The Planetary Health Alliance
BACKGROUND Episodic food insecurity, i.e. being without reliable access to affordable and nutritious food, has been linked to historical incidences of conflict, migration and social crises. Lack of resilience and food insecurity is exacerbated by an increasingly connected global food system, climate change and scarcity of land and freshwater. Societal responses to food insecurity potentially lead to negative health, equality, and environmental outcomes. Communities struggle when the natural systems on which they depend are compromised. Hunger and conflict forcibly displaced 66 million people in 2016. Empirical research clarifying the food-conflict/migration nexus is limited, and this work contributes to filling this gap.
METHODS Case studies were synthesised to elicit the common and differing aspects that determine food security resilience and societal responses. The case studies were geographically broad to facilitate wider comparison, ranging from El Nino events to the Arab Spring. Using both qualitative and quantitative methods, in-situ and ex-situ country responses to food system shocks and episodes were linked to capital underpinnings according to the Five Capitals Model.
FINDINGS Smallholder farmers in developing nations without access or availability of sufficient capital stocks are most vulnerable to food insecurity, with varied health and environmental consequences. Policy may inappropriately divert resources or fail to target those most in need. Price spikes may lead to income poverty, triggering groups to mobilise in protest, resulting in death, injury and political instability. Displacement and urbanisation may result in overcrowding, increasing the risk of communicable diseases. However, through implementation of weather-based index insurance, communities could have improved capital and therefore a stronger coping capacity to shocks. Though insurance itself is well established, using it to mitigate food insecurity is relatively new. It offers stability and mitigation against pervasive and harmful impacts that floods and droughts have on agriculture.
INTERPRETATION The evidence found of index insurance benefits has implications for sustainable development policy. It demonstrates how political and economic spheres can respond to increase the resilience of vulnerable nations to food system shocks in a world of increased severity, incidence and unpredictability of weather and geopolitical events. Insurance could mitigate conflict and displacement by offering a safety net in crisis, and credit access to invest in more sustainable farming practices. It could buffer against poor harvests and enable households to meet rising living costs. However, many food insecure regions do not currently have developed insurance infrastructure.
Climate change is expected to increase wildfire frequency and intensity around the globe. Examples of these impacts can already be observed in the recent historical record, and as the effects of climate change continue to intensify over the coming century, several studies predict a continuation of this trend. A recent modeling study demonstrated that global area burned may increase by approximately 8% by 2050 and 30% by 2100. This increase has the potential to nullify anticipated declines in anthropogenic sources of fine particulate matter (PM2.5), as wildfires become more dominant sources of PM2.5 around the globe. We use these model simulations of wildfire area burned from the present day to 2100 to generate the first quantitative estimates of the magnitude and economic value of air pollution-related health impacts worldwide associated with future fire activity.
We analyze projected PM2.5 for two alternative scenarios considering both climatic and socio-economic drivers of fire activity, where climatic changes are characterized by representative concentration pathways (RCPs) and socio-economic drivers by shared socio-economic pathways (SSPs). We apply the U.S. Environmental Protection Agency’s Environmental Benefits Mapping and Analysis Program – Community Edition (BenMAP-CE) and the 2015 Integrated Exposure Response (IER) Function from the Global Burden of Disease study to quantify the global health impacts associated with fire-related emissions for the present day and future under the two scenarios at a resolution of 0.1 degree x 0.1 degree worldwide. Results presented include the health burden from wildfire PM2.5 globally, by world region, and by country, for the present day, 2050 and 2090 under two scenarios of climate change and socioeconomic development.
Subsistence farmers are particularly vulnerable to shocks from natural disasters and already suffer from food insecurity and malnutrition. In 2017, unseasonably heavy rains in mid-April filled the Northeastern flood plain early and destroyed the annual rice crop before it was ready to be harvested. We aim to quantify the impact of this flood on food security and dietary diversity of women and children in the area, describe families’ coping strategies and evaluate whether a dietary diversification program could attenuate negative impacts.
The study is nested within the “Food and Agricultural Approaches to Reducing Malnutrition” (FAARM) cluster-randomized trial in rural Sylhet Division, evaluating the impact of a Homestead Food Production program on undernutrition. In 96 villages, nearly 2700 young women are visited every two months to collect data on diets, morbidities, pregnancies and births. We also collected data on flood affectedness, coping strategies and household food security half a year after the event and will continue to collect data on diets and health. We used multilevel regression adjusting for intervention allocation to quantify the effect of the degree of flood affectedness on food security and nutrition outcomes.
We have interviewed 2403 women and 56% reported that their families were affected by the flood to a great extent, while 21% were not affected at all. Of the 1571 families who usually grow rice and grew this year, 34% harvested at least as much as usual, while 28% expect a shortfall of 5 or more months of rice consumption this year compared to a usual year. Income losses were also reported by many households. Six months after the flood, only 30% of families were food secure and 40% of women consumed an adequately diverse diet.
Families with a large rice shortfall (5 or more months) had more than double the odds of food insecurity (OR 2.5, 95% CI 1.8-3.6) than those with no shortfall, adjusting for baseline food insecurity and usual rice harvest. Dietary diversity among women in these families was 0.4 food groups lower (95% CI 0.1-0.7) than in families with no shortfall, adjusting for dietary diversity one year ago. The most commonly reported coping strategy of the 1335 greatly affected families was borrowing money (58%), mostly from outside lenders.
