Mental health and the global climate crisis.

AIMS: Not only is nature essential for human existence, but many of its functions and contributions are irreplaceable. Studying the impact of these changes on individuals and communities, researchers and public health officials have largely focused on physical health. Our aim is to better understand how climate change also exacerbates many social and environmental risk factors for mental health and psychosocial problems, and can lead to emotional distress, the development of new mental health conditions and a worsening situation for people already living with these conditions. METHODS: We considered all possible direct and indirect pathways by which climate change can affect mental health. We built a framework which includes climate change-related hazards, climate change-related global environmental threats, social and environmental exposure pathways, and vulnerability factors and inequalities to derive possible mental health and psychosocial outcomes. RESULTS: We identified five approaches to address the mental health and psychosocial impacts of climate change which we suggest should be implemented with urgency: (1) integrate climate change considerations into policies and programmes for mental health, to better prepare for and respond to the climate crisis; (2) integrate mental health and psychosocial support within policies and programmes dealing with climate change and health; (3) build upon global commitments including the Sustainable Development Goals, the Paris Agreement and the Sendai Framework for Disaster Risk Reduction; (4) implement multisectoral and community-based approaches to reduce vulnerabilities and address the mental health and psychosocial impacts of climate change; and (5) address the large gaps that exist in funding both for mental health and for responding to the health impacts of climate change. CONCLUSIONS: There is growing evidence of the various mechanisms by which climate change is affecting mental health. Given the human impacts of climate change, mental health and psychosocial well-being need to be one of the main focuses of climate action. Therefore, countries need to dramatically accelerate their responses to climate change, including efforts to address its impacts on mental health and psychosocial well-being.

When Land Is Under Pressure Health Is Under Stress.

The land provides vital resources to support life on Earth. Land ecosystems services have social, cultural, and spiritual benefits and promote human health and well-being. However, human activities, particularly ongoing unsustainable land practices, are negatively impacting ecosystems through desertification, land degradation and drought (DLDD). This article highlights the pressures and impacts of DLDD on human health through exposure pathways, including water security and safety; sanitation and hygiene; food security and safety; air quality; and soil quality. We describe the impacts on 19 health outcomes in three groups: non-communicable diseases; injuries; and infections, parasitic and nutritional diseases. The magnitude of these health impacts is mediated by social, economic, and health system-related factors. We propose actions for the health sector to respond to the DLDD challenges.

Towards Climate Resilient and Environmentally Sustainable Health Care Facilities.

The aim of building climate resilient and environmentally sustainable health care facilities is: (a) to enhance their capacity to protect and improve the health of their target communities in an unstable and changing climate; and (b) to empower them to optimize the use of resources and minimize the release of pollutants and waste into the environment. Such health care facilities contribute to high quality of care and accessibility of services and, by helping reduce facility costs, also ensure better affordability. They are an important component of universal health coverage. Action is needed in at least four areas which are fundamental requirements for providing safe and quality care: having adequate numbers of skilled human resources, with decent working conditions, empowered and informed to respond to these environmental challenges; sustainable and safe management of water, sanitation and health care waste; sustainable energy services; and appropriate infrastructure and technologies, including all the operations that allow for the efficient functioning of a health care facility. Importantly, this work contributes to promoting actions to ensure that health care facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their local settings. To this end, we propose a framework to respond to these challenges.

Drought in the Semiarid Region of Brazil: Exposure, Vulnerabilities and Health Impacts from the Perspectives of Local Actors.

INTRODUCTION: The objective of this study was to understand and assess the perception of communities, organized civil society, health professionals, and decision-makers of several governmental institutions, regarding vulnerabilities and health impacts in drought prone municipalities of Brazil. METHODS: This study was carried out through a qualitative investigation in eight municipalities in the Brazilian Semiarid region. Data collection was done through semi-structure and structure interviews, and discussion with local actors, which included communities groups, health professionals, governmental managers and organized civil society. RESULTS: The results point to the local actors' concerns and to the fragility of the health sector in the planning of integrated actions directed towards risks and impacts associated with drought conditions on human health. DISCUSSION: The lack of a specific knowledge contributes to making invisible the process that determines the impacts of drought on health, leading to an acceptance of drought in those municipalities, reducing the capacity of the health system to respond to droughts. KEYWORDS: drought, vulnerability, risks, health, perception, Brazilian Semiarid, resilience.

