Heat stress adversely impacts a growing proportion of individuals in India. The heat-related lived experiences of Indians in smaller towns and villages are largely unknown. We conducted seven structured focus group discussions in the town of Dalkhola, West Bengal, India; with 5–10 participants in each group. All conversations were digitally audio recorded, transcribed into Bengali, and then translated to English. Two researchers separately performed a thematic analysis of the transcripts to identify common themes pertaining to the ‘effects of heat’ and ‘coping strategies’ used by participants. A total of 56 (mean age 48.9 ± 17.6; female 61%; Scheduled Tribe 9%) individuals participated. There was wide variation in individual experiences of heat, with some people preferring to work in the winter while others preferred the summer. Housing characteristics, nature of work, gender and access to water and green spaces heavily influenced an individual’s vulnerability to heat stress. Trees were seen as the primary coping strategy for heat stress (regardless of vulnerability), though many participants noted a loss of tree cover in their vicinity. Cool drinking water from public taps and electric fans (particularly table fans) were other preferred coping mechanisms. Many participants did not have adequate access to cool drinking water or electric fans, leading to increased adverse experiences from heat. Based on participant input, several action items were identified for municipal and state/central governments, schools, and private organizations. Individuals affected by heat have a clear preference for nature-based solutions. This is in contrast with the current design of most heat action plans in India, which put more emphasis on infrastructure, information dissemination and behavioral solutions. Various agencies (governments, schools, private organizations) seeking to adapt to increasing heat stress need to better integrate citizen perspectives into their heat action plans.

Background The evidence for acute effects of air pollution on mortality in India is scarce, despite the extreme concentrations of air pollution observed. This is the first multi-city study in India that examines the association between short-term exposure to PM (25) and daily mortality using causal methods that highlight the importance of locally generated air pollution. Methods We applied a time-series analysis to ten cities in India between 2008 and 2019. We assessed city-wide daily PM (25) concentrations using a novel hybrid nationwide spatiotemporal model and estimated city-specific effects of PM (25) using a generalised additive Poisson regression model. City-specific results were then meta-analysed. We applied an instrumental variable causal approach (including planetary boundary layer height, wind speed, and atmospheric pressure) to evaluate the causal effect of locally generated air pollution on mortality. We obtained an integrated exposure-response curve through a multivariate meta-regression of the city-specific exposure-response curve and calculated the fraction of deaths attributable to air pollution concentrations exceeding the current WHO 24 h ambient PM (25) guideline of 15 pg/m (3) . To explore the shape of the exposure-response curve at lower exposures, we further limited the analyses to days with concentrations lower than the current Indian standard (60 pg/m( 3) ). Findings We observed that a 10 pg/m (3) increase in 2 & Oslash;y moving average of PM (25) was associated with 14% (95% CI 07-22) higher daily mortality. In our causal instrumental variable analyses representing the effect of locally generated air pollution, we observed a stronger association with daily mortality (36% [21-50]) than our overall estimate. Our integrated exposure-response curve suggested steeper slopes at lower levels of exposure and an attenuation of the slope at high exposure levels. We observed two times higher risk of death per 10 pg/m (3) increase when restricting our analyses to observations below the Indian air quality standard (27% [17-36]). Using the integrated exposure-response curve, we observed that 72% (42%-101%) of all daily deaths were attributed to PM (25) concentrations higher than the WHO guidelines. Interpretation Short-term PM (25) exposure was associated with a high risk of death in India, even at concentrations well below the current Indian PM (25) standard. These associations were stronger for locally generated air pollutants quantified through causal modelling methods than conventional time-series analysis, further supporting a plausible causal link. Funding Swedish Research Council for Sustainable Development. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

