New climate report paints grim picture for health in South Africa

Last week, The Lancet medical journal released its 2020 Countdown on Health and Climate Change Report. The fifth annual report of its kind highlights the worsening global climate crisis and how this impacts on human health.

The report’s findings on South Africa are concerning, particularly with the country’s increased exposure to wildfires, lower crop yields for staple foods such as maize and soy, as well as ongoing drought conditions and air pollution in heavily populated areas.

Amid the Covid-19 pandemic, the report calls for immediate increased attention to strengthen global healthcare systems as climate-related health issues could be the next global crisis.

To better understand the report’s implications, Spotlight spoke to senior specialist scientist Caradee Wright from the South African Medical Research Council’s Environment and Health Research Unit.

Wright says that the biggest environmental threats to people living in South Africa include poor air quality, especially in air pollution hotspots (like Johannesburg), lack of access to quality water and sanitation, lack of appropriate waste collection and disposal and inadequate and unsafe housing that leads to what she calls “thermal discomfort”.

“People burn wood, coal [and] paraffin, causing household air pollution and also conditions of mould and damp. Then there are things that exacerbate all of these threats, like poverty, inequality [and] discrimination,” she explains.

‘Worst crime in healthcare’

“The worst crime in healthcare, in my opinion, is to treat someone for an illness or disease and send them back into the environment [or] home in which an exposure exists that causes or worsens that condition,” says Wright. For example, a child with asthma being given an asthma pump and being sent home to a household where low-grade coal is used for cooking indoors without a chimney. A more holistic approach is needed in this case, she says.

“Should the health professional explain the risks of exposure to smoke from coal in the dwelling for the child? Does the family have agency and choice to change their fuel use? This is another example of a social determinant of health, inequality [and] poverty that exacerbates health impacts.”

The report highlights that one of the biggest climate-related threats to health is increased exposure to wildfires. In South Africa, the report finds that every person was exposed to an extra 33 days of high to extremely high wildfire risk between 2016-2019, compared with 2001-2004.

“Compared with the period 2001–2004, there was an increase in the risk of wildfire in 114 (58%) of 196 countries in 2016–2019, with the largest increases occurring in Lebanon, Kenya and South Africa,” states the report.

South Africa has two fire seasons, says Wright, the dry summer months in the Western Cape and the dry winter months in the rest of the country. “Health impacts from exposure to wildfires include physical burns, psychological distress, and exacerbation of asthma and chronic obstructive pulmonary disorder as well as other respiratory illnesses. Some evidence suggests exposure may also be linked to an increased risk of respiratory infections and all-cause mortality,” she says.

Wright adds that the country’s increase in wildfires can be attributed to several factors directly linked to climate change, including land use, changes in rainfall and increasing temperatures. Globally, the report states that temperature has increased by 1.2⁰C compared with preindustrial times, or since the beginning of the 20th century. “Increased drought and temperature make the perfect fire recipe,” says Wright.

Climate, disease and food insecurity

Increased temperature and abnormal seasonal rainfall conditions also affect disease. “The climate suitability for the transmission of a range of infectious diseases—dengue fever, malaria, and those caused by Vibrio bacteria—has risen across the world,” states the report. For South Africa, this raises a red flag for the country’s efforts to combat malaria. Wright says that changes in temperature and rainfall could make ideal conditions for breeding sites of mosquitoes. “We should also not only be concerned about malaria, but other vector-borne diseases too,” she adds.

The report notes that in 2019, South Africa experienced a reduction in crop growth duration — compared with a 1981-2010 baseline — of 12.8% for maize, 8.9% for soybean and 5.4% for winter wheat. A shorter crop growth duration means that the crops mature too quickly, which leads to lower than average yields. This has an impact not only on the price of food, but food security and household nutrition, particularly for poorer households.

“Food insecurity and malnutrition have devastating consequences for health and well-being in South Africa,” says Wright. “In 2016, our [stunting rate for children under the age of five] was 27%, 2% higher than the average for low- and middle-income countries. So, we have an enormous ongoing problem to not only improve our children’s food intake in terms of quantity, but more importantly in quality with the right nutrients required for healthy growing.”

Wright says during the Covid-19 pandemic, loss of income led to higher food insecurity (something that Spotlight has reported on extensively), and the consequences of this may be seen among children under the age of five and children born to mothers who were pregnant and malnourished during the pandemic. “These are all very worrying,” she says.

Aligning Covid-19 efforts with climate change

The report concludes by calling for sustained efforts to both protect and rebuild local communities and national economies in light of the Covid-19 pandemic.

“Despite concerning indicators across each section of this report, the 2021 UN Climate Change Conference presents an opportunity for course correction and revitalised NDCs [Nationally Determined Contributions, in other words, each country’s contribution to fossil fuel emissions and reducing environmental impact in response to climate change]. The window of opportunity is narrow, and if the response to Covid-19 is not fully and directly aligned with national climate change strategies, the world will be unable to meet its commitments under the Paris Agreement, damaging health and health systems today, and in the future,” states the report.

The Covid-19 pandemic has crippled healthcare systems globally, and to avoid this in the future, Wright says that a robust healthcare system, one that is fully operational and efficient, is what is required to adapt to any outside threat, whether it is the ongoing pandemic or the threat of a changing climate.

The Lancet report’s overall findings on a global scale are damning, yet the response remains “muted”, states the report.

Wright says that some steps have been taken nationally, but much more needs to be done.

“At the highest level we have the National Climate Change Bill and the National Climate Change Adaptation Plan, but more importantly the second National Climate Change and Health Adaptation Plan 2020-2024, which is presently with me for finalisation. We also have National Heat and Health Guidelines.” DM/MC

This article was produced by Spotlight – health journalism in the public interest. Sign up for our newsletter.