How extreme heat raises birth risk in Nigeria, others

•WHO’s new report highlights 10 priorities for safeguarding health of people, planet

Scientists at University of California – San Diego, United States (U.S.) and colleagues have found links between extreme heat and a heightened incidence of stillbirths and preterm births in relatively poor countries.

The study, published October 6 in the journal Environment International, is believed to be the first to link the two phenomena in a global context.

A research team including first author Sara McElroy, who recently completed a Ph.D. in epidemiology in the San Diego State University/UC San Diego Joint Doctoral Programme in Public Health wrote: “We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes.”

The research, coordinated by climate scientists and epidemiologists at UC San Diego’s Scripps Institution of Oceanography and the Herbert Wertheim School of Public Health and Human Longevity Science, overcomes a barrier presented by the dearth of daily temperature and health information from economically developing countries. The team used gridded global meteorological data and compared it to available health survey information in 14 low- and middle-income countries compiled by the U.S Agency for International Development.

There have been data collected in relatively affluent countries to indicate links between pregnancy outcomes and environmental extremes such as heat waves, ice storms and wildfires. Other previous studies in high-income countries have established that pregnant women toward the end of the gestational period are especially vulnerable to extreme heat as it affects their ability to stay hydrated and to keep cool through sweating.

Those data, say the researchers, are not necessarily indicative of what is happening in other geographical settings. High levels of poverty in developing countries act not only to make meteorological and health data-gathering rare within their borders but also make pregnant women more vulnerable to weather extremes because they are less likely to benefit from technologies and services such as perinatal health services, air conditioning, and other social determinants of health.

The researchers linked birth-outcome data with weather data in 14 countries such as the Philippines, Nepal, South Africa and Tajikistan. They evaluated more than 103,000 births and counted nearly 5,900 preterm births and 1,200 stillbirths among them. They found a strong correlation between extreme heat events endured by pregnant women in the last week of their pregnancy and their risk of such adverse birth outcomes.

“We brought attention to new evidence on the relationship between extreme heat and adverse birth outcomes in countries where the evidence has been scarce,” said McElroy. “Our analyses revealed an association between acute exposure to heat and increased risk of preterm birth and stillbirth and suggests differing critical windows of susceptibility to extreme heat for preterm birth and stillbirth.”

The authors advocated for improvement or establishment of early warning weather systems to enable pregnant women and their caregivers to prepare them for extreme heat events such as heat waves.

The researchers concluded: “Due to climate change, extreme heat events have become more frequent, intense, and longer-lasting in recent decades—a trend projected to accelerate in the future.

“Low- to middle-income countries lack the infrastructure to deal with extreme heat and so it is especially important to study how heat affects pregnancy outcomes, as pregnant women are a particularly vulnerable group of the population.”

Meanwhile, the World Health Organisation (WHO), on Tuesday, released 10 calls for climate action to assure sustained recovery from COVID-19 even as global health workforce urged action to avert health catastrophe.

The WHO said countries must set ambitious national climate commitments if they are to sustain a healthy and green recovery from the COVID-19 pandemic.

The WHO COP26 Special Report on Climate Change and Health, inaugurated Tuesday, in the lead-up to the United Nations Climate Change Conference (COP26) in Glasgow, Scotland, spells out the global health community’s prescription for climate action based on a growing body of research that establishes the many and inseparable links between climate and health.

WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, said: “The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment.

“The same unsustainable choices that are killing our planet are killing people. WHO calls on all countries to commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests. WHO’s new report highlights 10 priorities for safeguarding the health of people and the planet that sustains us.”

The WHO report is launched at the same time as an open letter, signed by over two thirds of the global health workforce – 300 organisations representing at least 45 million doctors and health professionals worldwide, calling for national leaders and COP26 country delegations to step up climate action.

The letter from health professionals read: “Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change.

“We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions.”

The report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on people’s lives and health. Increasingly frequent extreme weather events, such as heatwaves, storms and floods, kill thousands and disrupt millions of lives, while threatening healthcare systems and facilities when they are needed most. Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, while climate impacts are also negatively affecting mental health.

The WHO report noted: “The burning of fossil fuels is killing us. Climate change is the single biggest health threat facing humanity. While no one is safe from the health impacts of climate change, they are disproportionately felt by the most vulnerable and disadvantaged.”

Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide.

The report concluded that protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance. And it states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs.

WHO Director of Environment, Climate Change and Health, Dr. Maria Neira, said: “It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face.

“Bringing down air pollution to WHO guideline levels, for example, would reduce the total number of global deaths from air pollution by 80% while dramatically reducing the greenhouse gas emissions that fuel climate change. A shift to more nutritious, plant-based diets in line with WHO recommendations, as another example, could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050.”

Achieving the goals of the Paris Agreement would save millions of lives every year due to improvements in air quality, diet, and physical activity, among other benefits. However, most climate decision-making processes currently do not account for these health co-benefits and their economic valuation.

WHO’s COP26 Special Report on Climate Change and Health, The Health Argument for Climate Action, provides 10 recommendations for governments on how to maximize the health benefits of tackling climate change in a variety of sectors, and avoid the worst health impacts of the climate crisis.

The recommendations are the result of extensive consultations with health professionals, organizations and stakeholders worldwide, and represent a broad consensus statement from the global health community on the priority actions governments need to take to tackle the climate crisis, restore biodiversity, and protect health.

The COP26 report includes ten recommendations that highlight the urgent need and numerous opportunities for governments to prioritize health and equity in the international climate regime and sustainable development agenda.
• Commit to a healthy recovery. Commit to a healthy, green and just recovery from COVID-19.
• Our health is not negotiable. Place health and social justice at the heart of the UN climate talks.
• Harness the health benefits of climate action. Prioritize those climate interventions with the largest health-, social- and economic gains.
• Build health resilience to climate risks. Build climate resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors.
• Create energy systems that protect and improve climate and health. Guide a just and inclusive transition to renewable energy to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities.
•Reimagine urban environments, transport and mobility. Promote sustainable, healthy urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling and public transport.
•Protect and restore nature as the foundation of our health. Protect and restore natural systems, the foundations for healthy lives, sustainable food systems and livelihoods.
•Promote healthy, sustainable and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes.
•Finance a healthier, fairer and greener future to save lives. Transition towards a wellbeing economy.
•Listen to the health community and prescribe urgent climate action. Mobilise and support the health community on climate action.

The health community around the world (300 organisations representing at least 45 million doctors and health professionals) signed an open letter to national leaders and COP26 country delegations, calling for real action to address the climate crisis.

The letter states the following demands:
“We call on all nations to update their national climate commitments under the Paris Agreement to commit to their fair share of limiting warming to 1.5°C; and we call on them to build health into those plans;

We call on all nations to deliver a rapid and just transition away from fossil fuels, starting with immediately cutting all related permits, subsidies and financing for fossil fuels, and to completely shift current financing into development of clean energy;

We call on high income countries to make larger cuts to greenhouse gas emissions, in line with a 1.5°C temperature goal; We call on high income countries to also provide the promised transfer of funds to low-income countries to help achieve the necessary mitigation and adaptation measures;

We call on governments to build climate resilient, low-carbon, sustainable health systems; and We call on governments to also ensure that pandemic recovery investments support climate action and reduce social and health inequities.”