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The cost of inaction: Quantifying the impact of climate change on health

This World Bank report ‘The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries’ presents new analysis of climate change impacts on health systems and outcomes in the regions that are bearing the brunt of these impacts.

Key analytical insights to quantify climate change impacts on health

The report makes three contributions to our understanding of climate-health interactions:

First, it quantifies the massive scale of climate change impacts on health, projecting 4.1-5.2 billion climate-related disease cases and 14.5-15.6 million deaths in LMICs by 2050. This represents a significant advancement over previous estimates, which the report demonstrates were substantial underestimates.

Second, it illuminates the profound economic consequences, calculating costs of $8.6-20.8 trillion by 2050 (0.7-1.3% of LMIC GDP). The report employs both Value of Statistical Life and Years of Life Lost approaches to provide a range of economic impact estimates.

Third, it reveals stark geographic inequities in impact distribution, with Sub-Saharan Africa bearing approximately 71% of cases and nearly half of deaths, while South Asia faces about 18% of cases and a quarter of deaths. This spatial analysis helps identify where interventions are most urgently needed.

Policy implications and systemic perspectives

The report’s findings point to several critical policy directions:

• The need for systemic rather than disease-specific interventions emerges as a central theme. The authors explicitly advocate for strengthening entire health systems rather than pursuing vertical disease programs.
• The economic analysis makes a compelling case for immediate action, demonstrating that the costs of inaction far exceed potential investment requirements for climate-resilient health systems.
• The geographic distribution of impacts highlights the need for globally coordinated responses while prioritizing support for the most vulnerable regions.

The findings suggest that transforming systems to address climate change impacts on health requires not just technical solutions but fundamental rethinking of how health systems are organized and financed in vulnerable regions.

This aligns with recent scholarship on complex adaptive systems and organizational transformation in global health.

The report’s emphasis on systemic approaches represents a significant shift in thinking about climate-health interventions. This merits unpacking on several levels:

1. Inadequacy of vertical disease silos: The report challenges the traditional vertical disease management paradigm that has dominated global health programming for decades. While vertical programs have achieved notable successes in areas like HIV/AIDS or malaria control, the report argues that climate change’s multifaceted health impacts require a fundamentally different approach.
2. Need for systemic intervention: Climate change simultaneously affects multiple disease pathways, nutrition status, and health infrastructure. These interactions cannot be effectively addressed through isolated disease-specific programs. Building core health system capabilities (surveillance, emergency response, primary care) creates multiplicative benefits across various climate-related health challenges. Strong health systems can better identify and respond to emerging threats, whereas vertical programs often lack this flexibility.
3. Implementation implications: The report suggests this systemic approach requires: integrated planning across health system components, flexible funding mechanisms that support system-wide capabilities, enhanced coordination between different health programmes and investment in cross-cutting infrastructure and capabilities.

What about the health workforce facing impacts of climate change on health?

Between this clear-eyed assessment and effective action lies a critical implementation gap.

Interestingly, the report gives limited explicit attention to the health workforce dimension of climate-health challenges. Yet that is precisely where we need to focus attention, given that:

• Health workers based in communities are first responders to climate-related health emergencies
• Workforce capacity significantly determines a health system’s adaptive capabilities
• Climate change itself affects health worker distribution and effectiveness

Given the report’s emphasis on systemic approaches, the lack of detailed discussion about human resources for health represents a missed opportunity to explore what effective action might look like.

The Geneva Learning Foundation’s network, developed through nearly a decade of research and practice, has led us to identify a path for supporting the health workforce to strengthen preparedness and response in response to climate change impacts on health.

The network already connects over 60,000 health workers. They represent all job roles, rank, and levels of the health system.

One distinguishing feature of this network is its deep integration with existing government health systems. Over half of network participants are government employees, from community health workers to district officers to national planners.

62% of participants work in remote rural areas, 47% serve urban poor populations, and 21% operate in conflict zones.

These are not just statistics: they represent an unprecedented capability to mobilize knowledge and action where it’s most needed.

Since 2023, network participants have been sharing observations, experiences, and insights of climate change impacts on health. 

The model connects different levels of health systems:

• Community-based health workers share ground-level observations
• District managers identify emerging patterns
• National planners gauge system-wide implications
• Global partners access real-time insights

When a malaria control officer in Kenya observes changing disease patterns due to altered rainfall, the network enables rapid sharing of this insight with colleagues working on water safety, nutrition, and primary care. These cross-domain connections do not need to be left to chance – they can be enabled through structured peer learning processes that transcend traditional programme, geographic, and hierarchical boundaries

This creates what organizational theorists call “embedded transformation” – where system change emerges through existing structures rather than requiring new ones.

