Climate Change and Women's Health: A Scoping Review

Using environmental and exercise physiology to address gender inequalities in climate change and occupational health research

Climate change is a health-risk and health-inequity multiplier with excessive heat exposure a direct climate change impact already affecting the health and livelihood of billions globally. Women face greater risks and burdens from climate change impacts. Biological sex may or may not influence an individual's thermoregulatory capacity, heat tolerance or heat susceptibility. However at a population level, sex differences in physiological characteristics (anthropometrics, aerobic capacity, etc.) likely affect thermoregulatory capacity. Still, gender appears to play the most significant role in heat exposure and resulting health impacts. For climate change resilience and adaptation strategies to be effective, public health and occupational guidance/governance must be based on comprehensive and representative evidence. The current dearth of empirical evidence on how excessive heat exposure affects women prohibits this. Environmental and exercise physiology can help address this lack of empirical evidence by adhering to inclusive research guidelines. This paper is based on a symposium presentation given at Physiology 2023 in Harrogate, UK. Using a multi-year cohort study on industrial agricultural workers (the Adelante Initiative) as a case study, this review discusses the role of environmental and exercise physiology in generating inclusive research and evidence to inform occupational and public health guidance/governance for climate change resilience and adaptation, specifically heat exposure.

Climate change and gendered vulnerability: A systematic review of women's health

BACKGROUND

Climate change is an urgent global threat, with women in low- and middle-income countries (LMICs) disproportionately facing adverse health outcomes. Gendered roles, combined with socioeconomic, cultural, and environmental factors, exacerbate women's vulnerabilities, increasing the burden of mental health issues, water insecurity, sanitation challenges, and caregiving responsibilities.

OBJECTIVES

This review seeks to systematically examine the intersection between climate change and gendered health vulnerabilities, with a particular focus on women. It explores how climate change intensifies gender-specific risks and identifies pathways for integrating gender-responsive policies to mitigate both short- and long-term health impacts.

DESIGN

Following Arksey and O'Malley's methodological framework, this systematic review mapped key concepts and evidence from studies conducted between January 2011 and January 2024. The review focuses on identifying the multifaceted health impacts of climate change on women, particularly in LMICs and marginalized communities.

DATA SOURCES AND METHODS

A systematic search was conducted in Web of Science and Scopus databases using key terms and Medical Subject Headings related to climate change, women's health, gender inequality, mental health, water security, sanitation, and caregiving burdens. Studies were screened and selected based on relevance to the predefined criteria, with data extracted on study design, key findings, and limitations.

RESULTS

From 2163 citations screened, 61 studies were included in the final analysis. The review highlights that climate change disproportionately affects women, exacerbating pre-existing gender inequalities. Specific impacts include heightened mental health challenges, adverse maternal and newborn health outcomes, increased water insecurity, and an intensified caregiving burden. Women in LMICs are particularly vulnerable due to reduced access to resources, healthcare, and decision-making platforms, further limiting their adaptive capacities.

CONCLUSION

The findings underscore the critical need for gender-responsive climate policies that address both immediate health impacts and the broader socioeconomic and environmental determinants affecting women. Effective climate adaptation strategies must integrate gender perspectives, ensuring that women's specific vulnerabilities are accounted for in policy frameworks. This review advocates for the empowerment of women through increased access to resources and decision-making, thus enhancing their resilience and adaptive capacity in the face of climate change.

Bridging the gender, climate, and health gap: the road to COP29

Focusing specifically on the gender-climate-health nexus, this Personal View builds on existing feminist works and analyses to discuss why intersectional approaches to climate policy and inclusive representation in climate decision making are crucial for achieving just and equitable solutions to address the impacts of climate change on human health and societies. This Personal View highlights how women, girls, and gender-diverse people often face disproportionate climate-related health impacts, particularly those who experience compounding and overlapping vulnerabilities due to current and former systems of oppression. We summarise the insufficient meaningful inclusion of gender, health, and their intersection in international climate governance. Despite the tendency to conflate gender equality with number-based representation, climate governance under the UNFCCC (1995-2023) remains dominated by men, with several countries projected to take over a decade to achieve gender parity in their Party delegations. Advancing gender-responsiveness in climate policy and implementation and promoting equitable participation in climate governance will not only improve the inclusivity and effectiveness of national strategies, but will also build more resilient, equitable, and healthier societies.

