An Approach to Addressing Vulnerability and Enhancing Resilience
Author: Dr. Nitish Dogra, Senior Advisor, Climate and Health
Recent findings from the University College London-led commission highlight a pressing concern: climate change’s threat to human health is so great that it could undermine the last fifty years of gains in development and global health. This crisis impacts health through various indirect pathways like air and water quality, food security, and disease vectors, as well as direct effects such as thermal stress and climate-related disasters like floods, droughts, and cyclones. Recognising the need for a comprehensive approach to studying the intersection of climate-related disasters with health and nutrition, the Bihar Technical Assistance Support Team (BTAST) was set up.
The Bihar Technical Assistance Support Team (BTAST) has emerged as a crucial player. With a focus on health, nutrition, water, and sanitation, the team is working to create a robust response to the multifaceted impacts of climate change, particularly in the most vulnerable, flood-affected areas.
Shifting Focus: From Prevalence to Vulnerability
Traditionally, health sector planning has centred on prevalence rates—essentially, the cases revealed by the health system. This narrow focus can be misleading, as many individuals seek care outside of official channels. By shifting our perspective to vulnerability, we can better assess the true impact of climate-related health issues. Drawing from previous work on climate vulnerability indices in India and beyond, this approach aims to transform how health planning is conducted.
The Vulnerability Index
A crucial and informative tool in this research is the vulnerability index, derived using the Intergovernmental Panel on Climate Change (IPCC) framework. This index, which evaluates exposure, sensitivity, and adaptive capacity, was developed through processes undertaken examination by the BTAST team, followed by a review by the national and international experts. The final tool involved sixteen different socio-economic, health, and disaster indicators and was validated by a qualitative assessment in three districts.
Key Findings
The findings are revealing. Among fifteen districts studied, Madhepura, Sitamarhi, Sheohar, Muzzafarpur, and East Champaran rank in the highest tertile (one-third) of vulnerability. Other key findings include the following:
- Vulnerability did not coincide with disease prevalence, and an inverse relationship was observed in many cases.
- Several factors contribute to this phenomenon, including health access issues in the most vulnerable districts.
- Although health-seeking behaviour has increased, there is still a reluctance to utilise government health facilities.
- Women, children, the elderly, the poor, and marginalised groups, such as Dalits and Mahadalits, are most affected.
- Besides other health outcomes related to floods, snakebites are also significant.
- Human resources for health, such as doctors, district epidemiologists, and Anganwadi workers, remain a critical concern, which adds to the vulnerability.
- Malnourishment is also widespread.
- Enhancing early warning systems, strengthening emergency management services (EMS), triage training, a dedicated cadre of community volunteers, and a well-maintained road network are essential for effective disaster management.
Conclusion: A Call to Action
By advocating for a shift from prevalence to vulnerability in health sector planning, we equip decision-makers with a practical tool to address these urgent issues. There’s hope that this model can be adopted by other countries, especially in South Asia and Southeast Asia, to improve health systems and community well-being.
At a broader level, inter-departmental coordination linking disaster response, environmental policy, health services, and public health engineering is crucial for holistic planning. This integrated approach will not only enhance resilience to climate change but also strengthen societal systems overall. As we navigate these complex challenges, a collective effort will be essential in safeguarding health and promoting sustainable development in the face of climate adversity.