Sensitivity of health sector indicators' response to climate change in Ghana

Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.

Funding

This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

Spatial epidemiology of bacterial meningitis in the Upper West Region of Ghana: Analysis of disease surveillance data 2018-2020

Background

The use of a Geographic Information System in identifying meningitis hotspots in the Upper West Region (UWR) remains underutilized, making spatial targeting of meningitis hotspots difficult. We therefore utilized surveillance data enabled with GIS technology to target meningitis outbreaks in the UWR.

Methods

Secondary data analysis was conducted in the study. The dynamics of bacterial meningitis in space and time were studied using epidemiological data from 2018 to 2020. Spot map and choropleths were used to depict the distribution of cases in the region. Moran's I statistics were used to assess spatial autocorrelation. Getis-Ord Gi*(d) and Anselin Local Moran's statistics were used to identify hotspots and spatial outliers within the study area. A Geographic Weighted Regression model was also used to examine how socio bio-climatic conditions influence the spread of meningitis.

Results

There were 1176 cases of bacterial meningitis, 118 deaths, and 1058 survivors between 2018 and 2020. Nandom municipality had the highest Attack Rate (AR) at 492/100,000 persons, followed by Nadowli-Kaleo district at 314/100,000 persons. Jirapa had the highest case fatality rate (CFR) at 17%. The spatio-temporal analysis showed spatial diffusion of meningitis prevalence from the western half of the UWR to the east with a significant number of hotpots and cluster outliers.

Conclusion

Bacterial meningitis does not occur at random. Populations (10.9%) under sub-districts identified as hotspots are exceptionally at higher risk of outbreaks. Targeted interventions should be directed towards clustered hotspots, focusing on zones with low prevalence fenced off by high prevalence zones.

Broad spectrum integration of climate change in health sciences curricula

In response to a University of California systemwide initiative to expand the knowledge base of climate change, two half-day workshops were held for faculty in the College of Health Sciences at the UC Irvine. In the first workshop, 20 participants who teach in the Schools of Nursing, Medicine, Pharmacy, and Pharmaceutical Science, or the Program in Public Health convened to explore concepts of sustainability, theoretical models of curriculum integration, challenges to adding new competencies into professional training, and strategies for integrating climate change modules and case studies into the curricula. The second half-day workshop was held a year after the first workshop to review how faculty members have modified their syllabus to integrate climate change information with varying degrees of success. A case study is presented regarding an asynchronous fully online course Introduction to Global Health, which is open to enrollment by students from all campuses of the University of California. The outcomes revealed preferential adoption of models of curriculum integration which minimized disruption of the sequence of topics in pre-existing courses. These include, for example, the use of longitudinal climate datasets for quantitative analysis of disease outcomes, and description of episodic events involving extreme weather conditions to explore differences in social determinants of vulnerability to climate change impacts in different populations. Integration of climate change as a distinct topic seems easier in elective courses in comparison with required courses designed to cover pre-established professional knowledge, competencies, and skills. The emergent requirement for interprofessional training in the health sciences provides an opportunity for the development of a cross-cutting competency domain including climate change as a unifying theme in a stand-alone course or set of courses in a sequenced model of curriculum integration.

Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown

BACKGROUND

In the past decades, climate change has been impacting human lives and health via extreme weather and climate events and alterations in labour capacity, food security, and the prevalence and geographical distribution of infectious diseases across the globe. Climate change and health indicators (CCHIs) are workable tools designed to capture the complex set of interdependent interactions through which climate change is affecting human health. Since 2015, a novel sub-set of CCHIs, focusing on climate change impacts, exposures, and vulnerability indicators (CCIEVIs) has been developed, refined, and integrated by Working Group 1 of the "Lancet Countdown: Tracking Progress on Health and Climate Change", an international collaboration across disciplines that include climate, geography, epidemiology, occupation health, and economics.

DISCUSSION

This research in practice article is a reflective narrative documenting how we have developed CCIEVIs as a discrete set of quantifiable indicators that are updated annually to provide the most recent picture of climate change's impacts on human health. In our experience, the main challenge was to define globally relevant indicators that also have local relevance and as such can support decision making across multiple spatial scales. We found a hazard, exposure, and vulnerability framework to be effective in this regard. We here describe how we used such a framework to define CCIEVIs based on both data availability and the indicators' relevance to climate change and human health. We also report on how CCIEVIs have been improved and added to, detailing the underlying data and methods, and in doing so provide the defining quality criteria for Lancet Countdown CCIEVIs.

CONCLUSIONS

Our experience shows that CCIEVIs can effectively contribute to a world-wide monitoring system that aims to track, communicate, and harness evidence on climate-induced health impacts towards effective intervention strategies. An ongoing challenge is how to improve CCIEVIs so that the description of the linkages between climate change and human health can become more and more comprehensive.

