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Climate change brought on by changes in the concentration of greenhouse gases and resultant global warming pose an immediate challenge for the preservation of human health. Intense temperature variations, extreme weather events, sea level rise, degraded air quality all pose direct and indirect impacts on physical, social and psychological health of humans. Consequently ensuring human health is an integral part of climate change adaptation and mitigation.

Disease and vector control

Climate change poses challenges for preventing and controlling infectious and vector borne diseases, specifically since climate change is favourable to such pathogens. For example, distribution of vectors change with temperature increase, rainfall variations, extreme weather events such as cyclones and flood events and sea level rise. According to WHO one sixth of the illnesses suffered in the world is due to vector borne diseases. Every year more than one billion people are infected with vector borne diseases resulting in more than one million deaths.

Moreover, vector borne epidemics threaten health security and take a heavy toll on the economy in the way of health expenditure. For example, Campbell-Lendrum in ‘Climate change and vector borne diseases: What are the implications for public health research and policy?’ notes that vector borne diseases has wide socioeconomic impacts resulting in increasing health inequalities thereby acting as a ‘brake on socioeconomic development’. The per capita mortality rate from vector borne diseases is almost 300 times greater in developing nations compared to developed nations. Partly because vector borne diseases have higher incidence in the tropic and partly because under developed health sector. Consequently better and improved disease and vector control plays an imperative role in enhancing human health in the context of climate change.

Human factors such as geographic location of population and proximity to water bodies must be kept in mind while formulating policy to achieve sustainable health goals. For example, as previously reported in article titled ‘Government institutions top dengue violations list’, which appeared in December 10, 2016 issue of the Nation, it was reported that although in the urban setting domestic breeding sites such as discarded receptacles make up for 50 per cent of dengue mosquito breeding sites and rest is made up of various water storage containers and tanks, in the Northern Province shallow cemented wells have been identified as where most dengue mosquitoes are bred.

Raising living standards

Sustainable health goals can only be achieved if governments work to raise living standards. Better vector control programmes, insect and vector repellent, insect screens and air conditioning has to be introduced in order to keep vector borne diseases in check. Sri Lanka has failed miserably in this regard. As reported in article titled ‘Government institutions top dengue violations list’, according to the National Dengue Control Unit government institutions top the dengue violations list, with most breeding sites discovered from various government institutions. According to the Epidemiology Unit the greatest obstacle for controlling vector borne diseases in Sri Lanka is the garbage problem. Waste clogged drains provide the ideal breeding grounds for vectors, especially mosquitoes.

While governments should make waste management a priority in achieving sustainable health goals, water management is equally important, especially in the light of the fact that water retention and storage mechanisms constitute a considerable percentage of dengue breeding sites. Consequently, the government should rethink water retention and waste management mechanisms in conjunction when building new structures. City planning, architecture and design should go hand in hand in future city development ventures.

Urban settlements and housing design

Changes in urban and housing design play a vital role in enhancing human health in the context of climate change as infrastructure is vulnerable to climate change just as humans. Urban settings are vulnerable especially since they are immobile. According to the International Bank for Reconstruction and Development and The World Bank report ‘Cities and Climate Change: An Urgent Agenda’ (2010), Climate change poses direct threats to urban infrastructure, quality of life, and entire urban systems.
Infrastructure such as housing is directly impacted by sea level rise and sea erosion in coastal areas, is vulnerable to extreme weather events such as hurricanes, storms, tsunami, floods and landslides. It is imperative to safeguard infrastructure as property destruction due to climate change or extreme weather events disrupt livelihoods, increase risk of disease due to poor economic conditions, increase disease risks, as exemplified by unprecedented floods and heatwaves. In 2003, more than 70,000 people died in Europe from a severe heat wave. The temperature rose to 4800C in the May 2015 heatwave in India leading to 2,300 deaths.

Again in May 2016 Sri Lanka experienced unprecedented floods. On May 18, 2016, a record breaking 373.3 mm of rain fell on Kilinochchi. Pottuvil recorded the highest on May 15, 145.8 mm. The highest rainfall on May 17 was 267.8 mm, recorded from Mahailukpallamma. Awissawella, Hambantota, Kurunegala and several parts of Colombo City was inundated. Thousands of people were trapped in their own homes, without food or sanitation for hours. The floods were accompanied by two landslides in Aranayaka, and Bulathkohupitiya in Kegalle.

