Change of season

While the international community deliberates in Accra on adaptation and mitigation strategies on climate change, there is a huge task at hand for the public health fraternity. Stressed at the ongoing meeting of the ministers of health of the WHO’s Regional Committee for South East Asia, convened to discuss the challenges posed to disease control by climate change, was that public health issues need to be urgently shifted to the centre of the climate change agenda. Climate change has already begun to profoundly impact the availability of water, food, shelter and disturb socio-economic conditions that are all fundamental determinants of health. For urban health practitioners, climate change is an even greater worry; the worst sufferers will be city dwellers, especially in developing countries.

Research has shown that the clearing of trees and vegetation for development, as well as more concrete structures, the heat generated by air conditioners and industry exhaust equipment, air pollution due to vehicular emissions and other such urban features lead to cities trapping far more heat than the countryside that they replace, making the earth’s surface hotter. While rapid urbanisation to a major extent may be blamed for causing much of global warming, at the same time, the fact is that urban dwellers may also suffer the most from it.

With climate change, millions of people will be at risk from illnesses in a warming world beset by water stress. Dry conditions will reduce the water available for drinking and sanitary purposes further in urban areas which can trigger outbreaks of cholera, diarrhoea, dengue and chikungunya. Urban areas also present a greater risk of flooding when extreme rainfall occurs; lack of open space prevents water from infiltrating into the soil. Lately, both Delhi and Mumbai have seen what a few days — sometimes mere hours — of rain can do to our urban life. Further, the transmission seasons of several vector-borne and water-borne diseases — dengue, malaria, jaundice, typhoid — will be prolonged in a warming world. These climate-sensitive diseases are among the largest global killers already. We are also witnessing alteration in their geographic range, which means that these diseases are reaching regions that lack population immunity and/or a strong public health infrastructure.

Rising temperatures and heat waves will also increase the number of heat-related deaths and skin diseases. There are already high levels of malnutrition and food insecurity among the urban poor; food shortage due to failed agriculture may worsen the conditions. The slum, squatter and migrant population in the urban areas, with fewer coping mechanisms, are most exposed to catastrophic personal risk.

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