Balancing Adaptation and Resilience in Response to Impact of Climate Change on Human Health

Source of Title Image – AI Generated using Gemini (by Google) with prompt “Create Image Hospital on a barren land and Red Cross and Ambulance”

Abstract:

1. One of the possible ways to response to Climate Change on Human Health could be analyzed through following two components (can also be called factors / dimensions): - 

1. Adaptation and 

2. Resilience

2. “Adaptation” is the “Process Improvement” (to change human health) and Resilience is the “Capacity Development” (to provision healthcare services) in the pursuit of minimizing adverse effects of climate change on human health.

3. Response represented by these two components can help a Policy Maker in following ways: -

1. Assessment of Effectiveness of Response to effects of Climate Change on Human Health.

2. Estimation of Budget for Response to the effects of Climate Change on Human Health under major budget heads of Adaptation and of Resilience.

4. Risks with representation of Response by the above mentioned two components include: -

1. For practical purposes Adaptation and Resilience are treated as independent variables, however, they are actually inter-dependent and therefore, this could risk accuracy of calculation of Response. 

2. It could be difficult to synchronize Adaptation and Resilience to respond to changing dynamics of Response. Impact of Resilience efforts is immediately visible and at times need urgent attention but Adaptation efforts may take long to show results and may get lesser attention.

3. There is a possibility that Response to Climate Change may not get the required socio-political thrust in present day socio-political order.

5. Technology can be an enabler in planning Response to Climate Change on Human Health. Those firms, which are in medical technology business, which have got HIMS (Hospital Information Management System) in their product portfolio and which are not trapped into red ocean may surely consider enhancements to HIMS to accommodate climate change response right at facility levels (where actual action on health service provisioning takes place). 

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Winter has just arrived and it was an early evening of a bright sunny day. I was sitting all alone on a bench at the Patna Zoo (located at Patna, Bihar in India). The warmth of golden rays of setting Sun and freshness of cool breeze in a lush green landscape made me feel closer to the Mother Nature. I could sense the difference that urbanization has made to most of the Indian cities (in terms of noise, pollution and crowd). I began to think that this model of urbanization is the consequence of the Industrial Development led growth model, roots of such type of growth can be traced to Industrial Revolution. Blindly continuing with this model of growth for long time, we have now reached a point, where we are facing harsh effects of Climate Change. Retracting to a much more sustainable model of growth appears to be a daunting task.

The world's climate always varied naturally, but climate change largely variates due to the concentration of "greenhouse gases" in the earth's atmosphere since the industrial revolution began. Now overriding this natural variability and leading to irreversible climate changes. (Wadanambi, R. T., L. S. Wandana, K. K. G. L. Chathumini, N. P. Dassanayake, D. D. P. Preethika, and U. S. Arachchige. "The effects of industrialization on climate change." J. Res. Technol. Eng 1, no. 4 (2020): 86-94.)

I started to think about the phenomenon of climate change. In the process, I began to investigate deeper into the topic in the days that followed my visit to Patna Zoo. Having recently involved with a digital transformation project in healthcare sector, soon drew my attention to the impacts of Climate Change on Human Health. Questions kept coming to my curious mind and I kept on searching answers to these questions. In this blog post, I have jotted the sequence of queries that came to my mind with summary of corresponding explorations I did (by browsing available information through the internet). This is the reason, this post is written in question and answer format. I have also attempted to develop some ideas during my investigation on the topic, which I have attempted to illustrate through this post. 

1. What is Climate Change?

Climate change refers to long-term shifts in temperatures and weather patterns. Such shifts can be natural, due to changes in the sun’s activity or large volcanic eruptions. But since the 1800s, human activities have been the main driver of climate change, primarily due to the burning of fossil fuels like coal, oil and gas.

Burning fossil fuels generates greenhouse gas emissions that act like a blanket wrapped around the Earth, trapping the sun’s heat and raising temperatures.

