JAMBHALI, India – Farmer Kusum Gaikwad’s work start at 4 am daily. First, she burns the firewood and farm residue to heat water for 10 family members.  

By 7 am, she reaches the fields, manoeuvring through thousands of sugarcane plants, removing weeds, and checking for pests and diseases that could hamper their growth. This is followed by tremendous backbreaking labor, where she collects and lifts over 100kg of cattle fodder in the relentless heat. 

This has been her routine for the past two decades. But in 2017, Gaikwad started to get frequent headaches. Dizziness and severe pain in the chest and abdomen followed.

“It was unbearable, but I kept working for four months,” she says. Eventually, when it became difficult for her to even move out of bed, she consulted a doctor and was diagnosed with hypertension. 

She returned to the same routine within a week. Two years later, she was diagnosed with type 2 diabetes and also reported weakening of her bones. 

‘Mountains of smoke’

Perplexed, Gaikwad, now 66 years old, was determined to find the causes of her illnesses. When she went to the fields again in Jambhali village in India’s Maharashtra state, she met over 20 women who complained of similar symptoms.

“Everyone was coughing throughout the day, and that’s when I realized it was the air pollution,” she told Health Policy Watch.

Soon, Gaikwad found that almost every family in her village was burning at least 50 kg kilograms of firewood, agricultural residues, plastic bags, and seedling trays every day to heat water and cook food.

“Every morning, you can see a mountain of smoke here,” she says.

Over the years, a growing number of studies have found air pollution to be a risk factor for several noncommunicable diseases (NCDs), some of which include cardiovascular and respiratory diseases, heart attacks, and lower respiratory infections.

A paper published in 2020 analyzed the impact of air pollution on the health of 39,259 Chinese adults, finding that long-term exposure to air pollutants increased blood pressure and hypertension. 

Similarly, a study from India found that both short and long-term exposure to ambient PM2.5, fine particulate matter smaller than 2.5 micrometers that penetrate deep into the lungs, was associated with increased hypertension. 

In India, deaths from NCDs have increased from 38% of total mortality in 1990 to 62% in 2016.  The annual particulate pollution in India has increased by almost 68% from 1998 to 2021, reducing the average life expectancy by 2.3 years. 

Extreme heat exacerbates air pollution 

Rajakka Tasgave, 65, has become scared of going to the fields, something she has done for over five decades. 

“Every day, I see at least one woman collapsing because of the extreme heat. Someday, even I can be one of them,” she shared earlier this year. 

It didn’t take long for her turn, though. After collapsing in the fields in March, when the temperature topped 40 degrees Celsius in Jambhali, the doctor advised her to stop working in extreme heat. 

“From April to May, I didn’t step out of the house from 10am till evening,” she said. But this meant that she lost a significant chunk of her earnings as most of the farmwork happens during the day. 

Every day after returning from the fields, she experiences tremendous body aches. 

“Every week, I visit a doctor and take an injection (epidural steroid injection). Otherwise, I won’t be able to work.”

Alongside the unbearable heat, Tasgave frequently comes in contact with air pollutants from the nearby industries and firewood emissions. She has tried covering her face with the end drape of her saree, but that didn’t help. A few years back, she was diagnosed with chronic asthma. 

“If I forget to carry my inhaler, I will die of an attack,” she confides.

During extreme heat, her asthma becomes unbearable. She became breathless in May this year when the night temperatures didn’t drop as normal. 

“With no one to take me to the hospital, I leaned against the wall in the hope of easing my pain,” she shares. She found relief only the next day when a doctor administered medicines. 

Heart attacks and pulmonary diseases

Researchers have stepped up efforts to understand the combined effects of air pollution and extreme heat in the past few years. In one such paper published in Environment International, they investigated the impact of heat and air pollution on mortality in 36 countries.

The study found that heat-related mortality also increased with higher levels of air pollutants like PM, NO2, and O3. Moreover, they also saw an increase in PM—and O3-related mortality for higher air temperature levels. 

Extreme temperatures and higher concentrations of particulate matter significantly increase the risk of heart attacks, according to a study published in the American Heart Association’s journal, Circulation. 

The researchers examined 202,678 heart attacks from China’s Jiangsu province between 2015 and 2020. Also, they found that during extreme heat, women were at a greater risk of heart attack than men. 

In the presence of rising temperatures and high solar radiations, volatile organic compounds react with nitrogen oxides to form ozone, considered a harmful pollutant in the lower atmosphere. Ozone exposure can lead to respiratory infections.

