Empowering Communities to Address Climate Health Risks

Over the next 25 years, 250,000 people around the world will die each year from the effects of climate change who would otherwise be alive, according to estimates from the World Health Organization. The deaths will come from extreme heat waves, mega-typhoons, famine, and other causes driven by rising temperatures and unstable weather patterns.

The climate threat is not a potential problem or a future worry for billions of people — it’s already upon them, and one of the main ways it manifests is as a health crisis. In addition to killing and harming people directly, the climate crisis puts health at risk by destroying homes, health clinics, and livelihoods and by triggering or exacerbating outbreaks of infectious diseases and mental illnesses, including depression and anxiety.

The Global Health Research Core at Harvard Medical School is responding to the climate crisis by building a network that unites researchers from Harvard schools and affiliated hospitals with community-based organizations, ministries of health, and researchers in more than a dozen countries. The network is working together to prioritize climate-health-related research and to put in place solutions that empower communities to protect their own well-being.

“We know climate change is unhealthy; that’s nothing new,” says Megan Murray, MD ’90, faculty director of the Research Core and the Ronda Stryker and William Johnston Professor of Global Health in the Blavatnik Institute at HMS. “We want to use our research to find the best ways to help, using the strength of deep relationships with communities around the world as leverage.”

Murray — who leads the Research Core and is director of research in the HMS Department of Global Health and Social Medicine — is part of a team of physicians and researchers dedicated to finding and delivering solutions to some of the world’s most stubborn, complex health problems. One key is to start by asking the people who need help what problems they want to solve. Murray says more communities are naming health issues related to climate change. The next crucial step is to bring together the resources needed to start solving the problems that the communities have identified.

“When you’re thinking about global climate change as an environmental problem or a political challenge, it can feel very hopeless,” says Murray. “But, as a physician, when I see people who are sick or hurt, I’m trained to help. I need to do something.”

Focusing on solutions that bring together the strengths of researchers, physicians, and communities can have the added benefit of empowering all people involved, Murray says. “Making the challenges more concrete makes people feel less hopeless.”

A COVID test case

One early branch of the growing climate collaboration grew out of a multinational research project launched at the height of the COVID-19 pandemic. HMS researchers working with the international health care delivery nonprofit Partners In Health built a shared database combining electronic health record data from participating community health centers and hospitals in seven African nations.

User-friendly tools and dashboards enabled local leaders to address challenges related to the pandemic. In the absence of COVID tests, increases in reports of respiratory symptoms helped clinics prepare for surges in patients with the virus. During lockdowns, the tools could also identify decreases in access to crucial non-COVID care, such as prenatal visits and vaccinations, and help providers find ways to deliver services where they were most needed.

When the worst of the pandemic passed, the communities involved in the collaboration asked if they could use a similar approach to help deal with climate-related health challenges. The HMS Research Core, working with Harvard University experts in climate science, is now laying the groundwork for a series of pilot projects that bring together the unique perspectives of researchers, health care delivery organizations, and community groups to address pressing environmental and medical challenges.

For projects like these, Murray says, science can provide important tools for long-term planning and policy, while involving local community health organizations from the start can put near-real-time data to use to improve responses to health crises as they are happening.

Building a working network

To start the process of building an effective network of scientists, care providers, and communities working together to solve climate-driven health challenges, the Research Core and colleagues across the university hosted a number of in-person workshops to identify potential collaborations. These convened representatives from urban and rural workers’ movements, community-based health care systems, Indigenous people’s groups, and physicians and researchers working in areas such as health care implementation, earth science, database design, and genomics.

The initial goal was to identify shared challenges and begin the search for solutions. In addition to those with long-standing relationships with HMS faculty, the workshops include new groups that have worked with the Salata Institute for Climate and Sustainability at Harvard University and the Harvard Global Health Institute, which have also provided support for the workshops.  

Those meetings now form the foundation of a working network of collaborators, meeting regularly to discuss challenges, successes, and ongoing work. The stories and data that participants share in these meetings are being developed into a case-based course on climate change and health.

