By Upasona Ghosh, Indian Institute of Health Management Research
After a somewhat turbulent year, the first anniversary of Paris agreement is without doubt time to question whether we are on the right path tackle climate change. Despite the US intention to evade and to potentially retract from the agreement, the consensus between nearly 200 countries on the need to cut greenhouse gas emissions is indeed momentous. But is it enough?
If we just look at Hurricane Harvey or Irma in US or a series of floods and cyclones in South-Asian countries including Bangladesh, India, Myanmar, and Nepal and so on, it is evident that climate change does not differentiate between the ‘developed North’ and ‘developing South’. However, there are people and communities that are less equipped for and more vulnerable to the wrath of these epic weather episodes.
So while these storms and floods do not discriminate, the question is, do we? These events definitely differentiate between gender, age, race, class, ethnicity and geography, impacting those that are at the bottom of the ladder first and foremost. So alongside reducing greenhouse emissions, how do our global leaders, aka, those that have signed up to the Paris agreement ensure that the most vulnerable reap the benefits?
The point being, while we can reduce our emissions, the radical and turbulent weather patterns only exacerbate and contribute to mortality, malnutrition, spread of vector and water borne diseases to name a few. It is only the ability of the households, community and system to cope from the loss that determines the extent of climatic change impact within a community.
While an essential element of the Paris ratification is very much about long-term adaptation. Climate change may be a physical phenomenon, but its impact is very much social. So when we are thinking about adaptation, we need to think outside the box and consider the pressure and challenges that it is having on our health and wellbeing.
A case in point is The Sundarbans. The Sundarbans is the largest mangrove delta in the world, spread over the southern end of West Bengal (an eastern state of India) and neighbouring Bangladesh. This area is not only prominent as a UNESCO heritage site or as the largest remaining natural habitat of the ferocious Bengal Tiger, but also as one in which its close to five million population are prone to daily increasing vagaries of climatic events.
Recurrent climatic shocks and long term climatic variability has impacted life in many ways, including health, education and economic stability. But those living in inaccessible pockets are bearing the brunt of climatic changes more than their mainland counterparts because of inability of such regions and populations to adapt and respond to the changes. Future Health Systems highlighted the hardships faced by marginalised communities in the region, by explaining that ‘the proportion of chronically malnourished children was 52% – higher than both the state (45%) and the national average (48%)’.
In the case of The Sundarbans, climate change is remoulding the existing societal structures. Geography now supersedes the more traditional vulnerabilities like religion, caste and class. With this as the backdrop, it has become very evident that there is an extreme lack of knowledge within the health system about the community’s health needs and how to serve them. There is also a more physical challenge, with a lack of access to care, especially for those in the islands pockets.
There are many bureaucratic policies implementing blanket plans and programmes without comprehension or consideration of the special needs of the populations and voices on the ground. Conflict and a lack of convergence often arises between community and health service practitioners in responding to such policy measures, resulting in weakening health systems unable to address or respond to the community’s ills.
The growing dichotomy between perceptions of the policymakers and the grassroots institutions have prevented a re-evaluation of the threat and risk attached to climate change. Efforts need to go further in getting those that truly understand the challenges into the same room as those that can actually implement them, but in a connected up way that makes sense. Health Systems Global endeavours to tackle these very questions and seek to bring together community health workers, practitioners, policymakers and researchers to engage and share knowledge.
So, with the Paris ratification in mind, while it is quite remarkable to get that many signatories around the table and to agree with one another, the real work starts now. As demonstrated by the challenges in The Sunderbans, ‘a general adaptation plan’ for the health system or building its resilience is not at all feasible. In fact, it only serves to ignore existing vulnerabilities, be it traditional or related to climate change.
The Paris ratification stresses support from ‘the powers that be’, but it given the diversity around the table, surely it would be prudent to acknowledge that and bring in the bottom-up voices to share the reality of the situation?