Climate watch

Four charts that show how climate change is hurting India’s health

The rise in dengue cases and heat wave deaths demonstrates India is among the countries worst affected by climate change.

Climate scientists, public health specialists and economists have long been predicting that India will among the countries worst affected by climate change. It has a large population, the majority of whom are poor and vulnerable to changes in temperature, coastal disruptions like sea-level rise and shifting disease dynamics.

A worldwide report on the health effects of climate change released on Monday shows how India is already being hit hard by changing climate patterns.

The Lancet Countdown: Tracking Progress on Health and Climate Change report highlights the various ways in which climate change is hurting the health of people across the world. The report details three kinds of climate change impacts on human health. Direct effects are those that arise from changes in temperature and the frequency with which extreme weather events occur. Ecosystem-mediated impacts are changes in patterns of diseases due to changes in climate. Human institution-mediated effects are evident in undernutrition due to crop failure, population displacement due to sea-level rises and occupational health risks that arise due to climate change.

The most obvious direct impact of climate change on health is the exposure to rising temperatures, especially heat waves. The report estimates that 125 million more people were exposed to heat waves between 2000 and 2016 than in previous years. A record 175 million people around the world were exposed to heat waves in 2015 alone.

India has been disproportionately affected by heat waves, the report finds. Between 2000 and 2016, 125 million in India have been exposed to potentially fatal heat waves.

People over 65 are among the most vulnerable to heat and millions more people over 65 are being exposed to heat waves every year. Between 2000 and 2016, 31 million more people in India above the age of 65 have been exposed to heat waves than between 1986 and 2008.

The heat waves became considerably worse in 2014 when the average number of people over 65 exposed to heatwaves was 150 million more than in 1986-2008.

These trends have been evident in the rising number of heat wave deaths in recent years. In 2015, India recorded more than 2,400 heat wave deaths, with the majority of these occurring in Andhra Pradesh and Telangana. In 2016, there were more than 1,100 heat wave deaths. These recent heat waves have been accompanied by severe droughts in regions of central India like Marathwada and Bundelkhand.

Data from the National Disaster Management Authority shows the clear rise in the number of fatalities due to heat waves since 2000.

The spread of dengue

Climate change has also brought about a change in the distribution of vector-borne diseases like dengue and malaria and an increased burden of these conditions. The report estimates that between 50 million and 100 million dengue infections occur around the world every year, making it the world’s most rapidly expanding disease.

In fact, climate trends have led to an increase in the vectorial capacity – a vector’s ability to spread disease among humans – of the two dengue-carrying mosquitos. The capacity of Aedes aegypti has increased 3% since 1990 and of Aedes albopictus by nearly 6% in this period.

Along with climate change, the spread of dengue has been helped by factors like trade, urbanisation, global and local mobility, and climate variability. The authors of the Lancet report infer that while the causes for increased dengue mortality are complex, climate change will be an important contributing factor in the increased likelihood of dengue deaths.

India has seen worsening outbreaks of dengue in recent years. While some health officials attribute the greater number of cases to better reporting, other public health specialists point out that there may still be a large number of dengue cases going misdiagnosed or unreported.

For example, the National Vector Borne Disease Control Programme counts only those dengue cases that are confirmed by performing an enzyme-linked immunosorbent assay or ELISA test that detects the antibodies of produced by the body against the dengue virus. However, many patients are diagnosed using a test called the NS-1 antigen test, which is cheaper and faster. Because the National Vector Borne Disease Control Program does not consider NS-1 antigen testing as a confirmatory test, hundreds of patients who tested positive for dengue using the said test are not included in the database of cases.

Here’s a look at how the number of dengue cases and deaths that have been counted has risen in India in recent years.

The air pollution threat

Air pollution directly harms human health. Much of air pollution is due to greenhouse gas emissions that cause and exacerbate climate change. But research also shows that climate change can make the impacts of air pollution worse. For instance, climate change can change the dilution of air pollutants in the atmosphere, the rates at which pollutants are removed from the atmosphere, photochemical reaction rates, and the exchange of ozone between the upper layers of the atmosphere. Climate change may also increase wildfires and instances of lightning that produces nitrous oxides.

One of the most harmful components of pollution is fine particulate matter (smaller and 2.5 microns), known as PM2.5. Long-term exposure to PM2.5 increases risk of illness and death from cardiovascular and pulmonary disorders. The World Health Organisation estimates that there are about 3 million premature deaths every year due to ambient air pollution.

