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Abstract [200 words] (summarising the current situation, conceptualises the problem, outlines your argument and what would help the problem

Justification [500 words] (drawing upon the debates in the literature to defend the way you have conceptualised the problem in your poster).

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-          Global warming has increased likelihood of floods in India

-          Monsoon phases defy normal rainfall patterns

-          Predictions of a rise in total rainfall over India by 5-10%

-          Heavy rainfall causing cyclical migration and displacement

-          Bihar most affected by floods (Over 855,000 displacements in 2017)

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https://www.omicsonline.org/open-access/indias-energyclimate-dilemma-the-pursuit-forrenewable-energy-guided-by-existing-climate-change-policies-2157-7617-1000362.php?aid=77431

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The 2009 Joint Indo-U.S. Workshop on Climate Change and Health

The workshop was held in Goa, India, on 30 August through 2 September 2009; it was cosponsored by the University of Michigan's Center for Global Health, the U.S. Centers for Disease Control and Prevention's National Center for Environmental Health, and the Indian Council of Medical Research. Scientists from the cosponsoring institutions, along with other partners from academia, government, and nongovernmental organizations, met under the auspices of the existing Indo-U.S. Collaboration in Environmental and Occupational Health to discuss the current state of the science, identify gaps in understanding, and outline future research directions related to the human health effects of climate change in India. The focus was prediction and prevention in India, and discussions touched on the tremendous opportunities and significant challenges associated with designing, initiating, and conducting research, as well as pursuing related public health programming to improve public health infrastructure in the face of climate change.

The scope of the problem and current research

Poverty and baseline vulnerability

Many of the predicted effects of climate change are likely to become a reality in India. India is very diverse, geographically, climatically, and culturally (). It represents one-sixth of the world's population, supported on 1/50 of the world's land and 1/25 of the world's water ( Singh et al. 2010). With its huge and increasing population (~ 1.2 billion) and rate of urbanization, India is undergoing enormous change; climate change poses an overwhelming stressor that will magnify existing health threats. A greater understanding of the relationship between climate variability and human health in a country such as India could aid in the development of new prevention strategies and early warning systems, with implications throughout the developing world. Future studies must work to more explicitly define the relationship between climate variability and emerging and reemerging infectious diseases such as dengue, yellow fever, cholera, and the chikungunya virus ( Shope 1991), as well as chronic diseases related to cardiovascular and respiratory illness, asthma, and diabetes. Millions of people below the poverty line and those in rural areas represent high-risk populations who are exposed to myriad health risks, including poor sanitation, pollution, malnutrition, and a constant shortage of clean drinking water. However, as awareness and public health infrastructure increase, the burden of climate-related disease may be negated ( Dhiman et al. 2010).

Waterborne infectious disease

The burden of waterborne disease in India is enormous (). However, estimates vary widely because of a lack of reporting, poor surveillance, and minimal data infrastructure. A report from the Ministry of Health and Family Welfare estimates that nearly 40 million people are affected by waterborne disease every year that places a large burden on both the health sector and the economic sector. As a consequence, approximately 73 million workdays or US$600 million are lost each year ( Mandal 2008). Although the World Health Organization (WHO) estimates that 900,000 Indians die each year from drinking contaminated water and breathing polluted air ( WHO and UNICEF 2000), the Indian Ministry of Health estimates 1.5 million deaths annually among 0- to 5-year-old children. Cholera provides another example, with approximately 5 million cases reported by WHO each year; however, this estimate is thought to be a gross underestimation of the true burden of cholera because of a lack of surveillance and underreporting on the Indian subcontinent ( Zuckerman et al. 2007). Approximately 73% of the rural population in India does not have proper water disinfection, and 74% do not have sanitary toilets ( International Institute for Population Sciences and Macro International 2007). Freshwater availability in India is also a concern; available water is expected to decrease from 1,820 m ³ per capita to < 1,000 m ³ by 2025 in response to the combined effects of population growth and climate change ( Intergovernmental Panel on Climate Change 2007).

Research in this area must be both temporally and spatially specific. Furthermore, it requires local monitoring of the appropriate climate and disease variables ( Patz et al. 2002) because underreporting impedes the development of effective prevention strategies. It is critical to build a data infrastructure and conduct such research in India so that region-specific models based on climate and health can be developed. A systems approach focusing on health outcomes is critical to the success of future research in this area ( Batterman et al. 2009). As prediction models evolve, region-specific action plans and adaptation strategies can be developed.

