As climate risks intensify, India’s future will hinge not only on emissions targets, but on a health system ready for climate shocks
Climate change has become a threat to human health globally. Around 3.6 billion people live in areas highly susceptible to climate change, facing both direct and indirect health consequences. Extreme weather events such as heatwaves, storms, and floods, alongside rising pollution levels, directly contribute to adverse health outcomes and mortality. The consequent disruptions to food systems affecting nutrition, the rise in zoonoses, food, water- and vector-borne diseases, and the undermining of several social determinants of good health further contribute to the burden. According to the World Health Organization (WHO), between 2030 and 2050, climate change is expected to cause an additional 250,000 deaths annually, with direct damage costs to health estimated to be between US$2-4 billion (excluding costs in health-determining sectors such as agriculture, water, and sanitation).
According to the World Health Organization (WHO), between 2030 and 2050, climate change is expected to cause an additional 250,000 deaths annually, with direct damage costs to health estimated to be between US$2-4 billion.
While the effects will be felt by all, the already vulnerable and disadvantaged—such as women and children, minorities, migrants and displaced individuals, the elderly, economically poorer communities, and those with underlying health conditions—bear a disproportionately large burden of climate-sensitive illnesses. This threatens decades of progress made in development, global health, poverty reduction, the reduction in health inequities, and attaining universal health coverage (UHC). In this context, WHO states that regions with weak health infrastructure will be least able to manage the mounting health crises resulting from climate change.
In India, this crisis is already unfolding. An assessment by the Centre for Science and Environment found that in the first nine months of 2025, India saw a 48 percent increase in deaths caused by extreme weather events compared to the previous four years. Extreme weather events were recorded on 270 of 273 days, including heat and cold waves, lightning and storms, heavy rain, floods and landslides, claiming over 4,064 lives. Disparities existed across states, with Himachal Pradesh worst affected, experiencing 217 days of extreme weather events and 380 deaths, followed by Kerala, which recorded 147 days of extreme weather and 114 deaths, and Madhya Pradesh, which experienced 144 days and a staggering 532 deaths. Another study estimated that the temperature-attributable fraction of mortality in India was 7.29 percent, with 6.8 percent of all‑age medical deaths attributable to cold temperatures and 0.5 percent to heat over the period 2001–2013. There has also been a sharp increase in disasters over the past two decades.
Moreover, in 2024, India ranked fifth globally in terms of population-weighted average PM2.5 concentrations, with 10 of the 15 most polluted cities in Central and South Asia located in the country. In the capital alone, 15 percent of all deaths (17,188) in 2023 were attributed to air pollution according to the Global Burden of Disease estimates, an increase of 8.9 percent since 2018. Among 180 nations, India also ranks poorly (143rd) in terms of sanitation and drinking water as per Yale’s 2024 Environmental Performance Index. In addition, a 2018 NITI Aayog report stated that around 0.2 million deaths annually are caused due to inadequate access to safe water, estimating that by 2030, nearly 600 million people—approximately 40 percent of India’s projected population—may face water stress.
In the first nine months of 2025, India saw a 48 percent increase in deaths caused by extreme weather events compared to the previous four years.
Among indirect impacts, according to The Lancet, the average dengue transmission potential (R₀) for the mosquito Aedes albopictus in India has almost doubled, rising from 0.86 in 1951–1960 to 1.60 in 2015–2024, reflecting environmental conditions that support sustained outbreaks. By 2024, the share of India’s coastal area with environmental conditions suitable for Vibrio infections (such as cholera-like and other severe waterborne illnesses) was also 46 percent higher than the 1982–2010 baseline period, signalling a sharp rise in coastal disease risk with warming seas.
In the coming years, climate change is expected to exacerbate these burdens. Strengthening health systems to provide adequate care amid rising illnesses and deaths due to climate change should be an important part of India’s climate adaptation strategy.
