Pathwaysfor India to Reduce Ambient Air PollutionHealth 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.