The Health Burden of Climate Change: A Nigerian Spotlight
Doctors for Humankind Foundation (DHF) reviews a physician’s local experience of the increased global climate change-related health burden.
Climate change is real. The material presented herein is a narrative of a doctor’s personal clinical evidentiary experience with otherwise normal health conditions that have just over the last couple of years intensified in a manner that very clearly points the finger of causation at climate change and its exacerbating influence on the Nigerian and, by extension, the global disease burden.
People die from climate change. People get sick from climate change. Climate change is a matter of life and death. Let us all therefore recognize that in tackling climate change, we are essentially confronting a very challenging health issue.
Climate skeptics will always barrack whatever you say about the reality of the impact of climate change on the planet and on human health. However, those of us who grapple day after day with climate change and its health consequences are determined to forge ahead with measures both mitigating and adaptational, to tackle this challenge in hopes that the skeptics and denialists will eventually wake up.
Doctors in Nigeria have seen young adults in their early thirties, and without prior history of cardiovascular pathology, simply develop palpitations and angina, and die within minutes in the Accident and Emergency. In the same vein, we have watched some other young men, in their early 30s, rapidly worsen and die, within 6 months of diagnosis with mild hypertension and that despite professional treatment and satisfactory hypertension control.
We have also seen unprecedented levels of flooding across the country from north to south, leaving cholera outbreaks in its wake most times. Eye diseases have worsened in prevalence and incidence. Respiratory diseases, such as asthma, emphysema and bronchitis, have all become bigger problems despite our best efforts. Malnutrition and diarrhoeal disease amongst children continue to defy all efforts, and to chalk up ever worsening indices despite improved care because, to take just one or two examples of the simply devastating effects of climate change, Lake Chad has all but disappeared up north and the Sahara Dessert is encroaching down south at an alarming speed, foisting a shortage of everything from water to food and crowding the people more and more into townships.
#: climate change, health, cancer, ozone, ground level ozone, UV radiation, UVA, UVB, global warming, UNFCCC, floods, drought, cardiovascular disease, MDGs, NCDs, infectious disease, obesity, PTSD, respiratory disease, asthma, birth defects, prostitution, child protection, fossil fuel, infertility, subfertility, ovarian failure, cataracts, optic damage
We came back last month from the Durban Climate Conference to find that it was still raining: It was still raining all over southern Nigeria in December, a traditionally dry, harmattan month. This trended on twitter for a bit among climate-educated people in the country. We got Blackberry messages from cities experiencing this ‘strange’ phenomenon. But there are still people determined to believe that all this is a normal cycle.
Climate Change in Nigeria
Anthropogenic climate change has wreaked wide-ranging damage to the health of the people of Nigeria in ways that are only becoming apparent to medical practitioners and to lay people that are, otherwise, keenly observant.
But because Nigeria is the largest oil-producing nation in Africa, it is hard to separate morbidity and mortality directly from fossil fuels like petroleum and coal, both of which are in abundance in Nigeria, from indirect effects of fossil fuel exploration through climate change and its impact on health. Therefore, this paper will consider the health effects of climate change along with the health effects of the most central factor for climate change. And when there are oil spills, which is ever so often the case in Nigeria, the health hazards multiply and deepen exponentially.
On average, there are 1 to 2 oil spills in Nigeria every single day. To contextualize, some of the oil spills have been on the ground since 1960 and have for that long remained unremediated and have continued to wreak damage to the ecosystems of the affected areas and to emit green house gases constantly. These GHGs are laden with volatile organic compounds (VOCs) such as benzene, toluene and xylene. These VOCs react with the equally heavily present oxides of nitrogen (NOx) in the superabundant presence of sunlight to dangerously increase ground level ozone. Some of these VOCs are also CNS depressants (neurotoxins).
The Health Dimension
Every organ system is affected:
The eyes: Anthropogenic greenhouse gases, mainly from fossil fuels like petroleum, deplete the ozone layer and allow dangerous levels of ultraviolet radiation B spectrum through. These affect the eyes in any number of ways creating cataracts, even in children without a history of eye trauma, diabetes or any other possible explanation save the ophthalmic toxicity of climate change and UV irradiation and ground level ozone
Cancers: By the same damage to the ozone layer and the resultant admission of unsafe levels of UV light, damage to all human DNA now occurs in numbers and at frequencies that simply overwhelm the natural DNA repair processes and eventually lead to cancers of all sorts.
Leukaemias: Leukaemias have also been shown to be on the rise as a direct result of increased UV light penetration of our environment through a thinning ozone layer as well as the damaging effects of increased ground level ozone on the immune and white blood cells.
