Editorial of the Day: Climate events and an umbrella for urban health (The Hindu)

Context: The article discusses the monsoon season in India during the current year, highlighting the extensive damage caused in various regions. It makes references to the cyclonic storm Biparjoy that originated in the Arabian Sea in June, resulting in landfall in western India. Further, the article highlights incidents such as floods in the north-eastern state of Assam and heavy rainfall leading to devastation in parts of northern India. These events have raised concerns, particularly among policymakers. While efforts are underway to restore normalcy in the affected areas, the article emphasizes the potential challenges that lie ahead. It warns of the potential outbreak of common water and vector-borne diseases, such as typhoid, cholera, dysentery, leptospirosis, malaria, and dengue, in regions affected by heavy rainfall. The article also highlights the varying impacts of extreme climate events on different sections of the population. However, it underscores that urban households, particularly those in less developed parts of cities like slums and resettlement colonies, are likely to be the most vulnerable groups as they often experience poverty and work in the informal sector, lacking social security benefits. The article finally stresses the need to pay attention to the vulnerability of urban households to climate change-related events in India.

Decoding the Editorial

The article is discussing the findings from a recently published study in the Indian Journal of Public Health regarding the vulnerability of households to climate change-related events, particularly in the context of recent months’ experiences in India.

• The study highlights two important points:
• • Poor socio-economic indicators make households more vulnerable to malaria.
    • Urban households, in comparison to rural ones, face significantly higher odds of suffering from malaria.
    • This indicates that urban areas, despite having better socio-economic conditions on average, are more susceptible to malaria. Similarly, dengue also affects urban populations more.

• • Households in states that are climatically highly vulnerable or moderately highly vulnerable are at greater risk of suffering from malaria. This implies that regions prone to certain climatic conditions are more likely to experience malaria outbreaks.
• Controlling the spread of these diseases requires a systematic and coordinated effort, not only within individual states but also between different states.
• One of the reasons for the need for inter-state coordination is the movement of people between states.
• • People travelling between regions can carry diseases with them, potentially leading to outbreaks in new areas.
  • Therefore, coordinating efforts to mitigate and adapt to disease outbreaks can be challenging, given the complex nature of disease transmission and movement of populations.

Rebuilding the health system:

• Need for Rebuilding Urban Primary Health Care System: The author emphasizes the necessity of reestablishing and strengthening the urban primary health-care system. This is in response to the increasing exposure to unpredictable and extreme climatic events, which can have significant health implications.
• Focus on Vulnerable Urban Population: The rebuilt health-care system should prioritize the vulnerable urban population, particularly those residing in urban slums and peri-urban areas. These communities are more susceptible to the impacts of climatic shocks and need specialized attention.
• Resilience of Health System: A resilient health-care system is described as one that can effectively respond to emergencies, proactively prepare for impending crises, and adapt to changing public health requirements.
• Greater Public Investment: The article advocates for increased public investment in the urban health-care sector, with a specific emphasis on areas that are more prone to climatic shocks. Currently, insufficient funding is allocated to primary health care, and only a small portion reaches urban local bodies responsible for healthcare delivery.
• Role of National Urban Health Mission: While the National Urban Health Mission has initiated efforts to enhance primary-care systems in urban areas, there remain challenges due to the limited revenue-generating capacity of urban local bodies.
• Importance of Preventive and Public Health: Local bodies bear a significant responsibility for preventive and public health functions. Special attention is required to establish a resilient health-care system for vulnerable urban areas.
• Statutory Institutions and Special Funds: To address the gaps in funding, the article suggests the creation of a special fund targeted at building resilient health systems in vulnerable urban areas. This funding could come from institutions like the Finance Commission and should extend not only to cities but also to towns.

The COVID-19 experience

• Complexities of Urban Health Governance: The article acknowledges the complexities of managing health in urban areas due to the involvement of multiple agencies and fragmented care provision. It also highlights the increasing influence of the private sector in the health domain.
• Lessons from COVID-19 Pandemic: The COVID-19 pandemic demonstrated the need for enhanced coordination and cooperation among various stakeholders in responding to public health emergencies. This includes sharing knowledge and data, ensuring consistent preventive and curative measures, treatment practices, and regulating rates and standards.
• Universal Surveillance and Information Systems: The Integrated Disease Surveillance Programme and similar surveillance and information systems should be expanded, made more comprehensive, and strengthened to monitor and respond to health threats effectively.
• Shift to Comprehensive Health System Approach: The existing approach of vertical disease control programs should transition to a more comprehensive health system approach to manage public health programs. This approach would involve integrating various disease management programs and creating a cadre of multi-purpose, front-line public health workers who are accountable to both communities and the health system.
• Addressing Workforce Shortages: Integrating front-line workers across different disease management programs can help address the shortage of adequately trained health and allied workforce. This integration would contribute to a more efficient and effective response to health challenges.
• Climate Change Preparedness: The article emphasizes the need for health systems to incorporate climate change-led events into their planning and management. These events are expected to become more frequent and intense, and therefore, health systems should be better prepared to respond.
• Resource-Constrained Environment: The article acknowledges the resource limitations

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