In the past decade, we have become increasingly aware of the precarity of planetary life and the reality that climate change ought to be addressed at the crossroads of social, natural, and health sciences. The drought in Cape Town from 2015-2020 brought this home as water restrictions were enforced, while drought and water shortages continue to impact everyday life in other cities and provinces.(1) Bushfires and other fires in urban settlements each year take a heavy toll on human, animal and plant life, iconic infrastructure, services and ordinary dwellings.(2) Drought in poor communities has caused severe bacterial intestinal infections among children due, in the absence of clean municipal water, to drinking contaminated water from toxic riverbeds and sewer overflow. Temperature variance has increased with measurable impact on people who are vulnerable because of where they live, and their age, health status, and poverty.(3–5) Floods in KwaZulu Natal, Eastern Cape and Mpumalanga recently took further lives and destroyed livelihoods as domestic animals and livestock drowned, homes were flooded, and vehicles and other goods were washed away. Although it sometimes seemed otherwise, the Covid-19 pandemic was only one of many overlapping and coincidental crises. Covid-19 made explicit the uneven exposure and effects of the viral pandemic and highlighted the ways this unevenness was determined by race, class, and gender.(6) While the worst effects of the pandemic slowly fade, poverty, unemployment and inequality, and its most obvious symptom, food insecurity, continue to starkly divide populations.(7,8)
Devastating extreme weather events, as well as incremental changes to the weather system, have led to adversity regarding food, water, and energy.(9) There is thus a growing awareness of the need for mitigation strategies and programs that build resilience. But this assumes that institutions and species, including humans, other animals and plants, have the capacity for resilience – that is, they/we can rebound. It assumes the capacity of populations (and species) to survive or adapt to changed circumstances, without massive permanent disruptions and changes to social order and structure. Resilience as an ideology places responsibility on individuals, rather than political systems predicated on injustice, capitalism and corporate greed.
The emphasis on resilience also implies that stasis is feasible and desirable, and that it is possible to adapt to both short environmental crises or shocks without social, political and economic costs. Manderson and Alford observe that technological, social and environmental changes are occurring at a rate that precludes the possibility of ‘bouncing back,’ and instead require that we ‘bounce forward’ to adapt or to support transformational change.(10) In doing so, we need to address the structural factors that make this easier for some but not for others. Individuals and communities are recurrently asked to make such changes, consequent to extreme environmental events and related loss of territory, relocation and resettlement. The capacity of governments and institutions to change too is less clear, not least because such change implies political, economic, and policy realignment, and changes in the management and distribution of scarce goods and resources. Degrowth has been identified by Jason Hickel as a formidable contender for reducing planetary harms.(11) Degrowth means reducing rather than growing economies by using less of the world's energy. Hickel argues that human and planetary health ought to be put ahead of profit with the idea that by pursuing degrowth, it is possible to create economies of scale to support the planet and all sentient life. The alternative is to continue our current destructive course.
The slow creep of global warming
Unlike the pandemic, global warming and its accrued impacts are difficult to appreciate. Only with extreme weather events have the costs of climate change become increasingly clear. For example, the devastating floods in KwaZulu Natal in the first half of 2022 demonstrated that people living in poverty, with rudimentary shelter, without food and water security, are most likely to experience hardship. Those most likely to be affected directly by floods, fires, heat stroke, and drought experience the heaviest tolls and are also those with least power. Those with power have the least incentive to dramatically shift the social order of capitalism.
In South Africa, the structure of the economy and patterns of settlement, predating the colonial and apartheid eras, have shaped the geography of disadvantage. Those most vulnerable to water, food and energy insecurity continue to live as 25 years ago, in precarious circumstances in the outer rings of major cities, or crowded into decrepit buildings in the inner city, and sleep on the streets or in the sewers.(12) South Africa is the most unequal country in the world.(13) Areas of entrenched and compounded disadvantage, displacement and associated violence already carry the burden of climate variance and extreme weather events. Drought and erosion, followed by heavy rainfall, flooding and mudslides, impact poor populations the most, destroying private property, as well as loss of human and animal life. Flooding and sewage overflow, inadequate toilets and taps, electrical fires from water damage to electricity circuits and electronics, all further impact health, wellbeing, and livelihoods. Flood and fire damage to state infrastructure and resources amplify the effects on productivity with consequent impact on employment and availability of education, health services and communication systems. These are all critical for social resilience and are, therefore, matters of social justice.
Drought affects urban and rural communities, reducing available water for domestic, industrial and agricultural purposes. Changes in land capacity with increasing drought, depleted ground water and soil quality, affect animal health and crop productivity. People living on smallholdings, who rely on rain-fed agriculture, lack the capacity to store food and cannot afford to purchase food to feed animals. Pre-existing vulnerabilities among rural subsistence farmers and workers on commercial farms are amplified. The recent rise in temperatures and challenges to water and food security further intensify the health risks among already vulnerable farmworkers and others in rural areas. In her monograph on children's health among working children, Susan Levine pointed to excessive heat as the main health complaint of workers on wine farms at the height of the grape harvest season (December–February).(14) With temperatures reaching 40 degrees Celsius, children and women reported fainting, dehydration, exhaustion, migraine, skin irritation, dryness, and systemic thirst as an outcome of being forced to labour in unbearable heat conditions. In the context of these critical health afflictions and inhumane working conditions, we also note the likely impact of climate change on mental health amidst populations already confronting ‘multiple social stressors’.(15) The bundles of health stressors include Covid-19, HIV, TB, systemic hunger, liquor and drug addiction, all of which are further compounded by climate change.
