Editing IPCC:AR6/WGII/Chapter-9 (section)

==== 9.10.2.7 Air Quality-related Health Impacts ====

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Links between air quality and climate change are complex ( [[#Smith--2014|Smith et al., 2014]] ; [[#Szopa--2021|Szopa et al., 2021]] ). Increases in particulate matter concentrations are driven more by vehicle emissions, solid waste, biomass burning and development ( [[#Abera--2021|Abera et al., 2021]] ) than by climate change, and these factors vary widely across regions of the continent ( [[#West--2013|West et al., 2013]] ). Women and children who are exposed to high particulate matter concentrations when cooking indoors and HIV-infected people are more vulnerable to the health impacts of air pollution ( [[#Abera--2021|Abera et al., 2021]] ). Information on the direction of change of air quality in different African regions attributable to climate change are contradictory ( [[#Westervelt--2016|Westervelt et al., 2016]] ; [[#Silva--2017|Silva et al., 2017]] ). Additionally, much uncertainty remains about interactions between air quality and climate change and relative impacts of different modes of development and climate change on pollutants. However, increasing temperatures combined with a reduction in rainfall are ''likely'' to increase particulate matter concentrations ( [[#Abera--2021|Abera et al., 2021]] ), particularly in north Africa ( [[#Westervelt--2016|Westervelt et al., 2016]] ; [[#Silva--2017|Silva et al., 2017]] ).

Nevertheless, continued dependence on fossil-fuelled power plants will result in tens of thousands of avoidable deaths due to air pollution by 2030 ( [[#Marais--2016|Marais and Wiedinmyer, 2016]] ), and accelerate climate change. Actions to reduce air pollution can both mitigate climate change and have major co-benefits for health ( [[#West--2013|West et al., 2013]] ; [[#Rao--2016|Rao et al., 2016]] ; [[#Markandya--2018|Markandya et al., 2018]] ; [[#Rauner--2020a|Rauner et al., 2020a]] ; [[#Rauner--2020b|Rauner et al., 2020b]] ) see also AR6 WGIII, Chapters 3, 4, 8 and 10). Investing in renewable energy resources rather than reliance on the combustion of fossil fuels would mark an important step forward for African population health ( [[#Marais--2019|Marais et al., 2019]] ). This is especially important in South Africa which emits approximately half the total carbon emissions for Africa, ranking 12th in the world for carbon emissions ( [[#Mohsin--2019|Mohsin et al., 2019]] ).

Dust events in west Africa have severe health impacts (cardiorespiratory and infectious diseases, including meningitis) ( [[#Ayanlade--2020|Ayanlade et al., 2020]] ) given the proximity of the Sahara, which produces about half of the yearly global mineral dust ( [[#de%20Longueville--2013|de Longueville et al., 2013]] ). Wildfires are projected to become the main source of particulate matter in west, central and southern Africa under both the lowest and highest future emissions scenarios, whereas, under intermediate scenarios (i.e., SSP3/RCP4.5), anthropogenic sources of particulate matter are projected to exceed that produced by wildfires ( [[#Knorr--2017|Knorr et al., 2017]] ).

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'''Box 9.6 | Pandemic risk in Africa: COVID-19 and future threats'''
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Rapid advances in vaccination and other control measures in high-income countries means that the burden of COVID-19 is increasingly concentrated in low- and middle-income countries, including those in Africa. The extent to which the COVID-19 pandemic is influenced by weather or by future changes in climate remains contested ( [[#WMO--2021|WMO, 2021]] ). In time, COVID-19 may develop seasonal dynamics ( [[#Baker--2020|Baker et al., 2020]] ; [[#Kissler--2020|Kissler et al., 2020]] ) similar to other respiratory infections ( [[#Carlson--2020b|Carlson et al., 2020b]] ).

Early work interpreted low-reported cases of COVID-19 in Africa as suggesting evidence of a protective climatic effect, but increasing evidence indicates the role of climate is secondary to the timing of disease introduction, the pace of implementation of non-pharmaceutical interventions and surveillance gaps ( [[#Evans--2020|Evans et al., 2020]] ; [[#WMO--2021|WMO, 2021]] ). Going forward, testing coverage, reporting, governance, non-pharmaceutical interventions and vaccine distribution and uptake are ''likely'' to be far more significant for Africa’s COVID-19 trajectory than climate change. Compounding risks, where climate hazards and natural disasters impair outbreak responses, may disrupt interventions or cause additional deaths ( [[#Phillips--2020|Phillips et al., 2020]] ; [[#Salas--2020|Salas et al., 2020]] ).

