CLIMATE CHANGE SCOPING FOR A RISK AND VULNERABILITY

CLIMATE CHANGE SCOPING FOR A RISK AND VULNERABILITY ASSESSMENT FOR THE HEALTH SECTOR

Background The critical challenge in terms of climate change in South Africa is the way in which multiple stressors - such as the spread of HIV/AIDS, the effects of economic globalisation, natural disasters, the privatisation of resources, and geopolitical conflict - converge with climate change (Mc. Michael, 2009; Fields, 2005).

Climate change presents an unprecedented and urgent threat to sustainable development, human health and survival.

All health professionals have a duty to advocate for action at all levels to mitigate climate change. However, the global health sector has been slow to recognise the impact of climate change upon health (Mc. Coy & Montgomery, 2014).

To facilitate action to address the threat of climate change, the 2015 Lancet Commission on Health and Climate Change provides nine recommendations for governments to consider, one being the scaling-up financing for climateresilient health systems worldwide (Wang & Horton, 2015).

Responses to climate change, whether by mitigation of its effects or adaptation to them, will require strong and effective intersectoral organisation effort within government at all levels, along with interdisciplinary research and prevention efforts.

CLIMATE CHANGE SCOPING FOR A RISK AND VULNERABILITY ASSESSMENT FOR THE HEALTH SECTOR Climate Risk and Vulnerability Assessments have increasingly been used for adaptation actions, development planning at local, national and regional levels and for the identification of climate change hotspots. The need for assessments gained significance in the context of the National Adaptation Plan (NAP) process which was established in 2010 as part of the UNFCCC Cancun Adaptation Framework to complement existing short-term national adaptation programs of action (NAPAs).

In Outcome 2 of the National Development Plan 2030 (NDP) nine priorities are identified, which highlight the key interventions required to achieve a more effective health system. The priority that speaks to this assignment is: addressing the social/environmental determinants that affect health and diseases. One of the determinants relevant in this case, is climate change.

The Climate Change and Health Adaptation Plan (2014/19) indicates that to identify highrisk locations and groups, it is important that a national vulnerability assessment of the health sector be undertaken. The results of this project will highlight areas of strengthening of the health system and management of risk.

We are looking at how climate events can exacerbate sensitive diseases, induce preexisting health conditions, reduce the productivity of populations thus affecting the socio-economic growth of a country, and affect the effectiveness and efficiency of public health programmes and systems.

The product of this assignment of the German Development Cooperation (GIZ) is an in-depth scoping report which will serve to guide the National Department of Health (Do. H) and National Department of Environmental Affairs’ (DEA) intention to develop a Health Risk and Vulnerability Assessment (Health RVA) that will provide both departments with a solid foundation for responding to the impacts of climate change on the health sector.

The University of South Africa (Unisa) Unisa has over 300, 000 students, including international students from 130 countries worldwide, making it one of the world's mega universities and only such university in Africa.

We are the African university, shaping futures in the service of humanity. Unisa identifies itself as a public-spirited institution with a clear social mandate. It is focused on quality, development and transformation through education–teaching, research and community engagement–nationally, continentally and globally. Throughout its history, Unisa was perhaps the only university in the country to have resisted exclusionary dictates, providing all people with access to education, irrespective of race, colour or creed.

Furthermore, Unisa continues to play a pivotal role in the establishment of a national environmental sustainability Community of Practice under the auspices of Universities South Africa (USAf), and cohosted a climate change event with the German Embassy as part of the German Climate Support Programme (CSP). This initiative placed a strong emphasis on mitigating climate change, adapting to the impacts of climate change and protecting biological diversity.

The University of South Africa (Unisa) is project leading the scoping exercise in consultation with experts and researchers from: - Council for Scientific and Industrial Research (CSIR), - Africa Health Placements (AHP), - Centre National de la Recherche Scientifique (CNRS) and - Maastricht University.

Council for Scientific and Industrial Research (CSIR) The Council for Scientific and Industrial Research (CSIR) is South Africa’s national research organisation established in terms of the Scientific Research Council Africa (No. 33 of 1945) of the Parliament of the Union of South Africa and is situated on its own campus in Pretoria.

Africa Health Placements (AHP) is a social enterprise dedicated to solving the crisis of the shortage of doctors in Africa. They also work with health systems to create a patient-centric culture.

