1. Is climate change affecting global health?

Why is the world’s reliance on fossil fuels increasing the prevalence of disease, food insecurity and other illnesses related to heat? According to a Lancet report, how are changing weather events impacting lives? What action is required to stop the crisis from causing further damage?

The story so far:

Even as countries are meeting at the ongoing Climate Change Conference (COP27) in Egypt, a recent report by Lancet, has traced in detail the intimate link between changing weather events and their impact on the health of people. The 2022 Lancet Countdown on Health and Climate Change: Health at the Mercy of Fossil Fuels points out that the world’s reliance on fossil fuels increases the risk of disease, food insecurity and other illnesses related to heat.

What does the report outline?

The 2022 Lancet Countdown report comes at a time when the world is face-to-face with the threat of climate change.

According to the World Health Organization (WHO), climate change affects the social and environmental determinants of health — clean air, safe drinking water, sufficient food and secure shelter.

The Lancet report indicates that rapidly increasing temperatures exposed people, especially vulnerable populations (adults above 65 years old and children younger than one) to 3.7 billion more heatwave days in 2021 than annually in 1986–2005.

How is it leading to rise in infectious diseases?

The changing climate is affecting the spread of infectious disease, raising the risk of emerging diseases and co-epidemics. For instance, it records that coastal waters are becoming more suited for the transmission of Vibrio pathogens. It also says that the number of months suitable for malaria transmission has increased in the highland areas of the Americas and Africa.

The WHO has predicted that between 2030 and 2050, climate change is expected to cause approximately 2,50,000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.

What about food security?

Every dimension of food security is being affected by climate change. Higher temperatures threaten crop yields directly, with the growth season shortening for many cereal crops. Extreme weather events disrupt supply chains, thereby undermining food availability, access, stability, and utilisation. The prevalence of undernourishment increased during the COVID-19 pandemic, and up to 161 million more people faced hunger in 2020 than in 2019. This situation is now worsened by Russia’s invasion of Ukraine, the report underscores.

Is the world dependent on fossil fuel?

The war has led many countries to search for alternative fuels to Russian oil and gas, and some of them are still turning back to traditional thermal energy. The report argues that even if implemented as a temporary transition, the renewed clamour for coal could reverse whatever gains have been made in air quality improvement and push the world towards a future of accelerated climate change that would threaten human survival. Instead, a transition to clean energy forms would undeniably be the sustainable way ahead.

Are there any solutions?

But the report is not all gloom and doom. A health-centred response to the coexisting climate, energy, and cost-of-living crises provides an opportunity to deliver a healthy, low-carbon future, it states. This is the way a health-centred response would work – it would reduce the likelihood of the most catastrophic climate change impacts, while improving energy security and creating an opportunity for economic recovery. Improvements in air quality will help prevent deaths resulting from exposure to fossil fuel-derived ambient PM2.5, and the stress on low-carbon travel and increase in urban spaces would result in promoting physical activity which would have an impact on physical and mental health. The report also calls for an accelerated transition to balanced and more plant-based diets, as that would help reduce emissions from red meat and milk production, and prevent diet-related deaths, besides substantially reducing the risk of zoonotic diseases. The report indicates that this sort of health-focused shifts would reduce the burden of communicable and non-communicable diseases, reducing the strain on health-care providers, and leading to more robust health systems.

These incrementals notwithstanding, it is true that data shows that the pace and scale of climate change adaptation, planning, and resilience is insufficient. In this context, the report calls for global coordination, funding, transparency, and cooperation between governments, communities, civil society, businesses, and public health leaders, to reduce or prevent the vulnerabilities that the world is otherwise exposed to.

2. What does the World Bank report say about India’s cities?

Which entities are funding urban infrastructure in the country? What are the reasons, according to the global financial institution, for low private and commercial investments?

The story so far:

According to the World Bank, India would need to invest $840 billion over the next 15 years, that is, an average of $55 billion each year, to meet the demands of its fast-growing urban population. Its latest report, titled ‘Financing India’s Urban Infrastructure Needs: Constraints to Commercial Financing and Prospects for Policy Action’, puts forth the urgent requirement to leverage greater private and commercial investments to meet the emerging financial gaps.

Who provides finances to build cities?

Financing on a repayable basis can be done either through debt, private lending or public-private partnership investments. These require a recurrent source of revenue to meet obligations, thus, mandating raising adequate resources.

