NEW DELHI: Heat waves are turning deadly, with India recording over 100 deaths and 40,000 suspected heat stroke cases since March. But these numbers don’t tell the whole story, says Dilip Mavlankar, who played a key role in drafting India’s first heat action plan (Fall) was selected for Ahmedabad in 2013. The former director of the Indian Institute of Public Health, Gandhinagar, tells Ketaki Desai why governments need to wake up
Tell us about HAP in Ahmedabad?How did this come about?
The first step was to analyze the temperature and correlate it with all the factors Mortality Data (Total number of deaths every day in Ahmedabad). In the 2010 heat wave, 800 extra deaths were recorded in a week. Ahmedabad usually has 100 all-cause deaths in May. But one day that year the temperature was 47 degrees, and 310 people died. We looked at 15 years of daily mortality during summers at different temperatures to decide on three threshold points at which mortality and temperature were rising—41 degrees (yellow alert), 43 degrees (orange alert), and 45 degrees (red alert). There were four major HAP components: early warning and inter-agency coordination; public awareness and community mobilization; medical and para-medical systems; risk mitigation and long-term action. After each season, we reviewed to see what worked and what didn’t.
Why, even after more than a decade, only a few cities in India have HAP? With historically high temperatures, shouldn’t the capital have it?
If Delhi saw what is happening with all kinds of deaths, it would wake up to take some serious action. Instead, they are trying to hide the data. We have asked for data from Delhi and other cities several times. Cities like Nagpur, Bhubaneswar and Surat are doing so. But there is no national order from the National Disaster Management Authority (NDMA) or the urban development or health ministries. Over the last few years, the National Cooperative Development Corporation (NCDC) has created an online health reporting system to collect data from hospitals. But we need cities to do this because not all deaths happen in hospitals and not all hospitals report. When we looked at five hospitals in Ahmedabad, we found that only 76 people had died of heat stroke, while our data showed 800 excess deaths compared to the average mortality rate of that period.
What do you make of this year’s heat stroke and mortality statistics?
They have reported 40,000 cases of heat stroke. If there were 110 deaths, that is a mortality rate of about 0.3%. But if you look at heat stroke mortality in general, it is 20-30%. So, either these 40,000 are not really heat stroke cases or the mortality rate is under-reported. So the all-cause mortality rate is the best indicator. If there is no other explanation than the heat (no pandemic or major disaster), they are likely to be heat-related excess deaths. It also depends on doctors recording the cause of death, which does not always happen. A system was developed to analyse and print mortality rates during the plague in London in the 1660s. If London could do this 300 years ago, why is Delhi not doing it? National and international public health agencies are not pushing for this, nor is the Home Ministry which records deaths. If a person dies in a smart city and we don’t know why, what kind of smart city is it? How do you find a solution if you don’t acknowledge the problem?
What should the government do to better prepare ordinary citizens for extreme weather conditions?
In March, the IMD website said a heat wave was coming. After that, I have seen only a few advertisements from the government this entire season. If the government is not advertising, how will people know what to do? We have been breaking heat records every year since 2022. If we do not take action now, it will get worse. This is a warning.
What can other Indian cities learn from the Ahmedabad model?
A blueprint is ready. We need to take immediate action to raise awareness among citizens. We thought heat islands only differed by 5-6 degrees in the city centre, but a recent World Bank study in South Africa shows there is a 16-degree difference between rich and poor communities. We must do more such studies. Also, every city, state and country should have a chief heat officer to coordinate all government and stakeholder action.
In India, heat waves have highlighted inequalities between the haves and have-nots. How can such inequalities be reduced?
Those who are rich, who can afford ACs and who don’t have the facility to work outside in this heat will be fine. But the more ACs we install, the temperature will rise further. Poor people will be worse off. One suggestion is to have a holistic plan and focus on vulnerable sections within it. If someone lives in a slum in Delhi and works outside, HAP will not change his job or give him money. Ahmedabad has tried something called parametric insurance. If the temperature goes above a certain point for more than 7 days in a season, each person will be paid Rs 2,000 as compensation because they cannot work. Water is the second most important thing; the poor are not getting it in places like Delhi. Modi had developed Gujarat’s first climate change department as CM, but not much is happening at the national level.
