Climate change: A test for resilience of mental health systems?

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Introduction

Well before the COVID-19 pandemic disrupted global health systems and moved the needle for adopting a focused approach to the intersectionality of climate change and health, climate change had been proclaimed as a medical and health emergency by leading organizations devoted to public health, environmental health, patient advocacy, medical practice, and nursing services.

Many global and regional discussions and studies have highlighted the harmful impact of climate change on human health, prompting a One Health approach to health systems. However, these discussions often focus on the physical effects on people and animals, overlooking climate change’s lesser-known mental and psychosocial impacts, particularly on vulnerable groups.

Climate change and human health

Climate change has diverse impacts on the overall health of the affected population, leading to increased risks of mortality and illness from extreme weather events like heat waves, storms, and floods. As our planet warms due to climate change, infectious diseases, particularly zoonotic diseases, i.e., diseases that are transmitted from animals to humans (Ex. COVID-19, Rabies, Anthrax, etc.), are expanding their geographic range beyond traditional warmer latitudes. Extreme climate events also disrupt food systems and worsen issues related to food and water, thus contributing to health shocks, including mental health concerns.

There is clear evidence demonstrating the impact of climate change on mental health. Extreme weather events significantly aggravate stress and anxiety. They may lead to severe clinical conditions like depression, post-traumatic stress disorder (PTSD), and, in many cases, substance abuse disorders.

Children and older adults are more vulnerable to the mental health impacts of climate change. In children, factors such as physiological development, cognitive abilities, and emotional skills intersect with other threats like parental health, depression, anxiety, and poverty. In comparison, older adults face greater physiological susceptibility to climate-related health effects, compounded by factors like physical disabilities and limited access to resources and care.

Furthermore, climate change undermines factors crucial for good health, such as stable livelihoods, societal equality, and access to healthcare and support networks, disproportionately affecting marginalized and vulnerable groups like women, children, ethnic minorities, impoverished communities, migrants, older individuals, and those with pre-existing health conditions.

Dual burden of climate change

Extreme climatic events also impose a significant financial burden on vulnerable communities. These communities, already grappling with limited resources and socioeconomic challenges, bear the brunt of the economic fallout from climate-related disasters. The United Nations highlights how climate change accelerates financial burdens, particularly affecting those most vulnerable and impoverished. For instance, when extreme weather events strike, such as hurricanes, floods, or wildfires, these vulnerable groups often lack adequate insurance coverage or financial reserves to cope with the damages to their homes, businesses, and livelihoods. Global economies such as the European Union have experienced extreme weather and climate events that pose risks to debt sustainability. Financial resilience to climate change is still an under-explored and underfunded theme in India.

Extreme weather events also lead to supply chain disruptions such as transportation issues, labor troubles, and raw materials shortages. The cost of rebuilding and recovery further exacerbates the financial instability of vulnerable communities, perpetuating a cycle of poverty and stress.

Mental health burden in India

India faces a significant mental health burden, with a large portion of the population in need of care but lacking access to services. The utilization of mental health solutions is low, with only 30 percent of mental health patients receiving help and a significant treatment gap across various psychiatric disorders. The mental health infrastructure is inadequate, with a scarcity of mental health professionals and limited resources, especially in rural areas. The overall availability of qualified mental health personnel in the public and private sector is scarce, with only 898 clinical psychologists and 1,500 psychiatric nurses compared to a demand of 3,000, as reported to the Lok Sabha in 2018. The cost of accessing mental healthcare in India is high, with private therapy costing anywhere between INR 1,500 to 3000 (USD ~20 to 40) per session.  Access to care is limited, particularly in rural areas, which struggle with a deeper stigma associated with mental health. The stigma associated with mental health in India is a significant issue that affects the quality of mental health care and contributes to the hidden burden of mental health disorders. This stigma takes various forms, including public and self-stigma, and can be influenced by cultural, social, and economic factors and is driven by a pronounced lack of societal support and self-awareness.

Building a climate-resilient healthcare ecosystem in India

The Government of India has made several policies and programmatic steps to address these concerns, such as the Mental Healthcare Act 2017 of 2017 and the District Mental Health Programme (DMHP), built on the Bellary model, to detect, manage, and treat mental health concerns.

However, strategic investments in mental health infrastructure, including expanding services and training healthcare professionals, are crucial. Collaboration between government agencies, civil society organizations, and local communities is essential to develop holistic and culturally sensitive approaches to mental health resilience.

