Climate change and health in informal settlements: a narrative review of the health impacts of extreme weather events

Abstract

In this paper, we present a narrative review of primary research on the health impacts of extreme weather events in urban informal settlements published between 1990 and June 2021. We include 54 studies and examine the health impacts of extreme weather events and how these were determined. We find that these events impact health directly by causing mortality, injury and disease and through indirect pathways by impacting livelihoods, access to healthcare, coping strategies and adaptive capacity. Drawing on the social determinants of health framework to frame our analysis, we find that health impacts are determined by multiple intersecting factors, relating to individual circumstances, material conditions, health status, and political and socio-economic context. Consequently, vulnerability varies between and within informal settlements. Overall, we show that responding to and minimising these health impacts requires an intersectional approach to understand and address these contextual root causes of vulnerability.

Rethinking urban environments and health

“…22 Recent reviews have identified associations between extreme weather events such as floods, extreme temperatures, and drought with health among residents of informal settlements including increased infectious diseases due to food-and water-borne disease, worse mental health, and increased domestic violence. 22,23 Extreme weather events also indirectly affect health through poorer sanitation and hygiene, changes in food consumption, increased food insecurity, and loss of income and livelihoods. 22 Well-planned adaptation actions can reduce the likelihood of adverse health impacts due to climate change in urban areas, particularly for those facing poverty, housing informality, and lack of basic services.…”

“…22,23 Extreme weather events also indirectly affect health through poorer sanitation and hygiene, changes in food consumption, increased food insecurity, and loss of income and livelihoods. 22 Well-planned adaptation actions can reduce the likelihood of adverse health impacts due to climate change in urban areas, particularly for those facing poverty, housing informality, and lack of basic services. 24 Improved physical infrastructure in informal settlements such as increased access to piped water (<60% of urban populations in LMICs have access to piped water), 24 sanitation, and drainage can improve health, reduce inequalities, and improve resilience in the face of flooding or high temperatures.…”

“…21 Residents of informal settlements are particularly vulnerable to climate change due to a range of individual-level factors (e.g., occupation, existing health conditions, and poverty) as well as socio-economic and political factors (e.g., lack of housing rights and security, political and social exclusion, government neglect, and lack of access to services). 22 Recent reviews have identified associations between extreme weather events such as floods, extreme temperatures, and drought with health among residents of informal settlements including increased infectious diseases due to food- and water-borne disease, worse mental health, and increased domestic violence. 22,23 Extreme weather events also indirectly affect health through poorer sanitation and hygiene, changes in food consumption, increased food insecurity, and loss of income and livelihoods.…”

“…22,23 Extreme weather events also indirectly affect health through poorer sanitation and hygiene, changes in food consumption, increased food insecurity, and loss of income and livelihoods. 22…”

Socio-ecological impacts of extreme weather events in two informal settlements in Nairobi, Kenya

“…Climate change exacerbates these health risks. For example, research suggests that in flooding or heat events, health risks are worse for women as they stay indoors due to insecurity and privacy concerns ( 21 ). Women in these settlements face a number of gender inequities such as disproportionate childcare responsibilities ( 22 ) and household water, sanitation, and hygiene duties that are more challenging to fulfill in the face of extreme weather.…”