Background- The impacts of climate change have been increasingly evident in Bangladesh over the last decades, as evidenced by a rapid rise in sea levels, increased frequency and intensity of floods, and increased water and soil salinity. Coupled with climate and anthropogenic activities have contributed to the ongoing loss of biodiversity, such as mangrove deforestation. Objective- This project aims to understand the impact, perceived risk and lived experience of the on-going climate and biodiversity crises among vulnerable populations, especially women, infants and indigenous population and co-create sustainable solutions. Method- The project will be conducted in Matlab and Chakaria, Bangladesh over 3-year period. Matalab currently witnesses a large increase in levels of flooding and land degradation. Chakaria is in coastal Bangladesh with increase deforestation, coastal flooding and salinization. Iccdr,b has established a demographic and health surveillance site in both the areas. First a situational analysis will be conducted to assess impact of climate change and biodiversity loss among vulnerable population using meteorological data, biodiversity, health and demographic information. Perception on risk, interlinkage, consequences of the crises and biodiversity loss and how these has been communicated will be assessed using qualitative method. External policy and political context on policy, guideline and resource allocation on adaptation to climate change and loss of biodiversity using qualitative method. Co-design and pilot implement adaptation and mitigation strategies for vulnerable population using a qualitative and quantitative method. Discussion- The study will be led by a highly qualified team of interdisciplinary research scientists from iccbr,b Bangladesh with a multi-university team under the umbrella of Swedish Institute for Global Health Transformation (SIGHT) at Royal Swedish Academy of Sciences. In gaining a deeper understanding of how women, local and indigenous populations adapt to climate change and loss of biodiversity, this research will generate evidence to protect vulnerable populations.

Problem statement The production, delivery, use and disposal of health goods and services depend on non-renewable material and energy resources at imminent risk of depletion. The scarcity of medical products, especially personal protective equipment during the Covid-19 crisis, shows the dramatic health consequences of disruptions in supply chains. The health sector must urgently assess its use of these resources to strengthen its resilience. Solution The P4H Network seeks to launch a multi-year collaborative action-research group of diverse institutions to (1) determine how much health systems drain these resources, and (2) identify ways to provide needed health services with less or moderated use of these resources. Studies will help inform country level decision makers on what P4H considers a key dimension of resilience of social health protection. Methodology With methodologies based on life cycle assessment, four groups of experts from China, France, Singapore and Switzerland assessed resource consumption for specific items used in the Covid-19 response. They presented their findings during the 2022 Geneva Health Forum (www.ghf2022.org/session2_6/), at a panel Claude Meyer moderated. Now, P4H aims to expand on the four groups’ work to analyze current use of material and energy resources in primary health care and health-promotion and prevention services. The action-research group will work on defining the right indicators and adapting cradle-to-grave methodologies to the new scope. It will also encourage public health institutions, energy materials institutions and health care suppliers to collaboratively assess policy tools. Qualifications A global collaboration among 20 member institutions that promotes, develops and strengthens exchange and collaboration for social health protection and health financing, the P4H Network (www.p4h.world) is uniquely positioned to contribute to PMAC 2023’s agenda by exploring the importance of non-renewable material and energy resources in health systems and engaging with others to launch a related action-research group.

Background According to the World Health Organization (WHO), air pollution results in over seven million premature deaths annually. Ninety-nine percent of the global population breathes air that exceeds WHO’s guideline for ambient air quality. While air pollution is a major environmental and public health issue, the difficulties in mitigating it lie neither in science nor the availability of technical solutions, but rather in the larger socio-economic system in which air pollution plays out. This includes the structural and functional governance mechanisms responsible for managing air quality, presence of a strong civil society that advocates for clean air, and a private sector that invests in innovative solutions. Objectives USAID Clean Air was designed to address air pollution in the Kathmandu Valley by identifying, testing and scaling solutions developed in partnership with key actors – local government, communities and the private sector – within the larger socio-economic ecosystem. Methods USAID Clean Air uses a human centered design driven implementation science framework to develop and scale local solutions to air pollution that influence social and cultural norms, harness political will to adopt bold regulations, and align stakeholders’ economic interests. This process involves three phases: identifying evidence-based, relevant, and feasible interventions via listening tours; lean experimentation and solution building; and scaling up and sustaining effective solutions. Conclusion Effective action on clean air requires bold leadership from local governments, coordinated partnership among stakeholders, and strong ownership by local communities, which in turn necessitates an effective communication and coordination mechanism between the government, citizens, and private sector. It also requires identifying the structural barriers in the socio-economic system that hampers the state’s ability to effectively manage air pollution and then zooming in to address them on a micro community level. Keywords: air quality; air pollution; Nepal

