Global Health in a Changing Climate
Building on the closing plenary in 2019, the 26th Canadian Conference on Global Health (CCGH) is calling the global health community to action around planetary health— defined as the health of human civilization and the state of the natural systems on which it depends. The societies and the health systems we live in must be both resilient and responsive to the challenges of climate change—the overarching issue of our time.
For at least the near term, COVID-19 will continue to be a worldwide health priority exacerbating the disease burden for populations already affected by health inequities and environmental challenges. While the conference will focus on environmental and health promotion issues in a global health context, we will make use of the event to exchange ideas being raised in pandemic planning contexts that could accelerate progress towards environmental, health and the Sustainable Development Goals (SDGs).
“Today, we live longer and more prosperous lives than ever before. The unparalleled public health, agricultural, industrial, and technical advancements of the 20th century created the conditions for better health for billions of people. Yet this tremendous socio-economic progress is taking a heavy toll on the Earth’s natural systems. Our patterns of highly inequitable, inefficient, and unsustainable resource consumption, together with population growth, are degrading nature in ways that are actually undermining our well-being, including:
Reduction of food security and nutrition
- Loss of freshwater resources
- Higher exposure to communicable and increase of non-communicable disease; and
- Increased loss of life and well-being by extreme weather events”
It is becoming evident that non-traditional alliances between health human resources in acute care settings, community-led health promotion programs, government monitoring and evaluation expertise, and private sector collaboration will be necessary to respond to complex global environmental challenges.
At the CCGH, the immense health gains into the 21st century will be showcased—the challenges and solutions that led us here will be examined, and we will raise questions about whether these strategies will remain relevant in the context of change. This will be explored through the following subthemes:
- Environment and Climate Change
- Health Systems and the Burden of Disease
- Innovating for Health
- Changing politics
Environment and Climate Change
The observable effects of global climate change such as droughts, flooding, frequent wildfires, a higher intensity of tropical storms and heat waves, melting glaciers, and rising sea levels are linked to poverty, food insecurity, and disaster. According to the International Panel on Climate Change (IPCC), the effect of the climate change is felt everywhere, and exacerbated in the Global South, where humanitarian crises are becoming more frequent and the resources to mitigate or manage their impact are limited.
Climate change affects both the natural and built environment. Issues arising out of human-made environments resulting from changes in land use, urbanization, and globalization include air pollution, tainted drinking water; overcrowding, food insecurity, and the rapid spread of infectious disease (see Theme 2).
Yet both kinds of changing environments impact human health directly, so too do they affect the social, cultural, economic, and commercial determinants of health. The harmful effects of environmental change do not affect people equally. Health inequity is on the rise, with women and girls being particularly impacted, often because of social and cultural norms (e.g., women and girls’ nutrition, their roles as water bearers, caregivers, farmers, exposure to risky situations in contexts of fragility). \
Keywords: Built environments; healthy cities; natural environments (including food systems, animal, air, water, earth quality); weather pattern and acute weather events; gender and climate change; natural disasters; fragility; humanitarian crises (including conflict and migration); planetary health, social determinants of health
Health Systems and the Burden of Disease
“The climate crisis is a health crisis.” (WHO, 2020)
The economic and social costs of climate change for the health sector continue to increase. From the changing burden of disease to the working conditions of health workers delivering services to drug management (cold chain supplies), and health facilities at risk, effective mitigation and adaptation strategies will have to be considered, particularly at a time when our public health systems are under pressure owing to fiscal crises. Contingency plans and humanitarian responses for operating health facilities in the face of natural disasters require attention and collaboration from previously unlikely partnerships.
The leadership and skills required of health personnel within clinical and public health practice in the face of new disease patterns arising from climate change, and the “greening” of health systems need further exploration of collaborative approaches and new settings for care. Furthermore, how we consider environment and climate change in the design of digital solutions will be critical to understanding technological supports health care providers and the populations they serve.
In the context of continued economic growth and health progress globally, climate change is expected to cause additional deaths, due to heat exposure in elderly people, diarrhoea, malaria, and childhood undernutrition. Non-communicable diseases (NCDs) and infectious diseases are both impacted by climate change: new patterns of vector-borne diseases; chronic diseases (vulnerability to environmental stress with the elderly, pregnant women and children); respiratory problems from air pollution; mental health (post-traumatic shock – flood, storms, etc.); maternal and child health (access to services, water supply and food security); and, cardio-vascular and renal diseases (extreme heat and cold).
What is the link with social determinants of health, where socioeconomic status makes a difference in the burden of disease and mortality, migration patterns, and emergency planning? How can community-based health promotion and early intervention programs improve resilience and risk profiles for populations facing environmental stresses?
