"A vicious cycle made worse"

Dr. Maria S. Guevara is a senior operational advisor at Medecins Sans Frontières (MSF) / Doctors Without Borders in Geneva. After several years as a medical coordinator in the field, the focus of her work today is humanitarian advocacy, notably in relation to planetary health issues. Passionate about the existing and future impacts of the ecological crisis for the health of vulnerable populations, she answers our questions.

GS — As a medical doctor, can you tell us about the links between the climate emergency, food insecurity and malnutrition?

Dr. Guevara — There is so much research and science out now that highlights the connections between climate emergency to food insecurity and malnutrition, namely that climate change directly or indirectly impacts nutrition security by exacerbating existing threats. It works in a cascading fashion.

But rather than starting from climate change, let’s start from the disease itself, in this case, malnutrition, when one works backwards to identify predisposing factors leading up to such a state. The immediate causes are mainly inadequate food intake and presence of underlying morbidities, which in turn may have been due to household-level food insecurity, poor social or hygienic environment, or poor public health.  In turn, these may have been driven by the lack of established infrastructures, questionable government policies, lack of resources, disasters...

Climate change comes on top, whether due to rising temperatures or sea levels, increasing floods or droughts, or just making ‘the environment’ more unstable, unreliable and unpredictable.  All these factors lead to decreased quantity and quality of food, which if not addressed or corrected at any of the levels, would result in malnutrition.

Have you already observed the impacts of climate disruption in the field? Could you give an example?

As an organization with emergency response at the heart of our work, it’s hard to ignore the links between human-induced climate change and environmental degradation to human health impacts.

What our teams are witnessing and responding to across the world are:

• Increased transmission of infectious diseases such as malaria, dengue, cholera and now Covid;

• Water scarcity and food insecurity definitely contributing to malnutrition as mentioned previously;

• Impacts of pollution or heat exposure including acute dehydration leading to heatstroke or exacerbation of cardiovascular/respiratory conditions;

• Emergencies due to extreme weather-related events;

• And, of course, violence, forced displacement and mental health concerns.

All are compounded by climate change leading to the increased vulnerability of populations we serve.

As described above, however, the chain of events may not easily highlight climate change as the direct cause.  The role of medical humanitarian work is perhaps to not only address the impact at the last mile but to also take note of the events, bear witness, study, respond better and most certainly not add more harm than good through additional environmental degradation.

With more temperature increases and extreme weather events, how do you see the evolution of health needs for populations in low-income countries?

The short answer is that it will no doubt worsen, leading to multiplying levels of vulnerability for the already vulnerable.  While we know that temperature rise and the experience of extreme weather events are increasingly a global phenomenon, the impact of each is felt differently by different populations.  A major factor has to do with the capacity for resilience.

In low-income countries, more often than not infrastructures are not well established, health systems are weak and social supports are not always in place.  Meeting basic needs remain a huge struggle for half of the world’s population.

This means when you struggle to put food on the table on a consistent basis, you will fall at the risk of decaying health. And to go back to the nutrition cascade, malnutrition may then set in. It is a vicious cycle made worse by the increasingly severe, unpredictable and uncertain situations brought on by climate change.

I would caution however to simply highlight the vulnerability of populations in low-income countries.  It is important to also note that there are many who live under the poverty line in wealthy countries, including Switzerland. Covid, a zoonotic disease that I am convinced is part of the climate emergency, has certainly highlighted that no one and nowhere is immune. It is and must be a collective responsibility for all to address.

Researchers consider access to health and education for women to be one of the most effective policy tools to stabilize the climate because of its long-term impact on demography. What do you think of such an approach?

While climate change affects everyone, it is well recognized that the poorest and the most vulnerable, including women and girls, bear the brunt of its shocks, whether environmentally, economically or socially.

But it is also well known that when push comes to shove, the women are the ones who will try to fill in the shoes of keeping the household alive, being resourceful, even if it will put at risk their own health or life.

I believe in the empowerment of women and girls, especially as females make up 50% of the world’s population.  Social supports and good education for women can not only help dismantle gender stereotypes but also have been proven to improve the economic standing of a nation.

Regarding demography, there is no doubt that population growth is an important contributor to the ecological crisis. Human footprint is instrumental, if not the driving force in this Anthropocene age of climate change.

What I caution on however is to tag the solution for climate change to be about managing population growth alone, which by default means birth control, an onus normally left to women unfairly.

A larger and more effective response should be about behavioural change by all, decreasing consumption, living more sustainably, becoming more educated about climate, to which women can most certainly play a huge part.