By Dr Lokotola Christian Lueme
Climate change has an impact on the health of all life on our planet – from human and animal to vegetation. Primary health care is at the forefront of health care services. Climate change not only has direct and indirect impacts on human health, but also threatens the capacity of health systems to give proper care and protect population health.
The sixth report of the Intergovernmental Panel on Climate Change (IPCC), which was released last year, states that climate change is the biggest challenge facing human health in the 21st century. Climate change continues unabated, and extreme weather events, such as extreme temperatures, heat waves, subtropical cyclones and progressive droughts, have intensified and increased.
Climate change, health and health care services are related in three ways. First is the effect on morbidity and mortality rates and the ways in which health systems respond to the changing burden of disease. Second is the way in which health systems contribute to causing climate change. Third is the way facilities and health services are affected by climate change, and how they can adapt or become more resilient to maintain service delivery despite climate-related disruptions.
Morbidity and mortality rates are changing in diverse ways across Africa. There are changes in the incidence of infectious diseases. The geographic spread of vector-borne diseases such as malaria, Zika virus and chikungunya will change as they respond to changes in the climate. For example, mosquitoes may be able to spread disease at higher altitudes as these places become warmer. As water quality and quantity change, so does the spread of water-borne diseases. For example, flooding and poor sanitation may lead to cholera; higher temperatures and water scarcity to gastroenteritis and diarrhoea. Drought leads to malnutrition, as crops and animals fail and food insecurity increases. High temperatures may negatively affect labourers, pregnant women and children. Extreme events may lead to injuries and trauma. All these new challenges add to the mental health burden and may provoke migration.
The impact of these changes will also depend on the ability of people and communities to adapt and respond to them. The impact on people depends on a complex interaction between hazards, exposures, pre-existing vulnerabilities, and capacity to adapt. Early-warning systems may help communities to prepare better. Changes in morbidity and mortality rates may not be attributed to climate change, however, because of the complex interactions that cause them.
The IPCC report states that if the global health system were a country, it would be the fourth-largest carbon emitter in the world. Research on building less harmful healthcare services, which reduce their carbon footprint, is at an early stage. There is a mounting global movement on planetary health – which is a transdisciplinary and holistic approach to health that recognises the interdependency of human health and the health of our planet – and networks such as the Global Green and Healthy Hospitals. Primary health care in Africa, when compared to Europe or the USA, is likely to have an almost negligible carbon footprint.
Extreme weather events also destroy health care infrastructure, telecommunications and supply chains, and reduce access to both emergency and routine services. Health systems need to anticipate the challenges of climate change and prepare better to withstand the challenges it brings. For example, how do we build facilities that reduce indoor temperatures without relying on electricity and air conditioning? How do we maximise the co-benefits of alternative energy supplies such as photovoltaic panels to improve resilience and reduce greenhouse gases? How can we build facilities that will withstand floods or cyclones?
Many health professionals are unaware of the health impacts of climate change. Nevertheless, they have a substantial influence on individual patients, collective attitudes, health policy, and the resilience of health systems to climate change. There is a need to include more training and education around environmental stewardship and the environmental crisis facing health and health care.
The World Health Organization's (WHO) operational framework for building climate resilient health systems recognises that resilient health systems are based on primary health care. Therefore, health services can improve their resilience by doing basic and applied research at the primary health care level. Climate-resilient primary health care research needs to engage with local solutions and adaptations and build evidence to empower policy and decision-makers.
Unfortunately, in the African context, primary health care is often poorly developed, in terms of both access and quality. The WHO framework identifies a number of building blocks to consider. These consist of leadership and governance, financing, infrastructure and technology, supply chain, workforce, health information systems and service delivery.
Answering three questions can lead to climate-resilient primary health care in Africa. How has climate change affected health and primary health care service delivery in Africa? How can the primary health care system adapt better to the threat of climate change? How can the primary health care system mitigate its own contribution to climate change?
Dr Lokotola Christian Lueme is a lecturer in Planetary Health in the Faculty of Medicine and Health Sciences at Stellenbosch University.