Much of the urban infrastructure in India is financed by tied intergovernmental fiscal transfers, that is, vertical and horizontal transfer of finance for attaining certain objectives sub-nationally. Of the finances needed to fund capital expenditures for Indian cities, 48% is derived from State governments, 24% from the Central government and 15% from urban local bodies’ own surplus. The rest includes public-private partnership (3%), commercial debt (2%) and loans from Housing and Urban Development Corporation, or HUDCO (8%).

As for private debt, the World Bank observed, that only a handful of large cities have accessed institutional banks and/or loans. In fact, the volume of commercial debt financing might not be an accurate indicator, for States might accord loans to their entities via their self-regulated financial institutions at concessional terms. For example, Tamil Nadu Urban Development Fund and Tamil Nadu Urban Finance and Infrastructure Development Company provide loans on concessional terms.

What are some of the constraints?

The report argues that the overall funding base to raise commercial revenues “appears to be low” owing to weak fiscal performance of cities and low absorptive capacity for execution of projects.

Broadly, the global financial institution has argued that low service charges for municipal services undermine financial sustainability and viability. It goes to the extent that urban bodies are unable to recover operations and maintenance costs, thus, constraining their ability to further execute projects. In a related context, the report states that city agencies have been unable to expand their resource and funding base to support private financing for services such as water supply, sewerage networks and bus services, as they are highly subsidised. These are sourced from either their general revenues, own-source revenues (such as house tax, professional tax, property tax among others) or fiscal transfers.

Additionally, as for private-public partnerships, it states that revenue sharing designs between the two entities is not particularly viable for private investors and does not fully account for risk-sharing or risk-transfer mechanisms for project risks. Thus, problems arise during unanticipated demand shocks alongside legal and technical challenges that require restructuring to an entire public ownership.

Does the report propose solutions?

The central idea is to increase cities’ fiscal base and creditworthiness. For improving their fiscal base, it states, cities must institute a buoyant revenue base and be able to recover the cost of providing its services. The latter could be attained by revising property taxes, user fees and service charges, among other streams, from the current low base.

3. Editorial-1: A call to action to avoid climate catastrophe

Climate change is a global problem that requires cooperation between all nations. That is why today, more than 30 newspapers and media organisations in more than 20 countries have taken a common view about what needs to be done. Time is running out. Rather than getting out of fossil fuels and into clean energy, many wealthy nations are reinvesting in oil and gas, failing to cut emissions fast enough and haggling over the aid they are prepared to send to poor countries. All this while the planet hurtles towards the point of no return — where climate chaos becomes irreversible.

Since the COP26 United Nations climate summit in Glasgow 12 months ago, countries have only promised to do one fiftieth of what is needed to stay on track to keep temperatures within 1.5°C of pre-industrial levels. No continent has avoided extreme weather disasters this year — from floods in Pakistan to heatwaves in Europe, and from forest fires in Australia to hurricanes in the United States. Given that these came about from elevated temperatures of about 1.1°C, the world can expect far worse to come.

A fossil fuel ‘gold rush’

As many nations seek to reduce their reliance on Russia, the world is experiencing a “gold rush” for new fossil fuel projects. These are cast as temporary supply measures, but they risk locking the planet into irreversible damage. All this underlines that humanity has to end its addiction to fossil fuels. If renewable energy was the norm, there would be no climate emergency.

The world’s poorest people will bear the brunt of the destruction wrought by drought, melting ice sheets and crop failures. To shield these groups from the loss of life and livelihoods will require money. Developing countries, says one influential report, need $2 trillion annually to cut their greenhouse gas emissions and cope with climate breakdown.

Moral responsibility of rich countries

Rich countries account for just one in eight people in the world today but are responsible for half of greenhouse gases. These nations have a clear moral responsibility to help. Developing nations should be given enough cash to address the dangerous conditions they did little to create — especially as a global recession looms.

Rich nations should deliver on the promise of previously committed funds — such as the $100 billion a year from 2020 — to signal their seriousness. As a bare minimum, a windfall tax on the combined profits of the largest oil and gas companies — estimated at almost $100 billion in the first three months of the year — needs to be enacted. The United Nations was right to call for the cash to be used to support the most vulnerable. But such a levy would only be the start.

