Pakistan's Air Quality Crisis: A Public Health Challenge

Pakistan’s air quality crisis has reached an alarming and persistent level, placing the country among the most polluted nations globally. According to the IQAir 2024 World Air Quality Report, Pakistan ranked third out of 138 monitored countries, underscoring the severity and systemic nature of the problem (IQAir, 2024). The national annual average concentration of fine particulate matter (PM2.5) was recorded at levels approximately 14.7 times higher than the World Health Organization’s recommended guideline of 5 µg/m³, indicating that a vast majority of the population is chronically exposed to hazardous air pollution (WHO, 2021). Such prolonged exposure poses serious risks to respiratory and cardiovascular health, productivity, and overall quality of life.

The burden of air pollution is disproportionately concentrated in urban and industrial centers. Lahore, the provincial capital of Punjab, emerged as Pakistan’s most polluted city in 2024, registering an Air Quality Index (AQI) of 184, well within the “unhealthy” category (IQAir, 2024). Other industrial hubs, including Gujranwala and Faisalabad, have consistently recorded PM2.5 concentrations exceeding 100 µg/m³, reflecting the combined impacts of vehicular emissions, industrial activity, brick kilns, and seasonal agricultural burning. In contrast, relatively less industrialized regions such as Mohmand Agency in Khyber Pakhtunkhwa reported significantly cleaner air, highlighting stark regional disparities driven by population density, industrial clustering, and energy use patterns.

Historical trends suggest that progress has been uneven and fragile. While a temporary reduction in national PM2.5 levels was observed between 2018 and 2019, this improvement has not been sustained uniformly across cities. Karachi experienced worsening pollution during this period, whereas Lahore achieved a notable reduction, albeit from extremely high baseline levels. Compounding the crisis is the complex mixture of pollutants in urban air, including nitrogen dioxide, sulfur dioxide, volatile organic compounds, black carbon, and toxic residues from waste burning. Together, these pollutants amplify health risks and contribute to climate warming, reinforcing the urgency for coordinated policy, regulatory enforcement, and cleaner energy transitions.

Primary Pollution Sources and Structural Drivers of Air Quality Degradation in Pakistan

The persistent deterioration of air quality in Pakistan is the result of multiple, interlinked pollution sources that reinforce one another and complicate mitigation efforts. Among the most significant contributors are vehicular emissions, which remain a year-round and growing problem in all major urban centers. A large proportion of Pakistan’s vehicle fleet consists of aging, poorly maintained cars, buses, and motorcycles that operate on low-quality fuel. Combined with chronic traffic congestion and limited public transport options, these conditions lead to continuous emissions of fine particulate matter (PM2.5), black carbon, nitrogen oxides, and carbon monoxide, substantially degrading urban air quality (IQAir, n.d.).

Industrial emissions further intensify pollution, particularly in manufacturing hubs such as Faisalabad, Gujranwala, and parts of Lahore. Many factories, steel re-rolling mills, and brick kilns operate with outdated technologies and minimal regulatory oversight. The widespread use of coal, furnace oil, and biomass fuels results in high emissions of particulate matter, sulfur dioxide, and heavy metals, creating localized pollution hotspots that often affect nearby residential areas (IQAir, n.d.). Brick kilns are a major source of black carbon, contributing both to public health risks and localized climate warming.

Seasonal agricultural practices also play a critical role. The open burning of crop residues after harvest, especially in Punjab, leads to sharp pollution spikes during winter months. This practice coincides with meteorological conditions such as temperature inversions, which trap pollutants close to the ground and intensify smog episodes in major cities. Urban and construction dust adds a chronic layer of particulate pollution, driven by rapid urban expansion, unpaved roads, and weak enforcement of dust control regulations. Finally, the widespread practice of open waste burning releases highly toxic pollutants, including dioxins and furans, further compounding health risks.

The interaction of these sources creates a cumulative and self-reinforcing pollution cycle. Evidence from COVID-19 lockdowns, when industrial and transport activity declined sharply, demonstrated that air quality improvements were both rapid and reversible, underscoring the dominant role of anthropogenic sources in Pakistan’s air pollution crisis (IQAir, n.d.).

Public Health Impacts of Air Pollution in Pakistan: Morbidity, Mortality, and Systemic Burden

The public health consequences of prolonged exposure to Pakistan’s polluted air are profound, multifaceted, and place sustained pressure on an already constrained healthcare system. Fine particulate matter (PM2.5), due to its extremely small size, poses the most significant health risk. These particles penetrate deep into the alveolar regions of the lungs, bypassing the body’s natural defense mechanisms and triggering chronic inflammation (IQAir, n.d.). As a result, Pakistan has witnessed a high and growing prevalence of respiratory diseases, including aggravated asthma, chronic bronchitis, recurrent pneumonia, and the progressive development of Chronic Obstructive Pulmonary Disease (COPD). Children are particularly vulnerable; early-life exposure to air pollution is associated with impaired lung growth, increased frequency of respiratory infections, and a higher likelihood of developing asthma that persists into adulthood.