The main greenhouse gases that are causing climate change include carbon dioxide and methane. These come from using gasoline for driving a car or coal for heating a building, for example. Clearing land and cutting down forests can also release carbon dioxide. Agriculture, oil and gas operations are major sources of methane emissions. Energy, industry, transport, buildings, agriculture and land use are among the main sectors causing greenhouse gases. (Reference - UN)

Climate change is a long-term change in the average weather patterns that have come to define Earth’s local, regional and global climates. These changes have a broad range of observed effects that are synonymous with the term. (Reference - NASA)

2. What are the effects of Climate Change?

Some of the major effects of climate change as per (Reference - UN) are listed as under: -

1. Hotter temperatures

2. More severe storms

3. Increased drought

4. A warming, rising ocean

5. Loss of species

6. Not enough food

7. (More) Health risks

8. Poverty and displacement

3. What is ‘Vulnerability’ to Climate Change?

Vulnerability to climate change is defined as “the degree to which a system is susceptible to, or unable to cope with, adverse effects of climate change”. (Reference – The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment, Harvard; Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of IPCC the Intergovernmental Panel on Climate Change, Cambridge University Press)

4. How long the Climate Change will continue?

Future greenhouse gas emissions and concentrations are difficult to predict and depend on future developments such as future population growth, economic growth, energy use, uptake of renewable energy, technological change, deforestation and land use. 

The climate-modelling community has developed four Representative Concentration Pathways (RCPs). The four RCPs span a large range of future global warming scenarios. RCPs are space and time and dependent trajectories of future greenhouse gas concentrations and different pollutants caused by different human activities. RCPs quantify future greenhouse gas concentrations and the radiative forcing (additional energy taken up by the Earth system), due to increases in climate change pollution. Three different RCPs are used:

1. RCP 2.6 – Very low future emissions

2. RCP 4.5 – Low to moderate future emissions

3. RCP 8.5 – Very high future emissions

Due to the different future greenhouse gas concentrations, RCP2.6 will result in the least amount of global warming and only limited climate change. RCP 8.5 will result in more rapid warming and more climate change. (Reference – Copernicus). Analysts also takes into consideration RCP 6.0 (between RCP 4.5 and RCP 8.5) to categorize RCPs more precisely.  

Figure – 1: Global mean temperature change. averaged across all Coupled Model Inter-comparison Project Phase 5 (CMIP5) models (relative to 1986–2005) for the four Representative Concentration Pathway (RCP) scenarios: RCP2.6 (dark blue), RCP4.5 (light blue), RCP6.0 (orange) and RCP8.5 (red); 32, 42, 25 and 39 models were used respectively for these 4 scenarios. Likely ranges for global temperature change by the end of the 21st century are indicated by vertical bars.

The above figure taken from IPCC (Intergovernmental Panel on Climate Change) Report (Source: IPCC, 2020, FAQ 12.1, Figure 1). It shows global mean temperature change averaged across all Coupled Model Inter-comparison Project Phase 5 (CMIP5) models (relative to 1986–2005) for the four Representative Concentration Pathway (RCP) scenarios: RCP2.6 (dark blue), RCP4.5 (light blue), RCP6.0 (orange) and RCP8.5 (red); 32, 42, 25 and 39 models were used respectively for these 4 scenarios. Likely ranges for global temperature change by the end of the 21st century are indicated by vertical bars.

In general, global climate is projected to continue warming over this century and beyond. (Reference - NASA)

5. What are the effects of Climate Change on Human Health?

Climate change is directly impacting human health. In this regards, the following points be noted:

1. Climate change is directly contributing to humanitarian emergencies from heat waves, wildfires, floods, tropical storms and hurricanes and they are increasing in scale, frequency and intensity.

2. Research shows that 3.6 billion people already live in areas highly susceptible to climate change. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from under nutrition, malaria, diarrhea and heat stress alone.

3. The direct damage costs to health (excluding costs in health-determining sectors such as agriculture and water and sanitation) is estimated to be between US$ 2–4 billion per year by 2030.

4. Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond. (Reference - WHO)

Climate change affects people’s health in two main ways:

1. By changing the seriousness or frequency of health problems that people already face.

2. By creating new or unanticipated health problems in people or places where they have not been before. (Reference - EPA)

People can face multiple climate change effects at the same time, at different stages of their life, or over the course of their lifetime. A person’s vulnerability to climate change impacts depends on three key factors:

1. Exposure. People will encounter climate hazards differently. Exposure will depend on where and how long people spend time and what they do. For example, people who spend a lot of time outdoors may be more exposed to extreme heat.

2. Sensitivity. Some people are more sensitive than others to climate hazards due to factors like age and health condition. For example, children and adults with asthma are particularly sensitive to air pollutants and wildfire smoke.

3. Adaptive capacity. People can adjust to, take advantage of, or respond to climate change hazards. A person’s ability to adapt may depend upon their income, age, living situation, access to health care, and many other factors. (Reference - EPA)

6. Is it possible to suggest at least one of the possible approaches (or a way) to respond to Climate Change on Human Health?

Definitely, it is not easy to attempt a possible response at the intersection of two extremely unpredictable, dynamic and complex entities (Climate Change and Human Health). But, I will surely give it a try with limited understanding I have on the subject. And, I will leave it for experts to assess and to give opinions. All the comments, criticisms, outright rejections and all the suggestions (positive and negative) are welcome (as always).

Having gone through some of the available material on the internet, I feel that it is reasonable to maintain that the response to climate change on human health can be reasonably expressed through following factors (or dimensions or components): -

1. Adaptation:

The Fourth National Climate Assessment, also associated with the USGCRP, says that “[a]daptation refers to actions taken at the individual, local, regional, and national levels to reduce risks from even today’s changed climate conditions and to prepare for impacts from additional changes projected for the future.” (Reference - https://sgp.fas.org/crs/misc/IF11827.pdf)

2. Resilience:

The Department of Defense (DOD) uses a general definition of resilience when addressing climate change adaptation: the “ability to anticipate, prepare for, and adapt to changing conditions and withstand, respond to, and recover rapidly from disruptions” (Reference - https://sgp.fas.org/crs/misc/IF11827.pdf)

‘Adaptation’ and ‘resilience’ are often used interchangeably in policy and academic discourse, and while they are complementary concepts, there are important differences in these terms. At its most basic, adaptation refers to a process or action that changes a living thing so that it is better able to survive in a new environment, whereas resilience describes the capacity or ability to anticipate and cope with shocks, and to recover from their impacts in a timely and efficient manner. However, in practice, the distinctions and relationships between resilience and adaptation are more complicated and less easily defined. (Reference - What is the difference between climate change adaptation and resilience?, LSE, 2022)

So, with the above clarity, we will maintain (in this article) that “Adaptation” is the “Process Improvement” (to change human health) and Resilience is the “Capacity Development” (to provision healthcare services) in the pursuit of minimizing adverse effects of climate change on human health. Understanding the ground realities of competition in the race for Adaptation and Resilience is a much more complex than it appears on paper. 

To get a grip on grasping of the subject so far, let us organize all the above discussions pictorially in one figure (refer – Figure – 2)

Figure – 2: Adaption and Resilience as Response to Climate Change on Human Health

7. Ok…. Response to Climate Change on Human Health possibly can be thought in terms of Adaptation and Resilience. But, how will you break these two factors into sub-factors so that it becomes possible to take this articulation towards actionable components, which may eventually become basis for designing an Executable Response Plan (to Climate Change on Human Health)?

