The world broke eight climate records in 2021. The State of the Global Climate 2021 report released by the World Meteorological Organization just ahead of the Davos Meeting reflected the risk of catastrophic effects of a warming climate on health, food and water security, livelihood, economy, and others. Recognizing the urgency, earlier this year, when the world leaders assembled just about 400 km apart to decide the future of global health and economy, the withering effect of a never-so-prominent climate transition disorder came to the fore as a conflagration.

In my previous article, I shared general pointers to stimulate dialogue around some of the most compelling areas we must consider to thrive on a warming planet. In this article, I have tried to dig deeper to distill recommendations from recent research, reports, debates, and deliberations on climate change and human health and proffer an informed opinion on health systems adaptation in response to climate change.

Tapping the unplumbed treasure of adaptation

Climate adaptation refers to "maintaining or increasing the adaptive capacity and resilience" to lessen the climatic vulnerability of human and natural systems. In September 2019, the Global Commission on Adaptation (GCA) blazoned triple dividends of investing in climate adaptation by averting economic losses, accumulating positive gains, and adding social and environmental nest eggs. The commission's report estimated a yield of US$ 7.1 trillion in net benefits with an investment of US$ 1.8 trillion between 2020 and 2030. While the above projection did not include inflows in the health, education, and industry sectors, health appeared as a forerunner among the downstream beneficiaries.

However, it is arduous to directly gauze the health benefits of climate adaptation for two reasons–

1. health sector-focused climate adaptation programs were limited until the recent coupling of climate change and health, and

2. adaptation often takes place through synergistic measures, the benefits of which are often intangible.

While the quantum of gain from adaptation strategies remains unmeasured, the projected losses from the climate change impact can be cited as an anecdote to indicate the possibility of gains from allayed sufferings and prevented deaths. A large share of the climate-adaptation benefits can be accrued from alleviating climate-attributed conundrums of malaria, diarrhea, and undernutrition. The current projections forecast about 250,000 additional deaths per annum due to these diseases between 2030 and 2050 and health miseries amounting annually to US$ 2-4 billion by 2030 due to climate change.

Furthermore, recent reports affirmed sterling health co-benefits of overall climate actions. While these co-benefits do not emerge from health adaptation but are closer to mitigations, they do indicate how beneficial overall climate actions can be to global health. For example, air pollution is estimated to attribute 5 million premature deaths per annum. In the net-zero emission scenario, by 2030, the world is expected to witness 1.9 million lesser premature deaths due to household air pollution compared to 2020. Country and subnational estimates also project critical gains in human health through policy-level climate actions. For example, an assessment in India revealed the potential for an improvement of 1.01% in premature mortality by 2024 through policy interventions for clean air.

The naivety of the health sector

While most developed nations' health policymakers and practitioners have some propensity to shape climate-resilient health systems, overall, the health sector is a novice in climate change adaptations. Before the global leaders unlocked the weather-driven opportunities for health systems adaptation through the recent climate health programs, health was a neglected sibling in climate adaptation even in the early 2010s, primarily due to the absence of health communities in the National Adaptation Programme of Actions (NAPA) processes.

The 2018 report, Climate Change Adaptation in Africa, revealed that health was the primary sector in only one of the 26 projects supported by the UNDP in sub-Saharan Africa between 2000 and 2015. In 2014, the World Health Organization (WHO) highlighted that health adaptation received only 4% of the Least-developed Countries Fund (LDCF) portfolio, supporting the NAPA.

The compelling need for a structured health response 

Health has now attained the much-feted center stage in the climate change agenda, overcoming the historical fringing. The health response and benefits of climate adaptation sine qua non are one step ahead of the adaptation measures. For example, preventing climate change through nature-based solutions and the social sector responses, such as agriculture, construction, and land use, would protect the population from exposure to further changes in climate. In contrast, the bearings of response and recovery are more immediate in terms of preventing diseases and health perils through weather-based early warning and forecasting and mitigating the current impact of the warmer and hazard-prone planet on human health.

Adding to this account, Ebi and colleagues nuanced four critical health systems components that required increased resilience– health workforce, health information systems, service delivery, and financing. Their background paper to the commission's report prescribed four sets of actions in the areas mentioned above–

1. Building capacities by imparting knowledge and advancing tools to promote climate resilience,

2. Effective management of health risk by equipping health information systems with early warning,

3. Enhancing service delivery by climate-proofing "select" health care facilities and improving disaster risk management, and

4. Ensuring financing adequacy to limit indirect health effects.

The timing and scope of these actions depend on various factors, including, but not limited to the country's situation, the status of existing health systems, and the availability of resources. Therefore, while the executive recommendations are straightforward, it is imperative that the countries go through the rigmarole of vulnerability and adaptation assessments to find the launching pad for an adaptation program. 