A city's climate is affected both by global warming and the local factors such as built form and the landscape. The temperature related impacts of climate change make urban areas more vulnerable particularly due to higher population concentration as well as heat island effect. Cities in India are already experiencing enhanced temperature and precipitation related impacts of climate change and extreme events, e.g., >2 degrees C warming in some places. This study describes a case of Ahmedabad a city of around 5 million people (Census, 2011) and currently almost 7.8 million, located in the hot and humid western part of India to understand the current temperature-related mortality impacts and the role of land use. Satellite images (MODIS from NASA), temperature data from India Meteorological Department (IMD) and daily all-cause mortality from Ahmedabad Municipal Corporation between 2001 and 2015 have been used to create a distributed lag non-linear model. Using land surface temperature for mortality risk assessment gives significantly different results as compared to using air temperature for mortality risk assessment. This indicates impacts of localized temperature variations on mortality risks. Thus, the microclimate in a city as represented by land surface temperatures is a better indicator for estimating relative risk of temperature related mortality as compared to air temperature. The study also infers that with increase in built-up spaces by 1% in the land use mix, the relative risk of heat related mortality increases by 0.59 points at 40 degrees C and by 0.78 points at 45 degrees C.

India's urban future is under threat from a changing climate. Evidence over the last twenty-eight years shows an increasing trend in the frequency and intensity of extreme events. With over 300 extreme events, the majority of which occurred since 2005, estimated damages are around US$78.8 billion. There is a significant toll of these extreme events with over 1.33 billion people being affected. Studies on future climate projections indicate that as the frequency and intensity of extreme events increase, cities may experience nonlinear health impacts. In addition to increasing the burden of disease, it will put enormous strain on financial resources as well as health systems. These effects are exemplified in the context of themega-city, Mumbai. Urban planning choices have left the city vulnerable to flooding and heatwaves. There exists a substantial burden of both communicable and non-communicable diseases in Mumbai. A single, unprecedented rainfall event, in 2005, resulted in over 200,000 patients being treated in a single tertiary care hospital of the city. These findings indicate the need for cities to proactively plan for responding to extreme events. There remain significant opportunities to design cities that are resilient to extreme events and to protect the health of people.

Exposure to ambient particulate matter is a leading risk factor for environmental public health in India. While Indian authorities implemented several measures to reduce emissions from the power, industry and transportation sectors over the last years, such strategies appear to be insufficient to reduce the ambient fine particulate matter (PM2.5) concentration below the Indian National Ambient Air Quality Standard (NAAQS) of 40 μg/m3 across the country. This study explores pathways towards achieving the NAAQS in India in the context of the dynamics of social and economic development. In addition, to inform action at the subnational levels in India, we estimate the exposure to ambient air pollution in the current legislations and alternative policy scenarios based on simulations with the GAINS integrated assessment model. The analysis reveals that in many of the Indian States emission sources that are outside of their immediate jurisdictions make the dominating contributions to (population-weighted) ambient pollution levels of PM2.5. Consequently, most of the States cannot achieve significant improvements in their air quality and population exposure on their own without emission reductions in the surrounding regions, and any cost-effective strategy requires regionally coordinated approaches. Advanced technical emission control measures could provide NAAQS-compliant air quality for 60% of the Indian population. However, if combined with national sustainable development strategies, an additional 25% population will be provided with clean air, which appears to be a significant co-benefit on air quality (totaling 85%).

