4. Health hazards posed by client change and the importance of pursuing ‘One Health’

Japanese

Ever since Donald Trump’s inauguration as President of the United States in 2025, with the establishment of Agenda 47 and the renewed leadership of the U.S. Securities and Exchange Commission (SEC), rising concerns over climate change activities and associated environmental damage have been observed. At first glance, climate change may not pose much relevance to global health, but indirect impacts, such as increased risk of health hazards caused by climate change, are evident. Additionally, these risks are greater when the healthcare system itself remains weak. In fact, nations in the Global South face immense pressure on the healthcare system from increased risks of communicable diseases—an added threat to realising global health. In this essay, we will analyse specific examples of health hazards threatened by climate change in the Global North and the Global South. Moreover, we will explore what nations can do to combat climate disasters through ‘One Health’—a new initiative that has come into the spotlight in recent years.

1. What health hazards does climate change pose?

We will first begin by understanding the relationship between climate change and its relevance to health. In recent years, four main phenomena have been observed with climate change: increasing CO2 levels, increasingly severe weather, rising sea levels and rising temperatures. These climate trends lead to climate disasters, which in turn lead to health hazards (Diagram 1).

Diagram 1: Relationship between climate change, climate disasters and health hazards created

^{Created by PwC based on University of Pittsburgh (2021) "Climate Change and Global Health Research at the University of Pittsburgh*1"}

Frequent occurrences of climate disasters have significant impact, particularly in low- and middle-income countries that concentrate in the Global South. As mentioned in the previous essay, considering the already inadequate health access (UHC system, health infrastructure) witnessed in the Global South, the addition of climate change-induced health hazards will increase the vulnerability of the healthcare system and further widen the gaps in health accessibility between nations. While the continuation of nations strengthening their health access is crucial, measures against health hazards caused by climate disasters cannot be ignored.

2. Case study: Global North vs. Global South

In order to further understand the actual health hazards caused by climate change, this section will focus on three climate disaster topics. It will also delve into the differences of the impacts experienced by the Global North and Global South.

1) Impacts on water and food supply
2) Impacts on water quality
3) Impacts on air pollution

2-1. Impacts on water and food supply

First, we will focus on the impacts on water and food supply. In recent years, the frequency of extreme weather has significantly increased, as rising global temperatures disrupt seasonal and weather patterns. One major consequence has been irregular rainfall, leading to prolonged droughts in both the Global North and South. These droughts have caused significant shortages of water for everyday and agricultural use, threatening food security and public health. While the nature of drought-related challenges varies across regions, we will look into the United States, representing the Global North, and Ethiopia, representing the Global South, as examples to explore what both countries are facing and potential solutions.

<Global South: Ethiopia>

Climate change is severely affecting food security across Africa, with Ethiopia being one of the hardest-hit countries. Prolonged droughts have disrupted water resources and agricultural production, making it challenging for people to access safe drinking water and sufficient nutrition. These conditions have led to a rise in malnutrition and other health-related issues, negatively impacting multiple communities’ well-being and livelihoods^*2.

In Ethiopia, droughts occur regularly every three to five years, in which both frequency and severity have increased over the past few decades^*3. For instance, in 2022, the country experienced severe drought from insufficient rainfall during the rainy season for three consecutive years. This drought led to the depletion of surface water sources, such as rivers, ponds and reservoirs, resulting in a shortage for everyday and agricultural use. As a result, agricultural production declined sharply, and the number of people unable to access adequate nutrition rose significantly^*4. Acute malnutrition has become especially severe among mothers and children, with approximately 73% of mothers and 22% of children under the age of five diagnosed with acute malnutrition^*5.

Beyond their effects on public health, droughts have significant impacts on Ethiopia’s economy. Agriculture contributes to approximately 30% of the country’s GDP, and around 80% of the population relies on agricultural activities. Accordingly, a decline in agricultural output directly undermines the nation’s economic foundation, with reduced harvests destabilising rural economies and triggering sharp increases in food prices^*6. Given these challenges, sustained and comprehensive international assistance is essential to support Ethiopia’s recovery and long-term resilience resulting from drought.

While the impacts of climate change-induced drought differ between the Global South and Global North, we will now explore the situation and response measures in the Global North.

