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Health Inequity as a Driving Force for Climate Change Action

Prepared by Farah Abdou

22 April 2024

As the repercussions of climate change intensify, so do the disparities in health outcomes. The intersection between the climate crisis and health inequity is often overlooked in climate and health policies and initiatives. However, as climate change magnifies natural disasters and resource insecurity, risks to healthcare systems also arise. Climate variability can thus be identified as a key perpetuating factor for health inequality in Malaysia.

When formulating initiatives and climate adaptation plans, addressing health inequality should be a priority. The ongoing development of Malaysia’s National Adaptation Plan (NAP) can emphasize building of healthcare facilities and initiatives that are resilient in the face of the climate crisis.

Inequity in Healthcare 

Health inequalities are systematic differences in access to healthcare and overall health status of individuals, based on a multitude of factors. These inequalities do not just arise from unequal access to healthcare facilities, and physicians but are also affected by their income level, education, gender, age and access to other resources such as clean food and water[1], similar to measures of multidimensional poverty, which account for aspects that perpetuate and are intensified by poverty. Poor health is one of these main factors, as it is found to highly correlate with lower income. For instance, the WHO finds that children from the poorest 20% of households are nearly twice as likely to die before their 5th birthday, while close to 1 billion people globally live in slum conditions, making it difficult to access quality healthcare, and avoid the spread of communicable diseases[2].

Inequity in healthcare is similarly prevalent in Malaysia, with universal health coverage being an issue the country has grappled with over the years. In the 1980s, Malaysia introduced universal health coverage (UHC) following high rates of infant and maternal mortality, as well as low access to rural healthcare facilities[3]. The country has since established tax funded health coverage including prevention, treatment, rehabilitation and all medical services[4]. Achievement of UHC however did not eradicate all health concerns in Malaysia, as the country faces issues with an aging population, lack of equitable systems, and high burden of communicable and non-communicable diseases. For example, it was noted that 70% of all deaths of the younger economically productive population are caused by non-communicable diseases[5].

External Challenges to healthcare equity

While the healthcare system faces challenges due to disease spread and demographic changes, external factors often emerge as primary stressor for the sector’s operations. Drawing upon past experiences with the Covid-19 pandemic for example, Malaysia suffered RM 2.4 billion a day during lockdown and severely overloaded hospitals and clinics[6]. The pandemic not only impacted operations, but also increased hospital-related infections and intensified the spread of diseases across the the country[7]. Findings from a 2023 study show that there was an increase in hospital-acquired pneumonia, blood infection and ventilator-related pneumonia during the pandemic[8].

One current looming external factor on the healthcare system and health equity is climate change. As weather variabilities increase and their effects reach record highs, climate change is expected to be the main pressure factor on health inequality. Malaysia has faced 51 extreme natural disasters in the past 2 decades alone[9]. The period of 2019/2020 also saw over RM8.6 million in losses and 55,187 people evacuated from their homes solely due to floods[10].

The impact of climate change on health

Climate Change and Physical Health

Intense natural disasters and climate variabilities further perpetuate health inequality, exerting negative effects on populations’ physical and mental health, as well as access to healthcare, existing treatments and medications. Climate change has profoundly impacted health systems and individuals globally. Increasing temperatures have been identified as a key factor in the proliferation of transmittable diseases and reduced immunity among populations. Extreme weather conditions, coupled with scarce natural resources, and loss of biodiversity, have hyperstimulated the human immune system, and affected adaptive immunity; shown in increased numbers of novel bacteria and pathogens[11].

A recent study found that more than 58% of all diseases have gotten worse as a result of climate variability[12]. In Malaysia, there was a 78.6% increase in dengue fever related deaths from 2022 to 2023, attributed to water contamination caused by changing rainfall cycles[13]. Additionally, weather variabilities, fossil fuel usage, and natural disasters have also perpetuated existing health conditions. The increase in air pollution and pathogens has directly contributed to fatalities in patients with heart diseases, strokes, obstructive pulmonary diseases, hypertension and even neurodegenerative diseases[14].