Heat stress and air pollution

The summer of 2010 was the hottest summer on record in India, with temperatures approaching 50°C (122°F); the effects were far-reaching, including hospitalization because of heatstroke, suffering of livestock, and severe drought in some regions that affected health as well as agriculture ( Burke 2010). Research linking temperature and health effects in India is sparse. However, in a study of 12 international urban areas that included Delhi, McMichael et al. (2008) found a 3.94% [95% confidence interval (CI), 2.80-5.08%] increase in mortality for each 1°C increase above 29°C. Hajat et al. (2005) reported that individuals in the 0- to 14-year-old age group had greater vulnerability to temperature increases in Delhi than did those in the 15- to 64-year-old age group or in the ≥ 65-year-old age group. These findings are in direct contrast with results from cities in Europe and the United States that consistently identify the elderly as the more vulnerable age group. Hajat et al. (2005) also found that harvesting (whereby increases in mortality on one day are followed by substantial decreases in mortality in subsequent days) accounted for almost all temperature-related mortality in London, whereas in Delhi, the increase in mortality due to high temperatures was not followed by an immediate drop in mortality. This suggests that in Delhi, individuals who died on days with higher temperatures were not already near death.

Limited work has been conducted on the combined effects of weather, climate variability, and increased air pollution in India ( Agarwal et al. 2006; Karar et al. 2006). One study that investigated the effects of air pollution on respiratory disease found that emergency department visits increased by approximately 20% because of high levels of pollutants in Delhi ( Pande et al. 2002). In a second study based in Chennai, India, Ghosh et al. (2010) concluded that short-term exposure to particulate matter ≤ 10 μm in aerodynamic diameter (PM ₁₀) resulted in an estimated risk ratio of 1.0044 (95% CI, 1.002-1.007) per a 10 μg/m ³ increase in daily average concentrations; this risk estimate is comparable to similar estimates from other countries. An important contribution of this study, relevant to other low- and middle-income countries, was the development of new methods to address specific limitations of routinely collected data such as missing measurements and small footprints of air pollution monitors, but the link to temperature remains to be explored. Some work has been done on seasonal air quality monitoring ( Pulikesi et al. 2006); however, the relationship of temperature, ozone, and health requires further investigation ( Doherty et al. 2009). Indoor air pollution presents yet another major health threat, with 32% of deaths in South Asia attributable to the burning of solid fuels in poor, small, unventilated houses ( Smith 2000; WHO 2004). Whether these health risks will be exacerbated as a result of climate change is yet to be determined, but cobenefit interventions aimed at reducing the health impacts associated with indoor air pollution, decreasing the release of green house gases from the burning of solid fuel, and preventing deforestation by introducing alternative, more efficient stoves and fuels will have serious implications for health and society.

Vector-borne disease

India has approximately 2 million confirmed cases of malaria per year ( Kumar et al. 2007). Like most infectious diseases, prevalence varies by region (). Although WHO concludes that approximately 15,000 individuals die from malaria each year in India ( WHO 2008), a recent study by Dhingra et al. (2010) estimates approximately 200,000 malaria deaths per year in India before 70 years of age and 55,000 in early childhood. As Dhingra et al. (2010) suggest, accurate estimation of malaria mortality in India is difficult because correctly diagnosed episodes are successfully treated and do not result in death; in fatal cases without medical intervention, malaria is easily mistaken for some other life-threatening fever; and in most rural areas where death from malaria is common, proper medical attention at the time of death is uncommon. These challenges, which hold true in many developing countries, make it difficult to use hospital-based data to assess the association between climate variability and malaria, because disease burden may be vastly underestimated.

In India, 65% of malaria cases are reported from six regions (Orissa, Jharkhand, Madya Pradesh, Chattsgarh, West Bengal, and the North East). In Orissa, the disease has much more serious proportions than even in sub-Saharan Africa ( Narain 2008). A 2001 WHO report estimated the disability-adjusted life years lost because of all vector-borne diseases in the country to be 4.2 million, and malaria is believed to account for nearly half of this ( Dash et al. 2008). The emergence and rapid spread of drug-resistant strains of malaria further compound the problem. Chloroquine used to be the drug of choice for all kinds of malaria and was highly prescribed in India until 1973, when resistance was detected in Plasmodium falciparum. Chloroquine is no longer as effective, with increasing reports of Plasmodium vivax developing resistance ( Dash et al. 2008). In addition, the use of chloroquine, which selects against P. vivax, has allowed P. falciparum to become the dominant parasite ( Singh et al. 2004), a pattern with important epidemiological consequences, because it is the most virulent form of malaria in the region.

