What the air-pollution advisory from India’s health ministry hides

As winter in North India arrives with a persistent sting in the throat, the Union Health Ministry has issued an advisory to states and Union territories on air pollution. It explains who is most at risk, how hospitals should prepare and what the public ought to do.

On the face of it, it may simply seem like a routine governmental circular. However, on closer examination, it tells a deeper story about how the Indian state imagines health, risk and responsibility.

The document defines key pollutants, lists vulnerable groups and explains India’s Air Quality Index, It points to early-warning systems and app and tells health systems how to prepare for the seasonal spike in respiratory diseases.

It attaches model messages for social media and advisories for schools and construction sites, quietly revealing that the Indian state likes to govern health crises through advisories, invocations of behavioural change and through an alliance of experts and bureaucrats that rarely has to sit in the same room as those who live with the consequences.

The document walks through each level of the Air Quality Index, highlight what symptoms might worsen and suggests what is to be done at each step. It directs state health authorities to the Sameer app which provides provides hourly updates on the National Air Quality Index and to early-warning systems that forecast pollution levels a few days in advance. States are told to watch the AQI numbers and to prepare health facilities accordingly. Individuals are told to change their behaviour.

The advisory acknowledges that economically disenfranchised families using biomass for cooking, people who sweep streets or work at construction sites and people who live in cramped, poorly ventilated housing are more exposed and therefore more at risk. Yet, when it comes to recommendations, the burden of protection falls on individuals and households.

It recognises that a worker on a construction site is exposed to dust all day. It suggests masks and health check-ups, but it does not directly tie this to labour law and workplace safety regulation. Vulnerability is acknowledged, but responsibility is quietly shifted downwards.

The advisory asks states to integrate air-pollution risks into climate and health action plans, to designate sentinel hospitals to track pollution-related illness, to prepare facilities for seasonal spikes, and to strengthen respiratory care. This framing reveals the limits of how the health system is being imagined.

Health facilities and staff are framed as responders. They monitor, they treat, and they counsel. However, if the health sector only adapts without becoming a strong institutional voice against polluting industries, weak enforcement and inequitable urban planning, then the underlying drivers of the crisis remain intact.

The advisory sketches a political arrangement in which decisions about air, health, and risk sit firmly in the hands of a small circle of ministries and expert institutions, while everyone else is asked to adjust their lives around those choices.

There is a quiet bargain on offer, with the state giving citizens more information, more warnings and more advisories. In return, citizens are expected to accept that this is how the situation is for now. This is a system that is learning how to live with chronic harm rather than insisting that such harm is intolerable and more importantly, avoidable.

The advisory’s language of solidarity and cooperation, that “…together, we can work towards a healthier, cleaner and more resilient ecosystem…”, hides the fact that people are not equally placed in this crisis.

A family with multiple air purifiers and a worker who must sweep a main road early morning in December do not share the same choices. Yet the advisory speaks to them almost in one breath. That is where the politics lies: in presenting unequal exposure as if it were a shared, neutral condition, while the arrangements that made the air toxic in the first place stay largely untouched.

What would it mean for the state to respond differently?

It would mean taking the advisory’s recognition of vulnerable groups and following that logic all the way through. If certain segments of the population are at higher risk, then minimum standards for workplace safety, labour protections and access to clean cooking fuels have to become central to air-pollution policy.

The health ministry’s own advisory could explicitly demand that other ministries and state departments act on this evidence, rather than simply stopping at awareness.

It would also require the state and the scientific community to engage with these vulnerable groups as partners to map exposure and think through solutions. Imagine health advisories co-written with those who endure the worst of bad air.

None of this is easy. It is slower than issuing an advisory. But it is also more in line with the idea of a democratic health system that sees people as citizens whose knowledge and experience matter.

I live with chronic obstructive pulmonary disease, the kind of chronic breathlessness that does not wait for a “severe” AQI day to show up. It sits in the chest like a tightness that can be managed and worked around on most days until the air changes.

It is a strange thing to be writing about a public health concern and, at the same time, being reduced to a statistic on an advisory. So, when I read an advisory that tells people like me to “stay indoors” on very polluted days, or to “avoid exertion”, there is a quiet helplessness at play.

There are days when it feels as if the responsibility for survival has been passed down to those of us with broken lungs.

There is still, however, the possibility that our shortness of breath can be a starting point for demanding a politics of air that is less about enduring and more about changing the conditions that made breathing this hard in the first place.

Rishabh Kachroo is an independent researcher working on the public understanding of science and the larger knowledge politics questions that surround it.