Need for inclusive, integrated climate action

As the new Urban Development Minister is welcomed into Karnataka, there is an opportunity to rethink what makes a city healthy, resilient and equitable. Most public debates about urban development tend to focus on infrastructure and technology-driven solutions. But the true measure of a city’s progress lies elsewhere: in how its systems support the health and well-being of the people who keep the city running.

These include sanitation workers, street sweepers, waste collectors, sewer cleaners and others who perform essential services that sustain urban life. Their experiences offer a powerful lens for understanding urban systems, especially in the era of climate change.

Climate change is often discussed in terms of rising temperatures and environmental degradation. However, these effects are not experienced equally. They are filtered by housing conditions, employment arrangements, access to healthcare, social protection and public infrastructure. In other words, climate change is also an urban management problem.

Unequal experiences

In all cities of Karnataka, sanitation workers spend long hours outdoors. As heat waves become more frequent and intense, exposure to extreme heat is no longer an occasional occupational hazard but a routine reality. Heat stress can lead to dehydration, fatigue, kidney-related diseases, cardiovascular complications, and decreased productivity.

Moreover, a significant portion of cleaning workers live in informal settlements where access to basic services is unstable. Overcrowded housing, inadequate ventilation, inadequate water supply and limited green cover increase heat exposure. During extreme weather conditions, residents may struggle to find enough water to drink and cool down, while inadequate drainage can also increase vulnerability to flooding and disease outbreaks. The result is a double burden: Workers are exposed to climate risks both at work and at home.

What does this say about the health of our cities? Traditionally, public health indicators focus on disease prevalence, mortality, or service coverage. While these remain important, they often fail to understand how urban systems work in practice. A city may have health facilities, welfare plans and climate action plans on paper, but whether these systems reach those who need them most is another matter. Because sanitation workers exist at the intersection of multiple systems, they provide a useful barometer of urban system performance. Their experiences are shaped by municipal government, working regulations, housing conditions, environmental infrastructure, access to healthcare and social protection policies.

Consider access to healthcare. Many Indian cities have expanded urban primary healthcare in recent years. But there are still questions about whether workers whose health needs are closely linked to occupational exposures will be able to access these services. Are primary health centers equipped to respond to heat-related diseases? Are employees aware of available services?

Similarly, social protection programs often exist but remain difficult to navigate. Administrative barriers, lack of awareness, documentation requirements, and fragmented corporate responsibilities can prevent employees from taking advantage of their benefits.

As climate change intensifies, these gaps become even more important. Cities across India, including Bengaluru, are starting to develop climate action plans aimed at reducing emissions and building resilience. However, climate adaptation cannot be limited only to infrastructure investments. It must also address human fragility. This requires a change in the understanding of urban development. Health must move from being viewed solely as the responsibility of the health department to becoming a central issue in urban planning, housing and labor policies.

A climate-focused urban policy

Various priorities are emerging for the cities of Karnataka. First, climate and temperature considerations should be integrated into occupational health policies for municipal and contracted cleaning workers. Heat action plans need to include worker protections such as access to potable water, shaded rest areas, modified work schedules in extreme heat, and routine health monitoring. Second, investment in informal settlements is crucial. Improved housing, access to water, drainage and green infrastructure directly impact health outcomes and reduce vulnerability to climate-related risks.

Third, urban primary health care systems should be strengthened to respond to climate-sensitive health conditions. This includes training health care providers and ensuring services are accessible to workers. Fourth, cities need better data; Evidence regarding occupational heat exposure, health-seeking behavior, health care costs, and long-term health effects among urban workers remains limited. Finally, urban governance needs to become more integrated. Climate resilience, public health and workforce well-being are often treated as separate policy areas. However, for cleaning workers, such problems are inseparable.

As Karnataka plans its urban future, sanitation workers offer an important reminder: Cities are not defined only by their infrastructure. It is defined by the systems that enable people to live, work and stay healthy.

Aruna Bhattacharya is a medical anthropologist and public health expert specializing in urban health systems.

It was published – 01 July 2026 01:27 IST