In arid and semiarid regions of India, where malaria is epidemic, rainfall variability has been shown to drive the interannual variability of the disease ( Akhtar and McMichael 1996; Bouma and van der Kaay 1994; Laneri et al. 2010) and was the basis of one of the first early-warning systems for the disease in this region. Evidence suggests that rainfall variability plays an important role and that a long-term trend in increasing temperature during the 20th century is sufficient to significantly increase the abundance of vectors ( Pascual et al. 2009). Monthly parasite incidence was positively correlated with temperature, precipitation, and humidity ( Devi and Jauhari 2006). The implications of this association as it relates to long-term climate change remain an important open question. For other regions of India, monsoonal rains have shown an increase in the frequency and magnitude of extreme rain events, whereas the frequency of moderate events has been decreasing, with no significant change in the mean in the last 50 years ( Goswami et al. 2006). Temperature plays a major role, especially at high altitudes, preventing epidemic malaria from spreading into the highest altitude regions. The consequences of climate change in highland regions is an important open question based on future temperature predictions in these regions (Beig G, unpublished data). Little is known about the influence of climate variability or climate change on the prevalence of malaria in Indian urban areas ( Kumar et al. 2007). The issue of urban malaria becomes even more important when considering the rapid expansion of urban and periurban environments, water storage techniques, and rising poverty levels.

The need for adaptation

Although adaptation to climate impacts has attracted substantial attention recently, the effectiveness of specific strategies in relation to greater resilience of public health systems remains underinvestigated. Adapting to climate change will be necessary and will occur at physiological, behavioral, social, institutional, and organizational scales. To take advantage of already ongoing adaptations for creating more effective public health responses to climate change impacts-especially for poor rural communities whose access to health care is extremely limited even in the current policy environment-developing a baseline understanding of the region-specific demographic, social, and ecological determinants of health will be necessary. In designing public health responses, factors that must be considered include the population's age structure, socioeconomic profile, baseline prevalence of climate-sensitive diseases, public awareness of risk, the built environment, existing infrastructure, available public health services, and autonomous responses to climate impacts on health that households and communities might undertake by themselves ( McMichael 2004). Furthermore, adaptation strategies in response to climate variability and change must be designed on specific temporal and spatial scales relevant to India. Taking steps now to adjust to current climate variability and modifying existing programs to address the anticipated impacts of climate change will make future adaptation strategies more effective ( Ebi et al. 2006). The same changes may also aid in reaching additional environmental and social objectives, such as more equitable education, empowerment of women, and improved sanitation. These community-based initiatives should be complemented by government interventions. A variety of stakeholders, including those who will be affected most by climate change impacts, must be involved in the problem-solving process to enhance human and technical capacity across sectors at both local and national levels ( Agrawal 2009; Ebi and Semenza 2008). Failure to invest now will likely increase the severity of consequences in the future ( Haines et al. 2006).

Potential adaptation strategies in India could focus on controlling infectious diseases by removing vector breeding sites, reducing vector-human contact via improved housing, and coordinating monitoring of mosquitoes, pathogens, and disease burden. Another potential focus area for adaptation could be improving sanitation and drinking water by supporting inexpensive and effective water treatment and increasing rainwater harvesting, safe storage, and gray-water reuse. In some areas, the focus may shift to flood, heat wave, and emergency preparedness, including strategies to address the additional risks placed on displaced populations from these and other climate-sensitive hazards. One possible outcome could be the development of an integrated early warning system, emergency response plans, and refugee management plans, along with increased capacity to provide shelter, drinking water, sanitation, and sustainable agricultural products to the most vulnerable populations.

Current surveillance and data sources

Successful work in this area will require the health community to partner closely with climate scientists and development professionals to move beyond the assessment of climate variability and disease outcomes to predictive models accounting for climate change to facilitate targeted adaptation. Partnerships with both the government and nongovernment sector will also be necessary. An integrated disease surveillance system already exists under the director general of health services; any new work on climate change and health should be linked to the already existing system. The Energy and Resources Institute (TERI) in Delhi, India, is one example of such a group linking research and action by increasing awareness within India and sharing the "developing country" perspective on climate change with the rest of the world. Activities at TERI range from operating as a think tank at the local level to forging global alliances for collaborative research. Collaborative work is also being conducted at the National Institute of Malaria Research in partnership with Mercedes Pascual at the University of Michigan to assess the impacts of climate change on malaria and dengue at a national scale and to develop adaptation strategies. In addition, this same partnership is developing an evidence-based assessment of biophysical determinants affecting malaria in the northeastern states of India and a framework for malaria control under changing climate scenarios. Several other nongovernmental organizations are working on climate change in India, such as the Local Governments for Sustainability with a regional office in New Delhi; Resources for the Future, which is partnering closely with the Public Health Foundation of India; and Toxics Link, which is working on traditional environmental health with a new focus on climate change.

