New Delhi residents use clothes and books to protect their faces from the scorching sun on a hot June day in India. 2023 could be the hottest year on record. © EAP/Jiji
Summit’s first health ministerial follows record summer spike in heatstroke and dengue cases
SAYUMI TAKE, Nikkei staff writerNOVEMBER 22, 2023 06:00 JST
TOKYO — 2023 is set to be the world’s hottest year on record, and the consequences for the human body are deadly.
Record-shattering temperatures can cause headaches, dizziness and nausea. Disease-carrying mosquitoes flourish after torrential rain and devastating floods. Polluted air causes shortness of breath and respiratory illnesses. The health emergencies that accompany climate change are shaking communities across the globe.
The impact on Asia is already profound. The continent has warmed at twice the speed of the global average in the past 30 years due to its huge land mass, according to the World Meteorological Organization (WMO).
More people in Asia are dying or falling ill than ever before due to high temperatures, the United Nations scientific body Intergovernmental Panel on Climate Change (IPCC) reported in 2022. Heat stress is one of many health risks. Dengue and malaria are increasing in Thailand and Malaysia, while respiratory diseases caused by air pollution are rising in Indonesia. Even mental disorders like depression and anxiety are associated with climate change, according to a 2022 report by the IPCC.
“These impacts that we’re seeing today could be just a symptom of a very dangerous future unless we tackle climate change urgently,” warned Marina Romanello, executive director of the authoritative Lancet Countdown on Health and Climate Change report.
Pedestrians use umbrellas to shield themselves from the summer sun in Shibuya, Tokyo, on Aug. 18. Japan experienced its hottest summer on record this year. (Photo by Suzu Takahashi)
Health is an often neglected aspect of climate change discussions, but the struggle by some in the medical community to focus attention on the health effects of global warming has just won a significant victory. Next month, the first meeting of health ministers and senior health officials will take place on the sidelines of the 28th United Nations Climate Change Conference (COP28) in Dubai. Participants from over 50 countries are expected to gather.
“Just the fact that 50 or more health ministers are coming [together] is a milestone,” said Martin Edlund, chief executive at nonprofit Malaria No More and a veteran of global efforts to combat climate-health issues.
The absence until now of health policy decision-makers in high-level climate discussions is reflected in a global lack of resources, with reports showing that less than 0.5% of overall funding from multilateral climate finance sources is allocated to projects targeting health, Edlund said.
Medical systems are scrambling to cope with more patients due to climate change, and the health community is eager to pressure governments to help. In November, the World Medical Association and other groups representing 46 million health professionals published a letter to COP28 President-Designate Sultan Ahmed Al-Jaber, demanding that at the upcoming conference, “countries commit to an accelerated, just and equitable phaseout of fossil fuels as the decisive path to health for all.”
Ministers deliver statements during the closing plenary at the COP27 climate summit in Sharm el-Sheikh, Egypt, on Nov. 20, 2022. This year’s COP28 summit will take place in Dubai. © Reuters
Under the United Nations’ Paris Agreement, about 200 countries have committed to limiting the Earth’s temperature rise to below 1.5 C compared with preindustrial levels. Breaching that limit would have devastating consequences: increasing heat waves, longer warm seasons, and more serious droughts, rain and tropical cyclones, scientists say.
But in 2022, the global average temperature reached 1.2 C above preindustrial levels and is on course to warm as much as 2.9 C unless more stringent countermeasures are taken, according to the WMO and U.N. Environment Programme.
“Health-centered climate action can still deliver a prosperous future if we act today” to limit global warming, said Romanello of the Lancet. But “if we don’t act now … we know that we will definitely not be able to cope with the increase in those health hazards.”
Heat waves: record-breaking tragedy
On a July midday in Japan’s northeastern Yamagata prefecture, a teenage girl was found unconscious next to her bicycle on a sidewalk. She had been on her way home from her junior high school, where she had been attending club activities. She was rushed to a hospital with symptoms of heatstroke and died that night, according to local news reports. The high temperature that day was 35.5 C, 7 C higher than the 1991-2020 average highest daily temperature for July, according to the Japan Meteorological Agency.
“I have no words for our inability to send her home safely,” the head of the city’s board of education told a news conference two days later, bowing deeply before reporters. “I am very sorry for her loss.”
The incident, in a prefecture known for its cold winters and winter sports, jolted the educational community into strengthening measures for ensuring children’s health, bracing for more frequent and extreme summers ahead.
Japan’s summer heat this year was the highest since records began in 1898, at 1.8 C above the 1991-2020 average. That is three times higher than the global average rise in temperature of 0.6C, which was also a record. The nation’s highest temperature for 2023, 40 C, was recorded in Fukushima prefecture, which borders Yamagata.
