Impact of Climate Change on Health in India

As we file this report from Mumbai, India, neighbouring Pakistan is witnessing the biggest floods, due to heavy precipitation and the swelling of the mighty Indus. Millions are being evacuated. The direct consequences of such extreme climate events are so tragic that the indirect impacts including diseases don’t merit as much media attention.

End August 2010 and we are just recovering from almost twenty days of continuous though moderately heavy rain, here in Mumbai. What did get some media attention, though not as a consequence of Climate Change, was the fact that there is a near epidemic of malaria in the city.

The reportage of the Mumbai Mirror for instance puts it down to corruption:

“Another year, another monsoon, another spell of unrelenting rain. But this time, something is different. As per the latest BMC figures, the total number of people admitted to various private, municipal and government hospitals with monsoon-related ailments is 13,530. Unofficial estimates are much higher. Malaria, the talk of the season, tops the list. 25 deaths and 3,628 affected patients.”

“The number of dengue patients is 140, with three deaths, and there have been 25 leptospirosis patients with five deaths. The first 18 days of August have seen 8,600 cases of fever and 1,137 of gastroenteritis. The reasons are not far to seek either. Rampant construction, responsible for as much as 38 per cent of emission load of particulate matter, has been cited as the prime reason for increasing pollution. Add to it stagnant water, the breeding ground for mosquitoes, the general filth during the rains, the long commute, overcrowding, and you have a potent mix that takes a toll on your health. Dengue increases when there are intermittent showers while malaria increases when there is a continuous downpour.”

Another report by Pratibha Masand, Times of India, 17 August 2010, comes closer to the truth but does not connect it to climate change:

“If the weather in the last 10 days is taken into consideration, the city witnessed a great difference between the minimum and maximum temperatures. This fluctuation of temperatures may be responsible for the spread of the viruses in the environment, say doctors. The fluctuation in temperature is the main reason behind the increase in the seasonal flue.”

Such health impacts are generally associated with other poverty and governance issues. Speaking at the public hearing in Mumbai in December 2009, Ajay Kumar, a homeless person, said that out of the 8000 odd homeless person in the Mahim area of the city, there was not a single person who was not ill, during the last monsoon. Since their main employment like catering for wedding, labour for house-repairs/painting etc, are unavailable during the monsoon, they are low on cash as well as food. He added that even when they go to government hospitals, they get discharged within a day or two, and are therefore further vulnerable to diseases. In fact, most of the time they are just not admitted and treated, as the doctors and staff are always suspicious of their illness.

Impact on human health and life

How is climate change connected with these incidents? According to World Health Organisation (WHO) estimates, by 2020 we are likely to loose about 3,00,000 lives and 11 million years of healthy life due to global warming. Changes in temperature patterns will disturb many natural ecosystems. Frequent floods and droughts will cause shortage of food in many developing countries causing several million deaths due to malnutrition and starvation. Weather disasters end up in causing overcrowding in resettlement areas, which are poorly planned with poor sanitation.

The second IPCC report mentioned that the impacts of climate change will fall disproportionally upon developing countries and the poor thereby exacerbating inequities in health status and access to adequate food, sanitation and clean water. World Health Report 2002 estimated that 2.4% of world wide diarrhoea and 6% of malaria in 2000 was because of climate change.

Sea level rise causes inundation, and squeezing of poorer populations resulting in the same poor condition. Increased flooding leads to water logging, especially with highways and urban expansion blocking natural drainage systems. Disasters like floods and cyclones will cause breakdown of sanitation systems and displacement will also trigger risk of various infections. Changes in the water cycle may cause an increase in water borne diseases such as cholera, hepatitis, plague (Yersenia Pestsis), leptospirosis, Hanta virus pulmonary syndrome, tick borne encephalitis, plague.

The effects of climatic change will unleash a large number of deaths due to intensified heat waves and increase in vector borne diseases. With an increase in temperatures the geographical sphere of activity of organisms like mosquitoes carrying contagious diseases and their period of activity will expand resulting in an increase in contagious diseases like malaria, dengue fever, Japanese encephalitis, chikungunya and yellow fever. The extreme heat in certain season do also cause sun-strokes, which are at times fatal.

In addition, air pollution results compounded by poor and crowded environments, increase respiratory diseases. There is a known increase in the magnitude and severity of acute Respiratory Infections, Pneumonia in elderly, children, worsening of viral fever, bronchitis, asthma attacks, chronic obstructive lung disease (COLD) in elderly and women.

