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Addressing heat-related health risks in urban India: Ahmedabad’s Heat Action Plan

Summary of Adaptation Challenge

Higher daily peak temperatures and longer, more intense heat waves are becoming increasingly frequent globally due to climate change, and a new scale of coordinated action is essential to prevent the dangerous health effects of heat stress.

This report, Addressing heat-related health risks in urban India: Ahmedabad’s Heat Action Plan, looks at how the local community of Ahmedabad in Western India is preparing for the increasingly extreme heat of the city. It is part of CDKN’s Inside stories on climate compatible development series, and is authored by Dr Tejas Shah of the Ahmedabad Municipal Corporation,
 Dr Dileep Mavalankar and Dr Gulrez Shah Azhar of the Indian Institute of Public Health-Gandhinagar and
 Anjali Jaiswal and Meredith Connolly of the Natural Resources Defense Council.

Led by the Natural Resources Defense Council (NRDC) and the Indian Institute of Public Health (IIPH), a coalition of academic, health and environmental groups partnered to prepare local communities for increasingly extreme heat in the city of Ahmedabad, located in Gujarat state of Western India, through an early warning system and heat preparedness plan. Ahmedabad is the first city in South Asia to comprehensively address the health threats of extreme heat.

Lessons learned

Recognise heat as a disaster and growing health threat. Although extreme heat had already caused severe health impacts in Ahmedabad, government officials and the public did not consider heat waves as disasters, which will require high-level preparation like there is for monsoons and earthquakes. Sharing heat wave mortality information and preparation plans from Europe, the United States and elsewhere helped change this perception. Specifically, heat adaptation plans initiated by other cities offered best practices that were adaptable to the Indian context. Awareness building through education campaigns is still necessary to encourage the general public to take additional preventive steps.

The city’s leaders have taken ownership of the project and are continuing to lead the early warning system. Municipal leaders in Ahmedabad have budgeted for many activities in Table 1 of report below, demonstrating an ongoing financial commitment.

Share methods with other cities to create broader impact.The soaring temperatures and resulting deaths propelled the National Disaster Management Authority to recommend that heat waves be considered natural disasters in a letter to the Prime Minister, who has assigned a group of ministers to discuss the issue in 2013. Leading cities and states across the country have contacted the coalition to develop their own heat action plans. Some aspects of the Heat Action Plan (HAP), such as community awareness messaging to keep cool, can simply be adopted by other Indian municipalities given the similarities across cities, while other portions such as temperature thresholds for the early warning system need to be locally developed.

Encourage interagency communication and coordination.At the beginning of the project, communication among municipal agencies regarding heat waves was limited. Weather warnings were not being widely communicated to the local government and hospitals, and the general public was not alerted prior to impending heat waves. It quickly became clear that enhancing communication and providing public warnings were essential elements to successfully preparing local communities for extreme heat. The team tried to identify existing efforts and protocols to build on, such as appointing a lead officer already within the municipal health department and using established emergency procedures and low-cost media outlets to reach the public (see Figure 2 of downloadable report). Leveraging existing national, state and local programmes and infrastructure facilitated implementation of the Plan. Improving formal communication channels, developing longer-term forecasting tools, and designating a lead officer within the city government to direct heat-related efforts became key components of the plan.

Overcome data collection barriers. Collecting temperature and mortality data proved more challenging than expected, in part because hospitals did not monitor heat-related illnesses and deaths. Extreme heat vulnerability was initially not recognised as a public health hazard that could be reduced. Implementation of the HAP elevated the visibility of the coalition’s efforts and the team’s role as a non- governmental third party, which helped researchers develop trust and build relationships. However, although hospitals have begun monitoring heat- related cases, the team was not able to incorporate many tools to monitor health threats and evaluate the effectiveness of interventions during the 2013 heat season, and this will limit tracking of the Plan’s impact until a baseline can be developed.

Accommodate time constraints and budgetary concerns. As in many cities, financial resources in Ahmedabad are precious and must be allocated judiciously. Responding to budgetary concerns and timing constraints, project partners worked with the city to identify policies and programmes that would have the biggest impact for the most at- risk groups. The team prioritised short- term and long-term recommendations for vulnerable populations within the policy briefs and the HAP to ensure cost-effective and quick adoption of initial measures by the local government ahead of the 2013 heat season. Maintaining flexibilityregarding implementation efforts andleveraging available resources were key to keeping the overall project on track. For example, the team designed the outreach campaign with the city’s publicity department to identify free or low-cost media outlets, such as rickshaw ads. The coalition also encouraged graduate students to incorporatescientific research intotheir theses under the supervision of the team’s senior experts. Now that the city of Ahmedabad has rolled out these first-tier programmes, the project team is working with the localgovernment to increase future interventions.

Key messages

  • Climate change is fuelling more intense and frequent heat waves in India. A new scale of coordinated action is essential to protect communities, especially their most vulnerable members, from the dangerous health effects of extreme heat.
  • In Ahmedabad, Western India, strong local government leadership enabled the highly effective implementation of a pilot Heat Action Plan – the first of its kind in South Asia – and its continuation following completion of the pilot project.
  • The Plan, which is based on robust scientific research, builds public awareness of the risks of extreme heat, trains medical and community workers to prevent and respond to heat-related illnesses, and coordinates an interagency emergency response effort when heat waves hit.
  • Sharing international experiences and best practices helped change the perception among project stakeholders that heat was not a significant health threat. However, further awareness-raising is still necessary to convince the general public.


  • Gaining strong government buy- in and support from the beginning enabled this project to communicate through existing agency channels to achieve its goals. In this way, the heat action plan could be enacted more rapidly and effectively, and could also continue after the project’s completion. Capitalising on available resources and the community’s eagerness to participate also enhanced the project’s impact. Ongoing efforts to engage the private sector, including private emergency response groups and employers of outdoor workers, are also an important way to expand efforts locally.
  • Establishing a strong scientific foundation through on-the-ground research is key to effectively tailoring a health-focused climate adaptation plan to a specific community and building political will to act. To prioritise outreach within cities with a limited budget and capacity, the project should map vulnerable communities, noting factors that increase their vulnerability and those that could be used to increase their resilience. It should also identify appropriate strategies to formulate concrete recommendations for decision-makers.

  • While this detailed research on the current effects of heat on local communities was needed to develop the Ahmedabad pilot plan- the first of its kind in South Asia- leading cities could modify the simple steps of the pilot plan to start protecting communities from extreme heat. The recommendations, such as developing early warning systems or community awareness on preventive measures (drink water, stay in the shade, check on neighbours), are low-cost solutions that save lives.

  • Incorporating tools to monitor heat- health threats and evaluate the effectiveness of interventions is important to assessing risk and improving the plan over time.

  • As natural disasters devastate more and more communities, awareness of climate change and the importance of adaptation efforts is growing. Harnessing this increasing recognition may help support on-the-ground implementation of new adaptation projects – and save lives.

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