Climate Change Affects Cardiovascular Health: Africa can foster better awareness and mobilisation

Climate change has profound effects on cardiovascular health, especially for people living in Africa, posing challenges to healthcare systems in how they best address this growing crisis through adaptation and mitigation measures. But adaptation strategies are on hand to make change, says Professor Ntobeko Ntusi, president and chief executive officer of the South African Medical Research Council

Climate change is no longer just an environmental issue; it is a major public health challenge with profound impacts for healthcare systems worldwide.¹ In Africa, where healthcare resources are often stretched thin, the impact of climate change on people living with cardiovascular conditions and the healthcare practitioners caring for them is particularly severe. Rising temperatures, extreme weather events, and worsening air pollution are directly and indirectly increasing the burden of cardiovascular diseases.²

How Climate Change affects Cardiovascular Health in Africa

The link between climate change and cardiovascular disease is well established in the literature.³ Rising temperatures, particularly in sub-Saharan Africa, are increasing the risk of heat strokes, heart attacks, and heart failure.⁴ Heat waves place additional strain on the cardiovascular system, especially for vulnerable populations, such as older people and those with pre-existing heart conditions. High temperatures can lead to dehydration, increased blood viscosity, and higher rates of heart disease.⁵ 

Additionally, one of the most significant factors contributing to poor heart health in Africa is air pollution, which can have similar drivers to climate change.⁶ Populations living in rural and peri-urban areas rely on biomass fuels, such as wood and coal, for cooking and heating, with limited air-exchanges and ventilation. Fine particulate matter exposure increases the risk of hypertension, stroke and heart failure. Toxic fumes from vehicles in urban centers further exacerbates air pollution, contributing to a higher prevalence of heart disease. Climate change-related events such as floods also affect food and water security, leading to malnutrition and increased rates of cardiovascular disease.^{7 8} Poor nutrition contributes to hypertension, which is a major risk factor for heart disease.⁹ Limited access to clean drinking water also increases the spread of water-borne infections,¹⁰ which can indirectly worsen cardiovascular conditions.

Adaptation strategies to climate change’s impact on cardiovascular health

Africa’s healthcare professionals, including cardiologists, need to consider the impacts of climate change, such as heat and air pollution, as well as a person’s social, economic and health status, to better advise patients on how best to prevent and manage cardiovascular disease effectively.

By working together we can understand risk and develop effective adaptation and mitigation measures to drive action and improve cardiovascular health in Africa. Four areas are ripe for strategies. We can better address the impacts of climate change by improving the resilience of our healthcare infrastructure to ensure better access to cardiovascular health; create adaptive solutions to support under-resourced healthcare facilities; mobilise awareness on climate change in the healthcare community; and drive a cohesive, multisectoral and multilevel response.

Adapting to climate change impacts on healthcare infrastructure

Climate change impacts healthcare infrastructure, reducing the ability of patients to access cardiology (and related) health services which are already under-resourced in Africa. Floods, droughts, and other extreme weather events disrupt healthcare access, especially in rural contexts, and make it even harder for patients to receive time sensitive treatment.¹¹ For example, severe flooding in South Africa’s Eastern Cape region in 2022 had displaced communities, preventing access to emergency and routine cardiology care.¹² Therefore strengthening a country’s national disaster risk management (DRM) legal and policy framework is essential for building resilience. One effective approach is the implementation of early warning systems, enabling vulnerable patients to adopt proactive adaptation strategies. Other strategies may include establishing emergency medication stockpiles, ensuring access to essential medical devices, developing evacuation plans that prioritize the safe relocation of at-risk patients to healthcare facilities outside the disaster zone, and integrating telemedicine solutions to maintain continuity of care when physical access to healthcare facilities is compromised.¹³ 

Expanding telemedicine for healthcare facilities

Cardiology practices across Africa face numerous obstacles. Many rural areas lack sufficient medical facilities and cardiologists, leading to delayed diagnosis and treatment of cardiovascular conditions. The workforce gaps are significant: for instance, for a population of 1.2 billion, there are only 2000 cardiologists registered.¹⁴ One solution for consideration is expanding telemedicine services as they can help bridge the gap in cardiology care for rural and remote populations, ensuring continuous monitoring and treatment despite climate disruptions. Others could comprise the better use of trained allied healthcare workers such as general practitioners, nurses and community health workers to boost reach, as many patients cannot afford specialized cardiovascular care. Further, climate-related disasters can often divert government resources to emergency relief rather than chronic disease management, which means greater rethinking on this area by policymakers. 

Boosting awareness of climate change impacts in the healthcare sector

Climate change is still not widely recognized as a health issue, and not all patients and healthcare workers are aware of its direct impact on cardiovascular health. A cross-sectional study conducted in six African countries (Ghana, Nigeria, South Africa, Namibia, Ethiopia, and Kenya) revealed wide variation amongst public health professionals on their knowledge about climate change impacts on health.¹⁵ For instance, 27% of respondents in Namibia showed poor knowledge, compared to only 3% in Nigeria. Medical professionals do need specialized training on how climate change affects cardiovascular health. One solution is already appearing in South Africa, where its National Department of Health has already proposed a national curriculum to integrate climate-related health issues into medical education. This is an example of how climate change leadership can drive change. This leadership could also drive more focus on ensuring cardiology practices are more sustainable across Africa. Some hospitals in South Africa have already implemented greener energy practices to reduce reliance on fossil fuels and improve environmental sustainability, such as sourcing renewable energy and minimising use of single use medical devices.¹⁶  

Uniting the multisectoral response

Addressing the intersection of climate change and cardiovascular health requires a holistic approach encompassing both healthcare-specific and multisectoral interventions. Governments must implement urban planning policies that better understand how informal urban settlements can cluster in flood-prone areas, as well as develop climate-resilient infrastructure that can withstand extreme weather events. 

Additionally, more efforts can be undertaken on educating communities about the cardiovascular risks associated with air pollution and extreme heat, encouraging preventative measures such as limiting exposure to biomass fumes, staying hydrated and reducing exposure to high temperatures, by limiting outdoor activities.^{17 18} NGOs which have local presence as well as community leaders could support this outreach. Reducing the use of biomass fuels and expanding access to renewable energy sources like solar power could lower air pollution in urban settlements and help prevent cardiovascular disease.¹⁹ 

Conclusion

The growing impact of climate change on cardiovascular health in Africa requires urgent attention. From increasing heat-related illnesses, worsening air pollution and disrupted healthcare access, the challenges are multifaceted. However, with better awareness by the healthcare workforce and patients, coordinated multisectoral approaches, better public health policies, and investments in healthcare infrastructure and sustainable energy, Africa can adapt to these risks. Healthcare professionals, including cardiologists, as well as policymakers, and communities must work together to adapt to and ensure that cardiovascular care remains accessible and effective in the face of climate change.

Ntobeko Ntusi is a physician and cardiologist, currently appointed as the President and CEO of the South African Medical Research Council, as well as a Professor of Medicine at the University of Cape Town. He has a long-standing interest in heart failure in Africans, HIV-associated cardiovascular diseases, and resistant hypertension. His lifelong passion for evidence-based healthcare and noncommunicable disease multimorbidity has positioned him as a trailblazer in medical research. He obtained a BSc(Hons) degree in Cellular and Molecular Biology from Haverford College, USA, and an MBChB degree from the University of Cape Town. He holds numerous additional qualifications, including a DPhil in Cardiovascular Medicine from the University of Oxford, St. Cross College, and an MD in Cardiology from the University of Cape Town. Prof. Ntusi provides key scientific leadership globally through boards and scientific advisory committees of numerous organisations he serves on.