National Action Plan For Climate Change & Human Health: Ministry of Health & Family Welfare Government of India

VERSION AS ON 23 Oct 2018
Approved Draft, VMKatoch, 23/10/2018
NATIONAL ACTION PLAN

FOR CLIMATE CHANGE &
HUMAN HEALTH
Ministry of Health & Family Welfare
Government of India
Oct 2018
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PREFACE
Climate sensitive illnesses are on increase due to climate change and extremes of weather
either through direct or indirect impact. The United Nations Framework Convention on Climate
Change (UNFCCC) and its Kyoto Protocol in 1997 refers to the legal framework for Climate
change process internationally. The Conference of the Parties (COP) to the Convention meets
annually to negotiate and discuss the international climate change agenda and related
commitments from countries. The sustainable development Goal 13 (SDG 13) also emphasises
to “take urgent action to combat climate change and its impacts.”
India’s first National Action Plan on Climate Change (NAPCC) was released by the then Prime
Minister Manmohan Singh on June 30, 2008. It outlines existing and future policies and
programs addressing climate mitigation and adaptation. The plan identifies eight core “national
missions”. After the 21st Conference of Parties (COP 21) under the United Nations Framework
Convention on Climate Change (UNFCCC) concluded in Paris, Hon’ble Prime Minister Mr
Narender Modi broadened India’s response to climate change, by introducing four new missions
including one for “Health” in 2014. The proposed ‘Mission on Health’ will address the health-
related aspects of climate change through multi-pronged approach.
A National Expert Group on Climate Change & Health was constituted in July 2015 under the
chairmanship of Dr Vishwa Mohan Katoch, Former Secretary (Health Research), Government
of India and DG (ICMR) to prepare action plan, recommend strategies for adaptation, capacity
building etc. The National Centre for Disease Control (NCDC) is the nodal agency for drafting of
Action Plan under the Health Mission. The expert group (NEGCCH) had members’
representation from Dte.GHS, MoHFW, MoEFCC, ICMR, DST, NDMA, CGWB, Min of
Agriculture, CPCB, MoES, TERI, NEERI, which had drafted the National Action Plan on Climate
Change and Human Health after detailed deliberation.
India is a diverse country in terms of geography, climatic conditions, resources and health care
infrastructure etc. Owing to this diversity, each state and UT may have morbidity and mortality
due to diseases which may occur as per the geographic-climatic conditions. Hence it was
realised that country requires state/region specific action plan for climate change and human
health (SAPCCHH). Four regional consultations for all the states and UTs were conducted by
Centre for Environmental & Occupational Health, National Centre for Disease Control recently.
The states and Union Territories were sensitised on effect of climate variability and change on
‘occurrence and virulence of vectors’ and recent change in pattern of different climate sensitive
illnesses in their geographic area.
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TABLE OF CONTENTS
Page No.
Executive Summary 7-9
1 Introduction 11-16
2 Steps to Reduce Impacts of Climate Change 17- 19
3 India’s Strategic Framework for Adaptation of Human Health against Climate Change 20- 21
4 Integration of Health Mission with Other Ministries and Missions on Climate Change 22- 23
5 NAPCCHH: Vision, Goal & Objectives 24
6 NAPCCHH: Activity Matrix 25- 29
7 Climate Change vs Health Resilience 30- 31
8 Climate Resilient Health System: Stakeholders’ Intervention 32- 42
9 NAPCCHH: Organisational Framework for Implementation 43- 48
10 NAPCCHH: Capacity Building and System Awareness 49
11 NAPCCHH: Reporting, Monitoring & Evaluation 50
12 Framework for State Specific Action Plan for Climate Change & Human Health 51- 56
13 NAPCCHH: Budget 57
14 References 58- 59
List of Abbreviations 60- 61
Annexure: A: Office Order for constitution of NEGCCH 62- 63
Annexure B – Experts of NEGCCH 64-66
Annexure C: NAPCCHH-Proposed Annual Budget 67
Annexure D: Regional Meteorological Offices 68
Annexure E: State Pollution Control Board 69- 70
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EXECUTIVE SUMMARY
Climate change is occurring due to natural internal processes or external force and is defined as: “a
change of climate which is attributed directly or indirectly to human activity that alters the composition of
the global atmosphere and which is in addition to natural climate variability observed over comparable
time periods.” It affects social and environmental determinants of health like –clean air, safe drinking
water, sufficient food and secure shelter.
Climate change may negatively affect human health through a number of ways, but the commonly
experienced are increased frequency and intensity of heat waves, rise in heat related illnesses and
deaths, increased precipitation, floods and droughts, costing lives directly. High temperature is known to
increase the level of ‘ground level ozone’ and other ‘climate altering pollutants’ other than carbon dioxide,
which further exacerbate cardio-respiratory and allergic diseases and certain cancers. Beside these,
there is increase in transmission and spread of infectious diseases, changes in the distribution of water-
borne, food borne and vector-borne diseases and effects on the risk of disasters and malnutrition.
st
The United Nations Framework Convention on Climate Change (UNFCCC) came into force on 21 March
1994. Since then many steps were initiated to reduce the effect of climate change at meetings like “Rio
Convention 1992”, Kyoto protocol 1997”, “Convention of Parties”, “Cancun Agreement 2010”,” Durban
Platform 2011”,” Nationally Determined Contributions” (NDCs) at Conference of Parties 21”,
Initiatives undertaken by India are: a) Identification of Ministry of Environment, Forest & Climate Change
(MOEF&CC) as nodal ministry; b) Formulation of National Environmental Policy 2006; c) Formulation of
Prime Minister’s Council on Climate Change for matters related to Climate Change. MoEFCC has
developed National Action Plan on Climate Change with eight missions. Later on four new missions
(including Health Mission) were identified. As a follow-up action, MoHFW constituted a National Expert
Group on Climate Change & Health (NEGCCH) under the chairmanship of Dr Vishwa Mohan Katoch,
Former Secretary (Health Research), Government of India and DG (ICMR) to prepare action plan,
recommend strategies for indicators, mitigation, capacity building etc.
The Health Mission aims to reduce climate sensitive illnesses through integration with other missions
under NAPCC as well as through programmes run by various ministries, The vision of NAPCCHH is: To
strengthen health of citizens of India against climate sensitive illness, especially among the vulnerable
like children, women and marginalized population. With a goal to reduce morbidity, mortality, injuries and
health vulnerability to climate variability and extreme weathers. The NAPCCHH objectives with some
initially identified key actions are:
1. To create awareness among general population (vulnerable community), health-care providers

and Policy makers regarding impacts of climate change on human health.
a. Development of IEC material
b. Advocacy
2. To strengthen capacity of healthcare system to reduce illnesses/ diseases due to variability in
climate
a. Strengthening of Healthcare system in context of climate change
b. Capacity building (training) for vulnerability assessment.
3. To strengthen health preparedness and response by performing situational analysis at national/
state/ district/ below district levels.
a. Develop/ strengthen the monitoring and surveillance systems for climate sensitive
diseases
b. Develop mechanisms for EWS/ alerts and responses at state, district and below district
level
4. To develop partnerships and create synchrony/ synergy with other missions and ensure that
health is adequately represented in the climate change agenda in the country
a. Develop joint action plan with other deptt./ organizations In view of their capabilities and
complementarities
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b. Integrate, adopt and implement environment friendly measures suggested in other
missions on climate change
5. To strengthen research capacity to fill the evidence gap on climate change impact on human
health
a. Strengthening of healthcare services based on researches on climate variables and
impact on human health
Initial Inputs desired (first 2 years)

1. Establish ‘Environmental Health Cell’ in State Health Department,
2. Identification of State Nodal Officer- Climate Change at State Health Department
3. Notification of Task Force with representation of other health programmes (vector-borne disease,
infectious diseases, nutrition etc) multi-sectors/ departments such as Disaster Management
Authority, Health Information System, district unit of departments of Meteorology, Pollution
Control Board, Water and Sanitation, Public Works Departments and civil societies etc.
4. Vulnerability Assessment for baseline rate for Climate Sensitive Illnesses in terms of
a. Geography (Plain/ Mountain/ Desert/ Coastal), identify worst affected areas (districts)
b. Risk mapping with extreme events (heat/ cold/ drought/ flood/ cyclone/other),
c. Affected Population (Total, density, Vulnerable, Occupation)
d. Contributing/ exaggerating factors for these Climate sensitive illnesses
e. Healthcare Infrastructure/ facilities like PHC, CHC, District hospital, Tertiary care
hospitals- Government as well as Private.
f. Identify areas for capacity building –human resource, technical and healthcare service
delivery.
5. State health adaptation plan must be prepared for extreme events (heat related illness), Air
Pollution and health related issues, Vector borne diseases and Water borne illnesses
6. State health department should identify and strengthen department/ institute/ organization/ health
care facilities/ other stakeholders for providing assistance for management of cases and for
monitoring and surveillance for climate sensitive illnesses
7. Coordinate with premiere institute/ organisation like Centre of Excellence for developing training
module/ guidelines and Inclusion of mitigation and adaptation measures in Students’ Curriculum.
8. Develop, integrate and Implement media communication plan for common CSDs involving health
determining sectors and communities.
Process: 2 to 5 years
1. Formulate specific implementation framework for climate sensitive diseases.
2. Contingency plans for climate sensitive illnesses - appropriate and efficient health personnel,
logistics & resource allocation.
3. Capacity building and training of health care personnel on guidelines and treatment modalities
against climate sensitive illnesses at district level in each state.
4. Development of early detection tools for CSDs (rapid diagnostics, surveillance) or mathematical
/prediction models for preparedness of population and health care system.
5. Periodic reviews for improvements or deterioration of indicators (vulnerability, response capacity,
preparedness, and environmental determinants) identified for each CSD.
6. Awareness generation- integrate IEC, engage local leaders & community, yearly “Advocacy
network meeting” and health talks, specific day celebration, health melas etc.
7. With projected climate risks, adapt new technologies, building design, energy, water and
sanitation provisions for new constructions of healthcare facilities, but if already existing, modify
as per permissible building norms.
8. Link data on data of Climate sensitive diseases, environmental factors determining health,
meteorological information, and outcomes as morbidity and mortality.
9. Risk mapping and seasonal trend for CSDs: multi-sector management approach.
10. Research and epidemiological studies / surveys on vulnerable population for climate sensitive
illnesses.
Expected Output:
1. Awareness & Behaviour modification of general population for impact, illnesses, prevention and
adaptive measures for climate sensitive illnesses.
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2. Increase in trained healthcare personnel and equipped institutes/ organization towards
achievement of climate resilient healthcare services and infrastructure at district level in each
state.
3. Integrated monitoring system for collection and analysis of health related data with
meteorological parameters, environmental, socio-economic and occupational factors
4. Regulation on key environmental determinants of health: air quality, water quality, food, waste
management, agriculture, transport.
5. Evidence–based support to policy makers, programme planners and related stakeholders
The Monitoring & Evaluation of the implementation of NAPCCH has been stipulated with a mix of internal
and external approaches. MoHFW, State DoHFW, District Health Officers and the individual health
facilities will be involved in regular internal monitoring. External Monitoring will be done by an
independent agency.
To address the diversity and to target the specific health issues, four regional consultations with states
and Union Territories were conducted in 2017-18 by Centre for Environmental and Occupational Health,
National Centre for Disease Control, Delhi. The aim was to sensitise states/UTs’ health personnel to
reassess diseases’ morbidity and mortality with respect to climate variability and extremes. The states
and UTs were communicated to identify the ‘Nodal Person for Climate Change from State Health
Department’, Constitution of “State Environment Health Cell” at State Health Ministry level and
Constitution of a team of experts with representation from Ministry for Environment, Forest & Climate
Change, Ministry of Drinking Water and Sanitation, Ministry of Agriculture, Ministry of Earth Sciences,
ICMR branch (if in state), Disaster Management Authority, State Pollution Control Board or other
stakeholders identified by state.
These regional consultations had participations from health and non-health department of states and
UTs, as well as from WHO as well as research institutions. The representatives were aware of the
urgency and had serious concern for the agenda of these consultations. State health teams were
expected to list and prioritize climate sensitive illnesses in their state and UTs, compilation of data on
morbidity and mortality, statistics related to vulnerable population, geographical factors, health care
infrastructure/ facilities, or any mitigation and adaptation measures adopted by state against impact of
climate change on human health. The available data of states and UT need to be linked to climate/
weather data for which the assurance was given by the representative from Regional Centre
Meteorological Departments. Many states have initiated actions by identifying State Nodal Officer
(Climate Change), notified experts from non-health sectors for Task Force and few states have prepared
their action plan for climate change as well as adaptation plan for heat related illnesses.
Now, India is signatory to “Male’ Declaration” wherein health sector has to be strengthened so as to make
it climate resilient. According to Male’ Declaration, it is desired that health-care facilities should be
prepared & climate-resilient, particularly in promoting to encourage that these are able to withstand any
climatic event, and that essential services such as water, sanitation, waste management and electricity
are functional during such events. Further, for climate resilient, the health department has to undertake
measures to initiate the greening of the health sector by adopting environment-friendly technologies, and
using energy-efficient services.
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I. INTRODUCTION
Climate change refers to a change in the state of the climate that can be identified by changes
in the mean and/or the variability of its properties (usually by models or statistical tests), and
1-2,6
that persists for an extended period, typically decades or longer . Climate change may be
due to natural internal processes or external force such as modulations of the solar cycles,
volcanic eruptions, and persistent anthropogenic changes in the composition of the atmosphere
or in land use. The Framework Convention on Climate Change (UNFCCC), in its Article 1,
defines climate change as: “a change of climate which is attributed directly or indirectly to
human activity that alters the composition of the global atmosphere and which is in addition to
natural climate variability observed over comparable time periods 3”. The UNFCCC thus makes
a distinction between climate change attributable to human activities altering the atmospheric
composition, and climate variability attributable to natural causes 4,5.
Climate change is perceived to be

among the greatest health risks of
the 21st Century4,5. It affects social
and environmental determinants of
health like –clean air, safe drinking
water, sufficient food and secure
shelter. Climate change, together
with other natural and human-
made health stressors, influences
human health and disease in
numerous ways (Fig:1).
Fig:1. Likely Impacts of Climate Change on Human Health
Source: https://www.cdc.gov/climateandhealth/effects/default.htm
Climate change may have various impacts, but most commonly observed negative effects on
human health are seen as rise in illnesses and deaths. The climatic variables costing lives
directly are identified as increase in frequency and intensity of heat waves, increased
precipitation, floods and droughts17-18,26. High temperature is known to increase the level of
‘ground level ozone’ and other ‘climate altering pollutants’ other than carbon dioxide, which
further exacerbate cardio-respiratory and allergic diseases and certain cancers.
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Beside these, there is increase in transmission and spread of infectious diseases, changes in
the distribution of water-borne, food borne and vector-borne diseases and occurrence of
disasters and increased probability of malnutrition. The marginalised populations among all are
found to be more adversely affected due to variability and change in climatic conditions.
The World Health Organization (WHO) estimates that between 2030 and 2050, climate change
is expected to cause approximately 2,50,000 additional deaths per year, resulting from
malnutrition, malaria, diarrhea and heat stress. These deaths will further have financial
implications which are estimated to be between US$ 2-4 billion/year by 203013,14,16. Diseases
such as malaria, yellow fever, dengue and cholera are all sensitive to climate change due to
effect on the viability and the geographical distribution of the mosquitoes and micro-organisms,
which prefer a wetter, warmer world.
India is a highly populous country, undergoing industrialisation, with large scale rural to urban
migration, chaotic, unplanned urbanization, depletion of forest cover and requirement of high
energy demand makes it more vulnerable to adverse impacts of climate change. As evident
from various literature worldwide, the health effects may occur either due to direct or indirect
causes of climate change or extremes of weather 21.
A) Direct Impacts of Change in Climate and Weather on Health:
Changes in temperature and precipitation and occurrence of heat waves, floods, droughts and
fires directly impact health of people.
1. Heat-Stress and Related Impacts

