Environmental factor plays a vital role in individual's health specifically on women. The literature on the links of the climatic changes with women's health status envisages diverse effects. Therefore, it is the dire need to estimate and document effect of climate change on women's health.

Climate change, most important aspect of physical environment, is one of the emerging threats to global health. Climate change is likely to reduce cold extremes while increases frequency, intensity, and intervals of heat waves. Climate change might damage human health in many ways, comprising adverse variations in food production (Rosenzweig, 2011), concentrations of outdoor air pollutants (Bernard, Samet, Grambsch, Ebi & Romieu, 2001; Knowlton, Rosenthal, Hogrefe, Lynn, Gaffin, Goldberg & Kinney, 2004; Haines & Patz, 2004), thermal stress (Martens, 1998), malaria (Loevinsohn, 1994; Tanser, Sharp, & Le Sueur, 2003), aeroallergens (Beggs, 2004), waterborne diseases (Casman, Fischhoff, Small, Dowlatabadi, Rose, & Morgan, 2001; Charron, Thomas, Waltner-Toews, Aramini, Edge, Kent & Wilson, 2004), dengue fever (Hales, De Wet, Maindonald & Woodward, 2002), extreme events (Knutson, Tuleya & Kurihara, 1998; Ikeda, Yoshitani & Terakawa, 2005) and other diseases (Reiter, 1998; Patz, Campbell-Lendrum, Holloway & Foley, 2005). The hypothesis to be tested is:

H1a: Changing climatic pattern is negatively associated with women health status

Since last few decades, health economists pay much of their attention towards maternal and child health care only. But in recent decades women health gains attention worldwide in broader concept of biological, gender and social determinants. Exploration of women health is in transition phase. In this regard, there is a dire need to investigate how women health affects through physical environment. The exposure of interest in this study lies on physical environment spectrum where we discuss theoretically and analyse empirically the challenges faced by women health due to environmental variability and changing weather pattern. To our knowledge, this is the first study of its kind which analyses empirically the relationship between women health and climate change.

This paper is arranged as follows: Section 2 entails previous literature. Section 3 emphasizes on methods and data analysis. Section 4 gives detailed picture of empirical results along with robustness while Section 5 concludes the study.

Climate change is one of the emerging threats to worldwide health. Several studies

have examined the short and long run problems related to climate change on health, literature claims that higher mortality rates are associated with intensive heat and cold waves (Lee, Steer & Filippi, 2006; Deschenes & Moretti, 2009; Gosling, Lowe, McGregor, Pelling & Malamud, 2009; Deschenes & Greenstone, 2011; Barreca, 2012; Li, Horton & Kinney, 2013; Gasparrini, Guo, Hashizume, Lavigne, Zanobetti, Schwartz, & Leone, 2015).

Many widespread human diseases including mortality, morbidity, malnutrition and infectious diseases are related to climate fluctuations: extreme heat, cold and storms (Patz, Epstein, Burke & Balbus, 1996; Kovats, Campbell-Lendrum, McMichel, Woodward & Cox, 2001; Stott, Stone & Allen, 2004). It is projected that global average temperature will rise between 1.4⁰C - 5.8⁰C by the end of this century which in turn will raise sea level. Extremes of the floods and droughts are anticipated to upsurge with warmer temperatures. The most vulnerable areas are regions around the Pacific and Indian oceans, Sub-Saharan Africa. Above facts paint a grim picture of environment about the future.

Haines, Kovats, Campbell-Lendrum & Corvalán (2006) argue that climate is changing due to accumulation of greenhouse gases in atmosphere that result from burning of fossil fuels. Chemical reactions and volatile organic compounds that formulate ozone are highly sensitive to climate change (Sillman & Samson, 1995; Constable, Guenther, Schimel & Monson, 1999; Aw & Kleeman, 2003; Seinfeld & Pandis, 2016). Ozone concentration has adverse effects on health such as emergency hospital admissions, asthma and lungs issues (Lippmann, 1989; Dockery & Pope, 1994; Thurston & Ito, 1999; Bell, Goldberg, Hogrefe, Kinney, Knowlton, Lynn & Patz, 2007).

Climate change influence health outcomes through several ways, for instance, heat waves, droughts and floods, vector-borne diseases, malnutrition and risk of disasters. According to Dr. Asif Zafar Bhatti in a report on "Risks in flood areas of Pakistan", women and children are more vulnerable in floods. They have to face starvation, water borne diseases and lack of medical facilities that affect them badly. The girls, children and women are in real danger during flood times due to human trafficking, sexual abuse and lack of shelter. During 2010 flood in Pakistan, many 34,000 women including paramedical staff (lady health worker, LHW, LHVs, midwives and nurses) were missing and were victim of sexual abuse, violence, trafficking and injured (these are unauthorized figures according to a report by Tahira Abdullah). People who have experienced flood suffer from common psychological disorders. In addition, it also affects vector disease distribution (e.g. incidence of dengue, malaria and diarrheal diseases). Climate change influence goods and services (necessary for human health) by influencing ecosystem and biodiversity. Climatic impact is more vulnerable for young mothers who spend most of their time outside home comparative to those working mothers who spend time in ACs.

Women's health risk need attention to prevent harmful effects of changing physical environment which is the result of increasing temperatures inside and outside homes and release of chemicals and toxins in air. Although physical environment is easily accessible to all, yet its consequences are expensive in terms of health. Despite a huge strand of literature focused on climatic conditions and related effects of physical environment on health of individuals but less attention has been paid on the most important sector of the economy that is women. Women of lower income group are generally more vulnerable as they have to perform their HH tasks and also have to perform outdoor activities even in unacceptable weather conditions also. Literature has paid less attention towards physical health as a consequence of physical environment. In case of Pakistan, we find no single study analyzing the association of physical environment and women health empirically. To address this gap, we are focusing ever married women's health to check the vulnerability of physical environmental interactions.

