<p>Air pollution poses a serious global threat, affecting individuals, healthcare systems, ecosystems, and economies. Around 90% of the population of the world lives in areas surpassing WHO air quality standards. Urban areas contribute roughly 78% of carbon emissions, impacting over half of the global population residing in cities. Given the growing influence of environmental and socio-economic determinants on public health outcomes, the current study critically analyses the effects of air quality and inclusive development on life expectancy by incorporating the moderating roles of governance quality (QoG) and urbanization. Using annual data from 1990 to 2022 for the most air-polluted countries, the research employs the Method of Moment Quantile Regression (MMQR) for empirical analysis, alongside Ordinary Least Square (OLS), Random Effect (RE), and Fixed Effects models for robustness checks. The findings reveal that poor air quality and urbanization significantly reduce life expectancy, while inclusive development and QoG have positive effects. Human capital, information digitalization (ICT), labor force participation, and energy use also promote life expectancy. Notably, the interaction between QoG and air quality positively affects life expectancy, indicating that effective governance enhances environmental outcomes. However, urbanization exacerbates air pollution, further reducing life expectancy. Policymakers should strengthen environmental governance, promote sustainable urban planning, and invest in inclusive development, human capital, and renewable energy to improve air quality, reduce pollution, and enhance life expectancy.</p> Graphical Abstract <p></p>