Insights from the Climate, Health and International Development Seminar: Professor Kathryn Bowen, University of Melbourne (Part 1)

The Global Health Division at the Department of Foreign Affairs and Trade recently presented the second of its Health and Development Seminar Series: Climate Change, Health and International Development, supported by the Specialist Health Service (SHS). 

The seminar explored the impacts of climate change and health, its relevance to health policy and programming in the Australian aid program, and how to build climate adaptation into health programs throughout the aid cycle, from concept and design, to implementation, monitoring and evaluation.

In this episode we bring you insights from Professor Kathryn Bowen, who presented on climate change and impacts on health in our region.

Professor Bowen is Deputy Director at Melbourne Climate Futures and Professor with the Environment, Climate and Global Health at the Melbourne School of Population and Global Health, University of Melbourne. She was a lead author on the health chapter of Intergovernmental Panel on Climate Change (IPCC), Working Group II, Sixth Assessment Report 2018-2022. Kathryn is an international expert on the science and policy of sustainability (particularly climate change) and health issues, with 20 years’ experience in original public health research, science assessment, capacity development and policy advice.

We encourage you to join the conversation at @CentreHealthSec. You can follow Professor Kathryn Bowen at @kathrynjbowen and Melbourne Climate Futures at @MCFunimelb. More information is also available at unimelb.edu.au/climate and www.linkedin.com/showcase/melbourneclimatefutures

Transcript

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Dr Stephanie Williams 00:01

Welcome to Contain This. I’m Dr Stephanie Williams, Australia’s Ambassador for Regional Health Security. I'd like to acknowledge the traditional owners and custodians of country throughout Australia and our region. We recognise the continuing connection to land, waters, and community and pay our respects to Elders past, present, and emerging.

Here at the Global Health Division at the Department of Foreign Affairs and Trade, we launched a new learning series this year. I’m pleased to bring you the first of two insights from our latest seminar on Climate Change, Health and International Development. 

Today we will hear from Professor Kathryn Bowen of the University of Melbourne. Kathryn is an international expert on the science and policy of sustainability and health issues. She’s the deputy director of Melbourne Climate Futures and a professor of Environment, Climate and Global Health at the Melbourne School of Population and Global Health. She was a lead author on the health chapter of the Intergovernmental Panel on Climate Change (IPCC), Working Group II, Sixth Assessment Report and has generously shared her knowledge of the drafting of the report during the seminar you’re about to hear.
 
I hope you enjoy the episode.  

Professor Kathryn Bowen 01:15

I'm one of the Deputy Directors of Melbourne Climate Futures and Professor of Climate, Environment and Global Health at the Melbourne School of Population and Global Health. So thank you very much for the invitation to speak today. So I'll be bringing in the high-level takeaway messages from the IPCC six assessment report. The working group to which I was a lead author on which is around impacts vulnerabilities and adaptation in particular, I'll also obviously, talk to what we know, especially in our direct region in the Indo Pacific.

I’m a pracademic. Or a practicing academic. So I’m not a traditional academic. I work directly with politicians and policy makers to see the sorts of difference we can achieve, whether we are working in Australia with local government or working in Fiji. Whether we are working at a regional or an international level, I’m very much in the field a lot of the time and listening and understanding the particular characteristics and challenges we face. 

And again, just a note there that most of my work is international. And this is with a range of bilaterals, as well as multilaterals. And as well as the big global financing mechanisms, which Paul might talk a little bit more about too. So what you can see in this image is, I think probably one of the clearer images that shows the links between changes in our climate at the top there. So for example, rising temperatures, rising sea levels, increasing extreme events. And then you see the examples of health outcomes down the bottom there. So these range from injuries as a result of extreme weather events, such as flying or cyclone, through to issues on water, and food security, all the way through to social factors as well. So what we would probably put issues around like migration into that category. So there's so many examples of health outcomes that occur through exposure pathways, such as extreme weather events, heat stress, air quality, and so on. But what I want to also highlight for you is this box in the middle, and then what we would talk about being the determining factors, so the degree to which the climate change impacts at the top will actually have an effect on communities and individuals’ health and well-being. And I think that's that points to the equity that points to the social determinants of health that points to things like, what is the current burden of disease? What is the current health and nutritional status? What are the levels of poverty in a particular community or country that we're working with? What is the physical exposure that a community might have to a potential extreme weather event? So I think it's really important we take a very close look at those determining factors. When we start to unpack well, how is climate change going to have an impact on our health, it's not just directly through these extreme weather events straight onto our health is through these mediating factors such as governance, such as health issues, such as access to health systems and healthcare systems as well.