Over the years, India has taken steps to address the impacts of climate change on human health. In 2019, the Ministry of Health and Family Welfare launched the National Programme on Climate Change and Human Health (NPCCHH) with the objective of building capacity and strengthening the preparedness and response of the healthcare system to mitigate the health impacts arising from climate variability. Under it, State Action Plans for Climate Change and Human Health (SAPCCHHs) were formulated in 2023 based on national guidelines. The SAPCCHHs identified vulnerable districts and were tasked with preparing health adaptation plans for heat, air pollution, vector-borne diseases, and extreme weather events. States were expected to outline activities and devise strategies for strengthening early warning systems and health system preparedness to address the health impacts of climate extremes. They were also required to establish green and climate-resilient healthcare infrastructure. Additionally, surveillance is conducted through the web-based Integrated Health Information Platform (IHIP), where states and union territories report cases for vector-borne diseases and heat-related deaths.
While establishing the NPCCHH is a step in the right direction, it is still in its nascent stage, and a lot more needs to be done rapidly to build capacity in the health system and prepare for the public health challenges posed by climate change.
Although effectiveness and implementation analyses are limited, a 2025 analysis of the SAPCCHH in four states—Himachal Pradesh, Assam, Gujarat, and Kerala—found that the top-down approach followed in priority setting resulted in a lack of contextualisation to local settings. For instance, in Kerala, the impact of rising sea levels on health remained underexplored. In Himachal Pradesh, while the potential for hydroelectric power had been discussed, the consequences for health and ecology have not been investigated. Furthermore, although the departments are represented in state-level governing bodies, there is limited coordination and communication with the district and block-level officials, who are ultimately responsible for implementation. Meanwhile, the budget allocated to NPCCHH for the years 2020-2025 was merely INR 249.5 crore.
While establishing the NPCCHH is a step in the right direction, it is still in its nascent stage, and a lot more needs to be done rapidly to build capacity in the health system and prepare for the public health challenges posed by climate change.
Investing in health adaptation now will save lives while protecting long-term economic productivity. Health adaptation must be embedded as a core part of India’s climate strategy. Existing disease surveillance should be strengthened to cover all extreme weather events defined by the India Meteorological Department (IMD), which is not currently done. Vulnerable sub-populations, communities, and regions must be identified and prioritised to mitigate the adverse consequences of climate change on health for those most at risk. Early warning systems need to be built, and healthcare workers should be trained to respond to seasonal surges in cases. Healthcare facilities at all levels should be adequately equipped to tackle the growing healthcare burdens. Supply chain infrastructure also needs climate-proofing to ensure uninterrupted access to essential medicines.
Embedding health more centrally within climate planning is not merely a public health imperative, but a development and economic necessity, fundamental to safeguarding lives, productivity, and preserving the progress made in equity and human capital in an era of accelerating climate threats.
Moreover, health adaptation plans should be relevant to local contexts, tailored to region-specific climate and health risks, which requires enhanced coordination and communication among officials at the district, state, and national levels. Institutionalised feedback loops are essential to ensure that insights from district-level implementation and state-specific vulnerabilities inform national priority-setting, allowing overarching frameworks to remain flexible while accommodating India’s wide inter-state variation in climate hazards, disease profiles, health system capacity, and socio-economic conditions. Additionally, the public funding for the NPCCHH is currently strikingly low, and higher prioritisation is necessary to develop climate-resilient health systems.
As climate risks intensify, the resilience of India’s health system will increasingly determine the country’s overall adaptive capacity. Embedding health more centrally within climate planning is not merely a public health imperative, but a development and economic necessity, fundamental to safeguarding lives, productivity, and preserving the progress made in equity and human capital in an era of accelerating climate threats.
Nimisha Chadha is a Research Assistant with the Centre for New Economic Diplomacy at the Observer Research Foundation.
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Nimisha Chadha is a Research Assistant with ORF’s Centre for New Economic Diplomacy. She was previously an Associate at PATH (2023) and has a MSc ...
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