Climate change is no longer a distant threat. It shows up in record-breaking heatwaves, in pesticide-laden fields, and in the lives of communities affected long before any support reaches them. For this episode of the InnoHealth FAQ session, we sat down with Dr Ratika Samtani, Assistant Professor at IIHMR New Delhi, whose research spans five decades of extreme weather events across India, the health effects of pesticide exposure on women, and the case for millets as both a nutritional and climate solution.

The questions below are the ones our readers ask us most often — and the ones policy conversations in India still answer least well.

Setting the ground

Pinaki: We hear the term ‘climate change’ constantly — in news, in policy, in everyday talk. For most people it still feels like a big, abstract problem meant to be solved by some think tank in a government office. From where you sit as a researcher, what does climate change actually mean for people’s health, and why should someone in India worry about it?

Dr Samtani: I would actually reframe it as ‘climate solutions’. When we talk about climate and health, we focus on the visible events — heatwaves, floods, air pollution — and say temperatures are rising or the rainfall this year didn’t follow the usual pattern. But there is a bigger, deeper connection that receives very little attention: the systems. How climate change affects our food systems, our agriculture, what arrives on our plates, and ultimately what enters our bodies. And it isn’t just about human health anymore. We are talking about one health — how climate change is shaping the entire ecosystem and the biosphere. That is where people need to think about how climate is integrated into all these systems.

Q1. What are the less obvious connections between environmental changes, food systems, and population health that policymakers often overlook?

Dr Samtani: I’ll start with a simple example from a landmark study which found that climate change is not only affecting how much food we grow, but also the nutritional quality of that food. Rising CO₂ levels, when applied to staple foods like rice, wheat, peas, and soybeans, were found to reduce the content of iron, zinc, and protein. Now imagine a situation where everyone may have food on their plate tomorrow, but the nutrient value of that food is almost nothing.

This increases the risk of what we call hidden hunger — where people consume enough calories but still suffer from micronutrient deficiencies. For a country like ours, where many people depend on rice and wheat as staples, and where women and children already face a high burden of anaemia and malnutrition, this is deeply concerning.

Coupled with extreme weather events disrupting agricultural production, the picture becomes more complex. But solutions do exist. Traditional crops like millets — grown for centuries — are highly climate-resilient. They require less water, tolerate heat and drought, and are rich in essential nutrients. The Odisha Millet Mission is a beautiful model now being adopted by different states. I often call millets a triple-win solution: good for farmers, good for people’s health, and good for the planet. This reminds us that climate adaptation is not always about technology. Sometimes the solutions are rooted in traditional knowledge and sustainable systems.

I often call millets a triple-win solution — good for farmers, good for people’s health, and good for the planet.

— Dr Ratika Samtani

Q2. Climate change is often described as a threat multiplier. In the Indian context, which groups face the highest health risks, and why?

Dr Samtani: Absolutely. In India, the multiplication happens most violently at the intersection of three factors — poverty, occupation, and gender.

First, rural women. Research has consistently shown that districts highly vulnerable to climate change have children who are more likely to be underweight, and women more likely to have non-institutional deliveries. Climate vulnerability directly undermines maternal and child health. Women are also disproportionately affected because culturally, during any crisis, they eat less so that children and husbands can eat more. They walk farther for water when water tables fall. They take up informal, low-productivity work when household income collapses.

Second, tribal communities. Studies on communities in Madhya Pradesh report increasing heatwave days and rainfall irregularity, with severely reduced capacity to adapt due to poor housing, distance from health facilities, and dependence on diminishing forests. But I want to emphasise — these communities also hold the solutions. Their indigenous and traditional ecological knowledge systems, developed over centuries, hold valuable answers. Our ICMR study is documenting how tribal communities have adapted over the years.

