COPE - Combined impact of heat and air pollution exposure on human health in India: Evidence and solutions

COPE will develop advanced Early Warning and Decision-support Systems (EWDS) for heat and air pollution exposure in two major urban conglomerates in India – Delhi and Kolkata. The research is co-designed and will be conducted in collaboration with user groups, including from vulnerable communities, and stakeholder partners from health care sector and other governance actors. Outcomes of the research will be operationalized through partnerships with governmental agencies. COPE will identify health risk hotspots beyond the select cities and provide risk projections under different climate scenarios with a goal to establish guidance for EWDS in other high-risk areas. COPE aims to investigate and fill critical knowledge gaps concerning: 1) The health risks associated with co-exposure to elevated levels of heat and air pollution in the Indian context. 2) Optimal structuring of EWDS for timely early warnings for heat and air pollution to derive maximal health benefits, emphasizing the needs of most at risk socio-demographic groups and accounting for interactive affects arising from co-exposure to heat and air pollution. 3) Socio-cultural, behavioural, and economic factors that may hinder the adherence to EWDS. 4) Future hotspots for heat and air pollution in India, with a strategic perspective for future EWDS as well as equitable heat and air pollution mitigation and adaptation. COPE will address these research gaps by pursuing four specific objectives: (1) Identify and delineate health risks from individual and concurrent exposure to heat and air pollution in two focus cities of India – Kolkata and Delhi. (2) Build and assess the effectiveness of EWDS for exposure to heat and air pollution in two cities. The EWDS will be operationalized and provide customized alerts by accounting for specific coping and adaptive actions. (3) Uncover structural factors such as socio-cultural, economic, and behavioural factors that may contribute to reluctance or inability to comply with EWDS recommendations and investigate ways to address those. (4) Provide projections of future hotspots of co-exposure to heat and air pollution in India under alternative climate change and socioeconomic scenarios, which will act as a guidance for implementation of future EWDS along with adaptation and mitigation strategies. COPE brings together an international multidisciplinary consortium. COPE will quantify health risks in Indian settings, a low to middle income country (LMIC) experiencing more severe compounded heat and air pollution extremes that are projected to increase rapidly towards 2050. COPE will expand the scope of an existing EWS for air quality in Delhi by including exposure to heat, their concurrent exposure and health impact forecasts and evaluating its advantages, along with investigating the social and behavioural factors that impede their efficacy. COPE will extend this enhanced EWDS to the city of Kolkata. The team includes climate scientists from CICERO Center for International Climate Research (Norway), Indian Institute of Technology Delhi (IITD, India), Indian Institute of Tropical Meteorology (IITM, India) and National Science Foundation National Center for Atmospheric Research (NCAR, USA), epidemiologists at The London School of Hygiene and Tropical Medicine (LSHTM, UK), University of Queensland (UQ, Australia) and IITD, social scientists at NCAR and Environment Conservation Society -SwitchOn nongovernmental organization (SwitchON, India), and a communication team from CICERO and SwitchON. The consortium will leverage the groundwork laid by the project coordinators, which quantifies health risks associated with combined heat and air pollution exposure in Europe, as well as Delhi air quality early warning system (AQEWS) codeveloped by the partners at IITM and NCAR. COPE assesses the health risks from individual and co-exposures to heat and air pollution in Kolkata and Delhi. Daily time-series hospitalization and mortality data will be made available to formulate new exposure-response relationships (ERf) for heat and air pollution. The development of EWDS builds on the AQEWS. EWDS will generate detailed 72-hour forecasts for air pollution and heat by utilizing coupled chemistry climate models. It will use the formulated ERf to issue graded alerts regarding their potential health burden. An integrated decision support system will offer data on the factors contributing to air pollution and guidance on protective actions for heat stress management. The operationalization of the EWDS will be carried out by IITM, leveraging their position within the Ministry of Earth Sciences (MoES) and extensive expertise in developing and implementing the AQEWS. The significance of an effective EWDS lies in recognition of its benefits. COPE prioritizes active engagement and co-design with the stakeholders and user groups including vulnerable communities, health service organizations, schools, and labour unions. Through interviews, focus groups and stakeholder workshops COPE investigates socio-cultural, behavioural, and economic aspects to enhance information dissemination, understand response barriers, develop tailored risk communication, and action plans for diverse audiences, and improve coordination among stakeholders. Projections of heat stress and air quality will be made until 2050. The aim is to identify future hotspot areas where the frequencies of individual and concurrent exposure to heat/pollution in India are expected to be high. Projections will incorporate changing demographics, socioeconomic factors, GDP, and educational attainment. Results will help identifying strategic pathways for the prospective implementation of EWDS across Indian cities. Ultimately, the outcomes from the abovementioned work will converge to establish a functional EWDS designed for managing exposure to heat and air pollution and its impact on human health within LMIC settings. Communication and dissemination of the results from the project is core to obtain the objectives of the project, especially in relation to delineating health risks among vulnerable groups. COPE will have an internal communication workshop for knowledge sharing and for developing strategies for reaching out to stakeholders at different levels. COPE will maintain close collaboration with various stakeholders, including the Indian Meteorological Department (IMD), National Center for Disease Control (NCDC) under the Ministry of Health and Family Welfare (MoHFW), National Disaster Management Authority (NDMA), and the MoES, during all its phases. The Red Cross Red Crescent Climate Center will contribute to aligning project outcomes with stakeholders' and users’ needs effectively. To ensure the sustainability of the research conducted within the project's lifespan, COPE commits to providing long term support for the implemented and operational EWDS even beyond the project's conclusion.