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Indian Journal for the Practising Doctor

Protecting our Health from Climate Change - an Urgent Matter!

Author(s): von Hilderbrand, A

Vol. 5, No. 6 (2009-01 - 2009-02)

ISSN: 0973-516X

von Hilderbrand, A

Alexander von Hildebrand, Regional Advisor, Environmental Health, World Health Organization, Regional Office for South-East Asia, Ring Road, New Delhi 110002, India.
[E-mail: Hildebranda(at); Tel: ++.]

Climate change will affect, in profoundly adverse ways, some of the most fundamental pillars of health: food, air and water. The warming of the planet will be gradual, but the frequency and severity of extreme weather events, such as intense storms, heat waves, droughts and floods could be abrupt and the consequences will be dramatically felt. The most severe threats are to developing countries, with direct negative implications for the achievement of the health-related Millennium Development

Goals, and for health equity.

The health sector, at international, national and sub-national levels, has a responsibility, political leverage and staff with many of the necessary skills to protect the public from climate-related threats to health. Health professionals bring an understanding on how to reduce and prevent climate-related disease, injury and death.

During the last 100 years, human activities, particularly related to burning of fossil fuels, deforestation and agriculture have led to a 30% increase in the carbon dioxide (CO2) levels in the atmosphere causing trapping of more heat..The Fourth Assessment Report (AR4) of the Intergovernmental Panel on Climate Change (IPCC)3, states:

  • “Most of the observed increase in globally-averaged temperatures since the mid-20th century is very likely due to the observed increase in anthropogenic greenhouse gas concentrations;
  • Eleven of the last 12 years (1995-2006) rank among the 12 warmest years in the instrumental record of global surface temperature; and
  • The global average sea level rose at an average rate of 1.8 mm per year from 1961 to 2003. The total rise in the sea level during the 20th century is estimated to be 0.17 m. The AR4 IPCC 2007 report also draws on projections of future changes in climate:
  • “The projected globally-averaged surface warming for the end of the 21st century (20902099) will vary between 1.1 and 6.4 degrees Celsius. The projected rate of warming is greater than anything humans have experienced in the last 10 000 years;
  • The global mean sea level is projected to rise by 9.88 cm by the year 2100;
  • It is very likely that hot extremes, heat waves and heavy precipitation events will continue to become more frequent; and
  • It is likely that future tropical cyclones (typhoons and hurricanes) will become more intense, with larger peak wind speeds and heavier precipitation”.

At the 63rd meeting of the United Nations Security Council held at New York, on 17 April 2007, Mr Ban Ki-Moon, United Nations Secretary-General4, said that, according to the most recent assessments of the IPCC, the planet’s warming was unequivocal, its impact was clearly noticeable and it was beyond doubt that human activities had been contributing considerably to it.

WHO estimated that the warming and precipitation trends due to anthropogenic climate change of the past 30 years claimed over 160,000 lives, annually. In 2000, of the 154 000 deaths occurring globally that were attributable to climate change, about 77 000 of them occurred in countries of the South-East Asia Region (SEAR).

[SEAR countries are: Bangladesh, Bhutan, Democratic Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor Leste]

Populations within the SEA Region remain highly vulnerable to a wide variety of health effects from climate change, but are also the fast-growing contributors to GHG. Health impacts will be disproportionately greater in vulnerable populations. In SEAR, people at greatest risk include the very young, the elderly, and the medically frail. Low-income countries and areas where malnutrition is widespread, education is poor, and infrastructures are weak will have most difficulty adapting to climate change and related health hazards. Vulnerability is also determined by geography, and is higher in areas with a high endemicity of climate-sensitive diseases, water stress, low food production and isolated populations. The populations considered to be at greatest risk are those living on islands, mountainous regions, in water-stressed areas, mega cities and coastal areas in SEAR countries.

Mitigating the effects of climate change can have direct and immediate health benefits. A number of proposed mitigation strategies may improve health. For example, lessening the reliance on coal-fired generation of power will reduce air pollution, and associated respiratory and cardiopulmonary disease and death. Providing opportunities for the use of mass transport (bus, metro) can also reduce levels of ambient air pollution, traffic-related injury and death, and active transport (bicycling and walking) would bring down obesity rates.

Production and transport of food are major emitters of greenhouse gases. Adaptation is needed because some degree of climate change is inevitable, even if greenhouse gas emissions were abruptly capped.

Failure to respond will be costly in terms of disease, health-care expenditure and lost productivity. Estimated direct and indirect healthcare costs and lost income due to several environmental illnesses (e.g. those caused by air pollution) often match or exceed the expenditure needed to tackle the environmental hazard itself. WHO creates awareness at the global and regional levels.

