Science1 publisher2 min readPublished
Heidelberg researchers want health impact assessment built into climate policy before measures are adopted
Writing in Nature Human Behaviour, a Heidelberg group argues that health inequity is produced outside health systems, and asks climate planners to state in advance which groups each measure helps and which it leaves worse off.
The Scientist · Science desk
What happened
- Nihan Toprakkiran and colleagues at Heidelberg University published a paper in Nature Human Behaviour titled "Rising health inequities require looking beyond health".
- They argue that global inequality in health opportunities is more than a question for health systems and must be embedded as a central concern in climate and environmental policy.
- They state that low- and middle-income countries are disproportionately affected, as are poorer and older population groups living within high-income regions.
- Their central proposal is to embed health impact assessment in climate policy planning, reporting which groups gain in health terms and which are disadvantaged before a measure is carried out.
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Why it matters
- decision An ex ante health-distribution test would move the equity question into the appraisal stage of climate measures, so a planning ministry would have to name the groups a measure disadvantages before committing to it.
- constraint Official environmental and health data is thinnest in the highest-risk regions. That limits how precisely the inequality can be sized, and it leaves the distribution estimated from Earth observation and modelling.
- exposure Poorer and older residents of high-income regions sit inside the affected population, so domestic climate measures in wealthy countries face the same equity test as programmes aimed abroad.
The case for assessing hazards together rests on interaction. Joacim Rocklov, an epidemiologist at the Heidelberg Institute of Global Health, said the health risks entailed by the triple planetary crisis are rarely due to a single threat. Heat, environmental pollution, climate-related infectious diseases and limited resources can occur at the same time, he said [12]. He said those risks "don't just add up" and that they "strengthen one another" [13].
If that holds, a study measuring one hazard at a time understates burden where hazards overlap. The worst-affected group may not be the one a single exposure map picks out. "We have to take a comprehensive view of these threats in order to identify the most impacted population groups and develop effective measures," Rocklov said [14]. He is one of two coordinators of the European Lancet Countdown Report on Health and Climate Change [15].
Alexander Zipf, who heads the Heidelberg Institute for Geoinformation Technology, said, "In the regions with the highest risks, there is still a shortfall of official environmental and health data" [16][18]. The regions the authors name as worst affected are the ones with the least official data about it. Zipf's remedy is to join Earth observation to locally generated geodata, which he said would let researchers "identify regions that have long been overlooked" [17].
Seven of the eight safe and just Earth system boundaries have already been transgressed, the authors underline, and those boundaries are meant to capture the stability and resilience of the whole planet while accounting for equity for all people [5][6]. One is still inside its range [7]. The published account of the paper gives no effect sizes, no split of the health gap between the boundaries, and no comparison of health gains from climate policy against health-system spending [23].
So what the paper supports is a change in sequence, with the distributional question asked during climate planning instead of after it [19]. Nihan Toprakkiran, the political scientist who coordinates Heidelberg University's Climate-Life-Nexus Flagship Initiative, said that "prosperity and greater financial latitude enable people to better protect themselves from climate and environmental crises" [9][11]. She called that inequality "a key obstacle to health equity" [10].
The authors also call for more research on socio-ecological feedback cycles [20]. Their goal is a policy that links containing climate change, protecting biodiversity and reducing environmental pollution with measures to promote health equity [22]. Co-authors include the political scientist Jale Tosun and the eco-epidemiologist Marina Treskova [21]. The Climate-Life-Nexus initiative is set to begin its work soon [11].
What to watch
- Whether any national climate plan adopts an ex ante health impact assessment of the kind the Heidelberg authors describe.
- Whether HeiGIT publishes a risk map for one of the data-poor high-risk regions using Earth observation joined to local geodata.
- What the Climate-Life-Nexus Flagship Initiative produces once it begins work.