Environmental Linkages to Population Health and Wellbeing in Coastal Areas of the Bay of Bengal (EnHealth-BoB)
The Bay of Bengal region is known for experiencing some of the most intense storms and storm surges in the world, especially in the past century. Along with more frequent and intense sudden disasters, climate change is causing the region to encounter consistent coastal flooding, gradual sea-level rise, coastal inundation, and damages from saline-water intrusion. Coastal dwellers, traditionally engaged in farming and fishing, are exposed to these hazards resulting in immediate and long-term public health crises. While it is typical for research and studies to be conducted on environment and health, information regarding the interlinkages between climate change and public health remains scarce.
Understanding the diverse direct and indirect health-related risks due to climate change in the region requires the integration of available data across environmental, demographic, and health domains. The region would need immediate, bespoke approaches to improve system-level efficiency across several domains through appropriate local level adaptations and resilience equipped to deal with multiple hazards, both those faced currently as well as those that may arise in the not-too-distant future. The establishment of communication and dissemination of knowledge between stakeholders could guide policy action plans to better compensate for climate-related health risks.
EnHealth-Bob is a network created among stakeholders in the Bay of Bengal to link information and data from both public health and climate change domains, to promote appropriate policy action plans. The EnHealth-BoB is a network of individuals and institutions representing community-based organizations (CBOs), healthcare providers, policymakers, advocacy groups, research, and academia based in India and Bangladesh, along with researchers from the Stockholm Environment Institute (SEI) Bangkok, Thailand, and the University of York (UoY), UK. The Network, supported and developed with incubation support from the UoY- Global Challenges Research Fund (GCRF) and the Stockholm Environment Institute Seed & Innovation Fund, addresses dual challenges of development and environment primarily by focusing on the two critical impact areas of the SDG mission: (a) reducing climate risks and (b) improving health and wellbeing.
The members bring in rich, multidisciplinary expertise from ecology, geology, geography, medicine, and public health, demography, social science, and humanities, combined with key applied knowledge and skills from fields of disaster management, application of Geographic Information Systems (GIS), data science and participatory research. This is cemented further through important linkages and grassroot understanding of the CBO members representing people’s lived experiences in the frontier communities, providing core insights about the complex nature of the crisis and local solutions.
Aligning to the UoY’s vision on fostering multi-disciplinarity to approach complex challenges and exploring possible solutions, the EnHealth-BoB network aims to strengthen research and civil-society partnerships across the coasts of the Bay of Bengal spreading through multiple countries in South and Southeast Asia.
Aims and Objectives
EnHealth-BoB’s overall aim is to identify effective policy actions and develop public health interventions to respond to the growing challenges of climate-related impacts on public health and health systems. This is done by:
1. Promoting understanding related to the impact of climate and environmental risks on population health outcomes and health inequalities. Specifically, this will involve summarizing existing evidence and understand communities’ risk perceptions on impacts of long-term exposure to climatic risks on mental health outcomes in vulnerable communities and the scope for local-level health system interventions
2. Strengthening Information Systems: To develop and strengthen integrated information systems across key domains of climate/weather/natural hazards, environment, and health to help develop, prioritise, evaluate and support programme implementation for improving public health outcomes. This primarily involved:
- Identifying/mapping different information sources and levels;
- Scoping the feasibility of integrating different data systems and the relevant levels of aggregation; and,
- Scoping the feasibility of establishing community-level integrated surveillance units.
3. Fostering Community Perspective and Partnership by strengthening research and local-community partnerships and networks. Key activities involve understanding existing planning and implementation barriers and to improve intersectoral accountability towards developing resilient health systems and mechanisms to safeguard wider determinants of health against the emerging environmental risks
Methods and Activities
For the network to be effective in establishing knowledge dissemination and the promotion of policy adjustment the following steps were completed:
- A review was conducted of existing literature on the interlinkages between climate, environment, and public health; specifically focusing on the littoral region of the Bay of Bengal. This review included peer-reviewed publications, reports, articles in popular media, and unpublished grey literature. Sources of ethnographic records and case studies of climate-induced health vulnerabilities were also examined.
- Relevant data sources were identified and reviewed. Those sources included environmental systems, public health and health systems, and other demographic and socioeconomic parameters. Specifically, for environmental systems, meteorological databases on rainfall and temperature records, sea-level rise and salinity ingress, and the ecological vulnerability of the study regions were examined. For public health and health care systems, data on health outcomes, indicators for health service delivery, and infrastructure were assessed. By mapping out available datasets the level of disaggregation, periodicity and accessibility were also identified. This allowed for the assessment of areas for potential data integration.
- Health records for the Indian Sundarbans were digitalized. As more records are digitalized and made available from other project areas, insights into temporal and spatial linkages between environmental exposures and population health can be revealed.
- Interviews and webinars were held with community members and local stakeholders. These meetings were conducted to better understand how local communities and key stakeholders perceive the climate-related environmental risks to influence physical and mental health and wellbeing of people living in these areas. This was also a way to understand their perceptions for alternative policy actions for corrective public health service provision.
- The use of technologies was established and applied for partnership development. Given the current restrictions on travel and in-person interactions, mechanisms needed to be explored and validated for partnership building. This was done by continuing efforts that were made in the Sundarbans by a previous project, mainly using WhatsApp. Having communication accessible to all stakeholders is a key element to creating an inclusive network and encourages the flow and dissemination of information and knowledge. This will encourage research and policy adoption of climate-resilient strategies to improve population health and health service delivery in these regions.
During the creation of this network, it was apparent that many line departments in the various nations were collecting data regularly, but problems existed with integration and availability. Adaptation strategies are being implemented in several areas in response to slow-onset disasters, mainly saline intrusion from sea-level rise. All stakeholders and participants see the need for vertical integration; specifically the inclusion of local stakeholders, and horizontal integration; with increasing the flow of information.
As many of the health challenges presented in these coastal communities are location-specific, the cooperation and participation of local stakeholders has been vital. Public health infrastructure in these frontier locations has proven to be less than sufficient. This leaves communities vulnerable to the annual occurrence of pre-monsoon tropical cyclonic events that potentially result in large-scale public health tragedies. It is through partnerships established among local stakeholders that innovative and integrated approaches have been able to emerge.
As this project took place in 2021, Covid-19 created many challenges in implementing the creation of this network. For this reason, fieldwork and travel were greatly limited. This required a strong connection and reliance among partners. The project was dependent upon those working on the ground to organize webinars and invite local stakeholders, which have proven to be essential in the effectiveness of this network. This reinforces the concept that it is through strong connections and networks that challenges can be overcome and common goals can be achieved.
Outcomes of this project also contribute to the UK GCRF-funded initiative in the Sundurbans known as the Living Deltas Hub. More information on hub is found here.
Watch the webinar on the Right to Health in the Bay of Bengal from the World Forum on Climate Justice 2021 in the video above.