HEALTH SECTOR

Health Care

Climate change is a major threat in addressing health in the 21^st century, impacting human lives and health in many ways. Health sector takes up a key role in reducing climate change with the roles and advocacy it plays. Direct impacts with the increased frequency and intensity of heatwaves bushfires and floods alongside indirect impacts such as low air quality index, poor facility of good health (organic and nutritious food supply, safe and hygienic drinking water, mental health and proper shelter for one and all) will undermine the potential advancement in global health in the coming years. 

The State Government mainly provides medical facilities and infrastructure in the state. According to the Economic Survey of Manipur, 2021-22, the state has 118 Hospital (including PHC/UHC/CHC), 446 Dispensaries (including PHSCs), 1927 Bed where the Population per Hospital/ Dispensaries s is 6,366, and a population per Bed is 1,862.      

Impact of Climate Change on Health Sector

Sufficient quantities of carbon dioxide and other greenhouse gases to trap additional heat in the atmosphere and affect the global climate have been released over the past 50 years. The world has warmed by approximately 0.85°C in the last 130 years, while temperature trend analysis shows a moderate warming of summer maximum temperature (0.2°C to 0.4°C) in the districts of Manipur during the 30-year period. During the same period, winter minimum temperature has increased in the range of 0.25°C to 0.75°C. The weather events are also becoming more strong and more recurring. The overall scenario of global warming has a more negative impact on the health sector more or less. Determinants of climate change's effect on society and environment are secure shelter, sufficient food, safe drinking water, clean air and other biological infections. 

According to whether they occur predominantly through impacts of climate variables upon human biology or are mediated by climate-induced changes in other biological and biochemical systems, the health impacts of climate change can be divided into direct and indirect effects. An efficient regulatory heat system enables the body to cope effectively with thermal stress in healthy individuals. The risk of (predominantly cardiopulmonary) illness and deaths are substantially increased with temperature exceeding comfortable limits, in both cold and warm ranges. Based on factors like geographical location, age, gender, social status, and access to other infrastructure, these impacts can be further estimated.

Changes in the frequency of extreme weather events such as heat, cold, drought, heavy rain or flood, storm and bushfire can be referred to as a direct impact. The result of increase in death rates, injuries, thermal stresses or psychological disorders and loss of properties would be due to the occurrence of more extreme weather events. Reduction in the availability of freshwater, food and food affordability due to reduced crop yield is also included in the direct impacts of climate change.

Indirect impacts on human health are due to an increase in mean summer and winter temperature. Strong impact on thermal-related diseases, like change in the transmission of vector-borne diseases is due to increase in frequency or severity of heat waves.   

Major causes of morbidity and mortality are due to changes in behaviour and geographical distribution in the incidence of vector-borne diseases that might be influenced by temperature, humidity, precipitation and soil moisture changes. Whereas an increase in non-vector-borne infectious diseases such as acute Diarrhea, Typhoid, Measles, Acute Respiratory and Cholera are water-air related infectious diseases occur because of climatic impacts on water distribution, temperature and proliferation of microorganisms. Thus, major issues of health which can be focused on to the impact of Climate Change in the State of Manipur are Vector Borne Diseases, Air borne and Water borne diseases.

Vector Borne Diseases 

According to WHO, Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another, causing serious diseases in human populations. These diseases are commonly found in tropical and subtropical regions and places where access to safe drinking-water and sanitation systems is problematic. 

With a 30-fold increase in disease incidence over the last 50 years, the world's fastest growing vector-borne disease is dengue, Vector-borne diseases are infections transmitted by the bite of infected arthropod species, such as mosquitoes, ticks, triatomine bugs, sandflies, and blackflies. Arthropod vectors are cold-blooded (ectothermic) and thus are sensitive to climatic factors.

One of the great public health concerns and vector-borne disease is Malaria, most sensitive to long-term climate change. The link between malaria and extreme climatic events has long been studied. Because of the carrier mosquito whose gonotrophic cycle and sporogony is largely linked to surface temperature, rainfall, relative humidity, and wind velocity the incidence of malaria is largely climate sensitive. Excessive monsoon rainfall and high humidity identified as a major influence, enhancing mosquito breeding and survival. The determination of the transmission window is carried out both on the basis of the surface temperature which is coupled with relative humidity (RH).

During the last 57 years (1954-2011) in Manipur, the mean minimum and maximum temperature have risen from 13.9 to 14.90 C and 26.6 to 27.30 C respectively and the average relative humidity has increased from 70% to 80%. The increased current means temperature and the relative humidity is likely to favour the reduced sporogony of the vector mosquito. Moreover, at increased temperature the rate of digestion of blood meal increases this in turn accelerates the ovarian development, egg laying, reduction in duration of gonotrophic cycle and higher frequency of feeding on host amongst the vectors, thus increasing the probability of malarial transmission. District-wise distribution of percentage of malaria cases in the state indicates increasing trends of incidence (as per Annual report of NVBDCP, Manipur 2018-2022). Disease profile of malaria reveals that in the last 5 years Kangpokpi + Senapati has recorded the highest malaria which is followed by CCPur + Pzl District. As seen from the table Malaria cases in the state shows a downward trend for the consecutive year (2021-2022) in the incidence of the vector borne diseases with no record of death cases as of now, it is largely due to the better health infrastructure, preparedness and awareness amongst the people of the state as well as departmental intervention.