Birth defects: Increased UV irradiation plus the added consequences of water and food and general environmental contamination with hydrocarbons from half a century of oil spills has served to exponentially raise the prevalence and incidence of birth defects. Most of the substances at play have long been well established and documented as strongly teratogenic individually. What we now find in the health care services in Nigeria is that there is an exponential increment in the disease burden from all of them converging all at once on human health.
Maternal, Newborn and Child Health:
- Miscarriages/First Trimester Abortions: The unduly high prevalence and incidence of first trimester abortions in Nigeria is also not unconnected with the correspondingly high burden of prenatal teratogenic processes as has been observed. And a whole lot of the times the high level of ignorance as well as religiosity and superstition causes the dismissal of such unusual occurrences as from the gods of the land and therefore not to do with fossil fuels and climate change.
- Climate Change and Child Protection issues:
There is, ab initio, no social welfare system for our children; nor indeed for anyone in Nigeria. The only social safety net of any sort is the extended family system which has now come under extreme strain owing to economic woes not unrelated to climate change. But what is more, when climate disasters strike, such as floods and drought, no provisions whatsoever are on the ground for the children, and they simply scatter and get missing. Climate change is in fact hampering any progress towards instituting proper child protection. The Nigerian child is therefore at unprecedented risk for kidnapping, smuggling, modern-day slavery and trafficking for drug, child pornography, prostitution and sweatshop purposes. In some cases, parents who have been swept off their farms by years and years of poor yield owing to climate-induced flooding or drought, sell their children into prostitution and pornography in desperation.
Albinos: Nigeria, being a very large population of close to 200 million people, has a correspondingly large population of albinos. Our albinos are not as in danger of ritualistic deaths as in Tanzania and other parts of Africa. They are at risk of climate change. Albinos have either a quantitative or qualitative deficiency of the enzyme tyrosinase and are therefore much more vulnerable than the general population to UV and other toxin damage to the skin, eyes, and other organs. Due to the resulting melanin deficiency, we have registered more eye pathology ranging from just the red eye, to cataracts to blindness, than would have been the case without the observed increment in UV light penetration of our environment due to climate change. The albinos also suffer more than the epidemiologically expected prevalence and incidence of dermatitis and skin cancers.
Accelerated ageing: Increased UVA and UVB irradiation of our skin owing to climate change has also been demonstrated to cause damage to the skin, impairing its self-regenerating potentialities, causing accelerated wrinkling and ageing of the skin as well as delayed wound healing once it has been breached.
Early menopause: We have also observed the alarming rate of infertility amongst young couples where the doctor is hard pressed to explain the premature cessation of the menstrual cycle and the premature emergence of a climacteric hormonal profile. And it has now been postulated that in the absence of any intrinsic pathogenesis to the new observation, a cause might probably be found in the damaging effect of increased UVA and UVB irradiation of the ovaries. This will need to be researched a lot more in order to come to a scientific conclusion. At this point, it is only a curious clinical observation especially in the Niger Delta where in addition to the general global effects of climate change, we also have the direct effects of an alarming rate of oil spills on human health. These oil spills comprise chemicals with a proven capacity to damage bodily organ systems, including the ovaries.
- Increased Cardiovascular Disease Morbidity and Mortality: Just less than a decade ago, NCDs were not a major problem in Nigeria. We were then preoccupied with tackling infective diseases which obviously were the clear leader of all-cause mortality amongst Nigerians. However, we now observe an otherwise inexplicable acceleration of the health burden due to cardiovascular diseases, ranging from anginas to arrhythmias to sudden deaths from cardiac failures amongst young men in their 30s and a number of them well educated, well-to-do, and availing themselves the best healthcare in town and complying with cardiology treatment and appointments. In some cases, the time from diagnosis of mild hypertension to death, even with very stable control of the blood pressure within normal figures and no cardiomegaly on xray and no hypertrophy or strain or ischaemia on ECG, was as alarming as only 6 months. Considering that climate change and such apparently simple things as its effect on room temperature are now beginning to be discovered to have an effect on cardiovascular health and durability, we are getting all the more suspicious that increased average temperatures are working with other factors not far from climate change to accelerate the progression of cardiac disease.
- Obesity and Overweight: People stay indoors a lot more these days because of excessive outdoor temperatures. We doctors are actually the ones telling our patients in Nigeria to avoid outdoor activity between 9am and 4pm to avoid dangerous UV irradiation. But that has begun to encourage a sedentary lifestyle which was not the case among our people before now. They worked more outdoors, and on their farms. Harsh weather conditions are forcing people off their farms and back into the homes, and a lot of them now work from home. And of course the association between a sedentary lifestyle, overweight and cardiovascular disease deaths is well established.
