Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Environment and Health Research Unit, South African Medical Research Council and Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa.
Global Health. 2019 Mar 19;15(1):22. doi: 10.1186/s12992-019-0466-x.
Globally, the response to climate change is gradually gaining momentum as the impacts of climate change unfold. In South Africa, it is increasingly apparent that delays in responding to climate change over the past decades have jeopardized human life and livelihoods. While slow progress with mitigation, especially in the energy sector, has garnered much attention, focus is now shifting to developing plans and systems to adapt to the impacts of climate change.
We applied systematic review methods to assess progress with climate change adaptation in the health sector in South Africa. This case study provides useful lessons which could be applied in other countries in the African region, or globally. We reviewed the literature indexed in PubMed and Web of Science, together with relevant grey literature. We included articles describing adaptation interventions to reduce the impact of climate change on health in South Africa. All study designs were eligible. Data from included articles and grey literature were summed thematically.
Of the 820 publications screened, 21 were included, together with an additional xx papers. Very few studies presented findings of an intervention or used high-quality research designs. Several policy frameworks for climate change have been developed at national and local government levels. These, however, pay little attention to health concerns and the specific needs of vulnerable groups. Systems for forecasting extreme weather, and tracking malaria and other infections appear well established. Yet, there is little evidence about the country's preparedness for extreme weather events, or the ability of the already strained health system to respond to these events. Seemingly, few adaptation measures have taken place in occupational and other settings. To date, little attention has been given to climate change in training curricula for health workers.
Overall, the volume and quality of research is disappointing, and disproportionate to the threat posed by climate change in South Africa. This is surprising given that the requisite expertise for policy advocacy, identifying effective interventions and implementing systems-based approaches rests within the health sector. More effective use of data, a traditional strength of health professionals, could support adaptation and promote accountability of the state. With increased health-sector leadership, climate change could be reframed as predominately a health issue, one necessitating an urgent, adequately-resourced response. Such a shift in South Africa, but also beyond the country, may play a key role in accelerating climate change adaptation and mitigation.
随着气候变化影响的显现，全球应对气候变化的行动逐渐升温。在南非，过去几十年来应对气候变化的迟缓已经危及到人类的生命和生计，这一点变得越来越明显。虽然减缓气候变化的进展缓慢，特别是在能源部门，已经引起了广泛关注，但现在的焦点正在转向制定计划和系统以适应气候变化的影响。
我们应用系统综述方法评估南非卫生部门应对气候变化的进展。这个案例研究提供了在非洲地区或全球其他国家可能应用的有用经验教训。我们检索了 PubMed 和 Web of Science 索引的文献以及相关灰色文献。我们纳入了描述在南非减少气候变化对健康影响的适应干预措施的文章。所有研究设计都符合条件。对纳入文章和灰色文献的数据进行了主题总结。
在筛选的 820 篇文献中，有 21 篇被纳入，另外还有 xx 篇论文。很少有研究提出干预措施的结果或使用高质量的研究设计。国家和地方政府已经制定了若干气候变化政策框架，但这些框架几乎没有关注健康问题和弱势群体的特殊需求。预测极端天气和跟踪疟疾和其他传染病的系统似乎已经建立得很好。然而，几乎没有证据表明该国为极端天气事件做好了准备，或者已经紧张的卫生系统有能力应对这些事件。在职业和其他环境中，似乎很少采取适应措施。迄今为止，在卫生工作者的培训课程中几乎没有关注气候变化。
总的来说，研究的数量和质量令人失望，与气候变化给南非带来的威胁不成比例。考虑到政策倡导、确定有效干预措施和实施基于系统的方法所需的专业知识都在卫生部门，这令人惊讶。更有效地利用数据是卫生专业人员的传统优势，这可以支持适应并促进国家的问责制。随着卫生部门领导能力的提高，气候变化可以重新定义为主要是一个健康问题，需要紧急、充分资源的应对。这种在南非但也超越南非的转变，可能在加速适应和缓解气候变化方面发挥关键作用。
