Overview of the key issues, challenges, and

policy/ action to address extreme heat risks

Dr Lipika Nanda
Vice President, MPPH
Public Health Foundation of India (PHFI)

SAHHS 14-Feb-2020 IITM, Pune

Presentation overview

• Sustainable Development Goals (SDG)

• Paris Agreement – Key Features of India’s targets
• Priority Areas for Extreme Heat and Health
• Research and Education to support Policy to address these challenges
• Recommendations that will contribute to Policy change
• Take home messages
 SDG 13: Climate action

Goal 13
Take urgent action to combat climate change and its impacts.
RELEVANT TARGETS FOR GOVERNMENT

13.1 Strengthen resilience and adaptive capacity to climate related hazards and natural disasters in all
countries.

13. 2 Integrate climate change measures into national policies, strategies and planning 

13.3 Improve education awareness raising and human and institutional capacity on climate change
mitigation, adaptation, impact, reduction, and early warning.
 Key features of India’s targets

• Reduce energy emissions intensity by 30 to 35 % from 2005 levels by 2030

• Increase the share of non-fossil fuel energy to 40 % of India’s energy mix by 2030
• Focus on a climate adaptation strategy
• enhancing investments in programs in areas vulnerable to climate change,
• including health and disaster management

• Create a carbon sink of 2.5 to 3 billion ton of carbon dioxide (CO2) equivalent
• increasing forest and tree cover by 2030
Indian context
• India is undergoing enormous change; climate change poses an overwhelming stressor
that will magnify existing health threats.
• Millions of Indians below the poverty line, marginalized and those living in rural areas
represent high risk population.
 Climate change – Why it matters?

• WHO has estimated that in the year 2000, climate change accounted for the loss of 1.5 lakh lives
globally.
• Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional
deaths per year, from malnutrition, malaria, diarrhoea and heat stress.
• The direct damage costs to health is estimated to be between US$ 2-4 billion/year by 2030.
• The effects of climate change on human health in India is a broad topic, covering areas from extreme
weather events to shifts in vector-borne diseases. 
 Public Health Challenges – Impact of
Extreme Heat in India
• Vector-borne and Zoonotic Diseases
• Water-borne Diseases
• Heat stress and Air pollution
• Asthma, Respiratory Allergies, and Airway
Diseases
• Food security - nutrition
• Cardiovascular Disease and Stroke
• Human Developmental Effects
• Mental Health and Stress-related Disorders
• Neurological Diseases and Disorders
• Extreme heat-related Morbidity and Mortality

The increasing risks associated with Climate change resulted in its inclusion in the Sustainable
Development Goals (SDG) followed by the significant Paris Agreement.
Priority areas for Extreme Heat and Health
Surveillance and Monitoring
– Develop actionable early warning signals and surveillance systems
• Vulnerability Assessments and Threshold Assessments
– Establish extreme heat-sensitive exposure metrics with appropriate temporal and spatial
dimensions
– Development of risk maps for heat sensitive diseases like Chikungunya, Dengue, Malaria, etc
Public Health preparedness
– Conduct situational analysis to strengthen preparedness and response at
national/state/district/below district levels to cope with extreme heat related disasters.
Research
– Undertake epidemiological research in heat-sensitive locations
– Promote extreme heat related research at state and national level
– Influence Policy: Develop a national “extreme heat and health strategy”
…continued

Education
– Incorporate climate change education into educational programmes & school curricula
– Promote heat stress education, training, public awareness
Human and Technical capacity
– Promote skill development of health workers
– Build capacity for modeling and forecasting heat-related health effects
Technical Centre of Excellence
– Establish centers of excellence on different aspects of extreme heat and health at state level for
development of guidelines, capacity building, supporting implementation, periodic monitoring,
supervision, handholding and mentoring
….continued
Collaborations
Multi-sectoral
– Develop partnerships and provide technical advice and support to private sector, non-governmental
organizations, universities, and international organizations to more effectively address aspects of
extreme heat.

Inter-ministerial
– Collaboration with other ministries responsible for several ecological determinants of health in
implementing national preparedness measures related to the health effects of climate change, and
promote the public health benefits of heat stress mitigation and adaptation.
Key priority areas
Education and Research

• The importance of research and education in addressing extreme heat cannot

be stated enough.
• Includes all aspects of this phenomenon: science, direct and indirect impacts
(biophysical, social, economic and health), measures for reducing greenhouse
gas emissions and measures to adapt to a changing climate.
Education
• Inclusive integration of education on extreme heat and health in school curricula
• Advocacy for optional higher education systems – undergraduate, post graduate, certificate
courses
• Capacity building on extreme heat health impacts and their management by various modalities
such as workshops, webinars, websites. Developing training manuals, modules, courses etc for
educators and health workers
• Public awareness, education, and specific knowledge programs on heat stress/climate change
causes and solutions targeted at community to help empower citizens to address extreme heat
• Using media as a vehicle for sharing knowledge and providing education on extreme heat and
health
Three research tasks (Evidence Building)
Empirical studies
[epidemiology]

detection predictive
Learn
attribution modelling
mechanisms
responses

past present Future

2020s, 2050+

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Research
• Focus - building resilience, assessment of vulnerabilities and risk factors, and increasing
adaptive capability

• Undertake epidemiological research based on

 Heat-sensitive locations - test new approaches
 defining relationship between extreme heat and emerging & re-emerging infectious
diseases (Dengue, Chikungunya, Cholera) as well as chronic diseases (cardiovascular
and respiratory)

• Strengthen reporting and surveillance; build robust data infrastructure

• Promote research at state and national level by supporting relevant networks, making available
financial resources and creating training opportunities.
– Department of Biotechnology (DBT)
– Department of Science and Technology (DST)

– Ministry of Health (MoH)

• Collaboration with international organizations – forging global alliances for collaborative research.

• Policy action: Develop a “national heat and health strategy” that addresses health risks and opportunities
in health policy. This can be achieved by translating evidence based research on climate change and health
into policy.
Recommendations for research to address
public health risks – extreme heat
• Assessing the risks
o Improved evaluation of current heat-related health risks, rather than a
primary focus on risks over very long time frames
o Systematic research to identify subsections of populations and life stages
most vulnerable
o Quantification of the fraction of morbidity and mortality attributable to heat
hazards
• Identifying the most effective, proven and cost- effective interventions
o Methodological research to improve analytical tools for cost-effectiveness
analysis
• Guiding the health- promoting mitigation and adaptation decisions in other
sectors(energy, transport, etc).

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 …continued
• Improving decision-support
– by vulnerability assessment and health risks, to identify key health strategies,
policies and measures.
• Informing heat & health policy makers, practitioners, civil society and
the wider public in communicating and preventing heat related risks.
• Partnerships for heat and health research:
o International and interdisciplinary collaboration for global research around heat
stress
o Establishment of virtual forums on heat related health research to provide a
clearing house to bring together the existing bodies of research methods, tools,
data sets and results
• Establishment of expert panels to provide oversight, develop
guidance and tools.
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 Take home messages

• Extreme heat – as a result of climate change is “REAL”

• India is vulnerable to almost all heat related health risks
• Better understanding of the effects of extreme heat can be achieved
through predictive and prospective studies
• Relevant research should be used a used as a tool for change and to
improve awareness as well understanding of extreme heat