<Global North: US>

In the US—a Global North nation—the frequency and severity of droughts are increasing from ongoing climate change, just like what is witnessed in the Global South. These droughts contribute to water shortages, agricultural losses and health-related challenges. In 2024, reports highlighted the spread of ‘flash droughts’—rapidly developing drought conditions—affecting more than 45% of the mainland, highlighting the growing urgency of the issue^*7.

Moreover, in 2024, a drought emergency was declared in Washington State. This situation was closely monitored by the U.S. Drought Monitor, a joint initiative of the NOAA (National Oceanic and Atmospheric Administration) and USDA (U.S. Department of Agriculture). Reports indicated that reduced snowfall and declining reservoir levels could severely impact water availability over the following months^*8. Water shortages caused by drought make it increasingly difficult to secure water for both agricultural and everyday use, affecting daily life and public health. These challenges include food shortages due to reduced crop yields and a heightened risk of infectious diseases stemming from deteriorating sanitary conditions. The impacts are especially severe in rural areas and among low-income populations, raising serious concerns about health risks and social vulnerability.

The U.S. Drought Monitor plays a vital role in addressing the growing threat of drought across the country. This system provides real-time monitoring and assessment of drought conditions nationwide, supporting early detection, rapid response and informed policymaking^*9. For example, by identifying early signs of drought, farmers and local governments can proactively adjust water usage plans and prepare for potential impacts. In 2024, based on data from the U.S. Drought Monitor, Washington State implemented several emergency measures, including the allocation of up to US$4.5m in drought response subsidies and the facilitation of emergency water rights transfers^*8. Although droughts in the US are becoming increasingly severe, real-time monitoring and early intervention strategies are helping to mitigate damage to agriculture and local communities, while also reducing health risks.

While both the Global North and South face shared challenges of drought driven by climate change, there are notable differences in their capacity to respond and the strength of their institutional frameworks. In particular, the Global North has implemented advanced initiatives, such as real-time monitoring systems, which may offer valuable insights for the Global South. By flexibly adapting the knowledge and technologies developed in the Global North to suit local conditions, the Global South can strengthen their climate resilience and enhance their ability to respond effectively to environmental challenges.

2-2. Impacts on water quality

Alongside recent climate change, the phenomena of increasing water disasters and rising sea temperatures are occurring frequently worldwide, resulting in water pollution and further affecting people’s health. Health hazards caused by water pollution are not limited to one country but are a common issue throughout the world. In this section, we will explain the current situation regarding health hazards and solutions in Malaysia, representing the Global South, and Germany, representing the Global North.

<Global South: Malaysia>

Rising temperatures are thought to increase the volume of water evaporating from the ocean and land into the atmosphere—one of the factors that increases the likelihood of floods and other water disasters. In 2024, a total of 142 large-scale floods were reported worldwide, accounting for approximately 35% of all natural disasters that occurred during the year^*10. Malaysia—located in Southeast Asia—suffered long-term flood damage in 2014 that lasted approximately three weeks. This flood has been reported to have doubled the number of patients with leptospirosis, a waterborne infectious disease, compared to three months before and after the flood^*11. Leptospirosis is caused by water contamination by pathogens contained in the urine of carrier animals, such as cows, pigs and especially rats. It is said that direct contact with this water is the most common route of infection. Symptoms of leptospirosis diseases range from asymptomatic to severe, including multiple organ failure and death^*12.

In Malaysia and neighbouring Southeast Asian countries, many cases of waterborne diseases, such as dengue fever and typhoid, in addition to leptospirosis, have been reported^*13,14. In these regions, sanitation and drainage systems are inadequate during floods, which spreads contaminated water and increases the risk of contracting waterborne diseases.

Compared to the Global South, the Global North has better sanitation conditions and therefore suffers less damage from waterborne diseases, yet several cases have been reported in recent years due to climate change. We will now take a deep dive into the situation in the Global North.

<Global North: Germany>

In the Baltic Sea facing Germany, the hottest summer in the past 30 years was observed in 2018, with the surface water temperature 4–5°C higher than the long-term average since 1990^*15. Such increases in water temperature promote the proliferation of pathogens such as non-cholera Vibrio (NCV), Legionella and Cyanobacteria^*16. For example, NCV proliferates particularly in warm water at temperatures above 20°C. There are various routes of infection, including gastroenteritis caused by ingesting undercooked seafood, and wound infections caused by contact between wounds on the surface of the skin and water contaminated by NCV. Both gastroenteritis and wound infection can lead to sepsis with significant fatality rates, in which prompt medical treatment is a necessity.

