In India, a Plan to Beat the Heat Is Saving Lives

A little before noon on a busy summer’s day in the biggest produce market in Ahmedabad, western India, the sky was overcast, but it was already oppressively humid. For Mafain Sambhaji, 60, who sells lemons and ginger at the market, climate change is making it harder than ever to earn a living. Erratic rainfall in many parts of the country is damaging crops and hiking up prices. Longer hot spells mean produce spoils before he can sell it. And when the days grow warmer, Sambhaji’s health takes a hit. “I place a wet handkerchief around my neck throughout the day and keep sipping water, but it is becoming difficult to work as I grow older,” he said.

Harsh summers are not unusual in India, but in recent years the country has regularly experienced longer and more intense heatwaves, which the government generally defines as more than two consecutive days when maximum temperatures breach 45 ºC (113 ºF). This summer, India was in the grip of its worst heatwave in 15 years, prompting one hospital in Delhi to open what could be the country’s first dedicated heatstroke clinic.

For the past decade, Ahmedabad has been shielding its citizens from many of the worst health impacts of climate change by getting ahead of the heat. In 2013, it was the first city in South Asia to launch its own Heat Action Plan (HAP), a composite of measures and policies designed to save lives during extreme heat events. Along with an early-warning system, the ever-evolving HAP includes awareness-raising campaigns, initiatives to keep homes and outdoor spaces cool, and recommendations to limit workers’ exposure to heat during the summer.

Like many Indians, produce seller Mafain Sambhaji (on the left), in Kalupur market, Ahmedabad, said the country’s increasingly hot summers are taking a toll on his health. Credit: Swagata Yadavar

Within the first five years of the city’s HAP launch, the initiative had helped save 1,190 lives every year, according to an evaluation by researchers. Since then, it has saved thousands more, India’s officials say.

“In 2010, there was no forecasting system and no awareness, and our hospitals were flooded with patients,” said Dr Tejas Shah, Deputy Health Officer with the Ahmedabad Municipal Corporation (AMC), the local governing body that administers the city, and one of the people responsible for implementing the HAP. “This year so far, there were 12 consecutive days with an orange alert – for temperatures between 43.1 ºC and 44.9 ºC (109 ºF and 113 ºF) – and we recorded only four or five deaths.”

The World Health Organization (WHO) says rapid increases in heat can lead to a range of illnesses and conditions, including heatstroke, cramps, exhaustion, and hyperthermia, and can worsen chronic conditions including cardiovascular, respiratory, and cerebrovascular diseases and diabetes-related illnesses. Most affected are those who are already frail – such as older adults, infants, pregnant women and people with chronic diseases – and informal workers like Sambhaji, who make up 75% of India’s workforce and spend their days outside with little protection from the sun.

NGOs Leading Low-Cost Cooling Solutions

Taking inspiration from heat action plans in cities around Europe and the U.S., Ahmedabad’s first HAP focused on accurate weather predictions, with color-coded alerts and heat warnings in the mass media, along with an education campaign to encourage people to take the hot weather seriously.

Shahzahid Abdul Shaikh, 40, sells shade nets to local shops and offices and said business has been good since the public has become more aware of the dangers of extreme heat. He pays attention to the color-coded alerts, drinking plenty of water and taking frequent breaks on days with orange or more serious red warnings. “My boss ensures all of us salesmen get cold buttermilk to drink during the summer, and I add glucose powder in my water to avoid getting dehydrated,” he said.

Residents and small business owners in Kalupur market pooled their funds to install shade nets and water dispensers to help them keep cool during India’s worst heatwave in 15 years. Credit: Swagata Yadavar

NGOs are integral to the success of Ahmedabad’s HAP, working with the AMC to find new ways to protect citizens from the heat. For example, the grassroots organization Mahila Housing Trust (MHT) runs the Cool Roofs Initiative as part of the city’s HAP. This low-cost solution involves painting the roofs of low-income households with heat-reflective paint to bring down the temperature inside their homes.

In April 2024, the MHT also launched a heat insurance policy that gives women 2,000 Indian rupees (about $24) per season if the minimum temperature in Ahmedabad rises above the predetermined trigger of 44.2 ºC (112 ºF). The idea is that women will be more likely to skip work and stay home during heatwaves if they know they won’t miss out on income. “We are happy that at least [enrolled] women will be covered for their losses and will not need to step outside in extreme heat, risking their lives,” said Bhavna Maheriya, Program Manager at MHT.

A Complex Problem Needs Complex Solutions

Encouraged by Ahmedabad’s success, more than 120 cities and 23 states in India have so far adopted HAPs in various forms. But some climate and health experts think efforts to keep citizens safe from the heat could go further.

In the long term, HAPs can act only as Band-Aids, said Darshini Mahadevia, who specializes in urban studies and climate change at Ahmedabad University. If cities want to help their citizens beat the heat for generations to come, they need to focus on undoing the impact of rapid urbanization and shrinking green spaces, she said.

Cities need better housing, more greening, and changes in land-use policies to slow the spread of urban environments, for example. “Climate change is a complex problem and requires complex solutions,” Mahadevia said. “The extreme summer this year has woken up governments to get their act together.”

Find out more

WHO and the World Meteorological Association operate ClimaHealth, a comprehensive, searchable resource on climate and health-related initiatives worldwide.

WHO has been working on climate change and health for over 25 years, collecting evidence and providing support to countries. Their toolkit is publicly available.

The Lancet Countdown on health and climate change is an annual, global collaboration that tracks the health impacts of climate change.