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

PLOS One | https://doi.org/10.1371/journal.pone.0335529 November 26, 2025 2 / 17 1. Introduction Risks to human health from climate change are on the rise globally, adversely impacting and undermining multiple dimensions of health and well-being [1,2], including in India [3,4]. Climate change impacts on health include increasing mortality and morbidity from extreme events such as heatwaves [2,5], droughts, and floods [2]; spread of vector borne diseases [6,7] and altered disease patterns, disruptions in access to health care [8], destruction of health infrastructure [8]; and impacts on health-seeking behavior [9,10], to name a few. For instance, evidence shows that long term exposure to extreme heat increases the risk of death from existing illnesses including cardiovascular and respiratory illnesses, along with the direct impacts, such as exhaustion, headache, sleep disturbances and heat stroke [11–13]. Climate risks can adversely impact the achievement of the Sustainable Develop- ment Goals (SDGs) of the UN [14]. The SDGs comprise of seventeen global goals and targets enshrined under each goal, and are intended to ensure health, justice and prosperity [15]. Health is an important component of the SDGs, with SDG 2 (Zero Hunger) and SDG 3 (Good Health & Wellbeing) containing several health- related targets, such as ending hunger, improving nutrition, reducing mortality, improving access to healthcare, and ensuring universal health coverage. It is critical to accelerate progress in achieving the health targets of the SDGs, since the current

trends in these are insufficient to meet the health goal by 2030 [16]. Climate change, climate-related risks, and disasters can pose significant challenges to achieving the SDG targets [17], and potentially disrupt the achievement of SDGs [18,19]. For effectively addressing shortfalls and reducing disparities in health amongst vulnerable populations, it is therefore essential to take serious note of these impacts and drive investments in the right direction. The extent of vulnerability differs from one region to another, especially in a large country like India, and is influenced by local climatic, geographical, and socio-economic factors [20]. Around 64% [21] of the Indian population stays in rural areas while 46% of the population is employed in agriculture in 2023 [22]. As compared to urban areas, rural areas are under-served in terms of health care services [23] and infrastructure such as roads, electricity, hous- ing and communications [24]. The gap in consumption expenditure between rural and urban areas has been reducing [22] Given the significant share of population residing in rural areas, estimated to be around 915 million in 2023 [25] mapping and quantify- ing the shortfalls in health outcomes which are attributable to climate change impacts can help develop appropriate adaptation policies. The impacts of climate hazards on human health are severe and already being felt globally as well as in India [26–29]. This study is an innovative attempt merging data from the largest national survey on

health with climate data, to examine and provide quantifiable evidence on the links between climate and health outcomes in India. It examines whether climate action can contribute to achieving good health. The objective of the study is thus set-up to provide quantitative evidence on the extent to which climate change impacts and poses a barrier in achieving the health-related SDG targets across different districts in rural India. The data used for the analysis is taken from national level surveys conducted by government agencies Funding: This paper was written with support from the Wellcome Trust, UK [226740/Z/22/Z], for a research grant. PD is the principal inves- tigator, WJ the co-principal investigator, while GS, MC and G are research staff on the study team. The authors are solely responsible for the views expressed in this paper. The funder has played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://well- come.org/. Competing interests: The authors have declared that no competing interests exist.