Tell us about HAP in Ahmedabad?How did this come about?
The first step was to analyze the temperature and correlate it with all the factors Mortality Data (Total number of deaths every day in Ahmedabad). In the 2010 heat wave, 800 extra deaths were recorded in a week. Ahmedabad usually has 100 all-cause deaths in May. But one day that year the temperature was 47 degrees, and 310 people died. We looked at 15 years of daily mortality during summers at different temperatures to decide on three threshold points at which mortality and temperature were rising—41 degrees (yellow alert), 43 degrees (orange alert), and 45 degrees (red alert). There were four major HAP components: early warning and inter-agency coordination; public awareness and community mobilization; medical and para-medical systems; risk mitigation and long-term action. After each season, we reviewed to see what worked and what didn’t.
Why, even after more than a decade, only a few cities in India have HAP? With historically high temperatures, shouldn’t the capital have it?
If Delhi saw what is happening with all kinds of deaths, it would wake up to take some serious action. Instead, they are trying to hide the data. We have asked for data from Delhi and other cities several times. Cities like Nagpur, Bhubaneswar and Surat are doing so. But there is no national order from the National Disaster Management Authority (NDMA) or the urban development or health ministries. Over the last few years, the National Cooperative Development Corporation (NCDC) has created an online health reporting system to collect data from hospitals. But we need cities to do this because not all deaths happen in hospitals and not all hospitals report. When we looked at five hospitals in Ahmedabad, we found that only 76 people had died of heat stroke, while our data showed 800 excess deaths compared to the average mortality rate of that period.
What do you make of this year’s heat stroke and mortality statistics?
They have reported 40,000 cases of heat stroke. If there were 110 deaths, that is a mortality rate of about 0.3%. But if you look at heat stroke mortality in general, it is 20-30%. So, either these 40,000 are not really heat stroke cases or the mortality rate is under-reported. So the all-cause mortality rate is the best indicator. If there is no other explanation than the heat (no pandemic or major disaster), they are likely to be heat-related excess deaths. It also depends on doctors recording the cause of death, which does not always happen. A system was developed to analyse and print mortality rates during the plague in London in the 1660s. If London could do this 300 years ago, why is Delhi not doing it? National and international public health agencies are not pushing for this, nor is the Home Ministry which records deaths. If a person dies in a smart city and we don’t know why, what kind of smart city is it? How do you find a solution if you don’t acknowledge the problem?
What should the government do to better prepare ordinary citizens for extreme weather conditions?
In March, the IMD website said a heat wave was coming. After that, I have seen only a few advertisements from the government this entire season. If the government is not advertising, how will people know what to do? We have been breaking heat records every year since 2022. If we do not take action now, it will get worse. This is a warning.
What can other Indian cities learn from the Ahmedabad model?
A blueprint is ready. We need to take immediate action to raise awareness among citizens. We thought heat islands only differed by 5-6 degrees in the city centre, but a recent World Bank study in South Africa shows there is a 16-degree difference between rich and poor communities. We must do more such studies. Also, every city, state and country should have a chief heat officer to coordinate all government and stakeholder action.
In India, heat waves have highlighted inequalities between the haves and have-nots. How can such inequalities be reduced?
Those who are rich, who can afford ACs and who don’t have the facility to work outside in this heat will be fine. But the more ACs we install, the temperature will rise further. Poor people will be worse off. One suggestion is to have a holistic plan and focus on vulnerable sections within it. If someone lives in a slum in Delhi and works outside, HAP will not change his job or give him money. Ahmedabad has tried something called parametric insurance. If the temperature goes above a certain point for more than 7 days in a season, each person will be paid Rs 2,000 as compensation because they cannot work. Water is the second most important thing; the poor are not getting it in places like Delhi. Modi had developed Gujarat’s first climate change department as CM, but not much is happening at the national level.
