By Patralekha Chatterjee
Middle class urban youngsters in India grow up viewing exposure to the hot summer sun as something to be avoided because it darkens the skin — hardly surprising in a country where many equate fair skin with beauty and where skin-lightening lotions do a roaring business.
But when Vani Mehta volunteered for the city of Ahmedabad’s “Cool Roofs” campaign, she saw that there’s much more at stake on hot summer days. Mehta, a college student, picked up a paintbrush along with some of her friends, as well as Mayor Gautam Shah, municipal staff and health advocates. They fanned out into the city’s slums, painting roofs with a lime-based whitewash.
The reflective coating helps lower indoor temperatures by around 3 degrees (5.5 degrees Fahrenheit). This doesn’t just make being indoors more comfortable for poor people who can’t afford air conditioners. It also protects them from heat stroke and other health impacts that can easily turn fatal in a city where May temperatures regularly reach 43 degrees (110 degrees Fahrenheit).
“At home, we are always told ‘don’t go out in the sun in this heat; you will become dark’,” Mehta says. “Taking part in the Cool Roof campaign, going to slums, painting roofs white, made me realize the much greater dangers of exposure to extreme heat. I learned first-hand what it is to work out in the open during scorching summer months and come back to a hot room.”
The campaign, which aimed to reach 3,000 rooftops in slums, is the latest adaptive measure in Ahmedabad’s pioneering Heat Action Plan. That plan, launched in 2013, was the first by a city in South Asia to try and reduce the devastating health effects of heat stress on the local population. Since then, the idea of planning for extreme heat has been followed by 17 other cities in India, as well as many states. And it appears to be showing positive results that more cities can learn from.
Ahmedabad’s plan came in response to a 2010 heat wave that killed more than 1,300 people. The Ahmedabad Municipal Corporation launched it in collaboration with a broad coalition of scientists and policy experts from India and abroad. They knew that with climate change, more deadly heat waves are likely in the future — and the poorest urban residents are likely to bear the worst of it.
“People living in urban slums are among the most vulnerable, and that’s why the Cool Roofs campaign is so important,” says Nehmat Kaur, who works with the India team of the Natural Resources Defense Council, one of Ahmedabad’s partners on the heat plan. Heat planning is a matter of “climate justice,” Kaur says. “Saving lives from extreme heat is a low-hanging fruit. Deaths from extreme heat are preventable.”
Heat is now a hot issue in India — partially as a result of Ahmedabad’s efforts. But it was not always so. Until recently, few city leaders or even doctors fully understood the health risks of extreme heat exposure.
Extreme heat impacts the human body severely. Prolonged activity in temperatures above 40 degrees Celsius can lead to heat-related hazards like exhaustion or heat stroke. Small children, the elderly, people with chronic health conditions and those who work outdoors are particularly vulnerable. According to the National Disaster Management Authority, more Indians died of heat waves in 2015 than any other natural disaster.
The problem is particularly acute in India’s fast-growing cities. Thanks to the “urban heat island” effect, temperatures in cities run hotter in cities than in villages — all the pavements and concrete structures absorb the radiant heat and there are fewer green spaces to counter it.
The urban poor are among the worst affected. Slum dwellers often live in homes that are not well constructed or ventilated, and are thus the most exposed to extremes of temperature and weather. The poor spend a lot more time out in the sun, working in construction sites or as street vendors, for example. Unlike the rich or upper middle class, the poor can’t afford air conditioners, and they live in neighbourhoods more afflicted by power outages and scarce access to drinking water.
Ahmedabad’s Heat Action Plan has been a milestone. One of its key features is simplicity. It uses a simple, colour-coded early-warning system that alerts residents and city offices of predicted extreme temperatures and recommends precautions. The heat alerts then trigger a range of protective measures on the part of local authorities, such as increasing shade access by keeping all gardens and parks open throughout the day.
Tejas Shah, the plan’s nodal officer for the Ahmedabad Municipal Corporation, talks about the slew of measures taken by the city government since 2013. The initial steps were about spreading awareness through traditional media, social media and advertising about the dangers of exposure to extreme heat and the need to drink water constantly. In a city where many people lack reliable access to drinking water and can’t afford to buy extra supplies, a big focus is on ensuring emergency access. During summer months, the city has 1,000 rehydration centres, run mostly by NGOs, where people can drink water free of cost.