This is one I think this statement best summarises the findings from the second from working group two from our six that the scientific evidence is unequivocal. Climate change is a threat to human wellbeing and the health of the planet. And any further delay and conservative global action will be for brief and rapidly closing window to secure a Livable Future. So I just wanted to put that up there. And they're the sorts of statements that all countries who are signatories to the UNFCCC have agreed to. So that's a really important headline statement that came out of the IPCC last year.

So on to the IPCC and some of the highlights from the human health and wellbeing chapter. One of the first one was with very high confidence, that's that the HC there, we know that climate related illnesses, premature deaths, malnutrition, and threats to mental health and wellbeing are increasing, the evidence is stronger, there's more evidence, and we know that the impacts are increasing. We also know that with proactive timely and effective adaptation, many risks for human health and well-being could be reduced and some potentially avoided. So there's a lot we can do. And that's important headline statement for the IPCC to say that. However, we need key transformations to facilitate what we're calling climate resilient development, pathways to health and well-being. So climate resilient development is a newer concept that really emerged in the last four or five years or so. And it's an attempt to link adaptation and mitigation and sustainable development all together. So to try and remove this artificial, you know, binary nature of adaptation and mitigation, bringing those two together, how can we support policymakers to think of them at the same time, because often there are overlaps. I mean, if you think of green spaces as an example, we know that green space acts as a carbon sink and it also reduces the ambient temperature as well. So reduces urban heat island effect, for example. So there are ways that adaptation and mitigation can be bundled together, and with a view to achieving the Sustainable Development Goals in 2030. So bringing all those sorts together in this concept known as climate resilient development, but we need key transformations. What does that mean for the health sector? We do know that transformational changes will be more effective if they're responsive to regional, local and indigenous knowledge. and consider the many dimensions of vulnerability, including those that are gender and age specific.

This is a figure from the Intergovernmental Panel on Climate Change (IPCC) synthesis report that was released just a few months ago. So the synthesis report packages are working group one, which is the physical science of climate change. Working group two, as I said, adaptation and vulnerability impacts and working group three, which is on mitigation. And so it was really good to see that health and wellbeing had quite a prominent role in the IPCC synthesis report. Previously, it hasn't really achieved that prominence that it should have. But here you can see it is being clearly identified as all those for health and wellbeing issues, infectious diseases, heat malnutrition, and harm from wildfire, mental health and displacement, all been adverse impacts from climate change, and they will continue to intensify. 

Another of the key headline statements from the IPCC that relates to our region absolutely, is that health impacts are often interconnected, unevenly distributed across and within societies and will continue to be experienced inequitably. So at its core, climate change is an issue of justice. If you take away one point from my talk today, I'd love for you to take that one way. That it's an issue of equity and justice, and we're dealing with climate change and human health impacts. And this is a headline statement that's repeated in the fourth assessment report, and the fifth assessment report here will continue to be repeated. So let's try and make a difference. When we do our next report, we can say that we've made a difference in the work that we're doing.  

