Image of four children gathered around a waterspout and smiling as they run water over their hands.

From Trickle to Flood: How Water Extremes Can Impact Health

Wan Lee

July 10, 2018 | 3 Minute Read

Water and Sustainable Cities | Climate Change | Resilience | Health Systems | Health

Climate Change

Fluctuations in water availability caused by climate change can have huge public health ramifications. In this blog post, Wan Lee argues that sometimes the solutions to these burdens can be found outside the health sector.

In early 2018, drought-stricken Cape Town narrowly averted its “Day Zero,” the day when taps in the city would have run dry. Reservoirs filled up just enough to avert an all-out water crisis, and “Day Zero” has now been pushed to 2019. Meanwhile, in 2016, 2017, and 2018, floods in South Asia, Africa, Europe, and the United States have led to urban interruptions, evacuations, and deadly landslides.

Climate change experts have predicted that global water shortages and floods may be a harbinger of things to come. Recently there have been drought crises in California, Brazil, and Spain and changing weather patterns are increasing the number of extreme weather events, including heavy storms and rising sea levels, leading to floods that severely affect those living by rivers and seas.

For those of us who have access to readily available water and strong urban infrastructure, scenarios such as “Day Zero” and waist-deep floods seem like a distant reality. But, many communities living in developing countries are in a much more vulnerable position: These events can be devastating and have a huge impact on human health.

When Climate and Water Fluctuate: The Case of Cholera

Drought and floods have some obvious consequences. Drought stresses natural, agricultural, and livestock resources and creates conflict among water users. Floods can result in loss of human life as well as crops and livestock, property damage, and non-functioning infrastructure facilities. From these impacts, it is easy to see how drought and floods affect public health: Limited availability of clean water and food jeopardizes healthy individuals and communities. However, alarmingly, droughts and floods not only limit access to necessities, but also affect public health by accelerating the transmission of water borne diseases such as cholera.

A highly infectious and ancient disease spread by water and food, cholera had mostly disappeared from developed countries during the last 50 years. However, in recent years cholera cases have been increasing at an alarming rate, and outbreaks are re-emerging in many countries. Evidence suggests that climate is playing an increasing role in the resurgence of this infectious disease, and analysis of historical weather and epidemiological data over a 70-year period draws a clear link between climate change and the rise of cholera cases. Rising sea water temps, water scarcity caused by droughts, and damage to infrastructure from frequent and extreme weather-related events hinder people’s access to safe water and sanitation and the ability to practice good hygiene, all of which are key to preventing the spread of cholera.

The prevention and control of cholera requires a coordinated multi-disciplinary approach that examines activities both within and outside the health sector.

Official reports grossly underestimate the burden of cholera and, exacerbating the problem, many country health systems are geared towards a more reactive response rather than using preventative measures. Preventative measures, such as improving water, sanitation, and healthcare facilities as well as encouraging communities to adopt more hygienic behavior, are key to preventing the spread of cholera.

And, for an effective long-term approach, the prevention and control of cholera also requires a coordinated multi-disciplinary approach that examines activities both within and outside the health sector.

A Synergetic Approach: Looking Beyond the Health Sector for Solutions

National and international organizations, such as the WHO, FAO, and CDC, are now looking at ways to approach human health through a more holistic lens, looking at inextricable connections among the environment, animal health, and human health through approaches such as “One Health.” One Health is the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment. The phrase is new, but the One Health concept has existed for many centuries.

The current One Health initiative was created in response to the H1N1, Avian influenza, and Ebola outbreaks from the early 2000’s. At the 2007 International Ministerial Conference on Avian and Pandemic Influenza, 111 countries and 29 international organizations demonstrated their support to develop the One Health movement. Currently, nations such as Uganda and Rwanda are beginning to integrate One Health approaches into their national strategic plans.

By using One Health’s collaborative approach, countries can strategically identify multiple factors that affect the spread of cholera as well as solutions that might not be obvious initially. It is well documented that cholera is often linked to poor environmental conditions and scarcity in clean water. With One Health, countries can consider solutions that might not present themselves through a health-only lens. For example, clean water generation is key to preventing the spread of cholera, and studies reveal that high water quality, increased water flow, and water availability correlate with forest cover and healthy wetlands, which trap and filter out pollutants and also recharge groundwater points. With One Health, governments can explore long term strategic solutions that include supporting a healthy environment, leading to better human health outcomes and lessened disease burden.

There is little doubt that health impacts arising from the changing climate are bound to occur with more frequency and severity in coming years, and it is imperative that we plan for these globally. It is not enough to react to and treat diseases, such as cholera, as they occur because these are only temporary solutions. Instead, we must look at strategically planning health initiatives based on a multi-sectoral collaboration and a One Health lens – only then can we find solutions to tackle our changing environment and our changing health.

Blog posts on the Chemonics blog represent the views of the authors and do not necessarily represent the views of Chemonics.