Adapting global health aid in the face of climate change

Adapting global health aid in the face of climate change

Comment Adapting global health aid in the face of climate change WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attrib...

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Adapting global health aid in the face of climate change WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attributable to climateassociated increases in malnutrition, malaria, diarrhoea, respiratory disease, water inaccessibility, and heat stress.1 Spillover effects on state and regional security are inevitable. The World Economic Forum has identified climate change as the single greatest threat to global stability2 because of its considerable consequences on the health and stability of developing nations. Analysis of factors contributing to multiple global crises are illustrative of climate change’s effects on state stability. The ongoing civil war in Syria and the outbreaks of emerging tropical diseases, such as the Ebola and Zika viruses, are two such examples. Although multifaceted in origin, the Syrian conflict was preceded by the nation’s most severe drought on record, which led to widespread food and water insecurity and deteriorating health outcomes.3 Pathogens such as the Ebola and Zika viruses are likely to become more frequent as they exploit already overburdened health systems struggling to address both existing and emerging care needs.4 The complex interaction between climate change, health system burdens, and poor health outcomes, and their subsequent impact on politics, security, and society can be captured within the concept of a so-called climate-health-security nexus. Many of the world’s poorest and most politically fragile nations lie at the centre of this nexus. Within this nexus, poverty, state fragility, poor pre-existing health outcomes, and high susceptibility to climate change converge to amplify the effects of future famines, droughts, and neglected tropical diseases.5 This amplification subsequently leads to worsened economies, social instability, and reliance on external support. The nations most at risk for climate-triggered health crises are primarily scattered throughout sub-Saharan Africa and south Asia and are already afflicted by the highest rates of disease burden globally (table, appendix). Notably, most of these countries are low-income nations without the resources to adequately contend with climate-related challenges. Proactive acknowledgment of this climate–health– security nexus is an opportunity and necessity for the global health community, particularly given upcoming inflection points such as the inauguration of the new US Administration in January 2017. In the wake of the www.thelancet.com/lancetgh Vol 5 February 2017

Paris and Kigali Climate Accords, 2017 will be a crucial moment. Developed economies should prioritise supporting global efforts to adapt and strengthen national health systems to better contend with climaterelated threats. Furthermore, these interventions should focus on the regions highlighted in figure 1, since these nations represent the fault lines of the climate–health– security crisis. Income group†

Fragile states index‡

US climate adapted ODA§

Overall US health ODA¶

See Online for appendix

For the Notre Dame Global Adaptation Index see https://index.gain.org/ranking/ vulnerability/health For more on Fund for Peace see http://fsi.fundforpeace.org/ rankings-2016

Non-US DAC climate adapted ODA||

Overall non-US DAC health ODA

Niger

Low

Alert

0

0·11

4·00

Timor Leste

Lowermiddle

Alert

0

0

0

3·36

Central African Republic

Low

Very high alert

0

0

1·80

8·26

55·48

Ethiopia

Low

Alert

0·6

Somalia

Low

Very high alert

0

Madagascar

Low

High warning

0·03

Sierra Leone

Low

Alert

0

2·01

0·13

27·39

DR Congo

Low

Very high alert

0·77

57·98

11·43

158·13

Mozambique

Low

High warning

0·03

83·56

0·94

143·02

Liberia

Low

Alert

0·01

19·80

0·12

20·09

Eritrea

Low

Alert

0

Uganda

Low

Alert

0

78·96

0·13

57·76

Tanzania

Low

High warning

0·04

59·53

1·21

142·16

0 27·32

0

0

21·01

193·97

6·10

45·23

1·30

7·63

0

1·14

Mali

Low

Alert

0

16·67

6·47

57·96

Haiti

Low

High alert

0

7·46

0

28·17

Mauritania

Lowermiddle

Alert

0

0

5·01

7·22

Kenya

Lowermiddle

Alert

0·01

73·31

7·69

51·53

Afghanistan

Low

High alert

0·8

34·39

0

Malawi

Low

High warning

0·08

27·55

0·09

São Tomé and Principe

Lowermiddle

Elevated warning

0

0

0

111·65 83·55 3·56

ODA=Official development assistance. DAC=Development Assistance Committee. OECD=Organisation for Economic Cooperation and Development. GNI=gross national income. *Top 20 nations considered most vulnerable to the effects of climate change identified by the Notre Dame Global Adaptation Index. †Low-income group classified as GNI per capita of $1025 or less; lower-middle income group classified as GNI per capita between $1026 and $4035 (World Bank). Last reported economic data from Eritrea was in 2011 (World Bank). ‡Index of state instability based on twelve social, economic, and political indicators (2016). Nations are graded on a corresponding descriptive scale ranging from very sustainable to very high alert; source: Fund for Peace. §Official development assistance (in $ millions) from the USA targeting global environmental objectives for climate change adaptation (2014); source: OECD. ¶Reported in $ millions; source OECD.||Reported levels of DAC funding are exclusive of US contributions, ($ millions); source OECD.

