Lancet report and Pakistan's public health crisis

When I moved back to Pakistan, I had never imagined the scale of our health challenges. Having worked in some of the poorest countries in Africa, I assumed that Pakistan would be much better on different indicators. Unfortunately, every passing year we fall behind on health indicators compared to many poorer countries. Wild polio has been eradicated from all over the world even from war-torn countries, except for Pakistan and Afghanistan. In Pakistan, according to WHO, every single day 675 newborns and 27 mothers die in childbirth. Pakistan's maternal mortality rate is highest in South Asia when compared with India, Bangladesh, Nepal and Sri Lanka. One of the world's top medical journals, The Lancet has published "The 2026 Global Report of the Lancet Countdown", documenting how climate change is affecting our health. It is a separate discussion as to who is responsible for climate degradation and how much they should be held responsible for financial compensation. We must now think about safeguarding our already vulnerable population from increased health risks due to climate degradation. According to this report, the number of moderate or higher heat stress hours has increased significantly in both Pakistan and India (more than 2000 hours/year), costing Pakistan $17 billion and India $174 billion (of course, due to its larger population and economy). Increased heat is also increasing favourable months for transmission of mosquito-borne diseases like malaria and dengue. This year though our underreporting of dengue is showing few dengue cases. However, I myself was recently infected by dengue even though I was always meticulous about protecting myself. There is a limit to individual preventive measures if infectious diseases are not being controlled at the population level. Climate change is also bringing extreme floods and droughts in the region. In Pakistan, the 2022 floods damaged around 1,500 health facilities. Thirty-five percent of Pakistan's land has experienced extreme drought annually for the last many years. According to the same report, air pollution is now one of the major challenges, costing India $500 billion and Pakistan $33 billion. These numbers should alert decision-makers, even if we don't talk about the immense health costs of air pollution. A 20–30% increase in mortality from heart diseases, cancers and strokes is linked to air pollution. This year too both Indian and Pakistani cities are occupying four to five top slots in the top ten most polluted cities in the world. The Lancet report suggests some priority actions. First, consider the consequences of climate change like health emergencies, and start preparing for them. Since frequent floods and droughts are now part of regular cycles, be prepared. Build resilience by making sure there are flood-resilient health facilities with solar electricity and cold chains for vaccinations. Deploy mobile health services to operate in natural emergencies. Establish a real-time, representative and effective disease surveillance and response system. These are important steps to prepare for climate-induced health emergencies. But unless we address the core issues of our public health - such as population growth, safe drinking water and nutrition - our preparedness for emergencies will only be tinkering at the edges. Pakistan is an agricultural country, but 40% of our children are stunted. Severe malnutrition may reduce 10 to 15 IQ points in children. Over the decades, successive governments did nothing to improve the situation. Pakistan's fertility rate is around 3.5 while every other country in South Asia has a fertility rate of around 2 or lower. Our population explosion is now threatening national security as we can't provide food, health and education for our children. Our population is already physically and mentally disadvantaged, and the fast-approaching climate health crisis will affect us even more. We were already struggling with uncontrolled infectious diseases and non-communicable diseases, and this climate-related health emergency now completes a triple whammy of health crises. We need to strengthen our foundations while still repairing our roof for the incoming rains.