The story in India

In the last decade India has seen natural disasters more frequently than ever. Floods and cloud bursts are common. Extreme temperatures have been recorded in many parts of India. All these, have made post disaster like health problems, become a regular daily problem.

India’s Initial National Communication Report claims that the overall susceptibility of the population to environmental health concerns has dropped dramatically during the past few years with the improvement in availability of the health infrastructure. It however accepts the extent of access to and utilization of health care has varied substantially between states, districts and different segments of society.

The report mentions the summer of 1994, when western India experienced temperatures as high as 50°C, providing favourable conditions for disease-carrying vectors to breed. This was followed by heavy rains and flooding, as the state of Gujarat was hit by a malaria epidemic.

The report correlates data from extensive studies on malaria since the early 90s to compare incidence on days of temperature increase and humidity, and observes that temperature has more influence over malaria transmission than does precipitation. However, since the correlations are not strong (i.e. greater than 0.95), other non-climate parameters such as socio-economic conditions also influence vector generation and malaria transmission. The report also mentions that the peri-urban areas on the outer limits of cities, which now account for 25-40 per cent of the Indian population, are the new malaria phenomenon, because migrants often have chronic malaria, and the poor environmental conditions in their temporary settlements foster mosquito breeding and malaria transmission.

The time window for conditions favourable for transmission of malaria is expected to change dramatically. The National Communication Reports states that in the year 2000, eight states that of AP, Chandigarh, Karnataka, Kerala, Maharashtra, Orissa, TN, West Bengal are vulnerable all 12 months of the year, whereas the north eastern states and Gujarat, Haryana, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, Uttaranchal for nine to 11 months in the year.

Sumana Bhattacharya et al., concludes that malaria is likely to persist in Orissa, West Bengal and southern parts of Assam, bordering north of West Bengal. However, it may shift from the central Indian region to the south western coastal states of Maharashtra, Karnataka and Kerala. Also the northern states, including Himachal Pradesh and Arunachal Pradesh, Nagaland, Manipur and Mizoram in the northeast may become malaria prone.

The National Communication Report recommends adaptation policies should be designed taking into account the uncertainties associated with the impacts of climate change, the specific anticipated changes in the existing disease conditions, including the expected improvement in the socio-economic conditions of the people in the future. Thus, in addition to disease specific measures, the following actions might be taken to develop adaptation strategies for the future:

• Improved surveillance and monitoring systems

• Develop vector specific regional maps

• Technological engineering strategies

• Improved infrastructure to avoid artificial breeding

• Medical interventions

• Develop predictive models linking climate and incidence

• Develop integrated environmental management plans

• Public education

Conclusion

Health and Environment are intrinsically linked to each other, they cannot be dealt in isolation. It is well known that most diseases are water-borne and therefore preventable by providing basic access to safe-drinking water, drainage and sanitation. The basic inequities in health status as a result of inequity in access to adequate food, cleaner water, sanitation and drainage infrastructure and other resources. Climate change along with globalization will further exacerbate the inequities. Thus the shift from Public Health to privatised health care system, the shift towards market driven technological fixes; ad other polices associate with the Structural Adjustment Program, which have been accelerated under the economic reforms programme post 1990, which have led to cut Social Sector Expenditure; Denial of Basic Needs and Corporate Driven Policy Making.

However, much of the health risk are avoidable through existing health programmes and interventions. Concerted action to strengthen key features of health systems and the promotion of healthy development choices can enhance public health to reduce the vulnerability to effects of climate change.

We need to review the coping capacity of the health care system, develop and implement adaptation strategies against climate change risks. Training and retaining health personnel, improve health literacy and ecological literacy. This would involve strengthening primary health care, giving priority to neglected communicable diseases and addressing environmental diseases rampant in the tropics, ensuring nutrition and food security, health, water and sanitation. Health security of the vulnerable – women, children, elderly, poor- dalit and adivasi communities should be given priority. Inter-disciplinary research on health protection from climate change is essential.

Public health concerns must be kept in mind and safeguarded while making policy decisions related to other sector eg. Industrial Policy, Economic Policy and not let them be jeopardized by TRIPS plus bilateral and Free Trade agreement. Ensure the availability of essential medicines and their rational use; protect and use the flexibilities available in TRIPS regime.