The two factors could be considered to have following sub-factors for planning and execution of Response (Illustrative): -

1. Adaptability (Adaptability Efforts through Planning and Execution)

1. Financing

2. Redesigning Ecosystem (broadly impacting Adaptation)

1. Urban Infrastructure Design for Adaptation

2. Rural Infrastructure Design for Adaptation

3. Institutional Capacity Building

4. Ensuring required Biodiversity in the Environment

5. Encouraging Targeted Research (on Adaptation)

6. Encouraging Medical/Non-Medical Product Development for Adaptation

7. Regulations for Health Adaptation Supportive Work Place

8. Regulation for Power & Transportation to Support Health Adaptation

9. Upgrading Regulation on Human Displacements and Disaster Management to accommodate Adaptation Needs 

10. Initiatives targeted at Changes to Socio-Cultural Normative

• Community Engagement Health Adaptation Initiatives 

• Initiatives to Encourage Personal Health Adaptation Initiatives

2. Resilience (Resilience Efforts through Planning and Execution)

1. Financing

2. Human Resource and Infrastructure 

3. Supply Chain Upgrading

4. Community Awareness and Community Participation 

5. Governance

1. Enhancement and Excellence in Operations across entire system

2. Tune Healthcare Service Delivery Mechanism to Resilience Requirements (includes auxiliary services)

3. Upgrade Monitoring and Quality Control

4. Consistent Training and Capacity Building to face new Challenges

5. Required Redistribution of Resources for Optimal Utilization

6. Robust Information Management and Knowledge Management

7. Tracking Research and New Products

• Pharmacy

• Technology (MedTech)

• Pathogen Behavior

8. Preparedness (to handle)

• Human Displacement

• Clinical Response to Evolving Pathogen and drug resistance  

8. But, all the above contents are available at a mouse-click to anyone having access to internet. Anyways, considering that the suggested assumption (Adaptation and Resilience as a two-dimensional efforts to respond to impact of Climate Change on Human Health) is considered OK to go ahead, what help any Public Policy Officer or a Healthcare Strategist may get from this way of articulation of the response? How will measuring and monitoring of Response at Facility Level be conceived?

Using the mentioned factors of Response to the effects of Climate Resilience on Human Health, the following analysis could be helpful for policy professionals to organize thoughts and to think with clarity.

1. Assessment of Effectiveness of Response to Climate Change Effects on Health

The following entities (stored as information in data-sets) for a given geography may be captured to do an assessment (through a methodology discussed later in this section after points – A, B and C illustrate on entities): -

1. Measure of Changing Climate (be called ‘Climate Change’)

This may be measured by a selected Climate Change Indicators at the given geography like (Reference – WMO): -

1. Greenhouse gas concentrations

2. The global annual mean temperature

3. Ocean heat

4. Ocean acidification

5. Global mean sea level

6. Cryosphere

7. Exceptional heatwaves

8. Flooding

9. Drought

10. Hurricane

11. Food security

12. Displacement

13. Ecosystems

What weighted combination of above parameters will accurately represent change of climate for a given geography through a formula is a subject to be decided by experts. For now, we will assume that it is possible to come up with a acceptable value represented through a unit for Climate Change with the help of experts (specifically tuned to the local needs of observing impact on Human health). 

In this regards, it is mention worthy that there are some standard ways to calculate Climate Change for mitigation and other purposes examples are briefed as under (Reference – CCPI.org): -

1. The Environmental Performance Index (EPI) includes, apart from climate change mitigation, indicators on environmental health and ecosystem vitality. A total of 40 indicators in the EPI overview the state of sustainability in 180 countries.

2. Since 2005, the CCPI has provided an annual ranking of countries that are collectively responsible for 90%+ of all global greenhouse gas emissions. In CCPI 2023, we looked at the climate mitigation efforts of 59 countries and the EU.

3. Indexes such as the CCPI can help in the following, and more, ways:

1. Increase political pressure

2. Improve climate information outreach to citizens

3. Inform the financial market about the leaders and laggards for sovereign debt analysis

4. Advance international climate policy research

5. Provide civil society groups and lawmakers with sound arguments for more climate protection

2. Estimated Impact of Climate Change on Human Health (be called ‘Estimated Impact’) 

There is a link between Climate Change (as suggested in point A above) and its impact estimation on Human Health (as being discussed in this point B). In some way (say by suitably weighted parameters in a formula), Impact of Climate Change on Human Health could be estimated once Climate Change is calculated. This impact estimate may have qualitative and quantitative aspects. And, after the impact estimate is generated (calculated), the effect of this impact (of climate change) as manifested on human health in terms of health deterioration be linked to estimated impact calculated value(s) following some standards. This will enable Estimated Impact of Climate Change on Human Health to get expressed in terms of associated medical conditions amongst population. This will enable health service providers to estimate burden of cases of climate change generated health conditions. And also, to segregate and record actual cases of climate change generated health conditions visiting at health facilities. In this way, the Estimated Impact value(s) will lead to calculation of Estimated Impact and Actual Impact cases at facility level. Projecting Estimated impact in terms of burden for future time-frame may help in timely preparing health service delivery capacity.

