Climate Change and Health Preparedness in India: Protecting Local Communities in Ahmedabad, Gujarat, India from Extreme Heat

Heat waves in Ahmedabad – one of the fastest-growing cities

in India – are becoming increasingly deadly, exacerbated by

climate change. The Public Health Foundation of India,

Indian Institute of Public Health, Gandhinagar, and Natural

Resources Defense Council are working with city officials and

the health care sector to protect people from Ahmedabad’s

rising temperatures.

Various extremes of weather due to the effects of climate

change have been predicted and observed to be happening

with some regularity. Of these extreme weather events -

spells of extreme heat and cold, the heat spells are more

likely to occur than cold. Many of the heat related

morbidities and mortalities could be due to its direct and

indirect effects. While the direct effects include heat stress,

heat exhaustion and heat stroke, the indirect effects occur

when heat is an underlying cause of other mortalities and

morbidities. Thus, both higher than average temperatures

and more frequent and severe extreme heat events can lead

to higher risk of mortality and morbidity.

Cities and urban areas are more vulnerable due to the

phenomenon of the urban heat island effect, where the

temperatures in the urban areas have been found to be

higher than those outside the city limits. Urban

microclimates too have a role in higher urban temperatures,

and this provides opportunities for city municipalities to

implement specific and targeted actions to mitigate the

impacts of rising temperatures. In the past numerous spells

of extreme heat / heat waves have occurred in different

parts of the world, and some have been documented to be

associated with a massive number of deaths, such as those in

various parts of Europe, Chicago and California. The 4X4

report predicts increasing temperatures for India.

Ahmedabad experienced a heat wave in 2010 in which

hundreds of people died. For the future, projection studies

have been done which show the impact of climate change on

summer heat related premature deaths.

Noting these evidences, some countries have instituted

prevention strategies and preparedness plans to minimize

the human costs. These include best practices for city

municipalities and workplace health promotion strategies.

IIPHG, in partnership with NRDC, is also working with the city

government of Ahmedabad to implement a series of

measures to protect the people of the city from rising

temperatures.

Using qualitative vulnerability assessments, community

surveys, and focus-group-based workshops with the

municipal government and health care workers, we have

identified the most heat-vulnerable populations. Ongoing

qualitative and quantitative efforts are focused on

developing targeted climate change adaptation strategies to

enhance these groups’ resilience in the face of extreme heat.

Initial results indicate the groups most vulnerable to heat

waves include slum communities, the elderly, newborns, and

outdoor workers. Quantitative assessment indicates an

excess of total mortality and ambulance calls during heat

waves in Ahmedabad.

The project’s priority is to reduce heat-related health

vulnerabilities and implement an early health warning

system for future dangerous heat events. The early health

warning system for extreme heat events – the first of its kind

in India – is now being developed for a proposed launch

before the beginning of Ahmedabad’s summer season in

2013. For more information on the climate change and

health preparedness project, contact Gulrez Shah Azhar,

Senior Lecturer (gsazhar@iiphg.org).

PHFI Research Updates Monthly Newsletter

Vol. 1, Issue 10, November 2012

Project activities including vulnerability assessment of slum

communities in Ahmedabad

Acharya, A, Vellakkal, S, Taylor, F, Masset, E, Satija, A, Burke,

M, Ebrahim, S. The impact of health insurance schemes for

the informal sector in low- and middle-income countries: A

systematic review. The World Bank Research Observer.

2012.

Agrawal, P, Agrawal, S. Obesity and reproductive health among Indian women. Journal of Society and Communication. 2012; 1:38-68.

Arrow, KJ, Danzon, PM, Gelband, H, Jamison, D, Laxminarayan, R, Mills, A, Mwabu, G, Panosian, C, Peto, R, White, NJ. The Affordable Medicines Facility-malaria: Killing it slowly. Lancet. 2012.

Bhan, N, Srivastava, S, Agrawal, S, Subramanyam, M, Millett,

C, Selvaraj, S, Subramanian, SV. Are socioeconomic

disparities in tobacco consumption increasing in India? A

repeated cross-sectional multilevel analysis. BMJ Open 2012;

2:e001348.

Babu GR [letter] Evidence for health policy in India: Do we

have enough data? Journal of Royal Society of Medicine.

2012 September; 105:365.

Channon, AA, Andrade, MV, Noronha, K, Leone, T, Dilip, TR. Inpatient care of the elderly in Brazil and India: Assessing social inequalities. Soc Sci Med. 2012; 75:2394-402.

