Jacob McKnight: Preparing Kenya’s health system for extreme weather

My name is Jacob McKnight and I'm an Associate Professor at the Health Systems Collaborative.

My area of research, what I'm really interested in, is in helping health systems prepare for extreme weather. There's a lot of great work underway helping health systems become more sustainable, which means that they are polluting less, they're changing their energy systems to be more sustainable, that kind of thing. But my real interest is in periods of extreme weather and what health systems do during those periods. You've got extreme weather like floods or droughts or extreme heat, and during those periods demand for health services tends to go up but at the same time the provision of health services tends to go down because health workers and health systems are also affected by those events, so that's my interest.

The project I'd like to tell you about is called NEWRISK which stands for A Novel Extreme Weather Risk Insurance System for Kenya. Kenya is a really interesting and powerful example of why we need to help health systems prepare for extreme weather. They are already experiencing very troubling extreme weather this year. They had floods, and 300 people were killed which is of course terrible, but 300,000 people were displaced during the floods. Not only that, the health system really struggled to provide care, because again what happened was that these 300,000 people they have more needs, they have greater health demands due to being displaced. And while that happened the health facilities were flooded, or people couldn't get to work and couldn't open the health facilities, and even now they're struggling to get back on their feet as a health system, and all these new people have much greater needs. So yes, Kenya is a really good example of why we ought to help health systems prepare for extreme weather, and the NEWRISK project aims to do that.

The big questions I think are to do with the epidemiological transition and the fact that global health has had this amazing effect over time through things like vaccination and bed nets, the treatment of malaria, TB and HIV, have saved tens of millions of people around the world, but we're now seeing those traditional infectious diseases being largely dealt with. And what we're left with are more extreme versions of those conditions, more tricky versions of those infectious diseases and a huge increase in non-communicable diseases, which means that health services, hospitals and health facilities have much more complex cases to deal with and unfortunately, in lower and middle-income countries, as in higher-income countries in fact, it's a really bad period for health systems because demands are going up, demands are more complex as I was saying, and at the same time they've not had the economic growth, and so the investments aren't there to help health systems change to deal with these new threats. And then in the background of all that as I'm particularly interested in, you have these exogenous threats, antimicrobial resistance would be one of those, but extreme weather is also this unknown at this point, we already see it in Kenya and countries like that but the extents to which it will disrupt services and increase the demand for care are unknown.

We're really lucky on the NEWRISK project that we get to work with populations directly. One part of the project will explore where the most vulnerable people are and will then see what type of access they've got to health facilities and we'll explore how best to keep those health facilities open during those periods of extreme weather. Then once we understand where those people are and what their needs are and how this will change through different types of extreme weather, we want to work with those communities directly to make plans. If we can help them to plan, if we can help them to really prepare and become resilient, then they've got a much better chance of getting through that period of extreme weather without becoming displaced, without becoming much more affected, and we believe that extreme weather risk insurance might be a good idea for that too.

I think that climate change represents the largest threat to humanity that's ever existed. So far in health, in the science of healthcare and understanding health systems and health demands, we’ve focused on things like malaria and other infectious diseases, how these will change with heat and different types of weather changes. But really there's a much broader effect across the social determinants of health, how people are employed, how they access education, clean water, food supplies, these types of things. And I think as extreme weather and climate change really affects those social determinants of health, there'll be a much greater increase in the demand for health services, and at the moment we're simply not prepared, and so I think it's essential that we focus on that area.

This interview was recorded in July 2024.