India likely underestimating heat-related deaths, impacting response to increasingly severe heat waves


BENGALURU, India (AP) — Months of scorching temperatures that have soared to more than 50 degrees Celsius (122 Fahrenheit) in parts of India this year — the worst heat wave in more than a decade — have left hundreds dead and sick. But the official death toll in government reports is just the tip of the iceberg, and that has implications for future preparations for similar heat waves, public health experts said.

India now has some relief from the intense heat, and another round of extreme weather problems as monsoon rains batter the northeastbut for months the extreme heat had battered large parts of the country, especially in northern India, where government officials reported at least 110 heat-related deaths.

Public health experts say the true number of heat-related deaths is likely in the thousands, but because heat is often not listed as a reason on death certificates, many heat-related deaths are not counted in official figures. The concern, they say, is that undercounting deaths means the heat wave problem is not being prioritized as much as it should be, and that officials are missing ways to prepare their residents for the scorching temperatures.

All of India’s hottest years on record have occurred in the last decade. Studies by public health experts have shown that up to 1,116 people have died every year between 2008 and 2019 due to the heat.

Difficulties in recording heat-related deaths

As part of his work in public health, Srinath Reddy, the founder of the Public Health Foundation of India, has advised state governments on how to factor heat into death records.

He found that heat-related deaths are significantly underreported across the country due to “incomplete reporting, delayed reporting and misclassification of deaths.” Despite national guidelines for recording deaths, many doctors — particularly those in overcrowded public hospitals where resources are already stretched — are not adhering to them, he said.

“Most doctors only record the immediate cause of death and attribution to environmental factors such as heat is not recorded,” Reddy said. That’s because heat deaths can be classified as exertional or non-exertional: exertional deaths are when someone dies from direct exposure to high temperatures and non-exertional deaths are when young children, the elderly or people with pre-existing health conditions become seriously ill or sometimes die from the heat, even while indoors.

“The heat wave is the last straw for the second category of people,” said Dileep Mavalankar, former head of the Indian Institute of Public Health in Gandhinagar. “Most people who die during heat waves belong to this category, but their deaths are not recorded as heat-related.”

Mavalankar agreed that the official number of heat deaths this year is an underestimation. He said there were 40,000 registered cases of heat stroke but only 110 deaths. “This is only 0.3% of the total number of registered heat stroke cases, but normally heat deaths should be 20 to 30% of heat stroke cases,” he said.

“We need to count deaths better,” Mavalankar said. “That’s the only way we’ll know how bad the impacts of extreme heat are.”

Plans for future heat

In his previous role at the Indian Institute of Public Health in Gandhinagar, Gujarat, Mavalankar played a key role in developing India’s first-ever heat action plan for the city of Ahmedabad in 2013, three years after more than 1,300 people died in a heat wave there.

The heat plan included measures such as improving access to shaded areas for people working outside, converting relatively cool public buildings into temporary shelters for people without homes or access to electricity, and ensuring hospitals have sufficient medical supplies and staff during heat waves.

In the years that followed, Mavalankar and his team studied the impact of the heat plan by counting the number of deaths in subsequent hot summers. Because of a lack of data on heat-related deaths specifically, the team looked at deaths from all causes, which spike during heat waves, and used the number of excess deaths to determine how many deaths were likely caused by heat.

They estimate that the heat action plan has contributed to a reduction in the number of deaths during heat waves by as much as 40%.

With that data, while not perfect, Mavalankar said the city was able to prepare well for extreme heat and do more of what worked in the future.

But he said the lack of data elsewhere makes it difficult to reproduce the Ahmedabad results at the national level.

“Not reporting these deaths, not sharing data, is like the Indian Meteorological Department not sharing weather data,” he said. “We can easily do this across the country, but we have not decided that we should do it.”

Improving government data

The Indian government collects data on heat-related deaths through the health ministry’s National Centre for Disease Control, which is then shared with the National Disaster Management Agency. The agency then shares the data as a total nationwide figure for the year, but a state-by-state breakdown is not publicly available.

The National Crime Records Bureau also collects data on heat-related deaths as part of their records of deaths caused by ‘forces of nature’ and publishes these figures.

But there are huge discrepancies. In 2020, the last year with public data on heat deaths from both official sources, the Crime Records Bureau recorded 530 heatstroke deaths, but the disaster agency reported only four heat-related deaths.

The Associated Press reached out to the spokesperson for India’s health ministry, the NCDC and the NDMA for comment on the discrepancy but did not receive a response.

With better data, we can answer a lot of questions about who is most vulnerable and how best to help them, said Bharghav Krishna, a public health expert and fellow at the think tank Sustainable Futures Collaborative, “particularly around identifying who is dying, where they are dying, and what they are doing when they are dying.”

Krishna believes that the data currently being collected, while insufficient, can at least provide some insight and force action by policymakers and researchers if shared with the right people.

But Malavankar said the problems surrounding data collection are more systemic in nature and need to be addressed urgently.

“We have not conducted a national census since 2011. The lack of figures is our national weakness,” he said.


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