Devasenapathy, N, Neogi, SB, Zodpey, SP. Is intravenous iron sucrose the treatment of choice for pregnant anemic women? J Obstet Gynaecol Res. 2012.

Dhillon, PK, Kenfield, SA, Stampfer, MJ, Giovannucci, EL, Chan, JM. Aspirin use after a prostate cancer diagnosis and cancer survival in a prospective cohort. Cancer Prev Res (Phila). 2012; 5:1223-8.

Downs, SM, Thow, AM, Ghosh-Jerath, S, McNab, J, Reddy, KS, Leeder, SR. From Denmark to Delhi: The multisectoral challenge of regulating trans fats in India. Public Health Nutr. 2012.

Gurbel, PA, Erlinge, D, Ohman, EM, Neely, B, Neely, M, Goodman, SG, Huber, K, Chan, MY, Cornel, JH, Brown, E, Zhou, C, Jakubowski, JA, White, HD, Fox, KA, Prabhakaran, D, et al. Platelet function during extended prasugrel and clopidogrel therapy for patients with ACS treated without revascularization: The TRILOGY ACS platelet function substudy. JAMA. 2012; 308:1785-94.

Kumar, GA, Dilip, TR, Dandona, L, Dandona, R. Burden of

out-of-pocket expenditure for road traffic injuries in urban India. BMC Health Serv Res. 2012; 12:285.

Laxminarayan, R, Arrow, K, Jamison, D, Bloom, BR. Public health. From financing to fevers: Lessons of an antimalarial subsidy program. Science. 2012; 338:615-6.

Madhu, R. Prioritizing research on multi-stakeholder

approach to improve physical activity among adolescents in

India. Global Journal of Medical and Public Health. 2012;

1:1-2.

Madhu, R, Beinum, A. A systematic review of community

hand washing interventions leading to changes in hygiene

behavior in the developing world. Global Journal of Medical

and Public Health. 2012; 1:49-56.

Malhotra, S, Zodpey, SP, Chandra, S, Vashist, RP, Satyanaryana, S, Zachariah, R, et al. Should sputum smear examination be carried out at the end of the intensive phase and end of treatment in sputum smear negative pulmonary TB patients? Plos One. 2012 Nov;7(11): e49238. Mathur, MR, Chaman, P, Bose, V. E-networks for improving

public health education and practice in low and middle

income countries: Introduction public health global network.

Global Journal of Medical and Public Health. 2012; 1:56-8.

Nair, M, Ariana, P, Webster, P. What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India. Rural and Remote Health 12: 2311. Nair, M, Webster, P. Health professionals' migration in emerging market economies: Patterns, causes and possible solutions. J Public Health. 2012 Oct.

Prasad, M. Quick Response (QR) Code to promote library

services: An introduction. Journal of Library and

Information Science. 2012; 37(1): 1-9.

Prasad, M, Reddy, SHK. An Analysis of research in Mental

Retardation in India. IASLIC Bulletin. 2012; 57(2):89-101.

Rafiq, S, Venkata, KK, Gupta, V, Guru, VD, Spurgeon, CJ, Parameshwaran, S, Madana, SN, Kinra, S, Bowen, L, Timpson, NJ, Smith, GD, Dudbridge, F, Prabhakaran, D, Ben-Shlomo, Y, Reddy, KS, Ebrahim, S, Chandak, GR. Evaluation of seven common lipid associated loci in a large Indian sib pair study. Lipids Health Dis. 2012; 11:155.

Recent Publications & Grants 2

Publications

Rao, KD, Bhatnagar, A, Berman, P. So many, yet few: Human

resources for health in India. Hum Resour Health. 2012;

10:19.

Reddy, KS, for the GHME conference organising committee. Global health metrics and evaluation: A call for abstracts. The Lancet. 2012; 380:1722.

Sadhu, G, Chakravarty, N. Gender mainstreaming in water management. International Journal of Scientific and Research Publications. 2012; 2(11).

Sathyanarayana, TN, Babu, GR, Kadam, S. Barriers, challenges and possible solutions in establishing Diabetes Self-Management Education (DSME) in India: A policy perspective. International Journal of User-Driven Healthcare. 2012; 2(3), 1-8

Schneider, J, Kumar, R, Dandona, R, Kumar, P, Kumar, A,

Lakshmi, V, Laumann, E, Mayer, K, Dandona, L. Social

network and risk-taking behavior most associated with rapid

HIV testing, circumcision, and pre exposure prophylaxis

acceptability among high-risk Indian men. AIDS Patient Care

STDS. 2012; 26:631-40.