The health risks posted by climate change are global, and difficult to reverse. Recent changes in climate in the South-East Asia Region have had diverse impacts on health.

The WHO Regional Office for South-East Asia, in collaboration with WHO headquarters, started addressing the issue of climate change and health by co-convening a global meeting in Maldives in 2003. This event was oriented towards the urgent needs of Small Island States.

Together with the same partners, namely, the World Meteorological Organization, the United Nations Environment Programme and the United Nations Development Programme, WHO Regional Offices for South-East Asia and the Eastern Mediterranean, organized an interregional workshop on Human Health Impacts from Climate Variability and Climate Change in the Hindu Kush – Himalaya Region, in India in October 2005. This event was oriented towards the needs of Himalayan countries in the regions.

The members of the WHO/UNEP regional Thematic Working Group (TWG) on climate change, ozone depletion and ecosystem change took part in a WHO bi-regional “Workshop on Climate Change and Health in South-East and East Asian Countries”, which was held in Kuala Lumpur, Malaysia from 2 to 5 July 2007. The participants, both the TWG members and others reviewed the methodologies for country vulnerability assessment and mitigation, and developed a regional response to reduce the burden of disease from climate change in Asia.

Participants felt the need to strengthen capacity for assessment, research and communication on climate-sensitive health risks. They recommended that awareness on health impacts of climate variability and change needed to be raised among political, financial and community leaders, health practitioners, nongovernmental organizations, other sectors and the general public. These recommendations provided a basis for the development of a draft regional framework for action at the Bali workshop.

At the 25th Meeting of Ministers of Health (1 August 2007, Thimphu, Bhutan) the highest health authorities in the Region concluded that climate change posed a major threat to health security in the SEA Region and called upon WHO to, inter alia, “support the formulation of a regional strategy to combat the adverse health impacts of climate change”. The Health Ministers also requested WHO to select “climate change and health” as the topic for World Health Day.

In October 2007, the Director-General of WHO decided that “Protecting Health from Climate Change” would be the topic for World Health Day 2008. All the member countries of WHO South East Asia Region observed and celebrated the World Health Day in a truly befitting manner.

In November and December 2007, the WHO Regional Office for South-East Asia supported four national workshops on human health and climate change in Bangladesh, Indonesia, India and Nepal.

Taking all these aspects into consideration, the WHO Regional Offices of South-East Asia and the Western Pacific regions, in December 2007, WHO organized a regional meeting of representatives of all the Member Countries of the Region which prepared the Regional Framework for Action to Protect Human Health from the Effects of Climate Change. The goal of the regional action plan is to build capacity and strengthen health systems. The first step will be to increase awareness of health consequences of climate change.

National delegations from 193 Member States attending the 61st World Health Assembly, early May 2008 in Geneva, passed a resolution on climate change and human health (WHA61.19). It calls on WHO to strengthen its work in raising awareness of the health implications of climate change, collaborating with other agencies within and outside the UN, supporting capacity building and research in health protection from climate change, and requests the organization to consult further on developing WHO’s support to countries.

The resolution also calls on Member States themselves to further strengthen the engagement of the national health sector. It urges them to develop health measures and integrate them into adaptation plans; to build the capacity of public health leaders to be proactive and take rapid and comprehensive action; strengthen the capacity of health systems to prepare for and respond to natural disasters; promote health sector engagement with other sectors to reduce risks; and commit to meeting the health challenges of climate change.

The resolution was adopted unanimously.

In August 2008, all the Ministers of Health from the SEAR countries met in New Delhi, India and issued a declaration (“New Dehli Declaration”) where the highest health authorities committed to develop and implement effective and efficient strategies and measures relating to climate change and to implement the World Health Assembly resolution WHA 61.19, on climate change and health and the Regional Framework for Action to Protect Human Health from the Effects of Climate Change. They planned to strengthen health systems capacity and notably that of public health programmes that are already addressing health effects of climate change.

Actions will be taken to increase awareness of health consequences of climate change within the health sector and in collaboration with other key sectors such as education, but also with nongovernmental organizations, in particular youth groups and consumer organizations and networks; Priority will be given to develop the capacity of health-sector professionals and to promote applied research and pilot projects to assess health vulnerability to climate change and the scale and nature thereof.

A key aspect is to engage in supporting the empowerment of local communities to become more climate change resilient and thus reduce the potential burden of disease linked to it. The health authorities are aware that this task cannot be fulfilled alone and therefore plan to collaborate with other key sectors to assess health impacts of preventive and corrective measures undertaken and ensure that health concerns are integrated in an appropriate manner.

Countries in SEAR are Taking Action

Most SEAR countries have set up national expert committees, often under the direct supervision of prime ministers to formulate national plans for mitigation and adaptation to climate change. The active participation of the health sector needs to be improved.