The IPCC Special Report on Extreme Events (SREX)6 has a mention that there has been
an overall decrease in the number of cold days and nights, and an overall increase in the
number of warm days and nights, at the global scale. If there has been an increase in daily
maximum temperatures, resulting in increase in number of heat-related illnesses. As per the
basic processes of human thermoregulation, the health effects are seen when body
temperature rises above 38°C i.e. physical functions are impaired with experience of
weakness (heat exhaustion), when body temperature rises further to 40.6°C, the risk of
physical and cognitive functions get impaired (heat syncope), risks of organ damage, loss of
consciousness, and death increase sharply at further rise in body temperature usually
above 40.6°C (heat stroke). Various factors interplay in occurrence of these morbidity and
mortality majorly affecting mainly the vulnerable population especially in the vulnerable
regions21-23.
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The vulnerable population implies the demography (extremes of age, sex, population
density, pregnant women and certain occupations), Health Status (like proportion of
malnourishment, suffering with infectious and/ or chronic diseases, mental or physical
disability), socio-economic status (poor/ marginalised- more vulnerable), type of occupation
or socio-cultural practices. The vulnerable regions implies unplanned urban housing,
proportion of slums, drought risk zones, water-stressed zones, food-insecure zones and
remote rural areas
Numerous studies have reported increase in temperature-related morbidity (hospital

admissions or emergency presentations), events due to cardiovascular, respiratory, and
kidney diseases. These impacts have been related to the duration and intensity of heat.
Health risks during heat extremes are greater in people who are physically active.
Eighteen heat-waves were reported in India between 1980 and 1998, with a heat-wave in
1988 affecting ten states and causing 1,300 deaths. Heat-waves in Odisha, India during
1998 to 2000 caused an estimated more than two thousand deaths and heat-waves in 2003
in Andhra Pradesh, India, caused more than 3000 deaths. The significant correlation
between mortality and high temperature and high heat index has also been documented.
2. Drought, Storms and Floods

Climate change can result in more hot days, resulting in more periods of ‘drought’, ‘dust
storms’, or ‘heavy rains (precipitation)’, and even ‘flooding’. The health gets directly affected
due to injuries, hypothermia, hyperthermia, drowning and indirectly through population
dislocation, crowding, poor living conditions, faeco-oral transmission of gastro-intestinal
pathogens causing water and food borne illnesses, respiratory illness and other infectious
diseases (e.g., leptospirosis, vector-borne disease, cholera and also mental illnesses)48-50.
The reason primarily is due to contamination of water and sewage disposal.
3. Ozone
Ozone is a secondary pollutant, formed via sunlight‐driven photochemical reactions
involving precursor hydrocarbons and oxides of nitrogen. Ozone pollution is projected to
increase because warmer temperatures enhance these reactions. Ozone is a powerful
oxidant that has been persistently associated with damage to structure of airway or lung
tissue. It contributes to more severe symptom of asthma, increase in other respiratory
illnesses and deaths. High concentration of ground-level ozone accompanied with Heat
34-36
waves result in higher frequency and severity of cardio-pulmonary attacks . Similarly,
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combination of high level of Ozone and dust storms or alteration of allergens or all, will
result in outbreaks of asthma and allergic rhinitis.
4. Air pollution
Air pollution is a major environmental risk to health. The formation, transport and dispersion
of many air pollutants is determined partly by climate and weather factors such as
temperature, humidity, wind, storms, droughts, precipitation and partly by human activities
known to produce various air pollutants. It is thus logical to assume that climate change will
influence the dynamics of air pollution. By reducing air pollution levels, countries can
reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and
acute respiratory diseases, including asthma 29,30.
Ambient (outdoor air pollution) in both cities and rural areas was estimated to cause 3.7
million premature deaths worldwide in 2012. Air pollution also affect health by causing acid
rain; eutrophication due to nitrogen oxides emission in air from power plants, cars, trucks,
and other sources; Haze; toxic effects on wildlife; Ozone depletion; Crop and forest damage
etc. Over 4 million people die prematurely from illness attributable to the household air
pollution from cooking with solid fuels. 3.8 million premature deaths annually from non-
communicable diseases including stroke, ischemic heart disease, chronic obstructive
pulmonary disease (COPD) and lung cancer are attributed to exposure to household air
pollution41-43.
5. Ultraviolet Radiation
The IPCC AR5 mention few studies which states that ultraviolet radiation (UVR) are linked
to higher incidence of few skin carcinoma for every 1°C increment in average
temperatures36. However, exposure to the sun also has beneficial effects on synthesis of
vitamin D, with important consequences for health. Accordingly the balance of gains and
losses due to increased UV exposures vary with location, intensity of exposure, and other
factors (such as diet) that influence vitamin D levels.
The excess of exposure to solar ultraviolet radiation (UVR) even within the ambient
environmental range may results in sunburn, photo-ageing, cataracts, immune suppression
and skin melanomas37. UVR induced immune-suppression may influence occurrence of
various infectious diseases as well as affect vaccine efficacy. There is evidence to support a
relationship between sunburn during childhood and adolescence and skin cancer in
adulthood. The World Health Organization (WHO) has argued that school sun protection
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programmes should be emphasised, because a sizeable portion of lifetime sun exposure
occurs during childhood and adolescence. Similarly, personal exposure studies among
outdoor workers found that individuals engaged in road construction, horticulture, roofing
and other outdoor occupations received ~20 - 26% of the total daily ambient solar UV
radiation levels.
B) Indirect Impacts of Climate and Weather on Health:
Indirect impacts are due to ecological disruptions, rising sea level, changing temperatures
and precipitation patterns which leads to crop failures, shifting patterns of disease’ vectors,
water-borne disease, vector-borne disease. Climate dependant diseases particularly
affecting the vulnerable populations include the following:
1. Air-Borne and Cardio-Respiratory Illnesses: Climate change influences various illnesses

including respiratory tract infections like asthma, rhino-sinusitis, chronic obstructive
pulmonary diseases (COPD), respiratory viral diseases (Avian Influenza) & circulatory
collapse posing danger to cardiac patients. The cited reasons are poor air quality, high
ozone, dust storms, extreme heat, desertification, alteration of allergens, change in timing
and duration of survival and transmission cycle of respiratory virus, alteration in bird
migration. Further the other contributory factors are demographic factors (age, sex,
immunity status, pregnant women, prevailing endemic illnesses etc) low socio-economic
status, overcrowding, poor hygienic conditions, accessibilities to health care facilities,
population with tuberculosis, immune-compromised level, or mentally or physically
challenged people37-39.
2. Vector-borne diseases (VBD): Climate change and other weather parameters have
significant impact on vector borne diseases such as Malaria, Dengue, Chikungunya,
Japanese Encephalitis, kala-azar, and filariasis. The known parameters are temperature,
humidity, wind, rainfall, flood and drought, affecting ‘distribution of vector’ and ‘effectiveness
of transmission of pathogen’ through vectors. The temperature affects: vectors’ survival,
population growth, feeding behaviour, susceptibility to pathogen, incubation period,
seasonality of vector activity as well as pathogen transmission. The roles of rainfall on
vectors are: increase in breeding sites due to increase in surface water, increase vegetation
and expansion of vertebrate hosts, flooding bring vertebrate host close to human
population41-43.
Other factors affecting VBDs are population growth, population displacement, socio-
economic status, changes in residential pattern, changes in land use, water projects,
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agricultural practices, housing projects, international travel, resistance of diseases vectors
and pathogens, accessibility to health care and diagnostic facilities.
3. Waterborne & Foodborne diseases such as typhoid, hepatitis, dysentery, and others
caused from micro- organisms such as Vibrio vulnificus and Vibrio cholera, E.Coli,
Campylobacter, Salmonella, Cryptosporidium, Giardia, Yersinia, Legionella are some
climate-dependant infectious diseases. The increase in temperature is seen to be
associated with increased survival and abundance of micro-organisms44,46. The decreased
precipitation and drought result in decrease availability of safe-water, reuse of wastewater,
contamination of water sources, transmission from vertebrate to human or human to human
etc. Flooding cause contamination of water source as well as disruption of sewage disposal
system, further contributors are population displacement, overcrowding, poor sanitation and
hygiene, subsequent faeco-oral contamination and spread of pathogens etc .
4. Malnutrition and consequent disorders, like retarded child growth and development have
been identified as one of the health threat by the Working Group-II to the Fourth
Assessment Report of the Intergovernmental Panel on Climate Change. Climate change
result in food insecurity, namely, food availability, food accessibility, food utilization, and
food system stability. Drought occurrence diminishes crop yield, dietary diversity, supply
chain disrupted, increase in market prices, also reduction in animal and aquatic products
are being experienced. These factors reduce overall food consumption, and may therefore
lead to macro as well as micronutrient deficiencies.
For India, a proactive approach is critical as nearly half of children (48%) aged less than five
are chronically malnourished, more than half of women (55%) and almost one-quarter of
men (24%) are anaemic (NFHS-3). The health of the vulnerable population is further
threatened by the changing climate. For instance, in Gujarat, during a drought in the year
2000, diets were found to be deficient in energy and several vitamins. In this population,
serious effects of drought on anthropometric indices may have been prevented by public-
health measures48,49.
There are certain positive effects of climate change too, like modest reductions in cold-
related morbidity and mortality, geographical shifts in food production, and reduced
capacity of disease-carrying vectors due to exceeding of thermal thresholds. These positive
effects will however be increasingly outweighed, worldwide, by the magnitude and severity
of the negative effects of climate change.
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II. STEPS TO REDUCE IMPACTS OF CLIMATE CHANGE
The United Nations Framework Convention on Climate Change (UNFCCC) came into force on
21st March 1994. The “Rio Convention”, was adopted out of three conventions identified at “Rio
Earth Summit” in 1992. Today, this convention known as “Convention of Parties” has 197
countries. Industrialized nations agree under the Convention to support climate change
activities in developing countries by providing financial support for action on climate change.
This was followed by first Conference of Parties (COP1) that took place in Berlin in 1995.
Another milestone was Kyoto protocol, which was adopted in Kyoto, Japan, on 11th December
1997. The Parties agreed-for were made bound for ‘targets’ for reducing emission. The Kyoto
Protocol places a heavier burden on developed nations under the principle of "common but
differentiated responsibilities", owing to high level of GHG emissions by developed nations by
their industrial activity for approximately 150 years. The detailed rules for the implementation of
the Protocol were adopted at COP-7 in Marrakesh, Morocco, in 2001, and are referred to as the
"Marrakesh Accords." Its first commitment period started in 2008 and ended in 2012.
The Cancun Agreement came up in 2010 at COP-16 in Cancun, where Governments decided
to establish a “Green Climate Fund”. The fund will support projects, programmes, policies and
other activities in developing country using thematic funding windows. The objective was to
enhance action on adaptation, international cooperation and coherent consideration of matters
relating to adaptation under the Convention.
At COP17, Durban Platform, Enhanced Action drafted, where governments clearly recognized
the need to draw up the blueprint for a fresh universal, legal agreement to deal with climate
change beyond 2020, where all will play their part to the best of their ability and all will be able
to reap the benefits of success together. The Durban outcome recognized, in its spirit and
intention that smart government policy, smart business investment, and the demands of an
informed citizenry, all motivated by an understanding of mutual self-interest, must go hand in
hand in pursuit of the common goal.
At COP 21 in Paris, Parties to the UNFCCC reached a historic agreement to combat climate
change and to accelerate and intensify the actions and investments needed for a sustainable
low carbon future. The Paris Agreement requires all Parties to put forward their best efforts
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through “Nationally Determined Contributions” (NDCs) and to strengthen these efforts in the
years ahead.
India has undertaken many initiatives in pursuance to the obligation implied by UNFCCC like: a)
Identification of Ministry of Environment, Forest & Climate Change (MOEF&CC) as nodal
ministry for matters related to Climate Change; b) Formulation of National Environmental Policy
2006; c) Formulation of Prime Minister’s Council on Climate Change to advice proactive
measures, facilitate inter-ministerial coordination and guide policy in relevant areas.
The hon’ble Prime Minister of India office had released a National Action Plan on Climate
Change in June 2008. NAPCC addresses the urgent and critical concerns of the country
through enhancement of the current and planned programmes presented in the Technology
Document. It identifies measures that promote our development objectives along with yielding
co-benefits for addressing climate change effectively. It outlines a number of steps to
simultaneously advance India’s development and climate change related objectives of
adaptation and mitigation. The NAPCC identified eight national missions initially:
1. National Mission on Sustainable habitat
2. National Mission for Sustaining the Himalayan Ecosystem
3. National Mission for Sustainable Agriculture
4. National Solar Mission
5. National Mission for Enhanced Energy Efficiency
6. National Water Mission
7. National Mission on Strategic Knowledge for Climate Change
8. National Mission for “Green India”
The reconstituted Prime Minister Council on Climate Change (PMCCC) reviewed the progress
of eight national missions on 19th January 2015 and suggested formulation of four new missions
on Climate Change viz.
1. Health Mission
2. National Mission on “Waste to Energy Generation”
3. National Mission on India’s Coastal areas
4. National Wind Mission
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In this background, the proposed ‘Health Mission’ was undertaken by Ministry of Health &
Family Welfare, Government of India under the umbrella of ‘National Action Plan on Climate
Change’ by MoEFCC. As a follow-up action, MoHFW constituted a National Expert Group on
Climate Change & Health (NEGCCH) under the chairmanship of Dr Vishwa Mohan Katoch,
Former Secretary (Health Research), Government of India and DG (ICMR) to prepare action
plan, recommend strategies for adaptation and response plan for diseases occurring due to
climate variability and change.
National Centre for Diseases Control (NCDC) was identified as the nodal agency for ‘Health
Mission’ by Ministry of Health & Family Welfare, Government of India. An expert group was
constituted with members’ representation from DteGHS, MoHFW, MoEFCC, ICMR, DST,
NDMA, CGWB, Min of Agriculture, CPCB, Ministry of Earth Sciences, TERI, NEERI etc.
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III. INDIA’s STRATEGIC FRAMEWORK FOR ADAPTATION OF HUMAN
HEALTH AGAINST CLIMATE CHANAGE
India’s Health and Family Welfare System derives strength from several institutes and
infrastructures of the GOI, multi-lateral institutes, and NGOs including the National Institute of
Malaria Research; Indian Institute of Tropical Meteorology, India Meteorological Department,
Director General of Health Services, Indian Council of Medical Research, National Centre for
Disease Control and many others.
Measures that would help address the imminent challenges would include development of an
integrated early health warning system, state specific emergency response plan, along with
increased capacity to provide health care to the most vulnerable and the marginalized
populations.
Therefore a fundamental area of intervention would include strengthening of local monitoring of