Rather than creating new coordination mechanisms, the network enables:

• Health workers to learn directly from peers in other programs
• Rapid identification of cross-cutting challenges
• Spontaneous formation of problem-solving groups
• Systematic sharing of effective practices

Rather than replacing existing structures, TGLF’s model demonstrates how digital networks can enable health systems to:

• Maintain necessary specialization while fostering crucial connections
• Enable rapid learning and adaptation across programs
• Optimize resource use through enhanced coordination
• Build system-wide resilience through structured peer learning

Such a network enables what complexity theorists call “distributed sensing” that can provide:

• Early warning of emerging threats
• Rapid sharing of local solutions
• System-wide learning from local innovations
• Continuous adaptation to changing conditions

This has led us to posit that investment in such emergent digital networks could enable health systems to maintain necessary specialization while fostering crucial connections across domains.

This is obviously critical to respond to the systems-level complexity of climate change impacts on health.

Reference

Uribe, J.P., Rabie, T., 2024. The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries. The World Bank, Washington, D.C. https://doi.org/10.1596/42419

Image: The Geneva Learning Foundation Collection © 2024

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The cost of inaction: Quantifying the impact of climate change on health

This World Bank report ‘The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries’ presents new analysis of climate change impacts on health systems and outcomes in the regions that are bearing the brunt of these impacts.

Key analytical insights to quantify climate change impacts on health

The report makes three contributions to our understanding of climate-health interactions:

First, it quantifies the massive scale of climate change impacts on health, projecting 4.1-5.2 billion climate-related disease cases and 14.5-15.6 million deaths in LMICs by 2050. This represents a significant advancement over previous estimates, which the report demonstrates were substantial underestimates.

Second, it illuminates the profound economic consequences, calculating costs of $8.6-20.8 trillion by 2050 (0.7-1.3% of LMIC GDP). The report employs both Value of Statistical Life and Years of Life Lost approaches to provide a range of economic impact estimates.

Third, it reveals stark geographic inequities in impact distribution, with Sub-Saharan Africa bearing approximately 71% of cases and nearly half of deaths, while South Asia faces about 18% of cases and a quarter of deaths. This spatial analysis helps identify where interventions are most urgently needed.

Policy implications and systemic perspectives

The report’s findings point to several critical policy directions:

• The need for systemic rather than disease-specific interventions emerges as a central theme. The authors explicitly advocate for strengthening entire health systems rather than pursuing vertical disease programs.
• The economic analysis makes a compelling case for immediate action, demonstrating that the costs of inaction far exceed potential investment requirements for climate-resilient health systems.
• The geographic distribution of impacts highlights the need for globally coordinated responses while prioritizing support for the most vulnerable regions.

The findings suggest that transforming systems to address climate change impacts on health requires not just technical solutions but fundamental rethinking of how health systems are organized and financed in vulnerable regions.

This aligns with recent scholarship on complex adaptive systems and organizational transformation in global health.

The report’s emphasis on systemic approaches represents a significant shift in thinking about climate-health interventions. This merits unpacking on several levels:

1. Inadequacy of vertical disease silos: The report challenges the traditional vertical disease management paradigm that has dominated global health programming for decades. While vertical programs have achieved notable successes in areas like HIV/AIDS or malaria control, the report argues that climate change’s multifaceted health impacts require a fundamentally different approach.
2. Need for systemic intervention: Climate change simultaneously affects multiple disease pathways, nutrition status, and health infrastructure. These interactions cannot be effectively addressed through isolated disease-specific programs. Building core health system capabilities (surveillance, emergency response, primary care) creates multiplicative benefits across various climate-related health challenges. Strong health systems can better identify and respond to emerging threats, whereas vertical programs often lack this flexibility.
3. Implementation implications: The report suggests this systemic approach requires: integrated planning across health system components, flexible funding mechanisms that support system-wide capabilities, enhanced coordination between different health programmes and investment in cross-cutting infrastructure and capabilities.

What about the health workforce facing impacts of climate change on health?

Between this clear-eyed assessment and effective action lies a critical implementation gap.

