Reframing winter air pollution in Delhi through a health centered governance model for sustainable urban resilience

Every winter, Delhi, India’s capital, faces recurring episodes of severe air pollution, with particulate matter levels far exceeding World Health Organization guidelines. Despite repeated emergency measures, the city’s air quality shows little long-term improvement, highlighting ongoing issues in environmental management and governance. In this comment, we examine the structural and institutional causes of persistent winter air pollution, focusing on the limitations of reactive, short-term measures such as the Graded Response Action Plan (GRAP). We demonstrate that a complex political ecosystem, poor intersectoral coordination, and a lack of integration between indoor and outdoor air quality efforts undermine long-term mitigation, with multiple health consequences. Finally, we present a conceptual framework for the Megacity Environmental Health Governance System (MEHGS), informed by empirical evidence, policy analyses, and comparative urban experiences. By establishing MEHGS on five pillars with cross-sectoral operation, we demonstrate an integrated, health-centered governance that may address persistent gaps in current systems. Furthermore, as MEHGS is informed by successful pollution control strategies from other megacities, we believe that it may serve as a transferable framework for low- and middle-income countries confronting chronic air pollution and related health and environmental risks. However, it requires quantitative validation, contextual adaptation, and local expertise to serve as a “globally relevant and locally fit” model to strengthen urban preparedness for emerging planetary health challenges.