African policymakers ask for more data on climate and health

As extreme weather becomes the norm across the African continent, the health of vast swaths of the population is deteriorating. Malawi has been bombarded with cholera, fueled by flooding and weak sanitation systems. This week, the country was pummeled yet again by Cyclone Freddy, with catastrophic flash flooding expected to exacerbate the spread of the deadly bacteria. The Horn of Africa is also experiencing historic levels of a multiyear drought, leading to widespread malnutrition and all of the illnesses that accompany a body weakened by hunger. But the urgency with which health responders must work to protect the health of the communities they support across Africa has not always translated into policy. Some policymakers are confused about how they should handle the intersection of health and the climate crisis within their borders. Speaking at the Africa Health Agenda International Conference held in Kigali last week, health experts said policymakers are asking for more data on cost-effective strategies they can roll out. “A lot of policymakers are saying: ‘We are tired of hearing the problems. We want to know the solutions,’” said Eliya Zulu, the executive director of the African Institute of Development Policy. “If we don't address it, it's actually going to affect the very survival of the continent.” Providing evidence “There's an enormous gap in terms of data in Africa and data generated by Africans,” said Marina Romanello, executive director of the Lancet Countdown on health and climate change. And it's not just about producing the evidence, but ensuring it’s produced in a way that promotes uptake in decision-making, Zulu said. Evidence previously generated has often focused on outlining the problems. "The further down you go to the action, there's very, very limited evidence on which interventions should we use, cost-effectiveness of interventions, and implementation,” Zulu said. And often policymakers are also left out of research design. They aren’t consulted nor included on advisory committees in those early days — and so researchers don’t seek answers to the questions those in government want answered, Zulu said. “The policymaker has to be involved in procreation,” he said. “They can't just be passive recipients of the evidence that we are generating.” Research publications can also be prohibitively expensive, said Modi Mwatsama, head of capacity and field development for climate and health at Wellcome. And if government officials do have access to them, the findings might be written in a jargon-laden way that is incomprehensible. Beyond government officials, ordinary citizens also need access to that evidence, said Bonaventure Ahaisibwe, managing director for impact and innovation at Seed Global Health. “Citizens are the ones who hold the leadership accountable, not scientists,” he said. ‘A perfect storm’ The health threats emerging and thriving from the changes to the climate are “conspiring together to create a perfect storm,” said Dr. Sam Oti, a senior program specialist at Canada’s International Development Research Centre. “And unfortunately, for us in Africa, we are right at the eye of that storm.” Natural disasters can destroy water infrastructure leaching sewage into drinking water sources. Droughts lead to limited water for sanitation and can drive people to drink unsafe water. Vector-borne diseases are expected to move to new geographies exposing communities without prior immunity. As climate change alters ecosystems, animals might venture into areas they hadn’t before — which can lead to spillover of zoonotic diseases. Adelaide Lusambili, the Kenya lead for Climate Health, Maternal and Neonatal Health Africa, said extreme heat could reduce bed net use and prevent women from going to clinics for pre- or post-natal care. New mothers might not engage in “kangaroo care” — skin-to-skin contact after birth that has shown a variety of benefits — because of the heat. And they may stop breastfeeding because the heat makes it too uncomfortable. Women in labor might come into the health facility dehydrated, which can complicate delivery, she said. And the changing climate can drive up the cost of living — as resources become more scarce, agricultural yields reduce as populations grow, and people miss work due to climate-linked illnesses, Ahaisibwe said. This, in turn, leads to a higher cost of health care, which reduces access. “We're not talking about each of those hazards in isolation,” said Romanello. “It's all happening at the same time.” Health came late The advocacy to integrate health into the climate change movement has been slow both on the continent and globally. “Health came very late to the table on the climate change agenda,” Kris Murray, a senior lecturer at the Gambia medical research unit at London School of Hygiene & Tropical Medicine. Murray said the way health researchers are trained and the way the field of science is specialized have contributed to this disconnect. “I don't think it was a field that was really ready to adopt the complexity of climate change,” he said. Conversations around climate change have instead focused heavily on the environment — the melting icebergs and dying coral reefs — rather than a focus on the threats to human health. Because of this, health in the climate space is handled on an ad hoc basis, said Cecilia Kinuthia-Njenga, director of intergovernmental support and collective progress division at the United Nations Framework Convention on Climate Change. In the frameworks under the Paris Agreement, there are no formal processes to deal with health nor is health part of the formal UNFCCC negotiations, Kinuthia-Njenga said. But during the 26th U.N. Climate Change Conference initiatives around health were launched. This included asking countries to sign on to commitments to develop climate-resilient and low-carbon sustainable health systems. Twenty-four African nations have signed on to these commitments, according to Brama Kone, technical officer in the climate change and health division of the World Health Organization Africa regional office. WHO is working through its Alliance for Transformative Action on Climate and Health to encourage other countries to sign, while also supporting those that have to draft climate change national adaptation plans. Visit the Planet Health series for more in-depth reporting on the current impact of the climate crisis on human health around the world. Join the conversation by using the hashtag #PlanetHealth.