Natural disasters exacerbate food insecurity and worsen dietary diversity among subsistence farmers. In a changing climate, these are becoming more frequent in Bangladesh and elsewhere.
Background: Floods are the most common type of natural disaster globally. Climate change and the pressures of development to accommodate emerging population could increase the number of people at risk of flooding. Although the immediate risk of death and injury from flooding is known to be small in high-income countries, emerging reports suggest flooding has prolonged adverse impacts on mental well-being. However, evidence remained limited as most previous studies are based on the survey or self-reports without robust pre-flood records. This methodological challenge applies to other natural and man-made disasters.
Methods: This study examines the mental health impacts of floods in England using routine prescriptions data which can provide data for both pre-flood and post-flood periods in flooded and non-flooded populations. We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011-2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre-post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10km of a flood. Impact of neighbourhood deprivation and population density on change in prescriptions over time and the number of prescriptions for non-antidepressant drugs were additionally controlled.
Findings: After control for deprivation and population density, there was an increase of 0.59% (95%CI 0.24 to 0.94) prescriptions in the post-flood year among practices located within 1km of a flood over and above the change observed in the furthest distance band. The results did not change after control for non-antidepressant drugs. The increase was greater in more deprived areas.
Interpretation: This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. This small percent increase would if caused by flooding reflect a much larger increase in flooded households, which made up a very small part of the overall registered populations of these practices. Moreover, despite small increase in relative terms, high prevalence of mental disorders implied substantial mental health burdens after flooding, suggesting important implications for public health practices after disaster. More detailed linkage studies are required to detangle the contribution of actual individual flood exposure. We are currently extending this study with prescribing data of individual patient in primary care practices.
Background. Increased stress is associated with elevated cardio-metabolic health risks but establishing a causal mechanism is challenging and evidence on the longer-term consequences of large-scale stressors on health is limited. To fill these gaps, we investigate the impact of elevated stress from direct exposure to the 2004 Indian Ocean tsunami on health ten years later. The tsunami destroyed the built and natural environment along coastal Aceh, Indonesia, killed 5% of the population and caused very high levels of post-traumatic stress among those exposed.
Methods. The health of those who were living in heavily damaged communities at the time of the tsunami is compared with those in other communities drawing on population-representative longitudinal survey data collected before and after the tsunami, the Study of the Tsunami Aftermath and Recovery. Ten years after the tsunami, levels of glycated hemoglobin (HbA1c) were measured for all survivors age 20y and older including post-tsunami movers. HbA1c, a biomarker for diabetes risks, is measured using carefully-validated point-of-care tests in mobile laboratories at respondents’ homes.
Comparing the pre-tsunami characteristics of populations living at the time of the tsunami in communities that were heavily damaged with those living in other, coastal communities indicates no systematic differences between the populations. This is because the extent of damage in each community depended on land topography, elevation, wave direction and the physical structure of the off-shore sea bed: some coastal communities were heavily damaged while other, nearby communities, were largely untouched. Drawing comparisons of HbA1c of those who were living in communities that were heavily damaged by the tsunami with those from other communities, controlling age and gender, this quasi-experimental design provides an estimate of the causal impact of elevated stress on diabetes risks over the longer-term.
Findings and interpretation. Overall, 12% of males age 40 to 64y are diabetic (HbA1c>=6.5%). The rate is 7.6 percentage points higher (p-value=0.02) among those who were living in heavily damaged communities relative to communities that were not damaged. In contrast, HbA1c does not vary with exposure to damage among males age 20-39 or among females age 20 to 64y. Tsunami damage exposures were essentially the same for males and females in both age groups so differential stress exposures cannot explain these patterns. It is likely that the loss of livelihoods took a greater toll on the cardio-metabolic health of older males who faced greater difficulty rebuilding their wealth late in the life course.
Background: Climate change is likely to induce a large range of household-level responses, including changes in human fertility behaviors and outcomes. These responses may have important implications for human and economic development, women’s empowerment, and environmental sustainability. However, to date, few studies have explored the linkages between climate change and fertility behaviors and outcomes.
Methods: Drawing on the literature linking climate variability to rice production in Indonesia, we use large-scale longitudinal household survey and high-resolution climate data to explore changes in childbearing preferences, family planning use, and births following community-level climate anomalies (timing of monsoon onset and temperature) from 1993 to 2015 using a series of fixed effects logistic regression models.
Findings: We find that, over the short-term (1-12 months prior to survey), fertility desires increase and family planning use declines in response to delays in monsoon onset, particularly for wealthier populations. Over the medium-term (1-60 months prior to survey), however, fertility desires decline in response to high temperatures, particularly for poorer populations who also increase use of family planning. We also measure parallel shifts in household well-being as measured by rice, food, and non-food consumption expenditures, with substantial reductions in food and non-food expenditures measured among households without farm businesses and high levels of education.
Interpretation: Collectively, these results document human fertility responses to climate change in a country vulnerable to its effects, and suggest that some populations will want to reduce their fertility in a future with climate change. Ensuring access to high-quality family planning services may help provide an important adaptation mechanism to households seeking to adapt to climate change.