Indicators to measure risk of disaster associated with drought: Implications for the health sector.

INTRODUCTION: Brazil has a large semiarid region, which covers part of 9 states, over 20% of the 5565 municipalities in the country and at 22.5 million persons, 12% of the country's population. This region experiences recurrent and extended droughts and is characterized by low economic development, scarcity of natural resources including water, and difficult agricultural and livestock production. Local governments and communities need easily obtainable tools to aid their decision making process in managing risks associated with drought. METHODS: To inform decision-making at the level of municipalities, we investigated factors contributing to the health risks of drought. We used education and poverty indicators to measure vulnerability, number of drought damage evaluations and historical drought occurrences as indicators of hazard, and access to water as an indicator of exposure, to derive a drought disaster risk index. RESULTS: Indicators such as access to piped water, illiteracy and poverty show marked differences in most states and, in nearly all states, the living conditions of communities in the semiarid region are worse than in the rest of each state. There are municipalities at high drought disaster risk in every state and there are a larger number of municipalities at higher risks from the center to the north of the semiarid region. CONCLUSIONS: Understanding local hazards, exposures and vulnerabilities provides the means to understand local communities' risks and develop interventions to reduce them. In addition, communities in these regions need to be empowered to add their traditional knowledge to scientific tools, and to identify the actions most relevant to their needs and realities.

Measuring the invisible: Analysis of the Sustainable Development Goals in relation to populations exposed to drought.

Brazil, together with all the member countries of the United Nations, is in a process of adoption of a group of Sustainable Development Goals, including targets and indicators. This article considers the implications of these goals and their proposed targets, for the Semi-Arid region of Brazil. This region has recurring droughts which may worsen with climate change, further weakening the situation of access of water for human consumption in sufficient quantity and quality, and as a result, the health conditions of the exposed populations. This study identifies the relationship between drought and health, in an effort to measure progress in this region (1,135 municipalities), comparing relevant indicators with the other 4,430 municipalities in Brazil, based on census data from 1991, 2000 and 2010. Important inequalities between the municipalities of this region and the municipalities of the rest of Brazil are identified, and discussed in the context of what is necessary for achieving the Sustainable Development Goals in the Semi-arid Region, principally in relation to the measures for adaptation to achieve universal and equitable access to drinking water.

Diarrhea outbreaks in northeastern Brazil in 2013, according to media and health information systems - Surveillance of climate risk and health emergencies.

This study has the objective of analyzing information about diarrhea outbreaks in Brazil's northeast in the year 2013. Information came from electronic media and from health information systems. A total of 33 news events related to diarrhea outbreaks were identified, some of them mentioning causes and aggravating factors. The analysis of spatial and temporal distribution of the news, admissions and deaths showed that more than 100,000 persons were affected and, according to the news analyzed, the most affected states were Alagoas and Pernambuco, with a greater extent in the months from May to July. The use of alternative sources of water such as ponds, wells, water trucks and household water reservoirs were identified as the most immediate causes of these outbreaks. However, other underlying factors such as precarious water supply systems in the semi-arid region, the exceptional conditions of drought, considered the worst in the last 60 years, as well as the capacity of the health sector to respond to a large number of cases, should be considered to recover the context in which these outbreaks are produced.

Disasters related to droughts and public health - a review of the scientific literature.

In Brazil, the history of droughts has been marked by constant social and health tragedies, with estimates of up to 3 million deaths from the early 19th century until the late 20th century. There is a record of nearly 32,000 events related to the above and more than 96 million people were affected between 1991 and 2010. Although droughts have historically brought disasters to Brazil, which was noted in the scientific expeditions of Arthur Neiva and Belisario Penna that documented these droughts, there have not been many studies on them. The objective of this paper is to present a revision of the scientific articles related to droughts and public health. The following databases were used: PubMed, the Preparation and Response to Disasters Portal from BVS and the Capes Periodical Portal. The descriptors drought and health were used to search titles and summaries of articles in English, Portuguese and Spanish. Among the repercussions related to health that were discovered: malnutrition and nutritional deficiencies, mental health problems, issues relating to water and air quality and commitments made concerning access to health services. As there is a trend for more intense droughts and a scarcity of water until 2030, there is an urgent need for more research and studies in these areas.

