“We’ve named the beast. Now we need to rally behind solutions.”

As part of our series on climate and health, we spoke to Dr. Bilal Mateen, who shared his views on how climate change presents a direct threat to infectious disease control, mental health, and overall wellbeing, and reflected on the need for global-local engagement, digital solutions, and most of all, putting health at the center of the climate change conversation, if we are to adapt to and mitigate its impacts.

Tell us about your organization’s focus on looking to science to solve the urgent health challenges we face?

Dr. Mateen: Wellcome supports research into life, health, and wellbeing and we’re prioritizing three of the biggest worldwide health challenges: mental health, infectious disease and climate and health. It’s why we have committed to spending £16 billion over the next decade to support science and health research. Specifically, we want to create a world in which there is a reduced risk and impact of escalating infectious diseases, where catastrophic climate breakdown is averted, and where no one is held back by mental health problems.

Focusing in on your work on the impacts of climate change, tell us more about your approach to the problem?

Dr. Mateen: From our perspective, it’s about putting health at the heart of climate change action. At its core, our strategy is going to be based around driving a step change in the quality and quantity of evidence, on both the impacts and effective solutions to inform decision making, at the global and local level. And to be clear, impact for us is improving health and wellbeing globally, not just publishing high-impact papers – even if we recognize we need to build a robust evidence base for climate change adaptations that can best protect health especially in the most vulnerable communities, it amounts to little if we fail to advocate strongly for local and global resource mobilization to implement them at scale.

Climate and health have not been seen in an intersectional manner. How are they related and what problems are created by not looking at both in a holistic way?

Dr. Mateen: You’re absolutely right – the intersectionality is often missed, and critically, that intersectionality is in large part why the burden of climate impacts on health will not be equally distributed among us.

I’ll use a personal example to explain what I mean. In Pakistan this year, just a few hundred miles from where I was born, we saw temperatures exceed the wet bulb threshold at which sustained exposure is fatal. We didn’t expect to see population centers experience this for several more years, yet here we are. Back in 2010, we saw catastrophic flooding in Pakistan, which was later attributed to a longer-term climatic trend, and we were told to expect more extreme events of this kind. Now, 12 years later, we’ve experienced catastrophic flooding of the Sindh province in Pakistan. But remember, that happened in a context where local health systems and the population were already being challenged by extreme heat. Finally, with that flooding came infectious diseases, from over a hundred thousand reported cases of diarrhea to tens of thousands skin- and eye-related infections – and those are just the ones we know about. In essence, the health challenges we’ve chosen don’t exist in isolation; as the environment changes due to climate change, there will be increasingly profound impacts on our health, and we will miss the greatest opportunity for impact if we fail to recognize that intersectionality.

You mentioned the link to infectious diseases, how is climate change impacting your work in that space?

Dr. Mateen: Climate change has and will continue to influence the emergence and escalation of infectious diseases. Warming temperatures are making new environments much more suitable for disease-carrying vectors, such as mosquitoes. It is predicted that over than one billion people will be newly at risk of dengue, zika, chikungunya and other diseases by 2080, so we need to improve our understanding of these diseases and how climate affects their behavior, and develop more effective responses. Data and technology are vital here, from better tools and data to model these diseases, to effective early warning systems that give governments and communities a chance to get ahead of likely outbreaks.

What about your work in mental health? How does that intersect with the climate crisis?

Dr. Mateen: There’s growing evidence of the strong link between the climate crisis and mental health, and the people most likely to be impacted tend to be the most vulnerable. Research published earlier this year – funded by the Sustainable and Healthy Food Systems program, which is supported by Wellcome Our Planet, Our Health (OPOH) – looked at data on mental health and natural disasters in South Africa between 2008-2017. Those exposed to natural disasters were more likely to suffer from depression. And that number was even higher for groups like low-income and Black South Africans, as well as women, and people with less formal education.

What are the biggest gaps in addressing our current climate and health challenges? How is Wellcome looking to overcome them in a sustainable manner?

Dr. Mateen: The field lacks robust and evidence-based tools, especially in areas most affected by climate change - the climate and health communities don’t currently have a shared vision or consistent ways of working together. Addressing this issue requires training the next generation of climate-health scientists, practices that support information exchange, and tools to pinpoint whether a health incident was caused or affected by climate change and to what extent.

That will involve leveraging digital technology – tell us how it can transform the way we tackle problems in both health and climate, in one fell swoop.

Dr. Mateen: Digital technology can fill many gaps I’ve mentioned - from helping us better characterize the impacts of climate change on health, to ensuring we can reach vulnerable individuals at the last mile who often don’t have access to care in a timely manner.

Are there barriers to unlocking the value of technology in this space?

Dr. Mateen: Several.

First, the evidence base for most digital innovations is at best weak, and if I’m honest, largely just absent. In essence, most of us are either funding very expensive papers and code or facilitating an untested product making it into local public health practice. Thus, we need to invest more intentionally in generating best-in-class evidence for these IT-based interventions.

Second, it is very easy to forget about the people behind the digital innovations. More often than not, current funding mechanisms don’t recognize the long-term maintenance needs of these technologies, or the fact that there isn’t a clear incentive structure to reward those that have achieved true impact – in the sense that they’ve helped improved health and wellbeing rather than just having published a paper.

Third, we need to be mindful and weigh the impact of data storage and the increasingly computational nature of science and research against the value it provides. Lest we forget that data centers are now estimated to account for one percent of global electricity demand. This means our continued ability to realize the gains of novel technology without causing catastrophic harm to the planet is a very real challenge, and one that Wellcome is committed to helping tackle, by creating the tools and methods not just to understand better but also directly address.

Do we need to do better to help others understand the links between science, innovation, climate, and health?

Dr. Mateen: Yes! The last couple years have seen seismic shifts in both civil society’s and policymakers’ understanding of the nature of this problem. A year ago, the European parliament voted on whether to call for a fossil fuel non-proliferation treaty… it was voted down 168 to 510. A few weeks ago, it was raised again, and passed with 450 votes with only 119 against. But 119 is still too many!

At the World Health Summit a few weeks ago, we had protestors calling for recognition of climate change as a health issue – can you imagine that happening five years ago? What I’m trying to say is that there is a groundswell of support that’s building, in large part because we are all now starting to see the scale of the issue – the platform is on fire, as many of my colleagues would say – but we need the community-at-large to understand that more, and better-quality evidence is required to inform what we do about it. We’ve named the beast. Now we need to rally behind solutions. If climate is a health challenge, then research is the engine that will get us to where we want to be – a world in which catastrophic climate breakdown is averted in a way that allows human health to flourish.