Written by Hong Kai, Sabrina Hoong, Chanel Ng

The Malaysian Youth Delegation (MYD) hosted a study session: Climate Change and Public Health with Dr. Khor Swee Kheng, a public health specialist  focusing  on health policies and global health — more specifically the political economy of health and the strengthening of the health systems. He shared about the linkages and complexities between climate change and public health. Inspired by his sharing session, this article writeup intends to explore the linkages between the two.

The Intergovernmental Panel on Climate Change’s (IPCC) latest report revealed alarming findings. Substantial evidence reveals the significant human influence on the rising temperatures — a 1.5°C rise in climate temperature is now inevitable. This growth will have profound consequences for human civilisation, ranging from increased droughts and rainfall events to sea-level rise.

While it may not appear obvious, the worsening climate crisis directly impacts public health in various forms (see figure below). For instance, it was reported that extreme heat due to the changing climate could increase heat stress on humans (IPCC, 2021).

[Figure: Centers for Disease Control and Prevention (n.d.)]

In addition to heat stress, weather extremes such as increasing floods may favour the transmission of diseases. In 2014, Kelantan suffered its worst flood and one of its main adverse health outcomes was the rise in the incidence of diseases, particularly vector-borne Leptospirosis.

The types of diseases that affect public health can be broadly divided into communicable diseases and non-communicable diseases.

Communicable diseases are infectious and can be grouped into three categories — waterborne (e.g., Cholera), airborne (e.g., Covid-19), and vector-borne (e.g Dengue). Extreme weather events such as the El Niño can lead to ecological conditions facilitating the emergence of vector-borne diseases, thus increasing the risk of exposure towards society at large.

Climate change, which influences temperature and rainfall fluctuations, encourages the spread of neglected tropical diseases, such as Dengue (Paul and Tham, 2015). As this phenomenon worsens, ecological changes are expected to become more rapid. This increases the chances for new viruses to spread across the population, where mutation may in turn increase the potency of the virus (Shope, 1991).

Non-communicable diseases are chronic diseases developed by factors such as the environment, genes, and behaviour. Such diseases include respiratory diseases, cardiovascular diseases, mental disorders, cancer, and diabetes. Due to the indirect nature of their relationship, these diseases are often overlooked in the discourse of public health and climate change.

For diabetes, extreme weather events and rising temperatures may increase the morbidity of such patients, particularly those with existing cardiovascular diseases (Zilbermint, 2020). As for those without an existing condition, rising temperatures may lead to more people choosing to stay indoors. This discourages the practice of a more healthy and active lifestyle, weakening one’s immune system and physical health.

There is also a strong link between climate change and mental health. The relationship is often characterised through climate anxiety or eco guilt, new terms coined recently to reflect their growing occurrence. A major factor that contributes to climate anxiety is recognising the arrival of danger but lacking the ability to mitigate it. (Ingle and Mikulewicz, 2020). Climate anxiety is particularly prevalent amongst children and young people — a recent survey on ten-thousand 16 – 25-year-olds found that 95% of respondents were worried about climate change, and this is partly due to disappointment towards the lack of governmental action on tackling the crisis (Thompson, 2021).

Now narrowing our focus on Malaysia, prominent local climate-sensitive diseases include: cholera, typhoid, hepatitis A, malaria, dengue and chikungunya. (Alhoot et al., (2016). It was estimated that a reduction in short lived climate pollutants (SLCPs) could prevent 5,900 premature deaths attributed to outdoor air pollution per year, from 2030 onwards (Shindell, D., et al, Science, 2012). Storms, floods and droughts can lead to the rise and emergence of climate‐sensitive diseases due to contamination of water and environment, and creation of breeding sites for disease-carrying vector mosquitoes.

 

Malaysian healthcare strategies to manage public health in the face of climate change

The Malaysian government has introduced various strategies and roadmaps over the years to reduce the public health impacts due to climate change. However, some may argue that these plans were not implemented effectively.

For instance, the National Environmental Health Action Plan (NEHAP) was published by the Ministry of Health (MOH) in 2013, aiming to improve the quality of the environment and public health while maintaining the objective of sustainable development (Guidance document on NEHAP, MOH Malaysia, December 2013). It was introduced on the back of increasing incidences of food, water and vector-borne diseases over the years. However, the NEHAP 2016-2020 reported that the majority of the proposed action plan was not implemented, nor was there a concrete plan. The plan heavily focused on developing guidelines and research papers under institutional components and essential support functions for environmental health, but no mitigation actions were outlined to address the pollution sources.

As of 2015, one of the gaps in Malaysia in the report to the World Health Organisation (WHO) was the lack of planned allocations from domestic and international funds to cover the estimated costs of implementing climate resilient health systems. The development of an Integrated Disease Surveillance and Response (IDSR) system with early warning for climate-sensitive health risks and valuation of co-benefits to health of climate change mitigation activities was also absent.