The fast economic and population growth in India’s urban areas and the limited control of pollution are causing public health problems and significant environmental degradation, including air, water, land and greenhouse gases, which undermines the potential for sustainable socioeconomic development of the country, particularly with impacts on the poor. To improve air quality and enhance economic and social development, the Government of India has issued a National Ambient Air Quality Standard (NAAQS) for annual average PM2.5 concentrations of 40 �g/m3. However, this standard is widely exceeded, and according to the World Health Organisation (WHO), India was home to 13 out of the 15 most polluted cities worldwide in terms of PM2.5 concentrations in 2016. This study explores pathways towards achieving the NAAQS in India in the context of the dynamics of social and economic development up to 2050. For this purpose, we employ two well-established scientific modelling tools that explore the socio-economic drivers of pollution (the GCAM model), in particular, energy consumption, and the GAINS model that explores effective policy interventions to reduce population exposure and health impacts. We estimate that in 2015 more than half of the Indian population, i.e. about 670 million people, was exposed to ambient PM2.5 concentrations that do not comply with India’s NAAQS, and less than 1% enjoyed air quality conforming with the global WHO guideline value of 10 �g/m3. Without further political action, this figure is not expected to improve. While the existing emission control measures are effectively decoupling the trends of air pollutant emissions from economic growth, their impacts on ambient air quality are not directly visible since they are compensated by the rapid expansion of economic activities. The analysis reveals that advanced technical emission controls can deliver air quality improvements in India, but will not be sufficient to achieve the NAAQS everywhere. However, a package of development and decarbonization measures that are usually taken for other policy priorities can deliver significant co-benefits on air quality and achieve compliance with NAAQS for the vast majority of the population.

Farmer profit can be increased and air quality improved Although intentional use of fires to transform land has decreased globally (1, 2), particularly among highly capitalized countries through regulatory and market-oriented approaches and moral suasion, regulatory strategies have been less effective in southern and eastern Asia (see table S21). Some densely populated agricultural regions in China and India buck the global trend, showing increases in agricultural fires (2). This is particularly true in northwestern India, where rice residue burning makes a substantial contribution to air pollution and short-lived climate pollutants (3, 4). Regulations are in place to reduce agricultural fires, but burning continues because of uncertainty regarding policy implementation and regarding access and returns to alternative technologies. With the field burning season soon upon us, we synthesize emerging evidence on alternatives to burning, clarify the business case for alternative practices, identify remaining uncertainties, and discuss approaches to increase their widespread adoption. Often, there are difficult trade-offs between environmental improvement and profitable economic opportunities. The case of crop residue management in northwestern India does not appear to fit this pattern and provides lessons that may be useful elsewhere.

The lack of electrification in parts of the world leaves many healthcare facilities with inadequate power provision for even basic services. Pilot projects show that solar power can overcome this but, to expand further, more careful trials measuring health outcomes and better integration of energy and health policy are required.

Over centuries, the Indian capital of Delhi has been the seat of power for several empires. Today, however, Delhi finds itself in the unenviable position of being among the world's most polluted cities. Mitigating air pollution as well as greenhouse gases in Delhi without adversely impacting development remains a crucial goal. Further, climate change has profound impacts that Delhi must adapt to. From a health perspective, in addition to health impacts of pollution, addressing health impacts of climate change such as heatwaves is important.This chapter understands the transitions of key drivers of energy use such as population, vehicle use and per capita incomes that in turn drive emissions of pollutants and greenhouse gases. It provides estimates of greenhouse gas and pollutant emissions from Delhi. It estimates pollution as well as future heat-related mortality for Delhi. Finally, it argues that policies for GHG as well as pollutant mitigation require to be better aligned. This will ensure that health co-benefits are accrued for Delhi.

