The Water, the Heat, and the Vote: How Climate and Health Are Shaping Bihar’s Future
The campaigns are in full swing for elections in the Indian state of Bihar, which will see voting in two phases. The voters will seal the fate of candidates on November 6 and 11, with results set to be announced on November 14. The state of Bihar is one of the largest states in the country, and the stakes are high as these elections will see a generational shift in leadership.
Bihar has witnessed various alliances and shifting loyalties. The Janata Dal (United), led by incumbent Chief Minister Nitish Kumar, and the Bharatiya Janata Party (BJP), which is in power at the central level, have dominated state politics in the last two decades. Meanwhile, the opposition, now led by RJD’s Tejashwi Yadav, son of Lalu Prasad Yadav, a veteran politician, is trying to forge a broader alliance with the Congress and the Left and is now trying to position himself as the champion of social justice. JD(U) has shifted its loyalties multiple times, with Nitish Kumar forming the government with Tejashwi twice in the last ten years. Although the government was short-term, it does not seem to have made any dent in the credibility of Kumar, who has been portrayed as a man of development and a corruption-free state.
Both these groups have been continuously talking about unemployment in each other’s regime, migration, and industrialization in the state. But Bihar faces some other big issues that are deeply impacting people: the double whammy of healthcare deterioration and environmental degradation. These issues cut across caste, region, and income in the state, which is mostly mobilized along caste and regional lines.
Bihar is one of India’s most climate-vulnerable states. More than 76 percent of its population and three-fourths of its area live under the constant fear of threats. It accounts for 17 percent of India’s flood-prone area and 22 percent of India’s flood-prone population. 73.63% of the geographical area of North Bihar is considered to be prone to floods. Out of 38 districts, 28 districts get flooded (of which 15 districts are worst affected), causing huge loss of property, lives, farmlands, and infrastructure. These floods have devastated the state, destroyed crops, and led to intense migration. A study shows that 60 percent of post-flood water in its capital city, Patna, contained unsafe levels of dissolved solids. These contaminations leave lasting health impacts as they are a primary cause of waterborne diseases. Although the government has launched various initiatives to tackle these problems, implementation remains limited to urban areas.
The state has witnessed frequent outbreaks of Japanese Encephalitis and Acute Encephalitis Syndrome. Survivors of AES are left with long-term damage to the neurological system. These diseases stop children from attending educational institutions and hence reduce access to a better future.
The state has an action plan on climate change and human health, which acknowledges malaria, dengue, and other such diseases as a cause of concern. It also notes the fact that erratic rain patterns and rising temperatures are increasing the chances of their transmission. Bihar witnessed 829 per cent more than normal rainfall in October this year, leaving several districts reeling under floods. while it also saw a sharp maximum temperature of more than 40 degrees Celsius in over 12 district.
The other added burden on these is the poor healthcare infrastructure. Only 41 percent of primary healthcare centers in Bihar could meet the basic standard of having a minimum of four beds, compared to the national average of 74 percent. The doctor-to-population ratio in the state is at a much lower level when compared to WHO guidelines of 1:1000. It is currently at 1:2600, compared with the national average of 1:811. Close to half of the sanctioned posts in various health departments remain vacant in Bihar. For a state with a huge population, these numbers are worrying.
Bihar scores 67 on NITI Aayog’s Good Health and Well-Being Index, against a national average of 77. Malnutrition is widespread, with 43 percent of children under five stunted, 9 percent wasted, and 23 percent underweight. Sixty-three percent of women of reproductive age are anemic, one of the highest rates in India. These statistics translate into real human suffering – undernourished mothers giving birth to low-weight children who then grow up malnourished, trapped in a cycle of poor health and poverty. In such conditions, climate-related disasters hit hardest, eroding whatever progress families have managed to make.
Yet Bihar’s recent health record also shows that progress is possible when political will, policy design, and resources align. Immunization coverage has risen from 12 percent in 2005 to 84 percent in 2025. The maternal mortality ratio declined from 165 to 118 per lakh live births between 2014–16 and 2018–20, while the infant mortality rate fell from 42 to 27 per 1,000 live births in the same period. These improvements are encouraging, but they remain fragile. Each flood, each heatwave, and each outbreak threatens to push Bihar’s health system back to the brink.
The connection between health, climate, and development is neither abstract nor indirect. When floods wipe out crops and homes, families take on debt and cut back on food. Malnutrition rises. Children drop out of school to work. Illness spreads. Labour productivity falls. Public money is diverted to emergency relief. This vicious cycle – the poverty, health, and climate trap – is already visible across Bihar’s floodplains. For a state with one of India’s youngest populations, this is not just a humanitarian concern but a serious economic threat.
The upcoming government, whichever party it belongs to, must treat health and climate resilience as two sides of the same development agenda. Strengthening and expanding primary health care, especially in flood-prone districts, should be a top priority. Recruitment and training of medical staff must be accelerated, and infrastructure such as mobile health units and solar-powered clinics should be introduced to ensure services during floods. Technology should be used to reduce paperwork for ASHA and Anganwadi workers so they can focus on preventive and maternal care. Investments in sanitation, clean water, and waste management are equally critical, especially when 39 percent of households still lack toilets. Public health must be built into Bihar’s infrastructure planning, not treated as an afterthought.
Equally important is the need for coordination. Departments of health, agriculture, disaster management, and urban development must work together rather than in isolation. Local governments should be empowered to conduct health risk assessments and integrate them into district development plans. Early warning systems for floods and heatwaves must be linked to local clinics and hospitals so that preparedness becomes routine, not reactive.
As Bihar prepares to vote, its leaders must remember that the true measure of governance is not just growth in GDP or the number of roads built, but how well a government protects its people from preventable suffering. Bihar’s past achievements – from polio eradication to improved maternal health – prove that the state can deliver when political commitment is clear. The task now is to extend that resolve to climate adaptation and public health.
Anish Bari & Pranjal Pandey are co-founders of Health Spark.