Beyond floods and droughts: examining the insidious impacts of climate change on nutrition

As we sat down to speak with Dr. Zulfiqar A. Bhutta, tens of millions of people – from California to Pakistan to the Philippines – had been displaced by flooding, while millions more in the Horn of Africa were also displaced by a fifth straight year of drought, highlighting the growing and profound impact of climate change on health and nutrition.

Dr. Bhutta, co-director of the Center for Global Child Health, The Hospital for Sick Children, Toronto, and founding director of the Institute for Global Health and Development at the Aga Khan University, reflected on themes to be discussed in Bangkok's January 27-29 Prince Mahidol Award Conference: climate change, biodiversity loss, and pollution and the impact on nutrition – and about how health leaders can respond to this profound and existential challenge.

How has our understanding of the impact of climate change on food systems changed over the past few years?

Dr. Bhutta: We’ve known for a while that climate change causes cataclysmic events, including disasters that impact nutrition and food supply. For example, we know that floods destroy crops and uproot people, and that this can lead to acute poverty and food insecurity. We can see this happening right now in Pakistan where floods have uprooted about 33 million people.

That aspect of climate change and its effect on nutrition, food systems, and ecology is reasonably well known. What is less well known is how climate change, in its subtler varieties, such as global warming and heat shocks, influences nutrition in direct or indirect ways.

I recently wrote a viewpoint on this topic, essentially [about how] climate change-induced changes in precipitation, changes in water security, soil moisture content, all have a huge impact on just the ability to grow food. What we saw in America's Great Plains in the 1930s, when a severe drought created the Dust Bowl and forced families to abandon their farms in search of food and work, we’re seeing happen today in many low- and middle-income countries.

What people don't know is that climate change also has an impact on the content of a crop’s micronutrients and nutrients over time. Just as heat wilts the human body and affects metabolism above a threshold temperature, it does the same to crops.

When you have crops growing in extreme heat, irrespective of water and supply of fertilizers and nutrients, it impacts the micronutrient content of crops. That's been very well shown, all of them go down. Extreme heat also impacts crop yield, irrespective of how much nutrients you can pour in through the fertilizer route, which is unsustainable.

What should countries be doing to adapt?

Dr. Bhutta: Countries should be preparing for this in a big way. Take my own country of origin, Pakistan. The country is dealing with climate change in the worst possible manner, both chronic and acute. Last year alone, one third of the country was under water, close to 33 million people were affected, 10 million were displaced and over 700,000 cattle lost. It set back, in one stroke, the entire economy by more than US$20 billion. An impact of that scale doesn’t just affect Pakistan, it affects many other countries by driving up the price of food, impacting supply chains, the cost of living, and creating instability.

These climate change crises are often happening in countries or geographies where you have a concomitant issue of insecurity and conflict that is oftentimes associated with climate change. You look at humanitarian contexts like Somalia or Ethiopia or other regions, even Afghanistan, and you will find that in many of these places the issues are complex, and they impact nutrition, livelihoods, and security all at the same time.

Very few people recognize that some recent well-known conflicts had their roots in climate change. For example, conflict in Darfur actually started as a struggle over control of underground water reservoirs. Similarly, in Syria, the conflict flared following sequential drought, years after 2006 and diversion of water in the Euphrates River, forcing people to migrate to cities where protests flared.

In preparing for the impact of climate change, countries have to adopt a strategy that addresses the challenges across sectors and adapts and builds resilience in response to multiple crises.

Are there any under-recognized opportunities or tools that leaders should be thinking about as they seek to address climate change challenges?

Dr. Bhutta: I think the power of communities and the power of traditional thinking. There is some truth in climate solutions that come out of traditional wisdom, communal wisdom.

In Southern Pakistan, for example, average summer temperatures have often surged above 40 Celsius. [Though] 50s were rare, it was quite common to have temperatures in the 40s. Traditional societies knew how to live with it, in their construction materials, in the way they built their houses with wind catchers, high roofs, and ventilators to encourage ventilation.

Fast forward 50, 60, 100 years, and today, people use construction materials and construction designs which are totally climate-unfriendly, both in that they are difficult to make efficiently, and difficult to cool efficiently without using a lot of energy.

Are there any exemplars out there for countries that are dealing well with the challenge climate change poses to nutrition?

Dr. Bhutta: We are starting this research now and we have a sense of some innovative programs that are addressing this, but they tend to be small-scale, not national. Many of the examples of reducing carbon emissions, energy conservation, and promoting climate friendly buildings are from developed high-income settings, and often [have a] high cost. We are also exploring if there is tacit, traditional knowledge in many global settings that may be worth emulating or learning from.

We are evaluating the impact of best practices in some geographies in terms of addressing deforestations, water conservation, and heat-adaptation measures which have the potential of scale-up in other contexts. Others are experimenting with drought resistant crops and drip irrigation as well as low-cost climate-friendly housing in both urban and rural contexts. In some countries, such as Bangladesh, developing robust early warning systems and mitigation measures has led to a dramatic reduction in deaths due to hurricanes and cyclones. This is much needed interdisciplinary work if we are to make inroads into this global crisis.

What in this field are you excited about?

Dr. Bhutta: There is an opportunity that we could do some good in the medium- to short-term. Few people realize that this is not a science-free or evidence-free space.

What excites me here is this opportunity, and my group's work is now pivoting to looking at community-based solutions and platforms for building climate adaptation and resilience, particularly influencing behaviors and practices that relate to gender inequities and climate change, because the biggest impact of climate change in many geographies is on women. Women who have work in the fields and bring water for their households. They don't have the same ability as men to, number one, regulate their timings in extreme heat. Secondly, also in terms of reducing their own personal exposure. More often than not, they also have to cook indoors where the effect of environmental heat and pollution is quadrupled.

Climate change is such a big issue, what sort of impact can you have if you are focused on community-level interventions and adaptations?

Dr. Bhutta: Everything makes a difference. One hundred villages can easily multiply to 100,000 villages. This is how community health worker programs started.

I've spent much of my life in global health working on community-based solutions through community health workers. If you now go back to some of the evidence from the 1970s of how community health worker programs started, they also started very small. They weren't national programs. They were one area, one district, two districts, but gradually the momentum built around their viability, their effectiveness. It soon became clear that investing in community health worker programs provided an opportunity to do something for women and children that was much more effective than building a big hospital. Slowly and steadily, that's happened, but it's taken time.