Identifying vulnerable communities and their experiences related to climate change and respiratory health - creating awareness through community engagement | NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Biswajit Paul reflects on how a decade-long partnership between the University of Edinburgh and RUHSA, Christian Medical College Vellore, has transformed respiratory healthcare in rural India. Today, that collaboration is taking its next step—understanding how climate change is affecting the respiratory health and wellbeing of vulnerable communities and working with them to develop locally relevant solutions.

From improving respiratory health to tackling climate change

Climate change is no longer a distant environmental concern—it is a public health reality. Across rural India, communities are increasingly experiencing prolonged heatwaves, unpredictable rainfall, flooding, drought, water scarcity and deteriorating air quality. For people already living with respiratory diseases, these environmental changes make everyday life even more challenging. Yet the people most affected are often those whose voices are heard the least.

Our latest Scotland–India collaboration aims to change that.

The Climate Change and Health project brings together researchers from the University of Edinburgh and RUHSA, Christian Medical College Vellore, to understand how climate change is affecting the respiratory health, livelihoods and wellbeing of vulnerable rural populations—particularly women, older adults and children. Rather than studying communities from a distance, we work alongside them, listening to their experiences and co-creating practical communication strategies that build awareness, resilience and action.

For us, this project is much more than a new research study. It represents the natural evolution of a partnership that has been growing for over a decade.

A decade of learning together

Our collaboration with colleagues in Scotland began with a shared ambition—to improve respiratory health in low-resource, low-literacy rural settings where access to quality chronic respiratory care was limited.

Through the RESPIRE programme, supported by the National Institute for Health and Care Research (NIHR), researchers, clinicians, policymakers and communities have worked together to strengthen primary care pathways for chronic respiratory diseases. This has involved training healthcare professionals, building the capacity of health systems and developing models of care that are practical, affordable and sustainable.

One important milestone has been pulmonary rehabilitation. Once considered difficult to deliver in rural low-resource settings, our partnership demonstrated through pilot studies that community-based pulmonary rehabilitation was both feasible and acceptable. This work has now progressed into the multinational PuRe trial, generating evidence on how pulmonary rehabilitation can be successfully integrated into primary healthcare systems.

Alongside strengthening healthcare services, we recognised that sustainable improvements require communities to be genuine partners in research and implementation.

Listening before acting

One of the most rewarding aspects of our collaboration has been embracing community engagement as an equal partner in research.

Using participatory approaches such as Photovoice, people living with chronic respiratory diseases documented their daily experiences through photographs and personal stories. Their narratives highlighted challenges that clinical assessments alone could never capture—from exposure to smoke and dust, to financial hardship, social isolation and the emotional burden of living with chronic breathlessness.

These stories helped inform healthcare providers and policymakers, ensuring that services reflected the realities of people's lives rather than assumptions made from outside the community.

The lessons from Photovoice reinforced a simple but powerful principle: communities are not simply beneficiaries of research—they are experts in their own lived experiences.

This principle now forms the foundation of our climate and health work.

Gathering of women, elderly and children in rural India — A photograph showing a gathering of women, elderly and children in rural India- those most vulnerable to climate change effects on health.

Why climate change matters for respiratory health

Climate-related disasters have doubled globally over the past two decades, with low- and middle-income countries bearing a disproportionate share of illness and death. India is among the five countries most affected by natural disasters and is recognised as one of the regions most vulnerable to the future impacts of climate change.

The consequences extend far beyond extreme weather events. Rising temperatures, prolonged heatwaves, changing rainfall patterns, flooding, drought and worsening air pollution all influence respiratory health. These environmental changes also threaten livelihoods, food security, mental wellbeing and social stability—particularly among communities already facing poverty and limited access to healthcare.

India has recognised these challenges through the National Programme on Climate Change and Human Health (NPCCHH), which promotes climate-resilient healthcare and supports the country's commitment to achieving net-zero carbon emissions by 2070.

Generating local evidence is now essential to guide these national ambitions.

Understanding vulnerability through community engagement

Our project seeks to identify the communities and populations most vulnerable to climate change and understand how environmental changes are affecting their respiratory health and daily lives.

We will work closely with women, older adults, children and people in climate-sensitive occupations to document their experiences, identify risks and assess community needs. Equally important, we will explore how communities themselves understand climate change, the strategies they already use to adapt, and the support they need to become more resilient.

Rather than producing information for communities, we aim to develop communication resources with communities. By co-creating culturally appropriate awareness materials and locally relevant adaptation strategies, we hope to empower people to recognise climate-related health risks and take practical steps to protect themselves and their families.

Community engagement is therefore not simply a research method—it is the pathway through which evidence becomes meaningful action.

Looking ahead

Looking back over the past decade, it is remarkable how our partnership has evolved. What began as a shared commitment to improving respiratory care in rural India has grown into a multidisciplinary collaboration spanning implementation science, pulmonary rehabilitation, health systems strengthening, community engagement, policy influence and now climate resilience.

The challenges posed by climate change cannot be solved by healthcare alone. They require partnerships across countries, disciplines and communities, built on mutual trust and shared learning.

As our Scotland–India collaboration enters its next chapter, we remain committed to ensuring that the voices of vulnerable communities shape both research and policy. By combining scientific evidence with lived experience, we hope to build healthier, more resilient communities that are better prepared for a changing climate.

That, ultimately, is the strength of our partnership—not simply generating knowledge, but creating lasting impact together.

This blog was written by BIswajit Paul, Principal Investigator for the ⁠Vulnerable communities impacted by climate change project, linked below.