Despite the extension of the power grid to previously underserved regions in India, the quality and reliability of energy supply is far from guaranteed. Health centers in rural, remote areas operate without the certainty of adequate lighting, cooling or warming technologies and use diesel as the primary back-up source of energy. Our research examines the potential pathways for the adoption of renewable energy in an energy efficient manner across small and medium healthcare facilities as a dual antidote to the problem of energy deficiency as well as energy pollution. Following the government’s classification of designating a minimum of 30 beds for Community Health Centers and other schemes incentivising private facilities with a minimum of 50 beds, we have surveyed 8 such private facilities that are connected to the grid in urban and semi-urban areas. We have reviewed the literature that already exists on the unit economics of switching from diesel to solar and attempt to make a case for switching from the traditional grid entirely, using diesel as a back-up. This is backed by data from the health facilities about their usage of energy from the government grid, from diesel and solar, where available. We have then spanned out to a bird’s eye view to examine the impact that conducive policy environments could have on accelerating market adoption of these technologies by making financing options more competitive for small facilities and prioritizing solar energy purchasing from them to simultaneously green the health system and the main grid. We believe that this study showcases the full potential for ‘empowering’ healthcare in a climate and planet friendly manner, and has application potential for even smaller health units in remote locales for both the private and public sector and will advance the cause of health equity and justice.

In response to the surge in demand for medical oxygen during the COVID-19 pandemic and to prepare the health systems for future crises, the Government of India, along with the state governments and other stakeholders, installed over 4500 Pressure Swing Adsorption (PSA) oxygen generation plants across the country for onsite oxygen generation. In spite of the PSA plants being more energy efficient than other oxygen sources, they consume huge amount of energy, requiring as many as 150 units of power generated through coal-fueled power generation plants or through diesel generator sets, each day. Solarization, a green energy option, offers an opportunity for sustainable and uninterrupted supply of electricity to power the PSA plants. However, lack of evidence on sustainably powering oxygen plants with solar power, combined with insufficient data on PSA plant operations with solar energy, hinders optimal utilization of this option. PATH, a leader in global health innovation, is implementing a pilot to solarize an 800-Liters-per-Minute (LPM) PSA plant at the Government Hospital, Gundlupet, Karnataka in India, with an aim to reduce the fossil fuel consumption and run PSA on green energy. The solarization pilot, which will begin in August 2022 and be completed by November 2022, will provide one autonomy day and power back up of six hours for the PSA plant. Once functional, it is expected to lead to greenhouse gas emission savings of as many as 6,176 tonnes of carbon dioxide over the life of the PSA plant. This environmentally positive impact is equivalent to planting 12,345 trees. In addition, this pilot is expected to save nearly US$875,000 over project life equivalent of expenditure on fossil fuel dependent electricity. These savings can be used for purchase of medicines, strengthening infrastructure, and other necessary expenditure.

The current focus of local health systems on global climate change is toward health system preparedness to cope with the increased demand for health services as a result of, for example, emerging disease outbreaks or natural disasters. Although a global study report that health care system is among the most carbon-intensive sectors accounting for about 8% of global greenhouse gas (GHG) emissions, there is a dearth of research in the areas of health care’s carbon footprint at the country level. As such, this study aims to explore the hotspots of GHG emissions from healthcare operations in Thailand and provide recommendations for possible GHG mitigating options to the healthcare operators. Different levels of public hospitals in Thailand were selected as research case studies. By employing the GHG Protocol, the key results indicate that the use of purchased electricity represents the largest source of emissions, followed by fuel consumption for hospital vehicle fleets. Waste management contributed minimally on GHG emissions. To help tackle climate change, the following recommendations are proposed: emissions reduction target of health care facility should be established and measurable by engaging all stakeholders in carbon mitigation planning. The mitigation actions should also be aligned with health and well-being purposes. Further, staff commute and patient travel emissions, and in-use emissions from pharmaceuticals should be systematically accounted in assessment of carbon footprint health care facility in Thailand.

