by Tshepiso Masilonyane
World Health Day, observed on April 7th every year, not only marks the annual anniversary of the World Health Organisation, but is an opportunity to reflect on humanity’s global and local efforts to advance human-health issues and the right to health for all people. This year’s theme is a declaration that health is not just a privilege for some, but a right for all, and a call to advance this right by protecting the human right to a safe and clean environment, the right to decent work, informed consent, as well as the right to quality health services. As the world continues to grapple with global environmental degradation and the climate crisis, it becomes important to understand how climate change is affecting people’s ability to enjoy their right to health, and why advancing climate action simultaneously advances the right to health.
In 2015, the World Health Organisation published the Botswana Climate and Health Country Profile. This document looks at key climate hazard projections which could significantly affect human health, as well as data on some specific health risks resulting from climate change as experienced in Botswana. In this article, we take a look at the data, discussing future climate hazards, as well as specific health risks resulting from climate change in Botswana.
The data is stark—Botswana could see its mean annual temperature rise by up to 6.2°C by the end of the century under high greenhouse gas emissions scenarios. For context, climate change as we understand it today has only been as a result of a 1.1° Celsius change in average global temperature since 1880. With such a significant increase in temperature, we are expected to face around 240 days of extreme heat annually by the end of the century, a sharp rise from less than 10 days in 1990. Children born today will be early pensioners by the year 2080, I will be a young 82 years old. Due to the typical health sensitivities of older populations, I, as well my peers in this current generation, will particularly be vulnerable to these extremely high temperatures.
The prospect of heat waves accounting for almost three quarters of the year is not only alarming for our economy, which relies heavily on nature-based tourism and agriculture, but also especially for at-risk populations who do not have access to air conditioning at homes, as well as construction & informal sector workers who spend hours on end exposed to the scorching heat. But this isn't just about more days needing air conditioning; it's a matter of life and death. Heat-related illnesses and deaths, particularly among the elderly, are projected to skyrocket, with heat-related deaths potentially reaching 136 per 100,000 by 2080. Assuming the World Bank’s projected population of 4.1 million in 2080 for Botswana, this would mean 5,576 heat related deaths annually, which is not surprising considering temperatures are expected to go as high as 46.5° Celsius if we continue to burn fossil fuels to drive global development. For comparison, the top ten leading natural causes of death today (including HIV, pneumonia, hypertension, stroke and TB) are responsible for 5290 deaths. Essentially, in 60 years, extreme heat could be responsible for more deaths than all the 10 leading natural causes of death today combined.
While flood risks are expected to stay constant at 6 days annually, year-to-year variability is expected to be high. Year-to-year rainfall variability refers to the fluctuations in the amount of rainfall received from one year to the next. It includes the differences in rainfall patterns, including timing, intensity, and duration of rainfall over annual cycles. High variability means that rainfall can significantly differ from one year to another, making it unpredictable and challenging to manage and plan for. The health implications of increased flood risk variability in Botswana are profound. Flooding can lead to immediate health crises such as injuries and drownings, with high variability complicating preparedness and planning for public health systems. The aftermath of floods could see a rise in waterborne diseases such as cholera and diarrheal illnesses, which can be devastating. The stress and uncertainty related to livelihoods, especially in agriculture-dependent communities, can have significant mental health impacts.
The data underscores the critical need for climate resilience and preparedness strategies in the health sector. For Botswana, adapting to the reality of these extreme weather events means improving flood warning systems, enhancing urban planning to reduce flood risks, and bolstering the healthcare system to respond to post-flood health crises.
The Climate and Health Country Profile also specifically identifies three current and future health risks due to climate change. The first of these are vector borne diseases such as malaria and dengue fever. Vector-borne diseases are infections transmitted to humans (and sometimes animals) through the bites of insects known as vectors.
Mosquitoes are perhaps the most notorious vectors, responsible for spreading deadly diseases like malaria, dengue fever, Zika virus, chikungunya, and yellow fever. When a mosquito bites an infected host, it can pick up the pathogen and transmit it to the next person or animal it bites. Climate change can expand the habitats of mosquitoes, allowing them to migrate to new areas where people may have little immunity to the diseases they carry and where surveillance for such diseases does not exist. Warmer temperatures can also speed up the life cycle of mosquitoes, increasing their populations and the potential for disease spread.
The graph shows the difference in populations at risk of malaria under two scenarios;
RCP 8.5: This is a high emissions scenario, assuming that greenhouse gas emissions continue to rise throughout the 21st century. Under this scenario, the population at risk of malaria in Botswana is projected to increase steadily through 2070, surpussing 120,000.
RCP 2.6: This represents a scenario where there is a rapid decline in emissions. This scenario models a world where all appropriate climate policies and low emissions development actions have been put in place. Here, the population at risk increases until about 2050 but then begins to decrease steadily as global emissions decline.