Surtos de diarreia na região Nordeste do Brasil em 2013, segundo a mídia e sistemas de informação de saúde – Vigilância de situações climáticas de risco e emergências em saúde / Diarrhea outbreaks in northeastern Brazil in 2013, according to media and health information systems – Surveillance of climate risk and health emergencies

Resumo Este trabalho tem como objetivo analisar as informações sobre surtos de diarreia no Nordeste do Brasil ocorridos no ano de 2013, veiculadas pela mídia eletrônica e pelos dados obtidos por sistemas de informação de saúde. Foram identificadas 33 notícias com cunho informativo sobre os surtos, algumas contendo menções sobre as causas e os fatores agravantes dos surtos de diarreia. A análise da distribuição espacial e temporal de notícias, internações e óbitos revelou que mais de 100 mil pessoas foram acometidas e, de acordo com as notícias analisadas, os estados mais atingidos foram Alagoas e Pernambuco, com maior extensão nos meses de maio a julho. O uso de fontes alternativas de água, como cacimbas, poços, caminhões-pipa e reservatórios domésticos foram apontados como as causas mais imediatas destes surtos. No entanto, outros fatores subjacentes como a precariedade estrutural dos sistemas de abastecimento de água na região do semiárido, as condições excepcionais de seca, considerada a pior dos últimos 60 anos, bem como a capacidade do setor saúde para atender um grande volume de casos, devem ser considerados para recuperar o contexto em que estes surtos são produzidos.

Abstract This study has the objective of analyzing information about diarrhea outbreaks in Brazil’s northeast in the year 2013. Information came from electronic media and from health information systems. A total of 33 news events related to diarrhea outbreaks were identified, some of them mentioning causes and aggravating factors. The analysis of spatial and temporal distribution of the news, admissions and deaths showed that more than 100,000 persons were affected and, according to the news analyzed, the most affected states were Alagoas and Pernambuco, with a greater extent in the months from May to July. The use of alternative sources of water such as ponds, wells, water trucks and household water reservoirs were identified as the most immediate causes of these outbreaks. However, other underlying factors such as precarious water supply systems in the semi-arid region, the exceptional conditions of drought, considered the worst in the last 60 years, as well as the capacity of the health sector to respond to a large number of cases, should be considered to recover the context in which these outbreaks are produced.

Desastres relacionados à seca e saúde coletiva – uma revisão da literatura científica / Disasters related to droughts and public health – a review of the scientific literature

Resumo No Brasil, a história das secas é marcada por seguidas tragédias sociais e sanitárias, com estimativas de 3 milhões de óbitos entre o início do século XIX e o final do século XX e o registro de quase 32 mil eventos e mais de 96 milhões de afetados entre 1991 e 2010. Apesar de no Brasil a seca ser um desastre histórico, não encontramos, desde a expedição científica de Arthur Neiva e Belisário Penna em 1912 nas zonas flageladas pela seca, muitas pesquisas sobre a relação seca e saúde no Brasil. O objetivo deste trabalho é apresentar uma revisão dos artigos científicos sobre a relação seca e saúde coletiva. Foram utilizadas as bases de dados PubMed, Portal Preparação e Respostas a Desastres da BVS e Portal de Periódicos da Capes, utilizando-se os descritores drought and health no título e resumo, selecionando-se somente artigos em inglês e espanhol com relação direta com os temas em saúde. Dentre os efeitos sobre a saúde encontrados, destacam-se os relacionados à desnutrição e deficiências nutricionais, saúde mental, qualidade das águas e do ar, além do comprometimento da qualidade e do acesso aos serviços de saúde. Considerando-se as tendências de episódios de seca mais intensos e frequentes e de escassez de água até 2030, torna-se urgente ampliar as pesquisas sobre o tema e revisões da literatura.

