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Journal of Environmental and Public Health
Volume 2018, Article ID 7973519, 8 pages
Research Article

Building Resilience to Climate Change: Pilot Evaluation of the Impact of India’s First Heat Action Plan on All-Cause Mortality

1University of Washington, Seattle, WA, USA
2Indian Institute of Public Health, Gandhinagar, Ahmedabad, India
3Natural Resources Defense Council, New York, NY, USA
4Emory University, Atlanta, GA, USA
5Icahn School of Medicine at Mount Sinai, New York, NY, USA
6Indian Meteorological Department, Gujarat, India
7Indian Meteorological Department, Delhi, India
8Ahmedabad Municipal Corporation, Ahmedabad, India

Correspondence should be addressed to Jeremy J. Hess; ude.wu@ssehjj

Received 4 April 2018; Accepted 14 August 2018; Published 1 November 2018

Academic Editor: Evelyn O. Talbott

Copyright © 2018 Jeremy J. Hess et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Ahmedabad implemented South Asia’s first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP’s impact on all-cause mortality in 2014–2015 relative to a 2007–2010 baseline. Methods. We analyzed daily maximum temperature (Tmax)-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs. Results. The maximum pre-HAP RR was 2.34 (95%CI 1.98–2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02–1.53) estimated at 47°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for Tmax over 40°C was 0.95 (0.73–1.22) and 0.73 (0.29–1.81) for Tmax over 45°C. An estimated 1,190 (95%CI 162–2,218) average annualized deaths were avoided in the post-HAP period. Conclusion. Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad’s plan can serve as a guide for other cities attempting to increase resilience to extreme heat.