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Despite low per capita emissions, with over a billion population, India is pivotal for climate change mitigation globally, ranking as the third largest emitter of greenhouse gases. We linked a previously published multidimensional population projection with emission projections from an integrated assessment model to quantify the localised (i.e. state-level) health benefits from reduced ambient fine particulate matter in India under global climate change mitigation scenarios in line with the Paris Agreement targets and national scenarios for maximum feasible air quality control. We incorporated assumptions about future demographic, urbanisation and epidemiological trends and accounted for model feedbacks. Our results indicate that compared to a business-as-usual scenario, pursuit of aspirational climate change mitigation targets can avert up to 8.0 million premature deaths and add up to 0.7 years to life expectancy (LE) at birth due to cleaner air by 2050. Combining aggressive climate change mitigation efforts with maximum feasible air quality control can add 1.6 years to LE. Holding demographic change constant, we find that climate change mitigation and air quality control will contribute slightly more to increases in LE in urban areas than in rural areas and in states with lower socio-economic development.

Many children in India face the double burden of high exposure to ambient (AAP) and household air pollution (HAP), both of which can affect their linear growth. Although climate change mitigation is expected to decrease AAP, climate policies could increase the cost of clean cooking fuels. Here, we develop a static microsimulation model to project the air pollution-related burden of child stunting in India up to 2050 under four scenarios combining climate change mitigation (2°C target) with national policies for AAP control and subsidised access to clean cooking. We link data from a nationally representative household survey, satellite-based estimates of fine particulate matter (PM2.5), multi-dimensional demographic projection and PM2.5 and clean cooking access projections from an integrated assessment model. We find that the positive effects on child linear growth from reductions in AAP under the 2°C Paris Agreement target could be fully offset by the negative effects of climate change mitigation through reduced clean cooking access. Targeted AAP control or subsidised access to clean cooking could shift this trade-off to result in net benefits of 2.8 (95% uncertainty interval [UI]: 1.4, 4.2) or 6.5 (UI: 6.3, 6.9) million cumulative prevented cases of child stunting between 2020-50 compared to business-as-usual. Implementation of integrated climate, air quality, and energy access interventions has a synergistic impact, reducing cumulative number of stunted children by 12.1 (UI: 10.7, 13.7) million compared to business-as-usual, with the largest health benefits experienced by the most disadvantaged children and geographic regions. Findings underscore the importance of complementing climate change mitigation efforts with targeted air quality and energy access policies to concurrently deliver on carbon mitigation, health and air pollution and energy poverty reduction goals in India.

Introduction The health impacts of global climate change mitigation will affect local populations differently. We aimed to quantify the local health impacts due to fine particles (PM 2.5 ) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. Methods We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM 2.5 levels. PM 2.5 levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM 2.5 linking local population and mortality data with PM 2.5 -mortality relationships from the literature. We incorporated population projections under the SSPs in sensitivity analysis. Results PM 2.5 attributable burdens in 2050 differed across SSP-RCP scenarios, and scenariosensitivity varied across populations. Future attributable mortality burden of PM 2.5 was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM 2.5 attributable burdens mid-century. Discussion Our analysis of local PM 2.5 attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM 2.5 mortality burden to SSPs was particularly evident in low-and midlle-income country settings due either to high air pollution levels or dynamic populations.