The social costs of escalating change
The South African Weather Service for years has anticipated, documented and mapped the geography of global warming, identifying areas of the country especially vulnerable to extreme weather, drought, increased ambient temperature and sea rise. In 2015, climate scientists recorded the lowest annual rainfall in South Africa since 1904.(16) The same year, the Western Cape reported its highest temperature in the last 100 years at 42°C. The Western Cape government claimed that “a 2–4-degree Celsius rise in temperature threatens farming, dam levels, our natural environment (plant, bird and vulnerable amphibian species). Our food supply, water security and economy will be under threat.”(16) But since Levine's fieldwork in 1997,(14) mean temperature has already risen by two degrees.
Human health and planetary survival are threatened by rising temperatures, drought, and the challenges of water and food security. Based on current projections, Upington will becoming increasingly hot in the summer months, threatening the feasibility of permanent residence for those who cannot afford cooling. Extremely high temperatures, up to 50 degrees Celsius, will also undermine the viability of subsistence food gardens and cash crops, placing poorest families in precarious positions and contributing to a migration flow to the townships of major cities (Cape Town and Johannesburg, primarily) for work. As another example, Cape Town, Durban, Gqeberha and East London are all projected to be affected by sea rise in the foreseeable future, impacting especially on residents in environmentally risky areas such as the Cape Flats, where housing is already below sea level. Low income and limits to mobility determine where people live, and lack of risk-reducing measures determine the extent to which these areas will become inhabitable with sea rise.(17) Even without regular flooding, the rising water table and increased salinity of soil will have wide impacts on everyday life in such areas.
Changes in water levels and water temperatures will also change marine ecology, impacting seafood stock and the livelihoods of fisherfolk. Food supply could become precarious with climate change, as the latter may directly impact the stability of primary production for local, national and export purposes. Increased extreme weather events will also affect fuel prices and market systems. Poor households are especially vulnerable to changes in food supply and price fluctuations and lack the capacity to purchase and store food in quantity.
The greater frequency and severity of heat waves will especially affect poor populations. Urban air temperatures in Johannesburg are expected to increase as a result of the urban heat island effect due to heavy population density, limited vegetation and heat generated from vehicles and running of industrial equipment. These high temperatures will impact all but especially those living in substandard dwellings.(4,5) Those living in makeshift housing, with poor quality of materials, without ventilation, and crowded, are especially vulnerable to heat stress, heat stroke and dehydration. Inner city apartments are often derelict and at times abandoned, without functioning water and electricity, and grossly overcrowded. Residents are highly vulnerable to heat stress and dehydration. Elderly people, people with existing chronic illnesses, and people with limited mobility, are especially vulnerable to heat-related conditions and this will lead to spikes in mortality.
Global warming, environmental disasters and permanent changes to the physical environment have and will precipitate conflict, emergency, and seasonal and permanent population movement, in search of employment and survival.(18–20) Migration brings a greater risk of introducing new infections to naive populations, and increases demands for medical care and other services. At the same time, within South Africa government regulations limit the access of migrants to grants, education, housing, health and other services, amplifying the vulnerability of those who have crossed national borders in search of safer, more secure lives.
Race and gender both compound vulnerability to climate change, in relation to access to water, shelter, food and energy. These distinctions interact to produce inequalities in the effects of climate change and shape capacity to adapt to different circumstances.(21) In her review, Rebecca Pearse (22) demonstrates how existing gender inequalities and unequal power relations determine climate impacts, because of women's normative role in fetching water and fuel and producing food. At the same time, women are less likely to participate in climate governance, shape or influence policies to reduce greenhouse gases and are less likely to have the knowledge to act on climate change. Likewise, the fault-lines of South African society are racialised. Unemployment, irregular and, intermittent work, and unskilled labour, expose black South Africans to climate extremes and undermine their resilience.
Conclusion
Planetary health is also tied to rising temperatures, drought, water security, and food supply. Extreme temperatures, heat distress and heat stroke, low rainfall, heavyprecipitation and floods, affect not only humans but all life forms, including livestock and vegetation directly linked to human livelihoods. Without attention to the pervasive effects of changes in weather systems, then resilience by humans is highly problematic.(23)
The Covid-19 pandemic most recently demonstrated the challenges to developing programs and structural support to mitigate disaster. In theory, a policy of pandemic preparedness should have been in place, given the work a decade earlier following the H1N1 pandemic.(24,25) The lack of preparedness to respond to a pandemic as evident globally in 2020 highlights the challenges in ensuring the capacity by governments and populations to be able to respond to health and weather-related changes, and to be ‘resilient’, while more systemic measures are taken to respond to climate change.
Even with the capacity to respond promptly to climate, environment or health crises, resilience as a return to ‘normal’ does not address the economic and political factors that produced inequality within and between communities at national and global levels; and not everyone sees a return to (pre-pandemic) normal as desirable. Certain communities are disproportionately exposed to and affected by climate change, as Thomas and colleagues have argued: ‘Some social groups experience greater loss of resources and greater impacts to livelihoods and cultural identity than others. This differential vulnerability to comparable levels of physical change is primarily a function of social rather than physical factors’.(26)
Supporting transformational change requires that we address the social structural factors that make adaptation and mitigation easier. The social dimensions of how communities experience and adapt to economic, social and environmental change are complex and interconnected. Social matrices of vulnerability — race, class, gender, ethnicity, and the poverty and powerlessness that these produce — are compounded by environmental factors of vulnerability as a result of climate change, exacerbating such inequality in a continuing downward spiral. This has led to calls for climate justice, as a way of addressing growing social and environmental inequalities amplified by climate change.(27) Realizing this, and introducing strategies of mitigation and adaptation, requires attending to underlying and longstanding social inequalities.