Retrospective studies investigating climate variability and health dominate the literature, leaving predictive and prospective studies related to climate change open to be explored. However, both prospective and retrospective studies need high-quality data. Working groups at the Goa workshop were able to identify existing and relevant long-term data sets that can be used for environmental epidemiological analysis. For example, both the Indian Institute of Tropical Meteorology ( IITM 2010) and the India Meteorological Department (2010) have useful meteorological data with varying degrees of access. Additional government surveys such as the Census of India and the National Family Health Survey, India provide important information on social and economic variables. In some cases, individual investigators have accessed government hospital data sets and have daily all-cause mortality, albeit over a limited geography. The same goes for air pollution data, such as data on particulate matter (PM), which have been accessed at certain locations of interest, such as Chennai ( Ghosh et al. 2010). The use of exposure and emission models can help to fill in where air pollution data are missing; however, consistent monitoring of PM, ozone, and nitrogen oxides over a greater geographic area is needed. In cases where the data already exist, more work is needed to identify and access this type of long-term data, creating uniform repositories. In cases where it does not exist, surveillance and monitoring of relevant variables will be critical to the success of future prospective climate and health research endeavors. Furthermore, regional climate models for India such as PRECIS (Providing Regional Climates for Impacts Studies) developed at the IITM must be integrated with health data if we are going to transition away from surveying the health effects associated with climate variability to predicting the effects of climate change.

Changes to the current information infrastructure needed for this effort will depend on new or enhanced collaborations across multiple disciplines and among diverse institutions. Given the region-specific nature of the relationship between climate variability and health, further research is required throughout India. Satellite and geospatial technology may provide new insights regarding the geographic distribution of risk and disease. Integration of social, demographic, and land cover data with health data will aid in describing a holistic health scenario, which will help identify sustainable health solutions. These research needs and methodological limitations are relevant to many low- and middle-income countries. India, with its current health infrastructure and large population, can serve as an important natural laboratory for developing relevant strategies for promoting and managing climate health research in the developing world.

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Impacts of Climate Change on Public Health in India: Future Research Directions

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The workshop was held in Goa, India, on 30 August through 2 September 2009; it was cosponsored by the University of Michigan's Center for Global Health, the U.S. Centers for Disease Control and Prevention's National Center for Environmental Health, and the Indian Council of Medical Research.

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GLOBAL CLIMATE CHANGE

Climate change occurs over decades or longer time scales. Until now, changes in the global climate have occurred naturally, across centuries or millennia, because of continental drift, various astronomical cycles, variations in solar energy output, and volcanic activity. Over the past few decades, it has become increasingly apparent that human actions are changing atmospheric composition, thereby causing global climate change.[ 1] Humankind's activities are altering the world's climate by increasing the atmospheric concentration of energy-trapping gases (greenhouse gases [GHGs]), thereby amplifying the natural "greenhouse effect" that makes the Earth habitable. These GHGs comprise, principally, carbon dioxide (mostly from fossil fuel combustion and forest burning) plus other heat-trapping gases such as methane (from irrigated agriculture, animal husbandry, and oil extraction), nitrous oxide, and various human-made halocarbons. According to the Fourth Assessment Report (2007)[ 1] of the Intergovernmental Panel on Climate Change (IPCC), the observed effects include:

1. The global average surface temperature has increased by approximately 0.65°C over the last 50 years.

2. Eleven of the last 12 years (1995-2006) rank among the 12 warmest years since records began in the 1850s.

3. The rates of warming and of sea level rise have accelerated in recent decades.

4. Many areas, particularly mid- to high-latitude countries, have experienced increases in precipitation and there has been a general increase in the frequency of extreme rainfall.

5. In some regions, such as parts of Asia and Africa, the frequency and intensity of droughts have increased in recent decades.

6. The frequency of the most intense tropical cyclones has increased in some areas, such as the North Atlantic, since the 1970s.

As we continue to change atmospheric composition, climatologists forecast further warming during the coming century and beyond. The IPCC has made the following projections for the next century:

1. Global mean surface temperature will rise by 1.1-6.4° C, depending partly on future trends in energy use. Warming will be greatest over land areas and at high latitudes.

2. Heat waves, heavy precipitation events, and other extreme events will become more frequent and intense.

3. Sea level rise is expected to continue at an accelerating rate.

WHY SHOULD INDIA BE CONCERNED?