It may be noted that for the population within a geography, the Estimated Impact may slightly differ based on ethnicity, nature of employment, locality of residence or some specific medical history (say for instance population with diabetes or say those on immune-suppressants) of individuals residing within the geographic region.

This is getting too abstract, vague and complex. But how will the Estimated Impact be calculated from Climate Change indicator? This may need more elaboration. Can something be suggested on this for giving more clarity?

In general, the climate change affects people’s health in two main ways:

1. By changing the seriousness or frequency of health problems that people already face.

2. By creating new or unanticipated health problems in people or places where they have not been before.

The health effects of climate change include respiratory and heart diseases, pest-related diseases like Lyme disease and West Nile Virus, water- and food-related illnesses, and injuries and deaths. Climate change has also been linked to increases in violent crime and overall poor mental health. (EPA)

However, there are methods to reach to a set of more specific indicators to estimate impact of climate change on human health. Following paragraphs illustrate on this aspect.

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. (Reference - Di Napoli C, McGushin A, Romanello M, Ayeb-Karlsson S, Cai W, Chambers J, Dasgupta S, Escobar LE, Kelman I, Kjellstrom T, Kniveton D, Liu Y, Liu Z, Lowe R, Martinez-Urtaza J, McMichael C, Moradi-Lakeh M, Murray KA, Rabbaniha M, Semenza JC, Shi L, Tabatabaei M, Trinanes JA, Vu BN, Brimicombe C, Robinson EJ. Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown. BMC Public Health. 2022 Apr 6;22(1):663. doi: 10.1186/s12889-022-13055-6. PMID: 35387618; PMCID: PMC8985369. )

An Approach to Developing Local Climate Change Environmental Public Health Indicators, Vulnerability Assessments, and Projections of Future Impacts has been suggested by researchers Adele Houghton and Paul English accessible at following link: -

Developing Local Climate Change Environmental Public Health Indicators

On case to case basis, the localized indicators may need to be framed with due consideration to standards like CCIEVIs by Trained Health Experts. These experts may also be given responsibilities to calculate estimated burden and to assess occurrences of real cases on ground.

3. Response to Climate Change on Human Health (be called ‘Response’)

Calculating ‘Response’ may need capturing of Actual Impact and Actual Coverage Given to Impacted population. For actual impact calculation the number of cases (or some other quantum) of impact of Climate Change on Human Health in the given population could be considered. Thus, Response could be measured on following two aspects: - 

1. Adaptation Component (Adaptation) – Difference between Estimated Impact and Actual Impact (on a given population at a given geography)

2. Resilience Component (Resilience) – Difference between Actual Health Coverage Required (for impacted population at a given geography) and Actual Coverage Given (to impacted population at a given geography)

With the above discussions a possible model to monitor impact of climate change on human health has been suggested with the help of the following diagram. In addition to the above parameters, a Central Monitoring Unit for monitoring Climate Change for Human Health is assumed to be in place for improved administration of Climate Change (for the given geography) and is shown as ‘Monitoring Unit’.

Figure – 3: Monitoring of Response to Climate Change on Human Health (Source – Author)

As shown in the above figure, the Monitoring Unit receives inputs in the form of Estimated Impact (which is effect of on-going Climate Changes). It is assumed that Climate Change and Estimated Impact may have similar dynamics even though with some reasonable time lag (Climate Change will lead Estimated Impact and broadly they could be considered to be cause and effect relationship). Response is shown to have the above mentioned components of ‘Adaptation’ and ‘Resilience’.