The Philippines is among the world’s most vulnerable countries to climate change, experiencing wide-ranging climate-related impacts including more intense typhoons and rapid sea level rise. As a threat multiplier, climate change exacerbates public health problems and strains local health systems. Numerous global initiatives and national declarations have been made to address climate-related health impacts. However, these aspirations for building climate resilience remain poorly operationalized within local health systems that are often under-resourced to implement and innovate locally-appropriate strategies for climate-health resilience. This implementation project aims to pilot an innovative, municipal-level intervention to build climate-resilient local health systems in two Philippine coastal towns - Alabat and Ajuy. The project aims to support municipal governments (1) build climate and health knowledge and capacity; (2) develop climate-health plans, budgets, and project proposals; and (3) foster collaboration within the municipal government and with local and national stakeholders to generate political will and financial support for climate-health action. Some of the activities embedded in the intervention include (1) climate and health training for municipal staff; (2) iterative, collaborative, and participatory review of local climate change action plans through a public health lens; and (3) co-design of climate-health measures, climate-considerate health budgets; and climate-health project proposals for submission to potential funders. Research and evaluation are also embedded through pre- and post-activity surveys, key informant interviews, and analysis of secondary data. Local governments deal with a diverse range of concerns beyond climate and health. Therefore, being strategic in resilience-building initiatives is key (such as by identifying focal points and champions and building on existing efforts). The local health sector is oftentimes neglected in climate-related planning and budgeting processes. Hence, this project helps connect the health sector with other climate-relevant sectors, which is critical for identifying locally-led climate-health resilience strategies and galvanizing collaborative climate-health action at the local level.

The relationship of climate change and infectious disease is understudied in tropical countries like the Philippines. The changes in temperature, humidity, and rainfall could pose higher risk to certain diseases like dengue and leptospirosis. We conducted a study to determine the associations between mean temperature, relative humidity and accumulated rainfall with dengue and leptospirosis cumulative incidence (CI). We studied the largest city in Metro Manila and adopted the first two steps of the United States Centers for Disease Control and Prevention’s Building Resilience Against Climate Effects (BRACE) Framework. Statistical and spatial distribution analysis were performed to identify the magnitude and distribution of each climate and disease variable. Machine learning was also used for forecasting. The study was able to find a small but significant increase in annual dengue CI when annual relative humidity increases; however, no other significant predictor was observed . The leptospirosis model showed significant changes affected by all exposure variables, with the greatest effect from maximum and mean temperature. Precipitation showed an inverse relationship with leptospirosis CI, contrary to the positive relationship seen in most literature a . LISA spatial analysis showed no high annual incidence for both outcomes in one area; hence, no double burden is observed. Due to the lack of data points, the study was only able to forecast 6 months forward and has shown a decrease in disease outcomes when using the model estimates above. This study shows that climate change has the potential to worsen the burden of infectious diseases in a country like the Philippines. By understanding the relationship of climate change to health, local governments can better mitigate outbreaks from these diseases. However, this ability is reliant on having complete and comprehensive climate and disease data.

