Advertisement
  • Loading metrics

Climate change and women's health: Impacts and policy directions

Climate change and women's health: Impacts and policy directions

  • Cecilia Sorensen, 
  • Virginia Murray, 
  • Jay Lemery, 
  • John Balbus
PLOS
x

Summary points

  • Climate change impacts on health—including increased exposures to heat, poor air quality, extreme weather events, altered vector-borne disease transmission, reduced water quality, and decreased food security—affect men and women differently, depending on local geographic and socioeconomic factors.
  • Climate change threatens to widen existing gender-based health disparities, especially in low- and middle-income countries.
  • Health impacts, and gender differences in those impacts, are mediated through socioeconomic, cultural, and physiologic factors. Policy action targeted towards these factors, which are often modifiable, can decrease negative health outcomes.
  • Integration of a gendered perspective into existing climate, development, and disaster-risk reduction policy frameworks requires improvement in data acquisition, monitoring of gender-specific targets, coordination between sectors, and equitable stakeholder engagement.
  • Empowering women as educators, caregivers, holders of knowledge, and agents of social change can improve mitigation and adaptation policy interventions.

Introduction

As noted by the United Nations Framework Convention on Climate Change (UNFCCC) [1], women, especially those in poverty, face higher risks and experience a greater burden of climate change impacts. This is notably true for health impacts, making climate change a risk multiplier for gender-based health disparities. Both men and women are at risk for amplified health impacts. Women have distinct health needs, such as nutritional demands during pregnancy, which places them at risk of suffering from climate-sensitive diseases. Men experience other risks, such as suicide and severe depression in the face of drought [2] and resulting agricultural losses, and may be at higher risk of drowning during severe weather [3]. Compounding women’s health vulnerabilities are cultural constructs, which amplify risk on a regional scale. Globally, a total of 1.3 billion people in low- and middle-income countries live below the poverty line, and 70% are female [4]. Yet while the interactions between poverty, gender-based social discrimination, and climate change threaten to amplify gender-based health disparities, women’s social roles and potential for agency afford opportunities for promoting solutions to sustainability, disaster risk reduction, and solutions to health threats. Ensuring that policies move beyond traditional separations of health, gender, and environment and embrace proactive and gender-based solutions is paramount to protecting women’s health and mobilizing their vast social potential to mitigate, adapt to, and respond to climate threats.

Health impacts

Climate change affects health through a multitude of mechanisms, including heat, poor air quality, and extreme weather events, as well as through meteorological changes that alter vector-borne disease, reduce water quality, and decrease food security [5]. The health risks associated with these exposure pathways are mediated through physiologic, cultural, and socioeconomic vulnerabilities, which differ substantially between men and women (Table 1). The lack of gender-disaggregated health data restricts conclusive understanding of thresholds of exposure for harm and may result in a lack of awareness by local, national, and even global decision makers and healthcare personnel. Many examples exist, including the following:

  • Globally, women suffer from higher rates of anemia and malnutrition and are sensitive to climate-driven food insecurity due to increased nutritional needs during menstruation and childbirth. Anemia is associated with cognitive impairments including poor attention span, diminished working memory, and poor educational outcomes [6]. Additionally, a majority of the world’s smallholder farmers are women, and therefore women’s livelihoods are at risk from climate-related crop failure, which threatens to increase poverty as well as poor health outcomes.
  • Respiratory and cardiovascular disease secondary to exposure to poor air quality preferentially impacts women due to a greater proclivity for higher deposition of particulate matter in lung tissue and higher rates of anemia [7]. Poor air quality is also associated with negative birth outcomes [8] and affects maternal/child health in that it is associated with stillbirth, intrauterine growth restriction, and congenital defects [9]. Women spend greater amounts of time in the home and thus are disproportionately exposed to particulate matter from the use of traditional indoor stoves for cooking and heating [10].
  • During climate-related disasters, women suffer disproportionate mortality [10], and survivors experience decreased life expectancy [11].
  • Women and girls are at a higher risk of physical, sexual, and domestic violence in the aftermath of disasters [12] and are at a higher risk for mood disorders and poor economic recovery [13]. These impacts are amplified when women have a lower socioeconomic status [4].
  • Forced migration and repeated short-distance moves are especially significant for poorer people, as well as for groups such as women, who are often excluded from migration analysis [13].
thumbnail
Table 1. Examples of disparate climate-related health impacts on women and relevant physiologic, cultural, and socioeconomic risk factors.

https://doi.org/10.1371/journal.pmed.1002603.t001

Policy frameworks

Climate change, poverty, and gender inequality are increasingly recognized as global problems; however, achieving the integration of policies, surveillance, and program creation and implementation necessary to make progress in solving these interrelated issues has proven challenging. For example, the Sustainable Development Goals (SDGs) contain separate targets for poverty (SDG 1), gender equality (SDG 5), sustainability (SDG 11), and climate action (SDG 13). Opportunities to interconnect these separate targets through subtargets and indicators that bridge sectors were largely lost during the development of the SDGs. Thus, while there are energy-related indicators in the health goal (related to household use of biomass fuels), there are no health-related indicators in the energy or climate goals. Disaggregation and failure to explicitly link health with these other goal areas leads to discordant efforts, inefficiencies, and communication barriers between involved agencies tasked with solving these multisectoral problems.

