Running head: Climate Change and Global Health 1

Health Impact Framework/Research Paper

Climate Change and Global Health

Delaware Technical Community College

NUR 310 Global Health

Misoon Kim

April 29, 2019

Climate Change and Global Health 2

Abstract
The average temperature of the Earth’s surface has increased by about 0.8℃ over the last

100 years (Skolnik, 2016, p. 186). This change in climate affects human health, and

increases the frequency of food-borne diseases, and leads to higher risk of mosquito-borne

diseases. Climate change affects everyone and every country in the world; however,

vulnerable populations such as children and the elderly are likely to suffer worse than other

groups because of their fragile physical statutes. Additionally, low- and middle-income

countries are affected greatly by climate change due to their generally weaker health

infrastructures and lack of sufficient preparation to adapt to the changes. In this paper,

climate change and its impacts on human health by using the Health Impact Pyramid will be

discussed. Nurses play critical roles in addressing the impacts and causes of climate change

and ​professional opportunities in global health are growing ​as globalization​. Governments

and national organizations should be aware of the negative health impacts of climate change

and take actions to reduce them, such as monitoring health trends in vulnerable countries

and making well-informed climate policies.

Climate Change and Global Health 3

Introduction

Climate change is happening now and ​is becoming​ a significant factor in some global

health problems.​ The average temperature of Earth’s surface has increased by about 0.8℃

over the last 100 years (Skolnik, 2016, p. 186). The weather in Australia, for example, has

warmed by about 1℃ since 1910, and warm months have occurred five times more

frequently over the past 15 years prior to that. The United Nations Secretary-General has

mentioned that fighting climate change and its impacts is one of the 17 goals of The United

Nations Sustainable Development Goals (Navi et al., 2017, p. 1).

Studies have shown that climate change affects human health directly and indirectly.

The most noticeable health risks come from extreme weather patterns such as droughts,

flooding and heat waves. According to The World Health Organization [WHO], “Climate

change will cause an additional 250,000 deaths per year between 2030 and 2050” (Skolnik,

2016, p. 186). The causes of deaths will be due to heat exposure, diarrhea, malaria, and

childhood undernutrition. Other adverse health effects of climate change are an increase in

food-borne diseases, a higher risk of mosquito-borne diseases, and displacement of people

due to migration (Navi et al., 2017, p. 4).

Climate change impacts the burden of disease and gives rise to enormous costs. For

example, ​in the developing country of Sri Lanka, health-care expenditures​, their health-care

expenditures were increase as a result of air pollution (Leffers & Butterfield, 2018). Climate

change can also cause the burden of disease in developed countries as well. In the United
Climate Change and Global Health 4

States, for instance, the extension of the warmer season causes longer pollen seasons, and it

increases allergic sensitization and asthma episodes (Human Health, 2014).

Climate change affects everyone and every country in the world; however, vulnerable

populations such as children and the elderly are likely to suffer worse than other groups

because of their fragile physical statutes. Children under five are at the greatest risk of this

disease because of its potential life-threatening complications. According to WHO, more

than 250,000 children die from malaria every year, with most deaths occurring in Africa

(WHO, 2019). Additionally, low- and middle-income countries are affected greatly by

climate change due to their generally weaker health infrastructure and lack of sufficient

preparation to adapt to changes (Skolnik, 2016).

In this paper, climate change and its impacts on human health by using the Health

Impact Pyramid (HIP) will be discussed. HIP is a framework for public health action to

improve health. It uses a five-tier pyramid to describe the impact of different types of public

health interventions. In the pyramid, socioeconomic determinants are at the base, followed

by public health interventions that change the context for health, protective interventions

with long term benefits, direct clinical care, and at the top, counseling and education

(Frieden, 2010, p. 591).

Socioeconomic Factors

Socioeconomic factors are social determinants of health. Cultural factors and health

beliefs also influence an individual’s health. According to the WHO, the main driver of

climate change and poor health is air pollution. The burning of fossil fuels, transportation,

and industry are the main sources of the air pollution (WHO, 2018). For example, people in
Climate Change and Global Health 5

low-income countries still use biomass fuels to cook indoors without appropriate ventilation.