Officers responsible for monitoring of health in a geography will take cognizance of following points (in reference to above discussions and above diagram): -

1. Climate Change Block - Climate change is being tracked at localized way. Tracking is done with workable precision and with acceptable representation of on-going climate changes.

2. Estimated Impact Block – Based on inputs from Climate Change Block, Estimation of Impact of Climate Change on Human Health is calculated. This Estimated Impact is converted in the form of estimation of burden of incidence at facility level (for facilities within the geography). This estimation of burden is comprehensive and gives indication about recognition of impact of climate change on health, intensity of problems faced by patients as a consequence of impact of climatic change on health and volume of cases of impact of climate change on health. In this block requirements at facilities to meet the service requirements of estimated burden is also calculated (Required Resilience).

3. Response Block – Response Block measures actual burden recorded at facilities and calculate following: -

1. Adaptation: Estimated Burden – Actual Burden (it is assumed that +ve value will mean impact of adaptation measures are yielding better results and a –ve value will mean that adaptation measures are yielding poorer results)

2. Resilience: Required Resilience – Actual Resilience (it is assumed that a +ve value will mean under preparation and –ve value will mean over preparation)

3. Based on calculation of Adaptation and Resilience (as above in points 1 and 2), suitable changes to Adaptation Plan and Resilience Plan will be made so that on execution of these plans, the respective efforts (Adaptation Effort and Resilience Effort) will be tuned. 

4. Monitoring Unit: Monitoring Unit will be an observatory with monitoring and control power to administer impact of climate change on the population within the territory under the jurisdiction of Monitoring Unit. All the above points (A, B and C) will be administered with a cross-functional experts from Monitoring Unit. Central Data Processing Unit with capabilities to capture and analyze big data will be part of Monitoring Unit. 

2. Budgeting for Response to Climate Change Effects on Health under major heads of Adaptation and of Resilience by Public Health Officer

Budget allocation for Response could be based on Adaptation Budget and Resilience Budget. In order to optimize the budget for best possible response, the following distribution could be considered.

Going back to Figure – 1 above, it is obvious that Response Budget will be more for Climate Change taking place by following RCP 8.5 curve in comparison to RCP 2.6 curve. It will also be reasonable to assume that impact of Climate Change on Human Health will also broadly follow the dynamics of Climate Change. 

Mostly, politics is driven by short-termism. Therefore, policy makers allocate much more budget to those efforts, which show results in short term (even if it means making compromise with the efforts having long term prospects). In this case also, the policy makers, finance experts and administrators (in general) may tempt to allocate much more funds to Resilience Efforts than to Adaptation Efforts.

It is noteworthy that population, geography, means of livelihood, level of urbanization and lifestyle influence impact of climate change. Therefore, localized data capture and decentralized financial power may be helpful for effective utilization of funds.

With these discussions, let us observe the following diagrams, the first diagram deals with amount of budget for Response (figure - 4) and the second diagram deals with distribution of funds obtained for Response (figure - 5). These are the figures drawn by the author. 

Figure – 4: Estimation of Impact of Climate Change on Human Health for a Geography (Illustrative Diagram only)

Figure – 5: Adaptation Efforts and Resilience Efforts (Illustrative Diagram only)

Based on the above figures, following observations could be made: -

1. In figure – 4, X – Axis is ‘Time in Years’ and Y – Axis is a measure of ‘Estimated Impact of Climate Change on Human Health’.

2. The figure – 4 shows a general illustration for possible projections of climate change impact of human health for a given geography. This takes an analogy from figure – 1 (above). The red projection (high) could be thought of as corresponding to RCP 8.5, the yellow projection (moderate) could be thought of as corresponding to RCP 4.5 and the green projection (low) could be considered to be corresponding to RCP 2.6. The graph is not a static graph and the projections shown may be consistently monitored with respect to real data as time progresses.

3. In reference to figure – 4, policy makers should ideally prepare Resilience for red projection (high) and prepare Adaptation for green projection (low). Probably, this will be the best possible attempt with whatever is the available fund for Response.

