Dialogue January-March, 2013, Volume 14 No. 3
Impact of the Climate Change on Health: Reference to Bangladesh
Mohammad Monirul Islam
Effects of climate change on the human health are no more in realms of prediction. Climate change is now perceived as impacting the health by exacerbating existing health risks, besides contributing to the emergence of new infectious diseases. Scientific revelations show an array of consequences caused by the global warming and climate change particularly on the health outcomes and these include, altering the distribution of some infections disease vectors, the seasonal distribution of some allergenic pollen and increasing heat-wave related casualties (IPCC 2007). Empirical research claims a deep connection of climate change with food production, fresh water availability, particulates and ozone rise in the air and all of these have an adverse bearing on human health ranging from malnutrition to water-borne diseases to respiratory difficulties.
Bangladesh is the world’s biggest delta and one of the worst victims of climate change. The impact of climate change in the country, results in drought, salinity of ground water, increase in flooding intensity and cyclone frequency. All these are directly or indirectly adversely affecting the health issues in Bangladesh.
Climate Change-Physical Health Link:
According to the most of the studies, the impact of climate change on health issues are classified as direct and indirect impacts. This paper however seeks to bring more clarity through causal-effect relationship by drawing four causal pathways as below:
Pathway-I (Indirect determinants-I)
Agricultural production and the resultant food security are perhaps seriously affected by the climate change and this is particularly true for Bangladesh- a country of huge population on a small land volume. Climate change results in extreme temperature, drought and salinity intrusion that could be held responsible, one way or the other, for declining crop yields in Bangladesh. With the reduction of arable land, crop production in many parts of Bangladesh has palpably been affected by erratic temperature and rainfall. One such study notes that a 4°C increase in temperature would have a severe impact on food production in Bangladesh, resulting in a 28 per cent reduction in rice and a 68 per cent in wheat production. The shortening of the winter season is reported to be resulting in a decline in production of winter crops. One of the principal outcomes of climate change is the frequent occurrences of flood in the country. On average during the period 1962-1988, Bangladesh lost about 0.5 million tons of rice crop annually as a result of floods.
One of the serious effects of climate change is the water shortage across the globe. This is particularly evident in the least developed countries like Bangladesh. Water stress would no doubt severely affect all aspects of human life. An IPCC report notes that the production of rice and wheat could fall by 8% and 32%respectively by 2050. Bangladesh is an agrarian country that needs adequate supply of food to feed its millions of people. Water shortage as visibly caused by climate change would push more people into the clutch of poverty which would ultimately lead to hunger, deficiency of minerals and supplements, malnutrition and other related diseases.
Pathway-II: (Indirect determinants-II)
It is accepted fact that health is significantly affected, during and after natural disasters like floods and cyclones. Flood certainly affects sources of drinking water and sanitation system which contribute to the outbreak of diarrohea, cholera, skin diseases including scabies. In addition to the water-borne diseases. Cyclones lead to sea level rise and salinity intrusion causing diseases like hypertension.
Incidence of diarrohea during major flood events in Bangladesh:
Incidence
of Diarrohea during major flood events
Major Flood Affected Population Incidence of
Diarrohea
(in million)
(in million)
1988 30 5.37
1998 30.6 2.06
2000 3 1.56
2004 36 2.33
2007 10 2.34
2008 1 1.9
Furthermore, climate change also contributes to some air quality problems (IPCC, 2007). Respiratory disorders may be aggravated by the increase of warm-induced frequency of smog and particulate air pollution. The potential impacts of climate change on asthma and other allergic diseases has been recognized for some time (IPCC, 2001), mostly a result of the well –established link between climate and many aero-allergens and aero-allergen producing organisms, on the one hand and air pollution on the other. In Bangladesh, about 25% of deaths of children aged less than five years and 40% of deaths in infancy are associated with the Acute Lower Respiratory Infections (ALRIs). More accurately, an estimated 07 million people including 04 million children suffer from asthma-related symptoms.
Pathway-III (Direct determinants-I):
Direct Temperature Effects
Human health is directly affected by climate change via average temperature rise. Such increases may lead to extreme heat waves during the summer while reducing cold spells during the winter. Particular segments of the population such as those with heart problems, asthma, the elderly, the very young and the homeless can be especially vulnerable to extreme heat.
Pathway-IV (Direct determinants-II)
Climate-Sensitive Diseases
Climate change may increase the risk of some infectious diseases, particularly those that appear in warm areas and are spread by mosquitoes and other insects. These “vector-borne” diseases include malaria, dengue fever, yellow fever, and encephalitis. One study suggests that an increase in rotavirus diarrohea in Dhaka by 40.2% for each one degree rise in temperature above 29 degree Celsius. Another study indicates that on an average 22,956 people suffer from malaria in Bangladesh, while there are reports of 3305 cases of Dengu annually on an average in the country.
