Cases are up 30% since 2010 in country where decline in air quality is shifting from acute to chronic in more than just Delhi

A sharp rise in cases of chest and throat disease in India is being blamed by doctors on worsening air pollution in the country, which is now home to 13 of the 20 most polluted cities in the world.

According to India’s National Health Profile 2015, there were almost 3.5m reported cases of acute respiratory infection (ARI) last year, a 140,000 increase on the previous year and a 30% increase since 2010.

The number of ARI cases has risen steadily in India over the last 15 years, even when population growth is taken into account. In 2001, less than 2,000 cases per 100,000 people had an ARI. In 2012 the number was 2,600 per 100,000, statistics show.

The rise has occurred despite steady improvements in medical care and nutrition, as well as a shift away from using wood as fuel in rural areas. Together this has mitigated many factors long blamed for the high levels of respiratory diseases in India.

Doctors are blaming the increasing severity of the problem on unprecedented decline in air quality across India.

“Due to the awareness drives conducted about diseases like swine flu and influenza, people have become more aware ... Yet air pollution is playing a major role in [increasing] the numbers of such diseases,” Dr Jugal Kishore, head of community medicine at Delhi’s Safdarjung hospital, told the local India Today news magazine.

Attention to the problem of air pollution in India has so far focused almost exclusively on the capital. One study found that half of Delhi’s 4.4 million schoolchildren would never recover full lung capacity.

Facebook Twitter Pinterest Thick smog hangs over the Red Fort in Delhi. Photograph: Raveendran/AFP/Getty Images

But the rest of India has received less attention, though in many cases the problem is almost as acute, or possibly worse. The latest government figures show high numbers of lung and throat infections in the eastern state of West Bengal, the central state of Andhara Pradesh, as well as in tourist favourites Kerala and Rajasthan.

Mumbai also has pollution levels which, though lower than in Delhi, exceed safe limits set by the Indian government many times. Those limits are significantly higher than those set by international experts and western governments.

This summer, some reports suggested that Chennai experience worse pollution than anywhere else in India. Though the data has been challenged, it is clear that the levels of hazardous gases such as carbon monoxide, nitrogen dioxide and ozone, as well as of deadly fine particulates, in the southern city have consistently breached the World Health Organisation’s maximum safe limit.

“I always thought there was some washing off of pollution here due to the coastal breeze. But that seems to be wishful thinking,” said Prof Sudhir Chella Rajan, a specialist in urban air pollution at the Indian Institute of Technology Chennai.

Campaigners point out that the focus on Delhi has distracted from problems elsewhere. “Some reports are alarmist but in general, for sure, parts of Chennai are definitely worse than Delhi,” said Shweta Narayan, an activist.

Other major regional centres, such as Mumbai, Bangalore, or Bhopal are also badly affected.

“The older parts [of the Bhopal] have horrendous air. There’s no mass transit system, lots of very old substandard vehicles, open fires. It’s very serious,” said Nityanand Jayaraman, an environmental campaigner who regularly visits the Madhya Pradesh capital.

Facebook Twitter Pinterest A landfill, in Bhopal, India. Photograph: Sanjeev Gupta/EPA

A report this summer highlighted the damage air pollution is causing the famous Golden Temple in Amritsar,Punjab.

Blackspots within individual cities around India are rarely identified by official figures, either on the prevalence of respiratory illness or air quality.

The worst affected areas of Chennai, which has a population of around 4 million people, lie on its northern rim, where petrochemical works, car factories and coal-burning power stations exist close to residential areas. In July, levels of deadly PM2.5 particulates in the Manali neighbourhood were four times the WHO safe limit. These particulates lodge in the lungs and allow heavy metals to enter the bloodstream.

In other cities across the country the problem was even worse. In Ahmedabad, in the west, levels of PM2.5s peaked at eight times the WHO limit for a 24-hour average. In Lucknow, in the north, levels reached seven times the limit. Levels of CO2, nitrogen dioxide and ozone in less known cities have also regularly exceeded WHO guidelines by huge margins.

India has the highest rate of death from respiratory disease in the world, according to the WHO,. The rate was 159 per 100,000 in 2012, about 10 times that of Italy, five times that of the UK and twice that of China.

Officials in Chennai say they are aware of the problem, and point to measures from the new $3bn (£2bn) metro to the construction of traffic islands as evidence of their intent to tackle it.

But similar mass transit systems across India do not have a significant immediate impact on pollution, experts say. Most are too small and have been built too late. Studies show that Delhi’s metro users previously travelled on buses, by bicycles or on foot, not in cars.

One effective, and considerably cheaper, scheme in Chennai has been the introduction of minibuses on smaller roads between the major bus routes. “It has worked and been very popular,” said Narayan.

The problem has a broader cultural aspect too. In India, as in the west in the 1950s and 1960s, cars bring not just mobility and convenience but are tangible symbols of social success.

On a sheet of paper pinned to a wall of the spotless Alandar station, contented passengers have scrawled their impressions of Chennai’s month-old metro. “Very wonderful, fantastic, unforgettable,” they gush.

Natarajan Ramesh, an off duty policeman buying a ticket in the station’s cavernous entry hall, was also impressed. “It is very nice. It is the need of the hour. It will help commuters travel in such a quick span of time and is very clean too,” he said.

Facebook Twitter Pinterest Employee walks between parked cars ready for shipment at a port in the southern Indian city of Chennai. Photograph: BABU/Reuters

However, Ramesh’s own ambitions are less environmentally sensitive. “My dream is to have a car,” he said. “Trains are all nice and useful but not the same as a car. I would like a Honda, or maybe a Volkswagen.”

The number of vehicles, including motorbikes, on Chennai’s roads has more than trebled in 15 years. In Delhi and many other cities the increase has been even greater. Hundreds of smaller towns, for which there are no reliable air quality figures available, have horrific congestion and pollution from ageing power stations and poorly regulated industry.

Facebook Twitter Pinterest Smoke rises from brick kiln chimneys on the outskirts of Delhi. Photograph: Altaf Qadri/AP

There is still hope for improvement, though only in the long term. Officials in India no longer deny there is a problem and air pollution is fast becoming a significant political issue for many wealthier urban residents.

On Tuesday, a joint initiative by police and local businesses led to a “car free day” in Gurgaon, a satellite city of Delhi. Though only a limited number of roads were shut, pollution levels dropped dramatically, local newspapers reported.

Pollution expert Raja worked for five years at the Californian Air Resources Board. The air in the US state, once infamous for its smoggy cities, is now cleaner than in decades, even though problems remain.

“They have done an enormous amount … but it took 40 years. Here [in India] air pollution is probably going to be very severe for a couple of decades before it gets any better,” he said.