In addition to prompt medical treatment, preventing contact with water contaminated with NCV is considered to be the most effective infection control. Accordingly, EU countries are using a monitoring tool called the ‘Vibrio Map Viewer’ provided by the European Centre for Disease Prevention and Control (ECDC) to predict NCV proliferation. This tool predicts environmental conditions suitable for the proliferation of NCV by tracking real-time data on water temperature and sea surface salinity. If the risk of proliferation is determined to be high, an alert is sent to public health authorities^*17,18. Based on this alert, measures to prevent NCV infection can be taken, such as warning medical workers and the general public, as well as closing beaches.

The most important measures to address health hazards caused by water pollution are the development of water supply and sanitation facilities. However, many countries in the Global South still have less than 50% of their population with access to safe water and sanitation^*19,20. Therefore, it is necessary to work on building social infrastructure, such as water supply and sanitation, on a global scale to help prevent the gap between the Global North and South from widening. In addition to establishing a solid foundation for these activities, we believe that the promotion of collaborative initiatives among relevant countries, such as the ECDC’s monitoring tools, will further strengthen our measures to prevent waterborne infectious diseases.

2-3. Impacts on air pollution

Finally, we will delve into the impacts of climate change on air pollution. Unlike its direct effects on water and food supply (2-1. Impacts on water and food supply) and water quality (2-2. Impacts on water quality), climate change indirectly impacts air pollution, primarily through human factors that exacerbate climate change. In this section, we will compare the state of air pollutants and their health impacts, as well as potential solutions, by taking a closer look at India, representing the Global South, and Poland, representing the Global North.

<Global South: India>

India is globally recognised as one of the countries with severe air pollution. A major cause is said to be rapid urbanisation, which contributed to a 67.7% increase in the annual mean concentration of PM2.5—a key pollutant—between 1998 and 2021^*21. As of 2024, the average annual concentration of PM2.5 was 104.7 μg/m³, approximately 20 times the WHO’s recommended level of 5 μg/m³^*22. PM2.5 are extremely small particles that can penetrate deep into the lungs, causing damage to the respiratory system, as well as trigger pulmonary cancer and cardiovascular diseases. In 2019 alone, PM2.5 exposure was responsible for about 1.67m deaths, with 32.5% from chronic obstructive pulmonary disease (COPD), 29.2% from ischemic heart disease, 16.2% from stroke and 11.2% from lower respiratory infections^*23,24.

To address air pollution and the implicated health hazards, the Indian government launched the National Clean Air Programme (NCAP) in 2019, setting targets for air quality improvement in various cities. However, further improvement is required as the current programme faces several challenges, such as a lack of legal enforceability, underutilised funds, a limited number of target cities and inadequate monitoring infrastructure^*25. In addition to these programmes, enhancing the fundamentals of the healthcare system is crucial to prevent health hazards caused by air pollution. Despite recent advancements in India’s healthcare system, issues such as insufficient public healthcare funding, a shortage of medical professionals and limited coverage under universal health coverage persist^*26.

Given the above, degradation of air quality is a universal concern. In this context, we will examine the current situation in the Global North, where a range of mitigation strategies have been implemented through both policy and technological advancements.

<Global North: Poland>

High levels of air pollution continue to be observed in certain Eastern European countries, including Poland^*27. This is primarily due to reliance on coal and household combustion activities, with coal consumption increasing during heat waves in the summer and cold waves in the winter season, resulting in a further increase in air pollution. Consequently, Poland experiences a distinctive smog phenomenon and a heightened risk of cardiovascular diseases, including non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). In 2019, air pollution accounted for 31,100 fatalities, underscoring the severity of the health threats^*28,29,30.

As a response measure, Poland has implemented several solutions. One example is the ‘Clean Air Programme’, which supports the replacement of coal-intensive heaters and the enhancement of residential thermal insulation. Beyond reducing greenhouse gas emissions, this programme is projected to save approximately 21,000 lives annually and lower home heating costs, resulting in strong support from Polish citizens^*31. Additionally, Poland has introduced drone-based airborne monitoring in compliance with smog prevention rules. This allows early detection of illegal activities, and legal penalties such as fines are imposed on offenders^*32. These stringent technological and systematic controls on smog sources are expected to reduce air pollution and its associated health hazards.

Both the Global North and South are implementing measures to combat air pollution. However, the Global North has been more successful by implementing measures with strong national support, achieving notable results in mitigating health hazards. It will be crucial for the Global South to align measures closely with policies that reflects citizens’ needs in order to reduce air pollution.