Poor nations also carry debts that make it impossible to recover after climate-related disasters or protect themselves from future ones. Creditors should be generous in writing off loans for those on the frontline of the climate emergency. These measures need not wait for coordinated international action. Countries could implement them on regional or national levels. A nation’s cumulative emissions must be the basis of its responsibility to act. While private finance can help, the onus is on big historical emitters to stump up the money.

Solving the crisis is the moonshot of our times. Getting to the moon succeeded within a decade because huge resources were devoted to it. A similar commitment is needed now. But an economic crisis has reduced rich countries’ appetite for spending and the planet risks being trapped in fossil-fuel-dependence by a rearguard action of big business. Yet, during the pandemic central banks across the world lubricated states’ expenditure by buying up their own governments’ bonds. The trillions of dollars needed to deal with the ecological emergency demands such radical thinking returns.

Act now

This is no time for apathy or complacency; the urgency of the moment is upon us. The United Nations Framework Convention on Climate Change must be about the power of argument, not the argument of power. Key to maintaining the consensus in Egypt is not to let disputes over trade and war in Ukraine block global climate diplomacy. The United Nations process may not be perfect. But it has provided nations with a target to save the planet, which must be pursued at COP27 to stave off an existential risk to humanity.

4. Editorial-2: Undermining federalism, eroding States’ autonomy

When the National Democratic Alliance Government (NDA) took office in 2014, there were hopes that India would move towards cooperative federalism. This was because Narendra Modi, as the Chief Minister of Gujarat, had been championing the cause of States’ autonomy. This hope was reinforced when NITI Aayog replaced the Planning Commission of India with the main objective of promoting cooperative federalism.

The Cabinet Resolution of January 1, 2015 constituting the National Institution for Transforming India (NITI Aayog) has articulated, among others, that “India is a diverse country with distinct languages, faiths and cultural ecosystems… The States of the Union do not want to be mere appendages of the Centre. They seek a decisive say in determining the architecture of economic growth and development. The one-size-fits-all approach, often inherent in central planning, has the potential of creating needless tensions and undermining the harmony needed for national effort”.

One of the main mandates of NITI Aayog is to foster cooperative federalism through structured support initiatives and mechanisms with the States on a continuous basis, recognising that strong States make a strong nation.

It is unfortunate that NITI Aayog has not taken any major steps since its constitution to promote cooperative federalism. Contrary to its public statements on promoting cooperative federalism, the Government of India has been doing exactly the opposite. The following instances clearly demonstrate as to how the central government’s policies have undermined the spirit of federalism and eroded the autonomy of the States.

Breaking the ‘award and package’ tradition

It has been a well-established tradition to treat all the recommendations of the Finance Commissions relating to transfers to States as an award and a package. This tradition was broken for the first time while dealing with the recommendations of the Fifteenth Finance Commission. The Fifteenth Finance Commission, in its first report, had recommended a special grant to three States amounting to ₹6,764 crore to ensure that the tax devolution in 2020-21 in absolute terms should not be less than the amount of devolution received by these States in 2019-20. This recommendation was not accepted by the Union Government. Similarly, the recommendation relating to grants for nutrition amounting to ₹7,735 crore was not accepted. A similar approach has been followed by the Union Government with regard to grants to States recommended by the Finance Commission for the period 2021-26. The sector-specific grants and State-specific grants recommended by the Commission amounting to ₹1,29,987 crore and ₹49,599 crore, respectively, have not been accepted. This clearly demonstrates that the Union Government has undermined the stature of the institution of the Finance Commission and cooperative federalism.

Off-Budget borrowings

The decision to treat off-Budget borrowings from 2021-22 onwards serviced from the State budgets as States’ borrowings and adjusting them against borrowing limits under Fiscal Responsibility and Budget Management (FRBM) in 2022-23 and following years is against all norms. This is the first time that the Government of India is proposing to treat off-Budget borrowings as government borrowings retrospectively from 2021-22. The Government of India has indicated that such a decision is in accordance with the recommendation of the Finance Commission. In fact, there is no recommendation to this effect by the Fifteenth Finance Commission. The Finance Commission recommended that governments at all tiers may observe strict discipline by resisting any further additions to the stock of off-Budget transactions. It observed that in view of the uncertainty that prevails now, the timetable for defining and achieving debt sustainability may be examined by a high-powered intergovernmental group and that the FRBM Act may be amended as per the recommendations of this group to ensure that the legislations of the Union and the States are consistent. No such group has been appointed so far by the Centre.

