{"id":20118395,"date":"2023-07-06T16:09:55","date_gmt":"2023-07-06T10:39:55","guid":{"rendered":"https:\/\/www.thethirdpole.net\/?p=118395"},"modified":"2023-07-25T14:46:12","modified_gmt":"2023-07-25T09:16:12","slug":"medical-processes-hide-true-number-of-deaths-from-india-heatwave","status":"publish","type":"post","link":"https:\/\/dialogue.earth\/en\/climate\/medical-processes-hide-true-number-of-deaths-from-india-heatwave\/","title":{"rendered":"Medical processes hide the true number of Indians dying from extreme heat"},"content":{"rendered":"\n

Between 15 and 22 June this year, more than 150 people died<\/a> in two hospitals in Ballia and Deoria districts, in north India\u2019s Uttar Pradesh state. In this period, temperatures in Ballia neared 45 degrees Celsius, with a relative humidity of 30-50%. According to the National Oceanic and Atmospheric Administration\u2019s Heat Index Calculator<\/a>, these conditions would feel like more than 60\u02daC to the human body \u2013 indicating extreme danger<\/a>. The India Meteorological Department had earlier issued warnings<\/a> that heatwave conditions were \u201cvery likely\u201d.<\/p>\n\n\n\n

Heatwaves in India<\/span>
\n

In India, a heatwave is declared<\/a> if the maximum temperature at a weather station reaches at least 40 degrees Celsius (\u00b0C) in the plains, 37\u00b0C along the coast, and 30\u00b0C in hilly regions, or if temperatures are at least 4.5\u00b0C above normal, for two consecutive days.<\/p>\n<\/div><\/div><\/div>\n\n\n\n

A state minister reportedly<\/a> said that the heatwave was one of the reasons for the spike in deaths in Ballia and Deoria. An investigative team that was sent to Ballia concluded<\/a> that heat could have contributed to the deaths, but was not \u201ccausative\u201d, noting that most patients had underlying health issues. This has raised the question of how India records the health impact of extreme heat<\/a>, a key facet of climate change in the country.<\/p>\n\n\n\n

\u201cBirth and death systems in the country are not organised,\u201d Dileep Mavalankar<\/a>, director of educational establishment the Indian Institute of Public Health, told The Third Pole. \u201cThe government’s lack of interest in recording excess mortality points towards a flawed death management system.\u201d<\/p>\n\n\n\n

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Recommended<\/span><\/span><\/div><\/a>\n\n\n\n

\u201cDuring the 2003 heatwave in Europe, 70,000 additional deaths<\/a> were recorded in just three weeks. But not all were directly linked to the heat,\u201d Mavalankar added. \u201cSimilar things happened in Ballia and Deoria this year, where excess mortality was recorded but no reason was given.\u201d<\/p>\n\n\n\n

On 20 June, India\u2019s health minister Mansukh Mandaviya announced<\/a> that the Indian Council for Medical Research will conduct research into minimising the impacts of heatwaves on public health.<\/p>\n\n\n\n

How are deaths from heat determined in India?<\/h2>\n\n\n\n

Rakesh Parashar, a medical doctor and health policy advisor who works with the World Health Organization and World Bank programmes, explained that in India, death certificates can list both an immediate cause of death and \u2018antecedent\u2019 and \u2018preceding\u2019 causes \u2013 underlying issues or conditions which led or contributed to the ultimate cause of death.<\/p>\n\n\n\n

\u201cDeath certificate rules ask [doctors] to mention immediate medical causes such as ischaemic heart disease [reduced blood flow to heart] or acute kidney failure, which may be precipitated by heat exposure or heat stroke in some people, especially in the elderly and diabetics,\u201d said Parashar. \u201cThus, heat exposure can be a contributory or a preceding factor in death.\u201d<\/p>\n\n\n\n

\u201cHeat can exaggerate cardiac events, especially in the elderly, and that is completely missing [in heat mortality data], as heat mortality data captures mostly the deaths because of heat stroke or suspected heat stroke,\u201d Parashar explained. \u201cIn UP\u2019s case, it could be ignoring the contribution of heat to the cardiovascular deaths and missing out on correctly identifying heat stroke, leading to denial [of the role of extreme heat in several deaths].\u201d<\/p>\n\n\n\n

