5.3 Key Adaptation Sector - Human Health


Climate change aside, a significant proportion of South Africans and in particular the poor, already have serious and complex health challenges which are compounded by poor living conditions. This constitutes a unique disease complex comprised of the highest global prevalence of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), complicated by waterborne and chronic respiratory disease, with children being particularly prone. Life expectancy has declined to about 48 in 2005 from about 61 in 1990 and infant mortality has increased from 45 to 55 per 1000 live births in the same period. Underpinning these conditions are the common denominators of malnutrition, poor indoor air quality and the lack of social amenities. Acquired Immune Deficiency Syndrome (AIDS) caused by HIV and TB now account for about 75% of premature-deaths in South Africa. In particular sections of the country the threat of expanding vector-borne diseases like Malaria, Rift Valley Fever and Schistosomiasis are already an ever-present reality, requiring concerted public health initiatives. Any new compounding factor such as unpredictable weather patterns and climate aberrations will have significant impacts on this vulnerable sector of society, further aggravating the depth of poverty, food insecurity and demographic imbalances.

Notwithstanding these challenges, significant climate change is injurious to humans either directly (e.g. through heat stress) or indirectly (by affecting floods, fires, and ecosystem services), leading to changes in the epidemiology or emergence of infectious diseases and famines, and ultimately to displacement and conflict. Impacts in this regard are likely to include –

  • The immediate human and ecosystem health impacts from extreme weather and climate variability and associated loss of livelihoods are well researched and recorded but those from climate change are gradual and widespread, their manifestations indirect; and they are not easily quantified, less known and very difficult to respond to.
  • Climate change impacts on human health will not be felt in isolation but will increase in magnitude and severity with corresponding impacts on biophysical, economic and social structures. This would exacerbate the difficulty and expense of effective responses, especially for poor and rural communities.
  • Water scarcity and its consequences of reduced water quality is another significant threat to human health. Diarrhoeal disease is already the third largest cause of disease in children under the age of 5, 3 million people still have no access to water and over 14 million do not have adequate sanitation. Flooding and droughts, which are common seasonal occurrences, exacerbate this problem, by reducing access to potable water.
  • From direct observation, surveillance and models, increases in temperature and change in rainfall patterns in southern Africa are already favouring the range expansion of some vector-borne diseases such as Malaria and altering the range of tick-borne diseases. Increases in sea-surface temperature have been linked to increases in Vibrio cholereae the causative agent of cholera as a result of an increased abundance of phytoplankton and zooplanktons.
  • The immediate health impacts of extreme climatic events are well established and documented, but the impacts of gradual changes in temperature and precipitation are less tangibly measurable.
  • The immediate health impacts of extreme climatic events with longer term social impacts and loss of livelihoods are well established and documented especially in settlement populations that are directly exposed to the elements and where infrastructure is particularly prone to such events. Such populations are also most vulnerable to the disease complexes.

In response to these challenges, South Africa will –

  1. Reduce the incidence of respiratory diseases by improving air quality through reducing ambient particulate matter (PM) and sulphur dioxide (SO2) concentrations by legislative and other measures to ensure full compliance with National Ambient Air Quality Standards by 2020. Progress in this regard will be published on the South African Air Quality Information System (www.saaqis.org.za).
  2. Ensure that sound nutritional policies, health care infrastructure and education lie at the heart of all the health adaptation strategies by acknowledging that if a population’s nutritional status is robust, individuals will have greater resilience.
  3. Develop and rollout public awareness campaigns on the health risks of high temperatures and appropriate responses including, improved ventilation and avoidance behaviour.
  4. Design and implement “Heat-Health” action plans including plans in respect of emergency medical services, improved climate-sensitive disease surveillance and control, safe water and improved sanitation.
  5. Strengthen information and knowledge of diseases-climate linkage.
  6. Develop a health data capturing system that records data both at spatial and temporal scales and that ensures that information collected can be imported into multiple-risk systems such as the South African Risk and Vulnerability Atlas electronic spatial database system.
  7. Improve the bio safety of the current malaria control strategy.
  8. Strengthen the awareness programme on Malaria and Cholera outbreaks.


Human Health and National Climate Change Response

While it is a tragic statement that "Life expectancy has declined to about 48 in 2005 from about 61 in 1990 and infant mortality has increased from 45 to 55 per 1000 live births in the same period" it would be incorrect to try address issues that have nothing to do with Climate Change under the ambit of this document. Programmes to address HIV infection rates and infant motality have their place and Climate Change should not be used as a catch-all to address these serious challenges we face as a country.

This error in trying to address non-relevant issues is seen in 5.3.1. where "the incidence of respiratory diseases" will be addressed "by improving air quality through reducing ambient particulate matter (PM) and sulphur dioxide (SO2) concentrations by legislative and other measures". While it is noble to try and reducte the impact of these pollutants on human health, neither PM nor SO2 are recognized greenhouse gases should be addressed elsewhere not in a document dealing specifically with a National Climate Change Response.

In similar vein, one would have to ask what is implied by "sound nutritional policies" (point 5.3.2)? These again belong in other documents and not in this document.

Compliance with ambient air quality standards

Pg13, 5.3.1 refers.
What information is this goal based on and has it been identified as achievable?
Particulate matter in particular remains an on-going challenge across SA for compliance. In addition, given the status of air quality monitoring, which currently leaves large data gaps across the country where the air quality baseline is not known, it seems premature to expect compliance by 2020. The expectation of compliance also contradicts the principle of continuous improvement in the Air Quality Act, which requires on-going reduction of pollutant concentrations and lowering of compliance thresholds to drive this action.

cross cutting nature of issues such as health

Something to be addressed in the crosscutting section after all sectors is that in addition to those responses in health, one must look at options to restoration wetlands an water courses to ensure improved filtration, reduce pollution and thus decrease the risk of diseases such as cholera. Also working with landowners and industry to reduce water pollution is critical to health.