Similarly, some advances have been made within the UNFCCC and the United Nations International Strategy for Disaster Reduction (UNISDR). UNFCCC decision 21/CP.22 (2017) calls for a “gender action plan” to incorporate a gendered perspective in all elements of mitigation, adaptation, capacity, technology, and finance. Although this framework sets the stage for action, systematic integrative procedures are lacking, as are indicators to monitor progress. The Sendai Framework—an international covenant adopted in 2015 to establish common goals and standards for disaster risk reduction—formalizes climate change as a disaster-risk multiplier to women and recognizes women as important stakeholders in risk reduction [43]. Furthermore, it calls on adopters to “prepare, review and periodically update preparedness policies, plans and programmes with the involvement of all relevant institutions, considering climate change scenarios and their impact, and to facilitate the participation of all sectors and stakeholders” [43]. Strong accountability is fundamental to the framework, which contains 38 indicators to track progress in implementing the 7 targets, which aim to reduce disaster mortality and damage to critical infrastructure and economies through increased multihazard early-warning systems, improved national and local mitigation strategies, and enhanced international cooperation. The framework also incorporates the related dimensions of SDGs related to poverty, sustainability, and climate action. The Sendai Framework Monitor will also function as a management tool to help countries develop disaster risk reduction strategies, make risk-informed policy decisions, and allocate resources to prevent new disaster risks. It will also target disaggregated data collection with formal biannual reporting via the Sendai Framework Monitoring Process.

Towards integration

Gender mainstreaming throughout all climate targets has been recognized by the UNFCCC as critical to increasing effectiveness. Women play a vital role in the societal response to climate change; their participation at all levels has been shown to result in greater responsiveness to citizens’ needs and often increases in cooperation across party and ethnic lines, generally resulting in sustainable outcomes [23,44]. In order to support this action, we propose that effective engagement and communication with women and girls throughout society must be included at all levels and within the following practices to support an integrative policy approach (Table 2).

thumbnail
Table 2. Examples of multisectoral solutions to climate change impacts on women’s health.

https://doi.org/10.1371/journal.pmed.1002603.t002

Ensure participation

Recognizing women’s roles as educators, caregivers, holders of knowledge, and powerful agents of social change positions women to effectively design and implement culturally acceptable interventions where they are needed most. Women should be empowered as key stakeholders at the outset of any project with the understanding that combining scientific data and community knowledge will yield better results.

Prioritize education

Education regarding the gender-specific health threats of climate change is needed within public health, policy, medicine, and general education. Additionally, investment in skills and capacity building among women will foster leadership and strengthen resilience.

Improve data

Collecting high-quality gender-disaggregated data will enable better understanding of gender–climate–health associations and allow for predictive modeling that can inform community-based interventions and improve outcomes for both men and women.

Enhance preplanning

A comprehensive assessment of women’s and men’s assets and vulnerabilities is foundational to any adaptation or development project, including disaster risk reduction, transportation, finance, communication, water management, technology transfer, agriculture, and health. Such assessments not only provide a more in-depth understanding of the effects of climate change but also reveal the political, physical, and socioeconomic reasons why individuals suffer disproportionately. This creates a stronger opportunity for effective intervention.

Redefine success

Women’s health outcomes and economic prosperity can serve as surrogate markers for development, disaster risk reduction, and climate adaptation and should be used as indicators for project and policy success. Similarly, regions with poor health outcomes should be identified as “hot spots” for current and future vulnerability to climate change.

Improve multisector coordination

Developing mechanisms for reporting and regular analysis of gender dimensions using common indicators within all sectors will increase transparency and cooperation in achieving this cross-sectoral goal.

Conclusions

While gender has been increasingly factored into climate change projects and policy, progress has still been slow to reduce gender-based health disparities and to involve women in climate change mitigation, adaptation, and disaster risk reduction and management. The need for compliance with the monitoring processes advocated by the SDGs and the Sendai Framework are critical to address the complex interactions between poverty, gender-based social discrimination, and climate change that threaten to amplify gender-based health disparities. To support monitoring, effective mechanisms to gather and analyze data are needed. Women’s distinct social roles and potential for agency afford opportunities for promoting effective solutions to sustainability, disaster risk reduction, and solutions to health threats. High-level political engagement with the implementation of the UN landmark agreements is necessary to ensure that policies and programs move beyond traditional separations of health, gender, and environment and embrace proactive and gender-based solutions that protect women’s health.