The Third Assessment Report (IPCC-2001) concluded that vulnerability to climate change is a function of exposure, sensitivity, and adaptive capacity. India is a large developing country, with the Great Himalayas, the world's third largest ice mass in the north, 7500 km long, and densely populated coast line in the south. Nearly 700 million of her one billion population living in rural areas directly depends on climate-sensitive sectors (agriculture, forests, and fisheries) and natural resources (such as water, biodiversity, mangroves, coastal zones, grasslands) for their subsistence and livelihoods. Further, the adaptive capacity of dry land farmers, forest dwellers, fisher folk, and nomadic shepherds is very low.[ 4] Climate change is likely to impact all the natural ecosystems as well as socioeconomic systems, as shown by the National Communications Report of India to the United Nations Framework Convention on Climate Change (UNFCCC).[ 5]

The latest high-resolution climate change scenarios and projections for India, based on the Regional Climate Modeling system, known as PRECIS, developed by the Hadley Center and applied for India using IPCC scenarios A2 and B2,[ 6] show an annual mean surface temperature rise by the end of the century, ranging from 3 to 5°C under the A2 scenario and 2.5 to 4°C under the B2 scenario, with warming more pronounced in the northern parts of India. A 20% rise in all India summer monsoon rainfall and further rise in rainfall is projected over all states except Punjab, Rajasthan, and Tamil Nadu, which show a slight decrease. Extremes in maximum and minimum temperatures are also expected to increase and similarly extreme precipitation also shows substantial increases, particularly over the west coast of India and west central India. Rapid mountain glacier retreat has been documented in the Himalayas, meltwater from the Himalayan glaciers contributing a sizeable portion of river flows to the Ganges, Brahmaputra, Indus, and other river systems.[ 7] Public health, to a large extent, depends on safe drinking water, sufficient food, secure shelter, and good social conditions. A changing climate is likely to affect all these conditions.

Some of the current and future health effects include:

Health effects of extreme temperatures

Extremes of temperature can kill. While Himachal Pradesh and Uttaranchal experienced a cold wave, other parts in the country were subjected to heat wave. In 1998, the heat wave in Orissa was recorded as one of the worst, claiming more than 2000 lives.[ 8] 1998 was the warmest year globally.[ 9] Andhra Pradesh reeled under heat wave in 2003, killing 1421 people, which is an all-time high in the history of Andhra Pradesh.[ 10] Effects of heat wave were also observed in Uttar Pradesh, Haryana, Punjab, Rajasthan, Gujarat, Bihar, and Orissa in 2003. In June 2005, Orissa recorded the highest temperature of 46.3°C in Bhubaneswar of the last 33 years, which is 10° above normal,[ 11] leading to a heat wave. This is not limited to India only. In July 1995, a heat wave in Chicago, USA, caused 514 heat-related deaths (12 per 100,000 population) and 3300 excess emergency admissions. The record high temperatures in Western Europe in the summer of 2003 were associated with a spike of an estimated 70,000 more deaths than the equivalent periods in previous years. Most of the excess deaths during times of thermal extreme are in persons with pre-existing disease, especially cardiovascular and respiratory disease. The very old, the very young, and the frail are the most susceptible.[ 12] Extremes in maximum and minimum temperatures are also expected to increase. Therefore, it is anticipated that there will be an increase in the number of deaths due to greater frequency and severity of heat waves.

Health effects of extreme weather events

Extreme weather events such as severe storms, floods, and drought have claimed thousands of lives during the last few years and have adversely affected the lives of millions and cost significantly in terms of economic losses and damage to property. India and the subcontinent saw five of the 20 major natural calamities recorded worldwide in terms of victims. Orissa is no stranger to cyclones, but the 1999 cyclone was unprecedented for the sheer severity, with wind speed reaching over 300 km/h, leaving nearly 10,000 dead, and has gone down in history as the Super cyclone.[ 13] In 2003, floods claimed thousands of lives and rendered millions of people homeless in Assam, Bihar, West Bengal, Orissa, Uttar Pradesh, Himachal Pradesh, Rajasthan, and Gujarat. Severe drought conditions is most of the north west, major parts of north India, north east India, and parts of Andhra Pradesh, the Telangana and Rayalseema regions, and parts of Tamil Nadu destroyed crops to the tune of USD 25 million, with many starvation deaths being reported. Floods are an annual feature in Bihar, but the 2004 floods was unique for its severity. Recent climate emergencies in India included a heat wave in Orissa (2004), a cold wave in Uttaranchal and Uttar Pradesh (2004), a tsunami affecting Tamil Nadu, Andhra, Kerala, and the Andaman-Nicobar Islands (2004), floods in Madhya Pradesh and Gujarat (2005), rains and floods in Maharashtra (2005), and a cyclone in Andhra Pradesh (2005).[ 14] These climate extremes, apart from health, also damage the public health infrastructure. India, like other developing countries, is poorly equipped to deal with weather extremes. Hence, the number of people killed, injured, or made homeless by natural disasters has been increasing rapidly.