Interestingly, the report gives limited explicit attention to the health workforce dimension of climate-health challenges. Yet that is precisely where we need to focus attention, given that:

• Health workers based in communities are first responders to climate-related health emergencies
• Workforce capacity significantly determines a health system’s adaptive capabilities
• Climate change itself affects health worker distribution and effectiveness

Given the report’s emphasis on systemic approaches, the lack of detailed discussion about human resources for health represents a missed opportunity to explore what effective action might look like.

The Geneva Learning Foundation’s network, developed through nearly a decade of research and practice, has led us to identify a path for supporting the health workforce to strengthen preparedness and response in response to climate change impacts on health.

The network already connects over 60,000 health workers. They represent all job roles, rank, and levels of the health system.

One distinguishing feature of this network is its deep integration with existing government health systems. Over half of network participants are government employees, from community health workers to district officers to national planners.

62% of participants work in remote rural areas, 47% serve urban poor populations, and 21% operate in conflict zones.

These are not just statistics: they represent an unprecedented capability to mobilize knowledge and action where it’s most needed.

Since 2023, network participants have been sharing observations, experiences, and insights of climate change impacts on health. 

The model connects different levels of health systems:

• Community-based health workers share ground-level observations
• District managers identify emerging patterns
• National planners gauge system-wide implications
• Global partners access real-time insights

When a malaria control officer in Kenya observes changing disease patterns due to altered rainfall, the network enables rapid sharing of this insight with colleagues working on water safety, nutrition, and primary care. These cross-domain connections do not need to be left to chance – they can be enabled through structured peer learning processes that transcend traditional programme, geographic, and hierarchical boundaries

This creates what organizational theorists call “embedded transformation” – where system change emerges through existing structures rather than requiring new ones.

Rather than creating new coordination mechanisms, the network enables:

• Health workers to learn directly from peers in other programs
• Rapid identification of cross-cutting challenges
• Spontaneous formation of problem-solving groups
• Systematic sharing of effective practices

Rather than replacing existing structures, TGLF’s model demonstrates how digital networks can enable health systems to:

• Maintain necessary specialization while fostering crucial connections
• Enable rapid learning and adaptation across programs
• Optimize resource use through enhanced coordination
• Build system-wide resilience through structured peer learning

Such a network enables what complexity theorists call “distributed sensing” that can provide:

• Early warning of emerging threats
• Rapid sharing of local solutions
• System-wide learning from local innovations
• Continuous adaptation to changing conditions

This has led us to posit that investment in such emergent digital networks could enable health systems to maintain necessary specialization while fostering crucial connections across domains.

This is obviously critical to respond to the systems-level complexity of climate change impacts on health.

Reference

Uribe, J.P., Rabie, T., 2024. The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries. The World Bank, Washington, D.C. https://doi.org/10.1596/42419

Image: The Geneva Learning Foundation Collection © 2024

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#digitalLearning #globalHealth #health #JuanPabloUribe #LMICs #networkedLearning #peerLearning #TamerRabie #TheCostOfInactionQuantifyingTheImpactOfClimateChangeOnHealth #TheGenevaLearningFoundation #WorldBank

Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration

As immunization programs worldwide struggle to recover from pandemic disruptions, the Movement for Immunization Agenda 2030 (IA2030) offers a novel, practitioner-led approach to accelerate progress towards global vaccination goals.

From March to June 2022, the Geneva Learning Foundation (TGLF) conducted the first Full Learning Cycle (FLC) of the Movement for IA2030, engaging 6,185 health professionals from low- and middle-income countries.

A cornerstone of this programme was a series of 44 experience-sharing sessions held between 7 March and 13 June 2022. These sessions brought together between 20 and 400 practitioners per session to discuss and solve real-world immunization challenges.

IA2030 case study 16, by Charlotte Mbuh and François Gasse, offers valuable insights from these experience-sharing session:

1. what we learned from the experiences themselves and how it can help practitioners; and
2. what we learned about the significance and potential of the peer learning process itself.

Download the full case study: IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation.

For every challenge shared during the experience sharing sessions, there was always at least one member who had encountered or was encountering the same challenge and had carried out measures to resolve it.

These sessions provided a space to share practical stories that are making a difference – and supported participants in considering their relevance to their own situations.

Experience sharing also helped build confidence and motivation.

Members were able to identify with experiences shared, realizing they were not alone in facing similar challenges.

The sessions covered a wide range of critical immunization topics.

For instance, a participant from Nigeria discussed strategies for reaching zero-dose children in Borno state.

