This year’s heat wave is a warning to build resilience to climate change. (PTI)
The last three weeks have been very hot in most parts of India. Several cities in North and West India have recorded near 50-degree temperatures. There are reports of people suffering heat strokes and other heat-related illnesses. This is just the beginning of climate change. We are likely to see greater increases in temperatures over the next 50 years. It is, therefore, time to act and save people from extreme heat. Several lessons can learnt from Ahmedabad, which implemented its Heat Action plan more than a decade ago.
Ahmedabad had a major heat wave in 2010 when the temperature in the city went up to 47 degrees Celsius for a week in May. During this week, the Registrar of Births and Deaths recorded more than 800 additional deaths — mortality over what is expected in this period. There was no epidemic or any other reason for the high number of deaths. It was concluded that most of the 800 people had succumbed to the heat wave. But there was a catch — during this week, the recorded heat stroke cases were about only 270 and 76 heat stroke-related deaths occurred in the city’s five major hospitals. The analysis of all-cause mortality revealed that the much higher number of deaths was due to the heat wave. The first lesson from Ahmedabad is, therefore, to not focus on a few isolated heat stroke cases and deaths, but review the all-cause mortality every day and compare it with the expected mortality based on past records.
When the city’s administrators became aware of the high number of deaths, they decided to launch South Asia’s first threshold-based Heat Action Plan. This plan has been implemented in Ahmedabad since 2013. The evaluation of the strategy has shown that it saved a large number of lives at the peak of subsequent heat waves.
The second lesson from the Ahmedabad heat action plan is to take simple measures which do not require much resources. However, these measures need to be implemented well so that they reach the entire community, especially vulnerable groups. The major elements of Ahmedabad’s Heat Action Plan are the early warning system, coordination between agencies, creating public awareness about heat and protecting people from rising temperatures. Medical and paramedical services have to be in a state of preparedness and the community should take short-term and long-term measures to reduce exposure to the Sun and build resilience.
The third important lesson from Ahmedabad is appointing a nodal officer for heat action planning. Giving this officer security of tenure, for more than 10 years, allowed him to learn and become an effective leader. This nodal officer receives the IMD /Met service warning and disseminates alerts to the media, the public and various government departments.
The Heat Action Plan specifies the measures that have to be taken by various departments at different alert levels — yellow, orange and red. These alert levels are determined on the basis of the relationship between mortality and temperature in Ahmedabad using the last 15 years’ data from the Registrar of Births and Deaths and from IMD. The thresholds are derived from health-based outcomes.
The fourth lesson is to involve facilitating agencies such as local public health institutions, international knowledge partners, and NGOs and community-based organisations. Ahmedabad involved all such agencies. Some partners provided state-of-the-art knowledge from different parts of the world, while others facilitated media linkage. The city’s municipality took ownership of the plan and coordinated with all the partners.
The fifth lesson is to bear in mind that no plan is perfect. It has to be reviewed and improved over time. The review of the plan design and its implementation after each season tries to ascertain what has worked, what has not, what got implemented, what could not be implemented, and why. This led to course corrections.
The evaluation also included compilation of mortality and temperature data during the summer. This was compared with the mortality data in the years before the implementation of the plan. Such a system of reviews improved the plan every year and led to the addition of new elements as well as improved planning and implementation of the existing actions. It also provided hard data to the city to see if the mortality is declining. Two years after the plan was implemented, a pilot evaluation showed a substantial reduction in mortality even when temperatures rose more than 44 degrees Celsius. The evaluations also helped the City Heat Action plan to become a model for other cities and for the National Disaster Management Authority (NDMA) to scale it up nationally.
Finally, no heat action plan is suitable for all locations. Each city and district will have to adapt the framework provided by the Ahmedabad heat action plan, as well as by the national authorities such as the NDMA and National Centre for Disease Control, to suit their individual needs, environment and resources. Such locally adapted plans, if implemented in earnest, will ensure that people are protected from the unprecedented temperatures now and in the long term. This year’s heat wave is a warning to build resilience to climate change.
The writer is Distinguished professor of Public Health, IIPHG and Advisor, Centre for Environmental Health, PHFI
