How can India Build Climate-Resilient Health Systems?

REPORT

How Can India Make its Health Sector Climate Resilient?

A District-level Risk Assessment

20 February, 2025 | Climate Resilience

Shreya Wadhawan, Aryan Bajpai, Vanya Pandey, and Dr Vishwas Chitale

Suggested CitationCEEW and UNICEF. 2025. How Can India Make its Health Sector Climate Resilient? A District-level Risk Assessment. New Delhi, India: Council on Energy, Environment and Water.

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Overview

This report, developed in collaboration with the United Nations Children’s Fund (UNICEF), presents a district-level risk profiling for India's health sector, assessing the impact of extreme climate events on healthcare systems. Using an interdisciplinary approach, we systematically reviewed literature, identified key indicators, and employed the Delphi method to refine and weight over 50 indicators. The climate health risk index is computed following the IPCC AR5 framework, highlighting the growing vulnerability of India’s 200,000+ healthcare facilities, particularly to extreme precipitation, extreme heat, floods, and cyclones.

Despite increasing healthcare expenditures—rising by 14 per cent from 2023 to 2024—the study underscores the urgent need for district-level climate risk assessments to strengthen healthcare resilience. Introducing a scalable risk assessment framework, the report prioritises facilities for adaptation, ensuring climate-proof investments and enhanced disaster preparedness.

Key Highlights:

Risk: More than 40 per cent of Indian districts have healthcare systems that face very high to high climate risk, whereas approximately 20 per cent have moderate risk.
The majority of the districts with very high risk are concentrated in Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Karnataka, Kerala, Odisha, Maharashtra, Sikkim, Tamil Nadu, and Uttarakhand.
Hazard: Most districts in states such as Karnataka, Tamil Nadu, Gujarat, Assam, Andhra Pradesh, Bihar, Maharashtra, Odisha, and Kerala fall under the very high hazard category. More than 50 per cent of the districts in Uttar Pradesh, Chhattisgarh, Jharkhand, West Bengal, and Himachal Pradesh belong to the high category.
Exposure: More than 50 per cent of the districts in Andhra Pradesh, West Bengal, Maharashtra, Bihar, and Karnataka have very high exposure to extreme climate events.
Vulnerability: The majority of districts in states such as Himachal Pradesh, Uttarakhand, Arunachal Pradesh, Jammu and Kashmir, Manipur, Mizoram, and Nagaland fall under the very high vulnerability category. Many districts in Chattisgarh, Jharkhand, and Tripura come under the high category.

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Shreya Wadhawan

Programme Associate

[email protected]

“Building climate-resilient healthcare systems requires data-driven action. Climate risk assessments must guide both funding and on-ground interventions to ensure resources reach the most vulnerable states, districts, facilities and communities. By mainstreaming interdisciplinary risk assessments, enhancing professional capacities, and integrating climate health risks into financing decisions, we can position the health sector at the forefront of climate action.”

Executive summary

India is one of the world’s most at risk nations from the impacts of climate change–induced events such as floods, cyclones, and droughts (Eckstein, Künzel, and Schäfer 2021). Between 2000 and 2019, India experienced an annual average of 17 floods, making it the second most flood-affected country in the world (CRED and UNDRR 2020). Furthermore, as of 2021, about 68 per cent of Indian districts were exposed to extreme droughts (Mohanty and Wadhawan 2021).

The rising frequency and intensity of such extreme events cause damage to infrastructure and service interruptions in the health sector. By 2050, climate change is projected to cause an additional 14.5 million deaths globally, primarily due to extreme weather events such as floods, droughts, and heatwaves (WEF 2024). Moreover, vulnerable populations, especially in low- and middle-income countries (LMICs), are expected to bear a disproportionate share of the health impacts of climate change. UNICEF’s Children’s Climate Risk Index identifies India as a country where children are at very high risk with regards the adverse effects of climate change (UNICEF 2021a). Diseases sensitive to climate fluctuations, such as malaria and dengue, are predicted to spread into new areas, potentially putting an additional 500 million people at risk by 2050 (WEF 2024). The economic impact is also severe, with losses estimated at USD 12.5 trillion, alongside an additional USD 1.1 trillion burden on healthcare systems (WEF 2024). Furthermore, the economic losses in LMICs from non-communicable diseases (NCDs) are projected to exceed USD 7 trillion by 2025 (Bloom et al. 2011). Despite these challenges, there remains insufficient investment in addressing the social and environmental determinants of health in India.

Increasing investment in this area will improve the health sector’s climate resilience and support the attainment of the United Nations Sustainable Development Goals (SDGs), thus ensuring universal access to adequate health services. Figure ES1 highlights the various SDGs that will be achieved while enhancing the health sector’s climate resilience.

It is thus imperative for policymakers to prioritise the integration of climate adaptation strategies into health sector planning to safeguard the well-being of India’s most vulnerable populations. According to the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP), an investment of USD 1 in adaptation can lower the annualised average loss from extreme climate events, slow-onset hazards, and biological hazards by USD 5.5 (UNESCAP 2022). This necessitates conducting thorough and granular risk assessments across various sectors to identify the underlying key risk factors. In this study, we attempted to develop a national-level framework for assessing extreme events–induced physical climate risk to health sector in India.