According to Shah, Ahmedabad has had no heat-related deaths this year, although there has been a few instances of heat strokes and heat rashes. Another measure of the plan’s impact is what happened during an intense heat wave that affected much of the country in 2015. According to Dileep Mavalankar, director of the Indian Institute of Public Health in Gandhinagar, the 2015 heat wave left more than 2,300 people dead across India but fewer than 20 heat-related deaths were reported in Ahmedabad.
“The focus has been on identifying vulnerable groups, those who are more at risk from exposure to extreme heat than others,” Shah says. “Such groups include construction workers who toil even in the blazing sun through summer months, and slum dwellers who live in shacks made of tin or asbestos, which heat up severely in the summer sun, causing heat stroke even to people who are indoors.”
One of the most important aspects of Ahmedabad’s Heat Action Plan, now being replicated in several Indian cities, is training medical personnel how to spot and treat heat-related ailments.The Ahmedabad Medical Association is a partner in this effort.
“We have trained nearly 350 medical staff in the city’s big hospitals on how to treat patients suffering from heat-related illnesses,” Shah says. “Earlier, people were not aware of the early symptoms of heat-related illnesses such as muscle cramps. But awareness drives about how to identify such illnesses, about precautions and treatment.”
But challenges remain. Mavalankar, whose team significantly contributed to Ahmedabad’s plan, points out that data in India are unreliable when it comes to recording and analyzing causes of death. This hampers the country’s ability to accurately estimate the total number of deaths due to heat waves.
What gets widely reported, he says, are the obvious cases of heat stroke, which happen due to direct exposure to heat on roads or at work. These easy-to-identify cases are what is called “exertional” heat stroke. Less is known about cases that may occur indoors or in other less visible situations. “One of the real concerns today,” Mavalankar says, “is about ‘non-exertional’ heat stroke among elderly and vulnerable groups.”
In addition, those with chronic health conditions related to the heart, lungs or kidneys can see those conditions get worse during very hot weather. There are also the dangers of dehydration or developing an electrolyte imbalance in blood. Such cases can present themselves days after a heat wave is over, and can prove fatal if not treated properly. “In India,” Mavalankar says, “many doctors do not correlate heart or kidney failure that lead to a death to a heat wave.”
There are other challenges. Many state and city leaders have not yet come to see the link between environment and health, or the connection between climate change and rising temperatures and heat-related illnesses. And publicity campaigns which rely on technology such as smart phones also will not work with the very poor who don’t have the gadgets and sometimes can’t even read.
Still, Mavlankar feels that the Ahmedabad Heat Action Plan is eminently replicable as is borne out by the number of cities and states who have chosen to follow its lead. National authorities have been encouraging the spread. For example, the Indian Meteorological Department has begun making regular heat forecasts, which state and city authorities can use to trigger emergency measures. And India’s National Disaster Management Authority has come up with a set of guidelines for managing heat waves.
The guidelines encourage state and city authorities to formulate heat action plans like Ahmedabad’s. Those plans are to consist of four key strategies: forecasting heat waves and enabling an early warning system; building capacity of healthcare professionals to deal with heat-related emergencies; community outreach through various media; and inter-agency cooperation as well as engagement with other civil society organizations in the region.
One city that has taken action is Nagpur, where temperatures can touch 50 degrees Celsius during peak summer. The city began implementing its own heat action plan last year, says Dr. Nand Kishor Rathi, the nodal officer for it.
According to Rathi, Nagpur has begun training doctors and paramedics to spot and treat heat-related illnesses, and setting up ‘cool sheds’ where residents can get out of the sun as well as free water dispensaries where they can stay hydrated. The city issues heat alerts when temperatures climb above 43 degrees. The media plays a key role in getting the message out to the people. There’s also a group on the popular messaging service WhatsApp for local officials, health workers, field officials and media to stay updated.
“You can’t stop people from working in the summer, even in extreme heat,” Rathi says. “But you can have preventive measures that reduce their risk to heat-related illnesses.”