If we don't act on climate change it means that we are sort of living at the expense of what we shall leave to our children.

- Dr. Michael Jarraud

I am starting a LinkedIn article series to foster a debate at the intersection of global health and climate change.

Healthcare is one of the top 3 challenges the world faces today. Changing climate is disrupting the dynamics of every industry, and health services will be no different. The rise in atmospheric temperature is expected to reach 1. 5 °C degrees in about three decades. Global warming is putting more strain on the healthcare industry, and providing healthcare to more people worldwide will get more complex. At the same time, we are not doing enough to prevent future damage from climate change. In fact, our actions are often in the opposite direction. For instance, developed countries spend hundreds of billions of dollars every year on fossil fuels, which contribute to global warming. Yet we are cutting funding for energy efficiency programs and clean, renewable energy sources. At the same time, the health and allied industries and healthcare delivery systems are far from prepared to thrive on a warming planet.

I am sharing some broad pointers, knowing that the discussions can take very different pathways. So let's talk about these problems. Let's talk about what we can do to prevent future damage. And let's start a conversation about how to move toward a healthy future.

Impacts of climate change

As temperatures increase, water becomes hotter, snows melt, water levels of oceans rise, evaporation increases, and more areas become vulnerable to new and rare infections. This means that a warmer planet will have a faster loss of habitats, an increased number of refugees, more droughts, wildfires, and extreme weather events. Many people will suffer from illnesses and even die from the unavailability of appropriate care. These are just a few of the many problems we have already started facing due to climate change.

We can expect increased demand for food and water due to climate change. Currently, over 10% of the world's population lacks adequate nourishment. Compared to today, by 2050, humanity must increase food production by 70% to keep undernutrition restricted to the current level. However, changing climate, rising sea levels, droughts, and extreme weather events will soon become insurmountable impediments to food production. The impact of climate change will also increase global air pollution, adversely affecting millions of people worldwide. Climate change also has implications for the availability of energy resources. It will increase the cost of energy, which will require more funds for the healthcare industry to cope. All these changes can disrupt current healthcare trends and negatively affect the health and nutrition of millions of people.

Aging, chronic illnesses, and climate change

Another issue is population aging, which is happening worldwide. The baby boom generation is getting old and will increase healthcare costs in developing countries. The biggest problem with aging is that our bodies get weak. As we grow old, our muscles start to fail. This makes it more challenging to perform basic everyday tasks. At the same time, aging increases the risk of chronic diseases, and as a result, our healthcare costs will rise. The population's median age in the United States increased by 1. 2 years over the past decade. It has already become a significant issue and is expected to get worse with the arrival of the oldest of the baby boomers. Climate change will make it harder to deal with issues associated with aging populations. Older people will suffer more from heat-related and respiratory illnesses. They will be more vulnerable to getting trapped in marginalized heat sinks and coastal areas due to a lack of mobility. As the number of older people grows, so will the demand for healthcare services, which will require much more money.

Climate injustice in global health

In the social sector, the synergistic impact of climate change and pandemic is inflicting new concerns as inequality threatens to reverse the successes of universal health coverage. For example, access to health for the homeless and displaced was already a problem in the pre-pandemic era, and now, it is turning into a human rights issue. As the people in the temporary and emergency shelters using "shared air" showed a shocking increase in infection rates even in the developed countries, such as the US, France, and others, policies were inefficient in mitigating the problem. With climate change, especially indoor air pollution, the next pandemic will be even more catastrophic in the shared air settings.

To survive the changing environment, we must adapt to new ways of thinking and doing. This requires us to innovate and learn new things. With the rapid technological developments, we have seen a significant improvement in the healthcare sector. For instance, we are able to diagnose diseases earlier, find better ways of curing patients, and prevent diseases at early stages. Undoubtedly, technology has made many improvements in the past few years, and this will continue in the future. While the COVID19 pandemic has had a catalytic effect on many of these advancements, overall, the future of healthcare has become incredibly complex and unpredictable in the pandemic aftermath.

