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Picture: Ralf Vetterle/Pixabay
Picture: Ralf Vetterle/Pixabay

Khehla Mahlangu, 52, and Jeremiah Maseko, in his early 50s, both live in eMbalenhle, a township on the edge of Secunda on the Mpumalanga highveld. Both have lung problems and had to quit their jobs. 

“It’s the effect of air pollution,” Mahlangu told Bhekisisa. “Breathing becomes harder each day.”

Mpumalanga has some of the dirtiest air in the country because of the many large coal-burning industries here, including Sasol’s petrochemical plant and three Eskom power stations within an hour’s drive of the highveld town. 

Life will, unfortunately, become harder still in the coming years for people like Mahlangu and Maseko.


Because climate change means the air is getting warmer — which for people with lung diseases such as them, for instance, asthma or chronic obstructive pulmonary disease (COPD, in which the airways narrow and so make someone short of breath), will make breathing more difficult.


Our industries, cars and farms put lots of greenhouse gases such as carbon dioxide and methane into the air. Greenhouse gases trap heat in the Earth’s atmosphere, almost forming a blanket around the air. 

When too much of these gases go into the air — like from humans’ coal-burning activities over the past 150 years or so — the atmosphere close to the Earth’s surface becomes warmer than it should. The planet’s rising air temperature — global warming — drives the change in long-term weather patterns, aka climate change. 

Higher temperatures are a concern especially for people who are already ill with a respiratory disease, says Caradee Wright, a public health specialist who leads the climate change and health research programme at the South African Medical Research Council. 

“For example, in someone who has asthma, an attack is often triggered by air pollution. But when it’s very hot, [the body’s] ability to [deal with] heat is compromised because the person faces an existing health challenge,” she explained during the latest episode of Bhekisisa’s TV programme Health Beat.

It’s a double whammy for people who live in areas with badly polluted air, because burning coal not only puts more and more greenhouse gases into the air but also makes the air dirtier.

Changing weather patterns — for example, excessive heat, extreme cold or intense rainfall — will put pressure on public health systems. In a country like South Africa, where public hospitals and clinics are already overburdened, it will mean that people will struggle to get the care they need even more. 

The World Health Organisation says to fix this, the health effects of climate change need to be considered in every policy that guides how governments care for people. 

But the national health department is not quite there yet, Bono Nemukula, the department’s deputy director for environmental health, said during a Bhekisisa-hosted panel discussion on the effects of climate change and health this month. 

Though some policies have been drawn up, it’s not yet clear what type of data needs to be tracked to shape plans that will bring change, said Nemukula. “We have indicators [in] the District Health Information System. But when we look at them, they don’t give us more information in terms of us coming up with intervention, especially on climate change.”

Mia Malan sat down with Wright to find out more about the challenges climate change will bring to health systems — and what we should do about them. 

Mia Malan (MM): Why would climate change make air pollution worse?

Caradee Wright (CW): There are two ways by which climate change will make air pollution levels worse than what we're seeing now. The first is that the temperature in the atmosphere is changing. With the change in temperature, the chemistry of how things are made up changes, and when the conditions are just right, certain chemicals can break down and reform into different chemicals. This [can] then generate air pollution. The other way is related more to behavioural change. In a warmer or cooler climate — because climate change doesn’t just mean warming, we can also still get cold snaps — people could resort to burning [sometimes solid] fuel, like wood or coal or kerosene and paraffin to heat their homes or to cook. These activities within the homes then produce air pollution, which then goes outside and increases air pollution levels.

MM: What does the effect of climate change on how our bodies cope with heat or air pollution mean for our health system?

CW: We know that the health system in South Africa is already [over]burdened, not just because of the caseload, but also because of staff shortages and stockouts of drugs. If there’s an influx of people who are struggling during periods of intense heat, which does exacerbate some respiratory illnesses, we won’t be able to serve those people as they need [to be served]: with immediate attention to prevent further adverse effects. There’s a lot that needs to be done in preparing our health-care system as a whole, [for example,] infrastructure, buildings, capacity among staff, skills and knowledge to recognise the types of illnesses that are going to be triggered during these types of heatwave events.

In a country like South Africa, where public hospitals and clinics are already overburdened, it will mean that people will struggle to get the care they need even more

MM: How are we doing with that preparation? 

CW: There’s some teaching and learning [already] going on, but I don’t believe that it’s in depth enough to truly prepare our workforce.

MM: Life-altering events in our world, like pandemics or climate change, tend to magnify the problems we have in our world, for example inequality. How do we deal with climate change in the context of inequality? 

CW: The changes we’ve seen in our communities with regard to socioeconomic status — not only during the pandemic, but also before and [still] continuing today — means that some people will not have the adaptive capacity or the agency to implement changes in their lives to protect their health. That means they need to rely on the health-care system and services to give them either the preventive medication or the treatment that they need to ensure that their health and wellbeing are maintained. South Africa is one of the most unequal countries in the world, according to our Gini coefficient, and this is going to be exacerbated in the face of a changing climate. It’s concerning that [our health system] will likely not be able to help the people who need help the most.

MM: So should we use climate change to speed up our efforts to address inequality, which was already there before climate change and will likely become worse?

CW: Exactly. The World Health Organisation proposes that we have health [considerations] in all [climate change] policies and what we [as public health researchers] are lobbying for now. It affects every aspect of life, not just health-care systems, but also the social system, food, water and sanitation. All of these things will be affected and climate change should be addressed at the highest level in policy, to filter down into frameworks that [aim to] improve quality of life.

MM: Where should climate change be worked in where it wasn't previously?

CW: For example, think about the food chain. Keeping food cool from farm to fork is tricky when it gets warmer. But we need safe food for people to eat and maintain their health. So, [we have to think about] using different energy sources to fuel the refrigeration in these trucks. We hope that one day we'll get to the point where we’d see something like solar power being used. That’s just one way in which we are trying to adapt, through the national climate change & health adaptation plan, to help people's health.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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