Emerging and future pandemic threats

Future influenza pandemics are highly ''likely'' , as are regional epidemics and pandemics of novel zoonotic viruses (including coronaviruses and flaviviruses) ( ''high confidence'' ). In the next decades, climate change will reshape the risk landscape for emerging zoonotic threats as wildlife-livestock-human interfaces shift, facilitating the emergence of novel zoonotic threats and spillover of known zoonoses into novel geographies ( [[#Carlson--2020a|Carlson et al., 2020a]] ; [[#Mordecai--2020|Mordecai et al., 2020]] ). Characteristics of urban development and level of service provision, for example, crowded living spaces and transport facilities, and access to water and sanitation will influence the transmission of COVID-19 and future disease outbreaks ( [[#Wilkinson--2020|Wilkinson, 2020]] ). Historically, west and central Africa were considered especially at risk of outbreaks given their high biodiversity, high intensity of human–wildlife contact including wild meat trade, vulnerable health systems and history of Ebola virus disease outbreaks ( [[#Paige--2014|Paige et al., 2014]] ; [[#Allen--2017|Allen et al., 2017]] ; [[#Pigott--2017|Pigott et al., 2017]] ). However, as the Middle East respiratory syndrome coronavirus (MERS-CoV) and COVID-19 pandemics have shown, there are multiple hotspots of viruses with pandemic potential globally, many of which are not in Africa. Thus, labelling African rainforests as unique ‘hotspots’ undermines global health work and pandemic preparedness.

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'''Box 9.7 | The health–climate change nexus in Africa'''
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The intersections between climate change and human health involve interactions of numerous systems and sectors (Lindley et al., 2019; Yokohata et al., 2019). This complexity means that holistic, transdisciplinary and cross-sectoral (systems) approaches like One Health, EcoHealth and Planetary Health can improve the long-term effectiveness of responses to health risks (Zinsstag, 2012; Whitmee et al., 2015; Nantima et al., 2019). More research is needed to identify sustainable solutions (Rother et al., 2020), as recently re-emphasised by the Intergovernmental Panel on Biodiversity in its report on the COVID-19 pandemic (IPBES, 2020). The close dependency of many Africans on their livestock and surrounding ecosystems forms a context where integrated health approaches are especially critical for addressing climate change risks to health (Figure Box 9.7.1; Watts et al., 2015; Cissé, 2019).

Integrated approaches to health in Africa can deliver multiple benefits for humans and ecosystems For example, rather than addressing micronutrient deficiencies with supplements, which may not be accepted culturally and can be disrupted by stockouts or similar, addressing nutrient deficiencies in staple crops by selecting or breeding more nutritious varieties (e.g., orange-fleshed sweet potatoes or ‘golden rice’ for vitamin A deficiency) may prove to be more sustainable options (Datta et al., 2003; Nair et al., 2016; Laurie et al., 2018; Oduor et al., 2019; Stokstad, 2019). Additionally, some micro- or macronutrient deficiencies and food insecurities may be improved by addressing the depletion of soils through better management, including the incorporation of holistic, sustainable principles, such as those promoted by agroforestry or regenerative agriculture (Rhodes, 2017; Elevitch et al., 2018; [[#LaCanne--2018|LaCanne and Lundgren, 2018]] ; Chapter 5 Section 5.12.4).

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'''Figure Box 9.7.1 |''' ''' Human, ecosystem and animal health are intimately interlinked, and require transdisciplinary approaches such as One Health, EcoHealth and Planetary Health for effective, sustainable, long-term management.''' This schematic shows some examples of these interlinkages, and how they impact human health, highlighting the complex interactions and the importance of holistic, systems approaches to health interventions, including for climate change adaptation. Supporting literature: (1) (Egoh et al., 2012); (2) (Wangai et al., 2016); (3) (Failler et al., 2018); (4) (Ifejika Speranza, 2010); (5) (Brancalion et al., 2020); (6) (Bloomfield et al., 2020); (7) (Rojas-Downing et al., 2017).

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