7.6 Module F: Health

7.6.1 Introduction

Climate change can affect human health through a range of mechanisms. These include relatively direct effects of hazards such as heat waves, floods, and storms. Also included are altered infectious disease patterns and disruptions of agricultural and other supportive ecosystems with resulting nutritional impacts.[23]
Gender disparities, whether due to distinct roles and relations of men and women in a given culture or to gender norms that systematically value one group often to the detriment of the other, foster inequities between men and women in health status and access to health care.

“Health”is a sector in itself, but it is also an overlay of all human interactions with natural resource endowment, people, and built environments. Individual decisions and responsibilities as well as many collective decisions impact people’s health. The (mostly negative) impact of climate change on human health is by itself an essential reason for climate change adaptation and mitigation.

While the climate impacts on health are clear, to date there are not yet many health projects being submitted to the multilateral CCA funders.

7.6.2 Gender issues for health

Gender health inequalities start at birth
(Box 22). A large number of baby girls are not given the chance to live, are killed in the womb, or die from starvation and illness in infancy. Four million women are estimated “missing,”either from higher death rates than men’s or killed in the womb, simply because they were females;[24]
the largest numbers of missing women are in China and India.

Gender health inequalities continue throughout adult life in developing countries.
A wide range of reasons contribute to these inequalities: women die in labor or at childbirth for lack of transport, clean water, or energy. Women experience higher rates of morbidity due to domestic chores (water and fuel transport, indoor air pollution from cooking). Women also experience higher rates of malnutrition as they tend to prioritize feeding the family before themselves. In certain cultures, women cannot access health services unless accompanied (at times too late) by a male or a family member.

Men are exposed to different risks than women
. Young boys have higher morbidity rates from poor hygiene, and migrating men are more exposed to infectious diseases such as HIV/AIDS. Men’s mortality rates from motorized transport are higher.

Box 22. Barriers to gender equality in health

  • Traditional societal roles impact women’s health more than men’s
  • Socioeconomic conditions limit women’s access to public health
  • Educational levels limit access to health information
  • Women’s lesser decision-making power over their body exposes them to higher health risks
  • Limited health and transport infrastructure make women and children more vulnerable to access care
  • Social stigma hamper access to care for both women and men.

7.6.3 Gender-Health Issues in the context of climate change

Climate change impacts aggravate prevailing gender disparities in health.

Women’s health risks increase with the consequences of climate change.
Because of their low economic status and malnutrition, women are more susceptible to heightened bacterial and infectious diseases that result from changing weather conditions and the deterioration in water quality from floods or droughts. Women are also at greater health risks from extreme events such as floods, droughts, heat waves, and windstorms.

  • Rising temperatures may increase the transmission of malaria in some locations, which already causes 300 million acute illnesses and kills almost 1 million people every year.[25]
    Pregnant women are particularly vulnerable to malaria as they are twice as “attractive”as non-pregnant women to malaria-carrying mosquitoes. Maternal malaria increases the risk of spontaneous abortion, premature delivery, stillbirth, and low birth weight.

Vulnerability varies by sex
. Several studies, mainly in cities in developed countries, have shown that death rates increase as temperatures rise or fall from the optimum temperature for that population. More women than men died during the 2003 European heat wave, for example. However, men are more likely to die of heat-strokes as they tend to be more active outdoors during heat waves;old men are at greater risk because of social isolation. Women are also exposed to waterborne diseases more than men, both in rural and urban areas;women remain closer to the homestead and furthermore care for the sick, adding to their exposure to risk.

Natural disasters have a differentiated negative health impact on women and men
(Box 23). A review of census information on the effects of natural disasters across 141 countries showed that, although disasters create hardships for everyone, on average they kill more women than men, or kill women at a younger age than men. These differences persist in proportion to the severity of disasters and depend on the relative socioeconomic status of women in the affected country. This effect is strongest in countries where women have very low social, economic, and political status. In countries where women have comparable status to men, natural disasters affect men and women almost equally.[26]

  • The study found that natural disasters lower the life expectancy of women more than of men. Since life expectancy of women is generally higher than that of men, natural disasters actually narrow the gender gap in life expectancy in most countries. The study verified that the effect on the gender gap in life expectancy varied inversely in relation to women’s socioeconomic status.
  • Mortality is not the only gender-differentiated health impact of climate extreme events. Mental stress has been observed after disasters. In Australia and India, depressions and suicides increase among male farmers affected by droughts.

    Box 23. More women than men die in natural disasters

    In the 1991 cyclone disaster that killed 140,000 people in Bangladesh, 90 percent of victims were women. The death rate among people aged 20–44 years was 71 per 1,000 women, compared with 15 per 1,000 men. Explanations for this include the fact that more women than men are homebound and looking after children, old family members, and valuables. Even if a warning is issued, many women die while waiting for their relatives to return home to accompany them to a safe place. Other reasons range from the saris women wear that restrict their movements and put them more at risk at the time of a tidal surge, and the fact that women are less well-nourished and hence physically less able than men to deal with these situations. In Myanmar, among the 130,000 people dead or missing in the aftermath of the 2008 cyclone, 61 percent were female.