It is quite difficult for us climate scientists to work on the link between heat waves and heat stroke\/mortality without this data<\/blockquote>Roxy Matthew Koll, climate scientist at the Indian Institute of Tropical Meteorology<\/cite><\/div><\/div>\n\n\n\n

A lack of clarity around recording the role of heat is reflected in major discrepancies between data on \u2018heat deaths\u2019 collated by different government agencies in India. According to a report<\/a> published in 2021 by India\u2019s National Disaster Management Authority<\/a>, only four people died due to heatwaves in 2020. However, the National Crime Records Bureau (NCRB)<\/a>, which collects data on deaths from \u2018forces of nature\u2019, recorded<\/a> 530 deaths from \u201cheat\/sun stroke\u201d in the same year.<\/p>\n\n\n\n

Determining the role of extreme heat in causing a death can be very challenging. Laboratory tests can detect organ damage caused as a result of heat stroke, and a combination of tests can determine the impact of hyperthermia (high body temperature) on the central nervous system, but no single test can identify extreme heat as a cause of death.<\/p>\n\n\n\n

Mavalankar told The Third Pole that properly investigating a public health crisis involving extreme heat, such as that experienced in Uttar Pradesh, requires post-mortems to be conducted, with health statisticians and epidemiologists surveying the data. But in Ballia\u2019s case, he says, the investigative team was led by the head of the National Centre for Disease Control, which mainly deals with communicable diseases.<\/p>\n\n\n\n

Heatwaves set to get worse in India with climate change<\/h2>\n\n\n\n

An India Meteorological Department report<\/a> from April 2023 states that heat waves have already intensified in India, increasing by an average of one day per decade between 1961 and 2020. \u201cThere are long-term increasing trends of heat wave frequency, duration and maximum duration over northwest India,\u201d the report says.<\/p>\n\n\n\n

Such events are set to get yet more frequent and severe due to climate change. India\u2019s National Action Plan on Heat Related Illness<\/a>, published by the health ministry, states that \u201cClimate Change is expected to increase the Heatwave frequency (HWF) and Heatwave duration (HWD) in India by 0.5 events per decade and 4-7 days per decade, respectively.\u201d<\/p>\n\n\n\n

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Climate change is also likely to cause an increase in wet-bulb temperatures<\/a> in India, which take into account the combined effect of humidity and air temperature. High wet-bulb temperatures feel much hotter for the human body, and are much more dangerous.<\/p>\n\n\n\n

\u201cHeatwaves have already intensified over India. This is in response to the 1\u00b0C change in global mean temperatures [which has already occurred]\u201d, said Roxy Matthew Koll<\/a>, a climate scientist at the Indian Institute of Tropical Meteorology. \u201cGlobal warming is projected to cross 2\u00b0C by 2050, and the heatwaves by then will be much more intense, frequent, and cover larger areas,\u201d Koll added.<\/p>\n\n\n\n

\u201cWe should resolve this issue [of accurately recording the role of extreme heat in causing deaths] since it is quite difficult for us climate scientists to work on the link between heatwaves and heat stroke\/mortality without this data,\u201d Koll said.<\/p>\n","protected":false},"excerpt":{"rendered":"

Official responses to high death rates during extreme heat in Uttar Pradesh has raised questions around how mortality from heat is recorded in India \u2013 and whether this is obscuring the true impact of climate change<\/p>\n","protected":false},"author":20000963,"featured_media":20118427,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[761],"tags":[519,543,551],"hashtags":[],"country":[20000111],"class_list":["post-20118395","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-climate","tag-climate-impacts","tag-extreme-weather","tag-health","country-india"],"acf":[],"yoast_head":"\nIndia heatwave: medical processes hide the true number of deaths<\/title>\n<meta name=\"description\" content=\"Experts question whether the way deaths from heat are recorded in India may be obscuring the true impact of climate change on public health\" 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