Anticipatory Early Action: Considering Responsive Community Targeted Mental Health Intervention to Complex Climate Change Impacts
Climate change is a significant and emerging threat to public health and community social cohesion and may get worse as planet warms, oceans expand and the sea level rises. Extreme weather events such as floods and droughts have become more frequent and intense influencing the way societies must look at protecting vulnerable populations such as those in humanitarian situations, those economically disadvantages, the young, elderly, women and girls and those with or predisposed to chronic illnesses including mental health, emergency workers, first responders and the homeless.
According to the Intergovernmental Panel of Climate Change Summary for Policy Markers Report of 2022 there is notable dangerous and widespread disruption by climate change with great impacts to people and ecosystems affecting health and wellbeing. The climate hazards continue to threaten billions of people in the world with projections of 1.5 degree warning in the next two decades. The extremes; heatwaves, droughts and floods/flashfloods are intensifying in severity, frequency and magnitude with consequent risks to life on earth.
Most economic activities in the Greater Horn of Africa (GHA) are dependent on weather and climate. The Region is writhing from the vagaries of climate change manifest in extreme events of prolonged depressed rainfall for several rainfall seasons. For example, a recent report by ICPAC on the June to September 2022 Forecast season, which contributes 70% of the total annual rainfall for the Region, was forecast to be below normal for at least three countries. The report indicated that this is a scenario not seen in four decades and it spelt grim for over 20 million people. An example in the region, the Kenya Meteorological Department review of the March-April-May long rains season of 2019 recorded a generally poor seasonal performance, late onset and early cessation of the season, with poor temporal and spatial distribution across the country (KMD,2020).
Occasioned by climate change, the consequent drought and flooding conditions in GHA over the period has resulted in major losses across all the economic sectors. It has become a social, economical, environmental and political challenge facing humankind in the Region. It is evident that the severity and frequencty of impacts of climate change threatens to undermine development gains ravaging livelihoods affecting managment of resources, affecting health and productivity, leading to food insecurity, conflicts, increasing poverty and creating massive internal displacement of populations.
Nations in the Region have embraced bridging the gap between the users of weather and climate information, and the scientists who observe weather and climate data, process the data, develop and provide products and information as well as carry out the relevant research for further improvement of climate and weather services. This is evident in user engagement initiatives that have factored the sectors of the economy that are deemed most vulnerable to weather and climate. These include Agriculture and Food Security, Disaster Risk Management, Water and Energy, Livestock, Environment and Forestry, Security, Conflict and Health. This is premised on the fact that by understanding, planning for, and adapting to the changing climate, individuals and communities can reduce risks brought about by extreme weather and climate events and hence build resilience for sustainable economic development. There is marked strengthened co-production of weather and climate information services between producers, intermediaries and users. It illustrates targeted inclusivity in exploring the reality of climate change and variability and how the resultant impacts can be addressed as a way of building resilience in the populations.
Of emphasis in this article is that Climate Change affects social and environmental determinants of health — clean air, safe drinking water, sufficient food, secure shelter and resource base (livelihoods). There is a notable increase in health related challenges, though complex and in some ways indirect, more-so psychological and mental wellbeing of individuals and vulnerable communities. The World Health Organization-WHO documents various interlinks between climate change and mental health with environmental exposure pathways such as air pollution; insufficient water quantity, quality; food insecurity and ecological changes. In additional there are socioeconomic pathways that include but are not limited to loss of livelihood, loss of autonomy and control; conflicts and violence and forced migration. In the Stockholm50+ Environmental Summit the world leaders noted that risks posed by climate change to people’s mental health and well-being were on the rise. Notable was that emotional distress, anxiety, depression, grief and suicidal behavior were of concern.
Annual the global cost of mental disorders is estimated at US 1 trillion dollars with the crisis related to climate change likely to increase, as WHO cites. A study by Atwoli, Muhia and Merali (2021) recons that low and middle-income countries in Africa are highly vulnerable to climate change and that this affects mental health due to the disruption it occasions to social and economic infrastructure that populations depend on to address their health needs. This is collaborated by the WHO recent reports stating increase in populations of people with mental disorders maybe to some extent attributed to the severe and frequent impacts of Climate change.
As a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity, the Sustainable Development Goals were developed. Inclusive is the goal number three on health and wellbeing. It is important to point out that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability. There is no single solution– thus collective significance inclusive environment and social efforts are needed to preserve the planet and protect the future.
As such health related impacts of climate change (loss of lives, destruction of property and loss of livelihoods) to the vulnerable community includes predisposing individuals to develop and or trigger mental illnesses increasing the burden of disease to nations. For sustainable development building climate resilience needs to involve interventions for the promotion of holistic health for individuals and communities. This is in observance of the assertion that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO, 2020). An aspect of health, mental health is the state of well-being in which an individual realizes their abilities, can cope with normal stress of life, work productively and contribute to their community.
