Editorial 1: Beat the heat with people-centric responses 

Context

As India may be facing another hot year, there is a need for solutions that focus on people, involve multiple sectors, and are based on scientific innovations.

Introduction

On March 15, 2025, some States and cities in India experienced the first major heatwaves of the year, which came 20 days earlier than in 2024. Over the last decade, the number of severe heat days and the strength of heatwaves have been increasing. According to the World Meteorological Organization, 2024 was the hottest year on record, with temperatures about 1.55°C higher than pre-industrial times. In India, December 2022 was the hottest December since temperature tracking began in 1901. The frequency of heatwaves in India has gone up in the last two decades compared to the previous two decades.

• Rising external temperatures, heatwaves, humidity, and wind speed contribute to heat stress.
• When the outside temperature gets close to the body's normal temperature of 37°C, the body struggles to release the internal heat produced by the basal metabolic rate.
• This leads to heat stress, which can impact multiple organs such as the kidneys, liver, and brain.
• Heat stress can cause illness and, in extreme cases, death.

Socio-economic impact and equity issue

Heat action plans need nuances

• Most Heat Action Plans (HAPs) consist of four to five components:
  • Early prediction of heatwaves to issue alerts
  • Increasing awareness among communities about actions to be taken
  • Preparing and equipping the health system to manage health conditions
  • Long-term measures to reduce heat, including government initiatives to increase trees, parks, and open gardens
  • Collecting, analyzing, and interpreting heat stress, morbidity, and mortality data
• Many Indian states and cities have HAPs, but their implementation requires more focus. Success has been partial and often occurs when city authorities collaborate with state governments, public health institutions, subject experts, NGOs, and community organizations.

Key action points for India

1. State-Level HAP Development/Update:
   • States should develop or update HAPs based on existing plans, incorporating lessons learned and best practices.
   • HAPs should account for both temperature and humidity.
   • Local vulnerability assessments should guide HAP development.
   • Plans must define clear accountability and responsibility for stakeholders.
   • Activation should begin from March each year.
2. Improved Data Collection on Heat Stress:
   • A study in Preventive Medicine: Research & Reviews found excessive mortality from heat stress in Indian cities, requiring better data collection.
   • Data should be comprehensive and accurately reflect heat-related illnesses, identifying vulnerable areas and populations.
   • Understanding who suffers from heat strokes and where can provide actionable, potentially lifesaving information.
3. Integration of Day & Nighttime Temperature Monitoring:
   • Some countries, like the UK, use Heat Health Alert (HHA) systems that consider both daytime and nighttime temperatures.
   • Indian HAPs should integrate day and nighttime temperature monitoring.
   • Advanced, specific warning systems are needed to predict thermal comfort and identify times of day with cooler temperatures, ensuring health and continuity of activities like school and work.
4. Strengthening Long-Term Preventive Measures:
   • Improve building and urban infrastructure, using materials that reduce heat.
   • The poor are most affected by heatwaves; financial support for informal sector workers who may lose wages during heat events should be considered.
5. Context-Specific Heat Advisories:
   • A 2022 study across India, Pakistan, and Bangladesh found that a universal "stay indoors" advisory may not be effective for all families.
   • In poorer neighborhoods with confined spaces, temperatures may be higher inside homes and outside, especially in areas surrounded by high-rise buildings.
   • Heat advisories should be tailored to geographical and social contexts within cities.

Need for a people-centric approach

• Summer and Cold Shelters
  • More Indian cities should establish summer or cold shelters, similar to winter shelters.
  • Some States are already developing a ‘cool roof policy’ to promote the use of materials that reflect sunlight and keep houses cool.
  • There is a need for practical, science-based innovations to prevent heatwaves.
• Short-Term Measures During Heatwaves
  • Local authorities often issue short-term measures like advisories to encourage people to drink water.
  • Municipalities and city authorities must ensure the easy availability of:
    • Drinking water points
    • Electrolyte solutions / ORS powder
  • Offices and workplaces (both formal and informal) should:
    • Allow staggered work times
    • Enable early morning and late evening work
    • Close during peak heat hours, especially for those in the informal sector and open spaces.
• Cost-Effectiveness of Heat-Related Actions
  • Evidence shows that investments in heat-related actions and adaptation are highly cost-effective.
  • Efforts should focus on reducing the economic burden of heat stress in hospitals and emergency rooms.
  • Reducing the indirect social and economic costs of heat stress is equally important.
  • With rising global temperatures, heat-related measures are becoming increasingly urgent.

Conclusion

Actions should focus not only on short-term measures but also on long-term strategies to tackle rising temperatures. This includes better coordination between agencies and initiatives like providing insurance for lost workdays. If policymakers and planners recognize that heatwaves are an equity issue and adopt a people-centered approach, much of the work will be achieved.