Climate Change Is Enabling A Diseased Society, And The Time To Act Is Now!

“How dare you?”, Greta Thunberg had asked the world policymakers in the UN Climate Summit, 2019.

Today, the world cannot afford to oversee the fury behind this question. One of the most serious reasons is climate change, straight attacking human health and survival. 

Climate change leaves its impression on human life in a multi-dimensional way. In essence, it’s targeting livelihoods, denying access to essential services, demeaning the quality of life, and stirring human culture. But perhaps, the most vital impact lies in the terrifying health outcomes. What is suitable for the climate is good for health, and what is bad for the environment is bad for health—the equation is as simple as that. 

The year 2019 can seemingly be one of those years in the millennium, which will be remembered for global and local consequences, incidents, and controversies around the climate change phenomenon. With the climate strike movement spreading over countries, UN Climate Summit was at the focal point of global discussions and the fires in Amazon Forest terrified the world. 

In the Indian context, the protests in Mumbai for saving Aarey forests checked the patience of climate activism spirit. The sun was cruel to some Indian states during summers with heat stress and droughts, the river and urban flooding incidents continued even after traditional monsoon time, and it made people believe that climate change is now at the doorstep. The recent air pollution compelled the Delhi Government to declare a public health emergency – so many examples can be given where climate change discussions and debates simply became part of the household and public spheres. 

In this background, it also becomes noteworthy to analyse the adverse effects of climate change on human health in the past few years. The subject covers the diversity of directly and indirectly related health conditions. Let’s see some common manifestations prevalent in the Indian context. 

1.  Vector-Borne Diseases

Changes in seasonality patterns alter life cycles of vectors like mosquitoes, and as a consequence, vector-borne conditions become prevalent. Dengue, Malaria, and Chikungunya cases are expanding their existence in Indian states throughout all seasons beyond monsoon.

Reports often present epidemiological data. For example, National Vector Borne Disease Control Program reports claim more than 67,000 cases of Dengue, having claimed 48 lives by mid-October 2019. The hot and humid climate of the country is already favourable for the growth of Dengue mosquitoes.

Further, Dengue cases are rising with a higher average annual rainfall in India. Studies reveal how the variation in precipitation and temperature directly affects the incubation period of Dengue mosquitoes.

Similarly, Malaria researchers claim how its transmission is likely to deferentially increase in different regions of India with changes in temperature. 2019 has seen extreme temperatures and rainfall patterns. The probability of a rise in vector-borne diseases as per climatic conditions can be predicted in annual research findings.

The outbreaks of bacterial infections like Leptospirosis spread through animals, also resulting out of contact with contaminated floodwater, also add to a death toll. According to news reportage, 72 people lost their lives, and 1527 were affected in the state of Maharashtra during the last five years as a result of Leptospirosis. Apart from infections like Malaria, Dengue which have a history in India, some new diseases are taking birth. The infections like Zika virus and the Nipah virus were a matter of worry for Indian medicos in the year 2018. 

2. Waterborne Diseases

World Bank estimates that 21% of infectious diseases in India are linked to unsafe water and lack of hygiene. Over 500 under-5 age children die every day because of diarrhoea alone. Besides, climate change is posing a further threat. The International Panel predicted an increase in the burden of diarrheal diseases due to climate change on the Climate Change report.

The prediction seemed to be true in the last few years across various scenarios. Flooding makes a conducive environment for bacteria, which causes waterborne infections. For example, outbreaks of diarrhoea, jaundice, and other waterborne diseases were observed this year in western Maharashtra, Kerala, and Karnataka. On the other hand, water scarcity and droughts compelled people to compromise over hygiene, food safety, and access to safe drinking water. When Chennai witnessed a ‘zero-day’ situation of water shortage this year, advisory had been released warning possible outbreak of waterborne diseases among students.

3. Heat Stress

A recent study endorsed by GoI and which is based on mortality- temperature relationship predicts that 15 lakh Indians may die due to the rise in heat by 2100. During this year’s summer itself, most of India grappled with more than 40-45 degrees Celsius and subsequent heatwave effects. Rajasthan’s Churu even crossed 50 degrees Celsius mark. Twenty-two states witnessed 73 heatwave spells in 97 days. Casualties were observed, and in Bihar alone, 200 plus deaths were associated with heat stress in 2019. Coastal states faced discomfort due to the heat index, which is a combination of temperature and humidity. Andhra and Telangana in 2016 had seen more than 2000 deaths, directly and indirectly, due to heat.

