Citation: Sorensen C, Murray V, Lemery J, Balbus J (2018) Climate change and women's health: Impacts and policy directions. PLoS Med 15(7): e1002603. https://doi.org/10.1371/journal.pmed.1002603
Published: July 10, 2018
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: CS is currently in a post-graduate fellowship in Climate and Health Policy through the University of Colorado and National Institute of Environmental Health Sciences. The Living Closer Foundation provides financial support for this fellowship. This publication was supported, in part, by the NIH, National Institute of Environmental Health Sciences. The funders had no role in the preparation of the manuscript or the decision to publish.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: CNS, central nervous system; SDG, Sustainable Development Goal; UNFCCC, United Nations Framework Convention on Climate Change; UNISDR, United Nations International Strategy for Disaster Reduction
Provenance: Commissioned; not externally peer reviewed
- 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.
As noted by the United Nations Framework Convention on Climate Change (UNFCCC) , 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  and resulting agricultural losses, and may be at higher risk of drowning during severe weather . 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 . 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.
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 . 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 . 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 . Poor air quality is also associated with negative birth outcomes  and affects maternal/child health in that it is associated with stillbirth, intrauterine growth restriction, and congenital defects . 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 .
- During climate-related disasters, women suffer disproportionate mortality , and survivors experience decreased life expectancy .
- Women and girls are at a higher risk of physical, sexual, and domestic violence in the aftermath of disasters  and are at a higher risk for mood disorders and poor economic recovery . These impacts are amplified when women have a lower socioeconomic status .
- 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 .
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 . 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” . 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.
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).
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.
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.
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.
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.
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.
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.
The authors would like to thank Kevin Blanchard of Public Health England for his important contributions to this manuscript.
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