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Why is India worst in the world for environmental health?

India’s environmental performance is one of the worst in the world. On environmental health, it’s the worst.

A global index places India 177th place in a list of 180 countries ranked on their environmental performance. Only the Democratic Republic of the Congo, Bangladesh and Burundi place lower.

The Economic Performance Index (EPI) measures rankings against 24 indicators across ten categories. These are grouped into two policy objectives: environmental health and ecosystem vitality. On ecosystem vitality, India ranks 140th. On environmental health, India is bottom of the list. 

‘The leading environmental threat to public health’

Poor air quality is ‘the leading environmental threat to public health’ according to the EPI. India’s rank on air quality is far from ideal. It comes in at 178th place – third from the bottom, just ahead of Bangladesh and Nepal.

Pollution is the main driver of India’s poor air quality. Air pollution in India causes 1.1 million deaths every year. Multiple Indian cities are among the most polluted in the world. Gwalior in Madhya Pradesh and Allahabad in Uttar Pradesh are the second and third most polluted respectively. Two other Indian cities – Patna in Bihar and Raipur in Chhattisgarh – also place in the top ten.

The strain of economic growth

The EPI identifies India as a country whose low score ‘[reflects] the strain rapid economic growth imposes on the environment.’ India has industrialised rapidly in recent decades. This has grown the country’s economy. However, it also means Indian emissions of carbon dioxide have increased by 1,041 percent since 1971. This has led to pollution at a considerable cost to public health.

Smog pictured over Connaught Place in New Delhi. Image credit: Ville Miettinen [CC BY 2.0 (, via Wikimedia Commons
Air pollution in Delhi (the world’s eleventh most polluted city) made global headlines last year as toxicity levels in the atmosphere soared. This caused the Indian Medical Association (IMA) to declare a public health emergency in the national capital.

Air pollution is far from being urban India’s problem alone, however. Those in rural communities suffer roughly equal exposure to fine particulate matter in the air as their urban counterparts. They also shoulder a disproportionate number of the deaths. Seventy-five percent of India’s pollution-related fatalities occur in rural areas.

Water and sanitation

India’s environmental health crises are not just measured with regards to air pollution and air quality. India’s low ranking also factors in water and sanitation, where it ranked 145. An improvement from its score last year, it is still the lowest score of any of the BRICS countries and one of the lowest of the Indian subcontinent.

Copyright: ggfoto / 123RF Stock Photo
A rural indian toilet in Puttaparthi, Andhra Pradesh.

The Indian government has introduced several measures to improve sanitation coverage in recent years, most notably the Swachh Bharat (Clean India) initiative. However, the effectiveness of the government’s response is a topic of debate.

A WaterAid report published last year claimed 732 million Indians lack access to a toilet. Whilst that report was justly criticised by the government over claims it used outdated data, the situation remains far from ideal. Almost 60 percent of toilets built under Swachh Bharat are unusable and 40 percent are not connected to a drainage system. On wastewater treatment, India ranks 175.

Heavy metals: ‘A concerning spike’

In heavy metals – the third indicator under environmental health – India secures the 175th rank. This put it ahead of just Sudan, Bangladesh, Pakistan, Haiti and Afghanistan. 

Heavy metals is another emerging health threat. As Kota Sriaj notes in an op-ed for The Daily Pioneer, ‘there has been a concerning spike in the level of heavy metals in our daily life.’ Heavy metals is another crisis which can be linked to India’s increasing industrialisation. The sources of heavy metal contamination are generally anthropogenic in nature (though natural causes can also play a role.)

Industrial activity can lead to water resources being polluted with harmful contaminants. India’s revered Ganges River is a prominent example of this. Such exposure can be highly hazardous to public wellbeing. There is a range of potential adverse health effects in both the short and long term.

As a case in point, several villages in Punjab are witnessing ‘a steady decline in sperm count, disturbed ovulation cycles, increasing menstrual disorders, sterility, spontaneous abortions, premature births and birth defects’ because of heavy metal toxicity. A number of villagers suffer from heart disease, skin cancer and liver failure. Children are especially vulnerable to health problems due to pollution from heavy metals, including increased rates of mental and neurological conditions such as autism. 

‘Just rankings’

A section of India’s Ganges river, pictured in Bihar. The river is bearing a burden of environmental pollution in the country.

‘These are just rankings,’ says environmental minister Harsh Vardhan of the EPI. This may be true. However, the rankings point toward major shortcomings in India’s response to the many environmental challenges it faces. Unless further action is taken, India could see pollution-related deaths each year triple by 2050.

Environmental health threats such as air and water pollution could lead to significantly higher rates of noncommunicable diseases such as cancer, respiratory issues and heart disease. At a time when lifestyle factors are already causing increased rates of NCDs, further strain from environmental factors would massively increase the burden on India’s public health systems.

The full EPI report can be accessed here.

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