- Insect-borne diseases: Infectious diseases are caused by microorganisms that have life cycles that tend to be tied to the seasons and weather patterns across climes. Malaria transmission, just as an example out of many, is observably more intense all year round now than used to be the case. Therefore, in clinical practice, as much as we are reluctant to admit it, climate change is wiping out all the gains supposedly made towards MDG6, i.e., combatting malaria, tuberculosis, HIV/AIDS and other infectious diseases. The resurgence of polio in parts of northern Nigeria is thought to be linked to new weather patterns that are emerging due to climate change. The apparent resurgence of other infectious diseases such as yellow fever also has the same root cause.
- Waterborne diseases: We have seen diarrhoeal diseases simply overwhelm health care services in the wake of flooding, a spate of which hit across northern and southern Nigeria in an unprecedented fashion in 2011. But every single time, you find the healthcare systems terribly ill-prepared, especially infrastructurally, to deal with the numbers.
- Airborne diseases: Air borne bacterial and viral diseases such as meningitis, tuberculosis, bird flu, swine flu, etc, are all expected to get worse. In Nigeria, bacterial meningitis is a huge health challenge up north, and gets more intense during drought. And since the incidence of drought is worsening, we are beginning to see a corresponding increment in meningitis despite vaccination. The same applies to measles.
- Rodent-borne diseases: Floods will wash disease-bearing rodents from their hiding places into closer human cohabitation in ever increasing numbers. That translates to an expected increment in diseases such as the haemorrhagic fevers, eg, Lassa fever. And this we are encountering in clinics in Nigeria at the moment.
- Drug Resistance: We think that the spectrum and rapidity of the drug resistance headache will continue to worsen for Nigeria and for the rest of the world owing, in no small measure, to the mutagenic effects of global warming ranking possibly even bigger on the scale of factors for resistance than pharmaceutical, business, health practitioner and patient/client compliance.
Mental disorders: In the wake of so-called natural disasters, people are literally abandoned to sort themselves out. There are no social safety nets. Any ad hoc ostentations are purely immediate term media spin. Big politics understands how very short media attention span can be. The very next week, the victims of a climate change event are left in the lurch. This scenario, as expected, produces emotional, psychological and psychiatric challenges for health services and for the community down the line. Humans are social animals by nature. Social cohesion is critical to mental health in any society. And in no other society in the whole world is social cohesion a stronger factor for human mental health than in the African society. Often, against the back drop of a failed welfare regime across the continent, the nuclear and extended family and community system is the only kind of safety net there is to provide fraternity, solidarity, empathy and succor when adversity strikes. But when that adversity is so overwhelming and crosscutting that people and systems are simply washed, withered, twisted or quaked away literally within the twinkling of an eye, without the benefit of commensurate preparedness and response, people are simply confused and abandoned and out in the cold so suddenly. Little surprise then that climate change has been linked by studies in Australia and elsewhere, in the wake of so-called ‘natural disasters’ in those areas, to an inordinate increment in the prevalence and incidence of anxiety, depressive and post-traumatic stress disorders and substance abuse.
Other societal ills with health outcome significance:
- Poverty: Subsistence agriculture which is the main employer of labour in Nigeria is fast losing its allure owing to the sheer heat of the sun with its attendant health hazards, poor crop yield and high harvest loss, which are in turn the result of historically harsh weather conditions, thereby plunging people into joblessness and poverty
- Education: Education has incontrovertible connexions with health. Climate change attacks the educational systems in Nigeria through plunging breadwinners into abject penury on the one hand, and accelerated infrastructural decay far in excess of maintenance capacity on the other.
- Prostitution: Young women and girls who cannot farm, and therefore cannot afford school; or otherwise, lose livelihoods to the immediate and remote consequences of climate change are at especial risk of willingly and deliberately resorting to prostitution for survival. This is part of the reason prostitution and human trafficking and modern day slavery are such a stubborn malaise to uproot from the Nigerian society. And the whole world is that much more at risk of all sexually transmitted diseases.
- Crime: The men face the same situations as the females. But their reaction is usually to resort to crime as a survival stratagem.
- Drug abuse: Crime, prostitution and drug abuse are twins of the same mother. And in the case of the 21st century community, climate change is up there with other factors as parts of this composite mother.
- Militancy: Militancy has a special significance for Nigeria, especially in the Niger Delta region; but a bit more recently up north also by way of the Boko Haram fundamentalist movement. If people were gainfully employed and had enough food on the table, and did not have to scramble for resources in the desert-threatened landscape of northern Nigeria, they might have more purpose to life, and more satisfaction with self and neighbor. And so, at the heart of it, militancy in Nigeria is basically a desperate scramble in the face of climate-threatened resources. However, it has to be said here that the point being made is not that all these woes originate with climate change, but that climate change has had a catalytic effect on all of them. And that is how climate change works: it grabs hold of already existing health challenges, and then intensifies and multiplies them.
