<p>Clean air access remains critical for effective healthcare governance and prolonging human lifespan. However, public health risks attributable to air pollution undermine public life expectancy (PLE) and strain healthcare governance in developing countries. The study examines the role of immunization, clean cooking fuel, economic growth, population, and health expenditure (HE) on PLE and air pollution across South Asian countries. The study uses robust econometric techniques such as feasible generalized least squares (FGLS), panel-corrected standard errors (PCSE), and quantile regressions (QR) for long-run estimation. The results show that clean cooking fuel correlates with PLE and air pollution, implying that minimal access, socioeconomic dynamics, and governance inefficiencies constrain the automatic health and air quality co-benefits. While immunization and economic growth improve PLE, HE strengthens health governance by reducing air pollution as an ancillary benefit. However, population size contributes to air pollution through increased resource demands and industrial activity, although the effect of economic growth is heterogeneous. The findings suggest strengthening health governance policies to improve cooking energy efficiency, optimized healthcare budgets, and enhanced cross-border cooperation to preserve air quality and foster healthy lifestyles. Therefore, this study meticulously designs policies for air pollution reduction and public health improvement to achieve dual core agendas.</p>