Future-proofing health: Khyber Pakhtunkhwa’s groundbreaking study maps climate change's health impact

Climate change is no longer a distant threat— its impact on human health is already visible, especially in countries like Pakistan. With its diverse geography, Pakistan’s Khyber Pakhtunkhwa (KP) province is facing the highest incidence of climate disasters in the country, leading to devastating consequences for the health and well-being of its people. In response, the KP Department of Health, supported by the UK Foreign, Commonwealth and Development Office (FCDO), recently completed the country’s first Climate Health Vulnerability Assessment and Adaptation Assessment (CHVA), a critical study designed to assess and address the health-related vulnerabilities posed by climate change.

Completed in September 2024, the CHVA provides a comprehensive analysis of how climate change is affecting KP’s health system, focusing current vulnerabilities, system capacities, projected future risks, and recommended adaptations. The assessment offers a blueprint for strengthening the province’s health resilience against the increasing threats of climate change.

Figure 1, Anomaly in NOAA Heat index in KP (Khyber Pakhtunkhwa Climate Change and Health Vulnerability and Adaptation Assessment 2024)

Why KP is at the forefront of climate health risks?

KP’s diverse terrain — spanning cooler, mountainous areas in the north to hotter, arid plains in the south — makes it especially susceptible to climate-related disasters, including heatwaves, droughts, forest fires, floods, and Glacial Lake Outburst Floods (GLOFs). The province has already witnessed extreme weather events, such as the catastrophic floods of 2010 and 2022, which have severely strained its health system. 

The CHVA highlights how these climate events disproportionately affect the most vulnerable segments of the population, including women, children, the elderly, and those living with disabilities. With already limited staff, infrastructure, and resources, KP’s health system is struggling to cope with the additional burden climate change brings. Climate change will only increase this burden, particularly in areas such as malnutrition, where agricultural productivity is being compromised by extreme weather, and vector-borne diseases like malaria and dengue, which are on the rise due to changing rainfall and temperature patterns.

Key findings and future risks

Looking ahead, the projections are alarming. By mid-century, an additional 16-18 million people in KP’s flood-prone districts could face higher risks to water- and vector-borne diseases. Diarrheal diseases could surge by 10-20%, while malaria and dengue cases may spike by 30-40% as changing weather patterns create ideal conditions for disease spread. Respiratory illnesses, including asthma and bronchitis, could see a 10-20% increase driven by higher temperatures and worsening air quality. By 2100, projected temperature increases of up to 5.3°C will further intensify the risk of heat-related illnesses and exacerbate cardiovascular and respiratory diseases.

These alarming projections underscore the urgent need for adaptive strategies to mitigate health risks. Without immediate action, the province’s health system will be increasingly overwhelmed, with the poorest and most vulnerable communities bearing the brunt of the impacts.

Figure 2, Climate change vulnerability and climate-sensitive health risks (Khyber Pakhtunkhwa Climate Change and Health Vulnerability and Adaptation Assessment 2024)

Building climate-resilient health systems

The CHVA offers  practical, actionable recommendations for building a more climate-resilient health system in KP. Investing in robust leadership and governance by developing policy frameworks and enacting or amending legislation that integrates climate change adaptation into health is key. This includes developing a Climate Health Adaptation Plan (CHAP) while prioritising equitable access to universal health coverage for the most climate-vulnerable populations and establishing a climate health unit within the KP Department of Health. 

Existing health programmes should be reviewed and adapted for climate resilience, particularly addressing heat-related, water-borne, vector-borne, respiratory diseases, malnutrition, and mental health issues. Initiating research on climate-health vulnerabilities will support health programme development, review, and future planning. Service delivery should focus on vulnerable populations and leverage multi-sectoral collaboration to achieve cost-effective co-benefits, including contingency planning, surge capacity, continuity of service plans, and separation of key duties.

Additionally, integrating climate impact monitoring into health information systems, such as District Health Information Systems 2 (DHIS2), with early warning systems (EWSs) of the Provincial Disaster Management Authority (PDMA) and Meteorological Department, will enable timely anticipatory action. Finally, assessing and investing in the climate resilience of health infrastructure will enhance the functionality and responsiveness of health systems in the face of climate challenges.

The assessment provides a baseline for the KP government to update periodically, ensuring that the province remains responsive to evolving climate threats. 

A call to action for policymakers

The CHVA is not just a technical report; it is a call to action. Policymakers now have a clear roadmap for addressing the complex and interconnected health challenges posed by CHAP, which will guide efforts to enhance health system resilience and coordinate cross-sectoral responses to climate threats.

In the face of an uncertain climate future, the message is clear: the time to act is now. Failure to adapt will not only result in more deaths and illnesses but will also exacerbate social and economic inequalities, disproportionately impacting the most vulnerable communities.

But there is hope. If its recommendations are fully embraced through the CHAP, KP can transform its health system to not only meet today's challenges but to be ready for the climate realities of tomorrow. The time to act is now, and the steps we take will shape a healthier, more resilient future for all in KP.

About the authors:

Mahwish Hayee is a medical doctor, with a Master's degree in Public Health from King's College London, and a PhD in Public Health from Lancaster University. She works in public health, health systems strengthening projects, and quantitative research. She has more than 15 years' experience in the field of public health.

Shehryar Khan is a consultant in the Health Practice. He is a health system strengthening and public policy expert with extensive experience in Technical Assistance programmes, including project design, management, and implementation. 

Kainat Faheem Abbasi is an assistant consultant in the Health Practice.