Changed scenarios in health and allied industries

Digital health and telehealth

In the past couple of years, healthcare has changed rapidly due to innovations, relentless industry pursuit of automation, risk pooling, and changing consumer demands. Some niche markets at the intersection of health and technology have witnessed an unprecedented boom. For example, in just one year, the pandemic changed the CAGR of the digital health market from less than 10% (2019-2026) to over 30% (2020-2027). The telehealth market is also expected to grow at a similar rate, reaching a value of US$ 636 billion by 2028. However, fast growth in these markets exposes healthcare to several threats. For example, there will be a shortfall of experience and niche expertise, firefighting to advance solutions without adequate testing, a tendency to cut corners, and many others.

Vaccines, therapeutics, and other health technologies

Similar disruption is likely to occur in the biotechnology sector. Vaccines, therapeutics, and delivery mechanisms are fast changing. For example, recognizing the advantages of messenger RNA (mRNA) over DNA for gene transfer and expression is expected to change our outlook toward treating infections, cancers, and hereditary diseases. In addition, as we become more successful in stabilizing mRNA under physiological conditions, the delivery of therapeutics will be different. At the same time, new ecological concerns have started emerging with these changes. For example, last year, researchers reported the carbon footprint of a single mRNA vaccine dose as 0. 01 to 0. 2 kg CO2 equivalents. Therefore, new debates are on the horizon, and new regulations will come into force as the mRNA therapeutic market grows.

Health workforce

Unfortunately, despite the massive growth and unprecedented challenges in the health and allied sectors, the health job market witnessed massive cuts as the pandemic forced an unprecedented decline in routine clinic visits and cancellation or postponement of elective surgeries. Even as the industries have started returning to the pre-pandemic benchmark, with some even overshooting by manifold, the human resource in the health sector is yet to recover from the blow. This has caused a shortage of doctors, nurses, and other medical personnel. In fact, both the global North and South have reported a shortage of at least 1. 5 million healthcare workers. The deficit is expected to continue till the end of the year.

The human resources problem will worsen further as the issues will become more complex and require interdisciplinary capacities. While the world will still be able to manage the scarcity problems at the frontline, the niche capacity problems may become a critical threat to sustainability policies.

1. The most popular curriculum-based medical and health training programs have been traditionally non-inclusive of quantitative and management sectors.

2. With changing education environments and Ed-tech systems, a pervasive belief in makeshift training and certifications is gaining currency. The resultant capacity has limited strategic value.

Health financing

In addition to the human resource problems, the pandemic has also changed how health is funded. The dual chocking of the health and economic progress depleted the macro-fiscal reserve capacities and rendered global health financially less resilient. Last year, The World Bank reported that over 50 countries would face macro-fiscal constraints in maintaining health investments. Moreover, with growing resource constraints, the health agencies advocating for different areas will enter a fierce competition, making it incredibly difficult for policymakers and donors to decide on the "vital few".

One of the most popular ways of addressing a failed Pareto is to invest more in preventive reimbursements while switching to value-based care. However, preventive reimbursements alone can't protect an overstretched health system if other aspects of health promotion are not taken care of. For example, when healthier foods cost more than unhealthier foods, and climate change and aging increase the risk of chronic illnesses, only preventive health screening won't save the population from suffering. Rather, screenings in such scenarios may even increase the burden of disease on the health system with little effect on survival and wellbeing. The underlying reason is simple– not all early interventions effectively improve population health.

Therefore, even in the proper selection of the "vital few" for investments in health, the planet will continue to become sicker unless a cross-sectoral investment policy framework is created and implemented. More importantly, the power relations between and within sectors in the cross-sectoral environment will be the defining element for the future of global health. Instead of exclusivity (meaning funded in isolation), health outcomes and impact must be the qualifying criteria for investment in the health-determining sectors, such as education, agriculture, technology, construction, and others.

Lastly, a change in thinking about the world is not about changing our worldview. Our worldview has remained essentially unchanged since the rise of science. The pandemic can be the catalyst for a change in the way we think and act toward health issues, but only if we acknowledge that there is a problem and accept the need for change. With climate change silently overwhelming our abilities to thrive, we can ride on the momentum created during the pandemic, turn the weather obstacles into opportunities, increase the industry capacity, and change how we invest to set a new and resilient global health paradigm.