A three-year health screening of 10,352 frontline workers in Bengaluru has exposed a serious occupational health burden: reduced lung function, obesity, high blood sugar and uncontrolled hypertension are widespread among the people who keep the city moving, clean and under construction. The findings are not simply a medical snapshot. They show how Bengaluru’s urban systems distribute environmental and workplace risks among workers who spend long hours in traffic, on roads, at construction sites and in public spaces.
The screening was conducted by the city-based Vaayu Occupational and Environmental Respiratory Illness Clinic. It covered 4,517 Bangalore Metropolitan Transport Corporation employees, 3,287 traffic police personnel, 2,169 construction workers and 379 pourakarmikas. Most participants were men aged between 30 and 50, and all reported working for more than eight hours a day.
That combination of prolonged working hours and repeated exposure is important. Traffic police personnel work close to vehicle emissions. BMTC employees spend much of their working day around road traffic and transport infrastructure. Construction workers face dust and construction pollution, while pourakarmikas work in environments where road dust, waste and other workplace hazards can overlap. The screening does not establish that a particular pollutant caused a particular medical condition, but it identifies a concentrated health burden among occupational groups that are essential to the city’s daily functioning.
The respiratory findings are especially significant. Among participants with available lung-function data, 45% of pourakarmikas recorded reduced lung function, indicated by low forced vital capacity, or FVC, on spirometry. The corresponding proportions were 29.5% among BMTC employees, 28% among traffic police personnel and 15% among construction workers.
These figures do not mean that every worker with reduced FVC has the same illness or faces the same risk. They do, however, point to a need for systematic screening and follow-up rather than one-time awareness campaigns. A lung-function abnormality can be clinically meaningful only when it is assessed alongside a worker’s medical history, exposure, symptoms and subsequent testing. The central institutional question is whether Bengaluru’s occupational health systems have the capacity to carry that process forward.
The cardiometabolic results broaden the problem beyond air pollution. Overweight or obesity was recorded in 60.7% of BMTC employees, 51.3% of traffic police personnel, 29.2% of construction workers and 62% of pourakarmikas. Blood sugar levels above 200 were recorded in 63.8%, 50%, 20% and 52.9% of the respective groups. Uncontrolled hypertension affected 66.7% of BMTC employees, 25% of traffic police personnel, 76.9% of construction workers and 68.8% of pourakarmikas screened.
The categories are not directly interchangeable: lung function, body weight, blood sugar and blood pressure describe different clinical conditions and require different forms of intervention. But their presence together changes the interpretation of the screening. The findings point to a workforce health challenge that combines environmental exposure, long working hours, access to healthcare and the management of chronic disease. It also suggests that occupational health cannot be treated as a narrow safety issue confined to protective equipment.
The distribution across worker groups matters as much as the overall numbers. Pourakarmikas recorded the highest proportion of reduced lung function and the highest reported rate of overweight or obesity among the four groups. Construction workers recorded the highest prevalence of uncontrolled hypertension in the screening, at 76.9%, even though their reported rate of blood sugar above 200 was lower than that of the other groups. BMTC employees recorded high levels across overweight or obesity, elevated blood sugar and uncontrolled hypertension. Traffic police personnel recorded lower rates of uncontrolled hypertension than the other groups, but still showed substantial levels of reduced lung function, excess weight and elevated blood sugar.
The figures therefore resist a single explanation. They do not support treating all frontline workers as one uniform population, nor do they suggest that a single citywide intervention will be sufficient. The occupational setting, exposure pattern and existing access to medical care differ across departments and employment categories. A screening programme that identifies these differences creates the basis for targeted action, but only if the information is linked to responsible institutions and continuing care.
That is where the governance problem becomes visible. At a multidisciplinary roundtable titled ‘Protecting Those Who Protect Our City’, experts argued that Bengaluru must move from awareness-building to measurable public health interventions. Dr Arvind BA, professor of epidemiology at the National Institute of Mental Health and Neuro Sciences, said occupational healthcare systems should be strengthened and the findings integrated into existing systems. Dr G Gururaj, former director of Nimhans, called for laws and regulations to be translated into action through stronger capacity-building and sustainable implementation systems.
The comments point to a familiar weakness in urban administration: responsibilities are divided, while the risk experienced by workers is integrated. Worker welfare, public transport, environmental protection, sanitation and healthcare may be managed through different departments and agencies. A worker, however, experiences these conditions together during the same working day. If health data is collected by one institution but workplace changes, medical follow-up and pollution controls sit elsewhere, the screening can remain a report rather than become an intervention.
Swetavalli Raghavan, adviser to the health department and visiting professor at IISER Thiruvananthapuram, described a lack of coordination among government departments responsible for workers’ welfare, transport and environmental protection. Her assessment was that existing laws and systems need to work in tandem and that awareness alone would not be enough. This is a question of administrative design as much as medical treatment: who receives the findings, who acts on them, who funds follow-up and which institution measures whether conditions improve?
The proposed next steps also reveal the gap between identifying risk and institutionalising care. Dr Ravindra Mehta, founder and medical director of VAAYU Chest & Sleep Specialists, said the clinic had been waiting for a memorandum of understanding with BMTC to screen more than 5,000 workers. He said immediate measures should include providing masks and educating workers about air-pollution risks. He also called for cohorts to be followed over five to 10 years, requiring sustained funding, a clear agenda and institutional support.
A long-term cohort would answer questions that a cross-sectional screening cannot. It could show whether lung-function abnormalities persist, how chronic conditions change over time and whether workplace or medical interventions produce measurable improvements. The supplied findings do not establish such trends yet. They show the scale of the screening and the burden detected at that point, while the proposed follow-up would be needed to understand progression and intervention outcomes.
The data also places a different obligation on the city’s infrastructure agencies. Masks may provide one immediate layer of protection, but the screening’s occupational context raises questions about exposure reduction, worksite practices, access to health checks and departmental accountability. The source material does not provide measurements of pollution exposure, details of mask distribution, treatment uptake or department-wise health budgets. Those are important gaps because health outcomes cannot be evaluated fully without knowing what protections workers currently receive and whether identified conditions are being managed.
Bengaluru’s frontline workforce is often discussed through service delivery: buses must run, traffic must be managed, waste must be collected and buildings must be constructed. The screening adds a worker-health dimension to that urban equation. The city depends on labour that is physically exposed to its congestion, dust and service infrastructure, but the institutions responsible for the city may not yet share a common system for tracking the resulting risks.
The evidence confirms a substantial health burden across four frontline worker groups and establishes that the issue is broader than respiratory disease alone. It does not, by itself, establish causation, treatment outcomes or the effectiveness of any proposed measure. The developments to watch are the proposed BMTC memorandum of understanding, the creation of a coordinated occupational healthcare framework, the provision of immediate protective measures and whether long-term funding is secured for five- to 10-year worker cohorts. Without those steps, Bengaluru will know more about the health risks faced by its frontline workers without necessarily becoming better at reducing them.