Overcoming the climate injustice

One of the most troubling jigsaws in advancing climate-resilient health systems is the glaring disparity among countries in their readiness to espouse climate adaptation. The least and less developed countries still need to go a long way in strengthening their health systems before staving off the impending catastrophes of long-term climate change. However, a sequential approach bears the risk of the impending doom of climate change undercutting the returns on investments in health systems in these countries. Therefore, the 2021 report on the state and trends in adaptation in Africa argued for significant spending toward sustainable development alongside strengthening the health systems to improve health outcomes.

On the contrary, the initiatory of adaptations in the developed countries revolves around mapping the vulnerabilities and establishing regional awareness. One such example can be traced to the U. S. Climate Resilience Toolkit, which includes comprehensive and sector-based adaptation planning, emphasizing the local differences in understanding climate change. However, given the disproportionate injuries imparted on the most marginalized countries through industrialization, the global north must assume the responsibility of redlining assistance to bolster climate adaptations in the least developed countries while the latter leapfrog to a value-based healthcare system.

However, the pandemic siphon and the peace debacle inordinately curtailed the overclocking limits of even the world's best economies in the last couple of years. So, as the world leaders rallied to contemplate the public health crisis stemming from the two in the Geneva meeting in May this year, the WHO Director-General championed "shifting priorities" and the "highest-impact interventions" to move beyond reversing the losses.

Therefore, in economic terms, overcoming climate injustice in global health now requires tailored funding and propounds cost efficiency and improved targeting of health interventions. However, establishing a chiseled feature of such precision and inclusivity obligates building capacities of developing countries' policymakers and health program planners to help understand the evidence-driven decision-making processes, early warning mechanisms, and the intersection of health and climate. Therefore, more discursive approaches are needed to embrace equitable adaptation at the micro-level once evenhanded funding and intervention policies are set at the regional and national levels.

Leaving a wiggle room for everyone to contribute

In the aftermath of an HNAP, the succedent processes are the primary bottleneck for countries translating their policies into practice. Like the infamous binders of other national strategies that often sit on the shelves of program offices, the HNAP is no exception. An innovative way to overcome this snag is to employ design tools, such as prototyping.

Globally the donors may push the agenda for prototyping with specific use cases, such as malaria, heat, etc., and target niche geo-ecotypes that are often different from the mainland in terms of climate, social setting, access to services, and others. Parallelly, at the sub-national levels, countries may focus on targeted interventions within existing health programs and equipping that with weather-driven opportunities, such as early warning systems. Different prototyping tactics, such as dynamic mockup scenarios and storytelling, may help hone in on the local priorities and potential use cases, thereby enhancing cost efficiencies and magnifying impacts.

In countries with little prior experience in applying HNAP and limited resources, such trivia would ultimately build up to guide the more extensive reform programs, which can then filter into the most bankable interventions and solutions for scaling. At the same time, this approach will also provide the opportunities to incite third sector participation and build their capacities to bridge the social gaps.

Buying the fastest burners

With the four waves of artificial intelligence, the US$ 95 billion data science industry, and tremendously intuitive new visualization alphabets, the world has entered a new cult of making evidence-driven decisions, lickety-split. The new technologies powered by high-performance computing, emerging low code and no code environments, and beautiful visualization dashboards have enormous competency in overcoming the hurdles that would otherwise have put a pesky stop sign simply with the excuse of lack of feasibility in integrating the climate and health information. Countries must use these advancements to transition to real-world applications of health adaptation theories quickly.

However, all applications have limitations, and the famous maxim, "Garbage In, Garbage Out," is a perfect fit for this context. Every data technology will need quality data that comes from the grassroots. Therefore, it is critical to empower user communities with the desired level of data literacy while aspiring and planning for a system upgrade.

Moving the needle at the last mile

Every human's dream for their life course is different, but the right to live a healthy life is undeniable. Unfortunately, climate change disproportionately affects the last mile simply because of the lack of access of the most marginalized to essential services and facilities. Therefore, health adaptation alone cannot help protect the most marginalized. Hence, the agenda of climate health adaptation must be in sync with the overall developmental policy of a nation. Unfortunately, the least developed countries will have to burn the midnight oil in the coming decade to break the glass ceiling, and leapfrog to protect the most vulnerable and, simultaneously, scale the overall impact. Here comes the role of the developed nations and philanthropies who can provide the necessary surge capacity to empower these countries to call the shots.