By Sandipta Rath, Anwesha Mishra, Sruti Mohapatra, Purnasha Pany
CHHANW team, Institute of Economic Growth

“Buying an AC was never a choice but a need. When my father collapsed due to sunstroke during work, we made the decision to prioritize his health even if it means we will be tied to monthly installments and high electricity bills forever.”

– Daughter of an elderly outdoor worker, living in a slum area in Bhubaneswar

Vulnerable populations residing in low income settlements such as slums, often bear the maximum brunt of extreme heat during the summer months in India. The elderly, children and outdoor workers, are vulnerable to health risks, with little or no access to cooling equipment or sustainable cooling options.

Houses in these underserved slums are described as “furnaces” by the inhabitants, with structures made of tin, asbestos and concrete that trap heat with limited ventilation and inadequate cooling mechanism. This continuous exposure to heat, without the means to cool down the body temperature, pushes the residents towards heat-related illnesses (HRIs). In a recent survey conducted on heat-health risks by the CHHANW project team, HRIs reported ranged in severity from heat exhaustion, sleeping disorders, dizziness and dehydration to more acute conditions such as heatstroke and even death.

Experiencing “Heat Poverty,” is a growing concern amidst the vulnerable. While cooling has become an inescapable necessity, the financial burden associated with maintaining thermal comfort adds another layer of vulnerability to financially constrained households. Air conditioning is set to become the most prevalent heat-coping strategy worldwide, with sales increasing multifold across all segments of society over the last few decades. For many though, the capital and operational expenses incurred often outweighs the comforts.

Bhubaneswar, Odisha, is known for its high heat stress conditions in summer, with high temperatures combining with high levels of humidity reaching up to 80%. Within Bhubaneswar, a total of 40 heat zones have been identified, with the urban heat island effect playing a major role in raising the temperature (Swain et al., 2017). In low resource settings, the dire heat conditions have pushed some households to incur debt to purchase an air conditioner to protect the health and well-being of their family members.

In the primary survey conducted under the CHHANW project, in Bhubaneswar, individuals who sought treatment for HRIs, reported that the average total treatment cost incurred equaled ₹2370 for out-patient services and ₹3368 for in-patient/ hospitalisation services.

Describing her family’s struggle, a young woman residing in a slum, described the difficult decision of buying an air conditioner, despite it being unaffordable for the most part. Her father, an elderly outdoor worker suffering from diabetes, experienced a severe sunstroke that resulted in an extended period of illness and high medical costs. The family took a loan to purchase the air conditioner, with monthly installments and increased electricity bills resulting in a continuous financial strain. However, the family considered the air conditioner more affordable than the cost of suffering, after failing to gain respite from other available cooling options such as ceiling fans.

They observed a positive shift in the health of their father, who adjusted his work schedule to working in the evening hours, while resting during the peak afternoon heat. The installation of the air conditioner improved the thermal comfort of the father and the other members of the household.

The woman further stated,

“Even though we are paying for it every month, at least my father is alive and recovering.”

This story captured from the field highlights the multiplication of vulnerabilities compounded by age and chronic diseases that lead to serious heat related health risks. Heat disproportionately affects elderly people, as the ability of the body to dissipate heat slows down with age. The presence of co-morbidities such as diabetes, hypertension and other chronic conditions exacerbates the health risks. Access to cooling mechanisms becomes essential to preserve the health of the elderly.

While air conditioning may appear to be an inevitable solution to prevent heat-related illnesses (HRIs), and specially so among the elderly, it places a financial strain on households, compromising their ability to invest in other essential needs of household members. There is a critical need to develop low-cost and sustainable cooling alternatives. Investments are required in sustainable cooling strategies, which are affordable, scalable and do not contribute to the core problem, which is of increasing GHG emissions and a warming planet.

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