Climate Change.

FIRST LINE OF DEFENCE.

The World Health Organization (WHO) has labeled climate change “the biggest health threat facing humanity.” Rising temperatures result in increases in several direct and indirect health risks and adverse outcomes. CHWs are essential in responding to the health impacts of climate change and in promoting community resilience to climate change.

Climate change will impact human health through extreme weather events, increased exposure to vector-borne diseases, novel pathogens and the worsening of existing health conditions. These issues have already started to cause human suffering and loss of life.

The impacts of climate change have also highlighted gaps in the ability of health systems to respond to system shocks. It has never been more apparent that we need robust health systems to respond to these challenges. And robust health systems are founded on a well-supported health workforce, of which community health workers (CHWs) are the foundation.

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 in both responding to the impacts of climate change and promoting community resilience to climate change.

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 the first to respond to these increases in disease and provide crucial support to communities affected. 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.

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 neighbours more than ever. CHWs can help manage these conditions and prevent further complications.

PROMOTING COMMUNITY RESILIENCE

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.

Wuqu Kawoq

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.” Will we rise to the challenge of making proCHWs the norm and allow them to reach their potential?

Climate change will result in increases in several direct and indirect health risks and adverse outcomes. And whilst CHWs can’t prevent such events from occurring, they can play an important role in the response and preparedness of health systems to deal with these crises.

Countries that invest in a strong workforce of proCHWs who are salaried, skilled, supplied, supervised, and integrated into robust health systems, place themselves in the best position possible to tackle the challenges ahead.

RESOURCE LIBRARY

Community Health Workers in Pandemics.

Toward financing practices for community health programs that avoid harm and accelerate impact.

Harnessing Expertise to Optimize Community Health.

How six innovative partners joined forces to accelerate the adoption of high-impact community health systems design.

WHO Guideline on Community Health Worker Programs.

Community Health Impact Coalition’s (CHIC) contribution to the landmark CHW guideline by WHO.