Acknowledgments

The authors would like to thank Kevin Blanchard of Public Health England for his important contributions to this manuscript.

References

  1. 1. United Nations Framework Convention on Climate Change. Introduction to Gender and Climate Change. Available from: https://unfccc.int/topics/gender/the-big-picture/introduction-to-gender-and-climate-change. [cited 20 June 2018].
  2. 2. Kennedy J, King L. The political economy of farmers’ suicides in India: indebted cash-crop farmers with marginal landholdings explain state-level variation in suicide rates. Global Health. 2014; 10(1):16.
  3. 3. Thiery W, Gudmundsson L, Bedka K, Semazzi FH, Lhermitte S, Willems P, et al. Early warnings of hazardous thunderstorms over Lake Victoria. Environ Res Lett. 2017; 12(7):074012.
  4. 4. The World Health Report 2002: reducing risks, promoting healthy life. 2002. World Health Organization.
  5. 5. Crimmins A, Balbus J, Gamble J, Beard CB, Bell J, Dodgen D, et al. The impacts of climate change on human health in the United States: a scientific assessment. Global Change Research Program: Washington, DC, USA, 2016.
  6. 6. Jáuregui-Lobera I. Iron deficiency and cognitive functions. Neuropsychiatr Dis Treat. 2014;10:2087. pmid:25419131
  7. 7. Chen LH, Knutsen SF, Shavlik D, Beeson WL, Petersen F, Ghamsary M, et al. The association between fatal coronary heart disease and ambient particulate air pollution: are females at greater risk? Environ Health Perspect. 2005;113(12):1723. pmid:16330354
  8. 8. Šrám RJ, Binková B, Dejmek J, Bobak M. Ambient air pollution and pregnancy outcomes: a review of the literature. Environ Health Perspect. 2005;113(4):375. pmid:15811825
  9. 9. Health Effects Institute. Burden of disease attributable to major air pollution sources in India: Summary for policy makers. 2018. Available from: https://www.healtheffects.org/publication/gbd-air-pollution-india. [cited 20 June 2018].
  10. 10. World Health Organization. Gender, climate change and health. 2014. Available from: http://apps.who.int/iris/bitstream/10665/144781/1/9789241508186_eng.pdf. [cited 20 June 2018].
  11. 11. Neumayer E, Plümper T. The gendered nature of natural disasters: The impact of catastrophic events on the gender gap in life expectancy, 1981–2002. Ann Assoc Am Geogr. 2007; 97(3):551–566.
  12. 12. World Disasters Report. International Federation of the Red Cross and Red Crescent. 2007. Available from: http://www.ifrc.org/PageFiles/99876/WDR2007-English.pdf. [cited 20 June 2018].
  13. 13. Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2002;65(3):207–39. pmid:12405079
  14. 14. Duncan K. Global climate change, air pollution, and women’s health. WIT Trans Ecol Envir. 2006. 99.
  15. 15. Kuehn L, McCormick S. Heat Exposure and Maternal Health in the Face of Climate Change. Int J Environ Res Public Health. 2017;14(8):853.
  16. 16. Van Zutphen AR, Lin S, Fletcher BA, Hwang S- A. A population-based case–control study of extreme summer temperature and birth defects. Environ Health Perspect. 2012;120(10):1443. pmid:23031822
  17. 17. Ma Makhseed, Musini VM, Ahmed MA, Monem RA. Influence of seasonal variation on pregnancy‐induced hypertension and/or preeclampsia. Aust N Z J Obstet Gynaecol. 1999;39(2):196–199. pmid:10755779
  18. 18. Ha S, Liu D, Zhu Y, Kim SS, Sherman S, Grantz KL, et al. Ambient temperature and stillbirth: a multi-center retrospective cohort study. Environ Health Perspect. 2017 Jun;125(6): 067011. pmid:28650842
  19. 19. Beggs PJ, Bambrick HJ. Is the global rise of asthma an early impact of anthropogenic climate change? Cien Saude Colet. 2006;11(3):745–52.
  20. 20. Glinianaia SV, Rankin J, Bell R, Pless-Mulloli T, Howel D. Particulate air pollution and fetal health: a systematic review of the epidemiologic evidence. Epidemiology. 2004;15(1):36–45. pmid:14712145
  21. 21. Pope DP, Mishra V, Thompson L, Siddiqui AR, Rehfuess EA, Weber M, et al. Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries. Epidemiol Rev. 2010;32(1):70–81.
  22. 22. Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M, et al. Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet. 2017. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32464-9/fulltext. [cited 20 June 2018].
