View from the inside: The intersection of health and climate
Suresh Tiwari discusses how the climate crisis has impacted every aspect of public health policy in Nepal, and how all countries need to come together to mitigate the challenges ahead.
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Date
December 2024
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Areas of expertiseClimate, Energy, and Nature , Health
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CountryNepal
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KeywordsClimate governance , Climate policy and finance , Health systems governance [HSG] , COP29
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OfficeOPM Nepal
We sit down with OPM Nepal Country Director, Suresh Tiwari, who has journeyed from a public health worker to to a key policy architect, working together with the Government of Nepal to drive innovative approaches to climate and health challenges..
Q: How do health and climate change intersect in your experience?
When I started as a public health worker 26 years ago, we weren't thinking about climate change and health. But the 2015 earthquake in Nepal was a turning point. Suddenly, we saw how climate-induced disasters could completely compromise healthcare delivery systems - destroying health infrastructure, obstructing basic services like immunisation, maternal and child health, and creating massive economic challenges.
Since then, Nepal has transformed its approach. We've started integrating climate considerations into health policy, recognising that health is more than just hygiene and sanitation in the National Adaptation Plan (NAP). The challenge now is understanding the broader impact: climate change doesn't just affect health; it obstructs entire social service systems. It is indeed posing a great challenge in terms of achieving Sustainable Development Goals (SDGs).
The stakes are enormous. The Lancet reports that in the last five years, extreme heat events alone caused $200 billion in health-related economic losses. These impacts disproportionately affect countries with stretched economies, making it crucial for higher income nations to support more vulnerable regions.
The real challenge is getting countries to understand that we're all interconnected. What happens in low and middle-income countries ultimately affects everyone - a lesson Covid-19 made painfully clear.
Q: How has the role of public health worker changed since you started your career?
The transformation has been remarkable. When I first started, communication was incredibly challenging. We would walk for hours just to find a telephone booth, and accessing critical information was nearly impossible. Today, technology has completely revolutionised our work.
Now, health workers have internet connectivity even in the most remote areas. We can access real-time weather information, communicate instantly through social media platforms, and use telemedicine to consult with colleagues and patients. During the Covid-19 pandemic, we even created a Viber network with over a million members, allowing us to share critical health information rapidly.
The supply chains have improved dramatically too. In the past, transporting medicines and vaccines was a gruelling process that could take days. Now, improved road networks mean we can move critical supplies much more quickly and efficiently. Technology has given health workers incredible tools to respond to emergencies and provide better care.
Q: What changes have you personally observed in Nepal's climate during that time?
The changes are impossible to ignore. My hometown now experiences weather patterns that were unimaginable 26 years ago. Summers have become unbearably hot, and we're experiencing cold waves that we never had before. These aren't just minor variations - they're fundamentally changing how we live and work.
The environmental impacts are stark. Around Kathmandu, we used to see stunning mountain views every day. Now, we're lucky if we can see the mountains for 20 days a year. Air quality has deteriorated dramatically, leading to increased respiratory problems, more frequent flu outbreaks, and health challenges for vulnerable populations like children and the elderly.
As air quality is deteriorating, incidences of respiratory diseases during winter have increased significantly. Thus the US Centers for Disease Control and Prevention has even changed vaccination protocols, recommending flu shots twice a year instead of once. These aren't abstract scientific predictions - these are real, tangible changes that are affecting people's health right now.
What were your key experiences and objectives at COP28 and COP29?
At COP28 in Dubai, I was part of a historic moment when 148 countries signed a groundbreaking climate change and health declaration. It was incredibly inspiring to see global recognition of health as a critical climate change issue.
At COP29, I participated as an observer, which gave me more freedom to engage critically. I spent my time supporting civil society organisations, meeting with regional delegations from South and Southeast Asia, and consistently advocating for dedicated health financing. My core message was simple but crucial: health must be considered in every climate discussion.
We're not just talking about abstract policies. We're talking about protecting human lives, ensuring communities can access healthcare, and creating resilient systems that can withstand increasing environmental challenges.
What needs to happen at future climate conferences like COP30?
We need more than just discussions and declarations. We need committed, strategic action. Higher-income countries must step up and provide meaningful support to stretched economies. We need clear roadmaps for health and climate adaptation that prioritise human lives and future generations.
It's not about blame. It's about collective responsibility. We must develop practical plans that channel resources where they're most needed, protect vulnerable communities, and create a more resilient global health system.
The clock is ticking. COP30 isn't just another conference - it's an opportunity to transform our approach to global health and climate change. We need to move from conversation to concrete action, from promises to implementation.
About the author:
Suresh Tiwari is our Country Director in Nepal and a public health and public financial management professional. His areas of expertise include demand-side financing, conditional cash transfers, social protection, performance-based financing, transaction accounting and budget control systems, pro-poor health financing, and public health education.