The borrowings by corporations against State guarantees are mostly used for capital investment. The Centre has also been raising off-Budget borrowings but mainly for meeting revenue expenditure. The Comptroller and Auditor General of India (C&AG) Report on the Compliance of FRBM Act for 2017-18 and 2018-19 pointed out as many as eight instances of meeting revenue expenditure through Extra Budgetary Resources (EBR). Revenue expenditure met through EBR by the Centre amounted to ₹81,282 crore in 2017-18 and ₹1,58,107 crore in 2018-19. Such borrowings were not reflected in the Budget of the central government. In view of this, treating off-Budget borrowings of State corporations as States’ borrowings retrospectively is totally unjustified.

The use of cesses and surcharges

The NDA government has been resorting to the levy of cesses and surcharges, as these are not shareable with the States under the Constitution. The share of cesses and surcharges in the gross tax revenue of the Centre increased from 13.5% in 2014-15 to 20% in the Budget estimates for 2022-23. Though the States’ share in the Central taxes is 41%, as recommended by the Fifteenth Finance Commission, they only get a 29.6% share because of higher cesses and surcharges.

The C&AG in its Audit Report on Union Government Accounts for 2018-19 observed that of the ₹2,74,592 crore collected from 35 cesses in 2018-19, only ₹1,64,322 crore had been credited to the dedicated funds and the rest was retained in the Consolidated Fund of India. This is another instance of denying States of their due share as per the constitutional provisions.

Committee after committee appointed by the Government of India has emphasised the need to curtail the number of Centrally Sponsored Schemes (CSS) and restrict them to a few areas of national importance. But, what the Government of India has done is to group them under certain broad umbrella heads (currently 28). In addition, in 2015, the Centre increased the States’ share in a number of CSS, thereby burdening States. Most of the CSS are operated in the subjects included in the State list. Thus, States have lost their autonomy.

The Sub-Committee of Chief Ministers appointed by NITI Aayog has recommended a reduction in the number of schemes and the introduction of optional schemes. These recommendations have not been acted upon.

The Centre has enacted three farm laws though agriculture is a subject listed in the State List under the Constitution. These farm laws have been enacted under Entry 33 of the Concurrent List relating to trade and commerce in, and the production, supply and distribution of foodstuffs including edible oils and oils. Though these Acts have been repealed, their enactment is against the spirit of the Constitution, and States were not even consulted while introducing these Bills.

All these instances indicate clearly that the Centre has not walked the talk on cooperative federalism. Instead, its policies have made Indian federation coercive.

5. Editorial-3: Stay watchful

Policymakers can ill-afford to drop their guard in the fight against inflation

October’s inflation data point to a welcome softening in price gains that should offer some succour to monetary policy authorities, who have been battling to rein in runaway inflation since the beginning of this year. Retail inflation, or price gains based on the Consumer Price Index, slowed to 6.77% last month, from September’s 7.41%, aided by an appreciable deceleration in food price inflation. The year-on-year inflation based on the Consumer Food Price Index eased by almost 160 basis points in October, to 7.01%, from the preceding month’s 8.60%, helped by a “decline in prices of vegetables, fruits, pulses and oils and fats”, the Government said. With the food and beverages sub-index representing almost 46% of the CPI’s weight, the slowdown in food price gains understandably steered overall inflation lower even as price gains in three other essential categories, namely clothing and footwear, housing, and health, remained either little changed from September or quickened. Inflation at the wholesale prices level also continued to decelerate, with the headline reading easing into single digits for the first time in 19 months. A favourable base effect along with a distinct cooling in international prices of commodities including crude oil and steel amid gathering uncertainty in advanced economies was largely instrumental in tempering wholesale price gains.

Still, a closer look at sequential trends in retail inflation, especially in food items, flag the imperative for policymakers to remain watchful. While year-on-year inflation in vegetable prices slowed sharply to 7.77% last month, from September’s breathless 18% pace, the month-on-month gains accelerated to a four-month high of 4.1% and point to concerns that the supply disruptions caused by unseasonal rains in vegetable-growing regions as well as logistical difficulties posed by monsoon flooding may continue to keep prices volatile, at least in the near term. Prices of staple cereals including rice and wheat also remain an object of concern, notwithstanding the Government’s concerted efforts to cool volatility using export control measures. While inflation in the largest weight in the food basket ticked up to 12.1% in October, from the previous month’s 11.5%, sequentially, price gains came in at 1%, moderating in pace from September. Reports of paddy crops being submerged or affected by heavy rains in different parts of the country coupled with the shortages of wheat and flour that have pushed up their prices all signal more volatility ahead in cereal prices. With S&P Global’s latest Business Outlook survey pointing to an intensification of wage pressures and producer pass-through of costs, authorities can ill-afford to drop their guard in the fight against inflation.