  23. 23. United Nations Division for the Advancement of Women. Environmental Management and the Mitigation of Natural Disasters: A Gender Perspective. In Report of the Expert Group Meeting, Ankara, Turkey, 2001 Nov (Vol. 6, No. 9).
  24. 24. Tong VT, Zotti ME, Hsia J. Impact of the Red River catastrophic flood on women giving birth in North Dakota, 1994–2000. Matern Child Health J. 2011;15(3):281–8. pmid:20204482
  25. 25. Rahman MS. Climate change, disaster and gender vulnerability: A study on two divisions of Bangladesh. Am J Hum Ecol. 2013;2(2):72–82.
  26. 26. Chowdhury AMR, Bhuyia AU, Choudhury AY, Sen R. The Bangladesh cyclone of 1991: why so many people died. Disasters. 1993;17(4):291–304. pmid:20958772
  27. 27. Dankelman I. Gender, climate change and human security: Lessons from Bangladesh, Ghana and Senegal. 2008.
  28. 28. Cannon T, Twigg J, Rowell J. Social vulnerability, sustainable livelihoods and disasters. Londres: DFID. 2003.
  29. 29. Moosa CS, Tuana N. Mapping a research agenda concerning gender and climate change: A review of the literature. Hypatia. 2014;29(3):677–94.
  30. 30. Tobin-Gurley J, Peek L, Loomis J. Displaced single mothers in the aftermath of Hurricane Katrina: Resource needs and resource acquisition. Int J Mass Emerg Disasters. 2010; 28(2):170–206.
  31. 31. Food and Agricultural Organization of the United Nations The state of food insecurity in the world: Food insecurity—when people must live with hunger and fear of starvation. Food and Agriculture Organization. 2002.
  32. 32. German Development Institute. Drought adaptation and resilience in developing countries. 2017. Available from: https://www.die-gdi.de/uploads/media/BP__23.2017.pdf [cited 20 June 2018].
  33. 33. Shiva V, Jalees K. Water & women: a report by research foundation for science, technology, and ecology for national commission for women. 2005. Navdanya/RFSTE.
  34. 34. Birch EL, Meleis A, Wachter S. The Urban Water Transition: Why We Must Address the New Reality of Urbanization, Women, Water, and Sanitation in Sustainable Development. WH2O: J Gend Water. 2012;1(1):1.
  35. 35. Rijken MJ, McGready R, Boel ME, Poespoprodjo R, Singh N, Syafruddin D, et al. Malaria in pregnancy in the Asia-Pacific region. Lancet Infect Dis. 2012;12(1):75–88. pmid:22192132
  36. 36. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med. 2016;374(16):1552–63. pmid:27028561
  37. 37. Pouliot SH, Xiong X, Harville E, Paz-Soldan V, Tomashek KM, Breart G, et al. Maternal dengue and pregnancy outcomes: a systematic review. Obstet Gynecol Surv. 2010;65(2):107–18. pmid:20100360
  38. 38. Lindsay S, Ansell J, Selman C, Cox V, Hamilton K, Walraven G. Effect of pregnancy on exposure to malaria mosquitoes. Lancet. 2000;355(9219):1972. pmid:10859048
  39. 39. Mbonye AK, Neema S, Magnussen P. Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan. 2005;21(1):17–26. pmid:16317032
  40. 40. Steketee RW, Wirima JJ, Hightower AW, Slutsker L, Heymann DL, Breman JG. The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Med Hyg. 1996;55(1_Suppl):33–41. pmid:8702035
  41. 41. Foresight: Migration and Global Environmental Change: Future Challenges and Opportunities. 2011. The Government office for Science, London.
  42. 42. Adanu RM, Johnson TR. Migration and women's health. Int J Gynecol Obstet. 2009;106(2):179–81.
  43. 43. Sendai Framework for Disaster Risk Reduction 2015–2013. United Nations. Available from: http://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf. [cited 20 June 2018].
  44. 44. Kratzer S, Masson V. Ten things to know: Gender equality and achieving climate goals. Climate and Development Knowledge Network. Available from: https://www.africaportal.org/publications/10-things-to-know-gender-equality-and-achieving-climate-goals/. [cited 20 June 2018].
  45. 45. Kakkad K, Barzaga ML, Wallenstein S, Azhar GS, Sheffield PE. Neonates in Ahmedabad, India, during the 2010 heat wave: A climate change adaptation study. J Environ Public Health. 2014;2014(946875).
  46. 46. Wilkinson P, Smith KR, Davies M, Adair H, Armstrong BG, Barrett M, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: household energy. Lancet. 2009;374(9705):1917–29. pmid:19942273