Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.
Surveillance, resilience, adaptation—these activities happen at local and national levels around the globe. As the climate crisis grows—with interlocking symptoms ranging from extreme weather to higher human exposure to zoonotic diseases—how can we coordinate systems to go beyond human health to planetary health? Amanda Quintana, Adam Schaefer, and James White share their ideas in the latest episode of The Intersect.
- Climate Integration: Why the Future of Health Systems and Global Development Depends on It
- Climate Crisis on Main Street: How Can Local Governments Address the Environment, Housing, & Equity?
- Climate Change & The Impact on Health: It’s Not (Just) the Heat, It’s the…Everything
Read the Transcript
Eric Tischler: Hi, and welcome to The Intersect, I'm Eric Tischler. Abt Associates tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it'd be enlightening—and maybe even fun—to pair up colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges. Today I’m joined by not two but three of those colleagues: James White, Amanda Quintana, and Adam Schaefer.
James' specialties include infectious disease, brokering public private partnerships for national community-level health service delivery, and strengthening the quality of clinical services. Amanda supports climate and health strategy development and the integration of climate change into health programs. Adam focuses on clinical epidemiology to protect public health, and is a specialist in integrating environmental wildlife conservation.
Amanda Quintana: Thanks for having us, Eric.
James White: Thanks, Eric. Great to be here.
Adam Schaefer: Thanks, Eric.
Eric: As human activity continues to impact the climate, we increasingly feel that impact on our own bodies and surroundings. Ocean plastics eaten by fish are showing up in our blood, carbon and methane emissions from our technologies reduce air quality while exacerbating damaging weather events. As humanity further encroaches on habitats, we are increasingly exposed to zoonotic diseases while worsening the environment that supports us all. Meanwhile, health systems have to tackle these challenges even as they struggle to respond and adapt to ever more dangerous impacts. Clearly, these challenges aren't siloed. Human health, animal health, and the climate are inextricably connected—what we're talking about is planetary health, so how can we bring our capabilities in health and environment together to preserve and protect planetary health?
Amanda, I'm going to start with you because you really lean into climate as a facet of public health, which was kind of a shift of emphasis in your career. What made you want to make that pivot?
Amanda: Thanks, Eric. So, I think it's exactly that, having more of an understanding that there are many things that impact our health beyond just disease or an illness. We really are linked with the environment and the health of our environment really impacts the way that we live and our health.
So, my background was in global environmental health, and that's what I studied when I was focusing in my Masters of Public Health at the George Washington University. And really, from there, I was focusing in on water sanitation and hygiene—and air pollution more so. And it was really when I started my career at USAID Global Health Bureau where I noticed that it was much more than just the environment that was impacting our health. And we had a lot of programming out in the field on very vertical programs like immunization or maternal and child health service delivery, but one thing that they all were susceptible to were changes in climate and weather. And often, we heard from a program—that was out in Mozambique, for example, that was attacked by a cyclone—that their activities were completely destroyed and they had to shift the way that they were working on the ground. And I thought, how could we not have anticipated this?
I came from a very climate-vulnerable city in Miami, in Florida, and was used to hurricanes. And at the time was more and more the case that these hurricanes were becoming more intense and frequent, and that was the case for a lot of extreme weather events we were seeing around the world. So, I really got curious around this climate and health intersection and saw a huge gap in the way that we program in global development and decided to switch over to fully dedicate more of aligning my passions with wat I thought we need at the time. So, I really shifted for that purpose.
So, beyond seeing the ways in which climate impacts health, it's also the ways that the health sector contribute to climate change by the emissions that the health systems release, for example, and contribute to greenhouse gases. So, there's a lot of different things that we can think about when we think of climate and health, from vector-borne diseases to the health systems being on the front lines and responding during a climatic event. So, there are many things around that that I'm focusing in on.
Eric: Great, thank you. And, real quick, what do you see as sort of the top climate threats? You talked a little bit about the lack of preparedness, the lack of foresight, the lack of connecting dots. Is there anything you want to highlight, other things that might be going unnoticed?
