On 9 August 2016, India’s Minister of Environment, Forest and Climate Change (MoEFCC), Anil Madhav Dave, informed the LokSabha (lower house of the Indian Parliament) that approximately 1,36,000 climate change-related deaths are projected in India, primarilyowing to decreased food production, according to an Oxford University study. He went on to quote figures from a World Health Organisation (WHO) report published in 2014 in his reply. This report pins the cause of deaths between 2030 and 2050 on malnutrition, malaria, diarrhoea and heat stress.


The Ministry itself came out with a report way back in 2010 – Climate Change and India: a 4x4 Assessment – a Sectoral and Regional Analysis for 2030s – that identifies four key sectors (Agriculture, Water, Naturural Ecosystems & Biodiversity, Health) in four regions (the Himalayan Region, the Western Ghats, the Coastal Area and the North-East Region) as stressed (and/or projected to be stressed in the future) due to the impacts of climate change.


Trends that Link Climate Change to Health in India


One sector that is central to these reports and is now emerging as a thrust area of planning and policy in the country is – health. There are several trends that have pushed the government into action on this front. One among them is the alarming increase in the number of deaths due to heat stroke in the past decade or so. According to one report, between 2004 and 2013, there was a 61 percent rise in the number of such cases. This trend peaked in 2015, when nearly 2,500 deaths were supposedly caused by India’s one of severest heat waves in recorded history. Although some would refrain from linking these extreme conditions to climate change (deterministically), the government and a large proportion of the country’s scientific community have openly acknowledged that rising temperatures and varying precipitation patterns play a crucial part in the recurrence of heat waves. 


The second most palpable trend is deterioration in cardio-pulmonary health, especially among urban and peri-urban residents. A study published in 2013 revealed that air pollution has been one of the leading causes of death in India, attributing more than 600,000 premature deaths to it. The number of reported cases of Acute Respiratory Infection(ARI) has grown gradually in the past few years and this is being attributed mainly to worsening air quality in Indian cities such as Delhi, Chennai, Mumbai and Bhopal among others. From less than 2,000 cases per 100,000 people in 2001, the number of cases of ARI went up to 2,600 per 100,000 people in 2012. The damning fact that world’s 20 most polluted cities are in India (in terms of annual average concentration of the Particulate Matter[PM] 2.5) does not bode well for the country either, in such a situation.


While PM 2.5 is considered more of a “winter problem”, India has yet another problem to deal with during the summer. What is becoming increasingly disturbing is that the concentration of hazardous gases such as carbon monoxide, nitrogen dioxide and ozone in the atmosphere is on the rise, having direct and/or indirect impacst on climate change and human health. One of the causes of increase in ground-level ozone pollution is increasing temperatures that augment sunlight-driven photochemical reactions involving precursor hydrocarbons and oxides of nitrogen (including nitrogen dioxide).  There are umpteen number of studies that prove the negative impacts of ozone pollution on pulmonary health, in terms of aggravating shortness of breath, wheezing and coughing, asthma, emphysema, chronic bronchitis, respiratory infection and pulmonary inflammation.


These are the direct health impacts of climate change but there are various indirect impacts that have come to the attention of the country’s authorities – such as risk of diarrhoea, cholera, typhoid and dysentery from water contamination caused by flooding; deterioration in nutritional health caused by drought-induced crop failure; post-disaster mental illnesses such as trauma; spread of vector-borne diseases to hitherto disease-free areas, to name just a few. For instance, malaria(a climate-sensitive disease), which is found to be endemic in the central and eastern regions of India (contingent on temperature and relative humidity) currently, is likely to shift to northern, north-eastern and south-western coastal regions of the country due to varying climatic conditions (under the business-as-usual scenario). From an economic point of view too, these trends could prove to be disastrous for India. One study points out that deaths related to malaria could result in a loss of economic output of US$ 20.7 billion.


Risk ofDisease Outbreaks in Neighbouring Countries


India has to be prepared for outbreaks of various infectious diseases not only within its own territory, but also in neighbouring countries such as Bangladesh. Take the case of frequent cholera outbreaks in Bangladesh that some scientists have linked to progressively more intense El-Nino events in the Bay of Bengal and warmer sea surface temperatures, while a few other members of the scientific community would hesitate to connect cholera incidence to environmental factors. Considering inter-migration is already being studied as a part of the India-Bangladesh relations, outbreak of infectious diseases could be one of the drivers of population displacement and movement.


India’s northern Himalayan neighbour, Nepal, is equally affected by the spread of vector-borne diseases such as malaria, lymphatic filariasis, Japanese encephalitis, visceral leishmaniasisand dengue fever to non-endemic areas, partially being blamed upon warming of tropical highlands and temperate regions. Many studies and reports have reiterated that the rate of warming in the Himalayas has been higher than the global average in the last three decades, reinforcing the fact that the Himalayas are more climate-sensitive and vulnerable than many other parts of the world or that of the South Asian region. As higher altitudes (mountainous regions) are experiencing higher warming rates, this is touted to drive species to higher elevations and along with them, vector-borne diseases. Bhutan, another country in the Himalayan region, has also started to grapple with diseases such as malaria and dengue that it never had seen before.


Framing Climate-sensitive National and Regional Health Strategy


Earlier in 2016, the Ministry of Health and Family Welfare (MoHFW) released a draft report on National Action Plan for Climate Change & Human Health that lays out “a multi-pronged approach to address the health-related aspects of climate change.” It envisions to “strengthen health of citizens of India against climate sensitive illness, especially among the vulnerable populations like children, women and marginalized population;” with the goal to “reduce morbidity, mortality, injuries and healthvulnerability to climate variability and extreme weathers;” and the objective to “build capacity of health care services against adverse impact of climate change on human health.”


This mission is envisaged to be integrated with the other national missions on climate change – National Mission for Sustaining theHimalayan Ecosystem, National Water Mission, National Mission for “GreenIndia”, National Solar Mission, National Mission for Enhanced Energy Efficiency, National Mission forSustainable Agriculture, National Mission on Strategic Knowledgefor Climate Change, National Mission on Sustainable Habitat, National Mission on “Waste toEnergy Generation”, and National Mission on India’s Coastal Areas. It focuses on a series of must-dos in order to tackle climate-related threats to health –  information and early warning systems; public communication and health preparedness; primary, rural and community healthcare; risk assessment and emergency/disaster preparedness; exposure forecasts; integrated vector/pest control; sufficient animal and human immunization coverage; food and water quality control; occupational health exposure standards; and seasonal nutritional screening among others. 


At the national level, this is a welcome step although it remains to be seen how the Union Government implements the action plan through its nodal ministries and agencies in various states, considering health is in the state list. India has to push the agenda hard to achieve its objectives in this sector. At the same time, for a holistic improvement in the health scenario in the country, India also needs to integrate climate change and human health to its bilateral policies with the neighbouring countries as well as regional policies, may be through the South Asian Association for Regional Cooperation (SAARC). The 5th meeting of SAARC Health Ministers held at New Delhi in 2015, adopted the Delhi Declaration on Public Health Challenges, which addresses various issues, including vector-borne and infectious diseases.


Although health is one among numerous target variables in the SAARC regional climate change strategy, climate change is yet to feature prominently in the regional health strategy. To bridge the gap between the two remains a challenge for India and other countries in the region as it experiences further deterioration in human and public health caused by climate change related factors.


[This article is written as a part of the Adelphi-MARG project Climate Diplomacysupported by the German Federal Foreign Office]. The views expressed in this article are personal.