BENGALURU, India – Months of scorching temperatures at times exceeding 50 degrees Celsius (122 Fahrenheit) in parts of India this year – the worst heat wave in more than a decade – have left hundreds dead or ill. But the official death toll listed in government reports barely scratches the surface of the true toll, and that is affecting future preparations for similar outbreaks, according to public health experts.
India now has some respite from the intense heat and a different set of extreme weather problems as monsoon rain hits the northeastbut for months extreme heat affected large swaths of the country, especially in northern India, where government officials reported at least 110 heat-related deaths.
Public health experts say the true number of heat-related deaths is likely in the thousands, but because heat is often not listed as a reason on a death certificate, many heat deaths are not counted in official numbers. The concern, they say, is that the undercounting of deaths means the problem of heat waves is not as prioritized as it should be and that authorities are missing ways to prepare their residents for the scorching temperatures.
All of the hottest years on record in India have occurred in the last decade. Studies by public health experts have found that even 1,116 people died every year between 2008 and 2019 due to the heat.
As part of his public health work, Srinath Reddy, founder of the Public Health Foundation of India, has advised state governments on how to take heat into account when recording deaths.
It found that as a result of “incomplete reporting, delayed reporting, and misclassification of deaths,” heat-related deaths are significantly undercounted across the country. Despite national guidelines for recording deaths, many doctors – especially those who work in overcrowded public hospitals where resources are already scarce – do not follow them, he said.
“Most doctors only record the immediate cause of death and attribution to environmental factors like heat is not recorded,” Reddy said. This is because heat deaths can be classified as exertional or non-exertional: exertional is when a person dies due to direct exposure to high temperatures and non-exertional is when young children, the elderly or people with pre-existing health problems they become seriously ill or sometimes die from the heat, even indoors.
“The heat wave is the final straw for the second category of people,” said Dileep Mavalankar, former head of the Indian Institute of Public Health in Gandhinagar. “Most people who die during heatwaves fall into this category, but their deaths are not recorded as related. to the heat.”
Mavalankar agreed that the official number of heat deaths this year is an underestimate. He said there were 40,000 recorded cases of heatstroke but only 110 deaths. “This represents just 0.3% of the total number of heatstroke cases recorded, but normally heat deaths should account for 20 to 30% of heatstroke cases,” he said.
“We need to count deaths better,” Mavalankar said. “This is the only way we will know how serious the consequences of extreme heat are.”
In his former role at the Indian Institute of Public Health in Gandhinagar, Gujarat, Mavalankar was instrumental in developing India’s first heat action plan for the city of Ahmedabad in 2013, three years after more than 1,300 people died during a heat wave.
The warming plan included measures such as increasing access to shaded areas for outdoor workers, converting relatively cold public buildings into temporary shelters for people without homes or access to electricity, and ensuring that hospitals have adequate medical supplies and staff during waves of heat.
In the years that followed, Mavalankar and his team studied the impact of the heat plan by counting the death toll in subsequent hot summers. Due to a lack of specific data on heat deaths, the team looked at deaths from all causes, which increase during heat waves, and used the number of excess deaths to determine how many deaths were likely caused by heat.
They estimate that the heat action plan has helped reduce the number of deaths during heatwaves by up to 40%.
Having this data, however imperfect, Mavalankar said, allowed the city to adequately prepare for extreme heat and do more of what worked in the future.
But he said a lack of data elsewhere makes it difficult to replicate the results in Ahmedabad nationally.
“Not reporting these deaths, sharing data, is like the Indian Meteorological Department not sharing meteorological data,” he said. “We can easily do this across the country, but we haven’t decided we should do it yet.”
The Indian government collects data on heat-related deaths through the Ministry of Health’s National Center for Disease Control, which is then shared with the National Disaster Management Agency. The agency then shares the data as a national total figure for the year, but the state-by-state breakdown is not publicly available.
The National Crime Records Bureau also collects data on heat-related deaths as part of its count of deaths due to “forces of nature” and publishes those numbers.
But there are huge discrepancies. In 2020, the last year with publicly available data on heat deaths from both official sources, the criminal records office recorded 530 heatstroke deaths, but the disaster agency reported just four heat-related deaths.
The Associated Press contacted India’s Health Ministry spokesperson, the NCDC and the NDMA for comment on the discrepancy but did not receive a response.
Getting better data can answer a number of questions about who is most vulnerable and how best to help them, said Bharghav Krishna, a public health expert and member of the Sustainable Futures Collaborative think tank, “especially when it comes to identification of who is dying, where they are dying, what they are doing when they are dying.”
Krishna thinks that the data currently collected, although inadequate, can at least provide some information to policymakers and researchers and force at least some action if it is shared with the right people.
But Malavankar said data collection issues are more systemic and need to be addressed urgently.
“We haven’t done a national census since 2011, not having numbers is our national weakness,” he said.
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