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Will you drink a glass of water with visible contaminants if it is offered to you? The answer is a clear no. However, because we can’t see how dirty the air is, millions of people in India breathe contaminated air every single day. Leading health practitioners have been canvassing to have air pollution declared as a health emergency. The recent Air Quality Life Index (AQLI) released by the Energy Policy Institute at the University of Chicago (EPIC) rev-ealed that air pollution is likely to reduce the life exp-ectancy of about 40 per cent of Indians by more than nine years.

The link between air pollution and a variety of unfavourable health consequences is becoming increasingly clear, but its negative economic effect is less understood. In India, air pollution was responsible for 1.67 million fatalities in 2019, accounting for 17.8 per cent of the country’s total mortality, according to the Lancet Global Burden of Disease Report. The bulk of these fatalities (98 million) were caused by amb-ient particulate matter pollution and home air pollution (0.61 million). In India, economic costs due to premature mortality and sickness caused by air pollution amounted to US$28.8 billion and $8 billion, respectively, in 2019.

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The main issue is that we can’t perceive the intensity of air pollution with our naked eye, and we can’t always distinguish between haze, fog, mist or smog. Also, while it is important that we are aware about particulate matter (PM2.5 and PM10) and air quality index (AQI), we just can’t keep talking about them, because they are just jargon for the public, and only int-ellectualises the situation, causing us to lose touch with a campaign.

With this in mind, we began thinking about how we could best ‘show’ the people what they are inhaling, and what happens to their lungs when they inhale all of these harmful pollutants. While conceptualising this, we were also working towards the Clean Air Collective, for building a nationwide collaborative network of groups, individuals, and institutions working towards a shared agenda of a citizen-led campaign across cities with polluted air.

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The first appearance of the lungs billboard and, Clean Air Collective’s concept and debut are inextricably linked. On July 27, 2017, we had just finished our first-ever Clean Air Collective meeting, and thereafter, I was sitting at a restaurant in New Delhi with Avijit Michael, executive director of jhatkaa.org, discussing an idea that would grab people’s interest and attention. Most people believe that if you can’t see it, it doesn’t exist. We discussed a piece of art that would change colour depending on how filthy the air is. We had no idea it was going to be the lungs at the time. “Let me talk to an artist buddy of mine in Bangalore and get back to you,’ Avijit said at the end of our chat.

After speaking with an organisation called Think Happy Everyday, Avijit returned a few weeks later with the concept of ‘faux lungs that breathe’ and are equipped with filters and an exhaust fan. At that moment, the ‘Billboard that Breathes’ or what we popularly began calling the ‘lungs billboard’ was conceived as a one-of-a-kind campaign, which allowed people to ‘see’ the air. As a result, it is the most effective method for explaining the health impact of air pollution, since individuals can see it for themselves and even explain or demonstrate it to others physically. The prototype was created by a group called The Workshop in Bangalore, and the first installation happened on Bangalore’s Old Madras Road in February 2018. In 25 days, the lungs had become black.

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City Lights How fast the ‘lungs’ change colour in different places gives an idea of pollution levels.

Citizen groups and organisations like jhatkaa.org, Purpose, My Right To Breathe and the Lung Care Foundation worked together to bring the installation to Delhi in November of the same year at the Gangaram hospital. Everyone was shocked as it turned dark black in just six days! Since then, it has visited Gurgaon, Varanasi, Lucknow, Mumbai, Kharghar, Nagpur, and more recently Chandrapur and Ranchi in December 2021. ?

The use of such visuals is an essential way to increase awareness about finer particulates, and to paint a clear picture of how they affect the lungs. The influence must be felt by all stakeholders. The frequency of the installation’s changing colour was observed depending on the intensity of pollutants and the position of the lung billboard across cities. While regions with filthy air such as Delhi, Varanasi, Lucknow, Ranchi and Chandrapur required 6-8 days, the Mumbai Metropolitan Region took between 10 and 14 days due to natural features that helped reduce air pollution.

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In Mumbai, the campaign went a step further by splitting the ‘lungs’ into smaller pieces and sending them to decision-makers with a detailed message to emphasise that air pollution is a problem in many cities, not just Delhi. These efforts have witnessed active participation from local elected representatives, civic bodies, doctors, celebrities, and eminent personalities campaigning for clean air across these cities. ?

We must understand the concept of this installation to understand its efficiency. HEPA (high efficiency particulate air) filters were used to make these chalk-white lungs. The same filters are used to catch dust in operating rooms, anti--pollution masks, and other places. The lungs have also been equipped with fans that suck in air to simulate how lungs work when breathing. Particulate matter from dust pollution and automobile emissions will begin to accumulate in the HEPA filters in the following days. The lungs will change colour from chalk-white to brown to black as a result of this. Additionally, a digital air quality sensor is also installed on the billboard, which records and shows the AQI in real time.

Several pulmonologists in India, who have end-orsed the lungs billboard campaign in various cities, claim it is one of the simplest ways to demonstrate the effect of what happens to the lungs when a person breathes dirty air for an extended length of time. From four-year-old kids to mayors, municipal commissioners, MLAs, MPs and others visiting the installation in different places, the display has been a fantastic communication and engagement tool. This billboard will soon be on its way to its next destination, Pune, as civil society organisations from across India have requested that it be ins-talled in their city to highlight poor air quality, its health impacts, and bring the attention of state pollution control boards and civic agencies to the fore.

While the Billboard that Breathes has been esse-ntial in raising awareness about the issue, the ultimate purpose is not to have residents compete to see whose city’s lungs billboard went black first. The objective is to enable citizens to understand what is happening and have the ability to demand their most fundamental right to breathe clean, healthy air. Communities must speak up and demand the execution of city-wide clean air action plans, as well as health alerts from local governments on days when air quality is poor. It is a critical necessity for our health, not a choice.

(This appeared in the print edition as "Show, Don’t Tell")