RCPs are Representative Concentration Pathways. These are scenarios used in climate modelling and research to anticipate how different patterns of greenhouse gas emissions and concentrations will impact the climate system in the future. The particular projections in Figure 3 above show just how climate action could directly impact human health. By juxtaposing the two greenhouse gas emissions scenarios against malaria exposure, it illustrates why public health actors should equally be concerned by the deplorable state of climate inaction today.
We can also connect climate change with public health by looking at what causes climate change; the burning of fossil fuels. In other words, air pollution. Botswana is thought to be amongst the countries with worrying levels of air pollution. Air pollution accounts for 40% of the 330 child deaths from acute lower respiratory infections today. Moreover, household air pollution accounts for 26% of total deaths from ischaemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease (18 years +) and acute lower respiratory infections (under 5 years). A significant percentage of Botswana’s population still relies on solid fossil fuels for cooking, most of whom are in rural areas. Women are particularly vulnerable to complications resulting from household air pollution as they are traditionally responsible for cooking and other domestic household duties. Climate change mitigation solutions such as the provision of clean cookstoves have the co-benefit of reducing vulnerabilities to these respiratory & pulmonary complications amongst rural women. , further illustrating how climate action could advance health interests for marginalised populations.
In order to advance work on this very crucial nexus, it is important that we begin to treat climate change as a public health emergency and accelerate research towards better understanding its impact on health outcomes for key populations. We achieve this first by integrating climate considerations into the National Health Policy and Public Health Act to set the right policy foundations for coordinated action on clim-health. Other strategies for strengthening health and environmental systems include;
Improving Surveillance and Monitoring: Essentially developing integrated surveillance systems that monitor human, animal, and environmental health. This One Health approach facilitates early detection of pathogens and potential zoonotic disease spillovers, and using this data to anticipate health threats from environmental and climate triggers.
Climate-Sensitive Emergency Response Plans: Developing and regularly updating comprehensive emergency response plans that outline roles, responsibilities, and protocols for managing disease outbreaks and health sector disaster responses under various climate change scenarios. While Botswana’s disaster response regime is guided by the 1996 National Policy on Disaster Management and the 2009 Disaster Risk Management Plan, these have been deemed outdated and too generic to respond to variable disaster scenarios (for example, particularly for the health sector) or for issues such as pandemic preparedness, risk reduction and response.
Climate-health Focused Research and Development: Climate change contributes to the emergence and re-emergence of infectious diseases. For instance, warmer temperatures can expand the habitats of mosquitoes, leading to the spread of vector-borne diseases such as malaria and dengue fever into new regions. Research and development efforts need to anticipate these shifts by and create space for the development of vaccines and treatments that can be rapidly deployed as new threats emerge.
Cross-Sectoral Collaboration: Fostering collaboration between environmental scientists, public health experts, and policymakers to develop comprehensive preparedness plans that address both health and environmental risks. Eg, Rwanda’s One Health Strategic Plan (2021) helps provide guidance on multi-sectoral and interdisciplinary engagement across the human, animal, and environmental health sectors for efficient outbreak detection and prevention, and incidence response.
Infrastructure and Capacity Building: Developing healthcare infrastructure, including hospitals, laboratories, and quarantine facilities, equipped to handle surge capacities during climate-related disasters and pandemics. We also need to ensure that Batswana are able to access quality health services even (and especially) during extreme weather events such as floods and heat waves. Training healthcare professionals and support staff is also crucial for maintaining operational capabilities during crises.
Community Engagement and Education: Educating communities about the links between climate change and health. Local communities need to be empowered to participate in surveillance efforts efforts and planning processes intended to address climate-health risks
In looking at the available data, it is clear that much is to be understood about the health impacts of climate change on health in Botswana. But what is absolutely certain is that there is a stark relationship between the two, and addressing climate change could have an insurmountable impact on improving health outcomes for all Batswana. It is therefore appropriate to declare, that there is no health equity without climate justice.
World Health Organisation, Botswana Climate and Health Country Profile, Online
NASA Earth Observatory, World of Change: Global Temperatures, Online
Climate Change Knowledge Portal, Botswana, Climate Data Projections, Online
World Bank Group, Climate Risk Profile, Online
Botswana Climate Change Knowledge Portal, Mean Temperature Projections, Online
Statistics Botswana, Botswana Causes of Mortality 2018, Online
Climate Copernicus, Copernicus Climate Change Service – Global Impacts, Online
World Health Organisation, Air Quality Guidelines, Online
Samuel G et.al, Evaluation of national disaster management strategy and planning for flood management and impact reduction in Gaborone, Botswana, Online
Republic of Rwanda, One Health Strategic Plan 2021-2026, Online
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