Facing the challenge of reaching approximately 600,000 unvaccinated children, the presenter received practical suggestions from peers, including developing a zero-dose reduction operational plan, leveraging new vaccine introductions, and partnering with the private sector for evening vaccination services.

In another session, a subnational Ministry of Health staff member from Côte d’Ivoire presented challenges related to cross-border immunization campaigns.

Peers shared experiences of organizing cross-border meetings to identify unvaccinated children, synchronize efforts, and involve community representatives in the process.

Such context-specific, experience-based advice exemplifies the unique value of peer learning in addressing complex health system challenges.

The case study of 44 sessions highlights how these sessions fostered multiple types of learning simultaneously.

Participants reported learning from each other’s experiences, experiencing the power of solving problems together across distances, feeling a growing sense of belonging to a community, and connecting across country borders and health system levels.

A district-level Ministry of Health staff member from Ghana encapsulated the impact: “I have linked up with expert vaccinators worldwide through experience sharing and twinning. I have become more competent and knowledgeable in the area of immunization, and work confidently.”

This sentiment was echoed by many participants who found value not only in acquiring new knowledge but also in expanding their professional networks and gaining confidence in their problem-solving abilities.

The case study also reveals the adaptability of the approach in responding to unique contexts.

This resilience underscores the potential of digital platforms to democratize access to expertise and foster global collaboration.

However, the study also identifies areas for improvement.

• Participants expressed a desire for more follow-up support and opportunities to continue their peer learning groups beyond the initial sessions.
• Additionally, the need for better integration of community engagement strategies was identified as a key area for future development.

To contextualize these findings, we can turn to a 2022 study by Watkins et al., which evaluated a prototype of these experience-sharing sessions known as Immunization Training Challenge Hackathons (ITCH), conducted in 2020.

The ITCH methodology, developed by The Geneva Learning Foundation (TGLF), informed the design of the 2022 IA2030 Movement sessions.

Watkins et al. found that the ITCH approach fostered four simultaneous types of learning: peer, remote, social, and networked.

1. Peer Learning: This involves participants learning directly from each other’s experiences and knowledge. In the context of immunization, imagine a scenario where a vaccination program manager from rural India shares their successful strategy for improving vaccine cold chain management with a colleague facing similar challenges in sub-Saharan Africa. This direct exchange of practical, context-specific knowledge can complement more theoretical training, as it is based on real-world application.
2. Remote Learning: This refers to the ability to learn and solve problems collaboratively across geographical distances. For an immunization specialist, this might seem counterintuitive, as many believe that hands-on, in-person training is essential. However, the ITCH sessions demonstrated that meaningful learning can occur remotely. For example, a team in Bangladesh could describe their approach to overcoming vaccine hesitancy, and a team in Nigeria could immediately adapt and apply those strategies to their local context, all without the need for costly and time-consuming travel.
3. Social Learning: This concept emphasizes the importance of learning within a network. In the immunization field, professionals often work in isolation, especially at sub-national levels. The ITCH sessions created a sense of belonging to a global network, community, and platform of immunization practitioners. This social aspect can boost motivation, reduce feelings of isolation, and foster a collective approach to problem-solving that transcends individual or even national boundaries.
4. Networked Learning: This type of learning emerges from connections made across different levels of health systems and across country borders. For an epidemiologist, this might be analogous to how disease surveillance networks function across borders. In the ITCH context, it means that a district-level immunization officer could learn from and share ideas with national-level policymakers from other countries, fostering a more holistic understanding of immunization challenges and solutions.

These four types of learning operate simultaneously during ITCH sessions, creating a synergistic effect. 

For instance, a participant might learn a new cold chain management technique (peer learning) from a colleague in another country (remote learning), feel supported by the global community in implementing this new technique (social learning), and then share their adaptation of this technique with others across various levels of the health system (networked learning).

From an epidemiological perspective, this approach to learning could be compared to how we understand disease transmission and intervention effectiveness.

Just as multiple factors contribute to disease spread and control, these multiple learning types contribute to knowledge dissemination and capacity building in the immunization field.

The value of this approach lies in its potential to rapidly disseminate practical, context-specific knowledge and solutions across a global network of immunization professionals.

This can lead to faster adoption of best practices, more innovative problem-solving, and ultimately, improvements in immunization program performance that could contribute to better disease control outcomes.

While this approach may seem unconventional compared to traditional training methods in the immunization field, the evidence presented by Watkins et al. suggests that it can be a powerful complement to existing capacity-building efforts, particularly in resource-constrained settings where access to formal training opportunities may be limited.

