The average maximum temperature in Delhi breached 45 degrees Celsius on May 19, the hottest day of its 2026 summer so far. Hospitals across the National Capital Region are logging a measurable rise in admissions for heatstroke, cardiac distress and dehydration, concentrated among outdoor workers, construction labour and the elderly. In late April, the Union health ministry instructed every state to set up Heat Stroke Management Units, keep ambulances on standby and report heat-related illness in real time through the Integrated Health Information Platform.

For corporate India, with the state governments financing public health and the finance ministries underwriting energy subsidies, this is no longer a meteorological story. It is a balance-sheet story. The most rigorous global accounting of that balance sheet, the Lancet Countdown on Health and Climate Change, has just published numbers India can no longer treat as someone else's problem.

What the Countdown measures

Running since 2016, the Countdown is a collaboration of 128 experts across 71 institutions, including the World Health Organization. Every year it publishes hard indicators (heat exposure, vector-borne disease, food insecurity, air pollution, labour productivity, fossil-fuel finance) and reports what the data say. Its 2025 global report, released this October, finds that 12 of 20 indicators tracking health threats have reached record levels.

The figures are not forecasts. They are last year's accounts.

Numbers India's CFOs should be reading

Globally, heat-related mortality is up 23 per cent since the 1990s. An average of 546,000 deaths a year are now attributable to extreme heat, which works out to roughly one death every minute of the year. In 2024, the average person was exposed to 16 additional days of dangerous heat that would not have occurred without climate change; for infants and those above 65, the figure crossed 20 heatwave days. Drought and heatwaves pushed an additional 124 million people into food insecurity in 2023.

The labour-market numbers are the ones boardrooms should be staring at. The global economy lost 640 billion potential labour hours in 2024 to heat exposure, an output loss the Countdown values at $1.09 trillion, equivalent to almost 1 per cent of global GDP. Thirty-nine per cent of that loss occurred in agriculture. A further $61 billion was lost to heat-related mortality among older adults alone, a 208 per cent increase over the 2000 to 2004 average.

India, with one of the world's largest exposed workforces (construction, agriculture, logistics, street vending, delivery, brick-kilns), carries a disproportionate share of that loss. The Countdown's South Asia regional brief documents that least developed nations lost the equivalent of 6 per cent of GDP to heat-induced labour reductions in 2024. India's share is in the same order of magnitude.

That is not a climate cost. That is a competitiveness cost.

Fossil fuel paradox

The Countdown's most uncomfortable finding for finance ministries is this: Global fossil fuel subsidies reached $956 billion in 2023, exceeding global climate finance. In fifteen of 87 countries responsible for 93 per cent of global emissions, it exceeded the national health budget. Governments are paying twice. Once to burn the fuel. Once to treat the illnesses that follow.

India’s Union Budget for 2026-27 allocates Rs 1,06,530 crore (approximately $12.8 billion) to the Union Ministry of Health and Family Welfare. India’s direct fossil-fuel subsidies on LPG, kerosene, diesel under-recoveries and the tax concessions on petroleum products, run into multiples of that figure in any honest accounting. The implicit fiscal transfer from health to hydrocarbons is the single largest, and least examined, line item in India’s climate ledger.

Where data turns hopeful

The Countdown is not a counsel of despair. The same indicators show climate action working when it is funded. Between 2010 and 2022, the global retreat from coal prevented an estimated 160,000 premature deaths a year by cutting fine-particulate air pollution.

Renewable energy generation reached a record 12 per cent of global electricity and now supports 16 million jobs worldwide. Two-thirds of medical students worldwide received climate-and-health education in 2024. The trajectory is reversible, and the cost of reversing it is lower than the cost of absorbing it.

The Indian policy ask

Three interventions follow directly from the Countdown's framework.
First, redirect fossil-fuel subsidies into health-system resilience. Even a 25 per cent reduction in current subsidy outlays, redirected to State-level Heat Action Plans, hospital cooling, ORS and IV-fluid stockpiles and primary-health-centre upgrades, would transform monsoon and summer surge capacity within two budget cycles.

The Bio Pharma Shakti initiative announced in the 2026-27 Budget, with an outlay of Rs 10,000 crore over five years, is a useful precedent for ring-fenced health investment; the same logic can be extended to climate-resilient public health.

Second, re-frame India's Nationally Determined Contributions under the Paris Agreement around health outcomes. The Countdown's authors have argued, correctly, that mitigation pledges denominated in tonnes of carbon are politically inert. The same pledges denominated in deaths averted, hospital admissions reduced, and labour hours preserved would mobilise constituencies that current NDC language cannot reach. India, as a leading voice in multilateral health-and-climate negotiations, is uniquely placed to lead that re-framing at COP30 in Belém this November.

The bottom line

Climate change is no longer only an environmental story, or even an economic one. It is a clinical one. Every tonne of carbon avoided is, somewhere, a hospital admission averted. Every rupee of fossil-fuel subsidy redirected is, somewhere, a heatstroke bed funded.

That is a calculus policymakers, and voters, would do well to internalise before the next yellow alert turns red, as it surely will.

Pallavi Mishra is Assistant Professor at Symbiosis Law School, NOIDA Campus, Symbiosis International (Deemed University). Her research focuses on biodiversity law, international environmental governance and the public-health dimensions of climate change. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.

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