Abstract In Brazil, the history of droughts has been marked by constant social and health tragedies, with estimates of up to 3 million deaths from the early 19th century until the late 20th century. There is a record of nearly 32,000 events related to the above and more than 96 million people were affected between 1991 and 2010. Although droughts have historically brought disasters to Brazil, which was noted in the scientific expeditions of Arthur Neiva and Belisario Penna that documented these droughts, there have not been many studies on them. The objective of this paper is to present a revision of the scientific articles related to droughts and public health. The following databases were used: PubMed, the Preparation and Response to Disasters Portal from BVS and the Capes Periodical Portal. The descriptors drought and health were used to search titles and summaries of articles in English, Portuguese and Spanish. Among the repercussions related to health that were discovered: malnutrition and nutritional deficiencies, mental health problems, issues relating to water and air quality and commitments made concerning access to health services. As there is a trend for more intense droughts and a scarcity of water until 2030, there is an urgent need for more research and studies in these areas.

Medindo o invisível: análise dos Objetivos de Desenvolvimento Sustentável em populações expostas à seca / Measuring the invisible: Analysis of the Sustainable Development Goals in relation to populations exposed to drought

Resumo O Brasil, juntamente com todos os países membros das Nações Unidas, está num processo de adoção de um conjunto de Objetivos de Desenvolvimento Sustentável, incluindo metas e indicadores. Este artigo considera as implicações desses objetivos e metas propostos, para a região do semiárido do Brasil, região que apresenta secas recorrentes e que pode ser agravada com as mudanças climáticas, piorando a situação de acesso à quantidade e qualidade da água para consumo humano e, como consequência, também as condições de saúde das populações expostas. Este estudo identifica a relação entre seca e saúde, no intuito de medir o progresso nessa região (1.135 municípios), comparando indicadores relevantes com os outros 4.430 municípios do país, baseado e censos de 1991, 2000 e 2010. Importantes desigualdades entre os municípios dessa região e os do resto do Brasil foram identificadas e discutidas no contexto do que é necessário para alcançar os Objetivos de Desenvolvimento Sustentável na região do semiárido, principalmente em relação às medidas de adaptação para o acesso universal e equitativo à água potável.

Abstract Brazil, together with all the member countries of the United Nations, is in a process of adoption of a group of Sustainable Development Goals, including targets and indicators. This article considers the implications of these goals and their proposed targets, for the Semi-Arid region of Brazil. This region has recurring droughts which may worsen with climate change, further weakening the situation of access of water for human consumption in sufficient quantity and quality, and as a result, the health conditions of the exposed populations. This study identifies the relationship between drought and health, in an effort to measure progress in this region (1,135 municipalities), comparing relevant indicators with the other 4,430 municipalities in Brazil, based on census data from 1991, 2000 and 2010. Important inequalities between the municipalities of this region and the municipalities of the rest of Brazil are identified, and discussed in the context of what is necessary for achieving the Sustainable Development Goals in the Semi-arid Region, principally in relation to the measures for adaptation to achieve universal and equitable access to drinking water.

Atuação do setor saúde frente a situações de seca

A seca é um evento climático que afeta de forma permanente várias regiões do mundo. Geralmente, são de larga duração é difícil estimar quando um evento começará ou quan-do terminará. Os impactos econômicos, sociais e de saúde são pouco reconhecidos, sen-do as pessoas mais frequentemente afetadas as mais pobres e marginalizadas de um país. No documento final da Conferência das Nações Unidas sobre Desenvolvimento Susten-tável realizada no Rio de Janeiro em 2012, os líderes dos países participantes ressaltam que “a desertificação, a degradação do solo e a seca são desafios de dimensões globais e continuam a representar sérias dificuldades para o desenvolvimento sustentável de todos os países, em particular para os países em desenvolvimento”. No Brasil, como para vários países da Região das Américas, a seca é uma ameaça persistente para o seu desen-volvimento e para a saúde e bem-estar da população. O objetivo desta publicação é apoiar os gestores nas esferas nacional, subnacional e local na tomada de decisões de forma rápida apresentando medidas para reduzir e, de prefe-rência eliminar os impactos potenciais resultantes de secas sobre a saúde das populações.

Managing the health impacts of drought in Brazil.

