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I have spent my working life in public health, arguing that India must clean its air. I never smoked. At 35 I was diagnosed with lung cancer, the oncogene-driven kind that owes nothing to tobacco and everything to what a person breathes. I am not an exception. I am what Delhi's air now routinely produces: a non-smoker, a woman, much younger than the textbooks say this disease should arrive.
Lung cancer is now a breather's disease
For most of medical history, lung cancer meant a smoker. That is changing fast. At Tata Memorial Centre, Mumbai, 55% of lung cancer patients studied had never smoked, and the Indian Council of Medical Research projects more than 111,000 new cases a year. The subtype driving the shift, EGFR-mutant adenocarcinoma, is tied to polluted air, not tobacco, and appears most in non-smokers, in women, and in people a decade younger than the textbooks expect. My own survey of oncologists, presented at the Union for International Cancer Control's World Cancer Congress in Hong Kong this September, found the same from the front line: of 126 oncologists across 19 states and union territories, 86% reported lung cancer rising in young adults who have never smoked, 45% more often in women.
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The usual objection is that cancer has many causes, so you cannot blame the air. Cancer is almost always multifactorial, which is exactly why a carcinogen every one of us inhales for years is no footnote. In 2013 the World Health Organization's cancer agency placed air pollution in Group 1, the same category as tobacco. I was not supposed to get this disease.
What Delhi is breathing right now
You do not need a laboratory for this, only a November in Delhi. The city held out longer than usual this year, turning 'poor' only on 21 October, then slid fast: 'very poor' by 2 November, the 'severe' band within days as stubble smoke and Diwali arrived together. On 4 November the index hit 377, meaning a day's breathing did to your lungs roughly what ten cigarettes would. Newborns included.
Choking the city has become a flex
Every year the same argument arrives with the smoke: do not blame crackers. And every year it misses the point. No one serious claims firecrackers are the main source of Delhi's pollution; vehicles, industry, dust, power plants and crop fires do the bulk of it, all year round. But do crackers add to the violent spike on and after Diwali? Beyond doubt. Using a 2014 study in the journal Tumori, IndiaSpend measured the peak PM2.5 one firecracker throws into a closed room against a single cigarette. Here's what the results showed:
- Anar (flowerpot) = 34 cigarettes
- Laad (1,000-cracker string) = 277 cigarettes
- Snake (black snake pellet) = 464 cigarettes
Now look at Delhi's AQI on the night of Diwali and the morning after. Why has this become a flex, to burn more and more crackers through the night, louder and longer than the year before, as if a choking city were something to compete over? I am angry, and I have stopped pretending otherwise. It is not just governments that are failing Delhi. Citizens are failing it too, and frankly failing themselves and everyone forced to breathe beside them.
This is not about religion, and it is not about festivals. You can celebrate Diwali without setting a city's lungs on fire. The air a child breathes is not a cultural question but a biological one, and a right the Supreme Court has held to be part of the right to life. We should act as if we believe it, on Diwali night most of all.
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Why the city fails, winter after winter
So why does the same crisis return every year? Not for want of evidence or money. The response is the same each winter, brakes pulled in November and released by spring. The deeper failure is what we chose to measure. India has spent seven years and more than Rs 16,800 crore on the National Clean Air Programme (NCAP), built around the wrong things.
- The wrong particle: NCAP targets PM10, the coarse road and construction dust you clear with a broom and a water tanker. PM2.5, the fine particle from burning that actually kills, barely features. In seven years, it has set no target for health.
- The visible fight: About 67% of clean-air money went on road dust. Industry got roughly 1%, and biomass burning, linked to some 752,000 Indian deaths a year, also about 1%.
- Theatre: Rs 34 crore went on cloud-seeding that IIT Delhi calls ineffective, and on smog towers written off as cosmetic.
None of this persists for lack of knowing. The sources are mapped, the solutions known; what is missing is the will. In its place comes an annual blame game, between states, between the centre and the states, between city and farmer, that shifts with the wind and settles nothing. We still count no death from this air as it happens. The denial is no longer about the science. It is about who takes responsibility.
The cost is not a number on a dashboard
We have been trained to read this as an index, a figure that rises and falls and that we tune out. That is the trick of it. The cost was never the number; it is everything the number stands for.
- Lives. The Lancet Countdown attributes about 1.72 million Indian deaths in 2022 to human-made PM2.5, up 38% since 2010. In Delhi the air cuts an estimated 8.2 years off the average life. We are all dying prematurely here, only on different timelines.
- Money. The same report prices those deaths at about USD 339 billion in 2022, close to 9.5% of GDP, a hole in the economy, not a soft externality.
- Standing. 'Brand India' takes the hit every winter the world watches the capital disappear into grey. That image does more damage than any slogan can repair.
Delhi's yearly PM2.5 runs at about eighteen times the level the WHO calls safe, the gap between the air we have normalised and the air a body needs.
What has to change, and why I take it personally
NCAP has ended this year, and with winter closing in, no successor has been announced. Whatever replaces it must answer the question the programme never asked: is the air making fewer people ill? That means targets for lives saved and disease prevented, not dust removed, with funding tied to them; making PM2.5 what we measure and cut first; sending money where the disease is, not where the clean-up is easiest; and treating the air as one airshed, linking the pollution data we already collect to the hospital records we already keep.
I still go for my scans. I still do the work. When officials announce how far PM10 has fallen, I do not hear progress. I hear the wrong question answered. The one that matters, for me and for everyone breathing this air, is simpler: how many of us are still here, and how many get to stay.
By Urvashi Prasad is the Founder of PAVANA, the Centre for Air Pollution and Environmental Health. A public health and policy specialist and a former Director at NITI Aayog, she is a cancer patient-advocate and the author of the memoir Still Here.
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