Amanda: Yeah. So, I think a lot of it does come down to preparedness. And so, this is the whole resilience conversation that we have often around “How do you build climate resilience, especially in health or the health sector?” And a lot of it comes with the access and use of climate and weather information that is readily available in most places. It's utilizing available information to predict or help inform operations of health systems and planning and policy, so that we do have things in place. So, I'm really talking about early warning systems here when I talk about the use of climate weather information systems and how it can be used by the health decision maker. It's early warning systems for health. There have been a lot of shifts in vector-borne diseases, for example. That's a lot of the things that we see when we hear about the intersection of climate and health, especially with malaria. Early warning systems really help with the vector control strategies, for example. They can tell us when we would expect an increase in temperature and maybe when we would see a vector shift, and that can really inform the way that we do our programming and that we practice our vector control strategies. So, the utilization of this information is important and how it plays a role in our planning and preparedness on the ground is really important.
Eric: Great, thank you. And that's actually a good segue to Adam because I know Adam actually has some similar concerns. Adam, when you first came on board, I knew you as a zoonotic disease expert, but you're an environmental epidemiology expert and you've moved into climate human health practices. Want to talk a little bit about that shift for you.
Adam: Yeah, thanks Eric. For me, it was less of a shift and more of a natural progression in the research that I've been doing. All of my work's been anchored in environmental epi, but it's taken a really interesting path in terms of the One Health approach, which is a pretty popular framework for research. And that's really integrating human environmental and animal health, both agriculture animals, companion animals, and wildlife, which has been my focus. So, my research really focused on using apex predators and shared ecosystems with humans as sentinels, and then actually closing that loop of research and implementing the projects to protect human health and actually measure the impacts on humans, as well. So, it really comes full circle.
And some of the projects, a lot of them have the same kind of undercurrent of climate impacts. BioWorks ranged from looking at detecting the presence and concentrations of harmful algal bloom toxins, for example, in coastal ecosystems and sharks, and then naturally progressing that into coastal residents that were in the same areas and sharing some of those waterways in Florida, for example, and harmful algal blooms are impacted by things like salinity. So, storm events play a big role and water temperature, as well.
But I've also done work that's ranged from heavy metal and toxin concentrations and dolphins, and then again, closing that loop and looking at local fishermen because we were able to follow the pathway of exposure to their prey species, realizing that those prey species with the dolphins overlapped with what local fishermen were catching and tying to piece that together to look at early warnings and implementing. So, it's really been about taking the One Health concept and implementing it and then finding that everything is connected with ecosystem health, and climate change is right now a huge part of that. Like Amanda mentioned, we're really interested and concerned about impacts from climate change with emerging infectious diseases. We're talking like 75 percent plus of new and emerging infectious diseases are zoonotic, and a lot of those zoonotic spillover events are driven by things like habitat degradation that are directly impacted by climate change.
So we really want to take that One Health concept and implement it. Things like One Health committees around the world, One Health is one kind of big planetary health concept. But once you start implementing it at the local level, you have to realize that you have to be very adaptable. The challenges are unique, the resources are unique, and bringing together the right personnel from those areas, those countries that have the interdisciplinary expertise like the environmental health folks, the human health, you're talking about agriculture as well, to discuss the common needs and policies that can be implemented. It's pretty interesting how we look at even conservation implementation can directly impact human health and improve human health. So, it's about putting those pieces together and using data that's already out there and active surveillance. And Amanda, like you mentioned, with data that's already available and using that as an early warning system, that's including surveillance. So, that's including zoonotic surveillance and integrating veterinary professionals as well, to give us the best chance to adapt to the challenges that climate change is really presenting us.
Eric: And you've mentioned in the past that vets might see that data, but it's not necessarily getting where it needs to get for us to act on it more effectively. James, I want to get you in here and I think everything we're saying is leading up to you.
James: From my angle, I've spent the last 20 years-plus in clinical care, in emergency response in, as Amanda and others have talked about, vertical programming, where we're sort of reacting to events. And what concerns me is that we have health systems around the world that are still recovering from COVID that are going to face another wave of either COVID or an infectious disease, as Adam has mentioned, and that plus climate is deeply concerning. The vulnerabilities are heat, extreme weather events, the damage that those cause, but we're also talking about air quality, water quality, food security, and safety. We're talking about the aspects of ecology and encroachment on environment, which you mentioned Eric. And so, those are the vulnerabilities.
And as the public health clinician, my concern is the injury mortality that comes from that, the heat-related illnesses, the respiratory illnesses, the waterborne vector diseases that Adam mentioned. We're facing compounded challenges and my concern coming from an emergency response background is that we're not prepared. And that's the key word that's been thrown around is preparedness and moving away from reacting to these events and being very intentional in our prevention and response.
