In the brutal heatwave beating down on Uttar Pradesh and Bihar, one district in U.P., Ballia, reported the most deaths. The medical superintendent at the local government hospital was reportedly transferred after ascribing the deaths to the heat, followed by a visit by a State-appointed team to assess the local conditions. A member later told journalists that the team had expressed its doubts about the heat being a factor since the toll due to the same heatwave was lower in districts nearby. The member’s statement is a timely reminder that a heatwave is only half heat, the other being bad public infrastructure and social security. Ballia’s toll could be high because of, as the team suspects, contaminated water, or because the local people could not cool themselves. Heat’s deadliness depends on an individual’s general well-being, acclimatisation, physical exertion, comorbidities, location, relative humidity, and extent of heat exposure. But for all the complexity the interplay of these factors augurs, the fight against this mode of the climate crisis, which India is expected to suffer more often, can benefit considerably from some literacy and access to resources. Literacy needs to be rooted in a simple fact: heat is deadly when our bodies are unable to shed it as quickly as it accumulates. This can happen due to poor living conditions, adherence to caste- and gender-based strictures, or even in overcrowded hospitals. Amenities that can help include access to drinking water, indoor ventilation, health care, regular work breaks, and protections against wage loss. If a person dies in a heatwave, it is only fair to ask whether he/she was able to access these amenities.
If U.P. and Bihar are to forge a better way forward vis-à-vis their heat response, they need to register all heat-related deaths, assign the cause, ensure the medical certificates of the cause of death (MCCDs) follow the proper codes of the most recent revision of the International Statistical Classification of Diseases and Related Health Problems, and issue them. Next, the Office of the Registrar General should compile and release MCCD data every year to facilitate independent research and policy input and to prevent time-wasting disputes over official versus actual figures. However, the office has not released the corresponding reports for 2021 and 2022. In the 2020 report, which was uploaded only last year, Bihar assigned causes to just 3.4% of registered deaths — the worst among States. Not everyone who dies during a heatwave has died due to the heat, but only if good living conditions have been the norm. If they have not, the state is as much to blame as the heat..
