Already ill-equipped to deal with epidemics, it is the poorest areas, with limited public health resources – such as eastern Africa – that will suffer the most if climate change increases incidences of crippling and deadly diseases. HEALTHY FUTURES sought to understand the links between climate change and health, and developed tools to help local communities and regional actors assess and better manage the risks. The project focused on malaria, Rift Valley Fever and schistosomiasis in Burundi, Kenya, Rwanda, Tanzania and Uganda.

The three diseases are water-related and vector-borne – malaria and Rift Valley fever are transmitted by mosquitos, which breed in pools of water, while schistosomiasis is caused by parasitic worms hosted by freshwater snails.

Armed with current forecasts of potential climate changes, the project’s findings on local vulnerability to the diseases and mathematical models that predict how the diseases could evolve at various points in the future, the HEALTHY FUTURES team was able to create an online atlas showing risk, hazard and vulnerability.

Risk can be defined as the chance of harm, while hazard refers to anything that can cause harm.

Mapping change

The atlas is available to everyone. “It helps stakeholders come to terms with the possibilities decade by decade” explains Mark Booth of Durham University – he was a work package leader within the project and a member of the Healthy Futures scientific committee. “It’s about capturing uncertainty and trying to make sense of it in a rational way.”

The option to zoom in on a particular locality makes the atlas particularly valuable, providing information on spatial variations in risk and vulnerability, and ensuring relevance for the whole region. Current maps don’t show enough detail, says Booth.

The atlas is part of an array of decision support tools (DSTs) developed by the HEALTHY FUTURES team, which also includes guidelines for all three diseases. The guidelines are designed to facilitate decision making on actions to tackle the diseases under conditions of environmental change.

Initial response to the atlas has been positive, but Booth has plans to encourage further take-up and development of this and other DSTs. The World Health Organisation (WHO) has only recently begun to include climate change in its reports on disease control, and the project team would like to encourage this.

“I think it’s the right time to talk to the WHO about using the results of HEALTHY FUTURES and incorporating climate change into their strategy for disease prevention,” he says. Collaboration with the WHO would also help refine the project’s decision support tools. Initial discussions with the WHO are planned for May.

Although Healthy Futures finished at the end of 2014, the consortium is still active. “Everyone realises they have to continue with the project in some guise as it has a lot of potential,” says Booth.

Creating certainty through surveillance

While Booth and the rest of the HEALTHY FUTURES team are eager to raise awareness of their tools within the WHO, they also want to reach out to African stakeholders. The project had a head start in this respect as government departments from East Africa were involved in the project, and also reached out to other stakeholders through workshops. A new stakeholder network will also ensure that communities in all five partner countries get to benefit from the project’s decision support tools.

One of the key recommendations to come out of HEALTHY FUTURES is the need for surveillance, and in particular at the local level. In the case of schistosomiasis, for example, this could simply mean monitoring the presence of the freshwater snails that host the parasite responsible for the disease.

Monitoring will enable local authorities to take short-term decisions that could save lives.

“As uncertainty makes it difficult to fix the future, we need to have a flexible solution,” says Booth. He therefore expects more of an emphasis on surveillance and the development of plans that can be put in place as and when necessary, rather than plans for 20 years in the future.

Read related article in Horizon magazine