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Researchers at the University of East Anglia are exploring the global impacts of climate change on human health. From heat waves, rising sea levels, floods and droughts, to air quality, food safety and infectious diseases, our world-leading interdisciplinary research, supported by HealthUEA and ClimateUEA, seeks to identify and mitigate against the health risks of a changing climate.
One such project, led by Professor Paul Hunter, focuses on addressing business continuity challenges in the health sector in low- and middle-income countries (LMICs). The £3 million National Institute for Health and Care Research (NIHR) funded project comprises a cross-disciplinary team of UEA experts across Environment Sciences, Health Sciences and Global Development. Together the team will explore solutions to alleviate the effects of extreme weather events on health services within Malawi, Vietnam, Tanzania, and Uganda, working with key partners in those regions to integrate local and scientific knowledge.
HealthUEA spoke with Professor Paul Hunter, Norwich Medical School and Professor Roger Few, School of Global Development, to understand more about project and what the team hopes to achieve.
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Paul, could you tell us what stage the project is at and what you’ve learnt so far?
“We’re in the very early stages of the project. We've only been going just over four months now. When you're doing this sort of project, so much effort at first is getting the permissions and approvals and contracts sorted out and then getting through the ethics committees.
We've had one meeting in Malawi, which went very well. Except when we went to the area where the work going to take place. Malawi is one of the poorest countries in the world. But it's an absolutely beautiful place. We visited a part of the country that's been suffering from severe drought.
We were going to meet the community and talk with some of the senior people from one of the villages where we were working, and then we were scheduled to visit a hospital clinic.
When we arrived, it started raining for the first time in a long time. It was raining very heavily. We were meeting in the local church, which was just a brick structure with a tin roof. And it was so difficult listening to people talking, because of the torrential rain on the tin roof. Then we went back to the bus, and they told us we couldn’t visit the hospital later that day, or we wouldn’t be able to get back out. So, we piloted the bus and left.
When we got back to Blantyre [Malawi’s second largest city] we found out that in the area where we had just been, 1200 homes had been destroyed and many more people displaced. The health centre, the main hospital we were due to visit, was under a foot or more of floodwater, including the operating theatres. So that was quite something really. What happened that day was exactly why we were there."
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When we got back to Blantyre [Malawi’s second largest city] we found out that in the area where we had just been, 1200 homes had been destroyed and many more people displaced. The health centre, the main hospital we were due to visit, was under a foot or more of floodwater, including the operating theatres. So that was quite something really. What happened that day was exactly why we were there.
How is an interdisciplinary approach valuable to this type of project?
“So, although I'm specialised in microbiology and virology, my passion has always been public health. And the thing about public health is that you rely on a wide range of different sciences and approaches and methods in which to help make improvements. Public health traditionally was very interdisciplinary, and across this project, which is in collaboration with colleagues in Malawi, Uganda, Tanzania, and Vietnam, as well as the UK, the concern is that extreme weather events are becoming more common, and when they happen, they cause huge problems and can overwhelm health services. So, the question central to this research is how can we help health services in low-income countries reduce the impact of future extreme weather events? And when they do occur, how can we help them to recover more quickly?
When you look at the impacts of extreme weather events in health services, there are all sorts of considerations. One challenge is that it can destroy buildings, so you need engineers to tell you how to make the buildings more secure or rebuild them more quickly. One of the big problems with flooding is that you can't get patients in and out of the hospital. And then the nurses and doctors often can't get in and out of the hospital either, so if there's severe flooding, you suddenly lose half the staff. And so, we need experts in traffic and managing those sorts of access issues.
So, to address those challenges, you've got to have a broad group of expertise. The area that I'm known for is waterborne disease, because most of my grants are directly or indirectly related to drinking water and water health. So, I'm used to working with engineers in water engineering, and it just was natural for me to bring this specific group of people together.”
Hearing the voices of those who work in and who use the facilities is also essential, because their knowledge and experience of hazards is truly at the sharp end.
Roger, could you talk us through the next steps for the project?
“The initial stage of the project is focussing on design of the work packages and getting the managerial mechanisms in place for the consortium. This is a fully collaborative task, and each element is jointly managed by staff from the key partner organisations.
Two simultaneous sets of research activity are planned for the first two years of the project. At a broader scale, the team is conducting systematic reviews of literature and analyses of extreme events and health systems globally and nationally. At a more local level, the team is creating a multi-stranded programme of case study research with health staff and the public at district-level health facilities in each of the four study countries.
Gaining an in-depth understanding of how impacts and responses play out on the ground is crucial because, no matter how comprehensive a national plan or policy may be, there will always be constraints and variations in how this translates in practice – especially when we are looking at relatively resource-poor contexts in the case study countries. Hearing the voices of those who work in and who use the facilities is also essential, because their knowledge and experience of hazards is truly at the sharp end.
These two sets of research will then form the platform for work in the second phase of the project that seeks to analyse the gaps and needs in the health system, to model how improvements could be made to reduce impacts and enhance continuity of health services, and to scale up these recommendations beyond the study areas.”
The RESHAPE key project partners are Kamuzu University of Health Sciences and Patient and Community Welfare Foundation in Malawi; Mwanza Intervention Trials Unit in Tanzania; Mbarara University of Science and Technology in Uganda; Hanoi University of Public Health in Vietnam; and De Montfort University, University of Leeds and London School of Hygiene and Tropical Medicine in the United Kingdom.
Paul Hunter is Professor of Medicine at the Norwich Medical School. He specialised in medical microbiology and virology, but during his career, he’s been a consultant in microbiology and virology in hospitals, as well as consultant in public health, and more recently in the Health Security Agency. More broadly, Paul has interests in waterborne and foodborne diseases, industrial pollution and public health and the public health response to disasters.
Roger Few is a Professorial Research Fellow in the School of Global Development. His research centres on the connections between environmental change, risk, and human wellbeing, mainly in lower-income settings. Much of this work lies at the confluence between research in disaster risk reduction and climate change adaptation, with linkages to themes of livelihoods/wellbeing, environmental health, water security and social justice.
This research was funded by the NIHR using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