The health impacts of air pollution extend well beyond the respiratory system. Ultrafine particles and associated toxic compounds can translocate from the lungs into the bloodstream, initiating systemic inflammation and oxidative stress (IQAir, n.d.). This process significantly elevates the risk of cardiovascular diseases, including ischemic heart disease, myocardial infarction, strokes, and cardiac arrhythmias. Emerging evidence also links chronic air pollution exposure to metabolic disorders and damage to vital filtering organs such as the liver and kidneys, as these organs are continuously exposed to circulating pollutants and heavy metals.

Acute smog episodes further exacerbate these risks. During periods of severe air pollution, hospitals across major cities report sharp increases in emergency visits and admissions for respiratory distress, chest pain, and other pollution-related complications. These episodic surges strain healthcare facilities and increase public and private healthcare expenditures. Over the long term, the cumulative health burden manifests in reduced life expectancy. The World Health Organization estimates that ambient air pollution causes approximately seven million premature deaths globally each year, with countries experiencing persistently high PM2.5 levels, such as Pakistan, bearing a disproportionate share of this burden (WHO, 2023). Sustained exposure to polluted air can shorten average lifespans by several years, particularly in densely populated urban and industrial regions (WHO, 2021).

Current Mitigation Efforts and Future Pathways for Improving Air Quality in Pakistan

In response to the escalating air pollution crisis, Pakistani authorities, civil society organizations, and development partners have initiated a range of mitigation measures. While these efforts signal growing recognition of the problem, their scale, consistency, and enforcement remain insufficient to generate sustained improvements in air quality. Existing interventions have produced localized and short-term gains, but a more comprehensive and systemic response is required to reverse current trends.

Regulatory and monitoring initiatives form the backbone of current mitigation efforts. Provincial governments have introduced air quality monitoring stations and notified fuel quality and emission standards. However, weak enforcement, limited monitoring coverage, and widespread industrial non-compliance undermine their effectiveness. Expanding real-time, publicly accessible air quality monitoring networks and strengthening regulatory oversight particularly for industrial emissions and vehicular standards are essential to improve accountability and inform evidence-based policymaking.

Technological responses have also been deployed, most notably the use of anti-smog guns in urban centers during peak pollution episodes. While these interventions may temporarily suppress airborne dust and particulates, they do not address the underlying sources of pollution and offer limited cost-effectiveness. A more sustainable pathway lies in source control, including the adoption of cleaner industrial technologies, conversion of brick kilns to zigzag designs, improved fuel quality, and mandatory installation of emission control devices on vehicles and factories, in line with World Health Organization recommendations (WHO, 2021).

Public awareness initiatives led by non-governmental organizations and media outlets have increased understanding of health risks associated with air pollution. However, their reach remains fragmented. National-scale awareness campaigns, delivered in multiple local languages and integrated into school curricula, could foster behavioral change and build long-term public support for clean air policies.

Nature-based solutions, particularly tree plantation drives, have been widely promoted but face limitations due to long maturation periods and poor survival rates. Greater emphasis should be placed on protecting existing urban forests and developing large-scale green belts around cities to achieve more durable air quality benefits.

At the policy level, provincial smog action plans exist but suffer from weak coordination. Developing an integrated national clean air action plan, supported by subsidies for crop residue management, incentives for public transport, and alignment across energy, transport, agriculture, and industry, offers a more coherent path forward (WHO, 2023). The modest improvements observed in cities such as Lahore and Faisalabad demonstrate that targeted interventions can yield results (IQAir, n.d.), yet Pakistan’s persistent ranking among the world’s most polluted countries underscores that incremental measures are inadequate. Meaningful progress will require structural transformation, robust legislation, and unwavering enforcement across all major pollution sources.

Conclusion

Pakistan’s air quality crisis represents a critical intersection of environmental degradation, public health risk, and economic loss. The persistently high concentrations of PM2.5 and other harmful pollutants are not episodic anomalies, but symptoms of deep-rooted structural challenges linked to transport systems, industrial practices, energy choices, urbanization patterns, and agricultural methods. The evidence presented clearly shows that air pollution in Pakistan is both preventable and policy-driven, as demonstrated by temporary improvements during periods of reduced human activity and by localized gains where targeted interventions were implemented. However, the continued exposure of millions to toxic air highlights the inadequacy of fragmented and short-term responses.

Addressing this escalating crisis requires a decisive shift from reactive measures toward a comprehensive, source-focused, and nationally coordinated clean air strategy. Strengthening regulatory enforcement, expanding credible monitoring systems, and accelerating transitions to cleaner fuels and technologies must form the core of policy action. Equally important is the integration of public health considerations into environmental policymaking, recognizing clean air as a fundamental determinant of human capital, productivity, and long-term development. Without sustained political commitment, cross-sectoral coordination, and public engagement, Pakistan risks entrenching a cycle of poor health outcomes, rising healthcare costs, and diminished quality of life. Conversely, decisive action on air quality offers an opportunity to safeguard public health, enhance urban livability, and align Pakistan’s development trajectory with principles of sustainability and environmental justice.

References: IQAir; IQAir. (n.d.); WHO; World Health Organization.

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writers are affiliated with the Institute of Agricultural & Resource Economics, University of Agriculture, Faisalabad, Pakistan and can be reached at amjed.iqbal@uaf.edu.pk

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