    In Nepal, after the floods of 1993, a survey established age- and sex-specific flood-related deaths among more than 40,000 registered participants (including deaths due to injury or illness in the weeks after the flood). Flood-related fatalities were 13.3 per 1,000 girls aged 2–9 years, 9.4 per 1,000 boys aged 2–9 years, 6.1 per 1,000 adult women, and 4.1 per 1,000 adult men. The difference between boys’ and girls’ fatalities existed mostly among children under 5 years of age. This possibly reflects the gender-discriminatory practices that are known to exist in this poor area: when hard choices must be made in the allocation of resources, boys are more often the beneficiaries. This could be reflected in rescue attempts as much as in the distribution of food and medical attention.

    7.6.4 Gender entry points for CCA health projects
    income countries. IIED Human Settlements discussion paper series, Theme: Climate change and cities – 2. IIED, London. http://pubs.iied.org/pdfs/10556IIED.pdf

7.6.4 Gender entry points for CCA health projects

Choosing appropriate gender-sensitive health interventions
. All adaptation solutions can have a positive impact on human health and nutrition, and on gender equality in health. Therefore, CCA proposal writers and other practitioners can be confronted with a major dilemma (i.e., whether to include health components in all climate adaptation projects or to have health-focused adaptation projects).

  • The first approach is likely to optimize the benefits from adaptation investments and activities as it will bring women and men faster to a good health status, therefore to a higher productivity level;however, it may lead to more complex projects.
  • The second approach is likely to deal with more focused but equally effective health interventions.
  • The selection of one or the other approach could be determined by the results of a screening process, whereby all sector vulnerability assessments and adaptation strategies would be screened through a gender-sensitive health lens.

In terms of development effectiveness, it is clear that health can become the best advocate for climate change adaptation. It is to be noted that mitigation projects can also have significant health impact on women, and could also benefit from being screened through a gender-sensitive health lens.

Conducting gender-sensitive vulnerability assessments of health systems and health interventions
. A possible approach[27]
for assessing human health vulnerability and public health interventions to adapt to climate change is to start with a thorough gender-sensitive assessment of health issues in the project area and/or at the national and regional levels, and describe, with sex-disaggregated data, the health risks and likely outcomes of climate variability and risks. Such an assessment, which requires significant community participation, needs to confront the appraised situation with current strategies, policies, and measures to reduce the burden of climate-sensitive health determinants and outcomes. Such an assessment of likely health impacts of climate change would document, for example, if the climate change health risk is an increase in infectious diseases, in malnutrition, or in increased mortality in zones prone to extreme events. It would establish how women and men are likely to be affected differently and what policies or activities may be needed to ensure a gender-equitable response (e.g., outreach activities targeted separately to women and men, targeted emergency food distribution).[28]

Planning and design of gender-sensitive climate adaptation health interventions.
The preparation of a
gender-sensitive climate adaptation health plan
can form the basis for identifying targeted health interventions as part of a sector project (agriculture, transport, urban, etc.) or as a self-standing project. Such a plan will record priority activities, which may include, for example:

  • Expanding health care services

    for poor women and men is a direct way to reduce climate change vulnerability and enhance adaptive capacity.

  • Increasing accessibility to formal health clinics and medical personnel to serve the poor, to enhance not only the well-being of poor residents but also their resilience to climate change impacts. This may require significant investments in weather-proofing road infrastructure as well as adapted vehicular transport. Such an approach was taken in Ethiopia by the Government’s Road Department when they engaged in designing affordable “maternity taxis”to transport women on newly weatherized roads.
  • Enhancing the disaster-preparedness of public health services, including staff training, establishing stocks of essential medicines and bottled water, and developing public information systems.
  • Establishing monitoring and information systems to monitor diseases and provide early warnings

    about disasters can help to improve resilience by influencing behavior. This is especially true if such systems are deployed in conjunction with public awareness campaigns that effectively leverage community sources of knowledge and communications (Box 24). Infrastructure investments, in particular those that will improve water and sanitation and housing conditions with a focus on gender equality, will be needed to complement adaptation activities to improve health systems.[29]

Box 24. Health information tools help manage health impacts of climate change in
Brazil and China

An increase in the incidence of dengue fever is a well-documented consequence of climate change. Rio de Janeiro developed an extensive website on dengue, outlining the symptoms of the disease, prevention measures, and places to go if an individual contracts the disease. This information is also transmitted through the official anti-dengue effort that brings public health workers and other volunteers to the slums to educate residents about the disease. Another tool is the use of Geographic Information Systems to establish the location of disease prevalence and identify the most vulnerable groups. For example, using Geographic Information Systems have helped the Amazonian city of Manaus in Brazil to gather information and identify groups vulnerable to malaria.

In China, a heat warning system in Shanghai has been established to alert residents to high temperatures, and the Municipal Health Bureau ensures the preparation of hospitals and public services during these extreme heat conditions. Based on research conducted in Hong Kong, such steps are expected to contribute to lower mortality compared to previous heat waves.

World Bank. 2011a. Guide to climate change adaptation in cities. World Bank, Washington, DC.

