Building Resilience to Climate Change: Pilot Evaluation of the Impact of India’s First Heat Action Plan on All-Cause Mortality

Abstract EN

Background.

Ahmedabad implemented South Asia’s first heat action plan (HAP) after a 2010 heatwave.

This study evaluates the HAP’s impact on all-cause mortality in 2014–2015 relative to a 2007–2010 baseline.

Methods.

We analyzed daily maximum temperature (Tmax)-mortality relationships before and after HAP.

We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs).

We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs.

Results.

The maximum pre-HAP RR was 2.34 (95%CI 1.98–2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02–1.53) estimated at 47°C (lag 0).

Post-to-pre-HAP nonlagged mortality IRR for Tmax over 40°C was 0.95 (0.73–1.22) and 0.73 (0.29–1.81) for Tmax over 45°C.

An estimated 1,190 (95%CI 162–2,218) average annualized deaths were avoided in the post-HAP period.

Conclusion.

Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures.

Ahmedabad’s plan can serve as a guide for other cities attempting to increase resilience to extreme heat.