appropriate climate and disease variables. This would be directed at building temporally and
spatially disease specific database. A strong surveillance would help develop effective
prevention strategies, aid epidemiological understanding and predictive computations.
Improvements in information infrastructure that are innovative and that promote interdisciplinary
collaborations have been identified as areas that require strengthening in India (Bush et al.
2011).
The linkage of health with environmental and climate change determinants is well recognized.
Consequently, coordination and synergies with other Ministries becomes crucial to yield health
benefits. To facilitate joint action and Inter-Ministerial cooperation, it is imperative to develop
feedback mechanisms of health trends to related Ministries and agencies to enable health
statistics to leapfrog.
Health sector in preparedness for climate change needs urgent, serious, and multifaceted
action, which should include:
1. Strengthen/ develop coordination for health related early warning and surveillance
systems in specific areas (e.g. heat waves, floods, air pollution, ultraviolet radiation,
vector borne, water-borne and infectious diseases) through an integrated disease surveil-
lance system.
20
2. Feedback mechanisms to other ministries responsible for several ecological
determinants of health particularly- air, water, food, fuel and human resource.
3. Development of risk maps for climate sensitive diseases for each geographical area.
4. Strengthening/ developing response action based on innovative or new strategies or

technological approaches to increase access, early health care advice/ referral and
health tracking system incorporating Aadhaar card number to assist surveillance and
generate trends.
5. Undertake case studies and research and pilot test new approaches aimed at building
health resilience in climatically sensitive locations.
The proposed ‘Health Mission’ will take a multi-pronged approach to address the health-related
aspects of climate change through the strategies listed in the National Action Plan for Climate
Change and Human Health (NAPCCHH). The Health Missions seeks coordination with other
missions identified under the umbrella of National Action Plan for Climate change (NAPCC)
listed earlier in this document. The targets achieved by other national missions launched under
the NAPCC will also scale down the morbidity and mortality of various types of illnesses.
21
IV: INTEGRATION OF HEALTH MISSION WITH OTHER MINISTRIES AND
MISSIONS ON CLIMATE CHANGE
The frequency and magnitude of occurrence of “morbidity and mortality”, “acute and chronic”
“communicable” or “Non-Communicable” illnesses depends on socioeconomic status,
residence, occupation, level of nourishment, underlying illness, availability of safe drinking water,
sanitation facilities, overcrowding, pollution, extreme weather, chemical exposures, agricultural
practices, governance (local, state and national level), access to health facilities, trained/ skilled
health manpower, laboratory support, and religious practices etc.
The strengthening of the National Programmes under various ministries will raise the level of
health of people through direct or indirect impacts by reducing risk factors. To name the
beneficial national programmes/ schemes are: Namami Gange Programme, Mid Day Meal
Programme, Integrated Child Development Schemes, Indira Gandhi Matritva Sahyog Yojna,
Deen Dayal Upadhyaya Gram Jyoti Yojna, Atal Mission for Rejuvenation and Urban
Transformation, Gramin Bhandaran Yojna, Jawaharlal Nehru National Urban Renewal Mission,
Livestock Insurance Scheme, National Urban Livelihood Mission, Smart Cities Mission, National
Vector Borne Disease Control Programme, National Programme for Prevention and Control of
Diabetes, Cardiovascular diseases, Cancer and Stroke, National Mental Health Programme,
National Iodine Deficiency Disorder Control Programme, Revised National TB Control
Programme (RNTCP), National Programme for Control and Treatment of Occupational
Disease, National Programme for the Health Care for the Elderly, National Programme for
Prevention and Control of Deafness and Universal Immunization Programme.
The MoHFW seeks to coordinate & collaborate with other Ministries, departments &
NGOs/CBOs. These Ministries & Departments are: Ministry of Environment, forest & Climate
Change, Ministry of Information & Broadcasting, Ministry of Human Resource Development,
Indian Council of Medical Research, Ministry of Agriculture, Medical Council of India, Ministry of
Drinking Water and Sanitation, Min. of New & Renewable Energy, National Disaster
Management Authority, Ministry of Women and Child Development, Indian Institute of Tropical
Meteorology, Indian Institute of Tropical Meteorology, Department of Space, Department of
Science & Technology, Council of Scientific & Industrial Research, Ministry of Home Affairs,
Defence Research & Development Organization, Indian Council of Agricultural research,
National Institute of Malaria Research, Food Safety and Standards Authority of India,
Department of Health Research, National Environmental Engineering Research Institute,
Community Based Organizations, Public Health Foundation of India etc.
22
The possible health impacts of other missions under NAPCC are foreseen as follows:
1. National Mission for Sustaining the

Himalayan Ecosystem 1. National Water Mission
2. National Mission on Strategic Knowledge 2. National Mission on Sustainable habitat
for Climate Change 3. National Mission for Sustaining the
3. National Mission on Sustainable habitat Himalayan Ecosystem
4. National Water Mission 4. National Mission on Strategic Knowledge
for Climate Change
1. National Mission for

Enhanced Energy Efficiency 1. National Mission for
2. National Mission for “Green Vector Borne Sustainable
India” Agriculture
& Zoonotic
3. National Solar Mission 2. National Mission on
diseases Sustainable habitat
4. National Mission on
Sustainable habitat 3. National Water
5. National Water Mission Mission
6. National Mission for 4. National Mission on
Sustaining the Himalayan Strategic Knowledge
Ecosystem for Climate Change
7. National Mission on HEALTH
Strategic Knowledge for
Climate Change
1. National Mission for

1. National Mission for “Green India” Sustainable Agriculture
2. National Mission on Sustainable 2. National Water Mission
habitat 3. National Mission on
3. National Solar Mission Strategic Knowledge for
4. National Mission for Sustaining the Climate Change
Himalayan Ecosystem
5. National Mission on Strategic
Knowledge for Climate Change
1. National Mission on Sustainable
habitat
2. National Mission for Sustaining the
Himalayan Ecosystem
3. National Mission for Sustainable
Agriculture
4. National Solar Mission
5. National Mission for Sustainable
Agriculture
6. National Mission on India’s Coastal
areas
7. National Mission on Strategic
Knowledge for Climate Change
8. National Mission for “Green India”
23
V: NAPCCHH: VISION, GOAL & OBJECTIVES
Vision: Strengthening of healthcare services for all the citizens of India esp vulnerable like
children, women and marginalized population against climate sensitive illnesses.
Goal: To reduce morbidity, mortality, injuries and health vulnerability due to climate variability
and extreme weathers
Objective: To strengthen health care services against adverse impact of climate change on
health.
Specific Objectives
Objective 1:
To create awareness among general population (vulnerable community), health-care

providers and Policy makers regarding impacts of climate change on human health.
Objective 2:
To strengthen capacity of healthcare system to reduce illnesses/ diseases due to

variability in climate.
Objective 3:
To strengthen health preparedness and response by performing situational analysis at

national/ state/ district/ below district levels.
Objective 4:
To develop partnerships and create synchrony/ synergy with other missions and ensure
that health is adequately represented in the climate change agenda in the country
Objective 5:
To strengthen research capacity to fill the evidence gap on climate change impact on
human health
24
VI. NAPCCHH: ACTIVITY MATRIX
Activity
S.
Key Actions Indicators
No. Short term Medium Term Long Term
(First two years) (up to five years) (up to fifteen years)
1. To create awareness among general population (vulnerable community), health-care providers and Policy makers regarding impacts of climate change on human
health
Development -Identify nodal agency to -Develop integrated IEC -Determine whether - Number of states and UTs developed & translated IEC on Health
of IEC undertake communication strategy the target population impacts of Extreme weather event like ‘Heat’ in local language
material on needs assessment for the is covered/ informed
health target groups -Explore inter-sectoral / inter- timely - Number of states and UTs developed & translated IEC on Health
impacts of ministerial / civil society / impacts of Air Pollution in local language
Climate - Develop Communication NGOs for collaboration -Commissioning of
Plan & Tools impact studies - Number of states and UTs developed & translated IEC on Health
variability & -Integrate health impacts of impacts of climate change on vector borne illnesses in local language
change -Develop IEC materials in climate change into school and -Follow up
Hindi, English and other College curricula ‘Evaluation’ of - Number of states and UTs developed & translated IEC on Health
vernacular languages. awareness activities impacts of climate change on water borne illnesses in local language
- Periodic Impact assessment
- Dissemination of IEC: mass of communication activities -Actively pursue - Number of states and UTs developed & translated IEC on Health
impacts of climate change on food borne illnesses in local language
media and inter-personal and monitor dissemination and partnerships with
communication utilization of IEC material other agencies - Number of states and UTs developed & translated IEC on Health
- Training & Sensitization of -Explore additional sources of impacts of climate change on zoonotic diseases in local language
Health Care Providers funding
Advocacy on - Advocacy forum to conduct Provide evidence/ information Expand the span of - Number of states/ UTs notified Advocacy forum.
health and support workshops and for decision-makers to assess coalitions to
impacts of meetings. existing policies, practices and strengthen and -Number of sensitisation workshops / meetings conducted with
Climate systems support favourable healthcare personnel on issue of climate change and impact on health.
variability & - Evidence based Information legislatures/ policies
to legislators and decision Involve community-based - Number of workshop/ campaign conducted on issue of climate
change change and impact on health with community-based organizations
makers on issues of climate organizations (CBOs) for
change and impact on health dissemination of information. (CBOs)
Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Suggested Supportive Department/ Ministry: Min. I &B / CHEB/ DAVP / MoEF&CC / ICMR / DHR/ Min of Drinking Water and Sanitation / MHA/ Min of Agriculture/ ICAR & DARE
NDMA/ MoWCD Min. of HRD FSSAI
25
Activity Indicators
S.
Key Actions
2. To strengthen capacity of healthcare system to reduce illnesses/ diseases due to variability in climate
Strengthening -Establish ‘Environment Implement/ adapt/ modify - Share appropriate - Number of States/ UT with ‘Environment Health Cell’ at Health deptt
of health care Health Cell’ at Health deptt. Monitoring, Supervision and technology like
system in Evaluation tool for climate reduction in carbon - Number of States/ UT deputed State Nodal Officer (CC) at Health
context of - Depute State Nodal Officer – sensitive diseases footprint at healthcare Department
climate change Climate change as focal point facilities - Number of States/ UT which have notified Task Force
-Coordinate with other
- Notify Task Force with agencies (municipalities, PRIs) - Continue Phased
multiple stakeholders and -Number of meetings conducted with other stakeholders like
for efficient and effective Implementation of municipalities, other department PRI
review existing Indian Public implementation of proposed recommendations of
Health Standards and activities at state and below Task Force.
appropriate suggestions level.
- State to form climate - Phased Implementation of
sensitive health Programme the recommendations of Task
Implementation Plan (PIP) Force.
Capacity -Identify agency/ institute/ - As per priority list, State to - Extend and expand - Number of States/ UTs enlisted agency/ institute/ Organizations in
building for Organizations/ Centers of prepare guideline/ action plan trainings to reach their state for development of guidelines related to climate sensitive
vulnerability Excellence for developing and upload the same on its health care staff till illnesses.
assessment at guidelines, capacity building, website for ready reference. village level.
various levels supporting implementation, - Number of states/ UTs enlisted experts for Technical committees/
and liaison monitoring, supervision. -Develop training modules, - Conduct workshops/ working groups to support Nodal Officer and Task Force for climate
with centre organize training structured training in Change.
- Enlist (customized as per new treatment/
states’ vulnerabilities) - Conduct meeting / management - Number of states/ UTs conducted vulnerability assessment for
i) Technical committees/ Workshops/ Training on technologies at commonly occurring Climate sensitive illnesses in the state.
working groups to support the CC&HH for health care regional or local level
personnel - Number of States/ UTs conducted Training Need assessment in view
focal point, of climate sensitive illnesses.
ii) skilled staff, - Disseminate reports
- Sensitize and orient private and good practices;
(iii) logistics, health care providers - Number of States/ UTs made assessment in terms of required
(iv) funds logistics and funds thereof.

