Citation: Wright CY, Kapwata T (2023) An urgent call to address climate change-related human health impacts in Southern Africa. PLOS Clim 2(5): e0000204. https://doi.org/10.1371/journal.pclm.0000204
Editor: Jamie Males, PLOS Climate, UNITED KINGDOM
Published: May 2, 2023
Copyright: © 2023 Wright, Kapwata. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by the South African Medical Research Council (research funding to CYW and TK). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
The 2022 report of the Lancet Countdown on health and climate change recounts the dire climate change impacts currently affecting human health . Extreme weather events, floods, droughts, and wildfires have led to loss of lives, property and livelihoods . Increasing temperatures have increased human heat exposure impacts, changed the spread of infectious diseases and reduced crop yields causing food insecurity .
Africa is grappling with climate change impacts against a backdrop of existing and ongoing challenges: lack of services, high poverty levels, recovery post-COVID 19, high prevalence of HIV/AIDS and tuberculosis and a steady increase in non-communicable diseases . Most countries in Africa are vulnerable to climate impacts given their high dependence on rain-fed agriculture (in the face of drying conditions and drought) and low levels of adaptive capacity .
Southern Africa (population 69 million) is not spared from climate change impacts which are exacerbated by a high pre-existing disease burden, fragmented health services, and food/water insecurity . Mean annual temperatures over the region have increased between 1.04°C and 1.44°C from 1961–2015  and are projected to continue increasing . Over the past 40 years, the annual number of hot days has increased while the occurrence of cold extremes has decreased .
In Southern Africa, at an increase of average annual temperature by 2°C, on average precipitation is projected to decrease by 20% with more consecutive dry days in Namibia, Botswana, northern Zimbabwe and southern Zambia, and by 5–10% in the Zambezi basin . The effects of El Nino-Southern Oscillation (i.e., El Nino/Le Nina) are observed across the region–currently it remains in a La Nina state with late summer/early autumn rainfall likely above normal rainfall over summer rainfall areas of South Africa .
Here, we discuss climate change impacts on human health in Southern Africa before presenting a synopsis of activities that aim to prevent or curb these impacts. We conclude by commenting on what activities might be missing that might significantly help prevent climate change-related morbidity and mortality in Southern Africa.
Current and projected climate change-related health impacts in Southern Africa
The Special Report on Global Warming of 1.5°C (SR1.5)  stated there are substantial benefits in restricting global warming to 1.5°C as opposed to 2°C because the risk of irreversible climate change is lessened and the frequency of occurrence of extreme weather events is reduced. SR1.5 highlighted Southern Africa as a climate change ‘hotspot’ where climate change impacts are likely to be higher than the global context. The region is projected to become warmer and drier, with higher ambient temperatures, more hot days/heatwaves, less rainfall and more drought for both winter and summer rainfall regions. These conditions mean major agricultural risks: the region’s staple food, maize, is likely to reduce, and livestock will face heat stress that will affect wool, milk and meat production. Such food insecurity will lead to malnutrition and stunting among children, as seen in parts of KwaZulu-Natal province, South Africa .
Pressing climatic changes, i.e., increase in ambient temperature/heatwaves, drought, heavy rainfall/flooding, have occurred in Southern Africa. Associated climate change human health-related impacts include heat stress/heat stroke, changes in the spatial-temporal occurrence of malaria and other vector-borne infectious diseases (e.g., Dengue fever, Yellow Fever, Rift Valley Fever) and chronic/non-communicable diseases, i.e. cardiovascular disease from air pollution exposure. Climate-linked health emergencies are also increasing– 56% of 2 121 public health events in Africa were climate-related . Projections suggest an increase in severe storms, cyclones and flooding in the region that will result in substantial loss of life, injury and major damage to infrastructure. In 2022, six tropical storms in Southern Africa led to 890 deaths and 2.8 million people affected–including cholerae outbreaks in Malawi, Mozambique, Tanzania and Zambia .
Actions to protect human health and well-being from climate change impacts
While mitigation is the primary mechanism for reducing the intensity of climate change and global warming, adaptation is the preferred response to address health-associated climate change impacts. All 16 Southern African countries either have National Adaptation Plans that aim to reduce vulnerabilities to climate change impacts, including human health risks, or are in the process of developing such plans. The local or regional variability of climate and weather variables influences the scale and vulnerability of the impacts of climate extremes associated with climate change . Therefore, adaptation policies and action plans should be developed in the context of localized social, political, economic, environmental and climate-related risks . However, as is evident in Fig 1, adaptation programs are framed at a national scale posing significant challenges in the effective implementation of these well-meaning climate actions.
Despite the presence of national adaptation plans to provide policy guidance, in many instances it is unclear how these plans translate into actionable workplans and implementation tasks to prevent adverse climate change-related health impacts or to help strengthen the resilience of communities or healthcare systems and services to respond to these impacts. Regional bodies e.g., Clim-HEALTH Africa, play an important role in supporting implementation and monitoring of projects and programmes in several countries . They assist with capacity development for preparing Climate and Health Country Profiles and in-country planning workshops. Policy and action implementation also requires regular review, monitoring and evaluation to adjust and improve where needed  however, the availability of funds and their appropriate allocation for these activities remains a challenge. While funding initiatives that support climate change adaptation projects are available, such as The Africa Climate Change Fund, The Adaptation Fund, The Green Climate Fund, the African Development Bank and the Global Center on Adaptation, and the Development Bank of Southern Africa, further financing to facilitate the implementation of basic services and essential infrastructures in line with countries’ national development plans (especially public health components) is also required. Climate change adaptation in Southern Africa is largely driven by policies. Governance challenges that continue to hamper adaptive capacity are becoming increasing evident. Support in these areas will go a long way to help Southern African countries protect their communities against the threats of climate change.
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