Via Bloomberg, a look at how cities – the first line of defense in humanity’s battle against deadly heat – are working to protect their people from extreme temperatures:

Ahmedabad is an example of the patchwork coping mechanisms that cities around the world are taking to save lives in a hotter world. Thermometers have in recent days approached 45C (113F) in India’s northeastern states of Bihar and Uttar Pradesh, raising concerns about potentially heat-related deaths and driving home the need for proper preparation before the annual heat begins.

In addition to parametric insurance programs for outdoor workers, there are efforts in Ahmedabad to cover roofs with heat-reflective paint, implement early-warning systems and establish hospital heat wards in the city of more than 8.5 million people. The proactive approach has become a blueprint for other cities in developing countries who have accepted that record temperatures aren’t just freak weather: they’re the new reality as the planet continues to warm.

Greenhouse gas emissions from cars, power plants and other human activities have already made the planet 1.2C hotter than during pre-industrial times. The resulting extreme heat can exacerbate heart and lung conditions, especially when pollution levels are high, and make it harder for people to focus and work. The effect is particularly acute in packed cities, where the heat island effect makes things worse.

In India, high temperatures can easily become fatal when combined with humid conditions because it becomes harder for the human body to cool down by sweating. Last year, temperatures in the country hit a new record of 49C and days well above 40C have become common in almost every major Indian city during May and June.

Global warming of 2C, a threshold that the world is currently on track to blow past, would result in a sixfold increase in the number of heat waves in India, according to a 2018 scientific paper. A separate study earlier this year found over 600 million people in India — more than any other country — will be exposed to unprecedented heat by the end of this century if carbon pollution isn’t reigned in.

Chauhan still gets anxious when she thinks about the heat wave that engulfed Ahmedabad in 2010. As temperatures soared past 46C, she realized there was nowhere for her family to shelter. Even staying home was painful; poor ventilation, cement walls and a tin roof made it hotter indoors than it was outside.

That May, a slow-moving cyclone made pre-monsoon conditions in Ahmedabad even hotter than usual. More than 1,300 people died, hospitals were overwhelmed and, in a dystopian twist, 400 bats dropped dead from the heat. So much greenery had been lost as the city expanded that there were fewer trees to provide shade or cool the air.

“It was a wake-up call,” says Abhiyant Tiwari, a public health and climate expert who advised Ahmedabad’s municipality at the time. “We decided we would work on the issue of extreme heat so in the future, if it ever happened again, we could be prepared.”

More than a decade on, climate change has made the seasonal heat more intense and more persistent, but Ahmedabad has learned how to better deal with it. People like Chauhan now understand what a heat wave is, and the risks it entails. Most importantly, they have ways to mitigate the impact.

Following advice from SEWA, Chauhan daubed her home’s tin roof with cooling paint. Now, temperatures inside are bearable during the day, so her children can comfortably spend time there and her meat supplies aren’t in danger of spoiling. But when the mercury rises, women like her still face a dilemma: stay home and lose a day’s income, or brave dangerous conditions to earn a living?

“They get blisters on their hands from handling burning tools, miscarriages, urinary tract infections and headaches,” says Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center, which financially supports SEWA and subsidizes the parametric insurance program. “The key is to protect their health so they can protect their income.”

The center currently covers premiums for women so they only have to contribute a symbolic $1 to the program in order to be eligible for up to $85 payouts when temperatures over three days add up to a certain number, such as 134C. (For example, if the city saw 43C, 42C and 49C days in a row.) These workers make on average $3 a day. Baughman Mcleod says her organization developed an algorithm that accounts for more metrics such as night-time temperatures, cloud cover and air pollution levels.

Other organizations are looking at even more sophisticated approaches. London-based Global Parametrics is working with local nonprofit Mahila Housing Trust to design a layered program where different levels of heat would trigger corresponding payments. Mahila is currently conducting training and information sessions and expects to roll out the product in three Indian cities including Ahmedabad next year.

The best way to make the product sustainable is to spread it over a wide geographic area so that risk is more distributed, says Wendy Smith, impact and ESG manager at Global Parametrics. “The aim is to have something that won’t end just after it’s piloted for a year or two.”

Independent initiatives run by local collectives such as SEWA and Mahila are a key part of Ahmedabad’s climate adaptation story, but it’s the city’s coordinated approach that’s been the key to cutting heat-related mortality rates. And that wasn’t easy to achieve.

