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Facing the challenge of climate change in health issues
18/11/2010 by Rahajeng Tunjungputri Same Author (1)
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During my training as a medical student with overnight shifts in the wards of a government hospital,
new patients admitted with severe leptospirosis or dengue fever means that there may be another
long night without sleep. Infectious diseases wards are often overcrowded and a new patient can be
admitted only when a patient is discharged. As medical students with clinical responsibilities at the
hospital, we rarely have the chance to think beyond the hospital walls: about why the diseases these
patients come in with had happened in the first place.
Climate change as a major cause of infectious diseases in Indonesia
In Indonesia, infectious diseases are still the main health problem. Diarrhoeal diseases, dengue
haemorrhagic fever, typhoid fever, malaria, tuberculosis and respiratory infections are the most
common infectious diseases (World Health Organization, 2010). Most of these are vector-borne and
water-borne diseases which have been known to be influenced by climate change. The
IPCC (Intergovernmental Panel on Climate Change) has concluded that “climate change is projected to
increase threat to human health, particularly in lower income populations, predominantly within
tropical/subtropical countries.” Climate change has affected the incidence and pattern of infectious
diseases through environmental change, increased flooding, drought, changes in weather patterns
and increasing incidence of natural disasters (IPCC, 2001).
Temperature affects the range of microbes and vectors, and weather affects the timing and intensity
of disease outbreaks. Mosquitoes, known vectors for many diseases, are very sensitive to
temperature change. Environmental warming boosts their rates of reproduction and the number of
blood meals they take, prolongs their breeding season, and shortens the maturation period for the
microbes they carry. Outbreaks of dengue fever and leptospirosis which normally occur in the rainy
season now have a prolonged period of incidence throughout the year. Increasing floods are
frequently followed by disease clusters: the rain can drive rodents from burrows, provide new
mosquito-breeding sites and fungus growth in houses, and release pathogens, nutrients, and
chemicals into waterways (New England Journal of Medicine, 2010).
A vulnerable population
The vulnerability of a population to the impact of climate change on health depends on factors such
as population density, income level and poverty, food availability and distribution, level of economic
development, local environmental conditions, pre-existing health status, and the quality and availability
of public health care. Indonesia consists of more than 17,000 islands, about 6,000 of which are
inhabited, and a population of more than 218 million. Geographical, social, cultural, and developmental
diversity is inevitable. Poverty is still significant, with 27% of the population living below the national
poverty line (WHO, 2010). With poverty and high population density in urban areas, natural or man-
made disasters such as flooding can affect a large portion of the population. Urban crowding has led
to water contamination that may promote various pathogens, in addition to water-collecting trash that

2. may act as mosquito-breeding sites. With such difficult and diverse environments within the country,
some areas still lag behind in development and some populations are more vulnerable than others.
The necessity for a scientific, integrated approach to solve the problems
Research must not just be a scientific process but must have applications to protect the
vulnerable population through effective policy-making and sustainable programmes. The challenge is
to understand that health and climate change is a complex matter that requires an integrated approach.
Beyond the public health efforts and health-care service, a multitude of information must be involved in
an integrated manner to improve health: human demography and behaviour, land use and environment,
food and agriculture, travel and trade, economics, governance, and climate. Governments must allow
the participation of people in the planning, decision making and executing the programmes to evoke a
sense of ownership and ensure sustainability as well as accountability. Within an integrated
framework, the different sectors at all levels must work together simultaneously to improve not just
health, but also education, empowerment and economic development of people.
Addressing health issues demands thinking beyond the scope of medical services alone. These
perspectives are unfortunately still underestimated. Only a broad knowledge base that extends from
epidemiology to anthropology, politics, economics, and climatology will produce adequate responses to
prevent climate change from causing further adverse health impact. This integrated approach must be
applied involving contributions of various levels and sectors within governments, the
international community, NGO (Non-Governmental Organization), private sectors, civil
society, communities and individuals to take action. Once again, research then must be put into use to
better protect the vulnerable population, and to implement the most effective policies.
By Rahajeng N. Tunjungputri
REFERENCES
Haryanto, 2009. Climate Change and Public Health in Indonesia Impacts and Adaptation. [Online]
Available at: http://www.preventionweb.net/files/12431_haryanto1.pdf [Accessed 25 July 2010]
New England Journal of Medicine (NEJM), 2010. Global Climate Change and Infectious Diseases.
[Online] Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp0912931 [Accessed 25 July 2010]
The Intergovernmental Panel on Climate Change (IPCC), 2001. International consensus on the science
of climate and health: the IPCC Third Assessment Report. [Online] Available
at: http://www.who.int/entity/globalchange/environment/en/chapter3.pdf [Accessed 20 July 2010]
WHO, 2010. Indonesia. [Online] Available at: http://www.who.int/countries/idn/en/ [Accessed 20 July
2010]
Rahajeng N. Tunjungputri is a staff at the Department of Parasitology,
Faculty of Medicine Diponegoro University, Semarang – Indonesia
climate Climate change dengue fever female scientist hospital Indonesia infectious
diseases integrated approach Intergovernmental Panel on Climate
Change IPCC leptospirosis microbes Mosquitoes NEJM New England Journal of Medicine NGO Non-
Governmental Organization public health Rahajeng
Tunjungputri Science scientific WHO women Women's Forum World Health Organization
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