267657 Characterizing vulnerability to heat and heat illnesses among urban slum dwellers in Ahmedabad, India

Monday, October 29, 2012

Kathy Tran, MPH , Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
Gulrez Azhar, MD, MPH , Professor, Indian Institute of Public Health, Gandhinagar, Ahmedabad, India
Rajesh Nair, PhD, MPhil , Professor, Indian Institute of Public Health, Gandhinagar, Ahmedabad, India
Dileep Mavalankar, MD, DrPH , Academic Dean, Indian Institute of Public Health, Gandhinagar, Ahmedabad, India
Anjali Jaiswal, JD , Litigation team and India Initiative, Natural Resources Defense Council, San Francisco, CA
Kim Knowlton, DrPH , Health & Environment Program, NRDC (Natural Resources Defense Council), New York, NY
Jeremy Hess, MD, MPH , Department of Emergency Medicine, Emory University, Atlanta, GA
India is expected to face increasingly frequent extreme weather events as a consequence of climate change. Extreme heat events may have particularly significant impact since summer temperatures are historically high. Little is known regarding factors that may drive population vulnerability to extreme heat as well as strategies for minimizing heat exposure and susceptibility in this rapidly developing nation. To facilitate public health preparedness for extreme heat, an assessment of factors affecting vulnerability was conducted in summer of 2011 in Ahmedabad, Gujarat, India, a city where seasonal highs have reached 115F. The study focused on factors that affect heat exposure, susceptibility to heat related illness, and adaptive capacity, all of which are known to feed into vulnerability to heat. Indicators of these factors were identified through literature review and expert opinion, and assessed through a cross-sectional household survey. The survey used randomized cluster-based sampling to identify target households in twelve urban slum populations in Ahmedabad. This population was presumed by local public health authorities to be particularly vulnerable and have greater susceptibility and less resilience to extreme heat exposure. Associations between heat-related morbidity and individual and household demographics, medical history, access to weather warnings and health information, and social connectedness were determined. Multivariate logistic regression was performed with Generalized Estimating Equations to account for clustering effects to test the various associations between outcomes and covariates. Results indicated age, income, preexisting conditions, work location, drinking water sources, access to doctors and information, and social connectedness influence the occurrence of heat-related symptoms and illnesses among slum dwellers. These findings suggest several potentially worthwhile interventions including: working with community health workers to disseminate information and prevent heat illnesses as well as delivering information through television campaigns. Future research studies might include focus groups and evaluations of currently applied adaptive behaviors and future interventions.

Learning Areas:
Environmental health sciences
Public health or related research

Learning Objectives:
1. Define vulnerability in the context of climate change and health. 2. Identify factors that affect heat exposure, susceptibility to heat related illness, and adaptive capacity. 3. Discuss the relationship of demographics, medical history, access to weather and health information, and social connectedness to heat morbidity.

Keywords: Climate Change, Environmental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted original research, this study, for my thesis. In the process, I designed the survey, developed the sampling strategy, trained and managed research assistants to implement the survey, and analyzed the survey data. Among my applied public health interests has been the development, implementation, and evaluation of adaptation strategies for reducing the health and environmental impacts of climate change.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.