Vulnerable population: Heat on public health system
As the heatwave envelops North India, warnings have been issued by weathermen and disaster management agencies to gear up. This has raised concerns about the public health infrastructure’s preparedness.
The public health system is the first line of defence, and its dual challenge is having a shortterm plan for susceptible seasons and a long-term strategy against climate change-induced health crises.
In 2023, around 255 people died in the country due to a heatwave, according to government data submitted in Parliament. The number has fallen compared to a decade ago but, with temperatures touching new records, climate scientists warn of heat-related diseases, especially among the vulnerable communities.
Bhabesh Hazarika, economist at the National Institute of Public Finance and Policy (NIPFP), said vulnerable populations in urban and rural areas with limited access to healthcare are disproportionately affected by these ailments.
“Addressing these threats would require a robust public health infrastructure, disaster preparedness, climate adaptation measures, and efforts to mitigate the underlying drivers of climate change, alongside collaboration across sectors and communities,” Hazarika told Business Standard.
But he is not sure how the public health infrastructure will cope. “Structural weaknesses, highlighted by the pandemic, include inadequate medical supplies, shortages of healthcare workers, and disparities in access to healthcare services exacerbated by caste, class, gender, geography, and community inequities,” Hazarika said.
For the coming two months, the challenge is extreme heat.
“There are three kinds of heat-related illnesses. The mildest is heat cramps caused by dehydration and extreme heat. When it progresses further, it can lead to heat exhaustion. This causes nausea, vomiting, dizziness, and headache. The extreme form of heat-related illness is a heat stroke, which is not that common, but can be fatal, and requires urgent hospitalisation,” said Rommel Tickoo, director, Internal Medicine, Max Super Speciality Hospital, Saket, New Delhi.
Extreme weather events like heatwaves, floods, and droughts can also lead to water-borne diseases, such as cholera and typhoid fever, vector-borne diseases like malaria and dengue fever, respiratory issues, mental health challenges, malnutrition, and re-emerging diseases, such as Kyasanur Forest disease.
According to Tickoo, there has been an uptick in typhoid and waterborne gastroenteritis and stomach issues. There will be a spurt in cases when heatwaves intensify during Mayjune, and after the monsoon, when water-borne ailments witness a spike.
Climate insurance
In 2019, India launched the National Programme on Climate Change and Human Health (NPCCHH) along with the World Health Organisation to strengthen the response of public health towards climate change. The National Centre for Disease Control, the nodal agency of the programme, is yet to finalise the National Action Plan for Climate Change and Human Health, according to publicly available information.
In February, the National Disaster Management Authority (NDMA) conducted a workshop on heatwaves. In a presentation, Harshal Salve, Centre for Community Medicine, AIIMS-DELHI, suggested that apart from capacity building and training among medical staff, there is an urgent need for a monitoring framework for climate-induced disasters and the next step is having an SOP (standard operating procedures) for tackling such emergencies.
For building SOPS, he said, state-level officials of health and disaster control departments needed to work together.
Another presentation was by the Indian Institute of Public Health (IIPH), Gandhinagar, the first university in the country focused on public health. Dileep Mavalankar, former director, IIPH, delivering the presentation, said the first step towards building a heat action plan (HAP) was to have data on heat-related fatalities, which the local authorities failed to do. He suggested data to be collected from crematoriums, emergency admissions and even ambulance pick-ups. A yearwise analysis of heat mortality data in Ahmedabad led to a reduction in hospitalisation and better diagnosis, he said.
IIPH was instrumental in building the HAP for Ahmedabad – the first city in Asia to have one. The step was the result of the heatwave incident in Ahmedabad in 2010, which claimed 1,300 lives. Malvankar cited this incident and concluded by underlining – “This is the beginning of climate change – worse still to come – so let’s prepare now for the next 80 years.