Eric: Thank you. And right before this call, something you said, Amanda made me think of this. I was on another call with a colleague on our housing team and she's doing a podcast with someone else on heat and people experiencing homelessness. And Adam, I'm thinking of the podcast you and I did with Claire Lay because Claire had that report on just sort of the inevitability that deaths due to heat are going to increase, right? And that's not necessarily due to anything that we would think of as maybe dramatic like wildfires or hurricanes or cyclones. And yet, as you're sort of saying, James, we think of COVID was going on day after day after day. Climate change isn't just the climate and the climate crisis isn't just dramatic events. It's every day. It is our changing climate. So, as I think everybody is saying, how do we normalize the sharing of data so we can respond to those changes, adapt to those changes, and maybe head off those changes? Maybe let's level set it that way. How can we start talking about connecting those dots on the regular? So we’re just minimizing, adapting, and hopefully preventing.
James: I just want to mention something that Eric just raised that links to the social determinants of health. So, I've just mentioned a lot of health outcomes but, as you mentioned, food, clothing, shelter, and especially housing crises, these are everyday needs that are being impacted across the globe by climate. And so, it is that effect not just on our lives but our livelihoods and our ability to recover and progress from these crises. We've mentioned the impact on people that something you've raised is sharing information. Amanda mentioned the matching of data to resources, so that we can operate effectively. There are impacts and vulnerabilities on humans, but we can clearly see the impacts and vulnerabilities in our systems and our ability to even function, and that is where I think information comes in.
Amanda: So, I think it's also helpful with framing that we talk about what we mean by systems. A system seems like a very complex intangible thing, but we have a lot of the answers already. We have a lot of learnings and lessons from responses to COVID, for example, responses to Ebola, responses to previous wildfires. It's not the first time that we are experiencing similar climatic events. We need to distinguish between slow onset events, which Eric, you were referring to about it always being there and it's not necessarily only going to come in one wave of an extreme weather event, but it's also about acknowledging that things are changing overall and we just need to change the way that we do things. So, there needs to be a transformation of systems and in this case, we're talking about health.
So, what are those lessons that we can learn and draw from, whether it be around governance, whether it be around the way that we coordinated around a response, and how do we pull that into the preparedness side, so that we're not just responding consistently and in that loop but are being effective and building resilience, so that we don't go into a space of needing to respond all the time?
James: I just wanted to jump in on that keyword resilience. So, when we were talking about resilience, that's a very key word Amanda just mentioned. And when we think about it in the context of a health system, we're talking about three very key capacities. The first is to absorb a shock or stress, immediate or slow onset event. The next is to be able to adapt your way of doing, if that is a prolonged crisis or if it's a recurring event as Amanda's discussed. And then Amanda also mentioned transform. That's where we're really looking at health systems of the future that have taken all these lessons into account and have not just adapted, but transformed the way we live in our world to reduce all these vulnerabilities. And I think the animal zoonotic ecological aspect of that is what Adam works on.
Adam: Thanks for teeing that up perfectly, James. Yeah, when you talk about resilience, we also talk about integrated prevention and prevention in animal systems because we know the next pandemic, it's coming, right? It's a matter of time. It's not an if, it's a when, and it's how we structure that the early warning systems and response to prevent these widespread outbreaks where at least we can contain and then identify really early on. And again, that goes back to that early surveillance systems, where you have integration for large projects, where they're out searching for the next virus in wildlife.
There's a lot of other ways, especially working directly with animal care providers—veterinarians, for example, and farmers—where we've seen big wins. Again, you don't hear about them. The victories are not communicated enough. I think we get a lot of compassion fatigue and fatigue over what's coming next. Everybody's fearful, but we also need to recognize where these concepts have been successful in the past and build on those to build on resilience in those systems.
Eric: That's a great point, thanks. And so, with surveillance too, that sort of gets back to, I think it was Amanda saying it, we're talking about planetary health, which is the health of the entire planet. So, that is our environment, that is humans, that is animals. But talking about at the local level, like you're saying with surveillance, how do we start actually connecting the dots? Building on success stories like you just mentioned, Adam? Amanda, you said we have a lot of these capabilities already in place, so how do we start bringing these things together? Because we don't have to reinvent the wheel. We just need to put all the wheels on the car maybe.