Climate change impacts on maternal health and pregnancy outcomes in Africa

The review examines how climate change adversely affects maternal health and pregnancy outcomes in Africa, a region particularly vulnerable to climate-related disasters. It highlights the increased incidence of tropical and waterborne illnesses due to climate change, disproportionately impacting expectant mothers. The study thoroughly evaluates the effects of extreme weather events like heatwaves and floods on maternal health, both directly and indirectly. It underscores significant gaps in policy and research within African health sectors regarding these issues. Key findings reveal that maternal death rates remain alarmingly high, with risks like preterm birth, stillbirth, and maternal hypertension exacerbated by climate change. The review calls for urgent action, including enhanced research, increased funding for climate adaptation, and the integration of maternal health into broader climate resilience strategies. Additionally, it emphasizes the need for greater awareness and international collaboration to strengthen health systems in Africa, particularly addressing the vulnerabilities of pregnant women. This work aims to enhance understanding among policymakers and researchers about the critical health impacts of climate change on pregnant women in Africa.

A scoping review of the impact of extreme weather events on health outcomes and healthcare utilization in rural and remote areas

BACKGROUND

Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings.

METHODS

A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate.

RESULTS

The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints.

CONCLUSIONS

The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations.

The Impact of Saline Water on Women's Health in the Coastal Region of Bangladesh: Special Attention on Menstrual Hygiene Practices

Introduction Salinity intrusion is the most common global concern along coastlines, but it can happen inland also. The lack of freshwater is the primary issue affecting the coastal areas. Many health problems are prevalent among the inhabitants due to their frequent use of salted water. The health of women living along the coastline is getting progressively compromised due to salinity intrusion. Objectives The study aims to determine menstrual health practices and other health problems faced by women in the coastal region of Bangladesh. Methods The study was conducted using a survey research design from May 2023 to October 2023 on rural women aged 18 to 45 years, who lived in the Bangladeshi village of Koyra Upazila in the Khulna district. The sample size of the study was 101. Open- and closed-ended questions from a planned interview schedule were used to gather primary data. Additional information from appropriate sources, e.g., newspapers, publications, and books, was utilized to enhance the comprehensiveness of statistical analysis and support rationality. A p-value of 0.05 was considered significant. Statistical analysis was performed using STATA version 15 (StataCorp LLC, College Station, TX). Results Menstrual hygiene practices showed a higher prevalence of using fabric rags and reusing them after rinsing them in salt water (72.3%) than sanitary pads (25.7%). It was observed that the risk of diarrhea among tubewell water and rainwater users was significantly lowered by 0.25 times (95% CI = 0.06, 0.99; p = 0.049) and 0.06 times (95% CI = 0.01, 0.43; p = 0.005), respectively, compared to pond water users. Conclusion Salinity has a significant impact on the livelihoods and health of coastal women. The village women are unaware of the health risks of excessive saline water use. Establishing an adequate supply of freshwater reservoirs for the entire community throughout the year is an alternative for women to use as a source of water for hygiene necessities.

Exploring the Nexus of Climate Change and Substance Abuse: A Scoping Review

INTRODUCTION

The increase in average air temperature and multiple extreme weather events, such as heatwaves and droughts, pose significant health risks to humans. This scoping review aims to examine the current state of the existing literature concerning the potential relationship between substance abuse and climate change, along with the aspects it encompasses.

MATERIAL AND METHODS

The review followed PRISMA guidelines for methodological rigor, aiming to identify studies on drug abuse. Searches were conducted across the primary databases using specific search strings. Quality assessment involved evaluating the research question's clarity, search strategy transparency, consistency in applying the inclusion/exclusion criteria, and reliability of data extraction.

RESULTS

Most studies were conducted in the USA. They included observational and retrospective quantitative studies, as well as qualitative and prospective observational ones. Research examined the correlation between extreme weather and some substance abuse. All studies analyzed the adverse effects of climate change, especially heatwaves, on both physiological and pathological levels.

CONCLUSIONS

The scoping review notes the scarcity of studies about the correlation between substance abuse and climate change, and emphasizes the threats faced by individuals with substance abuse and mental health disorders due to climate change.

The Impact of Climate Change on Immunity and Gut Microbiota in the Development of Disease

According to the definition provided by the United Nations, "climate change" describes the persistent alterations in temperatures and weather trends. These alterations may arise naturally, such as fluctuations in the solar cycle. Nonetheless, since the 19th century, human activities have emerged as the primary agent for climate change, primarily attributed to the combustion of fossil fuels such as coal, oil, and gas. Climate change can potentially influence the well-being, agricultural production, housing, safety, and employment opportunities for all individuals. The immune system is an important interface through which global climate change affects human health. Extreme heat, weather events and environmental pollutants could impair both innate and adaptive immune responses, promoting inflammation and genomic instability, and increasing the risk of autoimmune and chronic inflammatory diseases. Moreover, climate change has an impact on both soil and gut microbiome composition, which can further explain changes in human health outcomes. This narrative review aims to explore the influence of climate change on human health and disease, focusing specifically on its effects on the immune system and gut microbiota. Understanding how these factors contribute to the development of physical and mental illness may allow for the design of strategies aimed at reducing the negative impact of climate and pollution on human health.

Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas

Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.

Transformative strategies for enhancing women's resilience to climate change: A policy perspective for low- and middle-income countries

This policy paper advocates for a transformative strategy to address the disproportionate impact of climate change on women in low- and middle-income countries (LMICs), emphasizing the need to integrate gender considerations into climate resilience initiatives. Recognizing the multifaceted nature of women's vulnerabilities, the paper calls for the dismantling of discriminatory socio-cultural norms and the enhancement of women's capacities through digital health literacy, political empowerment, and the protection of sexual and reproductive health rights. Focusing on the health implications of climate change, particularly for pregnant women and newborns, the paper promotes a multi-sectoral approach that strengthens health systems and encourages community-based interventions. It underscores the importance of incorporating gender perspectives into climate adaptation and mitigation strategies, advocating for tailored health services in LMICs, and promoting women's active involvement in climate-related decision-making processes. The methodology involves a qualitative, expert, and narrative synthesis of existing literature and policy analysis. The paper synthesizes existing research and policy recommendations to argue for a comprehensive policy framework and backs it with case studies from LMICs. This framework recognizes the complex interplay between women's vulnerabilities and climate change, advocating for women's empowerment as central to climate resilience efforts in LMICs. By integrating gender perspectives, enhancing health services for women, and fostering international collaboration, it proposes a holistic approach to mitigate the adverse effects of climate change on women's health and well-being. This approach not only acknowledges the specific challenges faced by women but also leverages their unique insights and experiences, positioning them as pivotal contributors to global climate resilience and sustainability efforts.

Climate change and health equity: A public health perspective on climate justice

Background

The discourse on climate justice has developed from the theoretical approaches and discussions on environmental justice. A central tenet of the concept of environmental and climate justice is that environmental and climate issues cannot be seen in isolation from issues of social justice.

Methods

A conceptual model was developed on the relationship between climate change impacts, social dimensions, adaptive capacities, biological sensitivity, and health equity in order to systematically analyse climate justice. Based on an exploratory literature review and the evaluation of the individual contributions of the status report on climate change and health, the evidence in Germany on social inequalities in exposure to climate change impacts and vulnerability to their direct and indirect health effects was summarised.

Results

This paper provides an overview of the international debate and examples of evidence on climate justice in Germany. Climate justice in the sense of avoidable, unjust social inequalities in exposure, vulnerability, and the effects of climate mitigation and adaptation measures on health inequalities is still insufficiently addressed in Germany.

Conclusions

A consistent integration of equity issues into climate policy is necessary. With reference to the international literature, options for action and research needs are identified.

Infectious Disease Sensitivity to Climate and Other Driver-Pressure Changes: Research Effort and Gaps for Lyme Disease and Cryptosporidiosis

Climate sensitivity of infectious diseases is discussed in many studies. A quantitative basis for distinguishing and predicting the disease impacts of climate and other environmental and anthropogenic driver-pressure changes, however, is often lacking. To assess research effort and identify possible key gaps that can guide further research, we here apply a scoping review approach to two widespread infectious diseases: Lyme disease (LD) as a vector-borne and cryptosporidiosis as a water-borne disease. Based on the emerging publication data, we further structure and quantitatively assess the driver-pressure foci and interlinkages considered in the published research so far. This shows important research gaps for the roles of rarely investigated water-related and socioeconomic factors for LD, and land-related factors for cryptosporidiosis. For both diseases, the interactions of host and parasite communities with climate and other driver-pressure factors are understudied, as are also important world regions relative to the disease geographies; in particular, Asia and Africa emerge as main geographic gaps for LD and cryptosporidiosis research, respectively. The scoping approach developed and gaps identified in this study should be useful for further assessment and guidance of research on infectious disease sensitivity to climate and other environmental and anthropogenic changes around the world.

Effects of climate-related risks and extreme events on health outcomes and health utilization of primary care in rural and remote areas: a scoping review

BACKGROUND

Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events.

METHODS

A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach.

RESULTS

We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community.

CONCLUSIONS

Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.

The Effects of Latitude and Temperate Weather on Vitamin D Deficiency and Women's Reproductive Health: A Scoping Review

INTRODUCTION

We conducted a scoping review to analyze the effects and implications of vitamin D deficiency on female reproductive health during the last decade, considering temperate planetary zones and climate change impacts.

METHODS

We used a qualitative methodology for a panoramic database review of PubMed, Web of Science, and Scopus covering articles from the last decade focused on populations living at latitudes higher than 40° N and 40° S. As descriptors, we used the phrases climate change, cholecalciferol or vitamin d3, pregnancy, and woman health and the Boolean operators AND and OR. We excluded letters to the editor, reviews, protocols, and clinical trials without human participants, as well as duplicate articles.

