Climate change and TB: An analytical framework – European AIDS Treatment Group

Report on the Intersection of Climate Change, Tuberculosis, and Sustainable Development Goals

Introduction

Climate change presents a significant threat to global public health, with the potential to exacerbate the determinants of Tuberculosis (TB), the world’s leading cause of death from a single infectious agent. This dynamic directly challenges the achievement of the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). Despite its severity, the link between climate change and TB is frequently overlooked in broader climate-health policy discussions. In response, the World Health Organization (WHO) has commissioned the development of an analytical framework to delineate the causal relationships between climate change and TB, aiming to integrate this critical health issue into the climate action agenda.

Analytical Framework and Published Findings

A position paper published in The Lancet Respiratory Medicine details the creation and application of the WHO-commissioned framework. The report serves to bridge a critical knowledge gap, providing a structured approach to understanding a complex, multi-faceted problem. Key contributions of the paper include:

• A detailed description of the analytical framework designed to map potential causal pathways.
• A comparative analysis of the framework against existing scientific evidence.
• The identification of critical domains where research and evidence are severely lacking.
• The suggestion of potential entry points for policy and programmatic interventions.

Implications for Sustainable Development Goals

The interplay between climate change and TB has profound implications across multiple SDGs, highlighting the interconnected nature of global development challenges.

1. SDG 3: Good Health and Well-being: The primary impact is on Target 3.3, which aims to end the TB epidemic by 2030. Climate-related factors such as malnutrition and displacement can increase TB susceptibility and transmission, undermining decades of progress in global health.
2. SDG 13: Climate Action: The findings underscore the necessity of integrating public health considerations, specifically for diseases like TB, into national climate change adaptation and mitigation plans. A failure to do so risks creating climate policies that neglect the most vulnerable populations.
3. SDG 1 (No Poverty) & SDG 2 (Zero Hunger): Climate change threatens food security and exacerbates poverty. Malnutrition, a direct consequence of food insecurity, is a leading risk factor for TB. This creates a vicious cycle where climate change drives poverty and malnutrition, which in turn fuels the TB epidemic.
4. SDG 11: Sustainable Cities and Communities: Climate-induced migration can lead to the growth of informal, overcrowded urban settlements with inadequate ventilation and healthcare access, creating ideal conditions for TB transmission.
5. SDG 17: Partnerships for the Goals: The WHO’s initiative to commission this framework exemplifies the cross-sectoral collaboration required to address complex challenges. Effective solutions will demand partnerships between health, environment, and development sectors.

Identified Research Domains and Intervention Pathways

The report emphasizes that a lack of robust evidence is a major barrier to effective action. It calls for a targeted approach to research and intervention to build resilience at the intersection of climate and health.

• Evidence Generation: There is a critical need for focused research to quantify the impact of climate change on TB incidence, transmission, and treatment outcomes.
• Integrated Interventions: Future strategies must move beyond siloed approaches. Interventions should simultaneously address health system strengthening, climate resilience, and the underlying socio-economic determinants of TB.
• Policy Coherence: National and global policies on health and climate must be aligned to ensure that actions taken to address climate change support, rather than hinder, progress towards ending the TB epidemic and achieving the broader 2030 Agenda for Sustainable Development.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s primary focus is on Tuberculosis (TB), which it explicitly states is the “world’s leading cause of death from a single infectious agent.” This directly connects to SDG 3’s mission to ensure healthy lives and promote well-being for all at all ages.
2. SDG 13: Climate Action
   • The central theme of the article is the impact of climate change on public health. It highlights that “Climate change is likely to exacerbate a range of determinants that drive TB.” This establishes a clear link to SDG 13, which calls for urgent action to combat climate change and its impacts.
3. SDG 17: Partnerships for the Goals
   • The article mentions a significant collaboration where the “World Health Organization commissioned the creation of an analytical framework.” Furthermore, the publication of a position paper in a renowned journal like *The Lancet* represents a partnership to disseminate knowledge. This aligns with SDG 17, which emphasizes the importance of global partnerships to achieve sustainable development.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases…
   • The article is entirely focused on Tuberculosis (TB), a disease explicitly named in this target. The discussion around understanding the drivers of TB and suggesting interventions is aimed at combating and ultimately ending the TB epidemic.
2. Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.
   • By investigating the “causal relationships between climate change and TB,” the initiative described in the article aims to build resilience within health systems against the climate-related hazard of increased disease burden. Suggesting “entry points for intervention” is a direct effort to improve adaptive capacity.
3. Target 13.3: Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning.
   • The article notes that “TB is often neglected in wider climate health discussions.” The creation of the analytical framework and the publication of the position paper are direct actions to improve awareness and build institutional capacity (via the WHO) to address this specific impact of climate change.
4. Target 17.16: Enhance the Global Partnership for Sustainable Development, complemented by multi-stakeholder partnerships that mobilize and share knowledge…
   • The collaboration between the World Health Organization (a global institution) and the research community that produced the paper published in *The Lancet* is a clear example of a multi-stakeholder partnership designed to create and share critical knowledge on a global health issue.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Implied Indicator for Target 3.3 (Tuberculosis incidence and mortality)
   • While the article does not provide specific numbers, its reference to TB as the “world’s leading cause of death from a single infectious agent” directly implies the use of mortality and incidence rates as key metrics. Progress would be measured by a reduction in these rates.
2. Implied Indicator for Target 13.3 (Institutional capacity and awareness)
   • The existence of the “analytical framework” commissioned by the WHO and the “position paper” published in *The Lancet* can be considered qualitative indicators. They demonstrate an increase in institutional capacity and a formal effort to raise awareness about the link between climate change and TB, addressing the fact that the issue is “often neglected.”
3. Implied Indicator for Target 17.16 (Knowledge-sharing partnerships)
   • The article itself, resulting from a commission by the WHO and published for a global audience, serves as a tangible indicator of a functioning knowledge-sharing partnership. The number and impact of such collaborative publications can be used to measure progress.

Summary Table: SDGs, Targets, and Indicators

Source: eatg.org