This document summarizes a study on the effectiveness of an awareness program in reducing deaths from heat waves in India. The study found that districts that participated in the Disaster Risk Management (DRM) program's intensive awareness campaign on heat wave dos and don'ts experienced fewer heat wave deaths compared to districts without the program, even during severe heat waves. A difference-in-differences analysis estimated the awareness campaign averted around 170 deaths in the DRM districts. Additionally, the use of multiple media outlets and grassroots programs together in the DRM districts was found to further reduce deaths compared to either approach alone. However, the results require validation with more detailed mortality, awareness exposure, and heat wave response data.

1. Awareness as an adaptation strategy for reducing
health impact from Heat Waves: Evidence from a
Disaster Risk Management Program in India
Saudamini Das, Asso Prof. Institute of
Economic Growth, Delhi
&
SANDEE Fellow
Economics of Climate Change Adaptation Workshop, UNDP, ADAPT ASIA-PACIFIC
Workshop, 24-26 Oct 2012, Bangkok
The views expressed are those of the presenter and should not be attributed to either UNDP or USAID.
Furthermore, it is strongly recommended that both the PowerPoint slides and the videos of the presentation of
content included herein are viewed in conjunction in order that statements appearing in the PowerPoint slides are
not interpreted out of context.

2. Heat Waves – Spell of hot & humid weather
Under normal conditions, the body’s internal thermostat
produces perspiration that evaporates and cools the
body.
In extreme heat and high humidity, evaporation is
slowed and the body has to work extra hard to maintain
normal temperature. If core body temperature exceeds
40.6 C, heat stroke occurs causing death.

3. • If normal temperature < 40° C
Heat Wave ⇒ + 5 or 6° C
Severe Heat Wave ⇒ +7° C
• If normal Temperature > 40°C
Heat Wave ⇒ +3 or 4° C
Severe Heat Wave ⇒ +5° C
• If max temperature is around 45° C for two
days (40° for coastal area), it is called heat
wave condition
Formal Definition: Heat Waves (Indian Meteorological
Department)

4. Background of Heat Waves
• Global phenomena
• Examples of high mortality: Chicago 1995, 1999; Mexico
1998; France, Italy and many parts of Europe 2003; Orissa
1998; AP 2003
• International Response:
 Study effects on health (California Study),
 Identify risk and effective intervention (Euro HEAT Project),
 Heat warning, activation of social network,
 Health education and awareness etc.
• No evaluation of health education / awareness
programs

5. Literature linking Heat Waves and Mortality
• Link between mortality and temperature rise is established
(Deschenes 2010; Deschenes & Greenstone 2008, 2007;
Menne & Ebi 2006; Basu & Samet 2002)
• Studies on heat wave incidences
 Individual event analyses (O’Neil et al. 2003, 2009;
Smoger 1998; Semenza et al. 1996; Naughton et al. 2002)
 Case cross over approach (Michelle L Bell et al. 2008)
 Impact evaluation of state responses (heat alerts) by
regression discontinuity method (Alberini et al (2008)

6. Heat Waves in Odisha
General features of the
State
 30 districts
 10 Agro-climatic zones
 Per capita annual income:
US$220
 Below poverty line:
47.15%
 Workforce in agri = 75%
 Urban population = 15%

7. Heat Wave Deaths in Odisha
Year
Heat
Wave
Days Deaths Year
Heat
Wave
Days
Deat
hs
1983 1 3 2002 21 41
1987 2 1 2003 28 67
1988 1 22 2004 8 41
1989 1 1 2005 29 234
1995 1 9 2006 4 21
1996 2 3 2007 8 47
1998 28 2042 2008 12 69
1999 25 91 2009 29 85
2000 18 29 2010 38 100
2001 12 25
HWDs

8. Temperature anomaly: distribution of max summer
temperature and heat wave days in Bhubaneswar
Max Temp

9. Odisha Government Interventions
Before 2002 (1999-2002)
 Calamity Committee meeting
(February and March)
 HW warning, Jal Chhatra,
Health facility, rescheduling of
work hours, school timing, bus
timing etc.
 Television discussions by health
department
Additional after 2002 (DRM
Project)
 Awareness generation through
multiple media
 Awareness activities
(GOs/NGOs)

10. Posters & Advertisements

11. Logic Model for Awareness
Program
Program input Program output Program impacts
• Do not go out of home in empty stomach,
• Drink lots of water, carry water bottle and
ors solutions
• Avoid travel during noon
• Carry umbrella or wet towels
• Wear light colored cotton cloths
• Small children, elderly, fat people and
persons with diabetic, blood pressure, heart
problem need extra care.
• Do not give water to persons becoming
unconscious and consult doctor
• Avoid alcoholic drinks
• Change in dietary habits
• Carry umbrellas or cover head with wet
cloths if traveling during noon.
• Less exposure during noon or change in
work plans
• Awareness on heat
waves
• Awareness of
consequences if do not
follow the instructions.
• Change in dietary habits
• Carry umbrellas or cover
head with wet cloths if
traveling during noon.
• Less exposure during
noon or change in work
plans
• Less mortality
• Less heat attack or
less hospitalization or
less work time loss

12. Study Objectives
• Does intensive dissemination campaign
on heat waves help reduce deaths
more? (DRM vs. non-DRM)
• Did the Awareness Campaign and
Grass root program compliment each
other?

