CASE BOX 4.6 INDIAN FAMINE CODE

A severe drought occurred in Bengal of British East India Company in 1769.

While rural distress had been reported, the reports were ignored by the Com-pany. Starvation started in early 1770 and reached its height in mid- 1770. Sub-sequent infectious diseases further increased the death toll. The famine and diseases ultimately claimed 10 million lives, one third of the total population.

As a result, large areas were depopulated and may cultivated lands were aban-doned. The Great Bengal famine of 1770 was the first and most severe one among a series of famines in British India that killed tens of millions of Indians.

To address the issue of famine in colonial India, the British created the Indian Famine commission to formulate the Indian famine code in 1880. The code classified food insecurity on a three- level scale of intensity with correspond-ing steps the government were required to take to mitigate famine risk: near- scarcity, scarcity (three successive years of crop failure, crop yields dropping to one- third to one- half of the normal level and large number of people in distress) and famine (an increase in food prices by 40% or more, the movement of peo-ple searching for food and widespread mortality). This code is one of the earli-est famine scales and became the basis of famine prevention until the 1970s.

Source: Brennan (1984).

they lose their capacity to generate income (endowments) for further exchange of food and other necessities (entitlements) in the future. This generates a vicious cycle that continues to worsen the food insecurity.

What are the health impacts of droughts and famines?

The impact of a drought is dependent on the context and underlying population vulnerability (such as the underlying water- use practices, infrastructure and socio- economic environment) (Stanke et al., 2013). With drought and its subsequent decrease in the quantity and/or quality of the food available, acquiring suffi cient nutritional intake is the greatest challenge for affected communities.

Health impacts of drought

Drought may have health impacts via a variety of pathways. The complex and slowly evolving effects of drought make it diffi cult to categorise the true impact;

however, various risk factors may determine the degree of drought’s impact on the health of the affected communities.

Disrupted food production/distribution caused by drought can lead to reduced food intake, malnutrition and various nutrient defi ciencies. Specifi cally, people who reduce their food consumption may encounter protein- energy malnutrition and morbidities related to micronutrient defi ciencies (such as iron- defi ciency anae-mia , scurvy due to vitamin C and vitamin A defi ciency that increases the risk of developing measles ). Undernutrition is a major cause of morbidity and mortality, particularly among children and pregnant women. Inadequate maternal nutrition may result in intrauterine growth retardation , low birth weight or various ges-tational problems. A study investigating 7,874 adults born between 1954 and 1964 during the famine in China revealed that exposure to famine during the foetal stage was associated with a higher risk of developing metabolic syndrome during adult life. In addition, undernutrition during the developmental stage can cause impair-ment in physical and cognitive abilities (Li et al., 2011) (see also Knowledge Box 4.6).

Communicable diseases : lack of clean drinking water and sanitation, com-pounded by the effects of malnutrition and displacement, can contribute to a higher population vulnerability to infectious diseases, such as cholera, typhoid fever, diarrhoea, acute respiratory infections and measles. Water stress also changes the dynamics of vector- borne diseases . Unprotected stagnant water sources might promote the breeding of vectors like mosquitoes and fl ies.

Psychosocial stress and mental health disorders : although more studies are needed to evaluate the impact of drought on mental health, it may create a broad range of stressors and weaken an individual’s ability to avoid mental health problems.

Reduced health service delivery : the disruption of local health services due to the lack of water supplies or out- migration of health care workers can compro-mise the access to health care of a community. Loss of buying power and lack of

health facilities limit people’s access to health services and increase overall morbidity and mortality (Stanke et al., 2013).

Socio- economic and environmental impacts of drought

Economic impacts : the reduction of crop production decreases farmers’ incomes.

Furthermore, reduced food availability causes an increase in food market prices.

Environmental impacts : droughts might trigger insect infestations, increas-ing plant diseases, worsenincreas-ing air quality and aggravatincreas-ing soil erosion and landscape degradation. While the natural ecosystems can usually rebound after short- term droughts, the impact of long- term droughts requires a lengthy recovery period.

Social impacts : water utilisation rights may be disputed and cause confl ict among users. Additionally, migrants from a drought- stricken area may increase the demand for water and threatens water security in host communities, possibly lead-ing to complex emergencies, such as confl icts and civil wars.

What are the responses needed?

Young children, women, older population and people with chronic diseases are the most at- risk groups in drought and famine situations. In addition, famine relief organisations must consider not only people’s dietary needs and food preferences but also both the physical and economic access to food. Relief organisations must also pay attention to micronutrient defi ciency in long- term feeding camps and food aid.

In summary, droughts are slow- onset disasters characterised by an extended period of unusual dryness, while famine is an extreme form of failure in food production or supply. The impacts of droughts and famines result in various health presentations, such as vector- borne diseases, communicable diseases, malnutrition, vitamin and micronutrient defi ciency, metabolic syndrome, gestational problems and impairment in physical and cognitive abilities.

Climatological hazards: extreme temperatures – heatwaves and cold waves

What is a cold wave?

A cold wave can be a prolonged period of excessively cold weather or a sudden invasion of very cold air over a large geographic area. If accompanied by frost, it can cause damage to agriculture, infrastructure and property (CRED, 2009).

What is a heatwave?

Since the average temperature differs across countries, there is no standard operational defi nition of a heatwave. A heatwave may be defi ned as a length of fi ve or more