According to NVBDCP Manipur, in the last 5 years incidence of the cases of Japanese encephalitis and Dengue are on the rise in the state. The highest positive case was recorded in the year 2022 with the highest number of deaths.  On the other hand, positive and death cases of JE are on the rise as seen from the table. Disease and epidemiological profile points towards the relationship between the occurrence of Dengue and Japanese Encephalitis to subtle changes in climatic conditions that favor the breeding and proliferation of their vectors. Adoption of preventive measures of Japanese Encephalitis and Dengue are critical as these diseases have caused serious morbidity and mortality in recent times across the state. According to NVBDCP, the year 2022 recorded the highest cases and deaths due to Japanese Encephalitis cases (332) and death report (6) as compared to the year 2021.

The National Vector Borne Disease Control Programme in the state of Manipur is being implemented as a component of the State Health Society under National Health Mission. The state programme officer is assisted in all spheres of programme implementation by three units of the programme.

Table: District wise Malaria cases of Manipur for the year 2018 to 2022

 Table: District wise Dengue cases of Manipur for the year 2018 to 2022

Table: District wise Acute Encephalitis syndrome (AES) and JE cases of Manipur for the year 2018 to 2022

Source: National Vector Borne Disease Control Programme, Manipur

Water Borne Disease

According to the WHO, Waterborne diseases generally arise from the contamination of water by faeces or urine, infected by pathogenic viruses or bacteria and which are directly transmitted when unsafe water is drunk or used in the preparation of food. The most well-known water-borne diseases such as cholera, dysentery, and typhoid are the leading causes of morbidity and mortality. The causative agents of water-borne diseases may be divided into three general categories: bacteria, viruses and parasitic protozoa. Bacteria and viruses contaminate both surface and groundwater, whereas parasitic protozoa appear predominantly in surface water. Bacteria and viruses are well-controlled by normal chlorination, in contrast to parasitic protozoa, which demand more sophisticated control measures. For that reason, parasitic protozoan infections may be more common than bacterial or viral infections in areas where some degree of disinfection is achieved. Natural disasters such as floods, storms, and earthquakes pose an increased risk of contamination of water supplies with disease-causing agents. In turn, the health of communities relying on water from surface sources, and those with poor sanitation is at greater risk of, for example, diarrhoeal diseases, typhoid fever and Hepatitis A & E. by increasing human exposures to pathogens, chemicals and cyanobacteria. Heavy rainfalls and floods will increase the release of chemical constituents from minerals and their concentrations in natural waters, including that of elements like Arsenic and Iron, that at high levels are dangerous for human health.

Air Borne Disease

Airborne diseases caused by pathogens and transmitted through the air as very small or aerosolized particles. Disease-causing pathogens are organisms that spread from an infected person to another through coughing, talking and sneezing - even breathing and laughing. 

According to the U.S. Centers for Disease Control, flu droplets can travel up to six feet away. Smaller, lighter particles are suspended in the air longer than larger and heavier particles. The smaller the particle, the farther down in the respiratory tract that particle can travel and these organisms can survive outside the body depends on the type of organism and the conditions of the air, such as its humidity and temperature. There are three main types of organisms that can cause airborne diseases - viruses, bacteria, and fungi.

A changing climate is likely to affect all these conditions and have a powerful impact on human health and well-being. Climate change can affect human health directly (e.g., impacts of thermal stress, death/injury in floods and storms) and indirectly through changes in the ranges of disease vectors (e.g., mosquitoes), water-borne pathogens, water quality, air quality, and food availability and quality. Human beings are already exposed to short- and long-term health risks of climate variability and change. Climate-sensitive diseases and health conditions today kill millions. Climate change threatens to increase disease burdens and erode the environmental conditions that support good health and well-being of mankind. The changing climate is linked to increases in a wide range of non-communicable and infectious diseases. There are complex ways in which climatic factors (like temperature, humidity, precipitation, and extreme weather events) can directly or indirectly affect the prevalence of disease.

The changing climate is linked to an increase in a wide range of non-communicable and infectious diseases. There are complex ways in which climatic factors like temperature, humidity, precipitation, and extreme weather events can directly or indirectly affect the prevalence of disease. Climate change can affect human health directly (e.g., impacts of death/ injury in floods and storms) and indirectly through changes in the ranges of disease vectors (mosquitoes), water-borne pathogens, water quality, air quality and food availability. Human beings are already exposed to short- and long-term health risks of climate variability and change. A changing climate is likely to affect the various conditions of air and water pollution and vector-borne diseases which in turn will have an adverse impact on human health and well-being.

Based on the projection of increased incidence of vector, air borne and water borne diseases, it is imperative that the climate change issues need to be integrated in to health sector planning of the state. The impacts of climate change summarized above are expected to increase the disease burden in the state. As a result, the constraints & barriers to adaptation need to be reassessed to address the problem in future. Further, these are correlated to the impacts of climate change and identified as thrust areas for proposed actions.

Vulnerability Assessment (VA) of Health for Climate Change

Through climate VA we can identify where health susceptibilities exist due to climate change, which will continue to alter the magnitude, frequency, duration, and geographic extent of various climate-related exposures that are detrimental to human health. A climate and health VA allows health departments to understand the people and places in their jurisdiction that are more susceptible to adverse health impacts associated with the climate-related exposures modified by climate change. Assessment of vulnerability in the health sector can be used to implement more targeted public health action to reduce harm to people.

While overall Manipur is potentially vulnerable to the consequences of climate change on health, certain groups such as -young children, the elderly, Pregnant Women and child bearing below 5 years, those with pre-existing health conditions, the poorest in urban and remote rural areas, those performing work in sun-exposed, migrant or displaced people may be more vulnerable. Besides, Birth rate, Death rate, infant Mortality rate, Maternal Mortality rate, Total Fertility rate, % of Mother with full ANC, % of pregnant women with severe Anemia, Institutional Delivery, Sex ratio at Birth, % of Full immunization are some of the health indicators to assess the vulnerability of the sector. An indebted vulnerability assessment of the health sector with reference to climate change needs to be studied for the state.