Some of them cannot afford to buy an improved stove; however, others just want to

continue their traditional way of cooking indoors using biomass fuels. The lack of education

of the health impact of cooking indoors contributes to indoor air pollution and the risk factor

for respiratory infection as well (Skolnik, 2016, p. 151). This phenomenon can be explained

by the Health Belief Model; people do not feel the severity of the health effects of climate

change, so they stick to their own traditional ways of cooking. However, if there is an

opportunity to educate people about the benefits of engaging in behavior that prevents the

adverse effects of climate change, people might change their actions to use modern, safer

practices.

Developed countries are great contributors of air pollution as well. According to the

United States Environmental Protection Agency [EPA], 27 percent of greenhouse gas

emissions in the U.S. is from transportation, the second leading source of greenhouse gas

emissions in U.S. (EPA, 2017). This is because most people in the U.S. own private cars,

not only for their convenience, but also because the culture, transportation systems, and

zoning laws are less friendly for people using public transportation.

Changing the Context to Encourage Healthy Decisions

The second tier in the pyramid is interventions affecting the environment which promote

healthy choices. In the U.S. there are programs to reduce carbon pollution from

transportation to decrease greenhouse gases [GHG]. For example, fuel economy standards

for vehicles were implemented “to cut 6 billion metric tons of GHG emissions over the

lifetimes of the vehicles sold in model years 2012-2025” (EPA, 2017). Another way to
Climate Change and Global Health 6

reduce air pollution is to encourage people to use public transportation, ride bicycles or walk

instead of driving. This intervention will not only help improve air quality, but it also has

public health benefits by lowering the rates of obesity, diabetes, and heart disease (Human

Health, 2014).

Long-Lasting Protective Interventions

The third level of the Five-tier pyramid is one-time or infrequent protective

interventions. It includes governmental and international treaties to control climate change,

and there have been several international agreements in recent decades. In 1997, the Kyoto

Protocol was launched in response to climate change, and there are currently 192 parties to

the Protocol. It is an international treaty which aims to reduce greenhouse gas emissions. In

2016, another international agreement, the Paris Agreement, was established to intensify the

actions to lower carbon. 175 world leaders signed the Paris Agreement to participate in the

global response to the threat of climate change. The goal is to keep the global average

temperature increase at a minimum, with each country contributing to mitigate climate

change (​Climate Change​. n.d.). However, there are still people who do not believe climate

change is occurring or is influenced by human activity, and some politicians ​have publicly

rejected ​climate change for political purposes. For example, in June 2017, U.S. President

Donald Trump withdrew from the Paris Agreement because he claimed to be skeptical of

climate change, but perhaps more importantly because the fossil fuel industries has great

political power within the Trump administration (Zhang, H., Dai, H., Lai, H., & Wang, W,

2017). The lack of knowledge or denial of climate change, as well as the unwillingness to
Climate Change and Global Health 7

take action on the current global problems, will lead to a significant amount of people in the

world suffering from the results.

Clinical Interventions

The fourth level of the Health Impact Pyramid is ongoing clinical interventions to

reduce or prevent the impact of climate change. One example of the health impact of climate

change is the increasing risk of vector-borne diseases which are caused by fleas, ticks, or

mosquitoes. According to the Centers for Disease Control and Prevention [CDC], “North

Americans are currently at risk from numerous vector-borne diseases, including Lyme,

dengue fever, West Nile virus disease, Rocky Mountain spotted fever, plague, and

tularemia” (​Climate and Health,​ 2014).

The prolonged, increased warm weather is causing earlier springs and hotter

summers, conditions which are favorable for many insects to carry vector-borne diseases

more easily. Malaria, a vector-borne disease that is transmitted by female Anopheles

mosquitoes, is one of these. Children under five are at the greatest risk of this disease

because of its potential life-threatening complications. According to WHO, more than

250,000 children die from malaria every year, with most deaths occurring in Africa. Until

recently, there were no vaccines available for malaria despite years of efforts to develop

one. However, in 2016, European Medicines Agency approved the world’s first malaria

vaccine, known as RTS,S (WHO, 2019). The good news is that 360,000 children in Africa

will receive the malaria vaccine this year as part of a pilot project (Hunt, 2019). Along with

the vaccine, individuals can make effort to avoid bug bites by using insect repellent or bed

nets. In the long term, to help protect our health from the vector- borne diseases and increase
Climate Change and Global Health 8

individual well-being, we need to reduce CO2 gas and stop increasing the global

temperature so that we can decrease the incidence of vector-borne diseases.