Table: Levels of climate-conscious health aid and overall health foreign aid in 2014 (US$ millions) received by the 20 most climate-vulnerable nations* globally

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For OECD statistics see http://stats.oecd.org/

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A 2014 assessment by WHO6 determined that global climate strategies for sub-Saharan Africa merely offered rudimentary solutions and were inadequate to implement effective health system adaptation to climate change. Regional adjustment to climateassociated increases in malarial and diarrhoeal diseases alone is estimated to exceed US$700 million annually.7 Although local and foreign governments and nonstate actors such as multinational aid agencies are already deeply invested in the health of African nations, the consequences of climate change for global security require more focused attention from all stakeholders. Existing climate adaptation projects focus primarily on enhancing local capacity in countering the increased incidence of malnutrition, water insecurity, and infectious diseases expected from climate change. Although these initiatives have been established, only a small fraction of development aid is currently allocated in their support annually. More than $1·7 billion health official development aid was distributed in 2014 to the 20 most climate-vulnerable nations by the Development Assistance Committee (DAC) of the Organization for Economic Cooperation and Development. However, only 2·84% ($49·76 million) of this development aid was targeted towards projects focused on the health effects of climate change. When examining USA contributions in isolation, comparatively less of America’s total health aid disbursements (0·43%, $2·37 million) were allocated for climate adaptation and to fewer countries than the rest of the DAC. Uganda, Kenya, and Ethiopia—nations that are populous, climate-vulnerable, have high burdens of disease, and already receive large foreign health aid packages—are ideal targets for increased climateconscious health funding. The proportion of total US health aid spent on climate adaptation efforts among these nations ranges from zero (Uganda) to 1·1% (Ethiopia). Although other nations in the DAC have contributed more than the USA in absolute aid commitments to these nations, additional resources are necessary, particularly as all three nations boast fledgling climate action plans agreed upon by their national legislatures.8–10 This local foresight makes it more probable that any scaled up aid will be effective in climate mitigation efforts.

There is a clear strategic and public health imperative to support struggling national health systems in the interest of global stability. Climate change represents an emerging threat to public health and security worldwide. Focused investment in the health systems of climate-vulnerable states now to offset the impending risks of future climate stresses represents a far-sighted, cost-effective, and preventive approach to global health and political stability in the developing world that the next US administration and all developed economies should urgently adopt. *Vin Gupta, Alexandre Mason-Sharma, Stephanie N Caty, Vanessa Kerry Harvard Global Health Institute, Harvard University, Cambridge, MA, USA (VG, VK); Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA (VG); School of Medicine, Boston University, Boston, MA, USA (AM-S); Department of Health Policy & Management, Harvard T H Chan School of Public Health, Cambridge, MA, USA (SNC); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA (VK); and Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA (VK) [email protected] We declare no competing interests. VG and AM-S are both first authors. Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. 1 2

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World Health Organization. Climate change and health. 2016. http://www. who.int/mediacentre/factsheets/fs266/en (accessed Aug 29, 2016). World Economic Forum. The global risks report 2016 11th Edition. 2016. http://www3.weforum.org/docs/GRR/WEF_GRR16.pdf (accessed Sept 1, 2016). De Châtel F. The role of drought and climate change in the Syrian uprising: untangling the triggers of the revolution. Middle East Stud 2014; 50: 521–35. Watts N, Adger WEn, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861–914. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693–733. World Health Organization. The African Regional Health Report 2014. 2014. https://www.aho.afro.who.int/en/publication/1786/africanregional-health-report-2014-health-people-what-works (accessed Sept 1, 2016). The World Bank. The Global Report of the Economics of Adaptation to Climate Change study. 2010. http://siteresources.worldbank.org/EXTCC/Resources/ EACC_FinalSynthesisReport0803_2010.pdf (accessed Sept 20, 2016). Wangombe C, Nyangena J, Onjala J, et al. National climate change action plan 2013–2017. Republic of Kenya Ministry of Environment and Mineral Resources. http://cdkn.org/wp-content/uploads/2013/03/Kenya-NationalClimate-Change-Action-Plan.pdf (accessed Sept 20, 2016). Climate change national adaptation programme of action (NAPA) of Ethiopia. 2007. National Meteorological Agency. http://unfccc.int/resource/docs/napa/eth01.pdf (accessed Sept 20, 2016). Background adaptation to climate change in Uganda. 2016. http://www. ccu.go.ug/index.php/adaptation/50-background- adaptation-toclimatechange-in-uganda (accessed Sept 28, 2016).

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