Based on the Global Climate Risk Index, India is the seventh most vulnerable country to climate change. Its diverse climate zones, terrain and ecosystems make it particularly sensitive to climate change-induced hazards such as disasters, epidemics, crop failures, loss of livelihoods and biodiversity, poverty and displacement, among other dangers. An analysis by the Council on Energy, Environment and Water (CEEW) suggests that more than 75 per cent of Indian districts are extreme events hotspots, making the need to mitigate and adapt for climate change ever more pertinent.
In line with WHO Building Blocks framework advocating for “people” to be at the centre of discourse, the Prayas health group, an NGO, initiated an exploratory action research in the villages of Bhor block of Pune district. This project sought to simultaneously prepare and learn from communities on climate change, with the aim of exploring opportunities to integrate the climate change lens into village-level health systems.
The bottom-up approach to strengthening climate-responsive health systems was facilitated through a series of sharing learning dialogues. Following a stakeholder mapping exercise, Participatory Rural Appraisal (PRA) tools were used to profile the village’s system. The dialogue also helped the community establish the connections between climate change, health and social determinants of health. Action-oriented dialogues were then conducted with various stakeholders to reflect on potential climate-sensitive adaptations which could be integrated into the existing health system.
The sessions facilitated discussions on local vulnerabilities and their connections to health outcomes, encouraging the community to share real-life cases and observations from different aspects of life, such as livelihoods and lifestyles. Mapping contextual vulnerability provided a guiding tool for health actions that the community could undertake.
Through the sessions, the community identified and recommended five components of the existing health system to include the climate change dimension, including:
- Accredited Social Health Activist (ASHA), the female Community Health Workers, to provide heat stress early warning messages to families for heat stress prevention
- Village Health Sanitation Nutrition Committee (VHSNC) to take up climate-sensitive health issues on its agenda, prioritizing these issues for budgeting and collective actions
- Customise the Annual Village Health Plan (VHP) as per weather monitoring, village-level heat health or air pollution, including early warning systems
- Including Climate Change messages in regular communications material in health centres, introducing heat and air pollution surveillance at the sub- centre levels
- Sustained engagement with private providers for improving early reporting of heat stress and respiratory illnesses, participation of private providers in health promotion messages
The engagements encouraged multi-stakeholder actions and fostered communication between village communities and health service providers. By bridging people’s and service providers’ perspectives, the community jointly agreed on practical action-oriented opportunities where climate change angle could be introduced. The sessions also served to prompt engagement in climate and health-associated behaviors.
Besides providing micro-level policy advocacy opportunities, this platform facilitated the development of a village action group of core members. In all, a total of 30 community-level dialogues were carried out; pitching to approximately 350 individuals. The initiative impacted 9 villages covering 9000+ population.
Underlying this initiative is the belief that people can play an active role in climate-induced health vulnerability mapping. Community engagement can be successfully implemented if people’s priorities are adequately listened to, and if the climate-health angle is integrated with the community’s priorities and beliefs. It also highlighted actions need to be flexible based on the context of leadership in the community, and that exclusive dialogues with sub-groups of stakeholders might be constructive to the process. Lastly, data at the village level should be generated to effectively inform actions and to address intersectionality.
Conclusion
Climate and environmental change has been identified as a priority programme of the World Health Organisation, culminating in the Male’ Declaration on building health systems resilience to climate change, signed by Ministers of Health of the WHO South-East Asia Region in 2017.
Climate resilience of health systems continues to be a key priority in the region. The WHO Regional Office for South-East Asia has highlighted support to member states for advocacy on the health impacts of climate change at national, regional and global levels; strengthening partnerships in addressing climate change impacts through adaptation and mitigation measures. WHO SEARO also encourages the enhancement of scientific evidence by developing research capacity and the facilitation of research in and between countries to strengthen health systems.
There remains significant scope yet to make our cities’ health systems even more resilient to climate change. As climate change is far-reaching, cities need to engage in multi-sectoral action to effectively mitigate and adapt to the challenges that we face today. Through evidence-based and innovative approaches, we can jointly strengthen our systems to care for all even in times of crisis.
Foo Jia Xin, General Manager
References:
Global Climate Risk Index. (2021). The 10 most affected countries in 2019. https://www.germanwatch.org/en/19777
Ministry of Health & Family Welfare, Government of India. (2023). Climate Change and Health: Driving Local Action. https://ncdc.mohfw.gov.in/wp-content/uploads/2024/06/Climate-Change-Health_Driving-Local-Action_Collection-of-Case-Studies-NPCCHH-1-1.pdf
Mohanty, A. (2020) Preparing India for Extreme Climate Events: Mapping Hotspots and Response Mechanisms
NASA. (2024) Extreme Weather and Climate Change. https://science.nasa.gov/climate-change/extreme-weather/
Sharma, S. (2023). India’s Climate Change Policy: Challenges and Recommendation. Indian School of Public Policy. https://www.ispp.org.in/indias-climate-change-policy-challenges-and-recommendations/
Wadhawan, S. (2021) Three Steps India Should Take to Climate-Proof its Infrastructure. https://www.ceew.in/blogs/3-steps-for-india-to-climate-proof-its-infrastructure-from-climate-change-threats
WHO. (n.d) Initiative on Building Climate Resilient and Environmentally Sustainable Health Systems. https://cdn.who.int/media/docs/default-source/climate-change/who-initiative-on-climate-resilient-health-systems.pdf?sfvrsn=73bdfd15_5
WHO SEARO (2025). Climate change in the South-East Asia. https://www.who.int/southeastasia/health-topics/climate-change