4. Thus, figure – 4-like-analysis for different geographies will be helpful in estimation of quantum of funds to be allocated to different geographical locations (ideally municipality or block level administrative boundaries) relative to their respective performance in previous financial terms and also relative to mutual requirements amongst all the geographies under consideration.

5. In figure – 5, X – Axis is a measure of ‘Adaptation Efforts’ and Y – Axis is a measure of ‘Resilience Efforts’.

6. In figure – 5, assuming that point ‘c’ bisects line ‘de’, assuming that ‘ac’ = ‘bc’ and assuming angle ‘dac’ and angle ‘cbe’ are right angles, the right angle triangles adc and bce are congruent (Hypotenuse Leg Theorem of Triangle Congruence). Assuming angles ‘adc’ and ‘bec’ are each 45 degrees, it can be considered that at ‘c’ value of a and value of b will be equal (a=b) that means resilience and adaptation efforts will be equal.

7. In reference to the point – F above, equal distribution of Response fund under Adaptation Head and Resilience Head sounds reasonable. But may not be the best distribution always.

8. From figure – 5 and point G above, considerations a public  policy maker may like to have are as under: -

1. Requirement for resilient effort will be less if paying capacity of population is good enough to bear the burden of OOPE (Out of Pocket Expense) and if the adequate and reliable private healthcare system is running in parallel to public healthcare system. Accordingly, for such a situation point ‘c’ in the figure should move towards point ‘e’ and reach ‘c1’. Thus, the demand for budget for Resilience will be less in comparison to long term public good generations through higher adaptation budget. Adaptation is a cross-sectorial effort and has capacity to aggregate to national aspirations for sustainable goals (like say SDG). In long run consistent efforts on adaptation may also reduce requirements for resilience efforts.

2. Similarly vice-e-versa will also hold true if paying capacity of the population is not so good to bear the burden of OOPE. In this case, point ‘c’ will move to point ‘c2’ to accommodate greater efforts on resilience with the available budget. Mostly, the priority of giving coverage to population at present will dominate over the future prospects of preparing the population to a better health.

9. Will it be as simple to respond to impact of Climate Change (on Human Health) as suggested above through two dimensional efforts (Adaptation and Resilience)? Is this not an oversimplification to look at an extremely complex and (arguably) the most important challenge health sector is facing in present times?

Agreed…. This is not just a simplification but also makes many questionable assumptions, which could seriously put questions on scientific validity of two dimensional efforts as response to climate-change effects on human health. Execution of initiatives aligned to these two factors may also be challenging. Some of these assumptions and some challenges are listed as under: -

1. Adaptation and Resilience are considered as independent variables and represented on separate axis of Cartesian – In fact, these two dimensions (variables) are inter-dependent variables. Many aspects of health and healthcare impact both adaptation and resilience (with varying intensity). An example could be - constituting advisory cells to educate patients on adaptation (adaptation to climate change based on medical records) within hospital premises could be considered as a resilience exercise with a profound long impact on adaptation. Similarly, improved outcomes due to adaptation efforts may surely reduce burden on resilience to some extent.

2. Difficulty of synchronizing Adaptation and Resilience to respond to changing dynamics of Response - Effectively preparing for and responding to current and projected climate change requires ongoing assessment and action, not a one-time assessment of risks and interventions (Reference - Kristie L. Ebi, Jan C. Semenza, Community-Based Adaptation to the Health Impacts of Climate Change, American Journal of Preventive Medicine, 2008). In this regards, the following point may be mention worthy that: -

1. Synchronizing short-termism (quick administrative response with changing burden) of Resilience with the long gestation (for outcome) of Adaptation efforts will be extremely difficult.