Health effects of more variable precipitation patterns

The Indian metropolitan city of Mumbai was besieged with India's heaviest downpour of the century in July 2005, killing nearly 600 people. According to the Indian Meteorological department, it was the heaviest ever rainfall received in a single day anywhere in India, recorded at 94.4 cm in the last 100 years. It broke the record of the previous highest rainfall at one place in India at Cherrapunjee in Meghalaya of 83.82 cm, recorded on 12 July, 1910.[ 11] On the other hand, Cherrapunjee in the north eastern state of Meghalaya, generally well known for being the wettest place in the world, is going through a rare rain crisis and is experiencing dry spells. This may lead to floods in some areas and drought in other areas and thus endangering food security and also affecting the quantity and quality of water. More variable rainfall patterns are likely to compromise the supply of fresh water. For example, in Kashmir (India), heat events have been increasing in the last decade. Rainfall in Srinagar appears to have been declining and Kashmir has experienced warmer than average winters, with snow melting as early as January and droughts occurring in the summer months of July and August. Water shortages have been reported during what have traditionally been wet summer months, with water having to be trucked in on occasion. There has been an increase in waterborne diseases and skin problems due to water shortages.[ 14] Water scarcity already affects four of every 10 people. A lack of water and poor water quality can compromise hygiene and health. This increases the risk of diarrhea, which kills approximately 1.8 million people every year, as well as trachoma (an eye infection that can lead to blindness) and other illnesses. Many diarrheal diseases vary seasonally, suggesting sensitivity to climate. In India, like in other tropics, diarrheal diseases typically peak during the rainy season. Both floods and droughts increase the risk of diarrheal diseases. Major causes of diarrhea linked to heavy rainfall and contaminated water supplies are cholera, cryptosporidium, E. coli infection, giardia, shigella, typhoid, and viruses such as hepatitis A.[ 15] In India, the threat from compromised quality of water will be larger as only 25% of the population has water piped into their dwelling, yard, or plot and one-third of the households treat their drinking water to make it potable. Half of those that treat their water strain the water through a cloth and almost one-third boil the water.[ 16] In 2030, the estimated risk of diarrhea will be up to 10% higher in some regions than if no climate change occurred.[ 12] Bundhelkhand in Uttar Pradesh had seen a reduction in rainfall in successive years from 987 mm in 2003-2004 to 240 mm in 2007-2008. Forty percent of the people have migrated from their homes and the region has faced violent conflicts over water.

Health effects of rising sea levels

Potential effects on health due to sea level rise[ 17] include:

1. Death and injury due to flooding.

2. Reduced availability of fresh water due to saltwater intrusion.

3. Contamination of water supply through pollutants from submerged waste dumps.

4. Change in the distribution of disease-spreading insects.

5. Health effect on the nutrition due to a loss in agriculture land and changes in fish catch

6. Health impacts associated with population displacement.

India has a 7500 km long densely populated coast line, which is vulnerable to coastal floods, hurricanes, cyclones, and tsunami. Any increase in frequency and severity of these extreme climate events or change in coastline as projected is likely to have serious effects and can cause population displacement. These displaced people are likely to face diverse health consequences - traumatic, infectious, nutritional, psychological, and other - that occur in demoralized and displaced populations in the wake of climate-induced economic dislocation, environmental decline, and conflict situations.[ 14]

Health effects of retracting glaciers

Glaciers are the source of drinking and irrigation water in the mountainous and Indo-Gangetic regions in India. Most of the states in the North, including Punjab, Haryana, Rajasthan, Uttar Pradesh, Madhya Pradesh, and the north east are dependent on river water with origin in the Himalayas. Rising temperatures may cause the snow to melt earlier and faster in the spring, shifting the timing and distribution of run-off. Projections are for a regression of the maximum spring stream-flow period in the annual cycle of about 30 days and an increase in glacier melt run-off by 33-38%.[ 14] These changes could affect the availability of freshwater for natural systems and human use. Excessive melt water could cause flash floods. If freshwater run-off is reduced in the summer months because of earlier melting, the result will be water insecurity and more interstate conflicts in the region.[ 14] Urban areas in developing countries, including India, will be more affected due to the pace of development and increasing industrialization.[ 18] Melting glaciers in the Himalayas may lead to glacier lake outburst floods, as occurred in Himachal Pradesh.