The extreme heat in Japan during mid-July-August this year “could not have happened without the temperature boost due to human-induced global warming,” an analysis by the country’s Meteorological Research Institute confirmed in September.
Extreme heat is the most dangerous kind of extreme weather, according to a November report by the WMO. About 489,000 people are estimated to have died annually due to heat between 2000 and 2019, with Asia placed under an exceptionally high burden, having suffered 45% of the deaths. Abnormally high heat can cause people to suffer potentially deadly illnesses such as heat exhaustion and heat stroke. It also can contribute to deaths from heart attacks and other heart diseases, according to the U.S. Environmental Protection Agency.
This summer’s extreme heat wave dealt an especially severe blow to northern Japan, which is unaccustomed to prolonged high temperatures. The region dealt with 12,032 emergency heat stroke cases from May to September, twice as many as for the same period of 2022, according to the Ministry of Internal Affairs and Communications.
“Japan’s average temperature is rising faster than the rest of the world, partly due to natural factors, but climate change is intensifying the results,” said Hisashi Nakamura, professor in climate dynamics at the University of Tokyo.
Yamagata prefecture in Japan is known for its mountainous landscapes and high snow levels in winter. But the region experienced sweltering heat this summer, prompting a spike in heatstroke cases. (Photo by Alice French)
In April, India, Bangladesh, Laos and Thailand were also hit by unusual levels of heat, “largely driven by climate change,” according to an international team of scientists with the World Weather Attribution group.
In India, where temperatures rose to 44 C in some areas in April, 264 people died due to heat as of June 30, the highest number since 2017, according to health ministry data.
In a particularly shocking event, about a dozen people died of heatstroke in western Maharashtra state after attending a government-sponsored award ceremony outdoors under the harsh sun. April is one of the hottest months in India, and the nation’s main opposition party has accused the government of “negligence” over the matter.
“The frequency of these extreme events and unpredictability in terms of their timing have been increasing over the last few years,” Sunil Dahiya, an analyst at the Centre for Research on Energy and Clean Air, told Nikkei. “Every year, the high-temperature record keeps breaking, so it is definitely a manifestation of climate change.”
Heat-attributable deaths and damage are inconsistently reported and take time to analyze, the WMO’s November report warned. The human toll of extreme heat is “far higher” than often reported, it said, and heat-related mortality could be 30 times higher than current estimates.
In Japan during the past couple of decades, yearly heat stroke-related deaths — like the one in Yamagata — have more than quadrupled to a rolling average of 1,134 for the 2017 to 2021 period, up from 229 for 1997-2001, according to calculations by the Ministry of the Environment. The crisis has been exacerbated by the country’s aging population. Health ministry data shows that around 85% of those who died by heatstroke in 2021 were 65 or older.
Women share a cold drink at a “cooling shelter” in Tokyo’s Sumida ward on July 11. Japan’s government has encouraged municipalities to set up such havens to help residents through hot summers. (Photo by Nanami Sato)
Concerned by these figures, the Japanese government in May approved an action plan to halve the number of heatstroke deaths by 2030. Measures include supporting schools to install air conditioners and urging local governments to secure “cooling shelters” — air-conditioned or cooled buildings that provide respite and safety during extreme heat.
While wealthy countries like Japan struggle with heat, the challenge becomes greater for developing nations that lack the resources to sufficiently attend to the threats.
Under India’s heat action plans, the India Meteorological Department issues alerts to help regions manage heat waves. The department also cautions workers in heat-exposed sectors such as construction to avoid direct sunlight and advises rescheduling of strenuous jobs to cooler times of the day.
Ensuring the effectiveness of the plans has been challenging. An analysis of 37 action plans of Indian municipalities in March by the Centre for Policy Research, a nonprofit think tank based in the nation, found that a majority are underfunded and not regularly updated.
Dengue and malaria: climate change killers
Abnormal heat has dire side effects.
On April 15, Thailand recorded an all-time high temperature of 44 C in Tak, a northern province. Warnings of heatstroke spread in a country where an average of 43 people die every year from hot weather, according to the Department of Medical Services.
But the indirect risks of extreme heat are just as deadly: The spike in temperatures this summer along the Thai-Myanmar border boosted the population of disease-carrying mosquitoes that breed there. Border provinces including Tak, Mae Hong Son and Kanchanaburi suffered the highest incidence of dengue and malaria this year.
A photo of a disease-carrying mosquito is displayed at a dengue fever awareness campaign event at a shopping mall in Bangkok on Oct. 24. (Photo by Ken Kobayashi)
The surging mosquito population has reversed years of progress made in Thailand to eradicate malaria, with cases topping 2,500 by midyear.
