Introduction. The problem of monitoring air quality and health risk remains important. The aim is to study the long-term dynamics of air pollution in Bratsk in order to improve the monitoring system and prevent impact on the population. Materials and methods. The dynamics of emissions and the integral indicator of air pollution “P” in Bratsk for 1984-2018 was studied. Results. Emissions decreased by 2 times in 1984-2018, the minimum level was observed in 1995-2005. The trend in “P” is associated with the emissions (rxy = 0.76, p = 0.000). The concentrations of 3,4benz (a) pyrene, carbon disulfide made main contribution to the “P” value. An increase in the content of 3,4-benz(a)pyrene has been recorded since 2015. The city population is at risk for respiratory, immune, bone, and central nervous system disorders; the formation of systemic pathology and additional deaths. Limitations. Gross emissions were estimated according to statistical reports with certain errors, monitoring programs for the concentrations of chemicals recorded at various observation posts and changed in different years. Conclusion. In Bratsk, several districts can be distinguished, differing in the level of pollution by 2-3 times, due to meteorological conditions for dispersion and urban planning features. The presented experience can be useful in the implementation and evaluation of the effectiveness of the national project “Ecology”.