Health SDGs are at risk from climate change: Evidence from India

PLOS One | https://doi.org/10.1371/journal.pone.0335529 November 26, 2025 11 / 17 of experiencing adverse health outcomes as compared to those in districts that are less vulnerable to climate change. The chances of being stunted, wasted, or underweight are 1.15 (CI: 1.109–1.198), 1.06 (CI: 1.017–1.112) and 1.25 (CI: 1.203–1.299) times higher respectively, for districts that are highly vulnerable to climate change. In these highly vulnerable districts, the chances of women having non-institutional deliveries or facing problems in accessing health care is also 1.38 (CI: 1.307–1.473) and 1.009 (CI: 1.00914–1.00918) times higher, respectively. The variation in odds ratios across health outcomes reveal that these are not equally sensitive to climatic vulnerabilities and that some outcomes are impacted more than others. The largest impact is observed on non-institutional deliveries, followed by being underweight and stunted. The distribution of wasting outcomes is more complex in the Indian context and finds higher prevalence across all the socioeconomic categories including amongst households in the higher wealth quintiles. In this regard, discerning a significant association with climatic vulnerability is of particular interest and suggests a potential role of the climatic factor in influencing the health outcomes. 4. Discussion This study highlights the criticality of the role of climatic vulnerability in determining key health-related SDG targets in India. Our findings reveal that climate change has a significant and distinct association with poor health outcomes even

after accounting for other well-established determinants for good health such as mothers’ education, birth orders of chil- dren, and access to health care facilities, in alignment with findings from major assessments [4,86–88]. The analysis reveals significant disparities in SDG outcomes across districts in India, in spite of progress being made in several of the determinants that are well-established as determinants of health outcomes. Districts which are highly vulnerable in terms of climate, underperform on health metrics including stunting, wasting, being underweight, having non- institutional deliveries and facing problems in accessing health care. Similar adverse findings for maternal and child health and nutrition attributable to climate change have been observed elsewhere [89–91] The study findings thus add value to the existing understanding on determinants of health outcomes in India, by providing substantive evidence at scale on how climate impacts act as an additional determinant. It innovatively brings together data from large and well-established datasets in India. The quantification of adverse impacts on health outcomes that can be attributed to climate change, Fig 3. Odds ratios. https://doi.org/10.1371/journal.pone.0335529.g003