Dengue cases have risen similarly this year, totaling 127,838 as of November compared to 46,755 in 2022. The WHO categorized this year’s Thai dengue outbreak as “severe,” putting it down to a prolonged rainy season and warmer ground temperatures. Thailand is set to match or surpass its 2019 record of 131,157 dengue cases by the year’s end.
Dengue and malaria, both already endemic in many Asian countries, are rapidly expanding as intensifying heat, rainfall and humidity create new habitats suitable for the mosquitoes that carry the virus and parasite that causes each disease. Hotter seas have also made 17% of Asia’s coastlines suitable for the transmission of water-borne viruses that cause severe skin and digestive infections, according to the 2023 Lancet Countdown report.
The damage is intensifying in Malaysia this year as well. As of Nov. 10, the country recorded 100,936 cases of dengue, up 96.9% compared to the same period of 2022, according to the Ministry of Health. Deaths from dengue have more than doubled to 78 cases compared to 35 the previous year.
The nation’s health care system is already straining with the burden of treating between 60,000 to 90,000 dengue cases annually. The situation is likely to worsen with climate change, according to Azrul Mohd Khalib, chief executive of Galen Center for Health and Social Policy. “We need to plan long-term for these public health emergencies. It is a matter of when they occur, not if.”
Bangladesh, meanwhile, is experiencing its most severe dengue outbreak on record, with over 1,500 deaths reported this year so far, according to the government. An abnormal amount of rainfall, high temperatures and high humidity have led to an increased mosquito population that is putting “huge pressure” on the health system, WHO Director-General Tedros Adhanom Ghebreyesus warned in September.
Dengue patients receive care at the Mugda Medical College and Hospital in Dhaka, Bangladesh, on Aug. 7. Summer floods turned much of the country into a mosquito breeding ground. © Reuters
Pakistan was hit by unprecedented flooding in 2022 — which experts say was linked to climate change — resulting in conditions that contributed to at least a fourfold increase in the number of malaria cases, to more than 1.6 million for the year, according to the WHO. People who were able to escape flooding are now dealing with the swarms of mosquitoes breeding in the stagnant pools of water, the organization said.
Vaccines for these diseases have been largely absent as effective types are only recently emerging. Proven and cost-effective initiatives to counter the diseases aim to eliminate human contact with the insects, such as setting up long-lasting insecticidal nets, spraying insecticides on houses’ interior walls and limiting the breeding of mosquitoes.
The WHO in 2001 endorsed the first such nets, produced by Japan’s Sumitomo Chemical, which applied technology originally used to repel insects from its factories’ windows. The nets, aimed at preventing malaria, are made of fiber that incorporates insecticide and is structured so that the chemical seeps out over the years. The company sells the nets to international financing organizations that donate them to communities in Africa and Asia.
The company is also making a small plastic disc containing a chemical that regulates insect growth. The product, endorsed by the WHO in 2017, is inserted into water, a common breeding site for mosquitoes that carry viruses. It is effective for over six months.
Mosquito nets infused with insecticide, produced by Japan’s Sumitomo Chemical, are part of the global effort to combat the spread of malaria, which is worsening as a result of climate change. © M. Hallahan/Sumitomo Chemical
“Dengue is increasing rapidly, especially in urban areas. … We launched the product as a business in the past year or so,” said Takao Ishiwatari, who leads the anti-mosquito initiatives at Sumitomo Chemical. The company is expanding in countries like Thailand, Malaysia, the Philippines and Brazil by selling the discs in batches to governments and international organizations. But such businesses, though worthy, are not very profitable, and making them more rewarding would motivate more companies to be engaged in combating health issues, Ishiwatari said.
Another measure being tested is to breed mosquitoes with Wolbachia, a common bacterium that naturally occurs in 50% of insect species. The bacterium is safe for humans and the environment but competes with viruses like dengue and Zika, making it harder for the viruses to reproduce inside the mosquitoes and spread among people.
A trial study in Indonesia led by the nonprofit World Mosquito Program in which Wolbachia mosquitoes were released in the city of Yogyakarta between 2017 and 2020 confirmed a 77% reduction in dengue cases and 86% fewer related hospitalizations.
Bad air days
Rising global temperatures are not the only deadly side-effect of burning fossil fuels. The process, combined with crop burning and wildfires, over the past 50 years has also led to an increase in emissions of harmful pollutants in Asia. Air pollution is estimated to be responsible for 4 million early deaths in the Asia-Pacific region every year, according to a 2022 report by the Asian Development Bank.
