Priority focus areas for a sub-national response to climate change and health: A South African provincial case study

Method and process towards developing a Health Vulnerability Index (HVI) for Extreme Weather Events (EWEs) for local residents in South Africa

An increase in incidence and amplitude of extreme weather events (EWEs) linked to climate change, has resulted in greater human exposure and vulnerability to weather-related health effects. Increases in the occurrence of EWEs, including storms, flooding, extreme heat and wildfires, will impact health globally, with poor and vulnerable populations disproportionately affected. Vulnerability to EWEs, and the ability to adapt to these weather shocks, are influenced by existing physical, social and political limitations of a given region. As such, developing context-specific health vulnerability indices to inform planning and decision-making for policy makers and citizens alike, should be prioritized. The existence and development of health vulnerability indices in South Africa are limited, therefore, this study provides a foundation from which future indices can build. Mixed methods approaches including evidence and data analysis/synthesis and focus groups are used to understand the interconnections between extreme weather events and human health, including citizens' understanding of emergent vulnerabilities linked to these events. The methods employed in this study include: •A rapid evidence review (RER) including data extraction identifying health impacts and indicators.•Development of a draft health vulnerability index (HVI) framework.•Focus groups and individual interviews testing the draft HVI for citizen input and framework refinement.

A story of (in)coherence: climate adaptation for health in South African policies

Climate adaptation strengthens and builds the resilience of health systems to future climate-related shocks. Adaptation strategies and policies are necessary tools for governments to address the long-term impacts of climate change and enable the health system to respond to current impacts such as extreme weather events. Since 2011 South Africa has national climate change policies and adaptation strategies, yet there is uncertainty about: how these policies and plans are executed; the extent to which health policies include adaptation; and the extent of policy coherence across sectors and governance levels. A policy document analysis was conducted to examine how South African climate change, development and health policy documents reflect the health adaptation response across national and Western Cape levels and to assess the extent of coherence across key health and environment sector policy documents, including elements to respond to health-related climate risks, that can support implementation. Our findings show that overall there is incoherence in South African climate adaptation within health policy documents. Although health adaptation measures are somewhat coherent in national level policies, there is limited coherence within Western Cape provincial level documents and limited discussion on climate adaptation, especially for health. Policies reflect formal decisions and should guide decision-makers and resourcing, and sectoral policies should move beyond mere acknowledgement of adaptation responses to a tailored plan of actions that are institutionalized and location and sector specific. Activities beyond documents also impact the coherence and implementation of climate adaptation for health in South Africa. Clear climate risk-specific documents for the health sector would provide a stronger plan to support the implementation of health adaptation and contribute to building health system's resilience.

Gaps and opportunities in the climate change, migration and health nexus: insights from a questionnaire based study of practitioners and researchers

Background

: While climate change and migration are separately recognised as public health challenges, the combination of the two - climate change-induced migration which is predicted to increase through this century - requires further research to ensure population health needs are met. As such, this paper aims to identify initial gaps and opportunities in the nexus of climate change, migration and health research.

Methods

: We conducted a questionnaire based study of academics and practitioners working in the fields of climate change, migration and health. Open-ended responses were thematically analysed.

Results

: Responses from 72 practitioners collected in October 2021 were categorised into a thematic framework encompassing i) gaps and opportunities: across health care and outcomes, impact pathways between climate change and migration, most at risk groups (specific actors) and regions, and longitudinal perspectives on migrant journeys; alongside ii) methodological challenges; iii) ethical challenges, and iv) advancing research with better funding and collaboration. Broadly, findings suggested that research must clarify the interlinkages and drivers between climate change, migration, health (systems), and intersecting factors including the broader determinants of health. Study of the dynamics of migration needs to extend beyond the current focus of rural-urban migration and international migration into high income countries, to include internal displacement and immobile/ trapped populations. Research could better include considerations of vulnerable groups currently underrepresented, people with specific health needs, and focus more on most at-risk regions. Research methodology could be strengthened through better data and definitions, clear ethical guidelines, and increased funding and collaboration.

