This presentation quickly reviews the situation of Pacific countries with regard to climate change and how WHO uses the framework to help build climate resilient health systems with a focus on primary health care. After that, it proposes what actions can be taken by physicians who play very important roles in protecting patients from the health impact of climate change and addressing the importance of taking action towards climate change.

1. Climate change and health and
the roles of physicians
30 June 2019
Changgyo Yoon, technical officer
This presentation is a collaboration of
the Pacific Health Systems unit and
the Pacific Climate Change and Environment unit,
Division of Pacific Technical Support

2. Outlines
 Health impact of climate change
 WHO’s efforts to respond to the health impact of climate
change
– Special Initiative on Climate Change and Health in Small Island
Developing States
– Building climate resilient health systems
– GREEN and SMART health care facilities in the Caribbean region
 Roles of physicians in fighting against climate change
 Take-home messages

3. Health impact of climate change
 Climate change affects the social and environmental determinants of
health – clean air, safe drinking water, sufficient food and secure
shelter.
 Between 2030 and 2050, climate change is expected to cause
approximately 250 000 additional deaths per year, from malnutrition,
malaria, diarrhoea and heat stress.
 The direct damage costs to health (i.e. excluding costs in health-
determining sectors such as agriculture and water and sanitation), is
estimated to be between USD 2-4 billion/year by 2030.
 Areas with weak health infrastructure – mostly in developing countries
– will be the least able to cope without assistance to prepare and
respond.

4. Diarrhea and precipitation in Suva, Fiji
Source: McIver et al., Fiji J Public Health, 2012

5. Pathways of health impacts from climate change

6. Special Initiative on Climate Change and Health
 WHO Director General addressed the Special Initiative on Climate
Change and Health in Small Island Developing States (SIDS) at COP23
meeting that Fiji has chaired and WHO and UNFCCC supported to
ensure SIDS have health systems resilient to climate change by 2030
 In order to help achieve this vision, WHO and Member States in the
Pacific region have developed the Pacific Islands Action Plan on Climate
Change and Health that shapes action priorities in the region

7. Empowerment
Supporting health
leadership in PICs to
engage nationally and
internationally
Evidence
Building the health
argument for
investment
Implementation
Preparedness for climate
risks, building climate
resilient health systems,
and health promoting
mitigation policies
Resources
Facilitating access
to climate and
health finance.
Action Plan Strategic Focus

8. Climate resilient health systems
 WHO’s definition
– is one that is capable to anticipate, respond to, cope with, recover
from and adapt to climate-related shocks and stress, so as to bring
sustained improvements in population health, despite an unstable
climate (WHO, Operational Framework for Building Climate Resilient Health Systems, 2015)
Adopted from WHO, Operational Framework for Building Climate Resilient Health Systems, 2015

9. A framework for climate resilient health systems
 Building climate resilient health systems is the
key steps in achieving UHC and health related
SDGs
– To ensure access to essential health services
 Given the Healthy Islands vision, it needs to
encompass the key concept of health systems
envisioned by Healthy Islands
– Children are nurtured in body and mind; and People
work and age with dignity (health service related pillars)
 Develop through integration of actions in the
core policy areas of health system strengthening:
– social determinants of health; risk reduction; public
health surveillance and disease outbreak management;
implemented within the framework of national
sustainable development objectives

10. Linking primary health care with climate resilience
 Primary health care is the
foundation of the health
system (12th PHMM)
– Is the most equitable and
efficient approach for UHC in
the Pacific
– Is the critical point to build
climate resilient health systems
– Links communities/people to
another level of care, providing
essential clinical and
comprehensive preventive
services
Adopted from a consultant report on climate
resiliency assessment toolkit

11.  Target countries and regions
– Kiribati (South Tarawa), Tuvalu (Funafuti, Vaitupu, Nui)
 Project period: 2018 - 2019
 Project goals
– To improve roles and functions of primary health care for climate resilience
– To facilitate community participation and actions towards climate resilience
– To support the ministry of health on policy/plan, emergency preparedness,
and health information systems
 Organizations in partnership
– Ministries of Health, WHO and the Korea International Cooperation Agency (KOICA)
Building Climate Resilient Health Systems
in Kiribati and Tuvalu

12. Project sites in Kiribati and Tuvalu
Funafuti: 5,529; Vaitupu and Niu: 1,937South Tarawa, Kiribati: 56,388
Funafuti
Vaitupu
Nui

13. Vulnerability Assessment: Kiribati
 Priority areas for climate change and health planning and adaptation
– Water safety and waterborne diseases
– Food safety and foodborne diseases
– Vector-borne diseases
– Disease surveillance
 Key adaptation strategies in NCCHAP (2011)
– Improve water monitoring; supply of reagents; awareness on water safety
– Improve food inspection; build capacity of EH in food testing and analysis
– Enhance surveillance, train staff, invest in equipment
– Build capacity of clinic nurses in public health, environmental health,
disease surveillance and primary care.
– Provide specific training for data surveillance officers in environmental
epidemiological techniques