Of the world’s 10 most polluted cities in 2022, nine were in Asia and six in India alone, according to Swiss air-quality tech company IQAir. Across the continent, the number of young healthy people developing respiratory problems due to polluted air is rising.
Ika Rahmatul Layly, 42, thought she had caught a regular cold in early August when she came down with a cough, stuffy nose and mild fever. The resident of South Tangerang, on the outskirts of Jakarta, said she would usually recover from such symptoms after taking vitamin C and resting for a couple of days.
But the symptoms persisted for three months, necessitating at least five visits to three different doctors. She was finally diagnosed with “an acute respiratory infection, caused by the pollution,” Layly told Nikkei Asia.
Smog covers Jakarta, Indonesia, on July 16. Many residents have complained of respiratory problems as air pollution in the capital worsens. (Photo by Ken Kobayashi)
She blamed the filthy air she was forced to breathe, despite wearing a surgical mask, whenever she was stuck in traffic on her scooter during rush hour. Many of her friends and neighbors contracted almost identical symptoms around that time and received similar diagnoses, she said.
Jakarta was the world’s most polluted major city for several days in a row in August, according to IQAir. Emissions from vehicles and coal-fired power plants near the Indonesian capital are believed to be responsible for the hazardous air, aggravated by a particularly bad drought and unusually high temperatures brought by the El Nino weather phenomenon between July and October.
The alarming levels of toxic pollutants prompted the Jakarta municipal government to impose a two-month work-from-home policy for half of the city’s civil servants; the dictate expired in October.
President Joko Widodo at one point ordered cloud seeding to induce rain, but the lack of clouds over greater Jakarta conspired against the idea. As part of long-term solutions, the government said it would keep pushing for the early phaseout of coal plants and accelerate the development of renewable energies and carbon tax.
Pandu Riono, an epidemiologist at the University of Indonesia, told Nikkei he suspects that the combination of polluted air and hotter conditions is contributing to the rising prevalence of a range of health issues, including diarrhea, heart attacks and mental health problems.
“Food becomes spoiled faster when left outside, causing spikes in diarrhea cases,” Riono told Nikkei. “Older people in particular are becoming more prone to heart attacks … especially when the air is toxic due to pollution. And the rising temperatures, combined with air pollution … are causing the quality of life to deteriorate, causing people a lot of discomfort. So, many are becoming stressed out, leading to an increase in mental health problems.”
The Suralaya coal-fired power plant in Cilegon, Indonesia, is one of many fossil fuel plants polluting the air across Asia. © AP
Some local governments, including in India, home to most of the world’s top 50 polluted cities last year, have tried introducing bans on construction or restrictions on car use to curb air pollution.
Experts say countries must kick their fossil fuel habits to have any chance of reducing air pollution and its health impacts. “The only solution [for India] is reducing the consumption of fossil fuel,” Dahiya, of the Centre for Research on Energy and Clean Air, told Nikkei. “We are losing more than a million lives every year just due to air pollution.”
No time to waste
The WMO warned in November that 2024 may be “even warmer” than 2023, with more intense heat waves, heavy rain and other extreme events in some regions. While El Nino impacts are partly to blame, “this is clearly and unequivocally due to the contribution of the increasing concentrations of heat-trapping greenhouse gases from human activities,” Secretary-General Petteri Taalas warned in a news release.
“Climate change is an unchanging trend and will undoubtedly enhance temperature levels. We have to take measures to adapt to the situation while making efforts to decarbonize and avoid the worst,” said professor Nakamura of the University of Tokyo. “The problem is, the change is happening at a scale so rapidly that the ecosystem can’t keep up.”
Monks walk in front of the Patuxai, or Victory Gate, on a hot day in Vientiane, Laos, on Aug. 8. The country was hit by unusual levels of heat this year. (Photo by Ken Kobayashi)
Health officials at COP are expected to discuss the connection between climate change and health, ways to build climate-resilient health systems, and how to mobilize investment in health, according to the COP28 presidency.
“The [climate change] challenge is getting harder, but the solutions are getting better,” said Edlund of Malaria No More. “If we move fast, we can address these diseases so that climate [change] won’t make them worse over time.”
Data shows that “we’re starting to increase our capacity to adapt to current levels of climate change, but we know that we’re heading to at least 1.5 degrees, probably much more than that if we don’t act now,” said Romanello of the Lancet. From building a resilient and decarbonized health system and increasing health funding to ensuring a just transition and rapidly phasing out fossil fuels, “there’s a lot more that we should be doing, particularly as we head to COP28.”
Additional reporting by Erwida Maulia in Jakarta, Francesca Regalado in Bangkok, Norman Goh in Kuala Lumpur and Kiran Sharma in New Delhi.
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