Assessing Inequities in the Adequacy of Heat Health Action Plans and Vulnerability of Indian States

Abstract

As global climate change intensifies, extreme heat events are becoming more frequent and severe, posing an increasing threat to public health. India is particularly vulnerable to adverse health outcomes from extreme heat due to its geographical location, rapid urbanization, high population density, and socioeconomic inequality. To mitigate this risk, the World Health Organization (WHO) has promoted the adoption of Heat Health Action Plans (HHAPs) to help governments plan context-specific strategies to deal with adverse health outcomes from extreme heat. These plans are guided by WHO criteria for high quality and effective implementation. However, there has been little research into the quality and implementation of India’s state and sub-state level HHAPs, particularly in regions most at risk. This thesis examines inequities in the adequacy- which encompasses both quality and implementation- and presence of HHAPs across Indian states. There were two central research questions in this thesis: (1) Do India’s state-level HHAPs meet the adequacy standards set by the WHO? (2) Is there an equity gap in HHAP adequacy and presence between the most and least vulnerable states? The first hypothesis predicted that the most vulnerable states would have the lowest HHAP quality and weakest implementation due to systemic inequities. The second hypothesis posited there would be an equity gap between highly vulnerable and less vulnerable states, thereby widening health and adaptation policy inequities. Using a mixed-methods approach, a content analysis of India’s state and sub-state level HHAPs using WHO criteria was conducted, and State HHAP Adequacy and Vulnerability Indexes were developed. Geospatial mapping was also performed to compare climate vulnerability and HHAP presence across India’s states. The results show that while the most vulnerable states do not always have the worst HHAP adequacy, there is an equity gap in HHAP adequacy and presence between the most and least vulnerable states. The most vulnerable states do not have the best nor highest presence of HHAPs despite the greatest need. Additionally, many of India’s HHAPs are not well implemented, failing to meet all of the WHO’s phases for effective implementation. Hence, the results highlight the need for improved implementation of existing plans as well as prioritization for the most vulnerable states. This thesis concludes with policy recommendations: strengthening HHAP implementation, focusing on the most vulnerable states, and improving HHAP quality. It is imperative that those most at risk are effectively protected from the adverse health impacts from extreme heat.