Seventeen of the hottest years in history were all within the last 18 years. The recent reports from the Intergovernmental Panel on Climate Change (IPCC), the US Global Change Research Program (USGCRP) and The Lancet all paint a grim picture of our future on a warmer planet. They detail the abundant evidence of how our changing climate will “affect human health with primarily negative consequences” (IPCC). These facts and figures can feel dense and impersonal, but we must remember there are people already suffering the consequences of that data, people like my patients in rural India.
28-year-old Mausam Bai (name changed) was visiting her mother’s house in the jungles of Achanakmar Tiger Reserve in rural Chhattisgarh to celebrate Teeja, a local festival when she developed a fever. She ignored her illness so she could enjoy some time with her mother and brothers.
Unfortunately, in the following days, the fever worsened and she developed severe abdominal pain and collapsed one day during the festivities. Her frantic family rushed her to the emergency room where I met her, laying on a stretcher in a crumpled sari, drenched in her sweat and moaning incomprehensibly.
Within fifteen minutes of arrival, she tested negative for malaria. We then treated her with a cocktail of antibiotics targeting the other most likely infections, while waiting a week for specific test results to return. After four days of intensive care, she recovered.
Three days later, her test returned positive for scrub typhus. Over the last year, twenty patients have been diagnosed with scrub typhus at our hospital. This is unusual. Investigators in Korea have suggested that climate change is likely contributing to the rising incidence of this mite-borne infection.
A common mosquito-borne infection, dengue was rare in our region until this year, when that changed. Chhattisgarh had its first large outbreak of dengue in 2018. Over the last three decades, dengue epidemics have become larger and more frequent throughout India. Rising temperatures, seasonal variations, and shifting precipitation patterns bring new places the precise conditions that allow mosquitoes or mites to flourish, helping dengue virus or scrub typhus to invade new communities like ours.
Infections carried by mites and mosquitoes aren’t the only dangerous diseases gaining ground as temperatures soar. Increased intensity and frequency of floods, and droughts have threatened food production systems and livelihood in Chhattisgarh.
Migration and tuberculosis
Jalwaayu Baba, (name changed) a middle-aged, subsistence farm labourer, used to harvest two crops each year, but now succeeds in cultivating only one. These low yields forced him to migrate from his rural village to Mumbai in search of employment. Migration compounded by malnutrition, poor housing and ventilation are well documented incubators for tuberculosis.
When Jalwaayu Baba developed a constant cough and weakness, he returned home to Chhattisgarh. He subsequently spread tuberculosis to his younger sister and now both are being treated by their village health worker.
These victims of our shifting climate have all been treated at the one rural hospital where we work, but their suffering is not unique.
Climate change has wreaked havoc throughout India, making the summers intolerable, rivers prone to flooding and land barren. Heat waves have caused more than 25,000 deaths since 1992. In 2018, Kerala has suffered its worst floods in 100 years. The consequences of severe flooding within a fragile health system have included outbreaks of leptospirosis and increased incidence of mental illness.
A global crisis
These are examples from India, but climate change was responsible for 5.5 million disability-adjusted life years lost in the year 2000, more than 75% in Africa and Southeast Asia. The carbon footprint of the poorest billion is only 3%, yet these are the communities most affected by climate change and least able to weather the consequences, an unjust paradox.
Climate change will be a defining health issue for our generation. It is testing the resilience and adaptability of health systems in the poorest nations on earth. As The Lancet report suggests, “the nature and scale of the response to climate change will be the determining factor in shaping the health of nations for centuries to come.”
An effective health-adaptation response must include building robust health systems for the most vulnerable communities and training the professionals working in those systems to face the challenges a warmer climate will bring.
Historically, health care in low- and middle-income countries has been focused on specific diseases prioritised by the global financiers like malaria, HIV and tuberculosis.
However, the health effects of climate change are widespread and varied, including heat waves, natural disasters, allergic conditions, malnutrition, waterborne infections and mental illness.
A system only adept at managing malaria will fail patients like Mausam Bai, who had scrub typhus that doctors didn’t predict. She needs a system with quality along the continuum of care, adaptive laboratory capacity, comprehensive pharmaceutical inventory, sensitive surveillance systems, thorough disaster preparedness plans and trained health providers.
Healthcare professionals ranging from village health workers to university academics should be trained to recognise the biological and social link between climate change and health. They must be prepared to respond to climatic health emergencies, to treat unfamiliar conditions and to sound the alarm when they see shifting patterns in the health of their communities. Health workers on the front lines are the natural advocates for people like Mausam Bai and Jalwaayu.
The human-toll of climate change will continue to rise and inequities in health status will deepen unless resources are dramatically increased to build a truly climate resilient health system that serves everyone justly.
Anup Agarwal is a HEAL initiative, UCSF fellow at Jan Swasthya Sahyog, India and Jennifer Bass is a HEAL Initiative fellow at Last Mile Health, Liberia and GIMC, Gallup.