This report is an outcome of One by One UHC Conference 2019, which occurred alongside the 74th UN General Assembly. This report discusses the relationship between human health, climate change, and environmental resources such as water, food, and air, and their importance in achieving UHC in Africa. By focusing on access to nutritious food, clean water, and air as the building blocks of a healthy society, the report examines the relationship between diseases prevalent in Africa and these fundamental underlying causes. The Report also shows how if left unmitigated, climate change will undermine these critical multi-sectoral efforts to improve health.

This Report has been developed by The Access Challenge and Harvard Global Health Institute. It has been informed by a set of diverse partners who participated in the 2019 One by One UHC Conference, “Achieving UHC: A Sustainable Future for Africa.”
Slowing Desertification Desertification, a natural phenomenon that leads to deadly sand and dust storms, is increasing exponentially in Africa due to climate change, land mismanagement, and unsustainable freshwater use.82 Desertification causes severe health impacts, such as damage to lungs, and worsen existing respiratory diseases like asthma and bronchitis. Careful soil stewardship, particularly at the edges of deserts, can help to slow or prevent desert expansion.
Recognizing desertification as a major challenge, nations in Africa and across the globe signed The United Nations Convention to Combat Desertification in Countries Experiencing Serious Drought and/ or Desertification and have committed to counteracting the harmful effects of land degradation. The Great Green Wall Initiative is an example of a pan-African effort where more than 20 African countries from across the Sahel region have come together to support forestation. Launched in September 2012 by the African Ministerial Conference on Environment (AMCEN), this initiative is directed by the African Union and has already planted 15% of the target area.

Nutritious food is a fundamental necessity to sustain people, reduce disease, and prevent early mortality. Illnesses caused by nutritional imbalance add an unnecessary burden to African health systems, which are already burdened with morbidity and mortality from undernutrition and overnutrition. Undernutrition and overnutrition are together known as the ‘double burden of malnutrition,’ and signal a failure of policy to intervene effectively in the food system.

Clean water, adequate sanitation, and safe hygiene practices, known collectively as WASH, are essential for good health. Without access to these most basic resources, entire populations can become exposed to a wide range of disease and quickly overburden health systems. WASH infrastructure. Prioritizing WASH is especially critical now as climate change continues to disrupt water patterns and facilitate the spread of disease. Multi-sectoral collaboration can support efforts for achieving UHC by ensuring people, infrastructure, and health care systems have clean and secure water, proper sanitation, and the resources needed to practice good hygiene.

Air pollution is caused by both natural sources, such as desert dust, and human sources, such as industrial and transportation emissions, incineration, and basic household activities.63 Collectively, these sources have far reaching impacts on human health, jeopardizing early development, contributing to the leading causes of death in children and adding to the rising burden of non-communicable diseases. Air pollution both causes and is exacerbated by climate change. The causes of outdoor air pollution include natural sources, industrial and vehicular emissions, and incineration.

The leading natural source of air pollution is desert dust. Africa is the world’s largest source of desert dust emissions. Desert dust emission contributes annually to an estimated 556,000 premature deaths in Africa, including a 22% increase in infant deaths. Industrial and vehicular emissions can primarily be linked to a lack of restrictions on industrial practices, the use of fossil fuel powered energy sources and unsustainable urbanization, such as a lack of urban traffic design and fuel-inefficient vehicles.

Without waste management infrastructure, open burning sites can lead to air pollution from the incineration of everything from plastics to electronics. The practice of burning agricultural and biomass waste for pest management and field clearing leads to an estimated 43,000 premature deaths per year. This crop burning practice is unsustainable as it reduces soil fertility and results in emissions of black carbon.

This UHC report introduces a new working framework for considering comprehensive UHC services. This Framework contextualizes the various activities and sectors a community needs in order to maintain good health. Each service is a point of intervention at which communities and their health system may promote health, prevent, diagnose or treat disease. Promotive Care includes the infrastructures and services necessary to foster living conditions that support human health: including access to clean air, clean water, and nutritious food. Meanwhile, Preventive, Curative, Rehabilitative, and Palliative Care includes the medical supplies and services needed to support a person at various stages of preventing, diagnosing and curing illnesses and providing safe maternal health services. This Framework demonstrates how sectors outside of health can support the health sector in UHC development. It also
shows how, through this collaboration, investment in promotion and prevention can minimize the prevalence of disease, the financial burden of disease treatment on health systems, and ultimately the cost of Universal Health Coverage (UHC)