Suggested Supportive Department/ Ministry: ICMR /Min. of Drinking Water and Sanitation / MHA/ DHR/ ICMR/ Min. of Agriculture/ ICAR & DARE/ DRDO / NDMA/ MWCD/
MoEF&CC
26
Activity Indicators
S.
Key Actions
3. To strengthen health preparedness and response by performing situational analysis at national/ state/ district/ below district levels.
Develop/ - Develop / strengthen surveillance for - Build an interdisciplinary platform i.e. Update monitoring and - Number of states and UT conducted
strengthen the each CSD link health databases with real-time surveillance system as per training for Concerned personnel on
monitoring and monitoring of weather, climate, new evidences surveillance system
surveillance -“Standardize information Prepare geospatial, and exposure data so as to
systems for Guidelines, reporting forms for CSDs. accurately forecast health illness/ event Evaluate inter-disciplinary - Number of states and UT integrated
climate platform and upgrade as relevant meteorological data in the
- Train all concerned personnel on - Develop/ modify mechanism and per evolving technologies. surveillance system of Climate sensitive
sensitive surveillance system (data collection,
diseases indicators to monitor trend of CSDs. illnesses.
collation and analysis) Identify gaps for research
- Conduct Joint Review Missions / - Number of states/ UT initiated Real Time
- Integrate relevant non-health data in Central Internal Evaluations and surveillance for Climate sensitive illnesses
the health surveillance system feedback mechanisms. (Illnesses due to Air Pollution, Heat
- Initiate Sentinel & real-time Exposure, Vector borne and Water borne
surveillance for illnesses due to Air illnesses)
Pollution, Heat etc - Number of states/ UTs initiated Sentinel
surveillance for illnesses due to Air
Pollution, Heat etc
Develop Constitute multi-stakeholder working -Review monitoring and surveillance Evaluation and - Number of States and UTs constituted
mechanisms for group for development of early warning system of CSDs modifications for the working group for development of
EWS/ alerts and system for each CSD appropriateness of the mechanism for EWS/ alerts
responses at -Develop thresholds/ prediction models plans’ for
state, district - Design and integrate public health for health events or CSDs. -Number of states and UTs developed
and below response plan with Meteorology Dept, -Thresholds of action mechanism to integrate public health
NDMA, EMR -States to develop communication plan response plan with related stakeholders
district level and dissemination systems to warn -Interventions to maximize
people and communities response effectiveness for - Number of states and UTs developed
the relevant community or communication plan and dissemination
region. systems to warn people and communities

Suggested Supportive Department/ Ministry: MoEF&CC / ICMR / DHR/ Ministry of Drinking Water and Sanitation / MHA/ Ministry of Agriculture/ ICAR & DARE NDMA/ Min. of
HRD/ ICMR / DRDO / NDMA/ MWCD
27
Activity Indicators
S.
Key Actions
4. To develop partnerships and create synchrony/ synergy with other missions and ensure that health is adequately represented in the climate change agenda in the
country
Develop joint -Enlist, map and analyse services by all - Broaden Stakeholders’ network and - Reassess tools for risk - Number of states and UTs enlisted
action plan with possible stakeholders in the state as per partnership and reassess service areas reduction and stakeholders for CRHS
other deptt./ their role in Climate Resilient Health to be served for climate related health Environmental Health
organizations In Services risk reduction and Environmental Health Impact assessment. - Number of states and UTs conducted
view of their Impact Assessment. stakeholders’ mapping
capabilities and -Identify or assess aspects/ areas - Share best management
underserved in management of CSDs - Evaluate Corporate Social practices which are -Number of states and UTs analysed
complementariti stakeholders’ services and identified
es Responsibility (CSR) under laws for affordable and acceptable
- Develop affordable and acceptable Health strategies, Policies and measures in social/ traditional underserved aspects/ areas related to
tools for risk reduction and for promotion of health context locally CSDs
Environmental Health Impact
Assessment - Meeting/ Consultation with local - Evidence based support - Number of states and UTs developed tool
governing body for reassessment of to decision makers for for Environmental Health Impact
- Establish Corporate Social Assessment for commonly occurring CSDs.
roles and services and appropriate addressing gaps in
Responsibility / Accountability in terms resource allocation and for limiting climate resilient
of finances for implementing measures - Number of states and UTs which have
duplication of actions healthcare services Involved corporate sector in management
for prevention/ reduction/ treatment of
CSDs of CSDs.
Integrate, adopt - Increase plantation in and around - Expand measures to make healthcare Assess and document - Number of states and UTs initiated
and implement building to make it ‘Green’ sector ‘Green’. reduction of climate risk in ‘Greening Effort’ in their healthcare sector
environment climate resilient building
friendly - Incorporate measures in building - Replicate the successful ‘model of design for replication in -Number of states and UTs ensured use of
measures design for making it climate resilient building design’ for new healthcare other states and UTs energy efficient equipments and
suggested in facilities technologies in healthcare sector
- Use technologies which reduce
other missions harmful chemicals emission & carbon - Explore and support technologies, -Number of states and UTs which have
on climate foot-print equipments and services which are successfully built the ‘prototype of
change energy efficient and reduce harmful healthcare building’ which has incorporated
- Use of energy-efficient equipments chemicals emission & carbon foot-print measures to make it withstand climate
and services disasters

Suggested Supportive Department/ Ministry: ICMR /DHR/ ICAR/DARE/ DRDO / NDMA / MoEF&CC / IMD /Min of Space/ NGOs / CBOs / Min. of New & Renewable Energy
28
Activity
S.
Key Actions
No. Short term Medium Term Long Term Indicators
5. To strengthen research capacity to fill the evidence gap on climate change impact on human health.
Strengthening - Create database of professionals, - Development of models mathematical - Develop and validate -Number of states and UTs with database of
of healthcare researchers and institutions engaged or other types for early warning alerts models, enhance research professionals, researchers and institutions
services based in studies of impact of weather and for CSDs. on the effectiveness of engaged in studies of impact of weather and
on researches climate on health CSDs management. climate on health
on climate -Develop / adapt techniques for
variables and - Create a platform for ‘data- modelling or use other research - Evaluate and improve the - Number of states and UTs which have
impact on repository’ of various researches on advances by transitioning them into effectiveness of modelling created a platform for ‘data-repository’ of
human health climate and health effects operational products and decision technique. various researches on climate and health
support tools effects
- Scenario-building (initiation of study, - Evidence based
data sources, mechanism used, - Reassess health data esp CSDs using information to Policy- - Number of states and UTs which have
apportionment of risk factor, modelling techniques makers listed ‘Best Practices’ of measures to combat
methodology, assumptions, model effect of climate change
used, confidence interval) for - Inform Policy-makers about ‘scenario’ - Conduct seminars,
establishing relation of climate of health-related statistics with focus on workshops, conferences on - Number of states and UTs conducted at
variables and health impacts. CSDs. best practices of measures least two seminars in a year on CSDs and
to combat effect of climate related aspects including ‘best practices’.
- Identify best practices in - Conduct seminars, workshops, change on human health.
implementation of measures to conferences on best practices of
combat the effect of climate change measures to combat effect of climate
change on human health.

Suggested Supportive Department/ Ministry: NDMA / IMD/ DOS / Dept. of Science & Technology / ICMR/DHR / ICAR/DARE/ DRDO/ CSIR
29
VI. CLIMATE CHANGE vs HEALTH RESILIENCE
As per the available evidences, it is known that change or variation in climate at any
geographic location may affect the pattern of morbidity and mortality among the dwelling
population. The commonly identified illnesses may be grouped as i) Extreme events (heat
related illness), ii) Air Pollution and health related issues, iii) Vector borne diseases and iv)
Water borne illnesses v) Malnutrition and vi) Various NCDs.
To protect health of people, it is necessary that health department of all states must consider
the climate change as an emerging threat in causation of most of the illnesses and hence
must undertake measures to adequately address this issue.
Initial Inputs/ activities desired (first 2 years)
1. Establish ‘Environmental Health Cell’ in State Health Department,

2. Identification of State Nodal Officer- Climate Change at State Health Department
3. Notification of Task Force with representation of other health programmes (vector-borne
disease, infectious diseases, nutrition etc) multi-sectors/ departments such as Disaster
Management Authority, Health Information System, district unit of departments of
Meteorology, Pollution Control Board, Water and Sanitation, Public Works Departments
and civil societies etc.
4. Vulnerability Assessment for baseline rate for Climate Sensitive Illnesses in terms of
a. Geography (Plain/ Mountain/ Desert/ Coastal), identify worst affected areas (districts)
b. Risk mapping with extreme events (heat/ cold/ drought/ flood/ cyclone/other),
c. Affected Population (Total, density, Vulnerable, Occupation)
d. Contributing/ exaggerating factors for these Climate sensitive illnesses
e. Healthcare Infrastructure/ facilities like PHC, CHC, District hospital, Tertiary care
hospitals- Government as well as Private.
f. Identify areas for capacity building –human resource, technical and healthcare
service delivery.
5. State health adaptation plan must be prepared for extreme events (heat related illness),
Air Pollution and health related issues, Vector borne diseases and Water borne illnesses
6. State health department should identify and strengthen department/ institute/
organization/ health care facilities/ other stakeholders for providing assistance for
management of cases and for monitoring and surveillance for climate sensitive illnesses
7. Coordinate with premiere institute/ organisation like Centre of Excellence for developing
training module/ guidelines and Inclusion of mitigation and adaptation measures in
Students’ Curriculum.
30
8. Develop, integrate and Implement media communication plan for common CSDs
involving health determining sectors and communities.
Process: 2 to 5 years
1. Formulate specific implementation framework for climate sensitive diseases.

2. Contingency plans for climate sensitive illnesses - appropriate and efficient health
personnel, logistics & resource allocation.
3. Capacity building and training of health care personnel on guidelines and treatment
modalities against climate sensitive illnesses at district level in each state.
4. Development of early detection tools for CSDs (rapid diagnostics, surveillance) or
mathematical /prediction models for preparedness of population and health care system.
5. Periodic reviews for improvements or deterioration of indicators (vulnerability, response
capacity, preparedness, and environmental determinants) identified for each CSD.
6. Awareness generation- integrate IEC, engage local leaders & community, yearly
“Advocacy network meeting” and health talks, specific day celebration, health melas etc.
7. With projected climate risks, adapt new technologies, building design, energy, water and
sanitation provisions for new constructions of healthcare facilities, but if already existing,
modify as per permissible building norms.
8. Link data on data of Climate sensitive diseases, environmental factors determining
health, meteorological information, and outcomes as morbidity and mortality.
9. Risk mapping and seasonal trend for CSDs: multi-sector management approach.
10. Research and epidemiological studies / surveys on vulnerable population for climate
sensitive illnesses.
Expected Output:
1. Awareness & Behaviour modification of general population for impact, illnesses,

prevention and adaptive measures for climate sensitive illnesses.
2. Increase in trained healthcare personnel and equipped institutes/ organization towards
achievement of climate resilient healthcare services and infrastructure at district level in
each state.
3. Integrated monitoring system for collection and analysis of health related data with
meteorological parameters, environmental, socio-economic and occupational factors
4. Regulation on key environmental determinants of health: air quality, water quality, food,
waste management, agriculture, transport.
5. Evidence–based support to policy makers, programme planners and related
stakeholders
31
VIII. CLIMATE RESILIENT HEALTH SYSTEM: STAKEHOLDERS’s INTERVENTION
India is signatory to “Male’ Declaration” wherein health sector has to be strengthened so as

to make it climate resilient. According to Male’ Declaration, it is desired that health-care
facilities should be prepared & climate-resilient, particularly in promoting to encourage that
these are able to withstand any climatic event, and that essential services such as water,
sanitation, waste management and electricity are functional during such events. Further, for
climate resilient, the health department has to undertake measures to initiate the greening of
the health sector by adopting environment-friendly technologies, and using energy-efficient
services (Annexure-).
The existing efforts in public health preparedness, disaster risk reduction, and programs for
communicable and non-communicable diseases may be inadequate, ineffective or
unsustainable, if they are not climate resilient. It requires vulnerability re-assessment and
should take into account both current climate variability and projected future impact of
climate change on disease burden and hence management. The overview of roles and
activities for health as well as non-health departments are listed below as guide for group of
Climate Sensitive Diseases. States and UTs have to make micro-plan as per their
vulnerabilities and geo-climatic conditions.
A. Human Health vs Extreme weather events
States and UTs may have recorded raised morbidity and mortality due to effect of extreme
weather conditions viz frequent and severe episodes of heat waves, floods, droughts and
fires as a direct impact of climate variability and affecting population at large.
Vulnerability factors: Demography especially people at extremes of age (>65yrs, children),

Health status, Socioeconomic status, Occupation, working place and working conditions,
unplanned urban housing, overcrowding, remote area, Drought/ flood prone area, water
scarcity zone
Role of Health Sector (State Nodal Officer and Task Force)
1. Develop/ adapt health micro-plans for extreme weather events based on meteorology
warnings and change in trend of illnesses in recent years.
2. Map vulnerable population based on demography, land cover, water bodies, potential
exposure, available resources health insurance coverage, and burden of chronic
illnesses in the community.
32
3. Develop or translate IEC in local language, and make a communication plan for
dissemination of health related alerts/ education materials for target or general
population.
4. Build capacity of health care personnel to detect and treat illnesses associated with
extreme weather events
5. Issue health advisory to healthcare personnel based on IMD seasonal prediction or
warning
6. Ensure health related Real-time Surveillance and Monitoring System in case of extreme
event
7. Explore collaborative mechanisms (e.g. memoranda of understanding) with other
departments, stakeholders, such as meteorological, pollution control board etc for
sharing data and for coordinating efforts to manage health risks.
8. Ensure Inter-sectoral convergence and coordination for improving architecture, design,
energy efficient cooling and heating system at health facility, increase in plantation i.e.
Climate Resilient Green Building Design.
9. Reassess ‘Occupational Health standards’ for various types of Occupation.
10. Ensure strict implementation of legislative/ regulatory actions as per Occupational
Health Standards.
Coordination with other sectors in reducing illnesses due to Extreme Weather Events
SNO-CC and the Task Force should explore collaborative mechanism (e.g. memoranda of
understanding) for regular sharing data and for coordinating efforts to manage health risks.
The suggested sectors are listed below, however the list may be expanded or modified as
per the need of the state /UT.
Meteorological Department
- Accurate and timely forecast for extreme weather
- Communication of ‘alert’ to state health departments, vulnerable groups/ agencies
Water Board
- Management and supply of safe and adequate water to all in the state.
- support & promote water conservation methods like rain water harvesting.
Municipalities
- Develop and promote building design and other infrastructure codes supporting ‘Green
building’ and use of energy efficient and natural ways of lighting and cooling
- Undertake actions like: planting trees, ensure non-burning of garbage, supply of safe
water and maintaining sanitation.
- build cool shades at public places, cool corridors for pedestrians
Ministry of Environment, Forest Climate Change
- Develop/ encourage projects to decrease the ‘Urban Heat Island effect’.
33
- Ensure green coverage in the cities through checking deforestation, urban planning and
increasing plantation.
Ministry of Education
- Sensitise students towards health impact of extreme events and disseminate health
ministry approved prevention and first-aid measures.
- Train teachers on first aid measures for all possible extreme events (as per state’s
vulnerability)
- During extreme events: keep a check on outdoor activities and close teaching institutes
in case of issue of alert from Government.
Ministry of Transport
- Provision of safe and improved Public transport like air conditioned buses, local trains
and other transport at affordable rates.
Media & NGOs
-Disseminate success stories, methods and measures to promote community awareness
on preventive measures and first aid to reduce health impacts of extreme weather.
B. Water borne & Food borne diseases