“Bringing together people with such a wide range of experiences and skills and working on a shared challenge is the best way to solve the complex challenges to health and well-being that communities are facing as the impact of climate change is felt around the world,” Murray says.

Among the participants are members of the India-based Self-Employed Women’s Association (SEWA), who have worked with a team led by Caroline Buckee, professor of epidemiology at the Harvard T.H. Chan School of Public Health, and Satchit Balsari, HMS associate professor of emergency medicine at Beth Israel Deaconess Medical. They are using heat sensors to measure the environmental temperatures experienced by women working in the informal economy, which includes street vendors, small business owners, domestic workers, and casual laborers and accounts for a significant portion of all employment in India. The temperatures these workers experience on the job are often considerably higher than those recorded at official weather stations.

Until recently, many Maya people in Guatemala have made a living on small upland farms, producing crops for their families and for market. Climate change has made this way of life increasingly precarious, and now many Maya workers migrate for jobs as laborers in lowland sugar plantations, where they also experience illnesses caused by heat exposure. At a recent workshop, SEWA members connected with rural workers from Guatemala’s Maya Health Alliance to discuss interventions that could relieve some of the health damage done by working in high heat and humidity. These include adding reflective coverings on building roofs, changing work hours, and establishing mutual insurance programs that could provide financial support for those unable to work during dangerous heat waves.

Better research, better health

“Sometimes the best ways to protect health aren’t medical interventions,” Murray says. “But we do have access to research and health care techniques that can help, and we want to share them whenever they can be helpful.”

Toward this end, the groups are exploring the potential of adapting a climate-health tool kit developed by Caleb Dresser, HMS assistant professor of emergency medicine at Beth Israel Deaconess Medical Center, and colleagues at the Harvard University Center for the Environment to enable community members to protect themselves from heat-related illnesses, dehydration, and other problems.

The Research Core is currently developing several other projects that would give local communities tools to allow them to participate directly in conducting research and solving the health challenges caused by climate upheaval.

This February, Murray and Ximena Tovar, the program director of the Research Core, travelled to Iquitos, a city in the Peruvian Amazon, to lay the foundation for a wastewater-based epidemiology project. In places with limited access to individual diagnostic tools for patients, sampling wastewater at community health centers could be an important tool for monitoring for outbreaks of known diseases and emerging pathogens, the researchers say. After the first sites are up and running, Murray says, the plan is to expand to the towns of Chachapoyas and Puerto Maldonado, and eventually to rural Indigenous communities. All of these communities are in areas that, like Iquitos, are shaped by humans and animals sharing habitats in new ways and climate-related pressures.

Buckee is looking to expand a project she launched in Guyana training youth to work as citizen-scientists, collecting data with smartphone-based tools developed by NASA that can identify the larvae of mosquitoes that carry dengue and other infectious diseases in order to give local health systems early warning about outbreaks. The project uses an inexpensive attachment that allows camera phones to take photos of mosquito larvae, coupled with an online tool that can identify mosquito species that are known to carry disease. This surveillance can help communities target efforts to remove water from rain puddles, tires, and other places where disease-harboring mosquitos breed. 

Sonya Shin, MD ’98, HMS associate professor of medicine in the Brigham and Women’s Hospital Department of Global Health Equity, is working with the Nature Conservancy and local Indigenous and environmental organizations in Peru to develop nature-based solutions to water shortages caused by climate change, such as replacing water-ravenous invasive plants with local plants adapted to drought.

Murray and colleagues are building on decades of experience working with community organizations in the most challenging circumstances. This time, instead of teaming up with locals to tackle multi-drug-resistant tuberculosis or Ebola, they’re working together to reduce the health risks of climate change.

“Instead of coming in with ideas about what we want to learn or how we want to help, we’re really interested in having communities define the research agenda that’s most important to them,” Murray says. “Then we can use our experience delivering health care around the world and all the resources we have at our disposal at Harvard to think about what practical things could be done now to reduce suffering and to give these communities the tools and skills they need to deal with these problems themselves.”

Jake Miller is a science writer in the HMS Office of Communications and External Relations.

Images: NASA’s Scientific Visualization Studio (global heat map)