Climate change-induced Immunosuppression and immunodeficiency: Ultraviolet radiation disrupts the immune system. This is one of the pathways by which UV radiation produces cancer. Studies are still ongoing in this area.
Increased Ground Level Ozone (IGLO): Ozone is a gas composed of 3 oxygen atoms. Ozone is good for human health up in the stratosphere where it shields us from UVA and UVB (Good Ozone). But IGLO (Bad Ozone) is bad for health. At ground level, O3 is formed by a chemical reaction between oxides of nitrogen (NOx) and volatile organic compounds (VOCs) in the presence of sunlight which Nigeria has a superabundance of thanks to being right at the equator and also to climate change. Motor vehicle exhaust, industrial emissions, gasoline vapours, and chemical solvents supply both types of compounds for this reaction. Smog is mainly composed of IGLO. And sunlight and hot weather cause it to rise to levels that are dangerous to human health. Ground level ozone, which we have an abundance of in Nigeria, especially in places that have suffered oil spills wherein these VOCs are superabundantly present, being major constituents of petroleum, is harmful to breathe and damages crops, trees and other vegetation. IGLO has been documented to worsen the health burden from respiratory diseases such as bronchitis, emphysema and asthma. Bad ozone reduces lung function and causes inflammation of bronchial epithelium and lung parenchyma. And prolonged exposure finally produces scarification and cardiorespiratory death. IGLO has also been demonstrated to disrupt the immune system. This has now been demonstrated to also affect immune response to vaccination such that O3 exposure subsequent to immunization tends to suppress antigenic response. Climate change thus has massive implications for all vaccinable infections in terms of cost, effectiveness of vaccines, frequency and, possibly, effective dose per vaccination.
Climate Change, Infrastructural devastation and health: If you have witnessed an unusually violent wind shatter a number hospitals over an area and cancel out health services for a long time in that whole area, then you have an idea what it feels like. If you have seen whole hospitals and access roads and electricity infrastructure washed away by floods that the people, just from the sheer violence of the phenomena, have superstitiously ascribed to the anger and finger of the gods, then we are on the same planet and you can relate to the direct impact of climate change on infrastructure and, therefore, indirectly on human health and health outcomes. These have happened in Nigeria. And I can tell you that 5 and more years on, those structures have not been rebuilt and have remained painful museums of climate change. The chemistry lab of my very own secondary school, the roof of whose lab got blown off by such a violent wind ages ago, has yet to be rebuilt. This helps contextualize the gravity of the health effects of climate change on Nigeria.
DHF and the Durban COP17/CMP7 Shock
The most depressing experience for Doctors for Humankind Foundation at the COP17/CMP7 was the apparent lack of recognition at the UNFCCC that climate change is essentially a health challenge, the greatest health challenge of the 21st century, despite the fact that the very first article of the document setting up the UNFCCC details this recognition. Health ought to have been at the very centre of all the events. People get sick from climate change. People die from climate change. At the end of the day, that is the real reason we are tackling climate change. But at the COP, we saw people caught up in the economics and the politics of climate change rather than climate change and health. And we were actually struggling to be heard. This needs to change.
The 21st Century Nigerian Climate Context
While the German city of Munich is gathering momentum to very soon become the first fully green-energy-powered city in the world, a truly 21st-century city, Nigeria is sinking more oil wells, contriving to re-open abandoned oil wells in Ogoniland and elsewhere, and awarding contracts for new coal mines and coal power plants.
We now know so much about the damage that can be done to the environment and to human health by oil and coal directly and through climate change. But for pure economic reasons totally deliberately blind to the health consequences, we appear set on the fossil course for the foreseeable future.
Nigeria is an emerging economy. It is at the point where it is beginning to develop its infrastructure and industry. A key part of Nigeria’s development considerations is the power sector. She needs to make historic decisions on the way forward for its power sector development against the backdrop of the 21st century climate change and health reality and the resultant imperative for a green, low carbon development path. It may be more financially attractive, in the short to medium term, to toe the regular line and develop on dirty energy, hoping to convert to green energy somewhere down the line, but in the end, such a choice, as has been demonstrated in the mature economies today, is so much more expensive in economic and health terms than doing the right thing which is a low carbon, green development right from the beginning.
Conclusion and Recommendations
We need to set a baseline of action with all stakeholders.
We need to have a clear-cut corporate social responsibility framework rolled into all MoUs with all body corporates operational in Nigeria, from the ones that have been here and have some form of such a document that obviously is not being implemented and therefore has to be reviewed, to new and intending investors. The era of investors tying themselves to politicians to escape corporate social responsibility is gone for good. The pre-climate change era of sacrificing corporate social responsibility on the anvils of an artfully contrived conflict of interest where the politicians are bribed or made ‘shareholders’ and their voice mortgaged as high up the realm as possible, with no one listening to the people and to the environment, is gone forever.