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      Development and Implementation of South Asia’s First Heat-Health Action Plan in Ahmedabad (Gujarat, India)

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          Abstract

          Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat’s adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan’s development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program’s scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively.

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          Most cited references44

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          Heat stress and public health: a critical review.

          Heat is an environmental and occupational hazard. The prevention of deaths in the community caused by extreme high temperatures (heat waves) is now an issue of public health concern. The risk of heat-related mortality increases with natural aging, but persons with particular social and/or physical vulnerability are also at risk. Important differences in vulnerability exist between populations, depending on climate, culture, infrastructure (housing), and other factors. Public health measures include health promotion and heat wave warning systems, but the effectiveness of acute measures in response to heat waves has not yet been formally evaluated. Climate change will increase the frequency and the intensity of heat waves, and a range of measures, including improvements to housing, management of chronic diseases, and institutional care of the elderly and the vulnerable, will need to be developed to reduce health impacts.
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            Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave

            Introduction In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8°C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. Methods We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. Results The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest “summer” months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83, p<0.001] and 2.12 [95% CI 2.03–2.21] applying reference periods (May 12–18, 2010) from various years. Conclusion The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.
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              Heat wave impacts on mortality in Shanghai, 1998 and 2003.

              A variety of research has linked extreme heat to heightened levels of daily mortality and, not surprisingly, heat waves both in 1998 and in 2003 all led to elevated mortality in Shanghai, China. While the heat waves in the two years were similar in meteorological character, elevated mortality was much more pronounced during the 1998 event, but it remains unclear why the human response was so varied. In order to explain the differences in human mortality between the two years' heat waves, and to better understand how heat impacts human health, we examine a wide range of meteorological, pollution, and social variables in Shanghai during the summers (15 June to 15 September) of 1998 and 2003. Thus, the goal of this study is to determine what was responsible for the varying human health response during the two heat events. A multivariate analysis is used to investigate the relationships between mortality and heat wave intensity, duration, and timing within the summer season, along with levels of air pollution. It was found that for heat waves in both summers, mortality was strongly associated with the duration of the heat wave. In addition, while slightly higher than average, the air pollution levels for the two heat waves were similar and cannot fully explain the observed differences in human mortality. Finally, since the meteorological conditions and pollution levels for the two heat waves were alike, we conclude that improvements in living conditions in Shanghai, such as increased use of air conditioning, larger living areas, and increased urban green space, along with higher levels of heat awareness and the implementation of a heat warning system, were responsible for the lower levels of human mortality in 2003 compared to 1998.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                25 March 2014
                April 2014
                : 11
                : 4
                : 3473-3492
                Affiliations
                [1 ]Natural Resources Defense Council, New York, NY 10011, USA; E-Mails: ajaiswal@ 123456nrdc.org (A.J.); bdeol@ 123456nrdc.org (B.D.); laurenksanchez@ 123456gmail.com (L.S.); radhika.khosla@ 123456gmail.com (R.K.); mconnolly@ 123456nrdc.org (M.C.)
                [2 ]Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
                [3 ]Ahmedabad Heat and Climate Study Group, Gandhinagar, Gujarat 380054, India
                [4 ]Ahmedabad Municipal Corporation, Medical Officer of Health, Ahmedabad, Gujarat 380001, India; E-Mail: suhaspkulkarni@ 123456gmail.com
                [5 ]Indian Institute of Public Health, Gandhinagar, Gujarat 380054, India; E-Mails: gsazhar@ 123456iiphg.org (G.S.A.); dmavalankar@ 123456iiphg.org (D.M.); amrutasri.nori-sarma@ 123456yale.edu (A.N.-S.); arajiva@ 123456iiphg.org (A.R.); priyadutta@ 123456iiphg.org (P.D.)
                [6 ]School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA; E-Mails: pjw@ 123456eas.gatech.edu (P.J.W.); vt25@ 123456mail.gatech.edu (V.E.T.)
                [7 ]Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; E-Mail: perry.sheffield@ 123456mssm.edu
                [8 ]Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; E-Mail: jhess@ 123456emory.edu
                [9 ]Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
                Author notes
                [* ] Author to whom correspondence should be addressed; E-Mail: kknowlton@ 123456nrdc.org ; Tel.: +1-212-727-4579; Fax: +1-212-727-1773.
                Article
                ijerph-11-03473
                10.3390/ijerph110403473
                4024996
                24670386
                30fce825-7bf9-4e92-bd83-ca53b7a069d9
                © 2014 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 26 January 2014
                : 26 February 2014
                : 04 March 2014
                Categories
                Article

                Public health
                heat,climate change,india,vulnerability,urban,public health,adaptation,disaster preparedness,temperature forecast,extreme weather,climate events

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