India is experiencing the hottest month of March in 122 years as per the Indian Meteorological Department (IMD) data. The data also notes that the number of heatwave days are only increasing with time. The country has witnessed a massive jump of 45% in the number of heatwave days between 1981 to 2020. The whole of northern India is reeling under an intense heatwave with signs of no respite in near future. Scientists have called this the most obvious and lethal impact of climate change.
However, this is not the first time that our cities are facing such a crisis. Ahmedabad in Gujarat witnessed record-breaking heatwave conditions back in 2010. The temperature crossed 48 degree celsius. (More than 4400 people lost their lives) and birds and cattle died on the streets. This served as a wake-up call for the local government to swing into action.
Since then the efforts that were taken by the Amdavad Municipal Corporation (AMC) and other agencies have become a case study for addressing this life-threatening issue. This is the right time to study the measures that were implemented by AMC and explore if they can be implemented across the country (or at least in some pockets) to manage the situation.
First Heat Action Plan in India
Ahmedabad is the first city, in India and in South Asia, to have designed its own Heat Action Plan (HAP) in 2013. The plan was subsequently revised in 2016 and 2019. AMC collaborated with some of the leading international civil society organizations to draw the action plan. HAP formally acknowledged the challenge of climate change and heatwaves. It called for preparing the health systems and residents against heatwaves.
HAP is built on three core principles: Public awareness and community outreach; initiating early warning system and inter-agency coordination; and capacity building among healthcare workers. AMC is the nodal agency to ensure the implementation of the plan. HAP lays down a special emphasis on vulnerable groups or high-risk populations like the ones living in slums or patients with serious health issues.
Improving interdepartmental communication
One of the key lessons that HAP highlights is the importance to prioritize seamless communication between the nodal agency and line departments. This improves inter-departmental communication and ensures effective decision-making.
As per the plan, as soon as AMC receives the heat alert, it immediately activates the communication lines and public messaging systems. It pushes the notification to State Disaster Management Authority (SDMA) and Integrated Disease Surveillance Programme (IDSP). It shares the same alert with other departments like hospitals, water department, labor department, power department, transport department, school board and others. These departments are mandated to issue specific advisories. For example, the school board will issue advisories with respect to school timings and to ensure adequate arrangements are made on the school campus. Labor Department will make sure that arrangements like shade and drinking water are available to workers at the site.
Public engagement is a vital aspect of HAP
Public messaging system is the soul of HAP. The plan designates a Press Cell under AMC to ensure that alerts are disseminated on time and all the supporting communication and outreach activities are streamlined. The mandate of the press cell is to liaise with the media, work on outreach, issue alerts on print, TV, radio, SMS and promote heat hotline. The cell also makes sure that temperatures and heat alerts are shown in real-time at various public places.
HAP lists down a list of actions for local NGOs and citizen groups too like distribution of heat protection materials, leading child-friendly educational preventive training, checking on vulnerable groups and educating fellow community members.
Documentation of heat-related morbidities and mortalities
Heatwaves have always been a silent killer. The health system has struggled to document deaths taking place due to heatwaves. HAP has proved to be a critical tool in establishing a linkage between heat and its impact on human health. It focuses on improving the reporting and documentation of deaths due to heatwaves. The plan calls hospitals to update their admissions and emergency case records to track heat-related morbidity and mortality. During peak heat season, hospitals are suggested to produce a weekly report of the public health impact during a heat alert.
Post heat season, HAP entrusts the health department to perform an epidemiological case review of heat-related mortalities during the summer. It also lays down that the department should measure mortality and morbidity rates based on data before and after the Plan’s intervention. The plan further talks about training hospital staff (nurses, paramedics, field staff and link workers) at local hospitals and urban health centers on heat illness.
Though, there has been a gap in implementation. Local media reports from Ahmedabad suggest that a lot of private and government hospitals have not reported any data on heat-related mortalities because heat-related ailments are not ‘notifiable diseases’, which makes it voluntary for the hospitals and doctors to report them.
Outcome of HAP – Mortality has decreased
Ahmedabad’s HAP was able to avoid 2380 deaths in 2014 and 2015. The relative risk of mortality decreased from 2.34 to 1.25 at 47 degrees. The number of heatstroke cases decreased from 274 in 2010 to 26 in 2018. City reported 65 deaths were caused due to heatstroke which was reduced to only 3 deaths in 2018. The heat action plans have expanded to over 23 states and 100 cities and districts through the National Disaster Management Authority (NDMA).
The city also started a Cool Roofs Programme in 2017 as a part of HAP, which was upscaled and implemented in 15000 slum roofs and 1000 government buildings in 2020. The program has also been adopted by the Telangana government, a region that also remains affected by heatwave.
Time to learn and replicate
A study has suggested that heatwave has claimed more than 17000 lives in 50 years (1971 to 2019) across the country. The data also shows that between 1960 and 2009, the probability of a massive heat-related mortality event (defined as more than 100 deaths) has shot up by 146%. All this indicates an urgent need to have a robust mechanism in place to mitigate the impacts of the intense heatwave season that is growing wildly. It is a good time to look at the key learnings of the HAP and the core principles that it is based on. It can be a good template for other cities to follow. The plan can be adapted and contextualized according to local factors and realities prevailing on the ground. This can prove to be a useful strategy in saving human life.
Rishabh is a lawyer and writer working in climate change, public health and social justice advocacy. He is Co-founder and Editor-in-Chief at TA. He tweets at @Writer_Rishabh.
The Analysis (TA) is a research and communication group working on the issues of Climate Change, Public Health, Gender and Human Rights. Feel free to share your submissions on these issues with us at contact@theanalysis.org.in