Amanda: As a globe, I don't think there's an answer for the world, but maybe in a local municipality, in Zambia for example, I could give you maybe a better response to that question. But we just want to acknowledge that not every person around the world experiences the same health system and even within a health system, they don't have the same access or experience to the health system. And I'm getting at the inequity of a health system, and when we think about the ways in which we are addressing or implementing such early warning systems and who they're for, we need to think about the most vulnerable and marginalized as well, so that we really think of equity in all of that we do. And I'd be really curious to know, how do you all consider equity also in the work that you're engaged in? And does this come up in the approaches that you're working on in One Health and in global health security?
Adam: That's great, Amanda. It comes up all the time, especially when you talk about the interface between wildlife ecosystems and humans. You have kind of the more marginalized folks, who are farming communities, for example, the ones who are encroaching on rainforest for example. They're more likely to come in to contact with wildlife, where those spillover events occur. But, like you mentioned, they're less equipped to deal with those spillover events or identify that it's an event before it spreads too fast. So, it's an essential component when we start thinking about implementing it, depending again on the geographical level that you're addressing that. But James probably has a bit more insight, especially from the system perspective.
James: For me, especially if you put it in the emergency response and/or prevention thinking, equity equals differential vulnerability. And that means that either because of who you are, your race, your creed, your gender, your physical ability and/or disability, this puts you at differential risk. And so, it requires acknowledging that people in our communities require extra assistance and we need to step up and provide that. So, I don't look at equity as something separate. I look at it as part of this: planetary health means acknowledging people, plants, and animals on our planet need protecting, and differential vulnerability is a big part of that and acknowledging that.
Eric: So James, I was going to ask you, to Amanda's point, there's not a planetary working group, right? That's going to come with the one-size-fits-all solution? We've talked about this being local. As you're listening to this from, again, that health system's perspective, connecting these dots, what might be a framework for thinking about this that could be scaled differently, applied differently. Do you feel like we have some approaches that could be expanded to adapt the surveillance we're talking about, baking in resilience, et cetera?
James: I think Adam's already mentioned the One Health committees that are being formed around the globe. That's a very, very good start. That's bringing human, animal, and ecological health "experts" together, and ideally decision makers, who can buy into that dialogue and we can get the political will through those committees, but it is a combined effort. It's going to take public and private actors. It's going to take people from all across different disciplines. So, One Health is one aspect. The other is the Pandemic Fund out of the World Bank, which is starting to be implemented, and we'll see how effective that can be in mobilizing political will. But this is the future. Again, we're talking about transformative health and transforming the way we do things and we're getting started.
Amanda: So, I think similar to what James described on what's working already in One Health, for example, in climate and health—albeit a new space—there is also this attempt of being cross-sectoral, working in a coordinated fashion, not just at a national level and a country government, but also at the local level to understand what particular risks need to be addressed and how people are going to be looking out for improving health or building resilience of the community's health to different climate risks depending on where they are. And you see these through climate and health vulnerability assessments. You also see this through a big push on policy under national adaptation plans that have time and time again named the health sector as a priority adaptation sector.
So, there's a big international push to think about climate and health and we are only just getting our feet grounded, but we can learn from disciplines like One Health that have already been working in this approach for some time. And that's why we see a lot now, this intersection of utilizing a One Health approach in the auspices of climate and health and what does that look like.
Eric: I think you're all saying the same thing: The pieces of the puzzle are there. Is the awareness there and it's just a matter of we have not caught up with that awareness or do you think we still need to build that awareness? Because I'm thinking, actually, Amanda, of your work with methane in the health sector. The health sector needing to understand how reducing methane really speaks directly to their work. Do you feel like there's more evangelizing we need to do across sectors?
Amanda: I think there's always a need to build awareness across sectors because when you are in a specific sector and you are day by day looking at a particular task, you might not be completely aware of other facets that might be impacting your work or that could improve your work. So, I do think that there's definitely always an element of awareness building. I also think it's about highlighting these lessons and sharing these lessons across countries and across projects whenever possible. “Everyday resilience” is a concept that's come up in the academic literature around health systems resilience because we were trying to understand “What does this mean?” And “resilience” is really a term that comes from ecology and is now being used in the health sector space. But how do you measure it? What does it mean? I think it's always there.
