
I’ve lived in Delhi during years of steadily deteriorating air quality. While I can’t conclusively attribute my cancer to pollution, it likely played a significant role. The greater tragedy lies in its impact on children, whose organs and immune systems are still developing. Exposure to air pollution equivalent to smoking 50 cigarettes a day can lead to lifelong health issues like asthma and compromised immunity.
While some families have moved out of Delhi to protect their children, such options are only available to the privileged. The poor, who lack the resources to escape, bear the worst effects. This disparity highlights the urgent need for systemic solutions. Unfortunately, the invisible nature of air pollution means many don’t perceive its dangers until it’s too late.
The attitude of seasonal tolerance—assuming air quality will improve after a few months—prevents long-term solutions. Addressing air pollution is possible, but it requires strong political will and collective action. In a democracy, public demand during elections is crucial to bring such issues to the forefront. Until then, the cycle of inaction and recurring health crises will persist.
Q: You have written quite often about the mental health crisis in India. How do you think climate change is impacting our mental health and wellbeing? What is needed to address the impacts of climate on mental health?
Urvashi: The connection between climate change and mental health is underexplored, yet it is a critical issue. To address it effectively, we first need comprehensive data, particularly from local communities in disaster-prone areas. Climate-induced events like floods, cyclones, extreme heat, and irregular rainfall are increasingly affecting mental health, but we also need to consider more subtle, ongoing changes.
Understanding these impacts requires looking at both visible disasters and the long-term shifts that may go unnoticed. The effects vary based on gender, disability, age, and socioeconomic vulnerabilities. For example, a person with a disability or a child would experience a climate-induced disaster differently from others, which necessitates a tailored approach.
Collecting disaggregated data is crucial for developing targeted solutions. Civil society organizations, especially those operating at the grassroots level, are well-positioned to collect this data. A collaborative effort with standardized research tools, including structured questionnaires and open-ended discussions, could offer deeper insights into how different groups experience climate change.
Relying solely on the government for data collection and intervention design is unrealistic, given the challenges states face. Civil society must step in to fill this gap, ensuring that research and interventions address the unique needs of vulnerable populations. Without this foundational work, policies risk being ineffective or limited to specific regions.
Q: Do you think that the lived experiences of persons/communities can play a key role in policy design and implementation? How can we ensure that lived experience is integrated with the policy development process in India?
Urvashi: Early in my career, while working on water and sanitation projects in urban slums, I realized the crucial role local communities play in identifying solutions once they understand the need for change. This highlights the importance of community ownership and engagement, which are vital for the success of any intervention. Unfortunately, in India, there is often tokenism when involving communities in policy processes, with limited engagement that lacks real impact.
India’s complex governance structure, spanning central, state, and local levels, makes it challenging but not impossible to integrate lived experiences into policy. Each state has its own unique socio-economic and cultural context, further complicating the process. For instance, when designing cancer care policies, it’s essential to include diverse inputs from patients of different socio-economic backgrounds, genders, and stages of the disease to ensure policies address the full range of challenges.
Decision-making often excludes the very groups that policies aim to serve, such as male-dominated panels discussing issues like menstruation, breastfeeding, or pregnancy. Policymakers, many of whom lack domain-specific expertise, must actively seek input from communities to craft interventions that truly reflect ground realities.
To institutionalize this approach, structured consultations with affected stakeholders should be mandated during policy design, and periodic feedback mechanisms should be implemented during the execution stage. Collaboration with civil society organizations can also help bridge the gap between policymakers and grassroots realities. Additionally, representation on decision-making panels must reflect the diversity of the population, particularly marginalized or underrepresented groups. Sensitization and participatory training for policymakers are essential to ensure they value lived experiences as a vital component of effective policy.
Without these measures, policies may become detached from the realities they aim to address, leading to ineffective solutions. Meaningful progress requires humility, inclusivity, and a commitment to valuing lived experiences, ensuring policies are both sustainable and impactful in India’s diverse landscape.
Rishabh Shrivastava is a researcher and writer working on issues of law, policy and development.
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