4. Respiratory Infections

When this article is being written, an unprecedented public health emergency has been declared in UT Delhi and the surrounding region. The city is being described as a ‘gas chamber.’ The Air Quality Index has crossed the hazardous level. Schools have stopped outdoor activities. Construction activities are banned. Masks are being distributed, and the much-discussed odd-even scheme is again being implemented for a week to reduce vehicular pollution. Immediate health symptoms of air pollution can be perceived as itching of eyes, suffocation, and breathing issues. Delhi hospitals are full of patients with cases like respiratory and cardiac complications, asthma, chronic obstructive pulmonary diseases, etc. 

5. Malnutrition 

India has been labelled as a country with severe levels of hunger by the Global Hunger Index (GHI) published recently.

Even statistics published by UNICEF for Indian children under “Status of World Children” report 2019 depicts an alarming situation of nutrition among children with data saying ‘every 2nd Indian child is malnourished’.

This malnutrition challenge is being further worsened by climate change. GHI report elaborates on how climate change is deteriorating food quality and safety. The nutritional value of cultivated food is being degraded and overall global food systems are getting affected.

This year India has seen erratic rainfall in October, November. It has destroyed crops and resulted in an agricultural loss. The links of climate change and nutrition cannot be neglected as proper nutrition boosts immunity. 

6. Non-Communicable Diseases (NCDs)

Non-communicable diseases form a threat to modern Indian society. These include blood pressure, diabetes, cardiac and renal complications, etc. Climate change doesn’t have a direct relationship with the rise in NCDs. However, people with NCDs are more vulnerable to climate-induced health impacts like heat stroke or airborne diseases. According to the WHO, the risk factors for NCDs are strongly linked to climate change.

A simple example to reveal this relationship is the advice given to stay indoors for avoiding air pollution, restrictions on walking, and this necessary lifestyle change as an additive factor for NCDs. Researchers have drawn similar complex interrelationships between factors together, posing a risk to global health. However, more India based studies will be required in the near future to plan local actions in this case. 

7. Road Traffic Accidents

It’s common to lose control of driving when the roads become slippery in the rain, or it’s also common to lose consciousness while facing excessive heat during peak hours of summer afternoons. Road traffic accidents (RTAs) serve as one of the most severe public health threats, and heat distraction or rains belong to the list of causes behind the RTAs. More research is needed to establish this indirect relationship, which is often revealed in experiences and anecdotes. 

8. Mental Health Effects

From 2015 to 2018, the state of Maharashtra has seen more than 12, 000 suicides of farmers. Farmers’s suicide is a public health issue resulting from varied social, economic, and environmental factors. Climate change-induced agrarian distress is one of the critical factors. Similarly, mental health issues like shock or depression are often diagnosed with flood or storm survivors who lose their families, work, and property.

Irritation, loss of concentration in labour, and conflicts are some of the daily repercussions of heatwaves and degraded air quality. As per the WHO definition, mental health is one big chunk of a person’s overall health. Experience of mental health illness as a result of climate change is a rising issue, worth studying. It becomes even crucial when routine societal stress is increasing.

The Socio-Cultural Face Of The Problem

Climate change affecting health – this is not a straight simple linear equation. Multiple demographic, social, economic, and cultural stressors amalgamate to result in health outcomes along with the climate. Existing health inequities based on age, gender, occupation, socioeconomic class, caste, and so on are often accelerated by climate change. Disproportionate provision of civic services also hampers health when coupled with climate. 

Here are some representative examples which show how these complex linkages operate. 