We, as people, as humans, are resilient beings and we're trying to survive and make it through the next day, and that's a part of resilience. And that's kind of a bit of the lessons that we need to draw from when we're talking about how we make our systems resilient—and the functions that we're working on resilient, as well.
James: I just think that's such a critical point because we talk about reducing emissions by X percent or we talk about concepts like resilience, but in the end, it's about acknowledging the shared risks. And I think that's what we've all been talking about is making people care. So, what is it going to take for us to care? And that's where I think some of the solutions we're talking about are practical, operational, tangible to not just make people care, but to show some progress.
Adam: Yeah, that's the important part, too. It's not just awareness and caring about it. It's also what will drive key decision makers to action and implementation. So, these frameworks and discussions are great, and some of them, like the One Health frameworks, have been out there for a while, but the key is actually implementing them and getting stakeholder engagement to implement them. We can talk amongst ourselves for hours about these concepts and these frameworks, but it's not going to lead to effective action unless we get key stakeholders and policymakers involved, convinced it's a problem, show clear solutions, and being able to measure those outcomes and the effectiveness of that preparedness, which is always the difficult part to prove and demonstrate how effective these approaches are.
James: If I could add one thing, in global health security, it often feels like I'm selling insurance. I'm trying to prevent something that may or may not happen. And if we're successful, it won't happen. And so, getting political will for when there are so many competing priorities, so many financial needs within a health system and within a country, how do you sell insurance to prevent something from occurring in the future? So, it's a big issue.
Eric: Well, thank you James. And I was just thinking about the work we did for New York and their climate plan and we said, “This is what you'll save by preventing these foreseeable health impacts” and that helped them get that plan approved. So, it is something that not only can be done but has been done. But I hear we all are saying it's also normalizing it and normalizing the steps, as well as showing the value.
James: And making the business case. Making the business case beyond advocacy. Advocacy is where you raise the awareness, hopefully; making the business case for why this is needed right now.
Adam: It's a clear cost benefit scenario when you're trying to sell some of these approaches.
Amanda: And when do we see insurance being purchased across the globe it’s when there's a crisis and then it’s too late. So often, we learn from crises and we learn from times of panic, and that is something that we're trying to prevent. We don't want to get to that stage.
James: One thing I'm doing, especially as we even talk about PEPFAR renewal and maintaining commitment to the HIV response, going back to this idea of the butterfly effect with climate, an event in Asia affects the globe. An event in North America affects the globe. And so, that goes again to shared risk and getting people to understand that we share risk regardless of where we're located.
Adam: And then to spur them to action, it's not just the shared risk, but the shared benefits that each of these countries can see by implementing these approaches.
Eric: We're a global company working with different countries at different scales in all these different areas. So, we've already said a lot of tools are in place, there's surveillance is in place, some of these conversations are happening at smaller levels. We just need to start connecting these dots.
James: Every tabletop exercise, every real-world emergency response activity typically demonstrates that coordination was the problem. So, as you've just described, it's about putting all these pieces together and doing it before an event occurs, not right after or not 10 years after. And coordinating effectively across all these various people. And to plug Abt, if you want me to plug Abt, one thing Abt does very well and has been doing for decades is bringing people together at round tables, in working groups to have those difficult conversations and to get to consensus, to get to resolution. And yeah, we're continuing that trend.
Eric: Continuing that trend is almost a theme because we're talking about how this needs to be standardized, right?
James: Well, I'll add one thing, and this is for our founder. So, I'll just say I think this is why Abt was created, with to tackle these huge problems, what we call “wicked problems” in the public health world.
Eric: Well, and understand, we've already started. This is the latest point in this conversation. To your point, James, Abt’s going for going on 60 years. So, we've been building to this, so we're not starting from scratch.
Amanda: No. We're part of a movement.
Adam: This is an evolution of our practice at Abt, and we have to continue to adapt and evolve to take on the challenges of climate change, of global health security, all while using the tools that we've created over the almost-60 years of existing.
Eric: So, to the extent that we continue these trends and normalize these conversations, hopefully the more progress we make. Thank you all for joining me.
Amanda: Thanks, Eric.
Adam: Thank you, Eric.
James: Thank you, Eric.
Eric: And thank you for joining us at The Intersect.