Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown.

BACKGROUND: In the past decades, climate change has been impacting human lives and health via extreme weather and climate events and alterations in labour capacity, food security, and the prevalence and geographical distribution of infectious diseases across the globe. Climate change and health indicators (CCHIs) are workable tools designed to capture the complex set of interdependent interactions through which climate change is affecting human health. Since 2015, a novel sub-set of CCHIs, focusing on climate change impacts, exposures, and vulnerability indicators (CCIEVIs) has been developed, refined, and integrated by Working Group 1 of the "Lancet Countdown: Tracking Progress on Health and Climate Change", an international collaboration across disciplines that include climate, geography, epidemiology, occupation health, and economics. DISCUSSION: This research in practice article is a reflective narrative documenting how we have developed CCIEVIs as a discrete set of quantifiable indicators that are updated annually to provide the most recent picture of climate change's impacts on human health. In our experience, the main challenge was to define globally relevant indicators that also have local relevance and as such can support decision making across multiple spatial scales. We found a hazard, exposure, and vulnerability framework to be effective in this regard. We here describe how we used such a framework to define CCIEVIs based on both data availability and the indicators' relevance to climate change and human health. We also report on how CCIEVIs have been improved and added to, detailing the underlying data and methods, and in doing so provide the defining quality criteria for Lancet Countdown CCIEVIs. CONCLUSIONS: Our experience shows that CCIEVIs can effectively contribute to a world-wide monitoring system that aims to track, communicate, and harness evidence on climate-induced health impacts towards effective intervention strategies. An ongoing challenge is how to improve CCIEVIs so that the description of the linkages between climate change and human health can become more and more comprehensive.

Economic, social and demographic impacts of drought on treatment adherence among people living with HIV in rural South Africa: A qualitative analysis.

The 2015 El Niño-triggered drought in Southern Africa caused widespread economic and livelihood disruption in South Africa, imposing multiple physical and health challenges for rural populations including people living with HIV (PLHIV). We examined the economic, social and demographic impacts of drought drawing on 27 in-depth interviews in two cohorts of PLHIV in Hlabisa, uMkhanyakude district, KwaZulu-Natal. Thematic analysis revealed how drought-enforced soil water depletion, dried-up rivers, and dams culminated in a continuum of events such as loss of livestock, reduced agricultural production, and insufficient access to water and food which was understood to indirectly have a negative impact on HIV treatment adherence. This was mediated through disruptions in incomes, livelihoods and food systems, increased risk to general health, forced mobility and exacerbation of contextual vulnerabilities linked to poverty and unemployment. The systems approach, drawn from interview themes, hypothesises the complex pathways of plausible networks of impacts from drought through varying socioeconomic factors, exacerbating longstanding contextual precarity, and ultimately challenging HIV care utilisation. Understanding the multidimensional relationships between climate change, especially drought, and poor HIV care outcomes through the prism of contextual vulnerabilities is vital for shaping policy interventions.

I will not go, I cannot go: cultural and social limitations of disaster preparedness in Asia, Africa, and Oceania.

While much work has been invested in addressing the economic and technical basis of disaster preparedness, less effort has been directed towards understanding the cultural and social obstacles to and opportunities for disaster risk reduction. This paper presents local insights from five different national settings into the cultural and social contexts of disaster preparedness. In most cases, an early warning system was in place, but it failed to alert people to diverse environmental shocks. The research findings show that despite geographical and typological differences in these locations, the limitations of the systems were fairly similar. In Kenya, people received warnings, but from contradictory systems, whereas in the Philippines and on the island of Saipan, people did not understand the messages or take them seriously. In Bangladesh and Nepal, however, a deeper cultural and religious reasoning serves to explain disasters, and how to prevent them or find safety when they strike.

Dealing with uncertainty: integrating local and scientific knowledge of the climate and weather.

While climate science has made great progress in the projection of weather and climate information, its uptake by local communities remains largely elusive. This paper describes two innovative approaches that strengthen understanding between the providers and users of weather and climate information and support-appropriate application: (1) knowledge timelines, which compare different sources and levels of certainty in community and scientific weather and climate information; and (2) participatory downscaling, which supports users to translate national and regional information into a range of outcomes at the local level. Results from piloting these approaches among flood-prone communities in Senegal and drought-prone farmers in Kenya highlight the importance of co-producing 'user-useful' climate information. Recognising that disaster risk management actions draw on a wide range of knowledge sources, climate information that can effectively support community-based decision-making needs to be integrated with local knowledge systems and based on an appreciation of the inherent uncertainty of weather and climate information.

The devil is in the details: An investigation of the relationships between conflict, food price and climate across Africa.

This study investigates the relationship between violent conflict, food price, and climate variability at the subnational level. Using disaggregated data on 113 African markets from January 1997 to April 2010, interrelationships between the three variables are analyzed in simultaneous equation models. We find that: (i) a positive feedback exists between food price and violence - higher food prices increase conflict rates within markets and conflict increases food prices; (ii) anomalously dry conditions are associated with increased frequencies of conflict; and (iii) decreased rainfall exerts an indirect effect on conflict through its impact on food prices. These findings suggest that the negative effects of climate variability on conflict can be mitigated by interventions and effective price management in local markets. Creating environments in which food prices are stable and reliable, and markets are accessible and safe, can lower the impacts of both climate change and conflict feedbacks.