Drought is often a hidden risk with the potential to become a silent public health disaster. It is difficult to define precisely when it starts or when it is over, and although it is a climatological event, its impacts depend on other human activities, and are intensified by social vulnerability. In Brazil, half of all natural disaster events are drought related, and they cause half of the impacts in number of affected persons. One large affected area is the semiarid region of Brazil's Northeast, which has historically been affected by drought. Many health and well-being indicators in this region are worse than the rest of the country, based on an analysis of 5565 municipalities using available census data for 1991, 2000 and 2010, which allowed separating the 1133 municipalities affected by drought in order to compare them with the rest of the country. Although great progress has been made in reducing social and economic vulnerability, climate change and the expected changes in the semiarid region in the next few decades call for a review of current programs, particularly in public health, and the planning of new interventions with local communities. This study reviews the literature, analyzes available data and identifies possible actions and actors. The aim is to ensure there will be sufficient and sustainable local adaptive capacity and resilience, for a population already living within the limits of environmental vulnerability.

[Natural disasters and health: an analysis of the situation in Brazil]. / Desastres naturais e saúde: uma análise da situação do Brasil.

Natural disasters are still insufficiently studied and understood within the scope of public health in this country, with impacts in the short and long term. The scope of this article is to analyze the relationship between disasters and their impact on health based on disaster data recorded in the country. The methodology involved the systematization of data and information contained in the Brazilian Atlas of Natural Disasters 1991-2010 and directly from the National Department of Civil Defense (NSCD). Disasters were organized into four categories of events (meteorological; hydrological; climatological; geophysical/geological) and for each of the latter, the data for morbidity, mortality and exposure of those affected were examined, revealing different types of impacts. Three categories of disasters stood out: the hydrological events showed higher percentages of mortality, morbidity and exposure; climatological events had higher percentages of incidents and people affected; the geophysical/geological events had a higher average of exposure and deaths per event. Lastly, a more active participation of the health sector in the post-2015 global political agenda is proposed, particularly events related to sustainable development, climate change and disaster risk reduction.

Desastres naturais e saúde: uma análise da situação do Brasil / Natural disasters and health: an analysis of the situation in Brazil

Os desastres naturais ainda são pouco pesquisados e compreendidos no âmbito da Saúde Coletiva no país, com impactos do curto ao longo prazos. O objetivo deste artigo é, a partir de dados sobre desastres registrados no país, analisar a inter-relação entre esses eventos e seus impactos sobre a saúde. A metodologia envolveu a sistematização de dados e informações contidos no Atlas Brasileiro dos Desastres Naturais 1991-2010 e diretamente na Secretária Nacional de Defesa Civil (SNDC). Os desastres foram organizados em quatro categorias de eventos (meteorológicos; hidrológicos; climatológicos; geofísicos/geológicos) e, para cada uma das mesmas, foram explorados os dados de afetados, morbidade, mortalidade e expostos, demonstrando diferentes tipos de impactos. Três categorias de desastres se destacaram: os eventos hidrológicos apresentaram maiores percentuais de mortalidade, morbidade e expostos; os climatológicos maiores percentuais de ocorrências e afetados; os geofísicos/geológicos maior média de expostos e óbitos por evento. Ao final propõe-se uma participação mais ativa do setor saúde na agenda política global pós-2015, particularmente as relacionadas ao desenvolvimento sustentável, mudanças climáticas e redução de riscos de desastres.

Natural disasters are still insufficiently studied and understood within the scope of public health in this country, with impacts in the short and long term. The scope of this article is to analyze the relationship between disasters and their impact on health based on disaster data recorded in the country. The methodology involved the systematization of data and information contained in the Brazilian Atlas of Natural Disasters 1991-2010 and directly from the National Department of Civil Defense (NSCD). Disasters were organized into four categories of events (meteorological; hydrological; climatological; geophysical/geological) and for each of the latter, the data for morbidity, mortality and exposure of those affected were examined, revealing different types of impacts. Three categories of disasters stood out: the hydrological events showed higher percentages of mortality, morbidity and exposure; climatological events had higher percentages of incidents and people affected; the geophysical/geological events had a higher average of exposure and deaths per event. Lastly, a more active participation of the health sector in the post-2015 global political agenda is proposed, particularly events related to sustainable development, climate change and disaster risk reduction.