Skip to main content

Table 1 Example framework for a global health impact assessment of a hypothetical policy relevant to climate change

From: Global health impacts of policies: lessons from the UK

Background Global impacts of climate change, transport, and agriculture policy on health
  Greenhouse gasses [GHG] are a major determinant of global warming and climate change, with temperatures forecast to rise by at least two degrees Celsius by 2050[17]. The UK government’s Carbon Plan outlined efforts towards the achievement of an 80% reduction in UK GHG by 2050 through a number of sectors including agriculture, transport, low carbon buildings [heating and energy efficiency], and low carbon industry [manufacturing and steel][18]. While the plan modelled economic impacts of climate change, it did not extend these to include the “social externalities” such as health impacts in the UK or globally[13]. Among the adverse effects of climate change, increased droughts, floods, storms and heat waves are forecast to pose a serious challenge to human well-being, health and equity[19, 20]. Relevant policies might include agriculture and transport: in the UK domestic transport accounts for around 21% of GHG emissions, while agriculture accounts for 9% of emissions[21]. Worldwide, the agriculture sector is estimated to account for 10-12% of total GHG emissions[22], while agriculturally induced change in land-use such as deforestation and conversion of pasture to arable land for feed production accounts for a further 6-17% of GHG[22].
STAGE 1 Screening: in the identified countries, will the policy affect a] access to health and social care, b] people’s individual ability to improve their own health and wellbeing or c] the wider determinants of health?
  Approximately 150,000 deaths and 5.5 million Disability Adjusted Life Years worldwide were attributed to climate change in 2000[23]. Over 85% of these adverse health impacts occurred in developed countries[23], disproportionally affecting the socially disadvantaged including elderly, children, coastal populations and urban slum dwellers[19]. Unless serious efforts are taken to tackle climate change these impacts will rise drastically and serve to widen inequalities. Therefore where a policy is thought likely to have significant positive or negative effects on climate change, this would trigger the need for a more comprehensive understanding of the health effects of that policy at the screening stage of a GHIA.
STAGE 2 Identify health impacts: establish causal links; use WHO, World Bank and Department for International Development resources; consult policy experts and literature
  The likely impacts of climate change on health include[24]:
  Increased deaths and disease events, including cardiovascular events and heat-stroke from temperature extremes – including very hot and very cold days
  Increased allergic disorders such as hay-fever and asthma, due to longer pollen season
  Increased water-borne infections such as cholera
  Increased food poisoning and diarrhoeal disease, eg from salmonella, due to higher temperature
  Increased vector-borne diseases from mosquitoes and ticks
  Population displacement and lost livelihoods due to sea-level rise
  A rise in conflict and instability due to resource scarcity, including food and water
  Such impacts should therefore be considered in the context of the proposed policy, according to the degree to which the policy is expected to have a global impact.
STAGE 3 Prioritise important health impacts, including consideration of differential and cumulative impacts on populations
  The health impacts identified at stage two that are relevant to the proposed policy should then be prioritised according to their likelihood and magnitude.
STAGE 4 Quantify health impacts (analysis): describe, quantify and/or monetise priority health impacts
  Example benchmark statistics that might be relevant in such a GHIA:
  Infectious diseases: By 2030, diarrhoeal diseases are forecast to increase by 10% primarily in young children – from a 2000 baseline – owing to climate change[25], while seasonal exposure to malaria is expected to increase by 16% to 28% in Africa by 2100[25]. The costs of treating rotavirus diarrhoea in India are in the region of $41–72 million a year[26], while Malaria is estimated to cost Africa about $12 billion per year in lost gross domestic product[27].
  Food security: In some developing countries, agriculture yields are forecast to reduce by up to 50% as a result of climate change, with significant impacts on food security, hunger and nutritional well-being, especially among the poor[16, 19].
  Insecurity and civil unrest: As climate change leads to rising costs of fuel, water and food, the risk of social unrest and security will be aggravated[19], particularly in conflict affected regions[8].
STAGE 5 Recommendations to improve policy: including remediation, suggested policy changes and ways of monitoring the on-going health impact to promote accountability and ownership.
  According to the policy under consideration and the priority health impacts identified, relevant recommendations might include e.g. technological changes, strategies to modify agricultural activity or transport usage, or wider policy changes such as influencing Common Agricultural Policy reform.