Pathways for India to Reduce Ambient Air Pollution Health Burden and Achieve the Sustainable Development Goal (SDG-3.4)

Sustainable Development Goal 3.4 (SDG-3.4) aims to reduce non-communicable disease (NCD) mortality by one-third by 2030, compared to 2015 levels. First, we examined whether the National Clean Air Program (NCAP) is sufficient to allow India to achieve this target. Subsequently, we integrated GAINS-simulated sector-specific PM_2.5 concentrations across three pathways─business-as-usual (BAU), advanced control technology (ACT), and sustainable development scenario (SDS)─with the Global Burden of Disease framework to assess potential health benefits for 2030 at a subnational scale and evaluate the feasibility of accomplishing SDG-3.4. In 2015, ambient PM_2.5 attributable premature deaths were 0.72 million (95& UIs: 0.53-0.89), and an aggregated 0.12 million (0.08-0.16) deaths could be prevented if the NCAP target is met by 2026. However, states could reduce 3.6-10.8% of targeted NCD mortality by 2030 with a lagged 40% reduction in PM_2.5 levels relative to the baseline. PM_2.5-attributable deaths would change to 0.79 million (0.57-1.1), 0.76 million (0.6-1.1), and 0.63 million (0.48-0.81) in 2030 under the BAU, ACT, and SDS pathways, respectively. Implementing stringent emission controls through policy and technological interventions, primarily focusing on household and energy sectors, would reduce NCD mortality by 5-13% across subregions. Simultaneously controlling other risk factors would accelerate India's journey toward achieving SDG-3.4.