Climate change is projected to have severe adverse impacts on India’s population, natural eco-systems, and socio-economic parameters. India’s vulnerability to climate change impacts is profound since around 650 million Indians are dependent on rain-fed agriculture for their livelihoods; around 250 million Indians live along a 7500 km of coastline that is at high risk due to sea level rise and extreme weather events; many of the 10,000-odd Indian glaciers are receding at a rapid rate; and deforestation is happening. India is concerned about climate change impacts. India occupies 2.4% of the global land area, supports 17% of the global population and contributes less than 4% of global greenhouse gas emissions. Sustainable development is at the core of Indian planning process and India has been making huge efforts for enhancing the quality of life of her people including sustained poverty alleviation efforts. The number of people below poverty line has declined from 469 million to about 388 million during 2005 to 2010. Even then roughly threefourths of Indian population lives below a daily income of US$ 2 (PPP). This also highlights the extent of number of people who are vulnerable to adverse impacts of a changing climate. India has submitted the Intended Nationally Determined Contributions to UNFCCC on October 1, 2015 highlighting a strong GHG mitigation plan until 2030 and also providing a glimpse into national vulnerability to adverse impacts of climate change across regions and sectors. According to IPCC AR5, adaptation and mitigation are complementary strategies for reducing and managing the risks of climate change. The below 2oC target also unequivocally includes reducing the combined and cumulative risks of mitigation and adaptation actions. The Lima COP-20 (2014) agreed on elevating adaptation onto the same level as the curbing and cutting of greenhouse gas emissions. This report analyzes the climate change that is already occurring in India, projected future climate change, the proactive measures Government of India is taking to adapt to the adverse impacts of climate change, and the Adaptation Gap that is ever increasing. India has experienced substantial changes in mean and extreme climate during the period of 1951-2013. For instance, mean annual air temperature has increased in many regions of the country. Other than the mean annual air temperature, prominent increase was observed in the number of hot days, night-time temperature, and growing degree days during the period of 1951-2013. Figure 1 indicates the regions that are experiencing temperatures equivalent to various RCPs currently. Based on our analysis, around 36 districts (5.5% of land area or ~36 million people) are observing temperatures equivalent to Representative Concentration Pathway 8.5(warming of 4°C+)., 65 districts (11% of land area or ~65 million people) RCP6 (warming of 3°C-4°C), 346 districts (59% of land area or ~704 million people) RCP4.5(warming of 2°C -3°C) and the remaining 190 (24.5% of land area or ~405 million people) districts RCP2.6 (warming of 2°C). The RCP are internationally accepted scenarios to project climate change. Similary for precipation, these numbers are 63% area for RCP 8.5, 2.6% area for RCP 6, 24% area for RCP 4.5 and 11% area for RCP 2.6. 35 districts are facing the highest risk facing due to enhanced temperature now (following profiles similar to RCP 8.5). These are Aizawl, Baran, Bhilwara, Bundi, Cachar, Champhai, Chandel, Chittaurgarh, Churachandpur, Darrang, Dhalai, East Garo Hills, East Kameng, Guna, Hailakandi, Jaipur, Jhalawar, Karimganj, Kolasib, Kota, Lalitpur, xii CLIMATE CHANGE AND INDIA: ADAPTATION GAP (2015) Lawngtlai, Lunglei, Mamit, North Tripura, Papum Pare, Sagar, Saiha, Sawai Madhopur, Serchhip, Sheopur, Shivpuri, Sivasagar, South Tripura and West Tripura. There are 408 districts for similar profile for precipitation and this are spread across various states of India. 22 districts which are following RCP 8.5 profile for both temperature and precipitation together are Aizawl, Baran, Bhilwara, Bundi, Cachar, Champhai, Chandel, Chittaurgarh, Churachandpur, Dhalai, East Garo Hills, Hailakandi, Jhalawar, Karimganj, Kolasib, Kota, Lunglei, Mamit, North Tripura, Serchhip, South Tripura and West Tripura

The relationship between cities and climate change has been under discussion by researchers and policy makers. It is an accepted fact that cities have a very important role to play in mitigating greenhouse gas emissions. This is especially true for rapidly growing cities in developing countries like India where urban population growth, spatial expansion, and economic development have resulted in increasing demand for energy. Future per capita CO2 emissions are expected to increase by four times between now and 2050. At the same time, like many other cities in developing countries, Indian cities are experiencing simultaneous challenges including infrastructure scarcity, air quality deterioration, and inadequate water resources. Large populations, high densities, presence of informal settlements, and industries within these cities have made them vulnerable to climate extremes. Urban infrastructure also will be at risk from climate change events including intense precipitation, flooding, and heat events. Future growth in urban areas will exacerbate existing issues of infrastructure provision and environmental issues of air quality, water, and waste. Climate change will be an added dimension to these urban challenges. Current urban planning process does not mainstream climate concerns and therefore necessitates the search for alternate approaches. Using case studies of selected cities, the chapter briefly highlights mitigation and adaptation challenges for these selected Indian cities and suggests a framework for integrating climate change concerns in urban planning and management.

