SUPPORT
SUPPORT

Heat Stress as an Emerging Public Health Priority in the context of Climate Change: Insights from Odisha

01/07/2025

Dr. Bhuputra Panda

Advisor, Health Systems Policy Research, InOrder- The Health Systems Institute

Introduction

Global temperatures are rising, and extreme heat events are intensifying. The World Meteorological Organization (WMO) reported that 2019 concluded “a decade of exceptional global heat and high-impact weather,” underscoring the emerging trend of heat extremes[1]. Further, the World Health Organization (WHO) warns that heatwaves are an escalating threat to human health worldwide[2]. In India, states such as Odisha are already experiencing severe summer heat; for example, the Odisha State Disaster Management Authority (OSDMA) codified heatwave warning levels in its 2019 Heat Action Plan, setting Bhubaneswar’s “yellow” alert at 36.2 °C and “red” alert above 41.4 °C to guide public health responses[4]. As a predominate coastal state with rapidly emerging urbanized towns, unplanned growth, limited green cover, and lower level of environmental consciousness, Odisha faces a growing public health burden from heat stress and related events.

Climate Change and the Health Burden of Heat

Exposure to high ambient temperatures directly increases the burden of disease. Epidemiological studies link extreme heat to higher mortality, particularly due to cardiovascular and respiratory conditions. Basu (2009) reviewed evidence from 2001 to 2008 and found that higher daily temperatures significantly raise mortality rates across diverse regions in India[6]. In the United States, Ostro et al. (2010) showed that hospitalizations climb substantially on hotter days, notwithstanding application of air conditioning – this suggests that vulnerable populations remain at risk despite mechanical cooling[5]. Physiologically, elevated temperatures impair endothelial functions and increase blood viscosity effects that can precipitate heart attacks and strokes[13][14]. The WHO emphasizes that heatwaves “pose a direct threat” by causing dehydration, heat cramps, and heatstroke, while also worsening chronic conditions[12]. Given projections of rising summer temperatures in India, experts call for urgent adaptation: public health strategies must prioritize heat stress prevention as a core climate-health issue[7][12].

Evidence from Bhubaneswar

Local research confirms that heat is already a critical public health problem in Odisha’s capital. A vulnerability assessment conducted by Panda B et al, then with Indian Institute of Public Health Bhubaneswar (IIPHB), in collaboration with IRADe and IDRC, surveyed ten urban “heat hotspots” in Bhubaneswar from 2018 to 2020. Over 90 percent of respondents, particularly outdoor workers such as traffic police and daily-wage laborers, reported heat-related symptoms (excessive sweating, dizziness, headaches, and dehydration) during high-temperature periods[2]. The study also documented significant economic impacts: two-thirds of outdoor workers missed an average of six workdays per summer, losing between ₹1,000 and ₹10,000 per month[2]. Furthermore, 83 percent of surveyed households had no health insurance, and 28 percent lacked in-home sanitation, highlighting how socioeconomic vulnerability compounds heat risk[2].

Odisha’s Heat Action Plan (2019) specifically targets Bhubaneswar and other urban centers for early warning issuance and community education, drawing on these local findings[4]. Yet urban “heat islands” – neighborhoods where built surfaces absorb and retain more heat – are intensifying exposures. Studies of Indian cities have recorded intra-city temperature differences of 3 to 4 °C, with industrial areas and densely built neighborhoods exhibiting the highest heat retention[15]. In Bhubaneswar, peripheral slum settlements and manufacturing zones likely experience these elevated temperatures most acutely.

Institutional and Community Gaps

Despite these data and planning documents, gaps remain in heat-health preparedness. Households in hotspot areas often dwell in poorly ventilated structures without access to mechanical cooling; One study found that nearly one-third of surveyed homes lacked basic sanitation facilities[2]. Primary health centers are similarly under-resourced: few have dedicated cooling spaces or adequate stocks of oral rehydration solutions (ORS) needed for heat stress management[2].

At the policy level, India’s National Disaster Management Authority (NDMA) issued “Guidelines for Preparation of Action Plan – Prevention and Management of Heat-Wave” in 2017, urging each state to develop localized frameworks[3]. Odisha’s 2019 HAP follows this guidance, but must improve implementation through stronger inter-agency coordination and community outreach. WHO guidelines emphasize that effective risk communication and sustained community engagement are essential; technical alerts alone do not guarantee behavior change[11]. Moreover, vulnerability to heat is multifaceted: beyond age or chronic illnesses, social factors, such as prolonged deprivation, poor housing quality, and social isolation shape the health outcomes of those at the most risk[16]. Global health authorities thus recommend integrating climate resilience into health systems by strengthening early warning capacity, ensuring uninterrupted water and power supplies, and maintaining emergency stocks of IV fluids and ORS[9][10].