Counseling and Education

The fifth and final tier of the health impact pyramid is health education, which is the

essence of public health action. To limit the adverse effects of climate change, providing

public education to communities is necessary, and it can help people to improve their health.

For example, the United Nations Environment Program established public health strategies

to prepare for potential negative climate change effects. These strategies include

implementing public health education such as posting notices on the importance of boiling

water during floods, raising public awareness of vector-borne disease, and promoting good

hygiene (Skolnik, 2016, p187).

When public health education is implemented, it is important to understand people’s

health beliefs and their behavior to health. This is because people must first have a desire to

change their health if such educational campaigns are to be successful. One of the health

behavior change theories is the Health Belief Model, which explains the factors that

influence individuals’ health-related behaviors. The main factors that affect people’s health

behaviors are how people perceive the susceptibility of getting the disease, the severity of

the disease, the benefits of engaging in behavioral change, and the barriers to action

(Skolnik, 2016). For example, when nurses use the Health Belief Model to educate people,

they can demonstrate the seriousness of the adverse effects of climate change by pointing to

the high number of deaths from malaria and increased of asthma occurrence resulting from
Climate Change and Global Health 9

climate change. Then, nurses can explain that actions to prevent climate change are as

simple as walking or bicycling instead of driving to reduce CO2 gas.

Nurses are the largest group of health professionals, and they play a critical role in

addressing the impacts and causes of climate change. According to research, “Nursing

practice must include strategies to reduce climate change impacts through patient

assessment and clinical care, research, advocacy, policy-making, and work with

communities to strengthen resilience” (Leffers & Butterfield, 2018, p. 211). An important

role of nurses regarding climate change is to educate the public. Nurses are good educators

and messengers to their patients and communities. Through education, people can

understand the important relationship between climate change and public health. Also,

nurses should make efforts to reduce the health consequences of climate change by

influencing policy-makers.

Recommended Future Intervention in Climate Change

Hospitals and nurses can promote environmentally sustainable practices in clinical

settings. Hospitals can incorporate non-fuel energy source such as renewable sources of

energy (e.g. sunlight) and promote the use of more energy-efficient buildings. Nurses should

make efforts to reduce medical waste and follow proper waste disposal procedures. Also,

collaborating with governmental and nongovernmental organizations is recommended to

prepare for climate change-related disasters. For example, working with the Federal

Emergency Management Agency (FEMA), the Red Cross, and local Medical Reserve Corps

is important to respond to emergency situations related to climate change in the future.

Additionally, there should be more support in federally funded research to minimize the
Climate Change and Global Health 10

local impacts of climate change by developing data-driven strategies that will aid

populations and geographic areas of high concern (Leffers & Butterfield, 2018, p. 212).

Professional Opportunities in the Global Health Field

The world is getting smaller thanks to modern transportation, and the increasing movement

of people can facilitate the spread the disease. One nation’s epidemic health problem can

impact many other nations, and it can lead to a global health problem. MacArthur states in

his article, “That’s why public health is no longer a local or even national concern – it’s a

global concern, and global public health professionals are essential… public health

professionals becoming more in-demand as globalization makes the world smaller”

(MacArthur, 2019, para. 1).

Public health professionals play a critical role in improving global health, and

there a lot of professional opportunities in the global health field. According to MacArthur,

possible career options include policy analyst, epidemiologist, global health educator, field

consultant, public health advisor, public health program manager, and medical officers and

workers in international organizations. The organizations that professionals in global public

health can work with include government agencies (in the US and abroad), international

organizations (such as WHO), private research firms and academia (universities and think

tanks), faith-based charitable groups (like World Vision), industry, banking and financial

organizations (like the World Bank), and international charitable foundations (like the Gates

Foundation) (MacArthur, 2019).

Climate Change and Global Health 11

References

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Frieden TR. (2010). A framework for public health action: the health impact pyramid.

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https://nca2014.globalchange.gov/report/sectors/human-health

Hunt, K. (2019, April 25). World's first malaria vaccine to go to 360,000 African children.

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from ​https://www.mphonline.org/best-international-public-health-jobs/

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