Mumbai: India is one of the five countries in the world whose vulnerable populations had the most exposure to extreme heat over the past five years, The Lancet Countdown report, released today, has said. And this exposure is increasing. Yet, like many countries, India is under-prepared to prevent, mitigate or treat the health effects of climate change.

By continuing to support fossil fuels and failing to do enough to adapt to the changing climate, countries including India are endangering the health of their citizens, as well as leaving them at risk of widespread food and water shortages and extreme weather, the report has pointed out. Independent Indian experts we interviewed said that the findings of the study should act as an urgent call for the country, with 270 million people counted as living below the poverty line, to adopt mitigation measures.

This year's report presents the "most worrying" outlook to date as key trends worsen, as per a press statement accompanying the release of The Lancet Countdown, a joint effort of 43 academic researchers and tracks 44 parameters relating to climate change and health such as exposure, vulnerability, adaptation, mitigation, economics and public and political engagement.

The latest issue of the countdown comes at a time when world leaders are preparing for the 26th Conference of Parties to be held at Glasgow, UK, from October 31 to November 12. Scientists have warned that they must realise the Paris Agreement's aim to limit the average global temperature rise to 1.5°C above pre-industrial levels and mobilise finances for an effective climate response, especially in developing countries.

Diseases on the rise

Climate change, and the resultant rising temperatures and altered rainfall patterns, are creating ideal conditions for transmission of infectious disease, the report said, adding that this could undo decades of progress to control diseases such as dengue fever, chikungunya, Zika, malaria and cholera. The report has also warned of more deaths, crop failures, mental health problems, pregnancy complications and heat- and humidity-related morbidity.

"We will see both direct impacts of heat waves on health, like heat exhaustion, stroke and dehydration, and indirect impacts in terms of crop turnaround, which means crops will mature faster and lose their nutrient content. This will result in nutrient insecurity, or the inability of people to access nutritious food," said Poornima Prabhakaran, deputy director, Centre for Environmental Health at the Public Health Foundation of India (PHFI). "We will see malnutrition in all its forms, and undernutrition, an extreme impact of food insecurity. We will also move towards overweight or obesity as more people will rely on processed food."

Healthcare systems in many countries are ill-prepared for climate-induced health shocks--current and future. In a 2021 World Health Organization survey of health and climate change, only 45 of 91 countries surveyed (49%) said they have a national health and climate change plan or strategy. Only eight said they had allocated human and financial resources based on their assessments of the effects of climate change on their citizens' health. As many as 69% of countries said insufficient financing was a barrier to implementing plans.

Droughts, food insecurity

In 2020, global heating hit staple crops across the world, leading to a decline in the output of maize (6%), winter wheat (3%), soybean (5.4%) and rice (1.8%) relative to 1981-2010, the report said.

Worldwide, in 2020, up to 19% of the global land surface was affected by extreme drought in any given month, a value that had not exceeded 13% between 1950 and 1999, the report said. Climate change is driving an increase in the frequency, intensity, and duration of drought events, threatening water security, sanitation, and food productivity, and increasing the risk of wildfires and exposure to pollutants.

India has been experiencing widespread drought every year since 2015, with the exception of 2017, IndiaSpend reported in April 2019. In 2019, about 42% of land area was facing drought in India, according to a drought monitoring platform, and failed monsoon rains were the primary reason for the situation.

Unequal impact

Low- and middle-income countries and vulnerable communities, including children, older populations, socio-economically poor communities, and those with underlying health problems, are most at risk from climate change. For instance, India, Pakistan, Bangladesh lost 216-261 hours of potential work per employed person due to heat exposure, against the moderate global average of 88 work hours, in 2020.

Heat-related deaths in people older than 65 years reached a record high in 2019 with an estimated 345,000 deaths, the report said. Between 2018 and 2019, all regions except Europe saw more heat-related deaths in this vulnerable age group.

"Changing climate patterns are favourable for vector-borne diseases and will impact parts of countries that have not seen this trend before like the upper regions of the Himalayas and northeast India," said Prabhakaran.

Heat wave no 'disaster' in India

In 2020, about 100 Indian cities and 23 state governments partnered with the National Disaster Management Authority (NDMA) to develop Heat Action Plans. Such plans need accurate meteorological data and forecasts, as well as integrated surveillance and monitoring of emerging health threats. Experts warned even then that India must invest much more to effectively deal with extreme heat, as we reported in June 2020.

The National Health Mission developed the National Action Plan for Climate Change and Human Health in 2018, with the aim to strengthen health preparedness and response at the central, state and district levels, PHFI's Prabhakaran said. Currently, it is developing an implementation framework at the national level, to be disseminated to states to use as a template for plans appropriate for their own vulnerabilities.

In India, heatwaves are not even recognised as a disaster under the disaster management law, depriving it of the government's disaster response fund for building relief and resilience and creating early warning infrastructure.

We contacted the National Disaster Management Authority seeking information on its preparedness to deal with health threats arising from climate change. We will update the article when we receive a response.

Push for polluting fuels continues

Countries that are already at risk, like India, are not responding effectively to their need to transition to clean energy, Marina Romanello, the lead author of the report, told IndiaSpend. "Countries that followed effective decarbonisation pathways, like phasing out coal and [ensuring] better regulation of air pollution, saw a lower impact on health," she said.

Despite countries' pledges to transition to renewables under the Paris Agreement of 2015, of the 84 countries reviewed for the report, 65 provided subsidies to fossil fuels in 2018. In many cases, these subsidies equalled a substantial proportion of the national health budget.

In September 2019, United Nations Secretary-General António Guterres urged countries to end coal subsidies and not build coal plants after 2020. While countries around the world were shunning coal-powered plants in favour of comparatively inexpensive renewable energy, India pushed for private investment in polluting coal, we reported in June 2020.

Only 5% of rural households in countries faring badly on the Human Development Index used clean fuels for cooking in 2019, relying heavily on biofuels instead, the report said. Exposure to these harmful air pollutants in homes resulted in an estimated 6.67 million deaths globally in 2019.

During the first lockdown in 2020, household air pollution increased by 2% in India, we reported in July 2020. Already about 78% of India's 1.3 billion population uses solid fuels for their primary and secondary needs, risking diseases like heart disease, strokes, respiratory diseases and lung cancer.

Window for change

The pandemic initiated a health and climate change engagement at the international level when world leaders called for coordinated action on the climate crisis and vaccine inequity at the UN assembly in September 2021. Urgent action on climate mitigation and universal access to clean energy could prevent millions of deaths annually from reduced exposure to air pollution and healthier diets, while contributing to reducing health inequities globally, the report noted.

To address the health consequences of climate change disasters, India must increase its health spending to 2.5% of its gross domestic product, we reported in August 2020.

India spent Rs 1,657 per capita on health in 2017-18, according to the National Health Profile 2019, but health experts estimated that it should be spending closer to Rs 4,000 per head to cope with the additional pressures of climate change. India is also short on healthcare practitioners: The country has 778 physicians per million population as opposed to an ideal of 1,000, according to the World Health Organization.

"We require commitment from government agencies and finances to strengthen public health infrastructure and workforce. And we need intersectional responses across ministries, not limited to the health or environment ministry," said PHFI's Prabhakaran.

We contacted the Ministry of Health and Family Welfare for a response on the country's readiness to combat the health hazards rising from climate change. We will update the article when we receive a response.

Additional reporting, data analyses and visualisations by Nushaiba Iqbal.

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