Poor health outcomes are associated with extreme weather events especially in areas with vulnerable populations and low access to healthcare. The Philippines is a double burden country that struggles with containing the spread of infectious disease coupled with a growing problem of non-communicable disease. This ecological research developed and visualized climate and disaster health risk of ten Philippine provinces using a spatio-temporal approach via a three-phase health risk assessment on climate-related diseases. Specifically, the study identified climate-sensitive diseases among the 48 most burdensome diseases in the Philippines (Wong et al., 2018). A total of 315 articles showed quality evidence of climate sensitivity of the 14 diseases, namely dengue, typhoid fever, cholera, acute bloody diarrhea, unspecified diarrhea, bronchitis, pneumonia, tuberculosis, asthma, diabetes mellitus, ischemic stroke, ischemic and hypertensive heart diseases, and dermatitis. Time-series analysis and Generalized Linear Mixed Modeling were conducted to assess the relationships among 2009-2019 monthly municipal data on climate (temperature, rainfall, humidity, wind speed) and health outcomes (incidence and mortality rates, PhilHealth insurance claims). Finally, municipal outliers and hotspots of each disease were identified across the ten provinces. Most model effects were weak to moderate, except for the strong association between wind speed and ischemic stroke-related claims. Annual models showed stronger associations compared to monthly models, which suggests long-term changes in climate have greater impacts on health compared to short-term or seasonal changes. This study found that temperature, humidity, rainfall, wind speed, and vegetation affect some of the most burdensome diseases in the Philippines. The impacts of changing climate are becoming more pronounced, and the need for prioritized planetary health interventions is more salient than ever. Results of this study serves as a baseline for climate change and health in the Philippines, which can help inform the national CCAH plan and local policies and interventions. The shortlisted diseases also provides a research agenda for climate-sensitive disease forecasting for the most burdensome diseases in a country ranked 17th in the world as the most affected country from extreme weather events (CRI, 2017).

Jeepneys are a common public transportation mode in the Philippines but they are also a major contributor to air pollution. Since jeepneys are open to the outside air, their drivers are exposed to the rising air pollution. Nonetheless, hazards experienced by transport drivers remain to be a research gap. This study then aims to evaluate the health status of jeepney drivers relative to their exposure to levels of particulate matter (PM2.5). To achieve this, longitudinal (hourly x 7 days) PM2.5 exposures of jeepney drivers in Quezon City, Metro Manila were measured. Outcomes (heart rate (HR), blood pressure (BP), oxygen saturation (sPO2) and peak expiratory flow volume (PEFV)) were likewise measured but at fewer timepoints. Questionnaires were also administered to measure the sociodemographic profile and medical history of the drivers. To assess the relationship of PM2.5 and health, a generalized linear mixed model (GLMM) was used. The study included 30 drivers. A typical 14-hour shift showed that PM2.5 was highest when the jeepney drivers were inside the terminals (i.e., at the start and end of their shifts). HR peaked at this time, dropping only after the rush hours. This trend was also present in other outcomes (e.g., systolic, diastolic, and mean BP, and sPO2). Percent PEFV was lowest in the morning and highest during the end of their shift. An increase of PM2.5 was found to significantly increase the HR, percent PEFV, and SPO2, but not the BP of the drivers. Our findings show that short-term exposures of jeepney drivers to ambient PM2.5 can lead to significant changes in their heart and lung parameters. Given the results, there is a need to further explore the health implications of worsening air pollution not just for commuters but especially for transport service providers.

The Philippines experiences multiple natural disasters each year resulting in large structural damage and the displacement of many from their homes. The frequency of disasters has further been exacerbated due to the ongoing effects of climate change. Local Government Units (LGUs) are tasked to handle disaster management; however, it has been found that their responses have not been streamlined. This has affected the timeliness of critical decision making during and after an emergency. Health needs of internally displaced persons (IDPs) such as water, sanitation, and mental health services have been found to be lacking. The inadequate conditions at these facilities can worsen existing conditions or create larger problems as IDPs are more vulnerable to health issues they were not previously exposed to. A Health Needs Assessment (HNA) tool was created to assess the health needs of IDPs and then incorporated into a Geographic Information System (GIS). These were co-created with disaster response teams from highly vulnerable cities around the country to capitalize on their previous experiences. The GIS dashboard provided LGUs access to the number and socio-demographics of displaced persons, food distribution frequency, nutrition and protection situation, available inventory and equipment. It also included an interactive map showing the spatial and social structures of temporary settlements and the location of critical facilities. The development took into account situations where internet connectivity was scarce ensuring that only the most pertinent data was included. The final GIS was pilot tested using historical data with the final dashboard given back to the sites for use after capacity-building sessions were completed. The study showed that it is possible to utilize technology for disaster management and for the improvement of the current response of LGUs to better address health needs during emergencies in low-middle income countries and to facilitate the efficient distribution of life-saving aid.