Study Yields Insights for Boosting Early Intervention of Climate-Related Health Risks

Dean Maureen Lichtveld shares key climate change and public health interventions in her recent Lancet article

Being able to predict where and when infectious disease outbreaks may appear alongside extreme weather and other climate change-fueled environmental effects can help public health officials respond earlier and more effectively, according to an analysis published November 9 in The Lancet Planetary Health.

“Infectious disease outbreaks exacerbated by climate change are one of the most pressing threats facing the health of people globally—especially as the world’s population is projected to reach 8 billion this month,” said study coauthor Maureen Lichtveld, MD, MPH, dean of the University of Pittsburgh School of Public Health and one of an international team of researchers from 15 institutions who took part in the analysis.

Such early warning systems have been developed in recent years to help control outbreaks of malaria, dengue fever and other diseases in parts of the tropics, but roadblocks such as funding uncertainties, overburdened local health systems, insufficient training for local health technicians, and a lack of buy-in from government decisionmakers often present roadblocks to implementation.

“We looked at five case studies and most of the barriers we identified likely could have been resolved by getting policymakers and community leaders on board right from the start,” said William Pan, Elizabeth Brooks Reid and Whitelaw Reid Associate Professor of Population Studies at Duke University, colead author of the analysis.

In the case studies, scientists often placed a higher initial priority on getting their monitoring systems, disease-control protocols and local partners in place before turning their attention to briefing national or regional policymakers about it. In hindsight, scientists realized that partners who were expected to manage local operations were not necessarily the government decisionmakers authorized to commit financial or political support for ongoing systems.

Training local health providers and technicians in environmental science also needs to be an immediate priority, the authors note. Local health systems, especially in poor or remote regions, are typically stretched thin and the people who do on-the-ground disease surveillance often have limited training in climate science or environmental epidemiology. They are trained in medicine or public health but not in how climate-sensitive environmental conditions such as extreme heat, drought or flooding can drive disease outbreaks.

“There’s currently no place in the world that has an early warning system for infectious diseases that integrates climate and environmental data with disease surveillance data. Policymakers just haven’t picked up on it yet, even though it is what science tells us we need to be doing,” Pan said. “It’s like trying to bake a cake with only half the ingredients.”

In this new publication, he, Lichtveld, and their coauthors propose a four-step, science-based framework for overcoming barriers and enhancing the success of early warning systems.

  • First, understand and anticipate potential barriers.
  • Second, engage and collaborate with key stakeholders to create the system together.
  • Third, identify promising strategies to overcome barriers and test how they work in pilot studies under varying conditions using data and stakeholder interviews to inform your analysis.
  • Fourth, measure resulting outcomes across a broad range of considerations, including acceptability, feasibility, sustainability and cost-effectiveness.

“Not merely engagement but cocreation, implementation and evaluation with communities and other key decisionmakers from the outset is essential. Otherwise, even the best laid plans can fail,” said Lichtveld.

The new analysis is based on case studies of early warning systems for climate-related disease outbreaks or public health risks that have been recently developed in Peru, Barbados, Ethiopia, India, and the Federated States of Micronesia and the Marshall Islands.

The publication was coauthored by researchers from the National Cancer Institute, part of the National Institutes of Health; University of Washington; the Pan American Health Organization; the National Institute of Environmental Health Sciences; the Barcelona Supercomputing Center; the Catalan Institution for Research and Advanced Studies; the London School of Hygiene and Tropical Medicine; the University of Florida; the Inter-American Institute for Global Change Research; the Pacific Island Health Officers Association; the Energy and Resources Institute of New Delhi, India; the University of Oklahoma; and the Barbados Ministry of Health and Wellness.

CITATION: “Advancing Climate Change Health Adaption Through Implementation Science,” Gila Neta, William Pan, Kristie Ebi, Daniel F. Buss, Trisha Castranio, Rachel Lowe, Sadie J. Ryan, Ann M. Stewart-Ibarra, Limb K. Hapairai, Meena Sehgal, Michael C. Wimberly, Leslie Rollock, Maureen Lichtveld and John Balbus; The Lancet Planetary Health, Nov. 9, 2022. DOI: to come