Need for inclusive, integrated climate action

As Karnataka welcomes a new Minister for Urban Development, there is an opportunity to rethink what makes a city healthy, resilient, and equitable. Much of the public conversation around urban development tends to focus on infrastructure and technology-driven solutions. Yet the true measure of a city’s development lies elsewhere: in how its systems support the health and well-being of the people who keep the city functioning.

Among these are sanitation workers, street sweepers, waste collectors, drain cleaners, and others who perform essential services that sustain urban life. Their experiences offer a powerful lens through which to understand urban systems, particularly in an era of climate change.

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

Unequal experiences

Across Karnataka’s cities, sanitation workers spend long hours outdoors. As heatwaves 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, exhaustion, kidney-related illnesses, cardiovascular complications, and reduced productivity.

Moreover, a significant proportion of sanitation workers live in informal settlements where access to basic services remains uneven. Overcrowded housing, poor ventilation, inadequate water supply, and limited green cover amplify exposure to heat. During periods of extreme weather, residents may struggle to secure sufficient water for drinking and cooling, while inadequate drainage can 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 capture how urban systems function in practice. A city may have healthcare facilities, social welfare schemes, and climate action plans on paper, but whether these systems reach those who need them the most is another matter. Sanitation workers provide a useful barometer of urban system performance because they sit at the intersection of multiple systems. Their experiences are shaped by municipal governance, labour arrangements, housing conditions, environmental infrastructure, healthcare access, and social protection policies.

Consider healthcare access. Many Indian cities have expanded urban primary healthcare services in recent years. Yet questions remain about whether these services are accessible to workers whose health needs are closely linked to occupational exposures. Are primary health centres equipped to respond to heat-related illnesses? Are workers aware of available services?

Similarly, social protection schemes often exist but remain difficult to navigate. Administrative barriers, lack of awareness, documentation requirements, and fragmented institutional responsibilities can prevent workers from receiving the benefits intended for them.

These gaps become even more significant as climate change intensifies. Cities across India, including Bengaluru, are beginning to develop climate action plans aimed at reducing emissions and building resilience. However, climate adaptation cannot be limited to infrastructure investments alone. It must also address human vulnerability. This requires a shift in how urban development is understood. Health must move from being viewed as the responsibility of the health department alone to becoming a central consideration across urban planning, housing, and labour policies.

A climate-centric urban policy

For Karnataka’s cities, several priorities emerge. First, climate and heat considerations should be integrated into occupational health policies for municipal and contracted sanitation workers. Heat action plans need to include worker protections such as access to drinking water, shaded rest areas, modified work schedules during extreme heat, and routine health monitoring. Second, investment in informal settlements is paramount. Improved housing, water access, drainage, and green infrastructure directly influence health outcomes and reduce vulnerability to climate-related risks.

Third, urban primary healthcare systems should be strengthened to respond to climate-sensitive health conditions. This includes training healthcare providers, and ensuring services are accessible to workers. Fourth, cities need better data; evidence on occupational heat exposure, health-seeking behaviour, healthcare costs, and long-term health impacts among urban workers remains limited. Finally, urban governance must become more integrated. Climate resilience, public health, and labour welfare are often treated as separate policy domains. Yet for sanitation workers, such issues are inseparable.

As Karnataka charts its urban future, sanitation workers offer an important reminder: cities are not defined by their infrastructure alone. They are defined by the systems that enable people to live, work, and remain healthy.

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