Climate change and waterborne diarrhoea in northern India: Impacts and adaptation strategies

•Diarrhoea incidences are influenced by temperature, precipitation and air humidity.•A conceptual framework for climate impact on diarrhoea was developed.•On average 13.1% increase in diarrhoea incidences are expected in north India by the 2040s.•Preventive actions have the potential to overcome the expected increase of 13.1%.•Concerted actions and a more effective implementation of policies are needed.

Although several studies show the vulnerability of human health to climate change, a clear comprehensive quantification of the increased health risks attributable to climate change is lacking. Even more complicated are assessments of adaptation measures for this sector. We discuss the impact of climate change on diarrhoea as a representative of a waterborne infectious disease affecting human health in the Ganges basin of northern India. A conceptual framework is presented for climate exposure response relationships based on studies from different countries, as empirical studies and appropriate epidemiological data sets for India are lacking. Four climate variables are included: temperature, increased/extreme precipitation, decreased precipitation/droughts and relative humidity. Applying the conceptual framework to the latest regional climate projections for northern India shows increases between present and future (2040s), varying spatially from no change to an increase of 21% in diarrhoea incidences, with 13.1% increase on average for the Ganges basin. We discuss three types of measures against diarrhoeal disease: reactive actions, preventive actions and national policy options. Preventive actions have the potential to counterbalance this expected increase. However, given the limited progress in reducing incidences over the past decade consorted actions and effective implementation and integration of existing policies are needed.