Climate Change and Mental Health

Mental health is significantly affected by the consequences of climate change, as an increase in disasters and climate variability deteriorates mental well-being. Climate disasters such as flooding, droughts, and famine, result in migration from homes and native areas, severely impact individuals with anxiety disorders.  Surviving climate change disasters may also result in Post Traumatic Stress Disorders (PTSD) as well as increased feelings of hopelessness; amplifying depression symptoms.

Moreover, unpredictable weather conditions such as heatwaves have been directly linked to increased aggression and suicide rates, especially among patients with severe existing conditions. For example, patients diagnosed with schizophrenia are among the main groups impacted by heatwaves which worsen their symptoms including psychosis and hallucinations. The British Columbia Centre for Disease Control found that higher temperatures triple the risk of death in schizophrenic patients.[15]. These effects are similarly observed in other mental disorders, as irregular weather patterns affect the nature of medications and their effectiveness. Lithium, commonly prescribed for patients with bipolar disorder, becomes toxic with dehydration, underscoring the amplified impact of climate change on individuals with mental disorders[16].

Climate disaster’s impact on low income individuals 

This magnified effect is a characteristic of climate change consequences, as disasters and weather changes disproportionately affect society's most marginalized groups. In Malaysia, areas most affected by natural disasters are often populated by lower-income individuals who reside in vulnerable areas such as floodplains, exposing them to the highest risks[17]. In addition to exposure to natural disasters, individuals in poverty also face challenges in seeking emergency care due to social and economic factors such as lack of education, limited infrastructure including roads and public transportation connecting them to healthcare facilities, and insufficient disposable income to afford such care. Income inequalities impacting access to healthcare are further exacerbated by climate change disasters, particularly through the urban-rural divide. In times of crisis, rural housing and infrastructure are less likely to be resilient, exposing these populations to severe injuries from building collapse and poor infrastructure.

Elderly populations, women and children suffer more intense climate change effects

Apart from having limited access to healthcare facilities and being more susceptible to the effects of climate change, vulnerable populations such as the elderly, women, and children are also increasingly affected by the spread of diseases and migration due to disasters. For example, the elderly and children are particularly vulnerable to the spread of water and food-borne diseases and negative impacts on immunity, as they often have compromised immune systems or existing health issues. As of 2019, 3-in-10 elderly Malaysians were identified to have hypertension[18].  The United Nations also found that global warming has led to decreased sexual and reproductive health rights for women in Sarawak[19].

Climate Change severely hinders health equity for individuals with Mental and Physical Disabilities

Individuals with mental and physical disabilities are equally vulnerable to climate change threats, as they may struggle to migrate out of high-risk areas and have lower access to transportation and facilities. They are also more likely to be taking high-risk medications. These factors highlight the fatal repercussions of climate change on individuals with existing vulnerabilities, physical illnesses, and mental disabilities.

Limited Access to healthcare facilities during crises

Finally, the increasing number of climate change disasters, disease spread, and heatwaves have overloaded healthcare systems globally, leading to failures and an inability to meet demand. In such cases, marginalized populations are the first to be impacted, as they are unable to access private healthcare services due to income constraints during public healthcare overloading. They also have limited access to a small number of healthcare facilities and physicians, exacerbating their vulnerability during such crises.

Tackling healthcare inequality through climate change action 

Climate change presents a significant challenge to achieving healthcare equity in Malaysia. The ongoing formulation of Malaysia’s National Adaptation Plan (NAP) in conjunction with other federal roadmaps, provides a crucial opportunity to account for health resilience amidst plans for climate resilience. Just as the ‘Health White Paper for Malaysia[20]addressed climate change issues, documents such as the NAP and the Long-Term Low Emissions Development Strategy (LT-LEDS) must equally prioritize healthcare initiatives and infrastructure to build a resilient system.

These initiatives should include climate financing focused on healthcare infrastructure to withstand climate-related challenges. Additionally, projects to increase accessibility and education for vulnerable populations on climate change and health equity are crucial. A robust, intersectional plan inclusive of all healthcare sectors and populations is accordingly essential for tackling climate change in Malaysia; given that the climate crisis equally constitutes a health crisis.

As weather variabilities continue to impact the safety and everyday life, prioritization of health and wellbeing of communities becomes imperative. Investing in healthcare infrastructure and education, can accordingly allow for building of more resilient systems that can withstand the challenges posed by climate change.

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