3. Responding to effects due to Climate Changes may not get the required socio-political thrust - An effective response to Climate Change is only possible when Social Consensus and Political Will simultaneously promote an ideological narrative confirming to the core value of supremacy of human health over all other aspects of social life (that is to say - ‘No Development will be permitted at the cost of Human Health’). Riding on such an ideological base, response to climate change on human health can get required centrality in political spectrum to push any government to adopt a development model which does justice to Health and to Climate Change challenges. However, situation does not look conducive to maneuver such a socio-political move considering the following points: -

1. Irrespective of local economic conditions and irrespective of the variant of development model adapted, all the major countries across the globe have gone for economic expansion with no change in inequality levels in societies over recent decades (reference – APPENDIX – 1). This means distribution of benefits of economic growth within countries is taking place in such a way that general comparative equality in society is not improving. And, this is happening despite welfare governments continue to put efforts to judiciously distribute resources within territories to reduce inequality.  

2. Most probably, this means socio-political forces working in favor of keeping distribution of income and wealth unequal are able to exploit the development model in their favor in a much better way than the governing bodies applying force to reduce inequality in society. And most probably, the temptation to keep the wealth accumulated in certain pockets is the power that wealth brings, through which it becomes possible to control scarce resources and also it becomes possible to enjoy relatively greater freedom in the society. However, in this sense (in terms of associated power) health is not wealth and power of health does not win the privileges as that of wealth in the present day social order. Therefore, a development model purely centered around health may be difficult to get wider acceptance.

4. Coordinated efforts operating both ways Bottom-Up and Top-Bottom may be required for success of Response - In addition to grassroots actions undertaken at the community level, reducing vulnerability to current and projected climate change will require top-down interventions implemented by public health organizations and agencies (Reference - Kristie L. Ebi, Jan C. Semenza, Community-Based Adaptation to the Health Impacts of Climate Change, American Journal of Preventive Medicine, 2008). Convergence of centralized governing agencies and decentralized governing agencies on an issue of health, which can have varying political significance may be difficult to achieve.

5. Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations. (Reference - Ansah, E.W., Amoadu, M., Obeng, P. et al. Health systems response to climate change adaptation: a scoping review of global evidence. BMC Public Health 24, 2015 (2024). https://doi.org/10.1186/s12889-024-19459-w)

6. Robust backbone information system will be required to record EHR (Electronic Health Record) of the entire population. The challenge will be to collate voluminous data available from private healthcare services providers and public healthcare service providers. A central data processing unit may be needed to be established with data analysis capability on big-data for health sector. Going ahead sensor based IoT (Internet of Things) devices are expected to revolutionize healthcare sector. This will mean minute to minute generated data for every individual, while using IoT enabled devices. Sequencing of genes of every individual may get cheaply available for the benefit of a large population. Correlation of health conditions of individuals with respective gene-sequence for meaningful contribution to health treatment may not be far. Such facilities will generate and consume huge amounts of data for every individual. Need for AI enabled sophisticated data analysis expertise on big data is only going increase in time to come.  

Even with some of the big challenges listed as above, I believe that the attempted approach to resolve Response into Adaptation and Resilience could be at least considered as an idea, which may help in organizing thoughts and in improving clarity about dealing with a complex issue of impact of Climate Change on Human Health. 

10. Ok, How could Technology Interventions help the ideas expressed so far?

Technology will be an enabler in assessing, refining and maturing the ideas expressed so far to an implementable solution. Those firms, which have got HIMS (Hospital Information Management System) products and which are not trapped into red ocean may surely consider enhancements to HIMS to accommodate climate change response to human health right at facility levels. AI enablement of HIMS product may bring ability to localize climate change, its estimated impact on human health, required capacity for resilience, projections on how and when adaptation may start to influence resilience requirements and many other related aspects.

Introduction of IoT devices to existing information technology systems (HIMS) with built-in AI (Artificial Intelligence) enabled big data analytics capabilities may soon start to collect and collate huge personal health data of population paving ways for personalized healthcare recommendation system including recommendations on impact of climate change to individuals.

APPENDIX – 1: GDP (GROSS DOMESTIC PRODUCT), GDP PER CAPITA and INEQUALITY INDEX (GINI COEFFICIENT) FOR SELECTED LARGE ECONOMIES OF WORLD

1. GDP

2. GDP per Capita

3. GINI Coefficient

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