HEALTH:

Indian city tries to thwart silent killer as summer temperatures soar

A new kind of billboard is going up in the Indian city Ahmedabad these days. Amid the larger-than-life pictures of politicians, film stars and consumer goods are signs that proclaim "Heat Alert," instruct you to "Drink More Water" and counsel you to "Save Yourself From Heat," both in English and the local language, Gujarati.

The billboards are part of a heat action plan that was launched earlier this month, the first plan of its kind in a South Asian city. Ahmedabad, with its 7.2 million residents, is the largest city of the western state Gujarat and, according to Forbes magazine in 2010, will be one of the world's fastest-growing cities in this decade.

The city is also no stranger to heat. When temperatures soared in the summer of 2010 to their highest in more than 90 years, the number of deaths rose dramatically with them. The mercury touched 46.8 degrees Celsius (116 degrees Fahrenheit), and the number of deaths spiked from a daily summer average of 108 to a macabre 300.

"In 2003 there was a severe heat wave in France, in Europe, where many people died, and that 2003 heat wave was a wakeup call. So in Ahmedabad, their wakeup call was the 2010 heat wave," said Anjali Jaiswal of the Natural Resources Defense Council in the United States. NRDC and its partner in the project, the Indian Institute of Public Health in Gandhinagar, found a ready audience in the city's municipal authorities, but they were still faced with the task of challenging public perceptions about heat waves.

Gulrez Azhar, senior lecturer at IIPH and one of the developers of the heat action plan, said state and national authorities had emergency plans in place for most extreme weather events but not for heat waves, which he calls "silent, insidious killers."

Azhar pointed out that the 46.8 C high measured in 2010 was a reading from the measurement station at the city's airport. City temperatures were likely to be higher because of the heat island effect. "Scientists are being conservative, and still they are talking about at least a 4-degree difference. So when they are saying 46 degrees, it's more than 50," or 122 F, he said.

Hidden mortality rate

The other reason 2010 was possibly worse than it looked is that the mortality rate reflects only registered deaths. The most vulnerable -- the homeless and elderly, those without families, and possibly children -- who died may not have been registered. Recalling the 2003 heat wave that killed close to 20,000 in Europe, Azhar said, "If that is the amount of death happening in Europe with all the health systems and things in place, imagine what's going on with India."

With global temperatures projected to increase by at least 2 C above preindustrial levels by the end of the century, the climate outlook for India is not exactly rosy. Scientists from the Indian Institute of Science have analyzed 18 climate models and found that the warming in India is likely to be in the range of 1.7 to 2 C by 2030 and 3.3 to 4.8 C by 2080.

So NRDC and IIPH, with help from researchers at Emory University, the Mount Sinai School of Medicine and the Georgia Institute of Technology, have come up with a plan tailored for Ahmedabad to help the city deal with more frequent 2010-like heat waves. They conducted surveys in slum communities, speaking to women who run houses that have corrugated tin roofs. They spoke to construction laborers who worked outdoors all day, every day. The team also interviewed doctors and community health care workers.

The analysis led to the three-point plan. As a first step, the municipal authority is distributing pamphlets and posters with information about health risks in a heat wave and tips to stay safe. The second step is to build a heat alert system to be activated during the summer months between March and July. The Indian Meteorological Department defines a heat wave as 4 to 6 C above normal and a severe heat wave as 6 to 7 C over the top.

Working within these parameters, Georgia Tech will issue a seven-day advance warning for Ahmedabad in case of an impending heat wave. The Ahmedabad Meteorological Department will then issue a two-day warning as the threat approaches. Alerts will go out via media and mobile phones with increasing levels of risk indicated by yellow, orange and red signals.

Where 'cooling centers' may not be so cool

During the extreme heat period, the city will run "cooling centers" in temples, public buildings and malls, and make sure emergency services are stocked with ice packs and intravenous fluids. Officials will encourage employers to shift schedules so outdoor workers don't work during the hottest afternoon hours.

The third part of the plan is gathering and reviewing data to measure the number of deaths and amount of illness resulting from a heat wave.

Even as the heat action plan gets going this summer, when temperatures are hovering around 43 C, Azhar recognizes its limitations. "You could talk about cold room support in developed countries. You can't do that in India. The most you can do in India is convert a night shelter into some kind of afternoon get-away-from-heat place," he said, as an example.

And yet, Ahmedabad's program is more than anything that has been done to save lives from heat stress in the country. NRDC's Jaiswal said the plan has already piqued interest in cities in other Indian states including Punjab and Odisha. "While this plan is physically prepared for Ahmedabad, it is a pilot and it is scalable to other cities. These are common-sense recommendations that many cities can implement," she said.

Azhar said, "It's totally not expensive, and you could be saving so many lives compared to other expensive public interventions. At the same time, we have to do a lot more. We have just started."

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