Health effects due to food insecurity

Increasing temperatures and more variable rainfalls and loss of agricultural land due to flash floods are expected to reduce crop yields in many tropical developing regions, where food security is already a problem.[ 14, 19] Simulations using dynamic crop models indicate a decrease in the yield of crops as temperature increases in different parts of India. This is likely to threaten the food security in the country where malnutrition is already an important public health problem. Malnutrition causes millions of deaths each year, from both a lack of sufficient nutrients to sustain life and a resulting vulnerability to infectious diseases such as malaria, diarrhea, and respiratory illnesses. In India, almost half of the children under age five and more than one-third of the adults are undernourished. In Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, and Orissa, more than two out of five women are undernourished. Anemia is another major nutritional health problem in India, especially among women and children. Among children between the ages of 6 and 59 months, the great majority (70%) are anemic. More than half of the women (55%) and one-fourth of the men are anemic in India. Anemia can result in maternal mortality, weakness, diminished physical and mental capacity, increased morbidity from infectious diseases, perinatal mortality, premature delivery, low birth weight, and (in children) impaired cognitive performance, motor development, and scholastic achievement.[ 16]

Vector-borne diseases

Changes in climate are likely to change frequency, lengthen the transmission seasons, and alter the geographic range of important vector-borne diseases, malaria and dengue being the most important. There is historical evidence of associations between climatic conditions and vector-borne diseases. Malaria is of the great public health concerns and seems likely to be the vector-borne disease most sensitive to long-term climate change. Malaria varies seasonally in highly endemic areas. The link between malaria and extreme climatic events has long been studied in India. Early last century, the river-irrigated Punjab region experienced periodic malaria epidemics. Excessive monsoon rainfall and high humidity were identified early on as a major influence, enhancing mosquito breeding and survival. Recent analyses have shown that the malaria epidemic risk increases around five-fold in the year after an El Niño event.[ 20]

Mosquitoes need access to stagnant water in order to breed and the adults need humid conditions for viability. Warmer temperatures enhance vector breeding and reduce the pathogen's maturation period within the vector organism. However, very hot and dry conditions can reduce mosquito survival. Periodic epidemics of malaria occur every 5-7 seven years. Between 1994 and 1996, India experienced a sudden rise in the malaria problem, resulting in epidemics and deaths due to malaria in the states of Rajasthan, Manipur, Nagaland, and Haryana.[ 21] The World Bank estimates that about 577,000 disability-adjusted life years were lost due to malaria in India in 1998.[ 17] The malaria modeling shows that small temperature increases can greatly affect the transmission potential. Globally, temperature increases of 2-3°C would increase the number of people who, in climatic terms, are at a risk of malaria by around 3-5%, i.e. several hundred million. Further, the seasonal duration of malaria would increase in many currently endemic areas. In India, the transmission windows for malaria are predicted to increase with climate change from 4 to 6 months to 7 to 9 months in a year in Jammu and Kashmir and Madhya Pradesh and from 7 to 9 months to 10 to 12 months in Uttar Pradesh.[ 22]

Dengue is another important arboviral disease of humans, occurring in tropical and subtropical regions, particularly in urban settings. Since 1960, more than 50 outbreaks have been reported to or investigated by the National Institute of Communicable Diseases in India. The 1996 epidemic in New Delhi was the worst of its kind, which affected 16,517 persons and killed 545.[ 23] El Niño Southern Oscillation affects dengue occurrence by causing changes in household water storage practices and in surface water pooling. Between 1970 and 1995, the annual number of dengue epidemics in the South Pacific was positively correlated with La Niña conditions (i.e., warmer and wetter).[ 24]

Rodents, which proliferate in temperate regions following mild wet winters, act as reservoirs for various diseases. Certain rodent-borne diseases are associated with flooding, including leptospirosis, tularemia, and viral hemorrhagic diseases. Other diseases associated with rodents and ticks, and which show associations with climatic variability, include Lyme disease, tick-borne encephalitis, and Hantavirus pulmonary syndrome.[ 15]

Other health effects

Increasing global temperatures affect levels and seasonal patterns of both man-made and natural air-borne particles, such as plant pollen, which can trigger asthma. About 6% of children suffer from respiratory tract infection and 2% of adults suffer from asthma.[ 16] Asthma deaths are expected to increase by almost 20% in the next 10 years if urgent actions to curb climate change and prepare for its consequences are not taken.[ 19]

Stratospheric ozone depletion is essentially a different process from climate change. However, greenhouse warming is affected by many of the chemical and physical processes involved in the depletion of stratospheric ozone. Exposure to ultra violet radiation has been implicated as a cause of skin cancer (melanoma and other types) in fair-skinned human populations living at mid to high latitudes[ 25, 26] and also to induce immunosuppression that could influence patterns of infectious disease.[ 27]

RESPONSE OPTIONS

Climate change already contributes to the global burden of disease and this contribution is expected to grow in the future. Approximately 600,000 deaths occurred worldwide as a result of weather-related natural disasters in the 1990s, some 95% of which took place in developing countries. The WHO estimated that climate change directly or indirectly contributes to about 77,000 deaths annually in Asia and the Pacific, about half of the world total attributed to climate change.[ 28]