After the 2010 heat wave, Ahmedabad’s leaders sought to import successful adaptation strategies from other developing countries, but found that none existed, says Tiwari. So they studied what Chicago did after a 1995 heat wave that left 739 people dead. They also looked at the European response to a heat wave that caused at least 30,000 excess deaths in 2003. The answer was to put in place an early-warning system that would alert citizens and trigger a coordinated emergency response across the entire public administration.

Interventions on India’s Heat Action Plans

Main areas of focus for cities fighting high temperatures

In 2013, Ahmedabad became the first South Asian city to launch a Heat Action Plan. The first challenge for local leaders was convincing the public that heat was even a problem.

“Unlike in the US or Europe, heat is not typically considered a disaster here,” says Tiwari, who now oversees heat initiatives in India for the Natural Resources Defence Council, a US nonprofit. “Being a tropical country, there’s the misconception that we’re ok with heat, that it can’t affect us.”

The next hurdle was getting the message to the poorer communities who suffer most from extreme heat. City authorities sent heat alerts by SMS and WhatsApp and put out press releases and billboard messages — but Ahmedabad’s most vulnerable are often illiterate. So authorities engaged health workers, community leaders and radio hosts to communicate weather warnings and advice for staying cool.

“What works for low-income groups is word-of-mouth,” says Rajeswari Gorana, a consultant with Mahila Housing Trust, which also pioneered cool roofs in the city. “Women had to be empowered, taught and trained on concepts like heat waves, indoor temperatures and ventilation.”

A color-coded alert system proved most effective. Yellow means it’s going to be a hot day, between 41.1C and 43C, while orange denotes temperatures of 43.1C to 44.9C. Red is the highest level, reserved for days above 45C.

On a yellow day, hospitals, schools and professional groups distribute pamphlets and posters with tips to prevent heat stress. Transport officials install fans and shades at train and bus stations, and distribute drinking water. City hall press officers brief local journalists.

These actions ramp up as heat levels increase. On a red day, temples, public buildings and malls are turned into cooling centers where people can find air conditioning and water. Hospitals set up wards with staff trained to treat heat strokes, cramps, dehydration and skin inflammation. Outdoor workers shift their hours to avoid the hottest part of the day.

“Now the people of Ahmedabad — right from the poorest and most vulnerable all the way to those living with best facilities — have started talking about heat and acknowledging its effect,” says Tejas Shah, a deputy health officer at Ahmedabad’s municipal corporation.

Before the plan came into full effect, the city’s average number of deaths in May and June was 20% to 30% higher than the rest of the year, Shah says. While India doesn’t have comprehensive cause-of-death data, Ahmedabad’s five main hospitals registered 65 heat-related deaths and 274 heat stroke cases during the heat wave of 2010. This season, there have been 46 heat stroke cases and no recorded heat-related deaths so far, according to the city’s latest available data.

Ahmedabad’s story shows how many lives can be saved with forward planning, even when resources are limited. Still, it’s just one part of the battle that the world’s most populous country is waging against scorching heat.

A more ambitious nationwide India Cooling Action Plan, which outlines measures to deal with rising heat over the next two decades, hasn’t been funded. That’s leaving many cities behind as temperatures creep up elsewhere.

“We have very enlightened leadership in some cities, but overall it’s not going fast enough,” says Anjali Mahendra, director of global research at the World Resources Institute’s Ross Center for Sustainable Cities. “Until we can attach budget streams from the India Cooling Action Plan at the regional and city level, there’s no point in having a policy just on paper.”

The scale of the challenge is hard to miss at one of Ahmedabad’s oldest markets, near the historic Lal Darwaja area. Every day, hundreds of vendors set up small, makeshift shops along the narrow lanes. It’s a bustling scene; everything from vegetables to electronics and plastic knick-knacks is on sale. The smell of street food and chatter of buyers and sellers fills the heavy air.

A vehicle arrives to deliver refillable water jugs to shopkeepers who can afford them. As temperatures start to rise, the unlucky ones begin to visibly struggle. Those working without shade succumb first, closing up early. Vegetables and flowers wilt. Over time, colored fabrics and plastics fade, making them worthless.

“The glass on these frames has cracked and now I cannot sell them,” complains Nathi ben Jagdish bhai Parmar, a purveyor of photo frames and cut-price home decorations. “I will have to bear the loss for all this,” she says, gesturing to wall hangings that have been bleached by the sun.