title: Multiple shocks, coping and welfare consequences: natural disasters and health shocks in the Indian Sundarbans.
abstract: BACKGROUND
  Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May 2009, this study tests for evidence and argues that health and climatic shocks are essentially linked forming a continuum and with exposure to a marginal one, coping mechanisms and welfare outcomes triggered in the response is significantly affected.
  
  
  METHODS
  The data for this study is based on a cross-sectional household survey carried out during June 2010. The survey was aimed to assess the impact of cyclone Aila on households and consequent coping mechanisms in three of the worst-affected blocks (a sub-district administrative unit), viz. Hingalganj, Gosaba and Patharpratima. The survey covered 809 individuals from 179 households, cross cutting age and gender. A separate module on health-seeking behaviour serves as the information source of health shocks defined as illness episodes (ambulatory or hospitalized) experienced by household members.
  
  
  RESULTS
  Finding reveals that over half of the households (54%) consider that Aila has dealt a high, damaging impact on their household assets. Result further shows deterioration of health status in the period following the incidence of Aila. Finding suggests having suffered multiple shocks increases the number of adverse welfare outcomes by 55%. Whereas, suffering either from the climatic shock (33%) or the health shock (25%) alone increases such risks by a much lesser extent. The multiple-shock households face a significantly higher degree of difficulty to finance expenses arising out of health shocks, as opposed to their counterparts facing only the health shock. Further, these households are more likely to finance the expenses through informal loans and credit from acquaintances or moneylenders.
  
  
  CONCLUSIONS
  This paper presented empirical evidence on how natural and health shocks mutually reinforce their resultant impact, making coping increasingly difficult and present significant risks of welfare loss, having short as well as long-run development manifestations.
authors.affiliation: Population Health & Nutrition Research Program (PHN-RP), Institute for Human Development, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mazumdar
authors.affiliation: Department of Policy Studies, TERI University, New Delhi, India.
authors.forename: Papiya Guha
authors.initials: PG
authors.lastname: Mazumdar
authors.affiliation: Future Health Systems-RPC India, and Indian Institute of Health Management Research, Jaipur, India.
authors.forename: Barun
authors.initials: B
authors.lastname: Kanjilal
authors.affiliation: Population Health & Nutrition Research Program (PHN-RP), Institute for Human Development, New Delhi, India.
authors.forename: Prashant Kumar
authors.initials: PK
authors.lastname: Singh
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D055867:Cyclonic Storms; D004190:Disasters; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D007194:India; D007223:Infant; D008297:Male; D008875:Middle Aged; D011203:Poverty; D055815:Young Adult