India’s Health and Climate Inequities: Navigating the Global North-South Divide

The intersection of health and climate change reveals deep inequities, especially in the Global South, where countries like India face compounding challenges. These challenges arise from both historical legacies of colonialism and current global governance structures that continue to favor the industrialized Global North. The global climate crisis is not just an environmental or economic issue; it has profound implications for public health, especially in countries already grappling with poverty, inequality and inadequate healthcare infrastructure. India’s struggle within this North-South divide highlights the urgent need for more equitable approaches to addressing both health and climate impacts.

Climate change has direct and indirect effects on public health, particularly in countries like India, where the vulnerability of populations is heightened by socio-economic disparities. Rising temperatures, shifting monsoons and extreme weather events are worsening food insecurity, exacerbating malnutrition, and increasing the prevalence of vector-borne diseases such as malaria and dengue. A 2023 systematic review published in Current Nutrition Reports points out that 200 million people in India are malnourished. Further, dengue and malaria are major health threats in India, accounting for 74.37% of the country’s vector-borne disease burden, particularly affecting tropical and subtropical regions.

Climate change in India exacerbates health risks, increasing mortality and morbidity, especially among the poorest communities. Environmental shifts and rapid urbanization intensify air pollution, causing respiratory diseases and premature deaths. The 2024 World Air Quality Report ranked India as the third most polluted country, with an average PM concentration of 54.4 micrograms per cubic meter —10.9 times above WHO’s recommended limit. From 2001 to 2019, India saw 37.6 million premature deaths from four major non-communicable diseases (NCDs). The poorest and most marginalized are disproportionately affected by these challenges.

Heatwaves are already claiming lives in India. In 2024 alone, more than 700 deaths were attributed to heat-related illnesses and over 40,000 heatstroke cases were recorded according to the non-profit HeatWatch. The country’s burgeoning population, coupled with inadequate healthcare facilities and a lack of climate-resilient infrastructure, leaves millions vulnerable to extreme weather events. A 2023 study by Shrikhande et al. highlights the urgent need for research focused on the health impacts of climate change, noting barriers such as limited funding, lack of interdisciplinary collaboration and minimal governmental support.

While climate change affects both the Global North and South, the nature and intensity of these impacts differ. The Global North, having historically benefitted from industrialization and extractive capitalism, is better equipped to mitigate and adapt to the consequences of climate change. Conversely, countries in the Global South, such as India, bear a disproportionate burden of climate-related health impacts, despite contributing far less to global emissions. This disparity can be traced back to the colonial extraction of resources, which continues to shape global economic systems today. Amitav Ghosh, in The Nutmeg’s Curse, argues that colonialism’s extractive practices laid the foundation for modern capitalism, which prioritizes profits over people and the environment. This system has continued to deplete the natural resources of the Global South while enriching the Global North. Ghosh draws attention to the historical and ongoing exploitation of land, labor and resources, which leaves countries like India with limited capacity to address climate-related challenges, both in terms of health and environmental protection.

An analysis of extractive capitalism in India further underscores the ongoing struggles of indigenous and caste-based communities, who are often at the forefront of both land dispossession and environmental degradation. These marginalized groups, who depend on natural resources for their livelihoods, face heightened vulnerability to climate change. The combination of extractive practices, environmental degradation, and exclusion from governance structures amplifies the health risks they encounter, from malnutrition to exposure to environmental toxins.

India’s health and climate inequities are a direct outcome of the country’s colonial past and the current global governance frameworks that perpetuate inequalities. Further, neoliberal policies have exacerbated vulnerabilities by promoting rapid industrialization without adequate environmental safeguards. India’s prioritization of economic growth over environmental protection has contributed to widespread deforestation, pollution and displacement of marginalized communities. India lost 668,400 hectares of forest over five years between 2015 and 2020, making it the second-highest country globally in terms of forest loss. The effects of these policies are most visible in urban centers, where poor air quality has led to significant health challenges.

India also grapples with a skewed global system that places the burden of climate action on developing countries, while the Global North continues to evade responsibility for historical emissions. The Paris Agreement, while a step forward, reflects this imbalance, as developing countries like India are expected to limit emissions and implement climate mitigation strategies despite their relatively low per capita emissions. India’s Nationally Determined Contribution (NDC) aims to cut the emissions intensity of its GDP by 45% by 2030 compared to 2005 levels. India’s contribution to global greenhouse gas emissions, though significant, is far smaller than that of industrialized nations. Yet, the burden of mitigating climate change disproportionately falls on India. This overlooks the historical responsibility of the Global North, which built its wealth on centuries of fossil fuel use and environmental exploitation.

Global governance structures, particularly those related to climate and health, continue to favor the Global North, leaving countries like India at a disadvantage. International financial institutions and multinational corporations wield disproportionate power in setting the global agenda, often prioritizing profit over environmental and public health concerns. This imbalance is evident in the global trade regime, which encourages the extraction of natural resources from the Global South to meet the consumption demands of the Global North. For instance, international trade agreements often prioritize intellectual property rights over access to affordable medicines, which affects India’s ability to provide healthcare for its citizens. This is especially concerning in the context of climate change, as rising temperatures and changing disease patterns require more robust healthcare systems and access to new medical technologies. The prioritization of profit over public health perpetuates inequities, as poorer countries are unable to afford the necessary treatments and technologies to address the health impacts of climate change.

India faces significant challenges in addressing the dual crises of health and climate change, but there are also opportunities for innovation and leadership. The country has made some strides in renewable energy, particularly through initiatives such as the International Solar Alliance, which aims to promote solar energy and reduce dependence on fossil fuels. However, these efforts are often undermined by the broader economic system, which continues to prioritize extractive industries and industrial growth over environmental sustainability. One promising area is India’s leadership in health diplomacy, particularly during the COVID-19 pandemic. The Vaccine Maitri initiative, which provided vaccines to neighboring countries, demonstrated India’s potential to lead in global health. This leadership could be extended to addressing climate-related health impacts, with India taking a more prominent role in advocating for climate justice and equitable access to healthcare technologies.

To effectively navigate the global North-South divide, India must continue to push for more equitable global governance structures that prioritize public health and environmental sustainability over profit. This will require not only domestic policy reforms but also concerted efforts at the international level to challenge the dominance of the Global North in setting the global agenda. Historical legacies of colonialism, extractive capitalism and current global governance structures have left India vulnerable to the impacts of climate change, particularly in terms of public health. While India has made some progress in renewable energy and health diplomacy, these efforts are often constrained by the broader economic system. To address these challenges, India must advocate for more equitable global governance that prioritizes climate justice and public health, ensuring that the Global South is not left to bear the brunt of a crisis it did not create.