India’s healthcare reforms have got further impetus with India’s Presidency of G20 and the attention on the concept of One World, One Family, One Earth, but more needs to be done
Savitabai and her extended family in rural Maharashtra have been onion farmers for generations. They make the most of their income during the summer season. The onion farmers work in the fields in the daytime, no matter what the temperature is. Yet, for the last few years, she and other onion farmers have fallen ill because of heat strokes on a regular basis. Some of the families, including Savitabai, switched to farming in the evening, which seemed like a better option, but this is not the story of Savitabai alone. Every year, cases of heat related illnesses in India are rising in number and severity. These have long term health impacts beyond the short episodes of the illness itself.
Symbiotic relation of climate and health
While climate change has been on the rise for decades, there is now increasing recognition of the association between climate change and health. These signals have become more visible in recent years with increased frequencies of floods, tsunamis, heat waves, forest fires and other extreme weather events. What is sometimes not immediately seen, no matter how well it has been established scientifically, is the connection between a rise in global temperature and the spurt in diseases carried by mosquitoes and other agents.
Between 1940 and 2004, around 350 new diseases emerged and caused human illness with nearly two-thirds of these being of animal origin. Then, in April 2022, a study published in the reputed journal, Nature, estimated that between 2020 and 2070, if the global temperature rises by 2 degrees Celsius, it can result in the emergence of around 15,000 new pathogens, which would no longer be confined to their current habitat in forests and many other previously secluded places. It has been estimated that some of these cause human illnesses, which means a higher chance of outbreaks and epidemics. The worst affected regions would be Africa and Asia.
While climate has a clear impact on human health, the health sector itself contributes to an estimated 5 per cent of all global carbon emissions going up to 10 per cent in more industrialised countries. And while the health sector’s contribution to the total country’s emissions is approximately 2 per cent, the fact that it continues to increase at a rate of approximately 5 per cent every year is a cause for concern.
The uncertainty is ever-increasing
Savitabai’s story has several interrelated aspects. The onions she has been cultivating are getting smaller every season due to rising temperatures. The water is getting scarcer, the monsoon rains have become unpredictable costing Savithabai’s farming community financial loss running into thousands of crores across the country, not to mention the food shortages. Clearly, climate change affects not just health but the entire cycle of our lives.
The health sector cannot afford to simply address health service related issues alone and the problems simply cannot be served within hospitals. The increasing recognition of zoonotic transmission of diseases, including those such as bird flu (H5N1) evolving to a phase of human-to-human transmission is a telling story. Understandably, the global health community is looking beyond traditional parameters of health to include plants, animals and the environment through the discourse of One Health. One health promotes diversity, cross-border, multi-sectoral, multi-domain approaches across human, animal and environmental health.
India’s chance to resolve the challenges
There are a few key levers that could transform this tricky, interconnected situation where climate change affects plant, animal and human health creating a formidable adversary to all the knowledge we have accumulated of medicine, technology and the environment.
Firstly, strengthening primary health care is key. While the health and wellness centre model under the Ayushman Bharat programme makes this attempt, its focus must not move away from people. This means that systems must be capable of handling diversity, in social and cultural norms, health expectations and contextual behaviours. There are insufficient health posts in hills, in rocky terrains, forest outposts and water channels, just to give an example of what is missing even at the level of infrastructure.
Secondly, there is the tricky issue of radical convergence and coordination. Traditionally, departments within the Ministry of Health and Family Welfare in India have struggled with coordination, and this is a situation that calls for collaborative, multisectoral action across ministries and across private and public sectors. It is not possible to ensure surveillance, strengthen prevention, and improve preparedness and response to health threats otherwise.
Thirdly, enhanced political commitment towards higher and more sustainable investment is needed in order to best tackle the risks emerging at the human-animal-environment interface.
And lastly but certainly not the least, there is an urgent need to (re)legitimise local human and non-human knowledge, in order to decolonise One Health and better prevent epidemic emergence.
Conclusion
There is hope for us yet, as India, in recent years has embarked upon various healthcare reforms. These have got further impetus with India’s Presidency of G-20 and our attention on the concept of One World, One Family, One Earth.
(Dr Angela Chaudhuri is Chief Catalyst of Swasti , a public health specialist and also a trained journalist and Dr Chandrakant Lahariya is a consultant physician and public health specialist. )