By Dr Tumi Moshoeshoe-Mthombeni

The Earth is in a state of emergency, and its symptoms are manifesting in our daily lives. From the sweltering heat of our cities to the parched farmlands, climate change is not a distant threat but a present-day reality that is deeply intertwined with our health and well-being. In South Africa, a nation already grappling with profound socioeconomic disparities, the health consequences of our changing climate are particularly acute, exposing the vulnerabilities of our communities and the urgent need for a new approach to health—one that recognizes the intricate connection between personal and planetary well-being.

The relentless rise in global temperatures is unleashing a torrent of weather-related disasters across South Africa, each with its own set of devastating health implications (1). The increasing frequency of heatwaves, amplified by the “urban heat island” effect in our cities, is leading to a surge in heat-related illnesses and a significant rise in morbidity and mortality (1). Prolonged droughts are not only decimating our agricultural sector, leading to food insecurity and malnutrition, but are also kicking up dust storms that exacerbate respiratory conditions (1). On the other end of the spectrum, extreme rainfall and flooding are creating fertile breeding grounds for vector-borne diseases like malaria and triggering outbreaks of waterborne illnesses such as cholera and other diarrhoeal diseases (1,2). The smoke-laden air from increasingly common wildfires further compromises our respiratory health (1).

These health risks are not distributed equally. It is the poor and marginalised who bear the brunt of this crisis (3). Centuries of systemic inequality have left many Black African, Coloured, and Asian communities residing in climate-risk areas, from coastal regions to polluted urban industrial zones (3). They often live in poorly constructed housing that offers little protection from extreme heat and lack access to essential services that could build resilience (2,3). This “environmental inequity” means that the health impacts of climate change are disproportionately shouldered by those who have contributed the least to the problem (3).

Compounding this issue is the stark reality that our health departments and infrastructure are ill-prepared to cope with the escalating challenges (2). While there are frameworks in place, their implementation at a local level is often hampered by a lack of resources, expertise, and political will (2). The health system, already strained by existing burdens, is struggling to respond effectively to climate-related emergencies (2).

The Pillars of Lifestyle Medicine Under Threat

For those of us who champion the power of lifestyle medicine to prevent and reverse chronic disease, climate change presents a formidable obstacle. The very foundations of a healthy life—the six pillars of lifestyle medicine—are being systematically eroded by our changing environment (4).

• A Whole-Food, Plant-Predominant Diet: Climate change is jeopardizing food security in South Africa, with crop yields expected to decline across the country (2,3). This not only threatens the availability of nutritious food but also drives up prices, making healthy eating a luxury that many cannot afford (2).
• Regular Physical Activity: The rising temperatures and deteriorating air quality are making outdoor physical activity increasingly unsafe (4). This is particularly concerning in a nation where a significant portion of the population is already physically inactive (4).
• Restorative Sleep: The discomfort of hotter nights, coupled with the anxiety and stress of living in a changing world, is disrupting our ability to get the restorative sleep that is so crucial for our physical and mental health (4).
• Stress Management: The psychological toll of climate change is undeniable. From “eco-anxiety” to the trauma of experiencing extreme weather events, the mental health of our communities is under increasing strain (2,4).
• Positive Social Connections: Climate-related disasters can lead to displacement and social fragmentation, breaking down the community bonds that are so vital for our resilience and well-being (4).
• Avoidance of Risky Substances: The stress and trauma associated with climate change can lead to an increase in substance abuse as a coping mechanism (4).

A Planetary Health Solution: The Senegal Schistosomiasis Intervention

In the face of these daunting challenges, a groundbreaking initiative in Senegal offers a powerful beacon of hope and a practical demonstration of what “planetary health” looks like in action. Planetary health is a solutions-oriented, transdisciplinary field that seeks to find and implement sustainable, win-win actions for the health of both natural systems and people (4,5).

In the Senegal River Basin, the construction of the Diama Dam, intended to boost agriculture, had an unforeseen consequence: a surge in the population of freshwater snails that transmit schistosomiasis, a debilitating parasitic disease (5). The intervention that followed is a masterclass in innovative, integrated thinking.