14. Vulnerability Assessment: Tuvalu
 Climate-sensitive diseases of high to medium risk
– Diarrheal disease (due to contaminated food and/or water)
– Respiratory disease (infective and obstructive)
– Compromised food security (with impacts on nutrition and NCDs)
– Vector-borne diseases
– Mental health/psychological problems
– Injuries and deaths from extreme weather events
 Key adaptation strategies in MOH work plan on CCH (2012)
– Upgrade laboratory facility/supplies for water testing capacity
– Provide training for staff in environmental health (including food and WASH),
vector-borne diseases, disaster planning and response, and mental health
– Build the capacity of health information systems
– Improve timeliness of reporting from the outer islands
– Conduct health promotion/community education programmes

15. Knowledge and skills
of health workforce
for essential health
services for climate-
sensitive health risks
Assessment of health
facilities and
workforce in capacity
and needs for climate
resilience
Health information
systems for improving
surveillance and
integrating climate
data
Essential equipment
and technologies for
climate-sensitive
health risks at health
facilities and
communities
Community
participation to
manage and address
public health risks and
measures towards
climate resilience
Government capacity
to plan and coordinate
policies and
programmes on
climate change and
health
Adopted from: Operational Framework
for Building Climate Resilient Health
Systems. WHO. 2015

16. GREEN and SMART health care facilities
 Green health care facilities
– a facility that has the ability to mitigate its impact on the
environment and reduce pollution; save costs; reduce
greenhouse gas emissions; and achieve adaptation, risk
reduction and development benefits (PAHO, 2017)
 SMART health care facilities
– Combines key concepts of safe and green hospital to make
facilities to be climate resilient and ensure health services
provided at all times (including acute phase of disasters)

18. SMART hospital/HCF tool kit available
 Hospital Safety Index: existing tool developed
by PAHO
 Green Checklist: evaluates water, energy,
atmosphere, IAQ, hazardous materials, etc
 Baseline Assessment Tool: Capture of
essential baseline information for design
specifications, SoW, and CBA
 Cost Benefit Analysis Tool by Florida
International University
 Knowledge, Aptitude and Practices (KAP)
Survey
 Preventive maintenance manual

19. The roles of physicians
in fighting against climate change
 Protecting patients from climate sensitive diseases at
clinical settings
– Providing public health / medical advice and support in planning
and implementing health promotion on climate sensitive
diseases
– Providing quality medical treatment to patients suffering from
diseases affected by climate change
 Great supporter for climate-health policy
– Taking actions in developing strategies to deal with the
impending effects of climate change on health and health
systems
 Strong advocate
– WMA was represented at the Katowice Climate Change
Conference in 2018
– Dr. Eidelman, WMA President, emphasized the ethical duty of
physicians to protect patients from the health impact of climate
change “Medical leaders must talk to politicians about climate
change.”
Table from the Canadian Association of Physicians for the Environment
http://climatehealthconnect.org/resources/physicians-guide-climate-change-health-equity

20. Results of Physician Surveys
on Climate Change and Health
Findings from surveys of the National Medical Association (NMA), the American Thoracic Society (ATS), and the American
Academy of Allergy, Asthma and Immunology (AAAAI) in 2015
Barriers and resources for physicians on climate
change many reported significant barriers to
taking action, including:
• Lack of time
• Not sure how to talk to patients about this issue
• Lack of resources and recommendations for
patients
• Non-billable activities
Specific resources that would assist physicians in
addressing climate change and health, including:
• Educational opportunities, such as webinars,
podcasts, or Continuing Medical Education units on
climate change
• Patient education materials and resources, as well
as training on how to talk to patients about these
issues
• Policy Statements from professional medical and
health associations
• Advocacy events, such as public and community
forums, opportunities for political action, public
service announcements

21. Take-home messages
 Climate change adversely affects the health of Pacific islanders
 Health leaders and WHO have been addressing the health impact of climate
change at the global and regional level
– Special Initiative on Climate Change and Health introduced by WHO Director-
General
 WHO significantly increases its efforts to make health systems climate resilient
and to effectively respond to climate sensitive diseases
– Building climate resilient health systems in Pacific countries
– Introduction of GREEN and SMART hospital concepts that can transform health facilities into
climate proofed.
 Physicians have a substantial role to play in fighting with climate change
– Prevention and treatment of climate sensitive diseases; supporter and advisor on making
health policies; strong advocate for climate change
– Physician surveys done in US show various responses and advice on how to support
physicians in taking actions towards climate change

22. Potential action points
 Personal Action
– Take steps to reduce your own carbon footprint.
• Walk or bike instead of driving; drive a low- or no-carbon vehicle.
• Reduce meat consumption; purchase local, fresh and seasonal food.
• Be energy efficient at home and in your office: use energy efficient appliances,
electronics, and light bulbs.
• Purchase renewable energy if you can.
 Patient Care
– Place climate change educational materials in your office.
– Look for appropriate ways to incorporate climate change and health into
patient education materials (e.g, disease management plans, discharge
materials, medication sheets, etc).
– Make sure climate change impacts are addressed in disease
management and care protocols.