13. Heat wave deaths in treatment and control districts
0
50
100
150
200
1999*
2001*
2003*
2005*
2007*
2009*
Year
Deaths
death_DRM districts
death_nonDRM

14. Methodology
• Difference-in-Difference (DID) for the 1st
objective
 Examine difference in deaths between DRM and non-
DRM districts
• Difference-in-Difference-in-Difference (DDD) for
the second
 Difference between DRM & non-DRM districts for
intensive campaign years over no campaign years
• Panel Data (13 (1998-2010) years, 30 districts)
from multiple secondary sources

15. What is DID?
Before
(2001)
After
(2009)
Differ
ence
DRM
(tt)
750 450 300
Non_
DRM
(cont)
500 400 100
-50
(Simple
diff)
200
(DID)
Deaths
Time
Before After
DRM
Non-DRM
DID
2 period, 2 group set up

16. Results -1:
(Diff-in-Diff between DRM & non-DRM districts)
Explanatory Variables District fixed effect Poisson est. Random effect Poisson est.
DRM_period 1.842*** (0.178) 2.015*** (0.165)
DRM_district ---------- -1.091 (1.248)
DRM_periodXDRM_district -0.536 ***(0.128) -0.683*** (0.117)
Time_Trend -0.524*** (0.029) -0.590 *** (0.027)
Population -0.111 (0.079) 0.104 ** (0.055)
DistrictNet Domestic Product 0.225 *** (0.083) 0.152 ** (0.074)
Per Capita Income 0.012 (0.011) 0.017* (0.009)
Dummy_ Coastal Districts ---------- -0.702 (1.513)
Forest_cover -0.004*** (0.001) -0.002*** (0.001)
Population_share_agri_labor 41.299 (118.053) -36.473 (33.469)
Population_share_other_worker 61.911 *** (21.886) 51.408*** (14.669)
Population_share_marginal_worker -46.441 (125.713) 60.152 (40.542)
Number_HeatWaveDays 0.001 (0.006) 0.003 (0.007)
Number_SevereHeatWaveDays 0.067 *** (0.007) 0.057*** (0.007)
Dummy_Excessive_Hot_Year 0.716*** (0.065) 0.712*** (0.065)
Days with more than 40C temp 0.044*** (0.003) 0.048*** (0.003)
Constant ----------- -2.668 (2.193)

17. Result – 2: DDD results for variable of interest
(District Fixed Effect
Poisson Estimates)
Variable of
interest (Triple
interaction
term)
Entire
Sample
(N =
390)
Restricted Sample
Districts and
years
(40deg_more>5)
(N=326)
Districts and
years
(HWD>1)
(N=330)
Districts and
years
(SHWD>1)
(N= 226)
Drm_PeriodXdr
m_DistrictXnu
mber_Awarene
s_media
-0.904
(0.601)*
-1.26
(0.603)**
-0.906
(0.594)+
-1.004
(0.587)*
• Averted Deaths for DRM districts = 155 (170 with revised data)
•Das & Smith, Climate Change Economics (2012), Vol 3, No 2.

18. Economic efficiency of DRM project for heat
waves adaptation
 Project cost (2002-2008): US$27m for 125 districts
 Share of Odisha (16 districts): US$3.4m or Rs167m (8 disasters were
covered)
 Expenditure on heat waves: Rs20.88m
 Cost per life saved: Rs0.12m
 VSL for Odisha at 2002-08 average PCI:Rs14.17m (118 times higher)
 VSL for India: Rs13.7-14.2 to Rs55.5-60.6million at 2000 - 01prices ≈
Rs17.8-18.4 to Rs72 -78.12m at 2002-08 PCI

19. Conclusions & Policy Implications
• ‘Issuing heat warning and making people aware of the dos and
don’ts during heat waves’ seems to be a successful adaptation
strategy
• Strategy disseminated intensively in DRM districts of Odisha
witnessed reduced heat wave deaths despite severe heat wave
conditions. The averted deaths around 170 in these districts.
• Media use and grass root programs seem to have complemented
each other.
• The results are not strongly robust – need to be re-examined with
more detailed data on deaths, awareness media and heat wave
measures

20. THANKS !!!!