Conclusion

: This study describes gaps, challenges and needs within research on the nexus of climate change, migration and health, in acknowledgement of the complexity of studying across multiple intersecting factors. Working with complexity can be supported by using the framework and findings to support researchers grappling with these intersecting themes.

Climate change and mental health within the African context

Africa is ecologically sensitive, with vulnerable communities which are at particular risk of the associations and impacts of climate change. Serious climatic events can result in traumatic stress, developing into chronic psychopathological and psychiatric patterns. Nonetheless, there remains a lack of psychiatric studies on mental disorders associated with climate change within the African context. There is a need in Africa for robust complex adaptive integrated research concerning climate change impacts and associations on and with mental health and healthcare systems, policy and practice, so that relevant interventions may be implemented and strengthened.

Mental health and climate change in Africa

It is now widely acknowledged that low- and middle-income countries in Africa are among global hotspots for high vulnerability to climate change, despite making comparatively low contributions to this phenomenon. Climate change has been shown to affect mental health as a result of disruption of social and economic structures that populations depend on for good health, including mental health. After decades of neglect, recent efforts by governments such as in Kenya to address the twin issues of climate change and mental health demonstrate the growing importance of these issues. Here we briefly review the evidence of climate change impacts on mental health in Africa and demonstrate that there is need for more contextual awareness and research in this area in Africa to mitigate or forestall potential mental health crises in the near future. We recommend systematic efforts to support funding for research and interventions at the nexus between climate change and mental health in Africa, and urge institutions and governments in Africa to begin paying attention to this emerging threat to the health of African populations.

Exploring Meteorological Conditions and Human Health Impacts during Two Dust Storm Events in Northern Cape Province, South Africa: Findings and Lessons Learnt

Dust storms are meteorological hazards associated with several adverse health impacts including eye irritations, respiratory and cardiovascular disorders, and vehicular road accidents due to poor visibility. This study investigated relations between admissions from a large, public hospital that serves people living in Northern Cape and Free State provinces, South Africa during 2011 to 2017, and meteorological variables (temperature and air quality) during two dust storms, one in October 2014 (spring) and the second in January 2016 (summer), identified from the media as no repository of such events exists for South Africa. Distributed nonlinear lag analysis and wavelet transform analysis were applied to explore the relationships between hospital admissions for respiratory and cardiovascular diseases, eye irritation, and motor vehicle accidents; maximum temperature, and two air quality ‘proxy measures,’ aerosol optical depth and Ångström exponent, were used as ground-based air quality data were unavailable. Eye irritation was the most common dust-related hospital admission after both dust storm events. No statistically significant changes in admissions of interest occurred at the time of the two dust storm events, using either of the statistical methods. Several lessons were learnt. For this type of study, ground-based air quality and local wind data are required; alternative statistical methods of analysis should be considered; and a central dust storm repository would help analyze more than two events. Future studies in South Africa are needed to develop a baseline for comparison of future dust storm events and their impacts on human health.

Understanding responses to climate-related water scarcity in Africa

Water scarcity is a global challenge, yet existing responses are failing to cope with current shocks and stressors, including those attributable to climate change. In sub-Saharan Africa, the impacts of water scarcity threaten livelihoods and wellbeing across the continent and are driving a broad range of adaptive responses. This paper describes trends of water scarcity for Africa and outlines climate impacts on key water-related sectors on food systems, cities, livelihoods and wellbeing, conflict and security, economies, and ecosystems. It then uses systematic review methods, including the Global Adaptation Mapping Initiative, to analyse 240 articles and identify adaptation characteristics of planned and autonomous responses to water scarcity across Africa. The most common impact drivers responded to are drought and participation variability. The most frequently identified actors responding to water scarcity include individuals or households (32%), local government (15%) and national government (15%), while the most common types of response are behavioural and cultural (30%), technological and infrastructural (27%), ecosystem-based (25%) and institutional (18%). Most planned responses target low-income communities (31%), women (20%), and indigenous communities (13%), but very few studies target migrants, ethnic minorities or those living with disabilities. There is a lack of coordination of planned adaptation at scale across all relevant sectors and regions, and lack of legal and institutional frameworks for their operation. Most responses to water scarcity are coping and autonomous responses that showed only minor adjustments to business-as-usual water practices, suggesting limited adaptation depth. Maladaptation is associated with one or more dimension of responses in almost 20% of articles. Coordinating institutional responses, carefully planned technologies, planning for projected climate risks including extension of climate services and increased climate change literacy, and integrating indigenous knowledge will help to address identified challenges of water scarcity towards more adaptive responses across Africa.