RESULTS

We included 35 studies in English, the majority of which were from North America or Europe. No studies were found from the Southern Hemisphere or having any direct relation with climate change, although studies demonstrated that latitude and environmental factors affected vitamin D deficiency, which had an impact on pregnant women and their children. Supplementation guidelines were not well developed, and there was a lack of studies among at-risk groups of women (eg, darker skin, higher latitudes, immigrants) across the life span.

DISCUSSION

Vitamin D deficiency is a global environmental problem that affects female reproductive health and depends on multiple environmental factors and human behavior. Therefore, we recommend consideration of environmental and sociocultural factors in public policy and clinical research and more research on the effectiveness of supplementation and fortification strategies. Health care professionals working in reproductive health need to generate actions for detection of, education on, and prevention of vitamin D deficiency among women across their life spans, considering the multicausality of the phenomenon, which includes environmental and climate factors in population health.

Advancing women's participation in climate action through digital health literacy: gaps and opportunities

Exploring the contribution of health informatics is an emerging topic in relation to addressing climate change, but less examined is a body of literature reporting on the potential and effectiveness of women participating in climate action supported by digital health. This perspective explores how empowering women through digital health literacy (DHL) can support them to be active agents in addressing climate change risk and its impacts on health and well-being. We also consider the current definitional boundary of DHL, and how this may be shaped by other competencies (eg, environmental health literacy), to strengthen this critical agenda for developed nations and lower-resource settings.

Analysis of Heavy Rainfall in Sub-Saharan Africa and HIV Transmission Risk, HIV Prevalence, and Sexually Transmitted Infections, 2005-2017

IMPORTANCE

Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown.

OBJECTIVE

To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022.

EXPOSURES

Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level.

MAIN OUTCOMES AND MEASURES

HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners.

RESULTS

The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment.

Relationship between achieving Sustainable Development Goals and promoting optimal care and prevention of birth defects globally

Birth defects affect eight million newborns annually worldwide. About 8% of global under-5 mortality is attributable to birth defects. The United Nations (UN) Sustainable Development Goals (SDGs) have set 17 global goals for human growth and development to be achieved by 2030 using multi-sectorial approaches. The third goal (SDG-3) focuses on ensuring healthy lives and promoting well-being; achieving SDG-3 improves birth defects care and prevention. However, we aimed to show how achieving other SDGs also influence optimal care and prevention of birth defects. SDGs focused on poverty reduction, access to nutritious food, universal health coverage, equitable education, gender equality, environment, inclusivity through infrastructure innovation, and strengthening social justice is crucial to addressing social determinants of health for individuals and families affected by birth defects. Understanding birth defects in the context of several relevant SDGs will allow practitioners, researchers, and policymakers to leverage the momentum generated by SDGs and make a case for commitment and allocation of funding and resources for advancing birth defects surveillance, care, and prevention. SDGs are built on principles of equity and social justice and we urge policy-makers to approach birth defects using various SDGs as a catalyst. The synergy between several SDGs helps to optimize birth defect outcomes and prevention. Our effort to present a more comprehensive look at various SDGs and their relationship with birth defects is parallel to several other health advocacy groups conducting a similar mapping exercise, thus bringing to the forefront millions of lives that are impacted by birth defects worldwide.

Effects of Drought on Mortality in Macro Urban Areas of Brazil Between 2000 and 2019

A significant fraction of Brazil's population has been exposed to drought in recent years, a situation that is expected to worsen in frequency and intensity due to climate change. This constitutes a current key environmental health concern, especially in densely urban areas such as several big cities and suburbs. For the first time, a comprehensive assessment of the short-term drought effects on weekly non-external, circulatory, and respiratory mortality was conducted in 13 major Brazilian macro-urban areas across 2000-2019. We applied quasi-Poisson regression models adjusted by temperature to explore the association between drought (defined by the Standardized Precipitation-Evapotranspiration Index) and the different mortality causes by location, sex, and age groups. We next conducted multivariate meta-analytical models separated by cause and population groups to pool individual estimates. Impact measures were expressed as the attributable fractions among the exposed population, from the relative risks (RRs). Overall, a positive association between drought exposure and mortality was evidenced in the total population, with RRs varying from 1.003 [95% CI: 0.999-1.007] to 1.010 [0.996-1.025] for non-external mortality related to moderate and extreme drought conditions, from 1.002 [0.997-1.007] to 1.008 [0.991-1.026] for circulatory mortality, and from 1.004 [0.995-1.013] to 1.013 [0.983-1.044] for respiratory mortality. Females, children, and the elderly population were the most affected groups, for whom a robust positive association was found. The study also revealed high heterogeneity between locations. We suggest that policies and action plans should pay special attention to vulnerable populations to promote efficient measures to reduce vulnerability and risks associated with droughts.