Illnesses due to contaminated water and food are usually seen following flood, drought,
religious or other mass gatherings. SNO-CC and the related stakeholders must undertake
suitable measures to keep a check on morbidity and mortality due to water and food borne
illnesses.
Vulnerability: Availability of safe water supply to all, sanitation facilities in general and in
urban slums and remote rural areas, personal hygiene, political willingness, Socio-economic
status, cultural beliefs, natural disasters, demographic changes, accessibility to health care.
1. Develop/ adapt health micro-plan for water and food borne illnesses (case
management, resources required like logistics, drugs, vaccines, laboratories’ role)
2. Map vulnerabilities: population at risk, geo-climatic conditions, recent trend of climate
variability (flood, drought), change in population demography (migration), available
resources, healthcare infrastructure, laboratories, burden of chronic illnesses in the
community etc
3. Build capacity of health care personnel to detect and treat water and food borne
illnesses
4. Strengthen/ Develop real-time surveillance, evaluation and monitoring system for
water and food borne illnesses, enhance this surveillance during high risk period
5. Issue advisory to healthcare personnel, laboratories and related stakeholders
dissemination of health related alerts/ education materials.
34
7. Ensure adequate supplies (vaccines and medications) for cases management with
other required logistic as identified to the affected region
8. Improve access to health care facilities by vulnerable population, especially those in
remote areas.
9. Coordinate with related stakeholders like Municipalities to keep a check and
strengthen surveillance of food handling units, local vendors, water supply etc.
10. Explore collaborative mechanisms (e.g. memoranda of understanding) with other
departments, stakeholders for sharing of data and for coordinating efforts to manage
health risks.
Coordination with other sectors in reducing water and Food borne illnesses
Department of Water & Sanitation
- Ensure minimum household safe water supply
- Reuse treated waste-water for non-household use
- Encourage water saving technologies like low-flow toilets & Showers, rain water
harvesting etc
Municipalities and other Local regulating bodies
- Ensure safe water supply and good sanitation to check transmission of infective agents
- Regulate street vendors, food handling units for quality food
Ministry of Agriculture
- Develop/ encourage programs for efficient use of irrigation water.
- Promotion of climate resilient crops among farmers
FSSAI and other food regulatory body
- Check food items for various types of contamination or adulteration
- Disseminate appropriate information for reducing food borne illnesses
C. Air Borne, Cardio-pulmonary & Respiratory Allergic Diseases

Climate variability and frequent change in weather and extreme events affects have been
linked to increase in illnesses of lungs and cardio-vascular system.
Vulnerability: Change in timing, survival, transmission & duration of certain microbes (like
Influenza virus), Interaction of air pollution, pollen and weather, Proportion of population-
malnourished, extremes of age, underlying illnesses, pregnant females, Commonest type of
occupation, urban slums and remote rural areas, Socio-economic status, accessibility to
health care
1. Develop/ adapt health micro-plan for ‘Air borne, Cardio-pulmonary and Respiratory
diseases (case management, resources required like logistics, drugs, vaccines, and
laboratories’ role).
35
2. Map vulnerabilities: population at risk, geo-climatic conditions, seasonal variation,
exposure to pollens or allergens by change in types of crops or flower plants, change in
population demography, migration (in & out), available resources, healthcare
infrastructure, laboratories, burden of chronic illnesses in the community
3. Strengthen/ Initiate Sentinel surveillance, real-time surveillance, evaluation and
monitoring system for respiratory and cardio-vascular illnesses, hospital admission as
well as Outpatient attendance in relation to weather and air quality parameters.
4. Enhance vaccination programs and ‘Vaccination Campaign’ for vaccine-preventable air
borne and respiratory diseases
dissemination of health related alerts/ education materials.
6. Capacity building and increasing awareness for individuals, communities, health care
workers through involvement of various media as well as campaigns and training
workshops.
7. Develop Standard treatment guidelines for allergen management based on exposure
forecasts – air quality, allergens, dust, etc.
8. Ensure adequate logistic support, including equipments and other treatment modalities
and supplies for case management at all levels of health care and also under
‘Emergency response Plan’ in case of any disaster where air borne illnesses may occur
as an outbreak
9. Inter-sectoral and stakeholders’ coordination to monitor health outcomes with early
warning system related to extreme weather events/ Air Quality Index/ ground level
Ozone etc.
Coordination with other sectors for reducing respiratory and cardio-vascular illnesses
(Adapted from MoHFW’s Steering Committee Report on Air Pollution & Health Related
issues 2015)
Ministry of Environment, Forests and Climate Change
- Ensure that Central and State Pollution Control bodies set standards for industry-specific
emission and effluent, monitor levels of pollutants and enforce penalties.
- Enforce strict air quality standards for pollution
-Strict implementation of Environment Impact Assessments (EIA) to minimize the adverse
impact of industrial activities on the environment
-Effective implementation of ‘National Green Tribunal’ directives on trash burning/ waste
disposal from different sources
-Take strict measures for unregulated sectors (such as brick kilns, trash burning, stone
crushing) which contributes to ambient air pollution
Ministry of Human Resource Development
- Regular screening of school children for early detection of diseases, this can be
attributed to the existing air pollution
36
- Inclusion of harmful health effects of environmental pollution (AAP and HAP) in the
school curriculum, including current policies and mitigation practices that are designed
to reduce air pollution
- Improve indoor air quality of educational institutions nationwide
- Improve walkability and access to educational institutions by non-motorised transport,
thus minimizing the air pollution in the school surroundings
- Sensitize students and teachers on using the Air Quality Index in planning outdoor
school activities
- Policy in place to promote multiple uses of crop residues and prevent their on-farm
burning.
Ministry of Rural Development
- Include health promotion (like clean air) guidelines as part of “Nirmal Gram Puraskar”/
Model Villages evaluation criteria/ create alternate awards with specific criteria based on
air pollution.
- Under integrated rural development, develop and implement micro level planning
policies/schemes with Panchayati Raj Institutions to address the social determinants of
health for reducing the hazards of air pollution (lack of education, unemployment,
poverty, poor housing conditions, etc.)
Ministry of Urban Development
- Formulate/revise urban transport policy which reduces vehicular pollution (Include
Health Promoting city guidelines in the “100 Smart Cities”)
- Develop and implement policies to reduce indoor air pollution (like disincentivizing diesel
gensets and promoting clean cooking fuels thus ‘making available clean and making
clean available’)
- Enforcement of ban on burning garbage or biomass (especially during winter months)
-Help cities develop air pollution alerts and emergency plans based on the Air Quality
Index or CPCB continuous air monitoring data
Ministry of New & Renewable Energy
- Develop policies for truly clean cookstoves and support research and development.
- Research and development of other non-conventional/renewable sources of energy and
programmes relating thereto, including locally generated power to supply cooking
appliances;
- Support and strengthen Integrated Rural Energy Programme (IREP) with emphasis on
indoor air pollution
- Develop National Policy on clean Biofuels (biogas, ethanol, etc) and set up National
Biofuels Development Board for strengthening the existing institutional mechanism and
overall coordination.
- Create a national consensus action plan for replacing biomass fuels with alternative
clean fuels
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Ministry of Petroleum & Natural Gas
- Expand new initiatives to increase the availability of LPG and other cleaner fuels to the
rural & tribal areas
- Expand the piped natural gas network to reach out to a larger population
- Better target LPG subsidies to poorer households
Ministry of Power
- Promote the development of more efficient cooking devices
- Evaluate the potential for electric cooking appliances to substitute for biomass and LPG
Ministry of Road Transport and Highways
- Ensure effective implementation of New Motor Vehicles Act, once approved
- Ensure proper engine checks for vehicles to assess pollution levels
Ministry of Information and Broadcasting
- Develop hard hitting, high impact and cost effective media plans, strategies and conduct
activities for awareness generation on harmful effects of air pollution and options for
their mitigation.
- Ensure enforcement of relevant provisions in the Cable Television Networks Act to
regulate advertisements of tobacco etc.
- Involvement of Songs & Drama division; Department of Field Publicity to promote health
promotion activity for air pollution and its impact on respiratory and NCD risk factors
- Develop policies to ensure that media houses allocate free airtime for health promotion
messages as a corporate social responsibility activity
Ministry of Communications & Information Technology
- Use of mobile phones to encourage healthy choices and warn people about air pollution
(both AAP and HAP, using Air Quality Index)
- Establish Telemedicine linkages between different levels of health care
Ministry of Labour and Employment
- Regular health check- ups for early screening of pollution related diseases.
- Frame guidelines and conduct workshops for health promoting workplaces, (guidelines
on indoor air quality),
- Strengthen the capacity of ESI Hospitals to cater to the growing burden of respiratory
diseases and NCDs
- Showcase and support companies which employ workplace policies that can reduce
vehicular travel such as telecommuting, or placing the workplace in sites that are
accessible through public transportation (eg. Metro) or non-motorised transport.
Ministry of Women and Child Development
- Advocate through Self Help Groups and Mahila Mandals for protection of women and
children from significant exposure to smoke from biomass while inside the house.
38
- Awareness raising can be done to improve household ventilation to reduce smoke
inhalation from lighting (ex. kerosene) or cooking fuel
Ministry of Finance
- Analysis of the economic and financial implications of the health and other impacts of air
pollution
Ministry of Law and Justice
- Support enforcement on bans of burning trash for heating or as a way of disposal
D. Vector-borne and Zoonotic diseases

Effect of variation in climate has been well established for illnesses which are spread
through vectors or which are transmitted from animals to humans..
Vulnerability: Weather variables: temperature, rainfall, humidity, floods, drought, wind,
daylight duration etc., Change in Vector / animal population due to change in growth,
survival, feeding habits, seasonality, breeding sites, resistance etc, Change in interaction of
vector/ animal & pathogen due to change in susceptibility, Incubation period, or
transmission, Change in demography, migration, land-usage practices, water projects,
agricultural practices and Public health infrastructure and access to it.
1. Programme Officer for National Programs for control of vector borne diseases
(NVBDCP) & various zoonotic diseases must consider climate variability as an
important factor for assessment of morbidity and mortality statistics and develop/ adapt
health micro-plan based on recent VBD & Zoonotic diseases trend
2. Map vulnerabilities: population at risk, geo-climatic conditions, seasonal variation,
change in population demography, migration (in & out), available resources, healthcare
infrastructure, laboratories, etc.
3. Strengthen/ Develop active and passive surveillance and establish sentinel sites for
vector borne & Zoonotic diseases.
workshops.
5. Develop or translate IEC on effects of climate change on VBDs & zoonotic diseases in
local language, and make a communication plan for dissemination of health related
alerts/ education materials.
6. Ensure adequate logistic support, including equipments and other treatment modalities
and supplies for case management at all levels of health care and also under
‘Emergency response Plan’ in case of any disaster or an outbreak
7. Vaccination of animals and animal handlers for vaccine preventable diseases.
39
8. ‘Environmental Health Impact Assessment’ of new development projects
9. Early warning system for vector borne and zoonotic diseases.
10. Enforce legislation and regulations of vector borne and zoonotic diseases
Coordination with other sectors for reducing VBDs & Zoonotic diseases
(As per the suggested sectors in the NVBDCP)
- Inter-sectoral collaboration for vector control
- Providing equipments and other related logistics for control of vectors
- Elimination and reduction of vector breeding sites.
- Encourage research on new safe and effective control measures
Intervention by veterinary task force
- Prevention and control of animal diseases and zoonoses
- Vaccination of animals & control on population of stray animals
- Safe destruction of carcasses and other material of animal origin
- The care of ‘food animals’, including collection, feeding, sheltering, slaughtering etc
Intervention by Community & Individual
- Eliminate/ control small & manmade vector breeding sites
- Make barriers for human dwellings to keep stray animals away from human dwellings
by fencing the residential areas especially if in approximation to forests etc.
- House protection by using screening windows, doors and fencing the garden etc.
- Use self protection measures like protective clothing etc,
E. Nutrition related diseases

Climate variability and extremes of weather events affect food quantity and quality through
reducing production, poor storage, pathogen infestation, disrupted supply chain, hike in
market price.
Vulnerability: Changes in food like availability, accessibility, utilization, system stability, crop
failure/ yield decline. Indirect effects are due to reduction in animal/ aquatic population,
agricultural yield
1. Develop/ adapt health micro-plan for reducing nutritional deficiency disorders