Evidence-Based Recommendations for a Climate-Responsive Health System

Drawing on international guidelines and Odisha’s local experience, the following strategies are essential to bridge the gap between policy and practice:

  1. Optimize Early Warning Systems
    • Ensure that NDMA’s multi-tiered heat alerts (yellow, orange, red) are disseminated in Odia and via SMS, radio, and local community groups to reach all socioeconomic strata[3][4].
    • Train community health workers to interpret these alerts and conduct door-to-door advisories in hotspot neighborhoods[11].
  1. Strengthen Health-Care Infrastructure
    • Upgrade primary health centers with shaded waiting areas, reliable power backup for fans or air-cooling units, and dedicated “heat corners” stocked with ORS, IV fluids, and first-aid materials[2][9].
    • Conduct regular training for clinicians and paramedics on heat illness diagnosis and management, following WHO protocols[10].
  1. Target Vulnerable Communities
    • Conduct vulnerability assessment in smaller towns and cities across states. Threshold analysis will be useful for issuance of early warning to communities.
    • Leverage satellite-based and ground-level mapping to identify and monitor urban heat islands; prioritize slum clusters, industrial zones, and high-density residential wards for interventions[15][8].
    • Introduce social protections, such as subsidized electricity tariffs, cool-roof paint programs, or shaded work-break areas, for low-income households and outdoor laborers.
    • Expand health insurance coverage (e.g., through Ayushman Bharat) to reduce financial barriers to seeking prompt care during heatwaves[2].
  1. Adopt Sustainable Cooling Approaches
    • Promote passive cooling: reflective roof coatings, green roofs, and street-tree planting in collaboration with urban planning departments to reduce ambient heat[2].
    • Encourage building designs with cross-ventilation and shading devices, especially in government housing projects and low-income settlements.
  1. Enhance Public Awareness and Behavior Change
    • Implement year-round IEC (Information, Education, Communication) campaigns, using local radio, TV, and community outreach, to educate about hydration, appropriate clothing, and recognizing early signs of heat illness[2][11].
    • Foster community-led “cooling shelters” in public buildings (libraries, schools, community halls) during peak summer months.

These evidence-based actions, grounded in WHO and NDMA guidance and informed by the IIPHB vulnerability assessment, can materially reduce heat-related illness and death. Heat stress is largely preventable with timely interventions[12].

Conclusion

Odisha stands at the forefront of India’s climate-health nexus. Rising temperatures and urban heat islands have already strained health systems, especially in Bhubaneswar’s low-income neighborhoods. While the state has instituted early warning and Heat Action Plans, there is great opportunity to strengthen healthcare access, infrastructure, and community outreach across the state. By heeding international best practices, integrating heat resilience into primary care, prioritizing vulnerable communities, and promoting passive cooling, Odisha can transform its response from being ‘reactive’ to being more ‘proactive’. As climate models project even hotter summers, building a climate-responsive health system is essential not only for Odisha’s well-being but also to act as a blueprint for other heat-vulnerable regions. Heat stress is no longer a future threat, it is a present emergency demanding immediate, coordinated action at local, state and national levels.

References

  1. World Meteorological Organization (WMO). 2019. 2019 concludes a decade of exceptional global heat and high-impact weather. Press Release No. 03122019.
  2. Indian Institute of Public Health Bhubaneswar (IIPHB). 2021. Management of Heat Stress and Related Illnesses: A Guide for Policy Makers and Managers. Bhubaneswar: IIPHB and OSDMA.
  3. National Disaster Management Authority (NDMA). 2017. Guidelines for Preparation of Action Plan – Prevention and Management of Heat-Wave. New Delhi: Government of India.
  4. Odisha State Disaster Management Authority (OSDMA). 2019. Heat Action Plan 2019 for Odisha. Bhubaneswar: Government of Odisha.
  5. Ostro BD, Rauch S, Green R, Malig B, Basu R. 2010. “The effects of temperature and use of air conditioning on hospitalizations.” American Journal of Epidemiology 172(9):1053-1061.
  6. Basu R. 2009. “High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008.” Environmental Health 8:40.
  7. Watts N, Adger WN, Agnolucci P, et al. 2015. “Health and climate change: Policy responses to protect public health.” Environmental Health 15:41.
  8. Azhar GS, Saha S, Ganguly PK, Mavalankar D, Madrigano J. 2017. “Heatwave vulnerability mapping for India.” International Journal of Environmental Research and Public Health 14(4):316.
  9. World Health Organization (WHO). 2015. Operational Framework for Building Climate Resilient Health Systems. Geneva: WHO.
  10. World Health Organization (WHO). 2011. Strengthening national health emergency and disaster management capacities and resilience of health systems. World Health Assembly Resolution WHA64.10, Geneva: WHO.
  11. World Health Organization (WHO). 2017. Communicating Risk in Public Health Emergencies. Geneva: WHO.
  12. World Health Organization (WHO). 2004. Heat-waves: Risks and Responses. Global Environmental Change Series Vol. 2. Geneva: WHO.
  13. Cheng X, Su H. 2010. “Effects of climatic temperature stress on cardiovascular diseases.” European Journal of Internal Medicine 21(2):91-93.
  14. Nawrot TS, Staessen JA, Fagard RH, et al. 2005. “Endothelial function and outdoor temperature.” European Journal of Epidemiology 20(5):337-342.
  15. Maragno D, Fontana MD, Musco F. 2020. “Mapping heat stress vulnerability and risk assessment at the neighborhood scale to drive urban adaptation planning.” Sustainability 12(3):1056.
  16. Zarowsky C, Haddad S, Nguyen VK. 2013. “Beyond ‘vulnerable groups’: Contexts and dynamics of vulnerability.” Global Health Promotion 20(3):5-9.