We also in the report, noted, we were able to assess the future to quantify the 3.3 to 3.6 billion people live hotspots of high vulnerability to climate change. And so these are across large parts of Africa, but as well as South Asia, Central and South America and small islands, so absolutely in our region. And there are overlapping challenges in these areas as well. So in these global hotspots, these overlapping challenges include limited access to water, sanitation, and health services. I'm sure you all know this, given your roles in the health teams, but it's a really important reminder that we're dealing with so many different challenges. So many communities and individuals have climate sensitive livelihoods. So it might be that a crop is entirely lost due to a flood or due to a drought. And if it's a single cropping system, then that entire livelihood for communities potentially lost. High levels of poverty, weak leadership, lack of funding and accountability and trust in government - all of these issues have health impacts. I am piling on the sort of very negative notes here, but it is important, I think, especially for the Sixth Report (R6), we were able to assess literature that started to understand the impacts and risks of compounding and cascading challenges on our human health. And so when multiple extreme events happen at the same time, they compound the overall risk and are more difficult to manage. And you can see here in this example, we've got increasing heat and drought. So we can say that an example might be that there'll be an increase in heat stress amongst farm workers, then this can result in reduced productivity, therefore reduced crop yields. It's not this linear, obviously, but it's a simple example to show that that there are these cascading effects arising from multiple hazards happening at the same time, increase in food prices, meaning a reduction in household income. And then what are the local effects it might mean that you can no longer send your child to school, or it might mean that you can no longer pay for that medication, or you can no longer attend that health service. and also potentially global effects on trade. 

We know that the projections are that it will increase in its intensity and frequency, also water scarcity. Approximately at two degrees, regions that rely on snowmelt could experience 20% decline in water availability for agriculture after 2015. I want to note that the IPCC is quite a conservative body. So these figures are generally an underestimate. But if we think about the impact of that on agriculture flowing from the north of Asia, through Asia through into the Pacific, the impacts on agriculture, food production, are really substantial from a 20% decline in water availability. So water and food security are vital issues that we're going to see keep increasing in terms of the risks that will we'll be experiencing as a population. I've already talked about food security, I think, but one of the major future global climate risks is flood risk. And about a billion people in low line seas by the sea and on small islands will be at risk from sea level rise in the mid century. And we know that's already a current threat in many parts of the region where we are.  

So I'll stop for a second. And I'd love to just ask two questions to get an idea of different perspectives in the room. So the first question is, how much public adaptation funding is explicitly directed to health projects? And I might run through the numbers and ask you to put your hand up. So 2%, 8%, 22% or 34%. Wow, that's incredible. Yeah, none of you are optimists at all. Yeah, the answer is 2%. So well done to 8%, you can keep that as a KPI. It's actually less than 2%. So it's an absolute major challenge that we have as a health sector. So yes, it's dire. So we often get shafted because we're not a hard infrastructure issue. We're not water, we're not agriculture, we can't build much stuff. So investing in health is a long-term strategy, but we can show some quick wins. 

The second question is of the countries surveyed. So there were 91 for The Lancet's Climate Change Canada 2021. How many countries had a national adaptation plan for health?  So hands up 35, 47, 63 sent me to my checking numbers in there to influence people to go for the far ends. But anyway, it was 47. So I think most of you actually said 47, which could be over half, which is good. But without the national adaptation plan for health, health will not get on the policy agenda. So national adaptation plans as a whole that governments develop, they generally have sectoral contributions on health and agriculture and water and women's and urban and so on. But health has been quite late to be to develop its own health national adaptation plan. That's a lot of work that I do in different countries is to support the health ministries is to write their national adaptation plans. So we've still got a fair way to go there as well. So moving to climate change impacts in small island developing states, what you can see here is that there are a lot of issues that are particular to small island developing states when it comes to climate change impacts. So I suppose the one we're most familiar with is sea level rise. That's a slow onset, what we call the slow onset hazard really. And so it's absolutely an issue there but there are so many others as well. So the impacts and risks are particularly pronounced in small island developing states. We know that they're often geographic geographically dispersed, really difficult to access many, many populations. 

