Leading Cities in the ‘Climate and Health Crisis.’ New Report Provides Framework for Addressing Its Results

TThe World Health Organization (WHO) estimates that extreme heat kills nearly half a million people each year—more than war, terrorism and malnutrition combined. That number is likely to rise as the weather becomes hotter and more unpredictable.

But the threats to public health posed by climate change go beyond extreme heat. Historic rainfall and rising temperatures are driving malaria, cholera and dengue, and spreading these diseases into new regions. Meanwhile, air pollution from wildfires has been linked to everything from cancer to heart disease.

These effects will be felt most in urban dwellers, where concrete absorbs and re-radiates heat, and the high population density allows germs to spread easily. Despite the fact that almost 70% of city leaders see climate-related health threats, and more than 90% report economic losses from such events, less than a third of cities have a resilience plan that integrates climate and health, according to a new report released by The Rockefeller Foundation, shared exclusively and TIME.

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With the support of the Rockefeller Foundation, the Urban Pulse Initiative surveyed 191 city leaders and civil society organizations from 118 cities in 52 countries, as part of a collaboration between Yale University and the Resilient Cities Network.

“On time [cities] who are at high risk, and woefully unprepared for what lies ahead,” said Naveen Rao, executive vice president of the Rockefeller Foundation’s Health Initiative, who led the development of the report in collaboration with thinktank Global Nation. The Foundation is donating one million to the C40 Cities Climate Leadership Group, a global network of nearly 100 mayors, to support the implementation of the three-pronged climate and health strategy it reports.

The report highlights individual cities that are implementing innovative ways to reduce climate-driven health risks. These isolated success stories could point the way forward for other cities facing what the report calls a “climate crisis.”

“The first episode [of the strategy] interfacing with weather/climate data and health data,” Rao said. “There are other agencies that live and die on weather data,” explained Rao, referring to aviation and agriculture. And although the WHO and the World Meteorological Organization (WMO) have worked closely together for nearly a decade, coordination at the local level is rare.

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Another developing city in this area is Rio de Janeiro. By combining health and climate data, Rio is developing an early warning system for dengue fever, a mosquito-borne viral disease, called “bone-break fever” because of its debilitating pain.

In Rio’s winter, when the weather is cool and dry, dengue cases decrease. But in 2023—one of Rio’s mildest winters—incidences of dengue remained unseasonably high. That same September, the city’s Epidemiological Intelligence Center, a team established in 2022 with weather assistance from the city’s municipal government, informed health authorities that the coming rainy season could create the right conditions for an outbreak of violence.

Gislani Mateus, health superintendent at the Rio Municipal Health Department says: “We were able to see where the number of cases was increasing, where they were concentrated.” Epidemiological modeling, which used weather data, case numbers and mosquitoes. -human data from a network of more than 2,500 traps, was used “to direct efforts to control both mosquitoes, and health care,” said Mateus the strategy will evolve to the Dengue Emergency Operations Center last February, when the city declared a dengue epidemic.

Although the team did not avoid the epidemic, its models predicted an increase in dengue cases two months earlier than traditional models of the disease predicted. As a result, Rio fared better than other cities in southeastern Brazil, and recorded the lowest death rate ever seen from a dengue epidemic. Mateus says they are now working with Brazil’s national health ministry to use the strategy elsewhere.

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Another city using a predictive model against dengue is Bangalore, India, where a team used weather and health data to make AI-driven outbreak predictions at the district level. But the majority, 77% of cities, do not use climate data in health monitoring systems, and replicating Rio’s success requires more than predictive modeling.

“Because of climate change, it is very important that we have this union between climate and health in our analysis of epidemics,” said Mateus. “But it is also important that we have public health services with sufficient numbers to cater for the population.”

The report outlines a second important step in urban preparedness: ensuring that experts in areas such as climate change, health, urban planning, and transportation communicate proactively before disasters. “A blaring smoke alarm is meaningless without a fire engine,” Rao said. Without this collaboration, even the best predictions will not translate into timely, effective public health interventions.

