Researchers around the world are drawing an ever-more distinct line between rising global temperatures and negative effects on maternal, foetal, and infant health. One of these researchers is Professor Matthew Chersich of the Wits RHI (Rural Health Institute), whose recent work has focused on using data science to understand the effects of heat on pregnant mothers and their babies in Africa.
Chersich's first warning is that there is a double burden on Africa as the continent is already being hit hardest by climate change but also has fewer resources to mount a sophisticated, wide-reaching, and sustained response.
"The continent is already warming faster than other regions in the world but is also a low carbon emitter," he said.
According to the Intergovernmental Panel on Climate Change, the northern and southern regions of the continent will become hotter and drier while the Sahel region will have increased rainfall.
"Right now we are in a phase of climate choice - the ten years we have left to do something and stop making nature our slave or that choice will cascade so that we won't have a choice because nature will be at its tipping point," he said. Chersich was speaking to Spotlight after delivering his inaugural lecture at Wits University at the end of August.
Inaugural Lecture of Professor Matthew Chersich. Title of Lecture: Climate Change and Maternal Health in Africa: from Thermal Physiology to Public Health and Advocacy Date: 24 August 2022
Time: 17:00-19:00Register here https://t.co/qxU0nh1Siq pic.twitter.com/bJFlwuwIgO
-- Climate, Energy and Health_PHASA (@ClimatePHASA) August 15, 2022
How a medic came to study climate change
In the lecture, titled "how a medic came to study climate change" Chersich recounted how seven years ago he and his family were living in a small hamlet in Italy among a subsistence farming community. Increased extreme weather events quickly turned to the lived reality and lived anxiety for the community that largely lived off the land. He experienced how humans' continued ability to thrive on a planet pushed into decline was slipping towards a precarious edge.
"Climate change and public health already intersect in some key areas, which makes this field an important new area of research that we in public health must be turning our attention to.
"Some of the intersections with the public health response include how droughts and floods cause poverty and social disruption; there is also the response of emergency medicine in the case of increased extreme weather events that destroy infrastructure; then there's work looking at the effects on how climate change is shifting infectious disease patterns. All pathogens are temperature sensitive which means we'll see malaria spread to higher altitude areas; and then there's work on maternal health, which is an area where Wits University and I personally have a lot of background, so this became an obvious area that I wanted to focus on."
[EVENT] The role of data science in driving the health sector response to the climate crisis: The HEAT Center and HIGH Horizons projects.
Do join this Data Science Lunch Time Chat with Prof. Matthew Chersich
For more details: https://t.co/WUKprgfOaw pic.twitter.com/zELbzziZHl
-- Civic Tech Innovation Network (@CivicTechAfrica) March 30, 2022
Building on previous work
He said choosing to focus on maternal health was strategic because maternal health has been the starting point for many past public health interventions including a massive reduction in mother-to-child transmission of HIV as well as interventions on nutrition and combating malaria.
Added to this, Chersich said, there was established foundational work done by Wits researchers in the late 1990s that measured the maternal-foetal temperature gradient. "The research found that a foetus is about half a degree warmer than its mother, which might not sound like much of a difference but if the mother's temperature rises with a fever to 40 degrees, the foetus is at 40.5 degrees and that makes an enormous difference physiologically," he said.
Impact of heat
Data from his research colleagues in Kenya is now showing that heat can be linked to preeclampsia, pre-term births, and complications in labour and childbirth - all of which can have knock-on effects for the mother and the child later on in life, he said.
Community health workers and women interviewed for Chersich and his colleagues' research have given revealing responses. These included: "The foetus is not at peace when it is hot; it only finds peace when it is born" or "it is difficult to push in the heat" and "the baby has come before its time because it is too hot".
"What is happening physiologically to cause these pre-term impacts related to heat are changes to the endocrine system; oxidative or inflammatory changes; changes in placental perfusion, which can change the circulation of blood flow to the foetus that regulates heat; and there is increased exposure and risk to infections that include food, water, and vector-borne infections," he said.
The research found that a foetus is about half a degree warmer than its mother, which might not sound like much of a difference but if the mother's temperature rises with a fever to 40 degrees, the foetus is at 40.5 degrees and that makes an enormous difference physiologically
Chersich said the evidence points to a looming crisis for maternal health and infant health and means "public health must be more than about treating disease".
Chersich set out a multi-layered intervention strategy. A critical layer is using data science more effectively. One of the projects Chersich is now involved in is a five-year study that will span research teams across Africa and the United States.
"It involves individual participant data and will be the largest data science project of its kind. Analysing this data will help us unlock some of the key questions and shape our interventions," he said.
"HIV scientist and activists are well placed to tackle the climate change issue." - @WitsRHI's Matthew Chersich discussing the benefits and approaches to integrating climate change into existing #HIV research programs. pic.twitter.com/YuP6DWnyLn
-- IAC - the International AIDS Conference (@AIDS_conference) July 8, 2020
More deliberate engagement
Chersich also said there is a need for the public health sector to wake up to the necessity to enter more directly and deliberately into the climate change space. One initiative he helped establish is CHANCE (The Climate-Health Africa Network for Collaboration and Engagement), which is an initiative to bolster research that aligns these two disciplines.
"The health sector is ripe to intervene and this should include making submissions for funding from the Green Climate Fund to do the research and put in place the kinds of strategies that will help those who will be worst affected on the continent," he said.
"We in this sector understand the tricks and the tricksters. We know the playbook of big pharma, of the tobacco industry, the food manufacturing industry, the meat industry, and now also the fossil fuel industries," he said of the public health sector.
It's a terrible insight but he argues that it could hold strategic advantage. It's a position from which to firm up boundaries with funders and call for more accountability and transparency where there is a conflict of interest. This while still compelling funders and donors - who may be industrial polluters - to fund research and support interventions to curb fossil fuel dependence and reduce emissions.
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Public health, he said, also understands how to manage big global donors, citing long-standing PEPFAR and Global Fund projects on the continent. And public health initiatives are where a groundswell for policy change can also take root, Chersich said.
But even before policy, he said interventions need to start with awareness on the ground. It could be healthcare workers knowing to make cool water available for pregnant women, especially during labour and childbirth; better advice on planning pregnancy according to seasonal temperatures; building more heat tolerant clinics and homes and planting more trees. It is all underpinned by a fight still for poverty reduction and building more equitable societies, he said.
We have an abusive relationship with nature. It underlies our problems. We think we can eat and eat [from] nature and it will just replenish itself but there is no slowdown in emissions and we are on a trajectory of many places in the world being unliveable.
Personal moral choice
Finally, Chersich used his inaugural lecture to bring home the most uncomfortable message of them all and that is the link between climate change and personal moral choice. Behavioural change, he said, will come with personal discomfort and personal sacrifice. It's eating less meat, taking fewer flights, consuming more mindfully and accumulating less. For researchers and universities, he said, it is about questioning relationships with funders and companies and industries that advance the fossil fuel dependency agenda and pay not to fix problems but for a blind eye turned, green-washing, and silence.
"We have an abusive relationship with nature. It underlies our problems. We think we can eat and eat [from] nature and it will just replenish itself but there is no slowdown in emissions and we are on a trajectory of many places in the world being unliveable. All this means if we in public health want to fight disease then we need to also [be] part of systemic change. We need to stop the eating," he said.
