Climate change and the health of the South American population: risks, threats, vulnerabilities and preparation31/01/2019
The process of climate change, consistent with global warming generated predominantly by human activity, has been detected since the 1950s. It is estimated that compared to the temperature of 130 years ago, the world has warmed up to approximately 0.85oC. In the last report of the Intergovernmental Panel on Climate Change (IPCC), published in October 2018, experts on the subject considered the need to limit global warming to 1.5o C, in relation to the pre-industrial levels, instead of 2o C, as established in the Paris Agreement, and analyzed their potential impacts on natural ecosystems and populations.
The effects of climate change on human health have been documented or projected through studies and models carried out over the last decades. These effects can occur directly, due to changes in temperature, rainfall regimes, with the consequent occurrence of extreme weather events and disasters, such as heat waves (or more intense cold spells), floods, droughts and fires. These same effects can be even amplified by the occurrence of respiratory, allergic and infectious diseases (this due to interruption, destruction or contamination of drinking water supply systems). The possible effects related to population displacement caused by disasters should also be considered. Damages to the infrastructure of services, including the health systems, generated by disasters, favor the occurrence of adverse health effects, or hinder the possibility of reducing or recovering these effects.
The effects on human health can also manifest indirectly, due to ecological disorders caused by climate change, related to the loss of biodiversity, decrease in crop production, decrease in the availability of drinking water and impact on quantity and quality of water resources. The consequences can be observed by increasing the incidence and mortality or by expanding the geographical distribution of infectious diseases (especially those transmitted by vectors and those transmitted by contaminated water or food), noncommunicable diseases, mental illness and malnutrition.
The effects of climate change can be mediated by some factors, not restricted to aspects related to climate. Vulnerability conditions favor the incidence of the adverse effects of climate change. Some conditions are related to biological factors, such as age or pre-existing morbid conditions. Vulnerability is also related to social conditions and inequity in health, associated with poverty, housing conditions, urban infrastructure, food, access to health services and others inequities related to social class, gender, race, among others. Although climate change can affect all populations and territories, its effects will have an impact, exacerbating pre-existing health problems, with more serious consequences for the most vulnerable populations. For example, prolonged drought generates a decrease in food production, strongly affecting availability for more vulnerable population groups such as children from poorer countries and regions, with increased malnutrition in these groups.
From the perspective of public health it is necessary to develop actions aimed at confronting the problem, addressing to the adaptation or mitigation of the effects of climate change. Aware of this need, in the South American region, the countries included among the objectives of the Constitutive Treaty of the Union of South American Nations (Unasur) the need to have cooperation in the fight against the causes and effects of climate change. In the Unasur instances, this issue has been addressed through the Disaster Risk Management in Health Network, which was supported by the Isags for the development of a South American Disaster Risk Management in Health Plan. In this Plan, the topic of climate change represents one of the strategic axes, which included the development of studies on the possible impacts of climate change on the health of the South American population.
In December of 2018 Isags presented the preliminary results of the study, in a Session of the Dialogues from the South, in which Eduardo Hage (Isags), Christovam Barcellos (Fiocruz) and Vanessa Veintimilla (Isags intern researcher) participated. The study analyzed the publications reviewed for the production of the IPCC reports for 2014 and 2018, to explore the current state of knowledge about climate change and the implications for the health of the South American population, as well as to identify the approaches and aspects present in publications and initiatives, programs and government projects to address the effects of climate change on health.
The study identified that there is a relevant production of knowledge about the current impacts of climate change on the health of the South American population, having as authors scientists from the region, who analyzed the main health problems and vulnerability to the problem. Meanwhile, it is observed that in the South American region, most of the studies available in the sources analyzed address the risks for the increase or spread of communicable diseases, with little production on other types of events. What stands out is that health events such as respiratory diseases and disasters, which in publications referring to other regions or globally are analyzed in their relations with climate change, are underrepresented in the publications presented in this study. In part, it may reflect the high burden of communicable diseases in the South American region, but it may also be related to search strategies in the literature used and the distribution of contents for the production of IPCC reports. For example, in the 2018 IPCC publication, the effects related to malnutrition are a specific topic, which is not the case in the 2014 report. In the 2018 report, it was still observed that there is scarce scientific production on the subject in the South American region, which may indicate that most of the articles produced in this region address the current impacts, risks and vulnerabilities, with few studies on projection in the face of new heating scenarios of 1.5o C and 2o C above the pre-industrial levels.
In the analysis of the dimensions related to the effects of climate change in the 2014 report, it is observed that the El Niño and La Niña climatic phenomena are well represented, which reflects the impact of these phenomena on the region and worldwide, as it has been observed in different publications. Another point to highlight is represented by the analysis of the conditions of vulnerability, especially related to the population groups that may be most affected by the effects of climate change.
In relation to the initiatives of the health sector to respond to the problem, in particular, the National Adaptation Plans to Climate Change, it is observed that there is progress in the fulfillment of the different international agreements assumed by the countries of the region in the regional instances (PAHO, ORAS-CONHU, Unasur, Mercosur), through the proactivity of the sector in the development of these plans. This incidence is fundamental, taking into account the expertise of professionals in this sector on the risks, threats and vulnerabilities that must be considered for the production of the Plans. As well as recognizing the central role that health services can have to restrict, as much as possible, the damage to the health of the population. It is also observed that there is a relevant diversity of strategies adopted by the Plans and other initiatives, which is necessary to make the strategy of the health sector more effective for the effects of climate change.
The elaboration and execution of the National Plans require political will and commitment of all the government instances to promote the planned activities. Initiatives for mitigation such as smart hospitals (safety, green and healthy) and for the response as Emergency Medical Teams also depend on public policies and direct demand from the health sector.
Addressing explicitly, decisively and committed climate change as a transversal axis in the health sector, calls us to take into account interculturality and the focus on human rights and gender as a key management factor. This approach implies recognizing that men and women, from different cultures, have developed knowledge and recognize signs that allow them to coexist with the climate and adapt to the changes they generate. It also implies that the impacts of climate change are not the same for different population groups, which should be considered in the prioritization and selection of adaptation strategies for the Plans.
Thus, the accumulated knowledge and the systematization and production of new information and knowledge for the region can meet the needs of adapting the response to events, taking into account that the effects of climate change can have a different effect on each geographical location (region, country, municipality), depending on the context of environmental and population vulnerability that shapes these effects.
Authors: Eduardo Hage & Vanessa Veintimilla
Desing: Raquel Cerqueira
Barcellos et al, 2009. Mudanças climáticas e ambientais e as doenças infecciosas: cenários e incertezas para o Brasil. Epidemiol. Serv. Saúde, Brasília, 18(3):285-304, jul-set 2009.
IPCC, 2018. Global Warming of 1.5º C. Especial report. 2018. Available in: https://www.ipcc.ch/sr15/. Access in 12.20.2018