And this is a regional bank breakdown on health and wellbeing impact. So I showed you that broad breakdown that's in the synthesis report, but this is a regional breakdown, impacts on health and well-being. So you can see I've just circled small islands there. And we can see that there isn't that the evidence is increasing. But the darker the circle, that the stronger the evidence. So even though we still don't have sufficient evidence to really talk with very high confidence about adverse impacts on health and wellbeing, we can say that the evidence is all adverse in small islands. So adverse impacts on infectious diseases on heat and malnutrition, on mental health and our displacement. But you can see by the lightness of those circles is that we still need to generate more of that knowledge and evidence. And that's a bigger discussion because I think a lot of that knowledge is actually available. And it's the way we package it up. And the IPCC is incredibly biased towards peer reviewed publications. So what can we do with our colleagues in the places that we work to support their work that they're doing so that it is published in peer reviewed publications. And so that's a discussion I'm having at the university with some colleagues in the region at the moment, because the IPCC process is, as I say, incredibly weighted towards countries that can produce that type of research. 

What I'll now do is briefly touch on the example of Fiji. So this draws on some work that the WHO conducted a couple of years ago, and so it's been really good, but WHO, they've been developing country profiles for each country, or many countries across our region in particular, and this is one that they developed for Fiji. So, you know, while there are common trends across the Pacific understanding, as I said, the different country context is necessary for us to be able to tailor responses. And so this work by the WHO showed a number of high priority climate sensitive health risks in Fiji. So for what you can see that that there are many effects of climate change that have been assessed as really important for Fiji to start considering and to develop its adaptation plan. So these range from direct effects, so extreme weather events, so the cyclones, the flooding that we know occur, but also indirect effects. So again, food and water security, vector borne diseases, and also what we call diffuse effects. But anyway, the main note, I suppose, is that we're starting to learn a lot more as I flagged earlier around mental health impacts. And from my own discussions with colleagues in the region, I think, particularly the voices of youth and their feeling is my community going to stay the same as an adult? How might the physical environment around me is changing year by year. The mental health impacts of how we see the future, really playing on the minds of particularly young people that I've spoken to in the region. NCDs are absolutely vital. We know the threat of NCDs currently and projected in the region, particularly in the Pacific. Really complex issues there related to agricultural productivity, again, isolation of, of particular islands in certain parts of the Pacific, reliance on processed foods and packaged foods, impacts on NCDs through, in a storm for example, losing an entire crop, how does that how does that then flow on to agricultural productivity and what communities and activities can sustain themselves. So that's the snapshot from Fiji.  

So how is the health sector armed to be able to deal with these continuing threats? So one way we are becoming more prepared is shifting to the system's view. And this image is the WHO's operational framework for building climate resilient health systems. I think this is the main tool that countries are starting to use as they develop their comprehensive climate action plans. And there is some support to implement that, through the WHO, but as we know, it's not the most well-funded organisation in the world. But it's really good to see that there is that systems approach being taken now or being advocated for anyway. 

But what I really want to draw your attention to is those five health emergency responses, as they're called here. You can see there. The second one is epidemic surveillance, early warning and response. There's a one here - special services for outreach and mobile teams. So these sorts of health emergency responses, their basic strengthening of the health system. So it's really, really vital that we do look at climate change as a health system strengthening issue. And we and we include a climate change lens when we're developing our health systems. 

I will just show you this last slide. And I like this one from the citizens report. It's the only figure, I think, an IPCC report that includes humans. So it's really good to see that we are in the image. But more seriously, it does show that the extent to which current and future generations will experience a hotter and different world depends on choices now, and in the near term. So it's up to us the choices we make, the work that we do, will determine whether we're going towards a very high future emission scenario, or whether we do reach a very low future emission scenario. So with that, I'll leave you there. Thank you.

Dr Stephanie Williams 22:36

You’ve been listening to Professor Kathryn Bowen from the University of Melbourne. This episode was the second of two insights from our latest seminar on Climate Change, Health and International Development. You can catch up with the next episode featuring Dr Paul Mitchell, Principal Climate Change Adviser of Save the Children on our feed in a fortnight’s time.

Thanks again for listening to Contain This, produced by the Indo-Pacific Centre for Health Security at Australia’s Department of Foreign Affairs and Trade.

Contain This is produced by the Indo Pacific Centre for Health Security. You can follow us on Twitter @CentreHealthSec.