2. Map vulnerabilities based on seasonal nutritional screening (Vit A, Anaemia) in
children, pregnant & lactating females high risk communities
workshops.
4. Strengthen/ Develop active and passive surveillance for nutritional deficiency
diseases
40
5. Strengthening surveillance & control programs for diseases like malaria,
schistosomiasis, parasitic infections
6. Scale up integrated food security, nutrition and health programmes in vulnerable
zones for at risk populations
7. Strengthen maternal & child health services and promote implementation of IMNCI
programme.
8. Expand & promote fortified food consumption in the vulnerable population
9. Develop or translate IEC, communication plan and mass media strategy for
behaviour change of vulnerable population.
10. Capacity building and increasing awareness of the population through regular
training workshops on health and nutrition education
11. Support and strengthen preventive programme on health nutrition (fortification and
supplementation) and projects within public health divisions, with emphasis on
community involvement projects.
Coordination with other sectors for reducing Nutrition related diseases
Ministry of Human Resource Development & Ministry of Women & Child Development
- Regular screening of school children for early detection of nutritional diseases.
- Inclusion of dietary guide in the school curriculum, with reference to Indian food habits.
- Sensitize students and teachers on nutritional deficiency, worm infestation and other
Gastro-intestinal infections leading to malnutrition.
- Promote agriculture practice addressing specific nutrition demand of general population
and availability of same
F. Non-communicable Diseases (NCD) & Mental illnesses
Non-communicable diseases and mental disorders have been found to be closely

associated with variation in climate, exposure to various types of pollutants and type of
occupation
Vulnerability: Demography, Health status, Socio-economic status, type of occupation,

accessibility to health care and diagnostic facilities, weather variables, exposure to pollution
and Nutritional status
Role of Health Sector and related non-health sectors (State Nodal Officer and Task Force)
1. Establish & Integrate multisectoral mechanisms to plan, guide, monitor and evaluate
and enactment of NCD through implementation of plans, policies and legislation
41
2. Adapt and implement WHO surveillance framework that monitors exposure (risk
factors), outcome (morbidity and mortality), and health system response
3. Implement effectively the national health programmes aimed at reducing/ controlling
NCD and mental illnesses.
4. Strengthen surveillance and monitoring for the high risk population and identify/
assess need in routine as well as in emergency situation (Emergency preparedness
plans).
5. Ensure access to appropriate diagnostic facilities, related logistics and case
management to the high risk population.
6. Define price regulatory mechanism for NCD drugs and basic diagnostic equipments
and laboratory tests to increase affordability by the poor section of the society.
7. Risk communication, counselling and case management skills, should be available at
all the levels including primary health-care level
8. Capacity building through training of human resource for addressing NCD related risk
factors due to climate change.
9. Raise public and political awareness and understanding about NCDs including mental
health, oral health, injuries and indoor air pollution through social marketing, mass-
media and responsible media-reporting during extreme weather.
10. Assess the health impact of policies in non-health sectors e.g., agriculture, education,
trade, environment, energy, labor, sports, transport, urban planning.
11. Strengthen supportive policies and legislations to promote healthy diet, reducing food
with high transfat content, artificial colours and junk food
12. Strengthen capacity of the enforcement agencies (Police, Food Trade Inspectors and
Road Safety Inspectors).
13. Provide adequate and sustained resources for NCDs by increasing domestic
budgetary allocations, innovative financing mechanisms, and through other external
donors
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IX. NAPCCHH: ORGANISATIONAL FRAMEWORK FOR IMPLEMENTATION
Operational framework for implementation of National Action Plan for Climate Change and
Human Health at National, States/UTs, District and Health-facility level is as follows:
National Level
A) National Level- Advisory Committee

This committee shall function under the Chairmanship of Secretary Health & Family
Welfare. The proposed members of this committee are:
Secretary Health & Family Welfare Chairman

Additional Secretary, Health, MoHFW, GOI Member
Secretary Health Research cum Director General- ICMR, GOI. Member
Director General Health Services, GOI Vice-Chairman
Director, NCDC, Dte.GHS, MoHFW, GOI Member Secretary
Director, NVBDCP, Dte.GHS, MoHFW, GOI Member
Representation from other Ministries/ departments
Director General, National Disaster Management Authority Member

Secretary, Ministry of Environment, Forest & Climate Change Member
Secretary, Ministry of Earth Sciences Member
Secretary, Ministry of Agriculture Member
Secretary, Central Ground Water Board, Ministry of Water Member
Resources, Rural Development and Ganga Rejuvenation
Chairman, Central Pollution Control Board Member
Representation from Department of Science & Technology Member
Roles and Responsibilities of the National Level Advisory/ Steering Committee

 Nodal body to take decision regarding the policy making and implementation
of the National Action Plan for Climate Change and Human Health
(NAPCCHH) in the country.
 Nodal body to roll out the NAPCCHH in the country.
43
B) National Level- Centre for Environmental & Occupational Health Climate
Change & Health (CEOH&CCH) at National Centre for Diseases Control. This
centre is nodal agency for Climate Change & Human Health and will provide
technical inputs and support to Environmental Health Cell at state and UTs regarding
the capacity building, implementation, monitoring, supervision & evaluation of the
NAPCCH program. Director, NCDC is the Nodal Person and Member-Secretary of
Climate Change and human Health. The proposed manpower structure at this centre
is as follows:
Additional Director & Head (Public Health) 1
Joint Director (Public Health) 3
Deputy Director (Public Health) 3
Assistant Director (Public Health) 6
Senior Consultant-Capacity building/ Training

2
Senior Consultant-Environmental Health Specialist
2
Senior Consultant-Monitoring & Evaluation
1
Senior Consultant- Public Health Informatics Specialist
1
Consultant- Finance & Admin
1
Consultant- Communication/ Advocacy
1
Technical Officer-Data Management
3
Secretarial Assistants cum Data Entry Operators
3
Roles and Responsibilities of the CEOHCCH Division, NCDC are:
 Technical inputs to be provided to all states and UTs for activities related to
climate change and human health.
 Plan, Coordinate, Monitor and evaluate NAPCCHH related activities at
National, State and below level
 Support states and UTs for development of health adaptation plan and
operational guidelines for Climate Sensitive Diseases’.
 Review meetings, field observations regarding implementation of
NAPCCHH.
 Strengthening of Surveillance of Climate Sensitive Diseases
 Strengthening of health care system by involving premiere institutes and
organisation for disease management
44
 Development of prototype of IEC and advocacy material, training modules
for healthcare personnel, revision of students’ curriculum.
 Guiding state health department for providing list of required manpower,
logistics, drugs and equipments for managing climate sensitive illnesses.
 Conduction of operational research and evaluation studies for the
NAPCCHH
For coordination with other stakeholders, government departments at National and

states/ UTs level in the country, the Environmental Health Cell at the Directorate
General Health Services will support CEOHCCH division at NCDC. It will help assess
the achievement of targets planned under the NAPCCHH programme.
State Level:
A) State Level - Governing Body

The state level governing body shall be working under Chairmanship of Honourable
State Health Minister. The other members may be as follows:
Honourable State Health Minister Chairman
Principal Secretary (Health) Vice Chairman
Director Health Services/Head of Health System Member Secretary
Mission Director-National Health Mission Member
Director Medical Education Member
Regional Director -Health & Family Welfare Member
B) State Level Task Force

This task force shall be working under the guidance of Principal Secretary (Health) of
the state. It shall be directly overseeing the implementation of the State Action Plan
for Climate Change and Human Health (SAPCCHH) in their state/UT. It shall be
working through Directorate of Health Services (DHS) of the state, which will be the
implementing agency for SAPCCHH.
DHS will create an Environmental Health Cell within State Health Department, and
will identify a Nodal Officer from Health department which preferably should be
Public Health Expert of the rank of Joint/ Deputy Director. The State level task force
shall have inter-ministerial members which are suggested as:
 Public Health Expert from State Health Department Nodal Officer
 Director, ICMR Institute/Centre (If any branch in the State/UT) Member
45
 Director, Meteorological department of State/UT Member
 Chairman, State Pollution Control Board Member
 Chairman, State Disaster Management Authority Member
 State Surveillance Officers Member
 Environmental Engineer/ Scientist from MOEFCC Member
 Secretary, State Agriculture Ministry Member
 Secretary, State Ground Water Board Member
The Task force of the State/ UT’s Environmental Health Cell will coordinate with the
Centre for execution of state/ UTs SAPCCHH. The proposed State Level Structure
of Environmental Health Cell is as follows:
Structure at State/ UT Environment Health Cell:

Nodal Officer (State Health Department) 1
Consultant-Capacity building/ Training/ HR Management 1
Consultant-Environmental Health 1
Data Manager & Analyst 1
Secretarial Assistants cum Data entry Operator 1
Roles and Responsibilities of the State/ UT Environmental Health Cell
 Preparation and Implementation of State Action Plan for Climate Change

and Human Health
 Conduct Vulnerability assessment and risk mapping for commonly
occurring climate sensitive illnesses in the state/ UT.
 Assessment of needs for health care professionals (like training, capacity
building) and organise training, workshop and meetings.
 Maintain State and District level data on physical, financial,
epidemiological profile for climate sensitive illnesses.
 Ensure Convergence with NHM activities and other related programs in
the State / District
 Monitor programme, Review meetings, Field observations.
 Timely issue of warning/ alerts to health professionals and related
stakeholders as well as general public through campaign or using mass
media (Electronic or printed),
46
 Social mobilization against preventive measures through involvement of
women’s self-help groups, community leaders, NGOs etc.
 Advocacy and public awareness through media (Street Plays, folk
methods, wall paintings, hoardings etc.)
 Conduction of operational research and evaluation studies for the
Climate change and its impact on human health.
District Level:
At District level, a District Environmental Health Cell shall be constituted; which shall
be comprised of the following:
The proposed District Level Structure is as under:

 District Magistrate/ District Commissioner Chairman
 Chief Medical Officer/ CDHO Member Secretary
 Deputy CMO (Admin) Member
 Senior Deputy CMO Member
 DMO/DVBDOPO Member
 District Health Education Information Officer Member
 District Coordinator Member
Structure at District Environment Health Cell:

District Coordinator 1
Data entry operator 1
Roles and Responsibilities of the District Environmental Health Cell
 Preparation and Implementation of District Action Plan for Climate

Change and Human Health.
 Conduct Vulnerability assessment and risk mapping for commonly
occurring climate sensitive illnesses in the district.
 Maintain and update district database of illnesses identified in the district.
 Assess needs for health care professionals and conduct sub-district/
CHC level training/ workshop and meetings for capacity building.
 Ensure appointment of contractual staff and engage them in the
assigned task of data management under the NAPCCHH.
 Maintain District level data on physical, financial, epidemiological profile
for these illnesses.
47
Community Health Centre Level
The proposed CHC Level Structure is as under:
 Medical Superintendent (CHC Hospital) :Chairman

 Health Education Officer :Member Secretary
 Block Development Officer :Member
 Health Supervisor :Member
Health Facility Level:
At the health facility, the responsibility for implementation will lie with the Medical
Officer (In-charge) of the facility. The existing machinery of NHM will be utilised for
the related activities. The Rogi Kalyan Samiti (RKS) would be reviewing and
monitoring implementation at the health facility level. The ANM, ASHA and
Anganwadi worker will assist in activities related to implementation of action plan at
local level.
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X. NAPCCHH: CAPACITY BUILDING AND SYSTEM AWARENESS
Capacity building will be based on the baseline and follow-up situation which should be
assessed periodically. Communication and training are crucial in adaptation to variability or
changes in the climate. Communication programmes based on a thorough needs
assessment must aim to enable and empower people, in particular, the illiterate, poor and
other vulnerable people such as women, children, the elderly, people suffering from
debilitating medical problems and those living in coastal areas, highlands and urban slums.
Such programmes should have adequate and appropriately designed communication tools
that are locally suitable, popular and comprehensible.
 Effective communication and public awareness activities/advocacy: sensitize, orient and

take support of leaders/ opinion makers / stakeholders/ celebrities/ civil societies.
 Communication intervention for target audience: Appropriate, efficient and cost-effective

measures include clear and timely information covering who is involved; what
happened; when it happened; where it happened; and why or how it happened or what
may happen – how, why, where, among whom and how to face it.
 National and Regional level capacity building institutions needs to be identified for
capacity building of health staff: include training and imparting technical skills for case
management, risk assessment skills, entomology, epidemiology, climate models,
disaster management, meteorology, monitoring and evaluation, and research.
 Conducive institutional and management arrangements to ensure involvement of private

sector by forming public private partnerships.
 Hospital and all other health-care systems must be strengthened. Involve community in
the process of strengthening and in managing and maintaining the system.
 Inventory management: standardized list of adequate and appropriate logistics

medicines, kits, equipment and machines along with efficient storage systems.
 Specific strategies and standard operating procedures for managing climate sensitive
diseases need to be developed in light of the future impacts of climate change with
prevention in mind.
 Communication interventions in schools are effective approaches for which teachers

would need materials and training to educate the children.
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XI. NAPCCHH: REPORTING, MONITORING AND EVALUATION
The Monitoring & Evaluation of the implementation of NAPCCHH has been stipulated with a
mix of internal and external approaches. MoHFW, State DoHFW, District Health Officers and
the individual health facilities will be involved in regular internal monitoring. External
Monitoring will be done by an independent agency.
a) Internal: Monthly / quarterly progress monitoring for climate sensitive illnesses has to
be done at all levels, i.e. District to State to MoHFW. These Monthly / Quarterly
Progress Reports should include a collation / aggregation of the data / information
compiled in each health care facility. The District Cell will have the responsibility of
collation / aggregations of the data / information compiled in each health care facility
and submit to the State Cell which will validate and forward the data to the National
Cell. A set of indicators for NAPCCHH implementation should be merged with the
overall HMIS that has been established under the NHM.
b) External: Each state should commission an independent evaluation every 2 years. At

the minimum, the audit should cover one well performing district and one slack
performing district. The agency to conduct the NAPCCHH Implementation Audit
should be chosen based on the background, experience in the State’s health sector,
environmental auditing and reputation of reliability. The recommendations of the audit
should be developed into an action plan to strengthen the existing system.
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XII. FRAMEWORK FOR STATE SPECIFIC ACTION PLAN FOR CLIMATE CHNAGE
AND HUMAN HEALTH
India is a diverse country in terms of geography, climatic conditions, resources and health
related infrastructure. Also, it is a highly populous country, undergoing rapid
industrialisation, unplanned urbanization, increasing malnutrition and having triple burden of
diseases comprising of communicable, non-communicable, emerging and re-emerging
diseases. All these factors have cumulative effect resulting in risk of ill- health of citizens of
India.
States have developed Action Plan on Climate Change (available at MoEFCC’s website),
but, ‘health related component’ is missing in it. Hence all states and Union Territories are
being encouraged to develop their State-specific Action Plan on Climate Change and
Human Health (SAPCCHH). The broad suggested framework for the same is as follows:
1. Background
(Following Data has to be compiled district wise)
Geo-physical & Climate variables: Type of area (Plain/ Mountain/ Desert/ Coastal), type of
Climatic or extreme events (heat/ cold/ drought/ flood/ cyclone/other) usually occurring in the
state/ UT with potential to affect health status of the population. Approximate green cover
and recent change in green cover/ forest, if any.
Statistics of state/ UT: Population (Total, Population density), Vulnerable Population (Under
five Children, Adolescents, Elderly, migrants and Occupation (Primarily for major population
and others).
Health care Infrastructure: Enlist the number of Health care Infrastructure/ facilities like PHC,
CHC, District hospital, Tertiary care hospitals- Government as well as Private in State/UTs
(preferably District wise).
Enlist and identify roles and responsibilities of operational district level bodies relevant to
climate change and their constitution, such as Distt. Disaster Management Authority,
Disease Surveillance Programmes, Distt. Health Information System, district unit of
Departments of Meteorology, Pollution Control Board, Water and Sanitation, Public Works
Departments and civil societies etc.
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2. Operational Framework at State Level
Governing Body
The state level governing body for policy level decision may be constituted under
Chairmanship of Honourable State Health Minister or any other Senior Officer. The
suggested body is as below:
 Honourable State Health Minister Chairman

 Principal Secretary (Health) Vice Chairman
 Director Health Services/Head of Health System Member Secretary
 Director Medical Education Member
 Mission Director-National Health Mission Member
 Regional Director -Health & Family Welfare Member
(However, State may take its own decision).