Keywords: NCDs/ NTDs/ infectious/tropical diseases; pandemics; mental health; migrant health; refugee health; nutrition; anti-microbial resistance (AMR); Health and human resources; health financing; health services; health information systems (HIS); greening the health system; community health workers
Innovating for Health
Successful societies invest in their populations’ well-being and protect their rights, as is evident from countries that have improved health and economic measures over the past few decades.
The paradigm through which many now countries operate is increasingly reflective of the role of women and girls as powerful agents of change who are capable of transforming their households, their societies and their economies. We are facing a challenging empowerment issue for women and girls, particularly in times of crisis whereby infringing basic human rights has been too often tolerated, meanwhile we should put social change in the agenda for more resilient and equitable societies . However, a mix of discriminatory laws and policies, compounded with inadequate services and harmful cultural practices, limits the sexual and reproductive health and rights of women and girls. The result is often a lack of comprehensive sexuality education and family planning services; restricted access to contraception, safe abortion and maternity care; child, early and forced marriage; and gender-based violence.
While many countries have made investments that led to impressive gains in health and nutrition, others have fallen behind or are at risk of slipping backwards—particularly those facing high levels of HIV/AIDS and other infectious diseases, the destabilizing effects of climate change, economic hardship or conflict. Furthermore, Women and girls are disproportionately at risk from the effects of climate change and need better support to mitigate and adapt to changes that threaten their health and economic well-being.
The laudable gains made, particularly in relation to women and girls’ health and economic empowerment, must be recognized. Investments such as oral rehydration solutions for diarrhoeal disease, micronutrients and nutritional supplements, immunization programs, prioritizing women and girls, and other innovative programs and projects have greatly improved health outcomes globally.
At a time of significant change—social, cultural, environmental, political—these gains are at risk. Will the same approaches that brought these successes remain relevant? Innovating for resilience and mitigating the effects of external pressures will require practical and cost-effective strategies and solutions to avoid setbacks.
Keywords: women and girls, women and children, adolescent health, sexual and reproductive health and rights (SRHR), health promotion, immunization, empowerment, engaging communities
Awareness around the health impact of climate change has gained traction, and, in an increasingly polarizing world, governments are beginning to pay attention, with civil society, grassroots movements, and professional associations beginning to demand action.
Changing politics requires new global governance structures to support political leaders and decision makers to influence global strategic calls and national responses. These responses need to address the inextricable links and influences of policies that have detrimental impacts on human populations. These responses also have to address the inequities that exist that hinder nations and communities to prevent, mitigate, and respond to these detrimental impacts. Without this ability to effectively respond, the most vulnerable are left with little option but to move to more hopeful, supportive and sustainable communities. As a global community we need to act in solidarity with the most vulnerable to achieve safe, peaceful and welcoming opportunities for those that wish to migrate, to reduce and prevent conflict and improve sustainable environments.
The health professions are increasingly politicized, with nurses and doctors taking action in their daily work as well as on the political stage, including civil disobedience that calls for addressing the structural issues behind climate change. With health represented in international climate discourse level (IPCC is starting to draw CMA, WHO, the Lancet, nurses and midwives associations among others), there is an indication that the global health community too is concerned and beginning to mobilize. We are now turning to historic and traditional knowledge keepers, whose holistic understandings of health are parallel to the concept of planetary health. This often also means contending with and reconciling difficult colonial histories (within Western countries, as well as addressing the Global North/South imbalance).
Governments are faced with balancing economic development with the need to sustain a healthy planet, and in a polarizing world, climate issues are taking the form of political movements (such as Fridays for Future, Extinction Rebellion, les Gilet Jaunes). Climate change requires global health researchers, practitioners and policy makers to bring evidence-based solidarity to our current polarized world.
Keywords: Global policy frameworks; policy action; activism; role of media; Indigenous voice and learning; global health security; Global North/South impact; intersectoral action; Sustainable Development Goals (SDGs).
Cross cutting themes that will be balanced throughout the program include:
- Equity (including gender equality and marginalized/vulnerable populations)
- Innovation and partnerships (new approaches/research methods, technologies, etc.)
- Intersectoral and systems approaches
- Intergenerational learning
The year 2020 marks the Year of the Nurse and the Midwife and the beginning of the UN Decade of Action—calling for sustainable solutions to the world’s biggest challenges. The global health community is well positioned to both respond and galvanize action around these calls. Join us at the 26th CCGH in Ottawa to explore this issue.
Rockefeller-Lancet Commission, 2015.