Heat action plans in eight Indian cities: Knowledge gaps & opportunities for intersectoral heat governance.

Background & objectives Extreme heat in cities poses significant health risks especially to vulnerable populations. Climate change has led to heatwaves in India increasing in frequency and duration. To address the heat-health challenges, heat action plans (HAPs) are a key instrument for heat governance. The objective of this study is to critically assess city level HAPs from India, in terms of the eight core elements identified by the World Health Organization guidance on heat-health action. Methods The study uses a benchmarking approach in mapping the representation of core elements across eight city-level HAPs, to assess the plan's coverage and extent of development for each element and its sub-elements. Supportive text analysis was conducted using R software to study the frequency of use of words in the HAPs and key words corresponding to core elements. Results The HAPs varied in design and scope, with core elements that require long-term institutional and/or intersectoral planning and implementation receiving least attention. These elements included care for vulnerable populations, health system preparedness, long-term urban planning, and surveillance of health outcomes. The study identifies the dominant framing of the issue of heat as a time-limited disaster event (namely, a heatwave) as a significant barrier in designing HAPs that are responsive to local contexts and calls for long-term measures required to shape structural drivers of differential vulnerabilities. Interpretation & conclusions A paradigm shift from solely top-down disaster management to coupling with decentralised, community-informed management and long-term measures is essential to effectively address heat-related health risks in both the immediate and the long-term.