Task Force: The task force under the guidance of Principal Secretary (Health) with
Directorate of Health Services (DHS) of the state, and will ensure implementation of the
State Action Plan for Climate Change and Human Health (SAPCCHH) in their state/UT.
Environmental Health Cell within State Health Department, DHS may identify a Nodal Officer
from Health department, preferably should be Senior Public Health Expert. The State level
task force shall have inter-ministerial members which are suggested as:
 Public Health Expert from State Health Department Nodal Officer

 Director, ICMR or other Research Institute Member
 Director, Meteorological department of State/UT Member
 Chairman, State Pollution Control Board Member
 Chairman, State Disaster Management Authority Member
 Environmental Engineer/ Scientist from MOEFCC Member
 Secretary, State Agriculture Ministry Member
 Secretary, State Ground Water Board Member
 State Surveillance Officers Member
The details of Nodal Officer and experts in Task Force like name, designation, contact
details (Phone number, postal address and email) should be listed in the SAPCCHH.
3. Current status of Climate Sensitive Illnesses
 Identify, assess, and document potential risks of climate sensitive diseases (as
applicable to the state) like
 Extreme weather events affecting health
 Vector Borne diseases
 Water & Food Borne disease
 Cardio-respiratory illnesses
 Zoonotic diseases
 Others like renal diseases, nutritional deficiency disease etc
52
 Document Morbidity, Mortality and related statistics of these Climate Sensitive
diseases with reference to change in recent years.
 Risk Mapping to identify the ‘Hot spots’ for vulnerable population with respect to
health infrastructure and other resources.
4. Adaptation strategy and action plan for each of the illnesses/ diseases sensitive to
Climate variability (as listed in point 3 above)
 List the stakeholders with defined roles and responsibilities (Govt. & non-Govt)
 Identify and list the resources available
 Identify actions for risk reduction that are agreed upon by stakeholders and the public
 Operational Coordination (Stakeholders’ role and involvement): Building partnerships
by involving citizens, organizations, and businesses.
 Make a detailed action plan with checklist for each identified climate sensitive illness:
o Logistics required at health care facilities
o Preparedness of health system and personnel
o List activities for prevention of illnesses (IEC, pamphlets, advisories, training,
workshop etc).
o Operational communication channel
o Mechanism to ensure data maintenance, surveillance, timely sharing with
concerned departments and stakeholders.
5. List Actions undertaken and further proposed to reduce the burden of Climate
sensitive illnesses at State/UT
 Activities conducted and planned for awareness generation on the health impacts of
climate change
 Activities conducted and proposed to integrate climate-sensitive health concerns in
respective health programmes or policy.
 Activities undertaken if any and further proposed to train health workforce on climate
change.
 Actions undertaken if any and further proposed to ensure unaffected water supply,
sanitation, waste management and electricity.
 Activities undertaken and further proposed related to greening of health sector i.e.
health facilities use energy-efficient services and technologies.
 Activities undertaken and further proposed related to integration with State Disaster
Management Authority for emergency risk reduction and early response.
53
 Activities undertaken and further proposed related to data collection and analysis,
strengthening of surveillance related to climate variable and climate change sensitive
illnesses.
6. Miscellaneous
 Diseases Specific Action plan/ Advisory/ IEC prepared if any, please enumerate and
may kindly share with NCDC at email: ncdc.env@gmail.com.
 Other factors (if any) contributing to increase/ decrease of climate sensitive illnesses
in your state
 How effective are current health and other sector policies and programmes to manage
the climate sensitive illnesses in your state/UT.
 Success Stories if any, of the State/ UT health sector for adaptation or mitigation of
climate sensitive illnesses.
 Research studies, reports, innovative actions etc related to climate change and
human health if taken in the state must be shared with CEOHCCH division at NCDC
for sharing it further with our states and UTs.
(Note: The indicators related to input process, output and outcome shall be added in the
State Action Plan during subsequent meetings at time of firming up the State Action Plan for
Climate Change and Human Health).
Regional Consultations
The Centre for Environmental and Occupational Health Climate Change & Health, National
Centre for Disease Control, Delhi, conducted four regional consultations in 2017-18
involving all the states and Union Territories’ of the country. Officials from Health
department and related stakeholders were invited in these consultations.
Regional consultations aimed at sensitising states and Union Territories on reassessment

of diseases’ morbidity and mortality with respect to climate variability and extremes have
been conducted. Prior to these regional consultations, the states and UTs were requested
for:
1. Identification of Nodal Person for Climate Change from State Health Department.
2. Constitution of “State Environment Health Cell” at State Health Ministry level.
3. Notification of a Task Force with experts from other departments/ organisation or
other stakeholders identified by state.
54
These regional consultations had participations from ministries and department of states
and UTs including Senior Regional Directors, Regional Directors from Regional Office of
Health & Family Welfare, State Nodal Officers, State Surveillance Officers, National Vector
Borne Diseases Control Programme, Officers from Integrated Diseases Surveillance
Programme, representatives from identified Centre of Excellence, representatives from
Regional Centre of Meteorological Departments, Ministry of Environment Forest and
Climate Change and Central Ground Water Board. The states and UTs’ representatives
were aware of the urgency and serious concern for the agenda of the consultation.
State health teams were expected to list and prioritize climate sensitive illnesses in their
state and UTs, compilation of data on morbidity and mortality, statistics related to vulnerable
population, geographical factors, health care infrastructure/ facilities, or any mitigation and
adaptation measures adopted by state against impact of climate change on human health.
The salient points of recommendations of regional consultations are as follows:
 Representative from Regional Centre, Indian Meteorological Department suggested

to use the term ‘Climate Variability’ to study the health consequence as Climate
Change is more vast and generic term.
 The geographical distribution, mapping and epidemiology of the diseases like vector
borne, water borne etc should be done at the earliest in each state/ UT.
 “Personal Cooling Garment” or equivalent devices developed by other agencies may
be advocated for use if it is (these are) found appropriate.
 Existing surveillance system like IDSP should be used for disease related data
capture, through expanding of reporting units and regularly conducting review
meetings may be weekly.
 As population is indirectly related and resulting to climate change, population policy
may be revised.
 Vector survival and breeding are known to be affected by the climate variability
hence programme on vector borne diseases control should be revised to check
diseases occurrence in new areas.
 For dealing with the extreme heat events, reconsider the following for issue of health
related advisories:
o OPD timings in healthcare settings
o Drugs and vaccine storage
o Norms for Working hours at workplace
o School timings etc
55
 Detailed plan for each climate sensitive illnesses should be laid down by each state/
UT considering planning for present illnesses and also with scope to include new/
emerging or re-emerging climate sensitive illnesses.
 The state while drafting their state health action plan for climate change should also
refer the Joint Monitoring Meeting report of IDSP.
 Rapid Response Teams may be trained at state level using infrastructure of CSU,
IDSP and medical colleges.
 Participants proposed rules and regulations formulation should be in place for the
factors which are directly or indirectly affecting weather and climate and hence the
human health.
 Actionable points/ good initiatives/ practices should be shared so as the same can be
adopted by other states/ UTs.
 Chairman proposed a ‘Climate Change Health Forum’ to include all experts as
informal members. This forum will help in sharing of experience, meeting outputs
and further it will bring all together to contribute in terms of feedback, suggestions,
56
XIII. NAPCCHH: BUDGET
The proposed activities under NAPCCHH focus primarily on awareness generation,

sensitisation for effect of climate on occurrence of CSD, making of health system climate
resilient, capacity building of states and UTs for preparing their specific action plan for
climate change, promotion of partnership with multiple stakeholders and strengthening of
monitoring, surveillance of CSDs in a geographic area and encouraging research for
identifying linkages between weather parameters and diseases in a geographic area and
supporting evidence based building capacity of health personnel.
To undertake proposed activities, it requires establishment of an ‘Environment Health

cell’, hiring of experts and other human resources on the subject, arrangement of
logistics/ equipments, carrying out capacity building activities like training and meetings,
development of IEC material and advisories (Dissemination cost of IEC material cost is
not included in the first year of proposed budget), development of Health Adaptation
Plan and prediction model for developing early warning system for climate sensitive
diseases.
The tentative budget proposal of NAPCCHH has been proposed under the NHM through
EPC. The proposed sub-heads are as a) Human Resource (Contractual), b) Logistics/
Equipments, c) Trainings/ Meetings/ Workshops, d) Centre of Excellence (initially six in
first year), e) Development of pilot models like Integration, Green hospitals etc, f)
Development of prototype of IEC/ Advisory for impact of Climate Change on Human
health (do not include dissemination cost) and g) Air pollution and Human health (do not
include dissemination cost).
The budget for states and UTs: As the states and UTs are in the initial phase of
establishment of ‘Environment Health cell’, identification of State Nodal Officer (CC) and
notification of Taskforce involving multiple stakeholders. Hence it is proposed that once
the initial phase is complete, state should propose their budget through State PIP and
the same will be released only after the establishment of Environment Health Cell in the
Health department of State/UT. The tentative annual budget is at Annexure-E
57
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_in_the_Severely_Drought_Affected_Areas_of_Gujarat
59
LIST OF ABBREVIATIONS
WHO World Health Organisation

IPCC Intergovernmental Panel on Climate Change
IPCC SREX Intergovernmental Panel on Climate Change -Special Report on
Extreme Events
UV Ultraviolet
GOI Government of India
NGO Non-Governmental Organisation
NIMR National Institute of Malaria Research
IITM Indian Institute of Tropical Meteorology
IMD India Meteorological Department
DGHS Director General of Health Services
ICMR Indian Council of Medical Research
MOHFW Ministry of Health & Family Welfare
MOEF&CC Ministry of Environment, Forest and Climate Change
NCDC National Centre for Diseases Control
NDMA National Disaster Management Authority
MHRD Ministry of Human Resource Development
NEERI National Environmental Engineering Research Institute
TERI The Energy and Resources Institute
PHFI Public Health Foundation of India
UNICEF United Nations International Children's Emergency Fund
IEC (ICT) Information Education Communication (Information and communications
technology)
EWS Early Warning System
PHC, Primary Health Care
CHC Community Health Centres
V&A Vulnerability and Adaptation Assessments for Climate Change
assessments
FSSAI Food Safety and Standards Authority of India
MHA Ministry of Home Affairs
DHR Department of Health Research
DST Department of Science & Technology
DOS Department of Space
GIS Geospatial Information System
ENSO El Niño-Southern Oscillation
60
PRECIS Providing Regional Climates for Intervention Studies
HADCM3 Hadley Centre Coupled Model, version 3
Ministry of I&B Ministry of Information & Broadcasting
MCI Medical Council of India
Dy.DG Deputy Director General
DoHF&W Department of Health & Family Welfare
NAPCCH National Action Plan on Climate Change & Health
RKS Rogi Kalyan Samiti
NHM National Health Mission
PIP Programme Implementation Plan
61
Annexure-A
Constitution of NEGCCH: Office Order
62
63
Annexure-B
National Expert Group for Climate Change & Health (NEGCCH)
S.No. Name & Designation
1 Dr Vishwa Mohan Katoch, Former Secretary (Health Research), Government of Chairman

India and Former DG, ICMR
2. Shri Anshu Prakash, Joint Secretary (PH & NCD), Ministry of Health and Family
Welfare, Nirman Bhawan, New Delhi – 110011 Member
3. Shri Ravi S. Prasad, Joint Secretary, Ministry of Environment, Forests and Member
Climate Change, Indira Paryavaran Bhawan,JorBagh, Aliganj, New Delhi – 03.
4. Dr N. S. Dharmshaktu, Additional Director General, Directorate General of Member

Health Services, Nirman Bhawan, New Delhi – 110011
5. Dr A.C. Dhariwal, Director, National Vector Borne Disease Control Programme, Member
Block Number -III, Ground Floor, Delhi IT Park Shastri Park, Delhi- 110053
6. Dr Inder Parkash, DDG(PH), Dte General of Health Services, Nirman Bhawan, Member
New Delhi –110011
7 Dr Mohammed Shaukat, DDG(NCD), Directorate General of Health Services, Member

Nirman Bhawan, New Delhi – 11
8 Dr A.K. Sinha, Senior Research Officer, National Disaster Management Member

Authority, No. 1, Safdarjung Enclave, NDMA Bhawan, New Delhi-110029
9 Dr Ajay Raghav, Scientist F, Climate Change Division, Ministry of Environment, Member

Forests and Climate Change, Indira Paryavaran Bhawan, Jor Bagh, Aliganj, New
Delhi – 03
10. Dr S. K. Peshin, Scientist F, India Meteorological Department, Prithvi Bhawan, Member

Opposite India Habitat Centre, Lodhi Road, New Delhi-110003
11 Dr B. C. Joshi, Scientist D, Central Ground Water Board, Bhujal Bhawan, NH-IV, Member
Faridabad – 121001
12. Dr Dushyent Gehlot, Soil Conservation Officer (Climate Change), Climate Member
Change Cell (Room No. 22), Department of Agriculture and Cooperation, Ministry
of Agriculture, Krishi Bhawan, New Delhi
13. Dr D. K. Shukla, Scientist G, Indian Council of Medical Research (ICMR), ICMR Member
HQ, New Delhi
14. Dr R.M. Bhardwaj, Scientist E, In-charge, Pollution Assessment Monitoring Member