This multifaceted approach allowed participants to not only acquire new knowledge but also to expand their professional networks and gain confidence in their problem-solving abilities—findings that align closely with the outcomes observed in the 2022 IA2030 Movement sessions.

The Watkins study emphasized the importance of building confidence and motivation through peer learning experiences, a theme strongly echoed in the Mbuh case study.

Furthermore, Watkins et al. highlighted the potential of this approach to create a “space of possibility” for innovation and problem-solving, which is evident in the diverse and creative solutions shared during the 2022 sessions.

Both studies underscore the significance of peer-led, digital learning experiences in accelerating progress towards global health goals.

By fostering peer learning and digital collaboration, these approaches empower health workers to turn global strategies into effective local action.

References

Mbuh, C., Gasse, F., Jones, I., Sadki, R., Brooks, A., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7014392

Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4

Image: The Geneva Learning Foundation Collection © 2024

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#CharlotteMbuh #continuousLearning #FrançoisGasse #FullLearningCycle #IA2030 #IA2030CaseStudies #ImmunizationAgenda2030 #ITCH #KarenEWatkins #learningCulture #MovementForImmunizationAgenda2030 #networkedLearning #peerLearning #remoteLearning #TheGenevaLearningFoundation

What learning science underpins peer learning for Global Health?

Watch Reda Sadki’s presentation about peer learning for global health at the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH) Symposium on 19 October 2023

https://www.youtube.com/watch?v=Q08dbbzUzzc

Most significant learning that contributes to improved performance takes place outside of formal training.

It occurs through informal and incidental forms of learning between peers.

This is called peer learning or peer-to-peer learning.

Effective use of peer learning requires realizing how much we can learn from each other (peer learning), experiencing the power of defying distance to solve problems together (remote learning), and feeling a growing sense of belonging to a community (social learning), emergent across country borders and health system levels (networked learning).

At the ASTMH annual meeting Symposium organized by Julie Jacobson, two TGLF Alumnae, María Monzón from Argentina and Ruth Allotey from Ghana, will be sharing their analyses and reflections of how they turned peer learning into action, results, and impact.

In his presentation, Reda Sadki, president of The Geneva Learning Foundation (TGLF), will explore:

1. What do we need to understand about digital learning?
2. Networked learning: rethinking learning architecture in the Digital Age
3. Social learning: peer learning is about making human connections
4. Practical examples of TGLF peer learning systems for WHO, Wellcome, UNICEF, and Bridges to Development that connect learning to change, results, and impact.
5. Emergent peer learning systems driven by local practitioner and community needs and priorities.

Join this #TropMed23 Peer Learning symposium on Day 2 of the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH).

What learning science underpins peer learning for Global Health?

Watch Reda Sadki’s presentation about peer learning for global health at the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH) Symposium on 19 October 2023

https://www.youtube.com/watch?v=Q08dbbzUzzc

Most significant learning that contributes to improved performance takes place outside of formal training.

It occurs through informal and incidental forms of learning between peers.

This is called peer learning or peer-to-peer learning.

Effective use of peer learning requires realizing how much we can learn from each other (peer learning), experiencing the power of defying distance to solve problems together (remote learning), and feeling a growing sense of belonging to a community (social learning), emergent across country borders and health system levels (networked learning).

At the ASTMH annual meeting Symposium organized by Julie Jacobson, two TGLF Alumnae, María Monzón from Argentina and Ruth Allotey from Ghana, will be sharing their analyses and reflections of how they turned peer learning into action, results, and impact.

In his presentation, Reda Sadki, president of The Geneva Learning Foundation (TGLF), will explore:

1. What do we need to understand about digital learning?
2. Networked learning: rethinking learning architecture in the Digital Age
3. Social learning: peer learning is about making human connections
4. Practical examples of TGLF peer learning systems for WHO, Wellcome, UNICEF, and Bridges to Development that connect learning to change, results, and impact.
5. Emergent peer learning systems driven by local practitioner and community needs and priorities.

Join this #TropMed23 Peer Learning symposium on Day 2 of the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH).

New NLC2024 Deadlines

Submission deadline for symposia/full & short papers
November 3, 2023

Submission deadline for workshops/round tables
December 15, 2023

Notification of acceptance
January 12, 2023

Final submissions
February 16, 2024

Early bird deadline
March 15, 2024

Conference—NLC2024
May 15-17, 2024

#NLC2024 #NetworkedLearning #Conference