Community Perceptions of Air Pollution and Health Risks in Urban Areas: A Comprehensive Qualitative Study from Pakistan
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Abstract
Background: Air pollution is a major environmental health concern in urban Pakistan, where recurrent smog, vehicular emissions, industrial activity, brick kiln smoke, crop residue burning, construction dust, and open waste combustion contribute to substantial community exposure. Although health risks are widely discussed, limited evidence exists on how affected communities perceive pollution, interpret vulnerability, and adopt protective behaviors. Objective: To explore community perceptions of air pollution, associated health risks, adaptive behaviors, and structural barriers among urban residents in Pakistan. Methods: An interpretive qualitative study was conducted in urban and peri-urban communities representing industrial, residential, low-income, and mixed commercial-residential exposure contexts. Data were collected through semi-structured in-depth interviews and focus group discussions with urban residents, parents, healthcare providers, community leaders, and occupationally exposed workers. Transcripts were analyzed using six-phase thematic analysis, with attention to credibility, triangulation, reflexivity, and trustworthiness. Results: Five themes were identified: awareness and understanding of pollution sources, perceived health risks and vulnerability, normalization of pollution exposure, adaptive and protective behaviors, and structural and policy-level barriers. Participants recognized visible pollution and respiratory risks, especially for children and older adults, but technical understanding of AQI, PM2.5, and long-term risks was limited. Protective actions were inconsistent and constrained by poverty, occupation, poor risk communication, and weak institutional trust. Conclusion: Urban communities recognize air pollution as harmful but often normalize exposure as unavoidable. Effective responses require practical risk communication, health-system integration, affordable protection, community engagement, and visible environmental enforcement
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References
1. World Health Organization. WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization; 2021.
2. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49. doi:10.1016/S0140-6736(20)30752-2.
3. Brook RD, Rajagopalan S, Pope CA III, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121(21):2331-78. doi:10.1161/CIR.0b013e3181dbece1.
4. Pope CA III, Dockery DW. Health effects of fine particulate air pollution: lines that connect. J Air Waste Manag Assoc. 2006;56(6):709-42. doi:10.1080/10473289.2006.10464485.
5. IQAir. World air quality report 2022. Goldach: IQAir; 2023.
6. Pakistan Environmental Protection Agency. Air quality monitoring and reporting: annual report 2021–2022. Islamabad: Ministry of Climate Change, Government of Pakistan; 2022.
7. World Bank. Pakistan: health expenditure, public (% of government expenditure). Washington, DC: World Bank; 2023.
8. Slovic P. Perception of risk. Science. 1987;236(4799):280-5. doi:10.1126/science.3563507.
9. Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu N, et al. The Lancet Commission on pollution and health. Lancet. 2018;391(10119):462-512. doi:10.1016/S0140-6736(17)32345-0.
10. Gupta A, Bherwani H, Gautam S, Kumari S, Gupta R, Kumar R. Awareness and perception of air pollution and its health impact among urban residents of Nagpur, India. Int J Environ Sci Technol. 2018;15(7):1457-66.
11. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. doi:10.1093/intqhc/mzm042.
12. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa.
13. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-97. doi:10.1080/2159676X.2019.1628806.
14. Islam MS, Tusher TR, Mustafa S, Mamun MA, Hossain M. Community perception of air pollution and its health risks in an urban city: a qualitative study in Dhaka, Bangladesh. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2020;55(1):101-9.
15. Egondi T, Kyobutungi C, Kovats S, Muindi K, Ettarh R, Rocklöv J. Time-series analysis of weather and mortality patterns in Nairobi’s informal settlements. Glob Health Action. 2013;6:19865. doi:10.3402/gha.v6i0.19865.
16. Wakefield SEL, Elliott SJ, Cole DC, Eyles JD. Environmental risk and (re)action: air quality, health, and civic involvement in an urban industrial neighbourhood. Health Place. 2014;12(2):136-54.
17. Walker G. Environmental justice: concepts, evidence and politics. London: Routledge; 2012.
18. Dockery DW, Pope CA, Xu X, Spengler JD, Ware JH, Fay ME, et al. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993;329(24):1753-9. doi:10.1056/NEJM199312093292401.
19. Broto VC, Macucule DA, Allen A, Apeaning R, Smit W. Building urban climate resilience through collaborative action in Maputo, Mozambique. Int Dev Plan Rev. 2019;41(3):333-52.
20. Champion VL, Skinner CS. The Health Belief Model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 45-65.
21. Fawell J, Nieuwenhuijsen MJ. Contaminants in drinking water. Br Med Bull. 2003;68(1):199-208. doi:10.1093/bmb/ldg027.
22. Health Effects Institute. State of global air 2020. Boston: Health Effects Institute; 2020.
23. Lercher P. Environmental noise and health: an integrated research perspective. Environ Int. 1996;22(1):117-29. doi:10.1016/0160-4120(95)00109-3.
24. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: SAGE Publications; 1985.
25. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-104. doi:10.1016/S0140-6736(05)71146-6.
26. Mbiatem BF, Bita CE, Dibong SD. Community awareness and knowledge on air pollution in sub-Saharan African urban areas. Sci Total Environ. 2022;832:154992.
27. Mustafa D, Smucker TA, Gier J, Johns A, De Deckker S. Gendered and differentiated access to water, sanitation and hygiene in urban Pakistan. Water Int. 2013;38(2):154-66.
28. Pakistan Bureau of Statistics. Pakistan Social and Living Standards Measurement Survey 2019–20. Islamabad: Government of Pakistan; 2020.
29. Rasool A, Uzair M, Khan S, Choudhry A, Yasmeen S, Sharif M. Evaluating the effectiveness of health policy implementation within Pakistan’s public health system. Journal of Public Health Research. 2026;4(6).
30. Riojas-Rodríguez H, Sousa Santana MM, Rábago Vega HG, Escamilla-Nuñez MC. Air pollution management and control in Latin America and the Caribbean: implications for climate change. Rev Panam Salud Publica. 2016;40(3):150-9.
31. Rosenstock IM. The Health Belief Model and preventive health behavior. Health Educ Monogr. 1974;2(4):354-86. doi:10.1177/109019817400200405.
32. Semple S, Garden C, Coggins M, Galea KS, Cowie H, Hurley JF, et al. Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes. Indoor Air. 2012;22(3):212-23. doi:10.1111/j.1600-0668.2011.00754.x.
33. World Health Organization. Ambient air quality database 2022. Geneva: World Health Organization; 2021.