There is little doubt that climate change poses an existential crisis for our planet. Despite the pleas of many climate scientists over the past 10-15 years that global warming is a serious threat to the world, these pleas were often drowned out by naysayers and lobbyists from the fossil fuel industry. It is only in the recent past that more attention has been focused on the specter of climate change, driven partly by the extremes of weather patterns being experienced all over the world.
The ill effects of rising temperatures and air pollution on health have been known for many years. The Intergovernmental Panel on Climate Change in 2018 highlighted that a global increase in temperature of 1.5°C above pre-industrial levels will result in major biodiversity loss and will have a major impact on health. (1) Based on the severity of threat of climate change to health, a joint editorial was published earlier this year in almost 200 international medical journals around the world calling for emergency action to limit global temperature increases, restore biodiversity and protect health. (2)
During the last 50 years the mean annual temperatures in South Africa increased by at least 1°C which is 1.5 times the global average. (3) Furthermore, the temperatures in South Africa are expected to rise above the world average and under a scenario of ‘business as usual’ by the end of this century, a rise of 4–6°C is expected compared with the 1961–1990 baseline. (3,4). In a study in three large cities in South Africa between 2006-2010, an overall increase in mortality of 0.9% per 1°C increase in the daily ambient apparent temperature for all age groups was found, with a significant increase to 2.1% in the over 65-year-old age group. (5) These higher temperatures have been associated with a variety of adverse health outcomes such as kidney failure related to dehydration, pregnancy complications, tropical infections in regions not seen before, increased skin cancers, worse mental health, as well as increased cardiovascular and pulmonary morbidity and mortality. (6) Importantly, the most vulnerable members of the population such as children, the elderly, those with underlying health problems and the poor and marginalized communities are most likely to be affected. (7)
Global temperature increase may also cause a deterioration in the quality and quantity of major crops such as grains and vegetables. In addition, extremes of weather leading to soil depletion will lead to food insecurity and consequent malnutrition. There is lack of adequate housing in many poor communities in South Africa making living with higher temperatures difficult for many. (8) South Africa also has the highest prevalence of HIV and tuberculosis in the world. With global warming the rising temperatures and heat waves will exacerbate social, housing and food insecurity and this may lead to higher mortality in this population because of decreased access to medical care, drug supply issues and non-adherence to antiviral and tuberculosis therapy. (9)
Unfortunately, Africa has contributed least to the environmental crisis, yet it is likely to experience a disproportionate burden of the consequences of climate change and is also least likely to mitigate against its harms. This may lead to more conflict, and it is imperative that wealthy countries abide by the Paris accord of financially supporting less developed nations in mitigating against the effects of climate change. As with the COVID-19 pandemic, we are globally as strong as our weakest member. (2)
To date there has been little attention given to the health consequences related to climate change in the African setting. The first major climate conference in Africa (COP 27) will be held in Egypt in November 2022, and hopefully this meeting will galvanize Africa to address the environmental crises unfolding in Africa. Thus, the editorial board of Wits Journal of Clinical Medicine (WJCM) felt that this was an opportune moment to publish a special issue of the Journal highlighting a series of articles focusing on the climate emergency and its health implications, particularly as it pertains to Africa and southern Africa. Going forward, it is also our intent to foster research in this area of science and we will continue to publish research, reviews and viewpoints on climate and associated health related matters, particularly those that affect southern Africa and Africa.
The rise in global temperatures related to global warming and associated extreme weather events, altered rainfall patterns, flooding, droughts, migration and relocation of populations all have myriad levels of impact on the health of individuals. This special issue of WJCM discusses many of these issues including the effect of climate change on infectious disease patterns, the cardiovascular system, kidney and mental health, maternal and new-born health as well as the impact on children. The first survey in South Africa on how health professionals view climate change is presented, as well as the urgent need for education about planetary health and sustainable healthcare in South Africa and the urgent consistent calls for health professionals to be more socially and environmentally accountable is discussed. The COVID-19 pandemic exposed the vulnerabilities of many health systems. The relationship of COVID-19 to climate change is presented together with lessons to be learnt on how to handle the coming health crises related to climate change.
Environmental change also significantly impacts health systems. The poor and elderly bear the brunt of many of the consequences of climate change. This special issue thus also discusses the societal need for social justice so that the poor and marginalized members of our communities get adequate health care and the importance of strengthening health systems so these needs can be met. The issue also presents thoughts on how physicians should address climate change as an accumulation of infrastructural shifts, behavioural change, and systemic resilience.
To help mitigate and adapt to environmental change, countries need a comprehensive strategy and policy. This issue also highlights the current status of these strategies and policies in South Africa, the most important one being the Climate Change bill, and provides a report card as how we as a nation are addressing the challenge of climate change.
Finally, in a video podcast, Francois Engelbrecht, a leading climatologist in South Africa, discusses the tipping points regarding the environmental crises as they relate to southern Africa and Africa.
The editorial board hopes that this special issue will be a springboard for health workers and heath care organizations to take cognizance of the risks of the environmental crises in southern Africa and Africa and take responsibility to chart a requisite path to mitigation and adaptation against climate change related health risks.
Pravin Manga
Editor
Wits J Clin Med