Millions of people in my country, Malawi, face unprecedented existential crises driven by climate breakdown. The frequency of extreme weather events and the massive impact they have on communities have left government officials like me with a huge dilemma of how to act fast enough to save lives. In the past three years, we have gone from facing the worst flooding in recent times to the most severe drought in a decade. The impact has been devastating to communities across the country.
When Cyclone Freddy hit us in March 2023, it killed more than 600 people. The cyclone injured many more, tore families apart, destroyed livelihoods, and the long-term effects from diseases were even worse. A little over a year later, we were in the middle of a raging drought, which the president, Lazarus McCarthy Chakwera, declared a national disaster in March. Millions of people are facing acute food insecurity, leading to malnutrition and health issues that are putting lives at risk, not least for people on long-term treatment for conditions such as tuberculosis and HIV.
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A common condition
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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
‘A common condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
Climatic stresses are increasing displacement and migration to urban areas, putting more strain on health systems and people’s mental health. Extreme weather events strain our health systems with injuries and a rise of sickness from diseases such as cholera and malaria. There are also long-term complications in prevention and treatment across health programmes due to the loss of essential medical supplies, equipment and infrastructure. Deaths surge because of these factors. After Cyclone Freddy, we had our worst ever cholera outbreak, which lasted over a year and killed more than 1,700 people. This year, we are battling malaria, which now accounts for almost 25% of hospital admissions. Women and girls, who already face challenges in terms of equality, access to resources and control over decision-making processes, are being disproportionately affected.
But we are fighting back, accelerating our interventions against the most climate-sensitive diseases while building agile and climate-resilient health systems that can withstand the shocks caused by these extreme weather events. We are accelerating the hiring of health workers and equipping them with tools to tackle emerging challenges. We are building more health centres, ensuring we bring much-needed services closer to the most vulnerable communities. We are using mobile clinics, which can also be deployedafter emergencies to ensure life-saving healthcare is available.
As weather patterns change, and become more unpredictable and severe, information will be key. We cannot plan, respond and be at our most effective if we cannot identify the challenges we are facing. In addition, existing paper-based systems are a huge risk. When the floods from Cyclone Freddy tore through villages in southern Malawi, they carried away books and health passports containing citizens’ health data. This has taught us that digitisation is an urgent imperative in our country. Besides protecting data, electronic health records will enable us to use large amounts of information to establish trends and build knowledge that can help us revamp health delivery, improve efficiency and quality of care, while better preparing for future disease outbreaks.
We recognise that the people most affected by extreme weather and climate events in places such as Malawi and across Africa are also the least responsible for the climate crisis. But I don’t think people understand how serious this is now. Those affected live in communities with the least capacity to adapt and counter climate impacts, and are mostly in countries with a high disease burden. These countries and communities, which have made almost no contribution to the heating planet, are paying the heaviest price: they are paying for that impact now and they are paying with their lives. It is getting worse, and some changes, such as migration, have irreversible and significant repercussions for people and their livelihoods.
The biggest emitters must invest more to mitigate their contribution to the climate emergency. They should also invest more in adaptation measures in areas such as global health, to support countries already suffering the severe effects of the changing climate.
Perhaps the seriousness is not yet apparent to those financing global development. Cop28 had the first-ever Health Day, which I hope marked a change in the global health community recognising that the impact of the climate crisis is here and will only get harder for the most vulnerable. In the margins of the 79th UN general assembly, taking place now, it is the first year that Climate Week will feature health as a primary theme. The connection between climate and health has never been more critical. While this awareness is a positive step forward, we need to move from talk to action, to financing that allows us to respond now and build climate-resilient systems for the future.
Wealthy nations can step up efforts to protect health systems and maintain progress against climate-sensitive diseases in countries disproportionately affected.
We cannot tackle the increased risks of the climate crisis alone and cannot mitigate the aggravated impacts on vulnerable populations. If we act together, now, based on the facts we have, it is possible to avert the worst consequences, support the most vulnerable and create an equitable world for all.
