Treating heatwaves as health care emergency - Hindustan Times
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Treating heatwaves as health care emergency

ByK Srinath Reddy
Jun 18, 2024 08:19 PM IST

Record-breaking heat in 2024 may soon be surpassed by 2025 due to worsening climate crisis. Heatwaves pose serious health risks, requiring urgent mitigation and adaptation efforts.

Even as 2024 enters the record books as the hottest year so far in human history, it wouldn’t be a surprise if it lost the title to 2025. Heat records will be reset repeatedly in the years to come, as the climate crisis worsens, thanks to human follies, and heatwaves become a leitmotif of this. It is estimated that one billion Indians experienced temperatures above 38 degrees Celsius in April 2022 (IS THIS 2022 or 2024?). The number will be higher for May-June 2024. The impact of heat is exacerbated by high humidity (leading to a condition called moist heat), and the adverse effects on human health can manifest even at lower temperatures. There will be many harmful impacts on health, as heat torments the body and mind. We need to reduce those ill effects, both through determined mitigation efforts on the climate crisis front, and effective adaptation to the warming.

A passenger drinking water is silhouetted against the sun on a hot summer day at Jalandhar Cantonment railway station in Jalandhar on June 11, 2024 amid heatwave. Photo by Shammi MEHRA / AFP) (AFP)
A passenger drinking water is silhouetted against the sun on a hot summer day at Jalandhar Cantonment railway station in Jalandhar on June 11, 2024 amid heatwave. Photo by Shammi MEHRA / AFP) (AFP)

The health effects of heatwaves range from heat exhaustion and heat stroke to much worse outcomes such as circulatory failure and death. Loss of water from the body compounds the heat stress on blood vessels, with an increased propensity for clotting, leading to brain strokes and heart attacks. Decreased blood flow to the kidneys can result in renal dysfunction and failure. Chronic lung disease can worsen. Mental health disorders can manifest or worsen from existing levels. Even eyesight can worsen through hastening of cataracts.

Infants and young children predictably are more vulnerable than adults since their bodies have more water content and physiologic systems have not matured enough to enable rapid responses for effective heat adaptation. The elderly, too, are quite vulnerable. So are persons with pre-existing health conditions such as heart disease, high blood pressure, diabetes, kidney dysfunction, or cancer. Severe heat also results in adverse pregnancy outcomes, from stillbirths to low birth weight. Persons living in informal settlements are more exposed to severe heat than those in regular housing. Dharavi, the mammoth Mumbai slum, was observed to be 5-6 degrees Centigrade hotter than its somewhat green neighbour, Matunga.

Global attention has turned to coping better with the effects of the climate crisis — or adaptation — in recent years. While the Conference of Parties (CoP) at Paris in 2015 articulated the need for adaptation, the 2023 CoP at Dubai underscored the need for strengthening national capacities for this. It is also well recognised now that low- and middle-income countries, which contributed the least to the climate crisis by way of both per capita and cumulative emissions, are the worst victims of the climate crisis and, therefore, most in need of adaptive protection.

Measures for protection against heatwaves have to be at the personal, household, local and national levels. Personal protection consists of avoiding or limiting exposure to the sun, especially in the 11am to 4 pm period of intense heat, and moving in shaded paths while wearing loose-fitting, light-coloured cotton clothes. Protecting the head with a cap and eyes with sunglasses would be prudent. Children and pets should not be left exposed to the heat, including in parked vehicles. It is important to keep well hydrated with water as the main source of fluid intake. Air conditioning or fans help to keep the house cool, while moist curtains may serve as a substitute. Homes should be well ventilated. Green areas, in and around the house, have a cooling effect. Alcohol and caffeinated beverages cause dehydration and are best avoided.

That said, protection against extreme heat should not be viewed merely as the responsibility of individuals and households. It is a collective civic responsibility. As urban areas become overcrowded in an unplanned manner, increased vehicular density and peri-urban industries add to the emission load, leading to higher warming. Green areas are exhausted to accommodate the urban sprawl.

All urban areas will need to develop heat adaptation plans, with green areas in residential areas of all types, shaded walkways for pedestrians and cyclists, water stations at accessible points, and transport-at-call and medical care for victims of heat-related emergencies. Buildings (especially roofs) and roads can be designed, or even retrofitted, to reduce exposure to heat. According to the Smart Cities Coalition, increasing the reflectivity of roofs and pavements can send 80% of the incoming heat back into space and reduce radiant heat. Cool roofs reduce the urban heat island effect. Porous pavements too reduce radiant heat. Porous parking lanes can drain stormwater and prevent run-offs while cooling cities. The potential of dense rooftop solar for cooling, apart from energy generation, also needs to be explored. Local, state and national governments, of course, must urgently provide policy frameworks for such steps. Schools, where children spend a large part of their time, must be ventilated, with green surroundings. Class timings are already being adjusted to reduce exposure to severe heat, and even online schooling during heatwaves is catching on. With all efforts made to minimise learning loss from the latter option, schools must explore making these a rule for heatwave conditions. Those who suffer long exposures to heat outdoors (such as manual labourers, gig workers, and traffic policemen) need to be given rotational shift duties to decrease the frequency and duration of exposure.

Rural residents are at risk, too, when work involves outdoor activities, such as farm work. Shaded heat shelters and water stations should be made available there too. Public education on heat effects and protective measures must have an extensive outreach. Emergency transport services must be available, in both urban and rural areas, for moving persons with severe heat-related health problems to medical facilities equipped to deal with this, especially to handle a heat “epidemic”. People should also be trained in providing first-response care for cooling down those suffering a heat stroke.

Adaptation, of course, will be a key piece of action as extreme heat becomes a common occurrence, but we must not lose sight of mitigation. We will exhaust our capacity for adaptation if we keep on heating the planet. There is no substitute for the reduction of greenhouse gas emissions, stalling deforestation and increasing efforts at reforestation, if the planet is to be kept from getting hotter. That alone can help save lives in the long-run.

K Srinath Reddy is honorary distinguished professor of public health, Public Health Foundation of India. The views expressed are personal

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