Core team Project manager: Prof Monika dos Santos (Unisa) Primary Researcher – Climate Change Adaptation and Health: Ms Juanette John (CSIR) Primary Researcher – Climate Change Adaptation: Prof Rebecca Garland (CSIR) Junior Researcher – Climate Change Adaptation/Health: Mr Romeo Palakatsela (Unisa) Other consultants Expert pubic health risk, vulnerability and workforce needs: Ms Stacey Pillay (Africa Health Placements) Expert quality assurance methodology, analyses and RVA skeleton input: Prof Arnaud Banos (Research Director for the Centre National de la Recherche Scientifique (CNRS), France) Expert review of reports, recommendations and RVA skeleton input: Prof Pim Martens (Maastricht University Graduate School of Sustainability Science (MUST), Netherlands)

Phase one - Desktop review and infograph • A desktop review of all climate change related literature in South Africa to date is being undertaken, and will be complemented by international literature. • This will allow us to identify where the relevant research, policy and implementation gaps lie.

• To be included in the final literature review, articles must describe the impact of climate change on health in South Africa. All relevant study designs are eligible, including: - modelling studies - narrative and systematic reviews - case studies - case series - qualitative research.

• All eligible full text articles will be screened. • We then extract data on the characteristics of the included articles. The findings presented in each included article will be used to draft the text of the review. • We will also include additional articles located through searches of article references or through targeted internet searches for policy documents, for example.

Web of Science, which includes the Web of Science Core Collection, Medline and Sci. ELO Citation Index, will be consulted. The Web of Science advanced search strategy will include free text terms, for example: TS=(climate change* AND South Africa* AND health), spanning from the year 1950 -2019 in English.

The Pub. Med advanced search strategy will include free text terms, for example: (“south africa”[Mesh Terms] OR “south” All Fields] AND ‘’africa”[All Fields] OR “south africa”[All Fields]) AND (“climate change”[Mesh Terms] OR (“climate”[All Fields] AND “change” OR “climate change”[All Fields]) AND (health”[Me. SH Terms] OR “health”[All Fields]).

Phase one - Interviews, analysis and draft report 20 key expert interviews are currently being conducted Research ethical approval has been obtained from the College of Human Sciences REC, Unisa.

Interview questions and probes Question: Do you think that climate change will impact the health of South Africans? If no, explore why and how, if yes: • • Who do you think will be most affected? Are there any specific areas in South Africa that you think need focused attention from an intervention, research or policy perspective? How can climate events affect the effectiveness and efficiency of public health programmes and systems? What are anticipated barriers to implementing these programmes and systems? What could be unintended consequences to the implementation of these programmes and systems? Examples of interventions? Examples of research questions/issues? What policies are in place/should be in place?

• How can adaptation plans be aligned with developmental priorities? Also explore how this intersecpts with the planned NHI programme. • How can support from actors/stakeholders at multiple levels be secured? What are the challenges for doing so? • How can the production of ‘usable’ climate knowledge (in the appropriate context) be optimised? (such as, information that can help inform management, planning, and governance). • How can collaboration between scientists and decision-makers be improved? • Question: How can problems can be solved in ways that fit within local knowledge frameworks?

Data Analysis • The interview data will be analysed by means of thematic content analysis, with the assistance of ATLAS. ti software. • Thematic content analysis methods have been proven to be constructive in the advancement of public healthcare interventions. • Thematic coding is implemented in the disaggregation and interpretation of core themes: it is a multi-step process of inquiry during interview data analysis that comprises a process of linking codes (categories and concepts) to one another via a combination of inductive and deductive reasoning (Babbie & Mouton, 2012; Breakwell, Hammond & Fife-Shaw, 1995).

• Responses are read, subjected to thematic content analyses by the investigators and deliberated on with a subset of key informants in order to establish the usability of the information. • Categories are established by removing the meaning units from the open-ended questions and by then applying phrases that comprise several of these units in their entirety.

• These categories were then coded in order to identify the regularities. • Categories that are grouped together became themes. To validate interpretations, study conclusions are taken back to a subset of participants for the enrichment and substantiation of analyses (Babbie & Mouton, 2012; Breakwell et al. , 1995).

Phase two All role players will be involved in this phase, while Africa Health Placements will additionally provide specialised public healthcare input with regards to the health risk and climate change vulnerability framework.

‘human health can – indeed should – be viewed as the real “bottom line” of climate change. ’