This brief provides a rapid review of literature and public evidence from various sources on the interface between financing climate justice, tax justice and health equity1. Prior EQUINET webinars on other areas of health equity raised growing concerns on the lack of delivery on commitments made for climate financing in the region. The brief thus complements the work done in previous EQUINET webinars on how climate justice interacts with different facets of health equity, available on the EQUINET website. All briefs from the webinars are being synthesised in a separate discussion document. This brief summarises key issues related to: climate financing in the region and the links to tax and economic justice and health equity; actions proposed to address these issues at local, national and regional level and in international/ global level processes; and issues for further research and discussion.
Latest Equinet Updates
East and southern African (ESA) countries have achieved many gains in health, but also face many health challenges, including from commercial risks and the challenges of climate change. Poverty and inequality continues to affect opportunities to lead healthy lives. This context, the region’s policy commitment to primary health care and the need for action by many sectors to address the drivers of ill health calls for authorities, approaches and tools that more firmly lever evidence, and multi-sectoral action to protect and improve health. In the same way as environmental impact assessment was institutionalized in the ESA region to play a role in protecting ecosystems, health impact assessment similarly needs to be institutionalized to embed evidence and health promoting changes in wider activities, systems and policies that raise health risks. Policy leaders in Africa recognized this in the WHO AFRO Regional Multi-sectoral Strategy to promote health and well-being, 2023–2030, with a target by 2030 to have institutionalized and integrated health impact assessment .
Assessing the effect of policies, strategies, corporate and economic activities on health is a core capability to protect public health. Health impact assessment (HIA) helps to identify where changes to project design or operation provide health benefits and mitigate health risks, adding economic value and wellbeing. HIA is a structured process that informs decision makers about the potential effects of a project, programme, economic activity or policy on the health and well-being of populations. In 2023, EQUINET and partners initiated work to provide online training and mentored case study work to build HIA capacities in multi-actor teams in ESA countries. The course built understanding of the theoretical basis of HIA, and knowledge of the methods, evidence, analysis in an HIA, of reporting of and engagement on HIA, and implementation and monitoring of proposed actions. It provided mentored guidance of participant HIA practical work, using real HIA case studies. Towards the end of the course there was discussion on issues and strategies for scaling up and integrating HIA in key sectors and in public health law. This report summarises the proceedings and issues raised.
EQUINET has been using participatory action research (PAR) for several decades, reflecting the understanding that the voice, power and self-determination that is inherent for equity should also be integrated in the production of knowledge, and that knowledge and its generation and use is a deeply sociopolitical activity. While some thematic areas of work in EQUINET have applied PAR approaches, not all had, and steering committee (SC) members felt that it would be important to widen understanding of the methods to see how they could be integrated within different areas of work, as a cross cutting process. This online skills session was implemented in June 2024 to give colleagues involved in EQUINET work a brief introduction to PAR and how it can be used in EQUINET’s various thematic areas. The session aimed stimulate interest in and understanding of how PAR can deepen the different areas of research work on health equity. A video of presentations in the session is available at https://youtu.be/OR_lhxoSQuQ
This EQUINET regional meeting gathered people from institutions involved in the work on urban health and health impact assessment (HIA) and related expertise in May 2024 in Nairobi, Kenya, to address issues relating to scaling up promising, climate responsive practice to promote healthy urban food, waste and ecosystems in ESA. It built on work implemented in the region on urban health from 2020 and used a mix of presentation, discussion and participatory processes. The meeting reports on information shared on experience and evidence from both urban health work and HIA in ESA on the laws, policies, systems, features, measures and tools that positively impact on and make linkages across economic, social, health and ecosystem wellbeing, including to respond to climate change. Delegates identified implications for policy and practice at national, regional and global level and a theory of change, strategies and recommendations to advance, support and scale-up the promising policies, practices and tools identified in the meeting.
This desk review on the health implications of the implementation of the AfCFTA within the ESA region implemented by the Southern and Eastern African Trade Information and Negotiations Institute (SEATINI) outlines the health sector and health-related areas directly or indirectly covered by the ACTFA and the relevant subsidiary instruments. It presents information on these and the AfCTA provisions and their implications for trade liberalisation, which are largely consistent with those under World Trade Organization (WTO) agreements. The paper identifies the AfCTA’s positive and negative actual and potential health sector and health- related impacts, including for health equity. It does this in terms of the products that will be subject to liberalisation, including those with potential benefit for health such as local production of health technologies and pharmaceuticals, as well as those that may be harmful to health such as tobacco and genetically modified and ultra-processed foods. It also explores the health implications of the AfCFTA on financial flows and public revenue and on the movement of people, including health personnel. Given this analysis of impacts, measures are proposed that individual countries and the ESA region as a whole may take to protect health equity goals, including monitoring mechanisms to track and report on those impacts.
This desk review explored how climate change is affecting health systems in east and southern Africa (ESA); how the region’s health systems are adapting to climate change; and to identify the health system advocacy and policy issues raised in climate change negotiations by ESA countries, including in relation to issues of equity. Climate change was found to be associated with increased demand for health care services and reduced access to them. An increased demand for health services was found to arise from malnutrition caused by drought-related food shortages, an increase in food and water-borne infectious diseases because of drought and floods, especially in low-income settings, as well as heat exhaustion and heat strokes due to heat waves, particularly among people living in informal settlements. Provision of health services was found to be reduced by extreme weather events, with flooding disrupting transport and communication networks, affecting laboratory services, staff and patient travel, supplies of medication and ambulance availability, especially in rural areas. ESA countries have raised a range of advocacy and policy issues related to climate change and health systems in negotiations at the African Ministerial Conference on Environment and the UN Climate Change Conference of Parties (COP).
Interventions on urban waste have been integrated into one solid waste management programme in Kariba through multi-actor participation with high literacy, involving existing community structures and different age groups of people, and incorporating their aspirations for a clean town. Different interest groups select their own interventions on urban waste linking to food, energy and other urban needs, and deploy their own innovation, local knowledge systems. These are then integrated into the overall programme. The activities use affordable technologies and locally available materials, creating a demand for local goods. Information and communication technologies used in the programme have been important contributors to successful outcomes. Bringing diverse social groups together contributes to system wide and holistic awareness and links action on urban waste systems to a circular economy and climate justice.
Understanding how waste management systems are linked to and interact with other sub- systems and the influence and moderation effects of contextual factors including climate change is important in informing actions and approaches that promote health and wellbeing. Waste management systems provide a potential entry point for fostering innovations, collaborations and system-wide changes for healthy communities and ecosystems, such as through strengthening their linkages with food systems and promotion of circular economies. This case study showcases experiences from the municipality of Manadriana in Antananarivo, Madagascar. It has been produced within a series on integrated urban health in EQUINET to foster learning on these promising approaches within east and southern Africa.
Bembeke, Dedza has been transformed from one of the worst dumping sites to one of the cleanest urban sites in Malawi. CMPD, in partnership with the Environmental Affairs Department (EAD), and stakeholders in Bembeke Dedza, devised and implemented a waste management initiative to turn waste into manure, reducing waste and improving food security in Bembeke. Bembeke farmers were trained to produce manure from waste and theatre campaigns were held in eight zones to sensitise communities on ‘waste to wealth’. Urban waste and food security interventions succeed when all key stakeholders, including community members participate from conception to completion. Turning waste into fertiliser for food production contributes to food security, environmental protection, circular urban economies and mitigates the effects of climate change.