“First came the rain. It did not stop for several days. The waters filled areas around our home. Then came the mosquitos. I was bitten but did not think much of it. Not long after my body started to ache. I was sweating and had to go to hospital. They said it was dengue. I was scared for myself, but also wondered, ‘who will take care of my daughter if I am sick?’”
Recently I met Som, a 21-year-old Lao mother. Her story was heartbreaking.
As I listened to her, recovering from a potentially fatal disease, I thought of the increasing, climate change-driven rainfall and temperature projections for Lao PDR over the coming years. Unfortunately, they provide the perfect environment for increasing numbers of mosquitos and infections transmitted them like dengue - just one of the many ways climate change threatens human health.
In November, leaders from around the world met for COP27, the world’s largest gathering on climate change. We saw some significant commitments on climate action, unfortunately both overall funding, and prioritization for health, fell short. Each will have a significant impact on our well-being.
Each year these commitments made become more critical. Some of the climatic impacts that have already occurred are irreversible, some can be reversed if action is taken now. Unfortunately, the impacts on health are less well known. It isn’t just dengue or disasters that people like Som, and all of us, need to worry about.
Globally, between 2030 and 2050, climate change is expected to cause 250 000 additional deaths per year from malnutrition, malaria, diarrhoea and heat stress. The costs to health services and infrastructure are estimated to be US$ 2–4 billion per year by 2030.
Lao PDR is particularly vulnerable, with projections of more extreme weather, a 2–3 °C rise in temperature by 2050, and a 10–30% increase in rainfall, particularly in the south.
The direct results are clear— increased natural disasters, injuries and destruction—but there are many less obvious effects on health, making action even more urgent.
Agriculture and food systems are under threat—70% of Lao PDR’s population relies on subsistence agriculture, vulnerable to extreme weather events and disasters—and food insecurity could lead to children like Som’s being forced to skip or limit meals, with a rise in malnutrition and the many health problems that brings.
Increasing temperatures cause heat stress, triggering a range of medical problems. In Lao PDR, under a high emissions scenario, heat-related deaths among elderly people are expected to increase to approximately 72 per 100 000 by 2080.
And, we must consider the added pressure these situations bring to an already overburdened health system. The health system here is not ready to provide high-quality services for suddenly increasing demands due to changing climate conditions and extreme weather events.
Fortunately, we can mitigate this threat. Important steps are already being taken. The Ministry of Health is ambitiously progressing towards a climate resilient and low-carbon health system following pledges as part of COP26’s health programme.
A new National Health Adaptation Plan outlines the way forward. Lao PDR and WHO are piloting an early warning and response system to predict climate-sensitive diseases. With support from WHO, the Global Environmental Facility and the European Union, more than 70 hospitals have joined the Safe Clean Green and Climate Resilient Healthcare Facilities Initiative – introducing practical support to assess, improve and manage climate-related risks relating to health, water and sanitation, in floods or drought vulnerable areas.
But these are only initial steps. Addressing the crisis requires commitment, investment, and a new level of collaboration with the Government, the health sector, and international partners.
The crucial component is strong climate policies with a focus on protecting human health. We must ensure climate policies—really, all policies—deliver climate and health benefits simultaneously.
Globally, ending our fossil fuel reliance will reduce air pollution and the seven million annual premature deaths it causes. Higher vehicle emissions standards will save approximately 2.4 million lives and reduce global warming by about 0.5 °C by 2050. Commitments at COP27 to phase down coal would have saved lives – reducing land burning for crop preparation in Lao PDR would contribute in the same way.
To develop and implement such policies effectively, high-income, high-emission nations must follow through on their pledges for climate adaptation financing for developing nations. Commitments made at events like COP27 are a step in the right direction but must be backed by concrete action and the necessary financing.
Beyond these steps, there are several crucial actions to be taken.
We must ensure climate change and adaption measures are reflected in national policies and translated into actions and our daily life. Unless the issue is recognized it cannot be properly addressed.
We need to include climate adaption in existing public health programmes, and equip our healthcare workers, volunteers, communities and other sectors with the knowledge to tackle climate-related events and impacts. And, ensure strong systems to collect data and information on health and weather. We need the full picture, and people able to respond correctly.
Finally, it is essential to improve health facilities by incorporating climate resilience into current water, sanitation, and hygiene efforts and infrastructure—for example, protecting water sources most likely to be impacted by flooding. Recent flooding in August showed how vulnerable infrastructure can be, and how urgently mitigation efforts are required.
Ultimately, these steps are not optional. We must protect health from the impacts of climate change.
Lao PDR is a low-carbon emission country. It has done little to contribute to the global climate crisis and, like many low emission countries, has limited capacity to face the threats ahead.
Addressing this crisis by righting the wrongs of our polluting history is non-negotiable, and requires support to ensure mitigation efforts occur at the scale and pace required. If not, gaps between health service availability and demand will only worsen, affecting income, productivity, and lives.
WHO is looking to address the problem at all levels. We have and will continue to support the Government to develop and implement health sector adaptation and mitigation plans, and build resilience at the hospital and health centre level. We will continue to drive multi-sector collaboration to achieve health benefits with sectors.
Events like COP27 are a crucial opportunity for the world to come together and re-commit to keeping the 1.5 °C Paris Agreement goal alive, and put health front and centre. We cannot afford to wait.
We may not be able to stop the rain entirely, but we can make changes now to ensure we are prepared to weather the storm ahead.
Dr. Ying-Ru Lo is the WHO Representative to Lao PDR. An infectious disease physician from Germany, she has more than 30 years of experience as a public health expert.