Third, farmers. A little less than half of India’s working population is involved in agriculture, and almost a third earns below the international poverty line. For these families, a single bad monsoon is not an inconvenience — it is an existential threat. There is no savings buffer, no insurance safety net. A very concerning trend is the increasing use of pesticides driven by climate change, as soils become less viable. Our study with the Department of Biotechnology found this connection clearly in Punjab: farmers are using unprecedented amounts of pesticides to maintain crop yields, without any protective gear or safety nets, exposing themselves to substances that affect hormones and may be leading to cancer.

What all three groups have in common is heartbreaking — they contribute the least to the greenhouse gas emissions that are changing the climate, yet they absorb most of the severe consequences.

They contribute the least to the emissions changing the climate, yet they absorb most of the severe consequences.

— Dr Ratika Samtani

Q3. Why is it so important to understand climate-health risks through a local lens when designing policies and interventions?

Dr Samtani: A local lens is absolutely critical — we cannot have one-size-fits-all solutions. Take a simple example. A heatwave that registers as a moderate temperature event in the national meteorological average may be catastrophic in a district where eighty per cent of workers are outdoor labourers, where the wet-bulb temperature regularly exceeds safe thresholds, and where the nearest health centre is twenty kilometres away. The same event in an urbanised district with predominantly indoor work and better health infrastructure creates a completely different health burden. A policy response calibrated only to the national average protects neither population.

Our own fifty-year data confirms this. Agricultural communities face very different risks from coastal communities, which face different risks from forest-dependent tribal communities. And here is something that will surprise you — a region that was heat-prone and drought-prone thirty years ago may now be flood-prone, and vice versa. Climate patterns have shifted so dramatically over decades that solutions relevant to a community at one point in time may be entirely irrelevant today.

The most effective climate resilience interventions are those rooted in locally contextualised definitions of climate change. We generally have a top-down approach, but we need a bottom-up one — going to communities, talking to them, recognising the unique knowledge and coping mechanisms they already possess. India has a critical asset in community health workers — ASHAs and ANMs — who already operate at the village level. But they are themselves vulnerable to heatwaves with no protocol or protection. Climate adaptation should not be imposed on communities; it should be developed with them.

Q4. India has made progress in recognising climate change as a public health threat. Where do you see the biggest gaps in our current preparedness?

Dr Samtani: I would highlight three gaps, and add a fourth from my own research.

The first is data. We still do not have strong, integrated systems that can accurately measure and track the health impacts of climate change. Many heat-related illnesses and deaths remain underreported or misclassified, making it difficult to understand the true scale of the problem.

The second is implementation. We have policies and plans, but they do not always reach the communities most at risk. Climate adaptation needs to move beyond documents and become visible in people’s daily lives.

The third is coordination. Climate change affects health, agriculture, nutrition, and livelihoods — yet these sectors still work in silos. The solutions need to be far more interconnected.

And the fourth, which my research has brought to light, is a knowledge gap. When we discuss climate solutions, we tend to focus on infrastructure, technology, and policy — all undoubtedly important. But many answers already exist within local communities. Millets, for example, were cultivated by tribal and rural communities long before they were recognised globally as a climate-smart crop. What we call innovation today is often traditional wisdom. Documenting these indigenous knowledge systems could go a long way.

My three priorities to address these gaps would be: strengthening climate-health surveillance so we better understand who is being affected; protecting vulnerable populations; and building climate-resilient food systems.

What we call innovation today is often traditional wisdom.

— Dr Ratika Samtani

Closing

Pinaki: Two things have stayed with me from this conversation — the need for deep integration between local communities and government-level policy, and the importance of that fourth gap, the knowledge gap, which is perhaps our biggest challenge and needs to be addressed head-on. Thank you so much for joining us today, Dr Ratika.

Dr Samtani: Thank you so much for having me.

About Dr Ratika Samtani

Assistant Professor at IIHMR New Delhi, working at the intersection of climate change and public health. Her research includes mapping five decades of extreme weather events across India, studying pesticide exposure and women’s health (with the Department of Biotechnology), and documenting indigenous climate adaptation (with ICMR).

This conversation is part of the InnoHealth FAQ Series, where we put the questions our readers ask most to the people best placed to answer them.