In 2015, air pollution contributed to 524,680 premature deaths in India, second only to China. The single biggest contributor was household air pollution produced mainly by solid cooking fuels , which was responsible for 124,207 premature deaths.

The Lancet report finds that PM2·5 concentrations in most cities far exceed the annual average limit set by the WHO of 10 micrograms per cubic meter. Cities in Central, South, and East Asia have the highest concentrations of ambient air pollution. India’s annual average PM2.5 concentrations is 59 micrograms per cubic meter, with a maximum measurement of 176 micrograms per cubic meter in Gwalior. Delhi also features high up on this list.

Higher temperatures in many parts of the world have also hurt occupational health and labour productivity, especially among people performing manual, outdoor labour in hot areas. Since 2000, productivity in rural labour has fallen by an average of 5.3% globally due to rising temperatures. In 2016, more than 920,000 people globally out of the workforce and 418,000 of them were in India alone.

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Changing the conversation around mental health in rural India

Insights that emerged from discussions around mental health at a village this World Mental Health Day.

Questioning is the art of learning. For an illness as debilitating as depression, asking the right questions is an important step in social acceptance and understanding. How do I open-up about my depression to my parents? Can meditation be counted as a treatment for depression? Should heartbreak be considered as a trigger for deep depression? These were some of the questions addressed by a panel consisting of the trustees and the founder of The Live Love Lough Foundation (TLLLF), a platform that seeks to champion the cause of mental health. The panel discussion was a part of an event organised by TLLLF to commemorate World Mental Health Day.

According to a National Mental Health Survey of India 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. The survey reported a huge treatment gap, a problem that is spread far and wide across urban and rural parts of the country.

On 10th of October, trustees of the foundation, Anna Chandy, Dr. Shyam Bhat and Nina Nair, along with its founder, Deepika Padukone, made a visit to a community health project centre in Devangere, Karnataka. The project, started by The Association of People with Disability (APD) in 2010, got a much-needed boost after partnering with TLLLF 2 years ago, helping them reach 819 people suffering from mental illnesses and spreading its program to 6 Taluks, making a difference at a larger scale.

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During the visit, the TLLLF team met patients and their families to gain insights into the program’s effectiveness and impact. Basavaraja, a beneficiary of the program, spoke about the issues he faced because of his illness. He shared how people used to call him mad and would threaten to beat him up. Other patients expressed their difficulty in getting access to medical aid for which they had to travel to the next biggest city, Shivmoga which is about 2 hours away from Davangere. A marked difference from when TLLLF joined the project two years ago was the level of openness and awareness present amongst the villagers. Individuals and families were more expressive about their issues and challenges leading to a more evolved and helpful conversation.

The process of de-stigmatizing mental illnesses in a community and providing treatment to those who are suffering requires a strong nexus of partners to make progress in a holistic manner. Initially, getting different stakeholders together was difficult because of the lack of awareness and resources in the field of mental healthcare. But the project found its footing once it established a network of support from NIMHANS doctors who treated the patients at health camps, Primary Healthcare Centre doctors and the ASHA workers. On their visit, the TLLLF team along with APD and the project partners discussed the impact that was made by the program. Were beneficiaries able to access the free psychiatric drugs? Did the program help in reducing the distance patients had to travel to get treatment? During these discussions, the TLLLF team observed that even amongst the partners, there was an increased sense of support and responsiveness towards mental health aid.

The next leg of the visit took the TLLLF team to the village of Bilichodu where they met a support group that included 15 patients and caregivers. Ujjala Padukone, Deepika Padukone’s mother, being a caregiver herself, was also present in the discussion to share her experiences with the group and encouraged others to share their stories and concerns about their family members. While the discussion revolved around the importance of opening up and seeking help, the team brought about a forward-looking attitude within the group by discussing future possibilities in employment and livelihood options available for the patients.

As the TLLLF team honoured World Mental Health day, 2017 by visiting families, engaging with support groups and reviewing the successes and the challenges in rural mental healthcare, they noticed how the conversation, that was once difficult to start, now had characteristics of support, openness and a positive outlook towards the future. To continue this momentum, the organisation charted out the next steps that will further enrich the dialogue surrounding mental health, in both urban and rural areas. The steps include increasing research on mental health, enhancing the role of social media to drive awareness and decrease stigma and expanding their current programs. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.