Earth System's Gatekeeping of "One Health" Approach to Manage Climate-Sensitive Infectious Diseases

Global response to climate-sensitive infectious diseases has been uncertain and slow. The understanding of the underlying vulnerabilities which forms part of changes created by forces within the Earth system has never before been critical until the coronavirus disease 2019, "COVID-19" pandemic with the initial developmental phase linked to weather elements and climate change. Hence, the heightened interest in climate-sensitive infectious diseases and GeoHealth, evident in the renewed calls for "One Health" approach to disease management. "One Health" explains the commonality of human and animal medicine, and links to the bio-geophysical environment, yet are at crossroads with how forces within the Earth system shape etiologies, incidences, and transmission dynamics of infectious diseases. Hence, the paper explores how these forces, which are multistage and driven by climate change impacts on ecosystems affect emerging infectious diseases, leading to the question "what drive the drivers of diseases?" Three questions that challenge broad theories of Earth system science on boundaries and connectivity emerged to guide study designs to further interrogating disease surveillance and health early warning systems. This is because, climate change (a) drives prevailing biological health hazards as part of forces within the Earth system, (b) shifts disease control services of ecosystems and functioning to effectively regulate disease incidence, and (c) modifies pathogen-species hosts relationships. Hence, the need to rethink pluralistic concepts of climate-sensitive diseases in their infection and management from a GeoHealth perspective, which "One Health" potentially conveys, and to also maintain ecosystem health.

Impact of extreme weather conditions on healthcare provision in urban Ghana

Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.

Short-term effects of diurnal temperature range on hospital admission in Bangkok, Thailand

Diurnal temperature range (DTR) is a key indicator reflecting climate stability. Many previous studies have examined the effects of ambient temperature, both hot and cold, on human morbidity and mortality, but few studies have evaluated health effects of DTR, especially those in developing countries. This study aimed to investigate the association between short-term exposure to DTR and hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand. We obtained daily meteorological variables from the Thai Meteorological Department from January 2006 through December 2014 and daily hospital admissions from the National Health Security Office during the same period. Quasi-Poisson generalized linear regression model combined with distributed lag non-linear model was used to examine the association between DTR and cardiovascular and respiratory hospital admissions controlling for daily average temperature, relative humidity, day of the week, public holiday, and seasonal and long-term trend. A J-shape relationship between DTR and hospital admissions was observed. With 7.8 °C DTR as a reference value, the relative risks for cardiovascular and respiratory hospital admission associated with extremely high DTR (11.6 °C) at cumulative lag 0-21 (21-day cumulative effects) were 1.206 (95% CI: 1.002-1.452) and 1.021 (95% CI: 0.856-1.218), respectively. The effects of extremely high DTR relative to a reference value did not significantly differ between males and females, as well as between young people (<65 years) and the elderly (≥65 years) for both cardiovascular and respiratory admission. When stratifying the effects by season, the effect of extremely high DTR in winter was greater than that in summer and rainy season. This study showed that short-term exposure to extremely high DTR was significantly associated with increased risk of hospital admissions for cardiovascular disease in Bangkok, especially during winter. Results from this study could provide important scientific evidence for policy decision making to protect populations from adverse health effects of DTR.

An institutional analysis to address climate change adaptation in Tenerife (Canary Islands)

Heat waves and Saharan dust outbreaks have been acquiring more frequency and intensity in the Canary Islands during the last decades. Both climatic hazards are known to produce impacts on human health such as mortality (due to heat waves) and morbidity (due to dusty weather). This work addresses possible climate adaptation policies in Tenerife assuming the increasing impact of heat waves and Saharan dust outbreaks in the island under a climate change scenario. It explores the institutional setting of climate change adaptation planning in Tenerife and evaluates the statu quo of adaptation planning in the island through the engagement of key social actors. An historical review of the local and regional press articles and legislation, an in-depth round of interviews, together with questionnaires to the main social actors allows framing the social and political context in which climate change adaptation in Tenerife is embedded. Key social actors were engaged, including international organisations, atmospheric research centres, local Universities, regional and insular governments, trade unions, and environmental NGOs, among others. The main obstacles mentioned by the social actors that hinder the development of an effective climate adaptation policy address scientific knowledge, data collection and policy making, focusing on the uncertainty of climate models, the lack of epidemiological data and contrasting opinions regarding the existing climate adaptation policies. Public participation, mainstreaming of climate policies and an integrated approach between mitigation and adaptation plans were identified as key policy issues. The outcomes of this study could be meaningful for climate adaptation initiatives at local or regional level, such as the Global Covenant of Mayors, that intend to promote climate resilience through the setup of climate adaptation strategies and plans at municipality level.

Effects of diurnal temperature range on mortality in Hefei city, China

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

Resilient futures of a small island: A participatory approach in Tenerife (Canary Islands) to address climate change

Adaptation to climate change has been considered to be crucial to current societies, especially for small islands. In this paper the case of Tenerife (in the Canary Islands) is analysed. Tenerife is a small island located northwest of the African continent, in the Atlantic Ocean. Tenerife presents a high vulnerability to heatwaves and Saharan dust events as a consequence of its closeness to the Saharan desert. In fact, increasing frequency of heatwaves and Saharan dust events has been reported and could worsen in the future due to global warming. An exploration of adaptation strategies to an increase of the frequency and intensity of these phenomena is therefore needed. Different social actors have been engaged in a participatory process aiming at exploring pathways for adaptation to extreme weather events. Resilience was argued as the relevant framing to address those hazards. Four focus group sessions were carried out in order to explore key transformative elements necessary to make resilient futures for Tenerife. The results highlight the need for broader climate-based policies across all sectors to assure that the island becomes resilient to climatic and non-climatic shocks.