Elucidating the changing particulate matter pollution and associated health effects in rural India during 2000-2019.

Atmospheric pollution is a serious problem in many countries, including India, and it is generally considered as an urban issue. To fill the knowledge gap about particulate pollution and its adverse health effects in rural India for well-informed region-specific policy interventions, we present new insights on the rural pollution of India in terms of PM. Here, we analyse PM pollution and its associated health burden in rural India using satellite and reanalyses data for the period 2000-2019. We observe a gradual and consistent rise of atmospheric pollution in rural areas of India. The highest PM levels are observed in Indo-Gangetic Plain (IGP) during winter and post-monsoon seasons (107.0 ± 17.0 and 91.0 ± 21.7 μg/m, respectively). A dipole reversal in seasonal trends between winter and post-monsoon seasons is found for black carbon (BC) and organic carbon (OC) in the rural IGP. The rural North West India (NWI) experiences elevated PM concentrations due to dust storms, while the rural hilly region (HR) in the Himalaya remains the least polluted region in India. The highest PM associated cardiopulmonary mortality in 2019 is observed in the rural IGP districts (1000-5100), whereas the highest mortality due to lung cancer at district level accounts for 10-60 deaths. The highest mortality attributed to PM is observed in districts of Uttar Pradesh, Bihar, West Bengal, Punjab, Haryana and Rajasthan. The priority-wise segregation of states as per World Health Organisation (WHO) Interim targets (ITs), as assessed in this study, might be helpful in implementation and development of policies in phases. We, therefore, present the first detailed study on the PM pollution in rural India, and provide valuable insights on its distribution, variability, sources and associated mortality, and emphasize the need for addressing this issue to protect public health.