Mapping mortality impacts of the projected climate in urban areas of developing countries will play a crucial role in instituting planned adaptation measures to protect public health. A comprehensive assessment of mortality in 52 urban areas (population >1 million) that are located in diverse climactic regimes in India are provided. To understand implications of the climate warming on heat wave mortality in the urban India, downscaled and bias corrected temperature projections is used from the Coupled Model Inter-comparison Project Phase 5 (CMIP5) models. Using the observed data for the period of 2005-2012, temperature-mortality relationships is analysed using Poisson regression models for the selected urban areas in India.

Indian cities are among the most polluted areas globally, yet assessments of short term mortality impacts due to pollution have been limited. Furthermore, studies examining temperature – pollution interactions on mortality are largely absent. Addressing this gap remains important in providing research evidence to better link health outcomes and air quality standards for India. Daily all-cause mortality, temperature, humidity and particulate matter less than 10 microns (PM10) data were collected for five cities – Ahmedabad, Bangalore, Hyderabad, Mumbai and Shimla spanning 2005–2012. Poisson regression models were developed to study short term impacts of PM10 as well as temperature – pollution interactions on daily all-cause mortality. We find that excess risk of mortality associated with a 10 μg/m3 PM10 increase is highest for Shimla (1.36%, 95% CI = −0.38%–3.1%) and the least for Ahmedabad (0.16%, 95% CI = −0.31%–0.62%). The corresponding values for Bangalore, Hyderabad and Mumbai are 0.22% (−0.04%–0.49%), 0.85% (0.06%–1.63%) and 0.2% (0.1%–0.3%) respectively. The relative health benefits of reducing pollution are higher for cleaner cities (Shimla) as opposed to dirtier cities (Mumbai). Overall we find that temperature and pollution interactions do not significantly impact mortality for the cities studied. This is one of the first multi-city studies that assess heterogeneity of air pollution impacts and possible modification due to temperature in Indian cities that are spread across climatic regions and topographies. Our findings highlight the need for pursuing stringent pollution control policies in Indian cities to minimize health impacts.

Background: Indian cities are among the most pollut ed globally, yet assessments of short term mortality impacts due to pollution have been limite d. Furthermore, studies examining temperature ‐ pollution interactions on mortality are largely abs ent. Addressing this gap remains important in providing research evidence to better link health o utcomes and air quality standards for India. Methods: Daily all-cause mortality, temperature, hu midity and particulate matter less than 10 microns (PM 10 ) data were collected for five cities ‐ Ahmedabad, Bangalore, Hyderabad, Mumbai and Shimla spanning 2005 - 2012. Poisson regression models were developed to study short term impacts of PM 10 as well as temperature ‐ pollution interactions on daily all-cause mortality. Results: We find that mortality associated with a 1 0 µg/m 3 PM 10 increase is highest for Shimla (1.36%, 95% confidence interval = -0.38% to 3.1%) and the least for Ahmedabad (0.16%, 95% CI = 0.31% to 0.62%). The corresponding values for Bangalore, Hyderabad and Mumbai are 0.22% (0.04% - 0.49%), 0.85% (0.06% - 1.63%) and 0.2% (0.1% - 0.3%) respectively. The relative health benefits of reducing pollution are higher for clean er cities (Shimla) as opposed to dirtier cities (Mumbai). Overall we find that temperature and poll ution interactions do not significantly impact mortality for the cities studied. Conclusions: This is one of the first multi-city st udies that assess heterogeneity of air pollution impacts and possible modification due to temperatur e in Indian cities that are spread across climatic regions and topographies. Our findings highlight th e need for pursuing stringent pollution control policies in Indian cities to minimize health impact s.