The impacts of climate on human health will not be evenly distributed around the world. Developing country populations, particularly in small island states, arid and high mountain zones, and in densely populated coastal areas, are considered to be particularly vulnerable.[ 29] The Third Assessment Report (IPCC-2001) concluded that the extent to which human health is affected depends on the exposures of populations to climate change and its environmental consequences, the sensitivity of the population to the exposure, and the ability of affected systems and populations to adapt. Adaptation[ 30] can reduce sensitivity to climate change while mitigation can reduce the exposure to climate change, including its rate and extent. Both conclusions are confirmed in this assessment. Therefore, response options to protect health from effects of climate change include the mitigation as well as adaptation. Adaptation and mitigation can complement each other and together can significantly reduce the risks of climate change.[ 1]

The mitigation of GHGs provides a mechanism for slowing, and perhaps eventually halting, the build up of GHGs in the atmosphere. Emission of GHGs can be reduced by more efficient use of energy, reducing dependence on carbon energy and switching to low-carbon energy like solar, hydro, or wind energy, etc. Steps to reduce GHG emissions or lessen the health impacts of climate change could have positive health effects. For example, promoting the safe use of public transportation and active movement, such as biking or walking as alternatives to using private vehicles, could reduce carbon dioxide emissions and improve public health. They can not only cut traffic injuries but also air pollution and associated respiratory and cardiovascular diseases. Increased levels of physical activity can lower the overall mortality rates.[ 12]

A slowing of the rate of warming by mitigation of GHGs could yield important benefits in the form of reduced impacts to human health and other systems. However, the inertia in the climate system means that there will be a significant temporal lag between emission reduction and slowing in the rate of warming. Even if GHG emissions are reduced in the near future, Earth's climate will continue to change. Hence, adaptation strategies must be considered to reduce disease burdens, injuries, disabilities, and deaths. Extreme weather events can have vastly different impacts because of differences in the target population's coping capacity. For example, cyclones in Bangladesh in 1970 and 1991 are estimated to have caused 300,000 and 139,000 deaths, respectively. In contrast, Hurricane Andrew struck the United States in 1992, causing 55 deaths (although also causing around $30 billion in damages).[ 12] Adaptation enhances a population's coping ability and may protect against current climatic variability as well as against future climatic changes. It includes the strategies, policies, and measures undertaken now and in future to reduce the potential adverse health effects. The rebuilding and maintaining of public health infrastructure is often viewed as the "most important, cost-effective, and urgently needed" adaptation strategy.[ 31] This includes public health training, more effective surveillance and emergency response systems, and sustainable prevention and control programs. Education, awareness-raising, and the creation of legal frameworks, institutions, and an environment that enables people to take well-informed, long-term, sustainable decisions are also of paramount importance.

The main determinants of a community's adaptive capacity are economic wealth, technology, information and skills, infrastructure, institutions, and equity. Adaptive capacity is also a function of current population health status and pre-existing disease burdens.[ 12] Developed countries are better to adapt because they have the economic resources to invest and to offset the costs of adaptation. On the other hand, the developing countries who are most vulnerable (with 10% of the world's health resources, carrying 90% of the disease burden)[ 12] and least able to adapt to climate change are the ones least responsible for it. Equity is a key issue to the adaptation. In poor countries, the impacts of major vector-borne diseases and disasters can limit or even reverse improvements in social development.[ 32] Adaptive capacity is likely to be greater when access to resources within a community, nation, or the world is equitably distributed. Countries that have contributed the majority of GHG emissions should acknowledge their responsibility for generating climate change and consequent health impacts, reduce their emissions, and support under-resourced and marginal populations in adapting to climate change, to help ensure the long-term sustainability.[ 14]

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Climate change and health: Why should India be concerned?

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Climate change occurs over decades or longer time scales. Until now, changes in the global climate have occurred naturally, across centuries or millennia, because of continental drift, various astronomical cycles, variations in solar energy output, and volcanic activity.

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Introduction of India case on health and climate ( general facts > developing countries > India)

Why is India concern?

Health effects of climate change

Policies/strategies already implemented

The Malaria case

(Response options/policies) is it someone part????

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Figure 1

Interactions between climate and health in India. (A) Climate zones in India (based on the Köppen classification that demonstrates the diversity of climates that exist in India) (B) State-specific estimates of cases of diarrheal disease across India in 2006 (C and D) Regional estimates of malaria prevalence across India in 2002 (C) and regions in India where the prevalence of malaria is predicted to increase because of changes in climate (D) (adapted from Bhattacharya et al. 2006).