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While India was battling with COVID-19 pandemic in 2020-21, death, displacement, and damages from climate change related events like floods, cyclones, droughts, and heatwaves added massive additional burdens to the system. According to government data, almost every Indian state was affected by an extreme weather event in 2020-21. The Global Climate Risk Index 2021 ranked India among the top ten countries to be affected by the devastating impact of climate change. Scientists, health professionals and indigenous communities have been warning us about the looming threat of climate change for over a quarter century—with a sharp rise in heat stress events, cyclones, floods, and drought, we are indeed witnessing it firsthand.
Extreme weather events have claimed thousands of lives in the last two decades, adversely affecting millions of others by displacement and damaging property and means of livelihood resulting in significant economic losses. Climate disasters cost India USD 87 billion in 2020 alone. According to a World Bank estimate, “Climate change could drag more than 100 million people back into extreme poverty by 2030”, and much of this reversal would be due to the “negative impacts on health”.
Climate change and health
Climate change will affect everyone, primarily due to the rising sea levels and temperatures, air pollution related to burning fossil fuels and growing numbers of extreme weather events. With an increase in temperature and water scarcity, incidents of extreme heat stress would be more common; extreme rainfall and floods will cause an increase in water- and vector-borne diseases; frequent occurrences of droughts in some parts of the world will reverse the progress being made in combatting hunger and malnutrition. It is also estimated that low- and middle-income nations will be the worst affected: they have the least capacity to adapt to the situation due to weaker infrastructures and health systems, and because of disproportionately higher exposure. So, the climate crisis is also a crisis of basic human rights and health equity that threatens everything—our air, water, food, shelter and security—all the basics on which the human life depends.
Read more: Health as the Central Driver for Action on Climate Change by Renee N. Salas, Yerby Fellow, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health
Public health: A climate solution?
In March 2021, the lack of available of hospital beds and oxygen during the second wave of COVID-19 pandemic and related deaths exposed the gaps in the Indian healthcare system. Any further increase in extreme weather events as is projected—and the related negative health effects—may cripple the already inadequate public health infrastructure in the country. Therefore, policies that seek to strengthen health and health infrastructure should be the top priority for climate change mitigation.
Health is an issue that perhaps can bring communities together because of our shared concern. Human health also interlinks with planetary health, and policies that foster good health for one are inherently good for the other.
In the last few years, India has taken significant initiatives both at the national and sub-national levels to focus on health and health care climate action.
The National Programme on Climate Change and Human Health
In October 2018, India drafted its National Action Plan on Climate Change and Human Health (NAPCCHH) with the objective to strengthen healthcare services against the adverse impact of climate change on health. Subsequently, the Ministry of Health and Family Welfare approved the NPCCHH under the National Health Mission in February 2019. NPCCHH focuses on common climate-sensitive diseases such as air pollution related, heat related, water-borne, vector-borne and cardiopulmonary diseases; mental health; food-borne and nutrition related illnesses etc. Currently the priority areas for NPCCHH include air pollution, heat related illnesses and the creation of green and climate-resilient healthcare facilities. Detailed health adaption plans are underway for more in-depth preparations; for example, in 2020, the national government is working with 23 states and over 100 cities and districts to develop and implement heat action plans across India.
As part of the NPCCHH, most Indian states are now putting together a comprehensive state-level plan to tackle the health impacts of climate change. States are committing to further strengthening existing health infrastructure to prepare for future health challenges, including not only climate change-induced adversity but also epidemics, other outbreaks and/or disasters. States are also increasingly recognising the critical role of health workers to promote action on climate change and its impacts on health, and are focusing on training them as messengers of climate actions.
Apart from these national initiatives, we are also witnessing a wide array of inspiring leadership and actions protecting health and health care infrastructure and building climate resilience at the sub-national level. For example, the state of Chhattisgarh in India has solarised over 1,400 community health centres and pledged to attain 100% solarisation to ensure energy access. Solarising health centers make them climate resilient and sets the state’s health sector on the path of reduction of significant carbon emissions. Solarisation also makes states more capable of delivering the COVID vaccine and reliably managing cold chains for medicines in general.
In another example of bold climate and health action, the Health Minister of Kerala signed the state’s Department of Health and Family Welfare up to the UN-backed global campaign Race to Zero in October 2021. By doing so, Kerala’s health department becomes the first sub-national government in Asia to join the prestigious programme, announcing its ambition of net-zero carbon emissions aligning to meet the Paris Agreement goals. This announcement also meets the health sector’s obligation to "first, do no harm", and sets a science-based greenhouse gas emissions reduction target to mitigate the impacts of climate change.
Nearly 700 million of India’s population of over one billion live in rural areas and directly depend on climate-sensitive sectors (agriculture, fisheries, and forests) and natural resources (such as water, biodiversity, mangroves, coastal zones, and grasslands) for their subsistence and livelihoods. We need to be proactive in framing plans and policies to meet the health needs of the affected populations. Strong, meaningful action will be required at all levels—national, regional, and local. India will essentially need a low carbon, climate resilient health system to face the challenges of the changing climate. Overall, the health care system should not be viewed merely as providers of healthcare; rather it should be the foundation for preventive care and the lead runner protecting against the health effects of climate change. Our biggest challenge is mitigating the human and public health cost of climate change. To be effective, climate actions must have health at the centre and solutions must be local, decentralised, community-owned and rooted in the principles of justice and equity.
 Connecting Climate Change and Health for Better Development. https://blogs.worldbank.org/health/connecting-climate-change-and-health-better-development
 Low-Carbon and Resilience Strategies for the Health Sector, 2017. www.worldbank.org
 National Action Plan on Climate Change and Human Health [Internet]. [cited 2020 Jul 30]. Available from: http://www.indiaenvironmentportal.org.in/files/file/national action plan of climate change and health.pdf
 Kumar A, Mahajan NP, Sorokhaibam R, Sunthlia A, Babu BS, Vardhan S et al. National Programme on Climate Change and Human Health-India, 2019. J Commun Dis 2020; 52(3): 43-48
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