According to DMC over 200,000 people were affected by the 2016 floods. The death toll stood at 92 and 109 were reported missing. But what’s noteworthy is that the Army had to evacuate approximately 26,000 people affected by floods in Colombo. The Kalani River rose in a matter of minutes, forcing the government to evacuate residents from the floodplain. The Meethotamulla Garbage dump disintegrated in the floods, leaving behind a huge health hazard for authorities to deal with for months to come.

Environmental quality

Maintaining drinking water and air quality plays an important role in enhancing human health. Climate change almost always accompanied by an increase in temperature and anthropogenic activities compromises air and water quality.
Drying changes land cover reducing vegetation and changing runoff patters, increasing evaporation, depleting ground and surface water, while also increasing chances of forest fires. These in turn adds to increased air and water pollution. Depreciated water and air quality invariably affects human health.

Water quality

Take, for example, the connection between toxic algal blooms. Although it is highly theoretical, it is believed that toxic algal blooms and heavy metals in surface water bodies work synergistically to cause CKDu. Heavy metals such as nitrates and phosphates are discharged into the sea as tourism industry waste is released into the sea untreated. These heavy metals leak into surface water bodies during dry spells as the water level of water bodies drop.

Moreover, these heavy metals, also used in agrochemicals, wash into water bodies as surface runoff. During dry spells when the water level decreases the concentration of heavy metals increase. Toxic algal blooms takeover due to lack of oxygen and it is hypothesised that chemicals produced by these and heavy metals work synergistically to increase CKDu incidence.

Add to the agrochemicals, the effects of urbanization and industrialization and the untreated waste dumped into water bodies exacerbates the effects of climate change. Waste decaying process emits nitrates, phosphates and sulphates that cause eutrophication. Between five to 13 million tons of plastic is dumped into the ocean annually and Sri Lanka is believed to be the fifth most polluting country in this regard. Sri Lanka generates 5,714,578 kilograms of plastic per day. These plastic refuse leak chemicals such as bisphenole A that bioaccumulates in the bodies of marine fish over their lifetime. Such persistent toxins can accumulate in the organisms in increasing concentrations at successively higher levels in the food chain. Ultimately the consumption of such contaminated fish is detrimental to human health.

Untreated sewage is dumped into the ocean in tons also exacerbating the effects of climate change induced water quality deterioration. In the October 15, 2016 Nation newspaper report titled Plan to cleanse dirty Colombo?, Colombo Municipal Council Director Engineering, MIM Salim admitted that 300 million litres of untreated sewage is dumped into the ocean. In the same report Prof Katupotha of Sri Jayawardenepura University, Geography Department, warned that sewage has become a food source for marine fish species. He pointed out that Sri Lankans who consume fish caught off Wellawatte, where one of the main sewage outfalls are located, have often confided are tastier than regular fish, hinting that these fish maybe feeding on the nutrient rich faecal matter.

Apart from the health impacts of eating contaminated fish, faecal contamination can help increase of pathogen such as Coliform and Ecoli that spread water and food borne diseases and diarrheal disease that are favoured by climate change. A clear parallel can be drawn between the number of cholera cases in Uganda and the El Nino event between 1997 and 1998, when the number of cholera cases increased drastically to over 45,000. It’s clear that there is a direct link between such diseases and climate change and therefore improvement of water quality plays a vital role in enhancing human health.

Air quality

Deterioration of air quality is caused by a number of factors other than climate change and global warming, such as; industrial expansion, increase vehicular traffic, increased thermal power generation, rapid urbanization. Motor vehicles are the most significant contributor to Sri Lankan air pollution, with the transport sector consuming more than 60 per cent of total fuel consumption in Sri Lanka. The Colombo metropolitan region has been identified as the most vulnerable area for air pollution. Other air pollution hotspots include Galle, Kurunegala and Puttalam.