Survey, Central Pollution Control Board, Parivesh Bhawan, East Arjun Nagar,
Delhi – 110096
15. Dr S. Venkatesh, Director, National Centre for Diseases Control, 22-Shamnath Member
Marg, Delhi-110054 Secretary
64
Special Invitees
1 Dr Sadhna Bhagwat, National Professional Officer (NCD), WHO Country Office For India, First
Floor, RK Khanna Stadium, Safdarjung Enclave, Africa Avenue, New Delhi-110029.
2 Dr V. Rao Aiyagari, Senior Advisor, Research and Scientific Operations, Public Health
Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon 122002.
3 Prof Nandita Basu, Director, School of Tropical Medicine, 108, C. R. Avenue, Kolkata 700073
4 Dr T. K. Joshi, Director, Centre for Occupational and Environment Health, Maulana Azad
Medical College, New Delhi 110002.
5 Dr Pravin Naoghare, Scientist, Environmental Health Division, National Environment

Engineering Research Institute (NEERI), CSIR Lab, Nehru Marg, Nagpur-440020.
6 Dr Suruchi Bhadwal, Associate Director, Earth Science and Climate Change Division, The
Energy and Resources Institute (TERI), Darbari Seth Block, India Habitat Centre, Lodhi Road,
New Delh-110003.
7 Dr Hema Achyuthan, Department of Geology, Anna University, Chennai
Invitees
1 Dr Jyoti Misri, Principal Scientist (AH), Indian Council of Agriculture Research (ICAR),
Room No. 410-A, Krishi Bhawan, New Delhi 110001
2 Dr Tanvir Kaur, Scientist E, Indian Council of Medical Research (ICMR), ICMR HQ,New
Delhi
3 Dr Anjali Srivastava, Chief Scientist and Head, NEERI Zonal Centre, LohaMandiMarg,
Naraina Industrial Area Phase I, Naraina, New Delhi, Delhi 110028.
4 Ms Meena Sehgal, Fellow, The Energy and Resources Institute (TERI), Darbari Seth Block,
India Habitat Centre, Lodhi Road, New Delh-110003.
5 Dr D.R.Sikka, Former Director, Indian Institute of Tropical Meteorology (IITM), Dr. Homi
Bhabha Road, Pashan, Panchawati, Pune, Maharashtra 411008.
6 Dr Akhilesh Gupta, Head, Climate Change Programme & Strategic Programme, Large
Initiatives and coordinated Action Enabler (SPLICE), Department of Science & Technology,
Technology Bhawan, New Mehrauli Road, New Delhi-110016.
7 Dr Nisha Mendiretta, Scientist F and Director, Climate Change Programme, Department of

Science & Technology(DST), Ministry of Science & Technology, Government of India
65
8 Dr D. Behera, Professor and Head, Pulmonary Medicine, PGIMER, Kairon Block, Sector-12,
Chandigarh – 160012.
9 Prof. Manju Mohan, Professor, Centre for Atmospheric Sciences, Indian Institute of
Technology, Delhi –16
10 Dr Sagnik Dey, Assistant Professor, Centre for Atmospheric Sciences, Indian Institute of
Technology, New Delhi – 110016.
11 Dr Vidhya Venugopal, Professor, Department of Environmental Health Engineering, Sri

Ramachandra University, Porur, Chennai – 600116.
12 Dr P.K. Sen, Additional Director, National Vector Borne Disease Control Programme, Block
Number -III, Ground Floor, Delhi IT Park, Shastri Park, Delhi- 110053.
13 Dr. Sher Singh, Assistant Director (PH), National Vector Borne Disease Control Programme,
Block Number -III, Ground Floor, Delhi IT Park, Shastri Park, Delhi- 110053.
OFFICERS FROM NCDC (Nodal Agency for Climate Change & Human Health)
1 Dr CS Aggarwal, Additional Director, Centre for Environment, Occupational Health, and Climate
Change, National Centre for Disease Control (NCDC), Delhi 110054
2 Dr Shikha Vardhan, Deputy Director, Centre for Environment and Occupational Health, National
Centre for Disease Control (NCDC), Delhi 110054
3 Dr Pranil M Kamble, Assistant Director, Centre for Environment and Occupational Health, National
Centre for Disease Control (NCDC), Delhi 110054
66
Annexure: C
NAPCCHH: Proposed Annual Budget
Proposed Annual Budget for supporting Activities at CEOHCCH Division at NCDC
S.No Expenditure Category Estimated Budget Recurring/ Non-Recurring
1 Human Resource (Contractual) Rs 1,67,40,000/- Recurring
2. Logistics/ Equipments Rs 12,60,000/- Non-Recurring
3. Trainings/ Meetings/ Workshops Rs 55,37,500/-
4. Centre of Excellence (Initially six in first year) Rs 15,00,000/-
5. Development of ‘Pilot Models’ like Green Rs 70,00,000/-

hospitals, Integration Platform
Recurring
6. Development of ‘Prototype’ of IEC/ Advisory Rs 2,00,000/-
for impact of climate change on human health
(Dissemination cost is not included)
7. Development of ‘Prototype’ of IEC/ Advisory Rs 2,00,000/-

for impact of Air Pollution (AAP, IAP & HAP)
on human health (Dissemination cost is not
included)
Subtotal at CEOHCCH, NCDC Rs 6,35,37,500/-
Proposed Annual Budget for Environment Health Cell at State Health Deptt#
1 Human Resource (Contractual) Rs 26,40,000/- Recurring
2. Logistics/ Equipments Rs 4,00,000/- Non-Recurring
Subtotal at Env Health Cell at State Rs 30,40,000/-
# The budget has to be proposed through State PIP and the same will be released only after the
establishment of Environment Health Cell in the Health department of State
Proposed Annual Budget for supporting Activities at Environment Health Cell at District level
1 Human Resource (Contractual) Rs 7,80,000/- Recurring
2. Logistics/ Equipments Rs 75,000/- Non-Recurring
Subtotal at Env Health Cell at District Rs 8,55,000/-
67
Annexure D
REGIONAL METEOROLOGICAL OFFICES: Address
Regional Meteorological office Address
India Meteorological Department, Regional New 6, Old 50, College Road, Chennai, Tamil
Meteorological Centre, Chennai Nadu- 600006
India Meteorological Department, Regional LGBI Airport, Guwahati, Assam- 781015

Meteorological Centre, Guwahati
India Meteorological Department, Regional 4, Duel Avenue, Alipore, Kolkata, West

Meteorological Centre, Kolkata Bengal – 700027
India Meteorological Department, Regional Regional Meteorological Centre, Mumbai,

Meteorological Centre, Mumbai Colaba, Mumbai, Maharashtra- 400089
India Meteorological Department, Regional Regional Meteorological Centre, IMD DBAI

Meteorological Centre, Nagpur Airport, Sonegaon, Nagpur, Maharashtra-
440005
India Meteorological Department, Regional RMC Building, Lodi Road, New Delhi- 110003
Meteorological Centre, New Delhi
68
Annexure-E
STATE POLLUTION CONTROL BOARD: Address
State Pollution Control Board Address
Andhra Pradesh Pollution Control Board Paryarana Bhawan, A-3, Industrial Area , Sanathnagar,
Hyderbabad-500 018, Andhra Pradesh
Arunachal State Pollution Control Board Government of Arunachal Pradesh Office of the Principal
Chief and Secretary (E&F) Conservator of Forests, Itanagar
791111, Arunachal Pradesh
Assam Pollution Control Board Control Board Bamunimaidam, Guwahati - 781021 Assam
A & N Islands Pollution Control Committee Van Sadan, Port Blair-744 102
Bihar State Pollution Control Board IInd Floor, Beltron Bhavan, Jawaharlal Nehru Marg, Shastri
Nagar, Patna 800023, Bihar.
Chattisgarh State Environment Conservation Nanak Nivas, Civil Lines Raipur - 492001 Chattisgarh
Board
Chandigarh Pollution Control Committee Chandigarh Administration, Additional Town Hall Building,
IInd Floor, Sector 17-C, Chandigarh 160 017.
Delhi Pollution Control Committee 4th Floor, I.S.B.T. Building, Kashmere Gate, Delhi-110006
Daman Diu & Nagar Haveli Pollution Control Office of the Dy. Conservator of Forests, Moti Daman-
Committee 396220, Daman
Goa State Pollution Control Board Dempo Tower, Ist Floor Patto Plaza Goa 403110
Gujarat State Pollution Control Board Sector 10-A, Gandhi Nagar 382043 Gujarat
Haryana State Pollution Control Board S.C.O.No.11 A-12, Sector 7-C Madhya Marg, Chandigarh –
160019
H.P. State Environment Protection & Paryavaran Bhawan, Phase III New Shimla -171 009
Pollution Control Board Himachal Pradesh
Jammu & Kashmir State Pollution Control Sheikhul Alam Campus, Behind Govt. Silk Factory, Rajbagh ,
Board Srinagar (April - Oct.) Parivesh Bhawan Forest Complex,
Gandhi Transport Nagar (Nawal), Jammu (Nov. - March)
Jharkhand State Pollution Control Board T.A. Building, HEC P.O. Dhurwa Ranchi - 834004 Jharkhand
Karnataka State Pollution Control Board 6th-9th floors Public Utility Building NSB Building, Mahatama
Gandhi Marg Bangalore 560001 Karnataka
69
Kerala State Pollution Control Board Plamoodu Junction Pattom Palace Trivandrum 695004
Kerala
Meghalaya Pollution Control Board “ARDEN”, Lumpyngngad, Shillong – 793 014, Meghalaya.
Madhya Pradesh Pollution Control Board E-5, Arera Clony, Paryavaran Parisar, Bhopal - 463016
Madhya Pradesh.
Maharashtra Pollution Control Board Kalpataru Points, 3rd & 4thfloor, Opp. Cine Planet, Sion
Circle, Sion (E) Mumbai-400 022.
Mizoram State Pollution Control Board M.G. Road, Khatna, Aizwal-796 012, Mizoram
Manipur Pollution Control Board Langol Housing Complex, Imphal-795 004, Manipur.
Nagaland Pollution Control Board Office of the Chairman, Forests Colony, Dimapur, Nagaland
Orissa State Pollution Control Board A-118, Nilakantha Nagar, Unit-VIII, Bhubaneswar 751012.
Orissa
Punjab Pollution Control Board Vatavaran Bhawan, Nabha Road, Patiala-147 001 Punjab.
Pondichery Pollution Control Committee Department of Science, Technology & Env. Housing Board
Complex, IIIrd Floor Pondicherry-600 005
Rajasthan Pollution Control Board A-4, Institutional Area, Jalana Dungri, Jaipur-302 004,
Rajasthan.
Sikkim Pollution Control Board State Land Use and Environment Cell Govt. of Sikkim,
Deorali,- 737101
Tamil Nadu Pollution Control Board No. 76, Mount Salai, Guindy, Chennai- 600 032, Tamil Nadu.
Tripura State Pollution Control Board Vigyan Bhawan, Pandit Nehru Complex, Gorkhabasti,PO-
Kunjaban, Agartala (W)-799 006 (Tripura) .
Uttar Pradesh Pollution Control Board IIIrd floor PICUP Bhavan, Vibhuti Khand, Gomti Nagar,
Lucknow - 226020, UP.
West Bengal Pollution Control Board Paribesh Bhavan, 10-A, Block LA, Sector III, Salt Lake City,
Kolkata-700 091.
70

National Action Plan For Climate Change & Human Health: Ministry of Health & Family Welfare Government of India

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National Action Plan For Climate Change & Human Health: Ministry of Health & Family Welfare Government of India

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VERSION AS ON 23 Oct 2018

Approved Draft, VMKatoch, 23/10/2018

NATIONAL ACTION PLAN

Executive Summary 7-9

2 Steps to Reduce Impacts of Climate Change 17- 19

5 NAPCCHH: Vision, Goal & Objectives 24

6 NAPCCHH: Activity Matrix 25- 29

7 Climate Change vs Health Resilience 30- 31

8 Climate Resilient Health System: Stakeholders’ Intervention 32- 42

9 NAPCCHH: Organisational Framework for Implementation 43- 48

10 NAPCCHH: Capacity Building and System Awareness 49

11 NAPCCHH: Reporting, Monitoring & Evaluation 50

List of Abbreviations 60- 61

Annexure: A: Office Order for constitution of NEGCCH 62- 63

Annexure B – Experts of NEGCCH 64-66

Annexure C: NAPCCHH-Proposed Annual Budget 67

Annexure D: Regional Meteorological Offices 68

Annexure E: State Pollution Control Board 69- 70

1. To create awareness among general population (vulnerable community), health-care providers

Initial Inputs desired (first 2 years)

Climate change is perceived to be

A) Direct Impacts of Change in Climate and Weather on Health:

1. Heat-Stress and Related Impacts

Numerous studies have reported increase in temperature-related morbidity (hospital

2. Drought, Storms and Floods

B) Indirect Impacts of Climate and Weather on Health:

1. Air-Borne and Cardio-Respiratory Illnesses: Climate change influences various illnesses

1. National Mission on Sustainable habitat

2. National Mission for Sustaining the Himalayan Ecosystem

3. National Mission for Sustainable Agriculture

4. National Solar Mission

5. National Mission for Enhanced Energy Efficiency

6. National Water Mission

7. National Mission on Strategic Knowledge for Climate Change

8. National Mission for “Green India”

2. National Mission on “Waste to Energy Generation”

3. National Mission on India’s Coastal areas

4. National Wind Mission

Therefore a fundamental area of intervention would include strengthening of local monitoring of

4. Strengthening/ developing response action based on innovative or new strategies or

1. National Mission for Sustaining the

1. National Mission for

1. National Mission for

children, women and marginalized population against climate sensitive illnesses.

To create awareness among general population (vulnerable community), health-care

To strengthen capacity of healthcare system to reduce illnesses/ diseases due to

To strengthen health preparedness and response by performing situational analysis at

Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Nodal Department/ Ministry: MOHFW / Dte.GHS / NCDC

Initial Inputs/ activities desired (first 2 years)

1. Establish ‘Environmental Health Cell’ in State Health Department,

1. Formulate specific implementation framework for climate sensitive diseases.

1. Awareness & Behaviour modification of general population for impact, illnesses,

India is signatory to “Male’ Declaration” wherein health sector has to be strengthened so as

A. Human Health vs Extreme weather events

Vulnerability factors: Demography especially people at extremes of age (>65yrs, children),