Mental health includes our emotional, psychological, and social well-being. It Affects how one thinks, feels, and acts. It determines how people handle stress, relate to others, and make choices, therefore inform individual and society growth. Mental illness, also called mental health disorders, refers to a wide range of health conditions —disorders that affect ones thinking, mood and behavior. Research informs that there are likely combinations of causes — biological, psycho-social, socio-cultural and environmental.
Global reports indicate that one billion people suffer from mental disorders globally and that 14.6% of years lived with disability are due to mental health (WHO, 2022).10% of global population have one or more mental disorders. For example, one mental disorder, depression, affects 264 million people globally, with women bearing the largest burden (5.1% females and 3.6% male). Research has shown that people with mental disorders die 10-20 years earlier than general population and further that mental disorders are also the leading cause of years lived with disability globally (WHO). Evidence also abides in a study by Opuko et al (2021) that observed that in Sub – Saharan Africa 34% of disability adjusted life-years are due to climate change. Also, poverty (some liked to climate disasters) is creating stress that triggers mental disorder and costs of treatment leading people deeper into poverty (World Bank Group, 2016). World Health Organization recognizes mental health as a top priority health issue because of the extent and pervasiveness of mental health problems. Notable is that a mental illness significantly affects how a person feels, thinks, behaves and interacts with other people with a definitive impact on people at every stage of life, from childhood and adolescence through adulthood.
Existing initiatives to build climate resilience; theability to anticipate, prepare for, and respond to hazardous events, trends, or disturbances related to climate, are lopsided. It is indisputable that climate resilience saves lives, reduces poverty, addresses underlying inequalities and delivers strong economic returns. The notable increase in climate related disasters may fuel upsurge of mental illnesses. However, health response to climate change impacts have concentrated majorly on communicable diseases or the physical health of the population and nutrition. The 77^th^ session of the United Nations General Assembly, through the WHO report observed that annually 17 million people below the age of 70 die due to noncommunicable diseases, which include mental disorders. Of these, 86% occur in low and middle income countries in which GHA region falls. In line with recommendations to global leaders at the Stockholm +50 Environmental summit, governments ought to prioritize mental health; ‘merge mental health support with climate actions, and build upon their global commitments’.
This study has identified a glaring gap, in addressing mental health for the affected population presenting a gloomy future, especially that these chronic illnesses compromise the quality of life for individuals, cost the families and consume huge resources of the national health budgets. A report of United Nations Children’s Fund of May 2022 points to lack of social support for children and adolescents predisposing them to mental illnesses, more so in disaster conditions. The report points at large-scale social determinants of health such as poverty, disasters, conflicts and migrations and recommends re-engineering of social and structural measures to mitigate emotional and behavioral challenges amongst children and adolescents globally, an aspect that can downscaled in GHA. Such mental disorders as Mood, Anxiety, Trauma related disorders and Substance Use Disorders are the more likely to develop amongst populations in humanitarian conditions and general public resulting from climate disasters. Further, for those with exiting chronic health conditions, comorbid conditions may be triggered, besides the exacerbating health conditions associated with old-age, amongst the elderly populations of GHA.
The call is, knowing that the science of climate change is indisputable, all be creative and futuristic in response for GHA needs; adopt and reset the health narrative and programs as, smart health interventions are smart for the people and the economy, makes investment sense to include mental health initiatives in climate change response. after all, health being a human right, it makes sense to apply the health justice framework to address health-care inequalities experienced by the vulnerable and marginalized populations with mental illnesses. Professionalizing and mainstreaming mental health to climate resilience will go a long way to help people identify their thoughts and behaviors; specifically regarding their relationships, environment, and life. It is a win-win for the ripple effect to the ongoing climate adaptation and mitigation measures maybe profound. There is no escape but concrete actions to mitigate mental disorders must be taken. GHA must ACT NOW.
IGAD Climate Prediction and Adaptation Centre. Summary for Decision Makers: Seasonal Forecast June to September. ICPAC, 2022
Intergovernmental Panel on Climate Change. Climate Change 2022: Impacts, Adaptation and Vulnerability. Working Group II Contribution to the IPCC Sixth Assessment Report. IPCC, 2022.
Intergovernmental Panel on Climate Change: Climate change: a threat to human wellbeing and health of the planet. Taking action now can secure our future. IPCC, 2022
Johns Hopkins Bloomberg School of Public Health and United Nations Children’s Fund. On My Mind. How Adolescents experience and perceive mental health around the world. JHU and UNICEF. Baltimore and New York 2022.
Kenya Meteorological Department. State of the Climate-Kenya 2019. KMD, 2020.
L. Atwoli, J. Muhia, Z.l Merali (2022). Mental Health and Climate Change in Africa. Cambridge University Press. doi:10.1192/bji.2022.14
Mental Health and Wellbeing. Towards Happiness and National Prosperity. Ministry of Health, 2020.
Opoku SK, Filho WL, Hubert F, Adejumo O. Climate change and health preparedness in Africa: analyzing trends in six African countries. Int J Environ Res Public Health 2021; 18: 4672.
World Health Organization. Mental Health and Climate Change: Policy Brief. WHO, 2022
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Source: Government of Kenya