3. The purpose of ‘One Health’

As mentioned in the previous section, it is evident that while the health risks posed by climate change are seen in both the Global North and Global South, there are differences in the ways in which the nations approach the impacts of these risks. Specifically, solutions to suppress health hazards (via monitoring systems, etc.), maturity of health access and high health awareness among citizens can be highlighted as key examples. Accordingly, as mentioned in the previous essay, continued support amongst nations is essential in building a robust healthcare system through universal health coverage (UHC) and health infrastructure. Additionally, in order to deal with health hazards immediately in the event of a climate disaster, health policies that consider actions towards climate change-induced health hazards are necessary by collaborating with relevant ministries and stakeholders.

Additionally to improving health globally, we must also work in parallel on improving health standards at an individual level. To do so, it is necessary to go beyond improving human health and extend it to animals, as well as protect the environment—both aspects that are strongly connected to people. This is where the concept of ‘One Health’ becomes critical. This concept can not only improve individual health but also contribute to reducing the impacts of climate disasters.

<Why is ‘One Health’ important>

It is said that approximately 70% of infectious diseases occurring worldwide in the past 30 years have originated from animals. There are concerns that these infectious diseases triggered by animals may arise or spread due to environmental deterioration, such as pollution and contamination^*33. This illustrates how closely human health relates and depends on animals and the environment.

Based on the above, ‘One Health’—a concept that comprehensively captures the health of humans, animals and the surrounding environment—has attracted attention worldwide (Diagram 2). The study of this concept began in 2004 and 2021, where four organisations—the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the International Veterinary and Eastern Affairs Bureau (WOAH) and the World Health Organization (WHO)—discussed and published the following as a worldwide definition of ‘One Health’^*34,35.

‘“One Health” is an integrated and uniform approach that aims to sustainably maintain and optimise the health of humans, animals and ecosystems in a balanced manner. We recognise that the health of humans, livestock, wildlife, plants and the broader environment (including ecosystems) is closely related and interdependent.’

Since cross-sectoral collaboration is required to realise One Health, the above definition aims to promote a shared understanding among stakeholders in various areas. Furthermore, in order to promote health using the One Health approach, the four organisations (FAO, UNEP, WOAH and WHO) have formulated a joint action plan named the ‘One Health Joint Plan of Action (2022‒2026)’, which supports efforts to realise One Health in each nation^*36.

Diagram 2 : Concept of 'One Health'

^{Created by PwC based on Evolution for Animal Health (N/A). 「One Health Global Approach」 *37}

<One Health initiatives in Japan>

Initiatives related to One Health, including those led by the government, have already begun in Japan (Table 1).

In addition to the initiatives outlined in Table 1, the International Cooperation Agency (JICA) is utilising its expertise in Japan to implement initiatives to promote One Health in the Global South. Specifically, in the case of rabies in the Philippines—a serious issue in the public health agenda—JICA supports ‘the development of a one-health network model that utilises and verifies Japan’s knowledge, develops new diagnostic methods and shares diagnostic information between animals and people, leading to efficient control action activities’^*41.

Despite the above, the number of examples that portray a full realisation of One Health in Japan remains limited. Possible reasons for this are as follows.

• Lack of human resources and governance with cross-disciplinary expertise: In order to realise One Health, collaboration in a variety of fields, including medical, public health, veterinary, agricultural and environmental sciences, is required. Currently, these fields are operated vertically in Japan, and there is no cooperative system in place.
• Poor awareness and interest in One Health: Although the importance of One Health has been recognised in part in the wake of the outbreak of a new-type coronavirus infectious disease (COVID-19), understanding and interest at a public level remains limited.

In the near future, it is essential for Japan to focus on building cross-disciplinary collaboration methods and increase human resources with the relevant expertise to lead One Health initiatives. This will allow Japan to increase examples domestically, which can be further leveraged to support other nations and to become a leader in such an agenda. 

Throughout the past four Global Health series, we have highlighted numerous examples of the importance of healthcare. However, in light of recent increases in climate-related disasters, the importance of protecting the health of not just humans but also animals and the environment has been brought to the forefront. As such, it is crucial for not only Global North nations to support the Global South, but to also collaborate across borders through practices such as One Health. We believe this cross-border collaboration will essentially lead to the protection of the planet itself.

Reference materials

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