As far back as 2009, the Lancet-UCL Commission on Climate Change predicted that climate change would be the biggest global health threat of the 21st century, and - the Covid-19 pandemic notwithstanding - so it is proving to be. According to the World Health Organisation (WHO), climate change will cause an additional quarter of a million deaths each year between 2030 and 2050 from malnutrition, malaria, diarrhoea and heat stress. Despite these warnings, more than a decade later the Lancet Countdown reports that “in absolute terms, climate change continues to be framed in ways that pay little attention to its health dimensions … climate change interacts with existing social and economic inequalities and exacerbates longstanding trends … which disproportionately harm the health of disadvantaged or otherwise marginalised populations.”
Yet with some notable exceptions, governments and insurers continue to deal with health and climate risks in silos, rarely looking to manage these interrelated threats strategically. “The most important thing is to look at holistic risk management,” said Dr Astrid Zwick, Head of Secretariat at the InsuResilience Global Partnership, during the latest MiN Expert Forum on climate change and health. “Different types of risk require different approaches, but in many countries, awareness about climate and health risks within governments is very different. There’s a lack of collaboration between ministries, no coordinated action, no common awareness of climate, disaster and health risk.”
Chronic underinvestment in public health services in many emerging economies adds to the impact of climate risk on health outcomes. Migration from rural to urban areas - exacerbated by unpredictable weather patterns, drought and decreasing crop yields - is already facilitating the spread of vector-borne diseases such as malaria and dengue fever And, as Milena Sergeeva, Liaison Officer for Latin America and the Caribbean at the Global Climate and Health Alliance, pointed out, the Covid-19 pandemic could double the projected number of climate-related deaths in the region. “Awareness about the relationship between climate change and health is low.” she said. “Governments give it little attention, and alarmingly, a recent survey showed only 15 percent of medical schools globally teach the effects of climate change on health.”
Lack of investment in public healthcare systems means private insurance is often the only way for individuals to manage their personal health risks, but despite a proliferation of inclusive health insurance products, they are often inaccessible to low-income people. “The biggest challenge in the poorest countries is related to healthcare financing,” said Dr Abdul Ghaffar, Executive Director of the Alliance for Health Policy and Systems Research. “60 to 80 percent of health expenditure in many LMICs is out of pocket because people have no insurance.” Dr Ghaffar called for a rethink of public health, which has traditionally focused on germ theory. “We have medicalised public health, yet in some countries between 25 and 35 percent of deaths are from air pollution, water pollution and road accidents. On top of that you have a significant increase in non-communicable diseases such as diabetes, hypertension and cardio-vascular disease which require medication for life - and without a properly funded public healthcare system, it’s too expensive.”
Alongside poor financial and insurance literacy, many low-income populations also have very poor health literacy. “Most poor people are not even aware they have to mitigate health risks,” added Dr Ghaffar. “They have no idea about insurance, and even those with insurance don’t fully understand the benefits. Public health systems are unable to communicate, no one is talking to consumers about the benefits of insurance.”
The Covid crisis has seen some governments refocus on universal health coverage (UHC), but with most low- and middle-income countries spending less than three or four percent of GDP on health, it’s hard to see that happening soon. “I’d like to see more money for public sector healthcare, more emphasis on health promotion and prevention, and insurance for health prevention and promotion,” said Dr Ghaffar.
Regional risk pools such as those in the Caribbean, Africa and the Pacific are already looking beyond climate risks to include health challenges such as pandemics. In August 2020, for example, at the height of the Covid crisis, the African Risk Capacity, in collaboration with the Africa Centre for Disease Control and Prevention (Africa CDC), launched a modelling tool to help governments predict and manage the spread of the pandemic.
Dr Zwick pointed out that in times of crisis, insurance companies can often move faster than governments or humanitarian agencies. The Munich Re-Global Fund Risk Management Partnership, for example, guarantees immediate funding for manufacturing mosquito nets in the case of a malaria outbreak - funding which might otherwise take up to nine months to get approval. “Malaria is shifting due to the increase in average night-time temperatures. Cholera often follows heatwaves and flooding. Insurers can help by developing solutions such as parametric insurance - not just for extreme weather events but for pandemics - which guarantee fast automatic payouts.”
Risk pools can also help rebuild critical infrastructure such as hospitals after a catastrophe. “Historically there has been health insurance for individuals, and that’s great, but climate-related extreme weather is damaging health facilities,” added Dr Ghaffar. “What happens when a clinic gets washed away? It can take years to rebuild because the government lacks funds. We need an insurance system for medical supplies and facilities - it’s a big gap and a serious problem.”
We’ve come a long way since the ancient Mayans made human sacrifices in an attempt to appease the weather gods, concluded Milena Sergeeva. “Now we don’t need to make human sacrifices, we know what needs to be done to work together to mitigate and adapt to climate change.”