Objectives of the risk assessment for the health sector in India

In this study, we developed a climate risk assessment framework that is contextualised to the health sector in India. It had the following three key objectives:

To identify and finalise indicators for health risks due to climate extremes in India, with a special focus on women, children, and other vulnerable groups.
To compute district-level climate extremes–induced health risk index.
To identify district-level risk hotspots and the key driving factors.

Methodology for development, computation, and representation of the risk index

In the current study, we define risk as per the Intergovernmental Panel on Climate Change’s (IPCC) Fifth Assessment Report (AR5), where risk is defined as a product of hazard, exposure, and vulnerability (adaptive capacity and sensitivity). The study consisted broadly of five steps, beginning with a systematic literature review (SLR) of 180 publications and reports from grey and non-grey literature and concluding with plotting geographic information system (GIS)–based maps highlighting the climate risk in the health sector in India, as depicted in Figure ES2.

The protocol, search, appraisal, synthesis, analysis, and report (PSALSAR) methodology served as a guiding framework for conducting the SLR, within which the population, intervention, control, outcomes, study design, and time frame (PICOST) model was used to define the research protocol. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Key findings

Hazard: Most districts in states such as Karnataka, Tamil Nadu, Gujarat, Assam, Andhra Pradesh, Bihar, Maharashtra, Odisha, and Kerala fall under the very high hazard category. More than 50 per cent of the districts in Uttar Pradesh, Chhattisgarh, Jharkhand, West Bengal, and Himachal Pradesh belong to the high category.
Exposure: More than 50 per cent of the districts in Andhra Pradesh, West Bengal, Maharashtra, Bihar, and Karnataka have very high exposure to extreme climate events.
Vulnerability: The majority of districts in states such as Himachal Pradesh, Uttarakhand, Arunachal Pradesh, Jammu and Kashmir, Manipur, Mizoram, and Nagaland fall under the very high vulnerability category. Many districts in Chattisgarh, Jharkhand, and Tripura come under the high category. Twenty per cent of the districts in India are very highly vulnerable to extreme climate events, and an additional 19 per cent fall under the highly vulnerable category. States such as Arunachal Pradesh, Himachal Pradesh, Sikkim, and Nagaland show very high to high levels of vulnerability.
Risk: More than 40 per cent of Indian districts have healthcare systems that face very high to high climate risk, whereas approximately 20 per cent have moderate risk, and 40 per cent have low to very low risk. The majority of the districts with very high risk are concentrated in Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Karnataka, Kerala, Odisha, Maharashtra, Sikkim, Tamil Nadu, and Uttarakhand. The high-risk category has a wide distribution across different regions of the country, including Chhattisgarh, Gujarat, Rajasthan, Madhya Pradesh, and West Bengal (See Figure ES3).

Recommendations and the way forward

Mainstream sub-district level, interdisciplinary risk assessments of the health sector: Detailed, sub-district risk assessments are crucial for quantifying the health sector’s vulnerability to extreme climate events. These assessments should incorporate interdisciplinary factors such as governance, socioeconomic conditions, and public health infrastructure.
Establish data dashboards to facilitate assessments: Developing an open-access, interactive data dashboard that hosts district-level climate vulnerability data is key to enabling healthcare institutions to assess physical climate risks. This dashboard should consolidate data from national surveys and extreme weather events and support physical risk assessments and resilience measures. Implementing this at the state and district levels through the state action plan on climate change and human health (SAPCCHH) and the district action plan on climate change and human health (DAPCCHH) will further enhance risk assessments and lead to informed policymaking. In addition to climate vulnerability data, the dashboard can also provide information on contextualised adaptation measures suited for the health sector; this will aid the health authorities in prioritising adaptation solutions in high- and very high-risk districts.
Assess and build the capacities of health sector professionals to conduct risk assessments: Strengthening the skills, knowledge, and resources of government departments and institutions related to the health sector is essential for conducting effective climate risk assessments. Drawing on resources such as CEEW’s capacity assessment framework (CAF), the Ministry of Health and Family Welfare (MoHFW) can assess the ability of state health departments to address climate change. The MoHFW could then use it to develop state- and national-level programmes for capacity building in the relevant stakeholders from government departments.
Maintain inter-ministerial and interdepartmental coordination for bringing health sector at the forefront of climate action: Since health systems and climate change are managed by two different ministries – the MoHFW and the Ministry of Forest, Environment and Climate Change (MoEFCC) – it is critical to ensure coordinated assessments and policies across departments. Collaboration among ministries such as Health, Environment, Rural Development, and Home Affairs will support unified monitoring of climate and health indicators and foster coherent policy responses and climate readiness. While formulating a national adaptation plan for India, special emphasis should be placed on enhancing climate resilience in the health sector through an effective coordination mechanism between the MoHFW and the MoEFCC.
Provide climate health risk–based financing for health systems in India: Allocating healthcare resources based on granular climate risk assessments will ensure that regions at high and very high risk due to climate-induced extreme events receive focused funding to strengthen their health systems. India can strengthen its health systems by integrating climate adaptation into national health policies, such as the National Health Mission (NHM) and the National Action Plan on Climate Change and Human Health (NAPCCHH). This integration could involve leveraging climate risk assessments to prioritise initiatives addressing climate-sensitive health concerns in medium- and long-term programme planning. For instance, similar efforts in other South Asian countries have focused on prioritising community-based interventions to address climate-induced vector-borne diseases (UNDRR 2018).

By prioritising these actions, India can make the health sector more resilient and capable of effectively addressing the challenges posed by climate change.