Climate Change.

CHWS ARE ESSENTIAL TO CLIMATE ADAPTATION.

Climate change is reshaping patterns of illness, from heat stress and wildfire smoke to the spread of malaria and other climate-sensitive diseases. These challenges are already causing human suffering and loss of life.

Community health workers (CHWs) are already on the frontlines.

CHWs should be understood not simply as a workforce affected by climate change. Working door-to-door in communities where climate shocks disrupt transport, electricity, and access to care, CHWs help health systems continue functioning when people need them most.

As governments, global health leaders, and communities respond to these concerns, we cannot ignore how essential proCHWs—CHWs who are salaried, skilled, supervised, and supplied—are to building climate-resilient health systems.

Governments do not need to build a new workforce to strengthen climate adaptation. ProCHWs are already working in communities on the frontlines of climate-related health challenges. Recognizing this creates a clear pathway for integrating community health into adaptation efforts and unlocking financing for frontline health resilience.

A Community Health Worker examining a child

Muso

EXTREME WEATHER EVENTS.

Extreme weather events such as heatwaves, floods, hurricanes and wildfires can cause injury, service disruptions and community displacement.

Rising global temperatures are causing increasing extreme weather events, like hurricanes, heat waves, floods, and wildfires. While such events can cause large losses of life and injury initially, the aftereffects also cause significant harm through essential health service disruptions, environmental risks and community displacement.

A multi-decade study on locations affected by tropical cyclones in the U.S. found death rates for injuries, infectious and parasitic diseases, cardiovascular disease, neuropsychiatric conditions, and respiratory diseases were elevated for six months after each cyclone, increasing proportionally for each additional cyclone day.

As trusted members of the community and a link between the health system and individuals, CHWs maintain health service equity and access during emergencies. CHWs can blunt the impact of health system shocks.

VECTOR-BORNE DISEASE.

As climate change alters temperatures and weather patterns around the world, the risk of vector-borne diseases like malaria, dengue fever and Zika virus will increase.

Almost all vector-borne diseases have a climate dimension. Climate change is affecting the geographic spread of vectors, extending the transmission season for vectors, and altering the behaviour of vectors. According to a 2019 study in the journal PLOS Neglected Tropical Diseases, by 2050, disease-carrying mosquitoes will ultimately reach 500 million more people than they do today.

CHWs are often among the first to detect increases in disease and provide crucial support to affected communities. In many Asian, African, and Central American countries, CHWs detect and treat between 30-50% of the malaria burden. To adequately rise to the challenge of increased vector-borne disease, proCHWs must be the norm.

NOVEL PATHOGENS

The COVID pandemic showed us that pandemics start and end in communities.

As the earth’s climate continues to change, researchers have predicted that wild animals will be forced to relocate their habitats to regions with large human populations, dramatically increasing the risk of a viral jump to humans that could lead to novel pathogens and the next pandemic. Research also suggests that the next outbreaks are likely to originate from low and middle-income countries (LMICs).

The COVID pandemic has made clear that CHWs play a critical role in the control of infectious diseases—identification of outbreaks and suspect cases, referral of suspect cases for treatment, isolation of patients, sharing of essential information at the household level about precautions to take, promotion of immunizations, and participation in vaccination campaigns. Faced with the COVID crisis, well-supported and protected CHWs demonstrated readiness for the fight. Using rapidly adapted protocols and armed with PPE, CHIC research found that CHWs ensured 5.2 million patients could continue to access essential health information and services.

And we’ve seen this before.

The 2016 Ebola epidemic marked a turning point for Liberia’s health service, which was forced to innovate in the face of disaster. As a result, the community health model was thrust center stage—providing, among other things, an early warning system for outbreaks. CHWs’ ability to rapidly identify infections was crucial in ending the outbreak in 2016—the same year the model was scaled nationally. CHWs were more effective at carrying out Ebola-related activities than outsiders. And their relationships with community members proved resilient over time.

In short: CHWs are central to preparing for and fighting disease outbreaks.

A Community Health Worker writing down the details of a patient in a log book

Wandikweza

EXISTING HEALTH CONDITIONS.

CHWs can help communities manage increasing chronic conditions and prevent further complications.

Rigorous studies indicate CHWs can effectively deliver health services as diverse as birth control injections and HIV care management. They also show CHWs can ultimately reduce child morbidity, child mortality, and neonatal mortality. CHWs have long been considered vital to promoting health-seeking behaviors in their communities. Studies from LMICs show CHWs can improve compliance with antiretroviral treatment and provide psychosocial support to people diagnosed with HIV.

With climate change likely to exacerbate existing health problems in populations, such as respiratory and cardiovascular diseases due to increased air pollution and exacerbating allergens, we need CHWs going door-to-door to their neighbors more than ever. CHWs can help communities manage these risks, maintain access to care, and prevent further complications.

BUILDING CLIMATE-RESILIENT COMMUNITIES

As recognized in the ‘COP29 Special Report on Climate Change and Health‘ (section 3.1), CHWs play a critical role in promoting community resilience to climate change through community-based strategies, education and awareness campaigns and being a link to vulnerable communities.

CHWs are often the first point of care for vulnerable and underserved populations in the LMICs that will be most impacted by climate change. We know that CHWs are not a second-rate stop-gap. Not a quick, second-class response to the challenge of providing health services for those most in need. Instead, CHWs are essential to realizing a first-class health system worldwide. Because CHWs can make it possible for all people to receive the vital services required for optimal population health, even in challenging circumstances.

CHWs play a critical role in promoting community resilience to climate change, by raising awareness and providing education about climate-related health risks. They also develop community-based adaptation strategies. And, in crises, they make sure that vulnerable communities have access to necessary resources, such as clean water, food, and shelter.

Now, more than ever, a proCHW workforce is not a nice to have. It is a necessity.

A Community Health Worker seated at the entrance of a house with a mother and her three children

Wuqu Kawoq

CHWs AND CLIMATE ADAPTATION

Climate resilience requires strong connections between communities and health systems. Working on the frontlines of climate-related health challenges, CHWs bring the unique C-R-E-D climate adaptation requires:

Connectors: feeding real-time information from communities into health systems and early warning efforts.

Responders: helping ensure essential services continue during climate-related disruptions.

Educators: helping families understand and reduce climate-related health risks.

Detectors: identifying emerging threats before they overwhelm facilities and communities.

THE PATH FORWARD.

The World Health Organization noted “there is no longer any question of whether CHWs can be key agents in improving health… the question now is how their potential may be realized.” As countries confront the health impacts of climate change, realizing that potential will require recognizing proCHWs as an essential component of resilient health systems.

While CHWs cannot prevent climate-related events from occurring, they play an essential role in helping health systems and communities prepare for, respond to, and recover from their impacts.

As governments develop climate adaptation strategies, they should recognize that resilient health systems depend on proCHWs. Integrating salaried, skilled, supervised, and supplied CHWs into national adaptation efforts creates a clear pathway for strengthening frontline health resilience and protecting communities from the health impacts of a changing climate.

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