We can only sustain and support healthy people if we enable a healthy planet

Hardly a day goes by without a news story on the effects of our ecological crisis. We are living on an increasingly unhealthy planet. Just in the last few days, we have heard about temperatures of 48°C and above in Mali with hundreds of deaths.

We have also seen power cuts to the major cities in Ecuador due to a drought that has disrupted hydroelectricity. In Pakistan and Brazil, unusually heavy rains have led to collapsed dams, floods, landslides, displacement of people and loss of life. Scientists have also reported unprecedented ocean temperatures every day in 2024 and mass bleaching of half the world’s coral reefs.

The ecological crisis is not just about climate change. We are also seeing global pollution, biodiversity loss, altered biogeochemical cycles, and changes in land use and cover.

This crisis has led to the emergence of a new branch of medicine called planetary health. Doctors are starting to join the dots between changes in people’s health and changes in the planet. The ecological crisis impacts our health through changes in air quality, food production, exposure to infectious diseases, access to fresh water and extreme weather events.

Family doctors are seeing increased malnutrition as the climate impacts on food supply and many people in Africa are dependent on small-scale farming and pastoralism. We are also seeing new outbreaks of infectious diseases such as malaria and cholera, as well as worsening control of diseases such as HIV.

Our changing relationship with nature allows new diseases to jump to the human population, Covid-19 being the most recent example. Air pollution and high temperatures impact people with non-communicable diseases such as asthma, diabetes, and hypertension.

Many people are displaced by climate events or migrate within Africa to look for better lives. Migrants may bring new or unexpected diseases and struggle to access healthcare. As you might expect, these challenges are associated with psychosocial stress and mental health problems such as depression, anxiety and post-traumatic stress.

Family doctors and climate change

On World Family Doctor Day (19 May), it is important to point out that family doctors are at the forefront of responding to these changes in people’s health. Primary healthcare is the most accessible part of the healthcare system and yet also vulnerable to the same climate events that disrupt our communities.

For example, clinics may be damaged by high winds, hospital operating rooms may be flooded, supply chains disrupted. In Africa, family doctors and primary care teams need to look at how they can build more resilience into facilities and services. How can we anticipate new health challenges and ensure that our services continue to function?

Read more in Daily Maverick: Family physicians can do a lot to save SA’s ailing public health system

Family doctors may need to engage communities and work with community-based services, such as community health workers to identify the climate risks and vulnerabilities of their communities. Plans can be made to reduce and moderate risks and improve the resilience of communities.

For example, ensuring that farm labourers are not working in extreme heat at midday, moving informal settlements out of flood plains and ensuring that storm drains are not blocked by waste, or planting trees to create more shade and reduce temperatures. We will need effective early-warning systems and to be prepared to react to climate emergencies.

Critical role of primary care

Ensuring the resilience of primary care services is one way of also improving the resilience of communities. Family doctors need to look at the infrastructure of their clinics and how well they will withstand climate events.

We need to anticipate disruptions to the supply chain, to communications, to the energy and water supplies. Primary care providers may have to sleep at the clinic in an emergency.

Clinics in South Africa have experienced the disruption to services caused by rolling blackouts and the need for alternative energy supplies. Primary care providers may need additional training to prepare them for climate-related events and diseases.

Countries such as Malawi have declared climate-related emergencies for several years in a row. This means that primary care facilities and services may not have time to recover before the next challenge arrives. Low-income countries may also struggle to have the resources to build back better. Many countries in Africa have contributed almost nothing to the problem and need assistance from the global North to deal with the loss and damage of climate change.

Although the health system in Africa has contributed very little to the problem of climate change, the global health industry is a major contributor. Some cities such as Cape Town have committed themselves to taking action on climate change and some health systems have joined the Global Green and Healthy Hospital initiative.

Family doctors need to look at the environmental footprint of their practices. Prescribing is a major issue. For example, the propellants in inhalers can be potent greenhouse gases. Installing renewable energy systems such as solar can reduce the footprint while also improving resilience. Managing hazardous waste better is also important. For example, incineration can cause air pollution and release greenhouse gases.

Family doctors have an important role to play in responding to the health needs of people on an increasingly unhealthy planet. We need to help build more resilience in the communities we serve and in our primary care facilities. We must ensure that as we do this, we do not contribute to causing the very problem we are responding to.

Finally, we need to raise our voices and speak to policymakers and governments. We can only have healthy people if we have a healthy planet. DM

Prof Bob Mash is the Executive and Divisional Head of the Department of Family and Emergency Medicine in the Faculty of Medicine and Health Sciences at Stellenbosch University. The views expressed are those of the author and do not necessarily reflect those of Stellenbosch University.