Climate Change- Mental Health Link:
The causal pathways by which the climate change affects mental health are, by and large, opposite to the ways it affects the physical health. The causal pathway that is designated as direct pathway for the physical health may be seen acting as the indirect pathway for the mental health and vice-versa. Climate change may affect mental health directly by exposing people to trauma. It may indirectly affect mental health, either by affecting physical or community wellbeing. UNFCCC 4th report on global warming states that there is a direct association between the presence of major mental illness like acute psychosis and schizophrenia in tropical countries. Ironically, the issue is overlooked very often and the effects of climate change on mental health are comparatively less known or not discussed.
Flood and cyclones- two known outcomes of the climate change indirectly impacting the physical health may impact directly on the mental health causing post traumatic stress disorder (PTSD) syndrome with varying degree of severity. The World Health Organization estimates that 20-40% of affected people suffer from short-duration mild psychological distress and another 30-50% experience moderate-to severe form of mental disorders after the Asian Tsunami of 2005.
Similarly drought- a likely consequence of climate change- may cause sustained mental agony to the poor farmers, by adding hardship to their financial crisis. There are reports suggesting that suicide rate among farmers in many parts of South Asia, especially in India, are high in the drought season compared to other seasons.
Post viral infection – likely to be facilitated by the climate change-is one of the important risk factors for damaging fetal brain in the intrauterine period which causes many developmental and mental disorders among children. Besides, natural disasters lead to human trafficking, specially women and children.
An analytical report reveals that the incidence of mental disorder is 22431 per year which is higher than that of Dengue (3305 per year). It underscores the need for prioritization of mental health in the health component of National Adaptation Programme of Action for climate change of Bangladesh
Challenges:
One should not lose sight of the fact that several limitations/challenges may stand in the way of establishing links between climate change and health. These may include, among others, complex and multidimensional nature of health issues, dearth of credible data/reporting on the climate variability and its impact on the health outcomes; little understanding and awareness among the masses of climate change and its impact on health; difficulty in identifying climate-related threshold for population health and uncertainty about effective steps required for adaptation/mitigation of climate change impacts on health.
Recommendations:
Bangladesh has adopted an expanded adaptation measures that embrace, among others, building dams, changing agricultural practices, developing crop varieties attuned to climate change, undertaking programs to cover 20% of land with forests by 2015, carrying out projects on protecting biodiversity, micro financing for poverty reduction under Poverty Reduction Strategy Plan (PRSP) etc. The government has already accorded its approval on the Bangladesh Climate Change Strategy and Action Plan (BCCSAP) and National Adaptation Programme of Action (NAPA). The government has also created a national climate change fund and budgetary allocations to this particular head are being made regularly. On the international front, Bangladesh has been arguing for deep emission cuts by the industrialized nations and consistently pressing for a legally binding agreement. Bangladesh has been advocating for a new climate change regime embedding the principles of responsibility, differentiated capacity to pay and equity. However, when it comes to climate change and its adverse effects on the populations health, the following points may be noted, both from the academic and policy making points of view:
Academic
(a) Climate change’s impact on health can not be seen in isolation, it needs to be studied holistically taking into consideration other social, economic and environmental determinants impacting the health outcomes
(b) The development of climate-health impact models in order to project/learn future health outcomes is still in its nascent stage which needs further study and research.
(c) A review could be made on the existing intervention measures to protect people’s health from climate hazards, with particular focus on the shortcomings of the existing measures and recommendation for new approaches in view of the projected risks in this regard.
(d) It is observed that substantial study has been carried out on the physical illness, but very little is done on the mental/psychological health. A comprehensive research on as to how the climate change is impacting on the mental health, particularly on women and children seems an urgent necessity.
(e) Since Bangladesh faces recurrent natural disasters, it is imperative to examine the pollutants/chemicals released in the environment that could be a potential threat to the human health. There is however little published evidence demonstrating the relation between climate change and hazardous materials released during natural/man-made disasters
(f) Since herbal/plant medicine forms an important component to Bangladesh’s medical sector, a comprehensive study can be done to ascertain impacts of climate change on the medicinal plants and its consequent effect on the cost of medicine.
Policy Making
(a) Health-protecting adaptive strategies should be designed considering the mitigation of current risks as well as future/projected risks.
(b) Adaptation and mitigation program in the health sector may include, inter-alia, disaster preparedness, early detection and treatment of vector borne diseases, continuous monitoring of infectious diseases, better nutrition, nutritional supplementation program, crop substitution, water harvesting, institutional capacity building and increase in professional health workforce.
(c) In order to adopt phase-wise adaptive measures, a survey can be done, if not already done, aiming to geographically split the country according to the degree of vulnerabilities to the climate change.
(d) Appropriate measures/policy decisions may be initiated in bringing change to the food habit/behavior in the long run, if not possible in the short term.
(e) Proper implementation of the existing environmental laws and regulations needs to be ensured. If required, new rules and regulations could be formulated for the purpose
(f) The ongoing awareness building exercise in mitigating the climate change impacts, especially on health may further be strengthened. Civil society and media may be engaged appropriately in this exercise.
