Monday, 8 September 2014

Complex combinations: climate, poverty and health in the Sundarbans

My first trip to Sundarbans was as a tourist. I was left mesmerized by the beauty of the natural mangrove trees and crisscrossing creeks. I found it difficult to imagine that, due to climate change, the five million islanders of this ‘beautiful forest’ (as Sundarbans means in Bengali) have the daily battle of an inhospitable terrain, combined with frequent climatic shocks like floods and cyclones which take place almost every year.

My later frequent visits to this island archipelago have been as a researcher of climate and child health in this vulnerable region. Working for the Institute of Health Management Research under two innovative projects – Future Health Systems and the STEPS Centre’™s ‘Uncertainty from Below’ project – I have tried to explore and understand the uncertainties faced by the people of Sundarbans, due to climatic events, not only in direct relation to community health, but also to the other social determinants, such as livelihood and food security.

The islanders face both visible and the not-so-visible challenges. The immediate impact of a visible and sudden climatic shock, such as flood or cyclone (a frequent occurrence in Sundarbans), is often a sudden rise in the incidence of flood related diseases (e.g. diarrhoea and respiratory infections) especially among children. In the long run, health care infrastructure takes a hit making the already weak system more inaccessible and unaffordable. Simultaneously, climatic shock erodes the opportunities for maintaining livelihoods and triggers food insecurity, sucking people deep into chronic poverty, resulting in malnutrition and recurrent disease.

Not-so-visible challenges, such as the slow and gradual change sea levels or weather patterns, like erratic rainfall or extended summers, deplete the traditional agro-fishing economy. This results in the outward migration of many men looking for work. Women are more likely to become part of the marginal workforce which can ultimately take a toll on other social determinants of health (food security, social support, seeking quality care etc.), especially for the child.

The continuum of these climatic uncertainties reinforces or intensifies adverse health outcomes. A suboptimal health care system weakens the coping ability of a household and results in negative resilience. A typical islander of the ‘˜beautiful forest’ is susceptible to an extra burden of health risks and a complex combination of poverty, environmental adversity, triggering inter-generational under-nutrition and ill health – the vicious cycle of underdevelopment.

by Upasona Ghosh, Senior Research Officer at the Indian Institute of Health Management Research, and researcher on the STEPS Centre’s project on Uncertainty from below.

This post was first published on the Eldis website. It is one of two case studies published on Eldis to mark the World Health Organization conference on health and climate, which took place in Geneva from 27-29 August.