Implementing gender-sensitive climate adaptation health interventions. Community involvement
 and the
of women and men in
health committees
are ways to ensure the success of adaptation interventions. Health activities are particularly relevant to mobilize women’s leadership skills and to capitalize on their experiential knowledge as health care-takers as well as capitalize on their kinship networks. With supplemental training on climate change health risks, women’s effectiveness can be considerably enhanced. Health adaptation activities can also be carried out as
income-earning activities
, supported by the community or micro-enterprises (see Box 25). In some cases, such activities may need to be supported by adapted credit facilities.

Box 25. Women take the lead in safe water businesses in India

To increase the availability of safe water and mitigate the impact of climate change, a commercially viable water kiosk was established in the slum settlement of Kalandar in Delhi, India. The water kiosk is managed by a women’s committee and provides safe water at affordable prices. Each household receives a user identity card, a membership number, and a set of coupons for a fixed daily quota of water per family. This initiative is the result of work done by NGOs and a research institute to raise women’s awareness on the poor water quality and organize a community mobilization process. Women were engaged in the planning, and the operation and maintenance of the water kiosk became a community enterprise. In several slums in the Tiruchirapalli district, women’s groups, with guidance and funding from NGOs, installed drinking water facilities and individual toilets in order to address the poor sanitary conditions, thereby minimizing the risks of contamination arising from increased variability in weather conditions. The state government initiated the program and provided the land, electricity, water supply, and loans to community members. A gender- sensitive community mobilization program with a focus on gender mainstreaming carried out by the women was part of the project.

Gotelind, A. 2011. Gender, cities and climate change. Thematic report prepared for Cities and Climate Change. Global Report on Human Settlements. UN-Habitat, Nairobi, Kenya. http://www.unhabitat.org/downloads/docs/GRHS2011/GRHS2011ThematicStudyGender.pdf
(URL is no longer available).

7.6.5 Monitoring gender impacts

Monitoring and evaluation of gender results and impacts of CCA health interventions.
Whether health interventions are part of other sector projects or of a health-focused project, monitoring and measuring gender results and impacts are most important. Results are likely to focus on the participation or women and men in health activities (consultations, training, employment as health workers), the increase in the rates of access to relevant services and infrastructure (health clinics, clean water and sanitation, access to clean energy, access to transport, and improved housing), and the disaster-preparedness of public health services for extreme events. Documenting the impacts with sex-disaggregated data by age groups is essential, in particular the trends in morbidity by type of disease as well as the trends in mortalities, in order to determine whether policy changes are needed.

Table 11 provides illustrative gender-sensitive indicators for CCA health interventions.[30]

TABLE 11. Illustrative gender indicators for health CCA projects
Intervention Area Illustrative Indicators
Consultation inclusiveness No. of gender-sensitive technical health information sessions and consultations sessions

No. of climate-related health information documents designed with gender-sensitive information

Improving gender balance of staff, partners or clients/client groups No. and percentage of men and women serving as health committee members and leaders

No. and percentage of women and men employees in health services

Active participation No. of people participating in consultations, disaggregated by sex
Leadership No. and percentage of men and women board members

No. and percentage of men and women management staff of health service institutions

Adoption of practices Capability of men and women to manage daily and extreme event challenges

Capability of communities to manage daily and extreme event challenges

Increased livelihood diversification Wages levels of health workers, disaggregated by sex

No. of skilled and unskilled people employed in public health services, skilled and unskilled, disaggregated by sex

Nontraditional practices or roles adopted No. of health professionals who received skill training related to the health impacts of climate change (new diseases, mental illnesses/PTS, etc.), disaggregated by sex

No. of people trained in climate-related emergency care through community-based activity, disaggregated by sex

No. of health professionals capable of handling climate-related illnesses, disaggregated by sex

Women’s status changes by household or community Ability of women to manage climate change related health issues, and preparedness for extreme events
Economic status Relative wage parity between women and men working in public health services

Annual income from employment in health services, disaggregated by sex

Service provided No. of childcare services available on or close to workplaces

Relative effectiveness of Early Warning Systems for reaching men and women

Monitoring systems for the incidence of climate-related illnesses, disaggregated by sex

Inclusive service provided Availability (no. and geographical distribution) of shelters and emergency health facilities that are safe for women and men
Client satisfaction Stabilization or improvements in nutritional* level statistics, disaggregated by sex and age group

Rate of malnutrition-related hospitalizations for children under 5 hospitalized for malnutrition, disaggregated by sex

Rate of anemia prevalence for women of reproductive age

Illness and disease rates, disaggregated by sex

*Nutrition is associated with the decline in food availability due to climate change or extreme events, hence the importance of monitoring nutritional levels as a result of more effective health programs and services

Policy change Level and percentage of budget allocations committed to gender-sensitive climate-related health programs, climate-relevant health and other infrastructure provision, and provision of emergency supplies of water, food, and medicine.

Number of gender-sensitive, climate-change related health training programs offered

Number of training-hours of gender-sensitive, climate-change related health training programs offered

Box 26 lists additional literature sources.

Box 26. Further readings on gender, health, and climate