Air quality deteriorates mainly due to soil erosion, increasing particulate matter causing respiratory illnesses, allergic reactions and skin conditions. Sever impairment of air quality is known to cause psychological and neurological conditions, as exemplified in the China Haze incident. Increase in ground level ozone can cause pneumonia, asthma, allergic rhinitis and can even result in death. Suspended particulate matter (SPm) are a complex mix of solids and aerosols in the form of dust, smog, or haze. This is pronounced in urban areas where heat islands trap these pollutants between high-rises.
PM10 are small enough to get through the filtration mechanism of the upper respiratory tract and penetrate the lower airways. PM2.5 pose grave health hazards to human health they as can attack the lymphocytes and phagocytes of the lungs. Exposure to such particles can cause heart disease, lung disease, pneumonia, loss of lung function and asthma. Likewise, Noxes, Sulphur dioxide, Carbon monoxide, Volatile Organic Compounds, Ozone and Lead can cause anything from cough and wheeze to heart disease and morbidity. Overall illnesses induced by inferior air quality affects the productivity of employees and national economic growth.

Remedy

An adaptation plan can be undertaken to avoid and prepare better for infectious disease outbreaks. This would prove vital in policy decisions. An adaptation plan evaluates the effectiveness of policies and measures adopted in reaction to climate-sensitive infectious diseases. It identifies measures to manage current and projected health risks, while also prioritizing such policy alternatives. Adaptation plans are often used to identify human and financial resources requirements, barriers, constraints and limits to implementation.
Adaptation plans can be used to develop monitoring and evaluation programmes to ensure continuum of such policies. This would ensure that despite regime changes human health in the face of climate change is not compromised for political reasons.
The government should attempt to prevent air and water pollution at the source. Cleaner production techniques can be employed to prevent pollution at source. This involves the optimal use of raw material energy and water. Polluting industries should be clustered preferably in industrial parks. This would localize pollution, making it easy to manage by regular and close monitoring by relevant authorities. Industries should be given incentives and laws should be enforced to encourage minimizing of pollution. All these have already been incorporated into the Sri Lanka Industrial and Environmental Pollution Management Policy Statement (1996). However, this has not been practically carried out. For example, pollution is hardly prevented at source, with only a few industry having adopted cleaner production techniques.

The best step any government can take to ensure water quality is to set Waste Water Discharge standards, which Sri Lanka has done. This standard set and maintained by the Environment Pollution Control Unit of the CEA has set tolerance limits for the discharge of industrial waste into inland surface waters, into land, marine coastal areas and discharge of effluents into public sewers with central treatment plants. Further, standards are met through the Environmental Protection Licensing process. The Sri Lankan government has also developed a Waste Water Discharge Fee based on the polluter pays principle to minimize pollution.

In addition, the Water and Sewage Management Policy is implemented by Ministry of Water Supply, National Water Supply and Drainage Board and Colombo Municipal Council. The only pipe borne sewage system is owned by the CMC. However, increasing population has reduced the capacity of the sewer system and the CMC has already undertaken the revamping of the sewage system, a commendable move a government can take to achieve sustainable health goals.

Thermal power generation is one of major air pollution causes. Thermal power generation generates a high concentration of sulphur. In order to remedy this, the government should develop an energy policy that’s bent on renewable energy.
Lack of maintenance of vehicles is a major cause for increasing air pollution from airborne particles from diesel vehicles, CO2 and volatile organic compounds from petrol vehicles. The government should make Emission Tests mandatory to encourage better upkeep of vehicles. Authorities should maintain a proper road network to minimize fuel wastage. Fuel wastage due to poor maintenance of roads is one of the major reasons for air pollution through burning of fossil fuel. Governments should make a policy decision to popularize public transport in order to reduce congestion.

Governments can make use of air quality management strategies such as setting emission standards, setting up legal authorities to implement permitting programmes for industrial and vehicular emission, developing control technologies, ambient air quality monitoring, implementing industrial smoke stack sampling and data management (CEA, Enviromental Pollution Control Unit).

Air quality standards such as Emission Standards and Ambient Air Quality Standards are meant to prevent concentration of pollutants from reaching harmful levels. Authorities can set emission standards for specific sources such as industrial smoke stacks and motor vehicles. Emission standards specify allowable concentration of pollutants depending on nature of activity. Ambient Air Quality deals with air quality in a particular area, specifying allowable pollutant concentrations. This defines adequate margin of safety for human beings, making it a vital strategy to be taken by the government to achieve sustainable health goals.

The Central Environment Authority has already set emission standards for thermal power plants, boilers, thermic fluid heaters, incinerators, cupola, blast furnace, coke oven, basic oxygen furnace and cement kilns. Vehicle Emission Standards are implemented through Vehicle Emission Testing programme. But monitoring in Sri Lanka is still below par compared to other countries. Which suggests that merely setting standards is inadequate.