Selvaraj, S, Hasan, H. Draft drug price policy 2011: Legitimising unaffordable medicine prices? Econ Polit Wkly. 2012; 47:13-7.

Selvaraj, S, Subramanian, SV. Financial risk protection and chronic disease care. Indian J Med Res. 2012; 136:544-6.

Sidney, K, de Costa, A, Diwan, V, Mavalankar, DV, Smith, H.

An evaluation of two large scale demand side financing

programs for maternal health in India: The MATIND study

protocol. BMC Public Health. 2012; 12:699.

Sharma, K, Zodpey, SP, Gaidhane, A, Syed, ZQ, Kumar, R, Morgan, A. Designing the framework for competency-based master of public health programs in India. J Public Health Manag Pract. 2013; 19:30-9.

Funded Proposals

Pensions, health and wellbeing of older people in low and middle income countries: Insights from the WHO SAGE survey | Co-PI: Sutapa Agrawal | ESRC Secondary Data Analysis Initiative Grant

Harm reduction approach for non-injectors in injectors' sexual network: An exploratory study from selected regions of Manipur | PI: Aruna Bhattacharya | Wellcome Trust Reproductive health, nutritional status, and macroeconomic

shocks: A multi-level, quasi-natural experimental analysis of

food commodity price fluctuations | Co-PI: Shah Ebrahim |

ESRC, NWO-WOTRO, PRB, RCN

Comparison of fiscal and regulatory policies to prevent non-communicable diseases in India | PI: Shah Ebrahim and Sukumar Vellakkal | IDRC, Canada

State of India’s Newborns (SOIN) report | PI: Sutapa B Neogi | Save the Children, US

Editorial Team

Giridhar Babu is the Editor in Chief for the Internet Journal of

Epidemiology. Giridhar received his doctorate from

University of California Los Angeles in September 2012.

Thursday Research Seminar | 4-5 pm

Dec 06 - Santanu Pramanik (PHFI): Small Area Estimation: General concept, basic methodology and some applications in the context of public health Dec 13 – Prema Ramachandran (Nutrition Foundation of India): Dual nutrition burden: Challenge or opportunity? Dec 20 – Arpita Ghosh (PHFI): TBA

*Information courtesy of PHFI, IIPHs Program/Research Coordinating Teams

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Open Access Articles

Infant and Child Mortality in India – Levels, Trends and Determinants http://www.unicef.org/india/Report.pdf

Estimation of Newborn Risk for Child or Adolescent

Obesity: Lessons from Longitudinal Birth Cohorts

http://www.plosone.org/article/info%3Adoi%2F10.1371%2

Fjournal.pone.0049919

Workshops/Trainings (December-January 2013)

Dec 6-8 - Writing a Research Proposal (IIPH-D) Dec 11-14 - Qualitative Data Analysis using Atlas ti- (IIPH-D) Dec 18-21 - Designing and Analysis of Cluster Randomized Trials- (IIPH-D) Dec 24-28 - Operational Research in Reproductive Health- Bangalore (IIPH-D) Jan 7-11 -Scientific Writing for AYUSH Professionals (IIPH-D)

BLOGROLL

Research Methods Super course

http://www.pitt.edu/~super1/ResearchMethods/index1.htm Multiple Datasets from Developing Countries http://ipl.econ.duke.edu/dthomas/dev_data/inde

x.html

Global Environmental Health Newsletter

http://www.niehs.nih.gov/research/programs/geh

/geh_newsletter/index.cfm

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Research Support

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For assistance in exploring and pursuing ongoing and potential funding, please contact Alka Chadha, Projects Development Coordinator (alka.chadha@phfi.org).

For inquiries or submissions to the PHFI-Institutional Ethics Committee, please contact Melina Magsumbol, Senior Research Fellow (TRC-IEC@phfi.org).

Air pollution drives up autism risk

http://www.futurity.org/health-medicine/air-

pollution-drives-up-autism-risk/

High fructose corn syrup linked to global diabetes

http://www.futurity.org/health-medicine/high-

fructose-corn-syrup-linked-to-global-diabetes/

Sleep gets better as waistlines shrink

http://www.futurity.org/health-medicine/sleep-

gets-better-as-waistlines-shrink/

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