Exploring rural hospital admissions for diarrhoeal disease, malaria, pneumonia, and asthma in relation to temperature, rainfall and air pollution using wavelet transform analysis

BACKGROUND

Climate variables impact human health and in an era of climate change, there is a pressing need to understand these relationships to best inform how such impacts are likely to change.

OBJECTIVES

This study sought to investigate time series of daily admissions from two public hospitals in Limpopo province in South Africa with climate variability and air quality.

METHODS

We used wavelet transform cross-correlation analysis to monitor coincidences in changes of meteorological (temperature and rainfall) and air quality (concentrations of PM_2.5 and NO₂) variables with admissions to hospitals for gastrointestinal illnesses including diarrhoea, pneumonia-related diagnosis, malaria and asthma cases. We were interested to disentangle meteorological or environmental variables that might be associated with underlying temporal variations of disease prevalence measured through visits to hospitals.

RESULTS

We found preconditioning of prevalence of pneumonia by changes in air quality and showed that malaria in South Africa is a multivariate event, initiated by co-occurrence of heat and rainfall. We provided new statistical estimates of time delays between the change of weather or air pollution and increase of hospital admissions for pneumonia and malaria that are addition to already known seasonal variations. We found that increase of prevalence of pneumonia follows changes in air quality after a time period of 10 to 15 days, while the increase of incidence of malaria follows the co-occurrence of high temperature and rainfall after a 30-day interval.

DISCUSSION

Our findings have relevance for early warning system development and climate change adaptation planning to protect human health and well-being.

Heatwaves in the Future Warmer Climate of South Africa

Weather and climate extremes, such as heat waves (HWs), have become more frequent due to climate change, resulting in negative environmental and socioeconomic impacts in many regions of the world. The high vulnerability of South African society to the impacts of warm extreme temperatures makes the study of the effect of climate change on future HWs necessary across the country. We investigated the projected effect of climate change on future of South Africa with a focus on HWs using an ensemble of regional climate model downscalings obtained from the Conformal Cubic Atmospheric Model (CCAM) for the periods 2010–2039, 2040–2069, and 2070–2099, with 1983–2012 as the historical baseline. Simulations were performed under the Representative Concentration Pathway (RCP) 4.5 (moderate greenhouse gas (GHG) concentration) and 8.5 (high GHG concentration) greenhouse gas emission scenarios. We found that the 30-year period average maximum temperatures may rise by up to 6 °C across much of the interior of South Africa by 2070–2099 with respect to 1983–2012, under a high GHG concentration. Simulated HW thresholds for all ensemble members were similar and spatially consistent with observed HW thresholds. Under a high GHG concentration, short lasting HWs (average of 3–4 days) along the coastal areas are expected to increase in frequency in the future climate, however the coasts will continue to experience HWs of relatively shorter duration compared to the interior regions. HWs lasting for shorter duration are expected to be more frequent when compared to HWs of longer durations (over two weeks). The north-western part of South Africa is expected to have the most drastic increase in HWs occurrences across the country. Whilst the central interior is not projected to experience pronounced increases in HW frequency, HWs across this region are expected to last longer under future climate change. Consistent patterns of change are projected for HWs under moderate GHG concentrations, but the changes are smaller in amplitude. Increases in HW frequency and duration across South Africa may have significant impacts on human health, economic activities, and livelihoods in vulnerable communities.

Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

Heat-health vulnerability in temperate climates: lessons and response options from Ireland

Background

In Ireland, rising temperatures remains the climate projection that national climate scientists associate with the highest degree of confidence. However, the health challenge of heat has been largely absent from Ireland’s public health sector. This is epitomised by the lack of a comprehensive public health-focused heat-health action plan or country-specific codes of practice for heat-health when working outdoors. Our objective is to highlight the anticipated heat-health challenges in Ireland, and other temperate regions, through analysing vulnerable groups and systems, reinforcing the need to respond.

Methods

A scoping literature review was conducted to determine how heat affects health of the vulnerable in temperate climatic regions, with a focus on Ireland. Additionally, national Google Trends data was coarsely analysed to determine whether heat is a growing societal concern.

Results and discussion

The heat-vulnerable include: older people; chronically ill; infants, pregnant women, children; outdoor workers; socio-economically disadvantaged; urban dwellers; food systems and the health sector. Google Trends data suggest an increase in heat-related health searches over time, demonstrating rising levels of concern to temperature increases, reinforcing a gap in national policy associated with communication of, and response to, the heat-health challenge. Specific, actionable recommendations for adaptation and mitigation strategies are proposed.

Conclusion

Heat poses a public and occupational health challenge, receiving limited attention in Ireland. Lack of a co-ordinated effort, places vulnerable populations at risk. Our recommendations, with reference to vulnerable groups and acknowledging the multi-sectoral nature of heat-health and climate change, advocate for the adoption of a “health and climate change in all policies” approach and the development of a public health-focused heat-health action plan.

Temporal variation of pesticide mixtures in rivers of three agricultural watersheds during a major drought in the Western Cape, South Africa

South Africa is the leading pesticide user in Sub-Saharan Africa. However, little is known about the occurrence of pesticide mixtures in surface water and potential environmental risks in Africa. This study investigated the occurrence of pesticides mixtures in three watersheds during a drought year in South Africa. The study was conducted in the Krom River, Berg River and Hex River watersheds within larger agriculture systems in the Western Cape. Pesticide spray records were collected from 38 farms. A total of 21 passive water samplers (styrenedivinylbenzene disks (SDB)) were deployed, each for two weeks per month, over seven sampling rounds during the main pesticide application period between July 2017 and January 2018. Samples were analyzed for 248 pesticide compounds using LC-HR-MS/MS. Pesticide occurrence was analyzed for temporal agreement with pesticide spraying events (Cohen's κ) and correlation with rainfall patterns and river discharge (Pearson correlation (r _p )). Pesticide time-weighted average concentrations were estimated and compared to environmental quality standards (EQS). According to the farm spray records, 96 different pesticides were sprayed during the sampling period and differed considerably between the three study areas, seasons and crops grown. In total, 53 compounds were detected in river water. We detected 39% of compounds from the spraying records and demonstrated close temporal correlations of seasonal patterns for 11 pesticide compounds between reported on spraying records and observations in the streams (κ = 0.90). However, 23 detected pesticides were not found on spray records, many of them being herbicides. Most of the estimated two-week average pesticide concentrations were below 40 ng/L. The insecticides imidacloprid, thiacloprid, chlorpyrifos and acetamiprid and the herbicide terbuthylazine exceeded at least once their EQS 58-fold (EQS 13 ng/L), 12-fold (EQS 10 ng/L), 9-fold (EQS 0.46 ng/L), 5-fold (EQS 24 ng/L) and 3-fold (EQS 220 ng/L), respectively. Our study substantially widens the view on pesticide pollution in surface water compared to previous studies in Sub-Saharan Africa by targeting more than 200 pesticides using passive sampling systems. This broad assessment revealed the presence of 53 compounds, some of them in high concentrations, indicating possible adverse effects on biota and the quality of the ecosystem. Whether the observed concentration levels in the year 2017 were exceptional due to the lowest ever recorded rainfall and river discharge needs to be tested with additional data to better understand how pesticide pollution levels manifest under average rainfall and river discharge conditions.