Further, a comprehensive community-driven, locally-led adaptation of the directives in the Mental Health Act, 2017, spearheaded by the State Governments and district administrations, will initiate a much-needed feedback mechanism for impact. Utilizing technology-enabled mental healthcare platforms can be a vital link between youth and community action.

Lastly, integrating mental health considerations into climate change adaptation and disaster response policies is vital to prioritize mental health needs during crises. More profound research on climate-resilient mental health systems is critical to inform evidence-based policies and interventions. Understanding the vulnerabilities of different population groups and identifying best practices for building community-based resilience at various levels is key to addressing the mental health challenges posed by climate change.

India must urgently address the intersection of climate change and mental health to ensure the well-being of its population, especially the most vulnerable. By integrating mental health resilience into climate change policies, India can take significant strides towards safeguarding mental health in the face of climate challenges. It is time for concerted efforts and collaborative actions to build a more resilient health system to effectively mitigate the mental health impacts of climate change in India.

Strategies for inclusive governance by Nandan Nilekani

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Mr. Nandan Nilekani, Cofounder of Infosys, highlights the need to enhance state capacity via people, processes, and technology. He advocates incentives for decisive actions, the need to foster continuous learning, and citizen-centric process design for anytime-anywhere access to services. He provides examples of technological interventions, such as Aadhaar and UPI, which facilitate national benefit portability and streamlined tax payments that drive efficiency. Mr. Nilekani stresses transparent government processes and citizen-facing services, which can ensure accessibility and efficiency for all stakeholders and mark strides toward effective governance.

Enhancing state execution capacity: Insights and strategies by Iqbal Dhaliwal

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In his interview, Mr. Iqbal Dhaliwal, Global Executive Director of MIT’s Abdul Latif Jameel Poverty Action Lab, discusses five bottlenecks that hinder state execution capacity: hiring challenges, role clarity, training adequacy, incentives, and data-driven decision-making. He encourages several steps to overcome these challenges. These include ways to implement competency mapping, promote lifelong learning, and strengthen accountability measures. He stresses the importance of using technology and investments in human resource management to bolster efficiency. Mr. Dhaliwal uses attendance improvements in rural health centers as an example to highlight the complexities of system design and implementation.

Addressing India’s public financial management challenges: Insights and advocacy by Anupam Kulshrestha

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Mr. Anupam Kulshreshtha, who once was the Deputy CAG of India, talks to us about ways to address India’s PFM challenges in the context of fiscal federalism-related complexities and bureaucratic obstacles. Though PFMS implementation has improved payment regulations, issues linked to integration remain. Mr. Kulshrestha advocates for JIT funding and emphasizes enhancing accountability mechanisms and data integrity. The separation of accounting and auditing functions within the CAG’s department ensures integrity, yet the reformation of accounting cadres poses administrative hurdles. He highlights the importance of proactive audit measures essential to sound policy formation and governance efficacy.

Ajay Shah on reinventing governance: Accountability and organizational reform

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Dr. Ajay Shah, Cofounder of the XKDR Forum, talks to us about ways to achieve effective governance. He discusses politicians’ engagement with citizens and systemic issues and stresses electoral accountability. Dr. Shah notes that an entrepreneurial spirit and managerial approaches are essential to confront challenges. He emphasizes organizational efficiency in governance and urges transparency and decentralized measurement. He also proposes that policymaking should incrementally integrate digital tools and prioritize foundational organizational functions, such as HR and finance, to ensure effective governance in India.

 

Empowering female smallholder farmers with gender-responsive agri-finance solutions

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Grace is a smallholder farmer in Uganda whose cultivation depends on seasonal rainfall. She relies solely on her half-acre land for income, while unpredictable weather limits her productivity. Grace would be able to transform her agricultural practice if she had access to an agricultural loan. She could then buy an irrigation pump and start cultivation all year round. This would improve her crop production and potentially increase her yield by 50%. However, banks are unwilling to lend to her because she lacks a land title. Countless women like Grace continue to face an uphill battle to access formal finance to transform their agricultural livelihoods.

Agriculture is Uganda’s largest source of employment. It employs 66% of the population. Women like Grace contribute 72% of the agricultural labor force. Yet, female farmers have less access to productive assets, which include financial services. The World Bank estimates that the reduction of gaps in access to assets for female farmers can lead to a 20 to 30% yield increase per household.

