In 2010, a pediatrician at Shardaben Hospital, a government hospital in Ahmedabad, noticed that newborn babies were developing fevers even in the absence of any infection. She wondered if the high temperature in the ward, located on the hospital’s fourth floor and painted with tar, had anything to do with it. At her insistence, the hospital administration shifted the maternity ward to the ground floor. Soon, the newborns showed a dramatic recovery. There were no longer unexplained instances of fever.
Abhiyant Tiwari, a public health researcher closely involved in developing India’s first Heat Action Plan (HAP) often repeats this anecdote when talking about the impact of the climate on public health.This summer, thanks to the efforts of Tiwari and others, close to 30 cities across 11 states—including Bihar, Telangana, Odisha and Maharashtra—are closely monitoring the weather to reduce adverse health impacts caused by heat waves.
This is one of the first initiatives of its kind in the developing world, linking climate and public health. A HAP is rather simple—it focuses on providing civic officials with climate data so that citizen groups, media and the hospitals can be warned ahead of a heat wave. The plans also includes making water stations available across cities and carrying out awareness campaigns asking residents to stay covered and hydrated on scorching summer days. This February, the National Disaster Management Authority (NDMA) held a two-day workshop in Vijayawada to prepare civic bodies and state governments for the summer of 2018.
Tiwari first heard about the newborns at Shardaben when he was conducting preliminary research on the impact of heat waves in Ahmedabad around 2012—two years after the city saw a sudden spurt in fatalities in public hospitals following a heat wave. Driven to action, in 2013 it became the first South Asian city to adopt a heat wave action plan, motivating dozens more to follow.
Called “silent killers”, heat waves can lead to dehydration, exhaustion, stress and can even be fatal. As climate changes, heat waves are becoming more intense, frequent and longer lasting.
“Most people, particularly in tropical countries, are unaware of the huge number of deaths caused by hot weather and heat waves, but when you look at the data the effect is crystal clear,” says Hannah Nissan, associate scientist at the International Research Institute for Climate and Society who has worked on South Asian weather and climate variability.
According to the National Disaster Management Authority (NDMA), heat waves caused 25,716 deaths between 1992 and 2016 across various states. Heat waves also caused the death of wildlife, birds, and poultry.
New York was one of the earliest cities to have a HAP, and the Natural Resources Defence Council (NRDC), a think tank based there, is helping Indian cities develop their own plans along with the Indian Institute of Public Health (IIPH), Gandhinagar. The plans acknowledge that “climate change is affecting our health right now and extreme heat is one of the most direct changes,” said Kim Knowlton, senior scientist, NRDC.
Manual labourers, traffic policemen, pregnant women, elderly people, and young children playing in the sun are most vulnerable to heat waves. “Those who already have respiratory and heart problems are worst affected as one tends to breathe rapidly during hot weather and the circulatory system tries to pump more blood,” Knowlton explains.
“While newborns are thought to be more susceptible to heat waves there is limited research in the area,” says Perry Sheffield, expert in environmental medicine and public health at Mount Sinai hospital, New York.
A HAP smoothens the communication between a weather department and civic bodies. In India, cities now depend on the Meteorological Department (IMD)’s five-day weather alert. Currently this alert goes out to over a 100 cities, and is colour-coded from white (normal) to yellow, orange, and red (severe). During summer, officials at civic bodies monitor alerts to warn journalists, NGOs and hospitals ahead of time so they can take simple preventive action.
“Most heat related mortality is preventable,” Nissan explains. “In many places heat waves are predictable, and that means we have the power to do something about them.”
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