As a result, many people from Jambhali are now suffering from chronic obstructive pulmonary disease (COPD), which restricts the airflow and causes breathing issues. The problem is so severe that this year’s State of Global Air Report found that 50% of global ozone-related COPD deaths were reported in India. 

Anxiety and stress rise with air pollution

Jambhali’s community healthcare worker Kamal Kore was always curious about why people like Gaikwad, Tasgave and many others have felt anxious and stressed over the past five years. 

“Year after year, the number of people complaining of anxiety and stress disorders has risen. A few cases had even culminated in cardiovascular ailments and deaths,” she says. 

After tracking over a thousand such cases, she found that, as air pollution increased, so did the number of people suffering from mental health issues.

Her observation isn’t a one-off case. A study published in April 2024 looked at more than 3,000 US counties, spanning over 315 million people, and found PM2.5 to be linked with depression and stress. These mental health issues, in turn, put people at risk of dying from cardiovascular diseases.

Its lead author, Dr Shady Abohashem of Massachusetts General Hospital, explains, “Biologically, PM2.5 can enter the bloodstream and induce systemic inflammation, oxidative stress, and neuroinflammation, all known to affect brain function and mood regulation.” 

The combined effect of PM2.5 and deteriorating mental health amplify the risk of premature cardiovascular mortality. 

“High PM2.5 exposure leads to systemic inflammation and endothelial dysfunction, critical factors in the development of cardiovascular diseases. When combined with poor mental health, which independently contributes to adverse cardiovascular outcomes through mechanisms like heightened stress response, disrupted sleep, and poor health behaviors, the risk is significantly magnified,” Abohashem explains. 

Air pollution disrupts sleep, causes depression

So severe was the impact that in counties with higher levels of PM2.5, people struggling with poor mental health experienced a threefold rise in premature cardiovascular mortality compared to those with better mental health in areas of lower pollution.

The problem isn’t restricted to the outdoor workers. Besides crop residue burning and industrial pollution, another source of PM2.5 is indoor air pollution caused by burning firewood. Many Indian families still rely on burning firewood for cooking. 

A study from India published in BMC Geriatrics this year found that indoor pollution led to sleep disorders and depression among older adults.

“Ambient air pollutants can travel from the nose through the olfactory nerve and reach crucial brain areas like the striatum, frontal cortex, and cerebellum, which are involved in various functions including movement, decision-making, and coordination,” says one of its authors, Dr Aparajita Chattopadhyay, a professor at the International Institute for Population Sciences in Mumbai. 

These pollutants trigger an inflammatory response which can lead to changes in the levels of neurotransmitters and, hence, disrupt an individual’s sleep and mood. 

“Sleep plays an important role in maintaining good health, failing which NCDs, including mental health issues, may crop up,” she adds. 

 Limited air quality warnings

The health problems caused by air pollution are mounting, as evident from community health worker Kamal Kore’s call records. The past five years have sent a jump in health issues – largely NCDs, especially since the temperature started rising rapidly. 

 “Every day, I get at least 10 calls from the villagers with complaints of cardiovascular and respiratory issues,” she shares, adding that she now spends most of her time making people aware of the harmful effects of air pollution.

 “Every day, I tell people to switch to clean energy sources for cooking and work during the hours when the pollution is comparatively lesser,” she says. 

“We don’t have any resources to deal with this.” 

A major problem healthcare workers like her face is the lack of adequate, real-time data on air pollution to warn patients about peaks. People currently simply observe the times of day when air pollution becomes severe and try to avoid these.  

Gaikwad’s husband, Narayan Gaikwad, 77, has written several letters to the district authorities demanding strict measures to curb air pollution. 

“People don’t understand how much unhealthy air they are breathing because there’s no one monitoring air pollution in the village,” he says. “I am now asking people to stop working during those hours.”. 

Chattopadhyay suggests that older people avoid major sources of indoor air pollutants, ensure proper ventilation, and use clean fuel.

 “A positive and strong social circle is also necessary to be mentally fit. Adults must be made aware of cues of contentment in life much before they get old — financial stability,  strong social circle, and remaining active daily in various tasks,” she adds. 

Given Gaikwad’s declining health, her family is considering a solar water heating system despite its crippling cost. 

While this will help her somewhat, she is worried about the smoke from the neighborhoods. “A solution can never work in isolation. It has to happen at the community level,” she warns.

Image Credits: Sanket Jain.