Bhutan aims to strengthen existing health programmes that are already addressing climatesensitive health outcomes by 2009. Bhutan’s National Adaptation Programme of Action is now accessible and available on the public domain.

In Indonesia, the National Climate Change Inter-sectoral Committee, led by the Ministry of Environment with the Ministries of Forestry, Energy, Industry, Agriculture, Health, Planning Board, Public Work and Universities as co-members, is currently incorporating health concerns and actions related to health implications from climate change into the new Five Year National Development Plan. At provisional and district levels, these concerns are being streamlined into the Healthy Cities Programme.

Currently, Sri Lanka is focusing on a series of activities that will benefit human health in the long run. Ministry of Environment has formulated a High Level Committee, including Health to study the situation and make recommendations.

Thailand is taking action to reduce green house gas (GHG) emissions in absolute terms by incorporating state-of-the-art technologies and a careful adoption of energy-efficiency measures. The Ministry of Natural Resources and Environment (MoNRE) has developed Thailand’s Strategic Plan on Climate Change (2008-2012) and has six strategies:

  1. Build capacity to adapt and reduce vulnerabilities to climate change;
  2. Promote greenhouse gas mitigation activities based on sustainable development;
  3. Support research and development to better understand climate change, its impacts and adaptation and mitigation options;
  4. Raise awareness and promote public participation;
  5. Build capacity of relevant personnel and institutions and establish a framework of coordination and integration;
  6. Support international cooperation to achieve the common goal of climate change mitigation and sustainable development.

WHO is closely working with the MoNRE on climate change and its effect on human health.

Immediate actions

The overarching goals for the international response to protect health from climate change are:

(a) to ensure that concerns about public health security are placed at the centre of the response to climate change;
(b) to implement adaptive strategies at local, national and regional levels in order to minimize impacts of climate change on the health of human populations; and
(c) to support strong actions to mitigate climate change and to avoid further dramatic and potentially disastrous impacts on health.

These goals can be achieved by working through existing public health frameworks with the following specific objectives:

Raise awareness of the need to ensure public health security by acting on climate change.

Strong, evidence-based and consistent advocacy by the global health community will be needed to raise awareness that global public health needs to be protected from climate change. Such awareness-raising will call for health-sector professionals to show leadership in supporting rapid and comprehensive actions, promoting mitigation and adaptation strategies that both improve health now, and reduce future impacts of the climate change.

The case for public health security should be made more clearly in national and international processes that guide policy and resources for work on climate change, such as preparation of National Communications and National Adaptation Programmes of Action, and the global Nairobi work programme on impacts, vulnerability and adaptation to climate change, under the United Nations Framework Convention on Climate Change.

Strengthen public health systems to cope with the threats posed by climate change.

Increased investment in public health systems is already necessary in order to meet the health-related Millennium Development Goals, whose achievement will be further compromised by the impact of climate change. For this reason, additional system strengthening and forward planning will be required. Within this broad context, at national level the health sector should:

(a) assess the potential impacts of climate change on health;
(b) review the extent to which existing health systems can cope with the additional threat posed by climate changes, and
(c) develop and implement adaptation strategies to strengthen key functions that already protect against climatic risks.

This approach will need to encompass interventions within the formal health sector, such as control of the neglected tropical diseases and provision of primary health care, and actions to improve the environmental and social determinants of health, from provision of clean water and sanitation, to enhancing the welfare of women. A common theme must be ensuring health equity and giving priority to protecting the health security of particularly vulnerable groups. Enhance capacity to deal with public health emergencies.

There is a particular need to strengthen systems to be able to respond to acute shocks associated with climate variability, including the health consequences of natural disasters, and more frequent, severe and wide-ranging epidemics.

Promote health development

National and subnational health agencies can promote health through assessment of the health implications of decisions taken in other sectors, such as urban planning, transport, energy supply, food production, land use and water resources. In this way, they can support those decisions that provide opportunities for improving health and at the same time reduce emissions of greenhouse gases that cause climate change; these opportunities include new investment in sustainable transport in developed and rapidly developing countries and in clean domestic energy in developing nations.

Enhance applied research on health protection from climate change.

Better evidence is needed of the effectiveness and efficiency of public health measures to protect health from climate change. Such activities require systematic, interdisciplinary applied research in Member States.

Monitor and evaluate delivery.

National and subnational agencies should improve identification and monitoring of the health status of vulnerable groups, and evaluate the effectiveness of interventions aiming to protect health better from climate change.

Foster cross-disciplinary partnerships.

In order to ensure wide-ranging and effective mitigation and adaptation, Member States should build partnerships at the national and subnational levels, exploiting the expertise of government agencies, intergovernmental and nongovernmental organizations, and community, industry and professional groups for health protection.


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