Erbsland, Ried & Ulrich (1994) follow Grossman health production function and model the effect of physical environment on health demand and health care. Environment affects health directly through exposure to risk factors like physical, chemical and biological factors.

To capture environmental effects, this study introduces climatic changes conditions which depreciate human stock of health. We are following Erbsland, Ried & Ulrich (1994) empirical model to analyze the effect of climatic changes conditions on women health. The model takes following form:

In this study, the data is being collected from the primary source (directly from the respondents), as it is original, reliable and relevant to the topic of the recent research. As the study is a field-based research so, survey was conducted in the selected areas of study. And for data collection from the field, closed ended (structured) questionnaire was designed to evaluate the perceptions of selected sample. The area of study is District Rawalpindi and it contains seven tehsils. The sub-divided tehsils are: Taxila, Kahuta, Kalar Sayedan, Gujar Khan Murree and Kotli Sattiyan, Rawalpindi. Rawalpindi city is the district capital and has an area of 5,286 km². At first, its area was 6,192 km² till 60s when Islamabad Capital Zone was engraved out of the district. Total population of Rawalpindi District is 5,405,633 (2017 estimates). It is situated on the Southern slopes of the North-Western extremities of the Himalayas, with large mountain territories with rich valleys navigated by Mountain Rivers.

The selection of these areas was done purposively as there is vast heterogeneity in physical environment as well as in social environment and also has cultural diversity. District Rawalpindi has a disparate environment including, alpine, temperate and tropical climate of rainy hot summers and cool dry winters. The environmental location of area around people has great influence on health, mood, psychological and behavioral activities, respiration, stress, and sensory perception.

The study specifies to married women's health. Therefore, sample size consists of 504 respondents that consist of married, literate and illiterate women of different areas of the cities. The sample size is selected randomly from the population. All data is analyzed using Stata 14. There was missing data for non-respondents, so it is excluded from the analysis. Out of 700 questionnaires, 504 are reported fully, the reason for non-participation of women in survey is mainly due to less awareness about environmental issues and its impact on health. Health is dependent variable in this study. We measure physical health of the respondent by asking the question: What is your physical health status? The anchors used to answer this question are excellent, very good, good, fair and poor. While for estimations, we recode our dependent variables as 0 to 1 following existing survey-based studies on health (Carlson, 2004; Nyqvist, Finnäs, Jakobsson & Koskinen, 2008; Ferlander & Mäkinen, 2009). We combined positive outcomes of self-rated physical health (excellent, very good and good) into 'good' and assign them '1', on the other hand, negative outcomes (fair and poor) are taken as 'poor' and a value of '0' is assigned to them.

Our focused variable of the study is climate change. Global atmospheric seasonal changes with increasing accumulation of greenhouse gases refer to climate change. Women have more acute issues due to climate changes. According to Bruce and Susan (Climate Reality Leaders and Health Experts), there are strong evidences that in adolescent girls the chances of asthma are more due to climatic changes while in elder women the probability of lung cancer and heart diseases is more. Different studies investigate the association between climate change and health related to high temperature and increased mortality (Lee, Steer & Filippi, 2006; Deschens & Greenstone, 2011; Barreca, Clay, Deschenes, Greenstone & Shapiro, 2016). So, to capture the effect of changing climate pattern the respondents are asked the question: Do you feel that changing weather pattern is affecting your health?

Graphical Representation of Analysis

This analysis investigates the prevalence of health effects of climate change on married women, aged between 16 to 65 years and more, of District Rawalpindi.

Descriptive analysis of the data reveals that changing climatic and weather conditions deteriorate health of the women. Association between health status of women and climatic conditions are explored through cross tabulation and logistic regressions. Climate changing conditions along with covariates are independent variables. Demographic data: age, husband age, and age gap with husband, socio-economic data: HH income, education, employment status, life events, women empowerment and environmental control variables data is also obtained. These variables are entered into descriptive analysis and in regression models as covariates in statistical analysis.

We also perform sensitivity analysis to check whether our results are robust to other determinants of health by adding variables one by one. We include medical facilities, greenery around homes, water quality, sanitation quality and overcrowding as potential determinants of health. Overcrowding has negative and significant effect on physical health outcome. People living with crowded environment are at a higher risk of illness, the major diseases are respiratory infections, hepatitis, tuberculosis and trachoma and others (Baker, M., McNicholas, Garrett, Jones, Stewart, Koberstein, & Lennon, 2000). Lack of medical facilities negatively affect health outcomes of women. Whereas, improved water and sanitation quality enhances health outcome, as safe and clean water, hand washing facilities, proper toilets and hygiene practices are crucial for improved individuals' health outcomes (Moe & Rheingans, 2006). The indicator of greenery has positive and significant effect on physical health. Living in natural beauty improves our quality of life and provides pollution free environment (Pretty, Peacock, Sellens, & Griffin, 2005). Overall results of sensitivity analysis suggest that findings are robust to inclusion of other determinants of health.

Our results show that climatic changes (increasing heat intensity, dry spells, unusual rains and others) affect women health badly. We have to improve our climate by offering different policies designed by state. This may include deforestation, plantation in and outside homes and environmental friendly policies like renewable energy that is a shift from coal and oil investing energy projects. Efforts should also be put to increase green areas within urban locality.

So, government should also be prepared to manage sudden environmental changes and take steps to create awareness in people to safeguards themselves from disastrous effects of changing climate. Awareness, preparedness and information cells can be managed through media to provide safe guards. Rising awareness among individuals is an essential way to reduce health associated risks of climate change.