6. Editorial-4: Health as the focus of air pollution policy

The worsening winter air quality in north India has yet again brought into public focus the harmful effects of air pollution on our health. The effects of exposure to bad air are felt in every organ of the body, and most deeply by the vulnerable in society — children, the elderly, pregnant women, and those with pre-existing health conditions. In India, in 2019, 17.8% of all deaths and 11.5% of respiratory, cardiovascular and other related diseases are attributable to high exposure to pollution (The Lancet). This public health emergency has resulted in calls for health to be made central to air pollution policymaking.

Glaring in its absence

The primacy of protecting public health — the raison d’etre of environmental legislation — is clearly laid out in the statement of objects and reasons of India’s key environmental laws. Yet, if we examine the constitution of our environmental regulators, expert groups and decision-making entities that define and translate those laws into air pollution policy, health expertise is glaring in its absence. Driven by a combination of the isolated nature of policymaking and an insufficient understanding of health among policymakers, air pollution policy is created and implemented in a vacuum. There is little cognisance of the effect it has on society.

So, what would it mean for India to place health at the centre of air quality governance and policymaking? So far, Indian air pollution policy has at best treated health as merely one of the several equally relevant facets in decision-making. It must transcend this. Health must be turned into a feature and eventually a function of air pollution policy.

To treat health as a facet of air pollution policy has meant to occasionally provide a health voice a seat at the table. However, an examination of even the most recently constituted institution, the Commission for Air Quality Management, reveals a lack of any health representation. Recent papers published by the Centre for Policy Research also reveal that health sector representatives comprise less than 5% of the membership of State Pollution Control Boards. How can their work as front-line air pollution regulators be effective or more sensitive to health needs if health doesn’t even feature in important policy discussions?

Lessons to be learned

What does it mean to make health a feature of air pollution policy? Health and epidemiological evidence will drive our determination to achieve substantial health benefits from clean air targets. The only effort till date in India, which has viewed air pollution through this lens, is the Ministry of Health’s Steering Committee on Air Pollution, which took an exposure-centered view to policy. It did this by prioritising interventions that contributed the most to reducing exposure and thereby providing health benefits. It also brought to light the local and global epidemiological evidence on the harmful effects of air pollution, and defined policy measures aligned with that science (for example, focusing on household cook stove smoke).

As India is in the process of revising its ambient air quality standards (NAAQS), it would do well to learn from this ground-breaking effort. The NAAQS review has remained a largely opaque process over the years, and foregrounding health in such a process would mean the standards would be determined not just by local conditions, but also by the impact of exposure on vulnerable populations.

Eschewing the status quo

The final step would require a radical rethinking of the way we design policy from the ground up. Behind every source that contributes significantly to air pollution, there is a story of parochial, sectoral, and isolated policymaking. Whether it is stubble burning (a by-product of ill-thought-out water conservation laws) or thermal power plant emissions (where more stringent standards have been delayed for over five years), decisions are made without any consideration of their potential second and third order effects, especially on health.

Here, again, there are lessons to be learned from the Health Ministry’s Steering Committee. The committee convened experts from a range of disciplines and sectors, including epidemiology, environment, energy, transport, public policy and economics, to develop a prescription that would primarily focus on health benefits. Indeed, such an approach that foregrounds the explicit health benefits of specific sustainable and effective interventions is needed to prevent the repudiation of basic science that ensures the proliferation of untested, ad hoc techno fixes such as smog towers. This kind of thinking would also lead us to accelerate climate and air quality actions that control emissions from those sectors that cause the greatest health burden.

We are at a crossroads in our fight against air pollution. The contemporaneous approach to tackling this issue has been tried for decades and has proven ineffective. The choice lies before us now on whether we want to centre science and health in what will likely be a long road to fixing this problem, or continue down the same path that has led us to this smoggy status quo.