Another city the report identifies as turning warnings into action is Dhaka, Bangladesh. In 2022, the Bangladesh Red Crescent Society (BDCS) partnered with other organizations and government agencies to implement a data-driven early action protocol to respond to heat waves. The protocol sets specific trigger points based on temperature.

The program is approved by the International Federation of Red Cross and Red Crescent Societies, enabling BRCS to receive pre-arranged funding to support rapid response efforts when those boundaries are exceeded, said Shahjahan Saju, assistant director and project coordinator. BDCS forecast based on financial system.

In April, Dhaka was hit by the longest heatwave in recorded history. But the temperature forecast meant the city was ready to respond before temperatures reached their peak, with efforts such as distributing 3,500 umbrellas, providing water to 30,000 recipients, and providing respite from the heat to 15,000 people with three dedicated cooling stations, Saju said. The WHO and WMO estimate that an increased warning system like this could prevent nearly 100,000 deaths a year.

Read more: How to Know When High Temperatures Are Dangerous.

Early warning systems are a matter of “low-hanging fruit,” said Celeste Saulo, WMO secretary-general, noting that many cities already collect the necessary health and climate information.

“It’s about connecting those different sources of information in a way that you can put an early warning,” he said.

While Dhaka and Rio show how early action can work, an important question remains: How do you get millions of urban residents to heed public health advice? Enter the third part of the report strategy: effective communication. The city of Lusaka, Zambia’s thriving capital, has found new ways to cut through the noise and deliver life-saving information and services where it matters most.

In October, the Zambia National Public Health Institute reported an outbreak of cholera in Lusaka, which has been hit by floods and drought. By January, the death rate had reached 4%, four times the WHO limit. Rachel James, interagency risk coordinator and community engagement coordinator for Collective Service, a partnership between IFRC, UNICEF, and WHO, remembers walking the streets in knee-deep water. “That’s when it becomes very real.”

The high death rate was, in part, due to negative risk perceptions, inaccurate information, and barriers to accessing health services. “To better understand what the public’s views were,” the Collective Service visited the communities, “talking to people who survived diarrhea, talking to families of people who died, and just people in regions where there are many cases,” said James. That information was shared with Zambia’s health department and partners to inform how they communicate, contributing to 100 percent cholera vaccine uptake, he adds.

Discussions with the community also revealed barriers that prevent people from accessing health care, such as lack of transportation. In response, the Zambian Ministry of Health and UNICEF jointly sponsored seven ambulances. Collection points were also established to provide rehydration solutions for those who did not need to be transported to a health facility, James said.

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Instead of waiting until the middle of an emergency, the Rockefeller Foundation report emphasizes the importance of developing “always on” communication strategies. “It is because of our work that we were already doing with the Rockefeller Foundation in the country that we were able to respond quickly,” said Maureen Mckenna, who is the global coordinator of Collective Service. “We have already been working in Zambia, preparing and developing risk communication and community engagement methods to be able to respond quickly to health emergencies. ”

In addition to providing a framework for city leaders and policymakers, the report says interventions that improve the resilience of health care systems to climate change bring “significant economic benefits.” Early estimates of research by Mathematica data scientists, commissioned by the Rockefeller Foundation, found that targeted heatwave preparation in Dhaka would bring health benefits of about seven times the cost saved in terms of human lives. But less than 5% of climate finance goes to adaptation, according to the Climate Policy Initiative. Rao says only a small portion of that goes to health-focused programs.

“We need to keep focusing on reducing the weight, because we cannot fix our way out of this problem,” said Rao, noting that those who “did the least to cause this problem, climate change, are the ones who suffer the most.”

Last December, at COP28, governments and other stakeholders committed $1 billion to the climate health crisis, including $100 million from the Rockefeller Foundation, on the first health day of the conference. But that falls far short of the $11 billion annually that Rao says is needed for low- and middle-income countries to adapt to climate impacts and health. “What is needed to tie this whole thing together is more funding.”