1.  Occupation groups like street vendors or traffic police officers are directly exposed to sunlight during summers and experience heat stress as compared to their counterparts, say, small shopkeepers who stay inside the shop. Urban neighbourhoods often are crowded, with no open and green spaces. They trap heat during the day and remain heated even during nights. On the other hand, in the case of coastal cities, intra-domestic comfort is less as humidity plays an important role. Here, the individuals who stay longer inside the house with no cooling resources, experience higher risks. 
2. The poor are affected disproportionately compared to the rich. Pune has seen high rainfall levels and urban flooding this year. Bastis like Ambil Odha, situated on the bank of the stream, have lost their houses, goods. People from Ambil Odha are more vulnerable to health issues and are struggling for compensation from Municipal Corporation. Here, the unauthorized and unplanned construction activities over the decades obstructed the rainwater flow and became the cause of damage coupled with untimely rains.
3.  Gender inequity in routine affects healthcare access to women and girls. They are the ones in the family who compromise in food intake, who spend less on medical care and who don’t prioritize healthcare service access. With climate change, disease burden is increasing, and existing gender disparity for healthcare is also widening. They are less likely to receive information about how climate change is accelerating health issues. 
4.  Vector-borne diseases don’t distinguish between the rich and poor. But the cause of the disease can be out of human behaviour. For example, in the case of the Sainik farm settlement of Delhi, the vibrant area of bungalows was found to be using nearby slum as a dumping ground. When already the seasonality is tremendously affecting the mosquito breeding, this kind of human behavioural pattern is not affordable. 

Multiple examples can be given in this way, and thus, climate and health equation cannot be seen in isolation, but more holistic lenses are required to understand it in-depth. 

Climate And Health Roadmap: A 5-Point Action Plan

So, viewing the situation, what can be our action? Here, based on my field knowledge, I would like to conceptualize a plan. 

• Evidence-Based Planning

1. Unless we don’t know the situation well, we won’t be able to act efficiently. It’s essential to generate a local database and keep it handy for the local self-government to plan the actions. Meteorological data and predictions must be coupled with morbidity and mortality data, and associations must be drawn. 
2. There are some moves towards evidence-based responses. For example, the government of Maharashtra is now set to carry out the wise disease survey in flood-affected areas. Leptospirosis incidence was better controlled in the city of Mumbai this monsoon than the previous year by taking evidence-based actions. Ahmedabad, a heat action plan, was first prepared in 2013 based on temperature mortality statistics. The planning strategy is replicated in other cities. 
3. However, urgent and compelling generation of local databases for different climate health correlations is advised.
4. More desegregated data for social indicators are required to take group-specific actions for certain signs, say, gendered data.
5. Furthermore, climate change doesn’t involve static, one-time research. Climate variability occurs temporally and spatially. The same is true for its health outcomes. This methodology generates the constant requirement of updated datasets.

• Collaborative actions

1. Pulling data from different sources like local weather stations, health facilities, and organizations is key. This also necessitates a lot of inter-sectoral coordination. 
2. Lancet countdown report (2018), in its briefing for policymakers, also emphasize “multi-stakeholder coordination and implementation through national and state action plans.”
3. For example, air pollution concerns in the context of occupational health will not be solved unless industries and the labour department are involved. Vector-borne disease control involves a lot of modifications in building designs itself, and the reduction will be efficient when the construction sector is part of the action.

•  Systematic capacity building

Producing just a huge amount of data will not serve the purpose. What’s important is seeing the patterns in data and plan actions accordingly. Administrators must be skilled in planning their actions by taking datasets into account. Local academic institutions must be willing to utilize the knowledge and skills of their resources to analyze local climate and health data.

Outside research agencies can demonstrate the actions, but they are not going to forever guide for local activities. More and more local capacity must be built to act through climate and health lens. Disaster preparedness plans must include post-disaster susceptibility to various diseases. 

•  Reviving Traditional Knowledge

Climate inclusive health actions have been part of India’s traditional culture, be it cuisine, dressing patterns, housing, or way of life. Different regions of the country are experts in growing and cooking season based food items. Traditional housing structures used to consider open spaces, green spaces, and subjective measures to combat heat stress. Such a wealth of traditional knowledge must be part of respiratory as well as actions. 

•  Climate Inclusive Health Communication 

Routine transfer of health messages through Information Education and Communication activities must include climate components in framing the messages. This will help to bring climate angle into people’s consciousness. Similarly, existing campaigns related to climate and environments like Swachh Bharat Mission or Vector-borne diseases must include health dimensions. Lancet’s report also recommends the strategic use of media in responses. 

In conclusion, I want to say that we are not saving our planet by combating climate change. The earth was always there and will be there forever. We are protecting ourselves – the human species on this planet. The path of saving ourselves goes through restoring our health. So, let’s build a healthy planet by saving our health.