(g) The current collaboration of government-NGO in combating climate change impacts on health may further be expanded. More substantive projects covering a wide range of areas/population in the health sector may be taken.
(h) More avenues for bilateral, regional and international cooperation in addressing climate change impacts on health may be explored. In addition to soliciting funds, Bangladesh may take up projects in partnership with other countries in this context.
(i) Proper disbursement of climate funds needs to be monitored and ensured.
Concluding Remarks
As reflected in the above discussion, the impact of climate change on the health can occur through a number of direct and indirect causal pathways. The severity of the impacts partly depends on the adaptive capacity of the population. People’s vulnerability to develop illnesses are possibly influenced by their living condition (poverty), livelihood (farmers, fishermen), geographical location (coastal areas) etc.
It is largely identified as to which sections of the population would be at the greatest risk to the potential impact of climate change in the health sector. Survey suggests that the most vulnerable sections in this regard include women, children and the poor as well as socially and economically marginalised communities. This is because these sections have limited capacity to adapt and cope with climate change impacts.
There is a paradox in the climate change-health impacts dynamics. Life expectancy increases due to the improvement of economic situation, especially with industrialization and modernization. Again the economic prosperity, particularly through industrialization is proportionately linked with environmental degradation. Bangladesh needs both economic development and environmental protection/preservation. That is why Bangladesh needs to adopt an innovative approach to deal with these twin issues. The sooner it is done the better for the country and its population.
In order to reduce climate change induced hunger and malnutrition, Bangladesh could consider adopting techniques facilitating climate-resilient and nutrition-sensitive agriculture, such as small-scale water-efficient irrigation system or cultivation of nutrient-rich products/grains.
In order to combat water borne diseases, access to ensure safe drinking water needs to be ensured for all time, essentially during the natural disaster. It is therefore required to develop simple, efficient and affordable water treatment strategies to purify contaminated surface water, during floods and cyclones.
In the context of international cooperation, Bangladesh needs to collaborate with other countries, especially with the neighbors in tackling the climate change impacts on health. It could be done in two ways. One is preventive and other is curative. As far as preventive measures are concerned, Bangladesh and its neighboring countries may join hands in protecting the environment sensitive parameters concerning health risks. In this context, Bangladesh along with other regional countries may take concerted efforts/initiatives in strengthening water management, improving agricultural outputs and effective flood/cyclone monitoring system to tackle physical illnesses originating from the contamination/ shortage of water, food crisis as well as occurrence of flood and cyclone. Even concerted efforts for the river basin management of the bordering rivers may substantially contribute to the reduction of saline water intrusion in the mainland ground water in Bangladesh which would in turn help to reduce salinity related diseases. One study shows that construction of dams over the rivers contribute to the sea level rise and that neighboring countries, particularly Bangladesh, India and Nepal need to cooperate with regard to building of dams over the common rivers. In terms of curative measures, Bangladesh could work out some projects in the health sector with the neighboring countries, especially with India. These two countries may also initiate exchange programmes with a view to developing human resource and enhancing institutional capacity in addressing health issues. Bangladesh and India may work out a natural disaster management plan in addressing the health problems emanated from natural catastrophe like floods and cyclones. It is encouraging to note that Bangladesh and India concluded a framework agreement during the visit of the Prime Minister of India to Bangladesh in September 2011 and this agreement talks about a wide range of cooperation including in the issues of climate change between these two friendly neighbors.
References:
Intergovernmental Panel on Climate Change (IPCC) Report 2007
PROFESSOR ANTHONY J MCMICHAEL,NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH, THE AUSTRALIAN NATIONAL UNIVERSITY, CANBERRA, AUSTRALIA, “Climate change and human health” (http://healthg20.com/wp-content/uploads/2010/11/121-136-Anthony-J-McMichael_2010.pdf)
Minhaj Mahmud,Department of economics and social sciences, Brac university
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http://www.moef.gov.bd
http://www.epa.gov/air/urbanair/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754000/
http://medind.nic.in/icb/t07/i6/icbt07i6p539.pdf
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0006737
The Daily Star, January 23, 2010, (http://www.thedailystar.net/newDesign/news-details.php?nid=123007)
Framework Agreement on Cooperation for Development between the government of India and Bangladesh
(http://meaindia.nic.in/mystart.php?id=530518197)
Prabhat Kumar Chand and Pratima Murthy, “Climate change and mental health” Regional Health Forum – Volume 12, Number 1, 2008
(http://www.searo.who.int/LinkFiles/Regional_Health_Forum_Volume_12_No_1_Climate_change_and_mental.pdf)
Helen Louise Berry, Kathryn Bowen and Tord Kjellstrom , “Climate change and mental health: a causal pathways framework” (International Journal of Public Health Volume 55, Number 2, 123-132, (http://www.springerlink.com/content/v4352r7113736147/)
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