Instead of simply relying on medication, the community was empowered to tackle the root of the problem. Invasive aquatic vegetation that served as snail habitat was cleared from the waterways (5). But the innovation didn’t stop there. This cleared vegetation, a public health nuisance, was transformed into a valuable private good (5). It was used to create compost, which significantly increased crop yields for local farmers, and was also found to be a cost-effective and nutritious feed for livestock (5).

The benefits of this single intervention were manifold:

• Improved Public Health: The removal of snail habitat led to a 1.46-fold reduction in intestinal Schistosoma infection rates in schoolchildren (5).
• Economic Empowerment: The use of the cleared vegetation as compost and livestock feed created new economic opportunities for the community, with benefit-to-cost ratios as high as 8.8 when including public health benefits (5). This provided a powerful economic incentive to maintain the cleared waterways, ensuring the sustainability of the intervention (5).
• Enhanced Food Security and Nutrition: The increased crop yields and improved livestock health contributed to greater food security and healthier eating within the community (5).
• Social Cohesion: The collaborative nature of the project strengthened social bonds and fostered a sense of collective ownership and empowerment, as community members worked together on the removal process (5).
• Environmental Sustainability: By returning the nutrients from the aquatic plants to the agricultural system, the intervention helped to close the nutrient loop, reducing the need for synthetic fertilizers and their associated greenhouse gas emissions (5). The physical labour involved also promoted physical activity (5).

A Call to Action: Lifestyle Medicine Prescriptions for a Changing Climate

The Senegal intervention demonstrates that solutions to our most pressing health and environmental challenges are within our reach. As lifestyle medicine practitioners, we are uniquely positioned to be at the forefront of this movement. We must expand our prescriptions beyond the individual to encompass the health of our communities and our planet.

Here is our call to action:

1. Prescribe Climate-Resilient Diets: Champion plant-predominant diets that are not only healthier but also have a lower environmental footprint (4). Advocate for and support local, sustainable food systems that enhance food security and reduce our reliance on carbon-intensive agriculture.
2. Promote Climate-Conscious Physical Activity: Encourage active transport like walking and cycling, which reduces emissions and improves health (4). Advocate for the creation of green spaces in our cities, which can mitigate the urban heat island effect and provide safe and inviting places for physical activity (4).
3. Foster Mental and Emotional Resilience: Acknowledge and address the mental health impacts of climate change (2). Prescribe time in nature, mindfulness practices, and other stress-reduction techniques to help our patients cope with climate-related anxiety and trauma (4).
4. Enhance Sleep in a Warming World: Provide practical advice on how to maintain a cool and comfortable sleep environment in the face of rising temperatures, which can disrupt sleep quality (4).
5. Strengthen Social Connections: Encourage community engagement and the building of strong social support networks, which are crucial for resilience in the face of climate-related disasters (4).
6. Advocate for Healthy Coping Mechanisms: Educate our patients about the dangers of using alcohol and other substances to cope with stress and anxiety, and instead, empower them with healthy, evidence-based lifestyle strategies (4).

The health of our nation is inextricably linked to the health of our planet. By embracing a planetary health approach and integrating these climate-conscious prescriptions into our practice, we can empower our patients and communities to not only adapt to the challenges of a changing climate but to thrive in a healthier, more sustainable, and more equitable South Africa.

References

1. Wright CY, Kapwata T, du Preez DJ, Wernecke B, Garland RM, Nkosi V, et al. Major climate change-induced risks to human health in South Africa. Environmental Research. 2021;196:110973.
2. Chersich MF, Wright CY. Climate change adaptation in South Africa: a case study on the role of the health sector. Globalization and Health. 2019;15(22).
3. Khine MM, Langkulsen U. The Implications of Climate Change on Health among Vulnerable Populations in South Africa: A Systematic Review. International Journal of Environmental Research and Public Health. 2023;20(4):3425.
4. Pathak N, Pollard KJ, McKinney A. Lifestyle Medicine Interventions for Personal and Planetary Health: The Urgent Need for Action. American Journal of Lifestyle Medicine. 2022;16(5):589–593.
5. Rohr JR, Sack A, Bakhoum S, Barrett CB, Lopez-Carr D, Chamberlin AJ, et al. A planetary health innovation for disease, food and water challenges in Africa. Nature. 2023;619:782–787.