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Strengthening health system responses to climate risks in multilateral processes

Climate change is a major global threat that has directly and indirectly impacted human health. It has threatened the essential components of good health, including clean air, safe drinking water, nutritious food, and safe shelter, and has the potential to undermine decades of global health progress. Climate change is expected to cause approximately 250,000 additional deaths per year between 2020 and 2050 due to malnutrition, malaria, diarrhoea, and heat stress.

[1]‚Äč Research has shown that over five million deaths per year are directly linked to abnormally hot and cold temperatures globally.[2] Additionally, more than 20 million people have been compelled to relocate every year since 2008 due to weather-related events.

While the physical impacts of these events are apparent, their impacts on mental health are difficult to quantify. These impacts pose an additional burden on the already overburdened health sector globally, particularly in low- and middle-income countries (LMICs) where health infrastructure and resources may already be limited.[4] Climate change not only leads to increased and changing healthcare needs, but also places undue strain on healthcare providers’ operations through damaged facilities and disrupted supply chains. It aggravates pressing environmental, social and governance issues in healthcare, including health disparities, workforce burnout and the availability of key resources like water. Examples illustrating this include the UK issuing a level 4 heat-health alert, a significant 50 percent increase in heat-related ailments in India, and New York hospitals incurring recovery costs of US$3.1 billion after Superstorm Sandy.[5] This added burden can further exacerbate existing health inequities and make it difficult to achieve global health goals.

Health systems have the primary responsibility for addressing the increased health burden resulting from climate change. This includes managing the displacement, injuries, and illnesses experienced by affected populations due to the rise in frequent extreme weather events like heatwaves, storms, and floods. It also involves dealing with the disruption of food systems, the escalation of zoonotic diseases, and the spread of food-, water-, and vector-borne illnesses. Additionally, health systems must address the mental health impacts associated with climate change. Evidence also highlights the adverse health impacts on vulnerable populations, such as low-income communities, indigenous peoples, those with pre-existing health conditions, and workers engaged in high-risk professions such as emergency responders and construction workers. Low-income countries with inadequate health infrastructure will face challenges in enhancing preparedness and responding effectively without assistance.[6] The COVID-19 pandemic has also highlighted the crucial role of the health sector in protecting public health. It has underscored the importance of strong and effective health systems in preventing the spread of infectious diseases and safeguarding public well-being. However, the pandemic has also revealed gaps in healthcare, including shortages of supplies, inadequate infrastructure, and insufficient funding. These challenges have not only impacted pandemic management but also had broader implications for other health conditions.[7]

Despite countries having multiple plans, policies, and programmes in place to ensure the health and well-being of their citizens, health system infrastructure across the world continues to face numerous challenges. One such challenge is the difficulty in providing access to quality healthcare, especially in LMICs. Additionally, the lack of funding and resources for public health programmes also limit their effectiveness in treating and preventing climate-change–related health impacts.[8] While many global health initiatives now emphasise strengthening health systems, sustaining these systems will be challenging without a robust monitoring strategy. Such a strategy is necessary to enable decision makers to accurately track health progress and performance, evaluate impact and ensure accountability at national and international levels. There are also major gaps in data availability and quality, particularly in developing countries. For instance, few countries conduct regular national health accounts studies; however, data on health worker availability and distribution is often incomplete and inaccurate, service delivery monitoring systems are limited, and data on population access to essential services is scarce.[9] Additionally, the complexity of healthcare systems and the involvement of multiple stakeholders make it difficult to enforce policies. Taking India as an example, despite comprehensive visions and objectives outlined in national health policies and programmes, their implementation faces several bottlenecks. Most programmes aim to address national health issues but often neglect regional specificities and needs and lack focus on technology adoption to improve services and delivery monitoring. Quality indicators and timely execution are often limited to selective components, and the implementation is frequently restricted to documentation rather than practical ground-level execution.[10]

To minimise the adverse impacts of climate change on health, countries have initiated climate and health programmes targeting issues like heat-related illnesses. These programmes require coordination among stakeholders, including healthcare providers, policymakers and community members, to ensure efficient resource utilisation and tailored interventions. However, achieving coordination is challenging due to limited communication and collaboration, competing priorities and scarce resources. Stakeholders often work independently, resulting in duplication of efforts, inefficiencies and service-delivery gaps. Furthermore, there is a lack of a well-designed framework for monitoring and evaluating the progress of such programmes. This absence hinders the ability to make informed decisions regarding resource allocation, policy development and programme implementation. Without this, the potential for successful prevention and management of climate-change–related health impacts might be limited.

There are data constraints too. The collection and analysis of health data is critical for effective decision making in health systems. Despite the availability of advanced tools and techniques for data collection in many LMICs, the quality of data remains an issue. The lack of digitalisation of data and information is a significant barrier to improving health outcomes globally. One of the significant challenges in health data collection is the absence of standardisation in the formats of collected data, thereby limiting its utility in decision-making processes.