Access to agricultural finance and its use are low in Uganda. Only 11% of the population borrows for agriculture. MSC conducted research on smallholder farmers in Uganda to understand the challenges they face when they access credit. The study found that high interest rates and lack of collateral are common issues, especially in areas where land ownership depends on informal customs and traditions. This limitation restricts their access to financial services and full participation in the agricultural value chain. Additionally, the limited presence of financial institutions in certain regions further restricts farmers’ access to financial services.

The seasonal nature of agriculture also poses challenges for farmers as it leads to income irregularities for them. As a result, they struggle to repay loans regularly. Smallholder farmers can earn as much as USD 7,568 in the harvest months and as little as USD 54 in the lean months, which highlights their financial constraints. Some respondents cited challenges with monthly charges on financial accounts, which are difficult to manage due to agriculture’s seasonal income patterns.

As noted above, land ownership among women is often informal, which leads to limited control over land transactions. Women own smaller plots of land, which range from 0.5 to 1 acre.

Additionally, men are the primary decision-makers in agricultural and household matters, which can limit women’s autonomy in the choice of crops, farming techniques, and access to financial services. Figure 1 shows this disparity. It is an extract of findings from three towns in Uganda based on MSC’s study. It shows that male smallholder farmers manage larger plots of land. In contrast, female farmers mainly engage in farming activities on smaller plots. This gender-based distribution highlights the need for interventions to address these inequalities and empower women in agriculture.

Financial inclusion for female smallholder farmers is not limited to access to credit. It also involves the design of products that address their unique challenges and empower them economically. The figure below shows some key implications in the design of credit products specifically for female smallholder farmers, which MSC identified during our recent study.

Recommendations to change the status quo

Promote gender equality in land ownership: Government agencies and policymakers should implement policies that promote gender equality in land ownership and ensure secure land rights for women. Additionally, support programs should facilitate women’s access to land rental agreements and promote gender-inclusive rental practices. In Rwanda, the land tenure regularization program ensured women’s land rights and increased productivity and income for female farmers.

Grant access to legal titles: Advocate for legal reforms that grant female smallholder farmers secure land ownership rights and access to legal titles. The land titling project was one such initiative that positively impacted Peru. It improved women’s access to land titles and enhanced their economic security and decision-making power.

Increase access to digital channels: Financial institutions and lenders should develop initiatives that provide training and resources to help female farmers overcome digital barriers and use technology for agricultural credit. myAgro, a social enterprise in West Africa, has significantly enhanced its engagement with female farmers, who now represent 65% of its clients. The organization offers a savings program that empowers smallholder farmers to afford essential agricultural inputs, such as seeds and fertilizers, through a prepaid scratch card system.

Enhance women’s participation in decision-making processes: Stakeholders should establish programs that empower women to participate in decision-making processes, provide training on marketing strategies, and promote gender equality in agricultural organizations. The FAO has established Dimitra Clubs in Africa, which are community-driven platforms in several African countries. These countries include Burundi, Burkina Faso, Central African Republic, the Democratic Republic of the Congo, Kenya, Madagascar, Mali, Malawi, Mauritania, Niger, and Senegal. These clubs empower rural communities, particularly women, through enhanced participation in community life and decision-making processes. Africa has 600 Dimitra Clubs, and 60% of the members in these clubs are women.

Segment female smallholder farmers: The segmentation of female smallholder farmers into subgroups should be a fundamental step in the design process and the development of such gender-tailored products. This segmentation reveals the nuanced similarities and differences among women and informs product uptake and usage patterns. One Acre Fund focuses on smallholder farmers, many of whom are women. Its programs often tailor support to the unique challenges faced by female farmers. It recognizes that women may have different levels of access to land and resources than men. This tailored support implicitly involves segmentation, which acknowledges and addresses the specific barriers that female farmers face.

Conclusion

The market demand for gender-responsive agri-finance credit signals a growing interest to address gender disparities within the agricultural sector. Moreover, the research planning, implementation, and prototype design processes must consider gender. Qualitative research methodologies, such as human-centered design (HCD) or MSC’s Market Insights for Innovation and Design, enhance the efficient design of impactful solutions and cater to the diverse needs of female smallholder farmers.

Collaboration among banks, FinTechs, MFIs, and development partners is essential to seize opportunities to improve female smallholder farmer’s access to credit. MSC’s support to such institutions has been pivotal in the development of credit products tailored to empower female farmers. Through such tailored solutions, women like Grace would no longer need to depend on the vagaries of unpredictable weather and look forward to a better and more secure future.