In 2019, Malaysia adopted a National Policy on Climate Change, which incorporates health perspectives in its key actions. One of which is to mobilise financial and technical assistance in the area of public health and climate change. Although this positive measure could contribute to a climate-resilient health system, there has been little progress in fund allocations since the WHO report in 2015.

However, there may still be hope. The National Policy on Climate Change aims to establish and implement a national Research and Development agenda on climate change taking into account public health services and delivery, as well as integrate measures into policies, plans, programmes and projects in public health. In 2019, MOH established 11 Thematic Working Groups (TWG) on:

• air quality;
• water and sewage system;
• solid waste;
• hazardous waste management;
• climate change;
• contingency readiness and environmental emergency plans;
• health impact assessment;
• information technology;
• urban drainage;
• environmental health experts; and
• vector-borne diseases.

The TWGs are tasked with finding ways of identifying threats to the environment, formulating strategies to overcome the issue.

The way forward

While climate mitigation measures provide clear and significant disease prevention opportunities in many sectors, including the health sector, these opportunities are not widely recognised or connected.

We have identified ways in which key measures addressing climate change can bring health co-benefits in a range of economic sectors. The health sector should participate in developing and executing relevant mitigation policies moving forward. For example, we need health leadership and participation in multi-sectoral and multi-stakeholder decision making processes relating to climate mitigation, through engagement with key public and private sector stakeholders.

We must establish and strengthen core public health functions and capacities, including the analysis and communication of health co-benefit opportunities associated with various climate mitigation policies. More importantly, climate mitigation measures should be incorporated into relevant national health systems policies and plans in areas where the health sector has primary decision-making over GHG emissions sources from healthcare activities. This ranges from medical waste management, procurement policies, and healthcare facility infrastructure performance standards, aligning with the national health adaptation strategy of building and upgrading healthcare infrastructures to be climate-resilient. 

Effective engagement with youth groups, civil society organisations and the private sector and providing them with a platform to advocate for climate justice will also help raise public awareness about opportunities for climate and health. This will play a transformative role in building public support and creating demand for broader uptake and implementation of climate and health promoting mitigation measures in Malaysia (Technical Briefing for the World Health Organization Conference on Health and Climate).

Climate change mitigation policies can prevent significant communicable and non-communicable diseases caused by key economic sectors, therefore saving health costs from reduced deaths and diseases. Harnessing climate actions for health benefits play a transformative role in the climate debate by strengthening public and policymaker will for action, which supports coordinated stakeholder engagement and partnerships.

References

Action Plan for Environmental Health. Ministry of Health Malaysia, 2020. http://nehapmalaysia.moh.gov.my/wp-content/uploads/2021/04/Action-Plan-TWG-NEHAP-2016_2020-Final-Dis-2020.pdf.

Alhoot et al, 2016. “Climate Change and Health: The Malaysia Scenario.” Climate Change and Human Health Scenario in South and Southeast Asia, 2016, 243-268. doi:10.1007/978-3-319-23684-1_15. 

“Climate and Health Country Profile Malaysia.” World Health Organization. Accessed October 11, 2021. https://www.who.int/globalchange/resources/PHE-country-profile-Malaysia.pdf?ua=1.

Guidance Document: National Environmental Health Action Plan (NEHAP) Malaysia. Ministry of Health Malaysia, 2015. http://nehapmalaysia.moh.gov.my/wp-content/uploads/2015/11/guidance_doc_malaysia.pdf.

Malaysia’s Third National Communication (NC3) and Second Biennial Update Report. Ministry of Energy, Science, Technology, Environment and Climate Change, 2020. https://unfccc.int/sites/default/files/resource/Malaysia%20NC3%20BUR2_final%20high%20res.pdf.

National Policy on Climate Change. Prime Minister’s Office, 2019. https://www.pmo.gov.my/2019/07/national-policy-on-climate-change/.

Paul, Bryan, and Wai L. Tham. “Interrelation between Climate and Dengue in Malaysia.” Health 07, no. 06 (2015), 672-678. doi:10.4236/health.2015.76080.

“Promoting Health While Mitigating Climate Change.” World Health Organisation. n.d. https://www.who.int/phe/climate/conference_briefing_2_promotinghealth_27aug.pdf?ua=1.

Shope, R. “Global climate change and infectious diseases.” Environmental Health Perspectives 96 (1991), 171-174. doi:10.1289/ehp.9196171.

Technical Briefing for the World Health Organization Conference on Health and Climate, 27-29 August, Geneva. Discussion Draft. https://www.who.int/phe/climate/conference_briefing_2_promotinghealth_27aug.pdf?ua=1.