Widening the lens of population-based health research to climate change impacts and adaptation: the climate change and health evaluation and response system (CHEERS)

Abstract

Background: Climate change significantly impacts health in low-and middle-income countries (LMICs), exacerbating vulnerabilities. Comprehensive data for evidence-based research and decision-making is crucial but scarce. Health and Demographic Surveillance Sites (HDSSs) in Africa and Asia provide a robust infrastructure with longitudinal population cohort data, yet they lack climate-health specific data. Acquiring this information is essential for understanding the burden of climate-sensitive diseases on populations and guiding targeted policies and interventions in LMICs to enhance mitigation and adaptation capacities.

Objective: The objective of this research is to develop and implement the Change and Health Evaluation and Response System (CHEERS) as a methodological framework, designed to facilitate the generation and ongoing monitoring of climate change and health-related data within existing Health and Demographic Surveillance Sites (HDSSs) and comparable research infrastructures.

Methods: CHEERS uses a multi-tiered approach to assess health and environmental exposures at the individual, household, and community levels, utilizing digital tools such as wearable devices, indoor temperature and humidity measurements, remotely sensed satellite data, and 3D-printed weather stations. The CHEERS framework utilizes a graph database to efficiently manage and analyze diverse data types, leveraging graph algorithms to understand the complex interplay between health and environmental exposures.

Results: The Nouna CHEERS site, established in 2022, has yielded significant preliminary findings. By using remotely-sensed data, the site has been able to predict crop yield at a household level in Nouna and explore the relationships between yield, socioeconomic factors, and health outcomes. The feasibility and acceptability of wearable technology have been confirmed in rural Burkina Faso for obtaining individual-level data, despite the presence of technical challenges. The use of wearables to study the impact of extreme weather on health has shown significant effects of heat exposure on sleep and daily activity, highlighting the urgent need for interventions to mitigate adverse health consequences.

Conclusion: Implementing the CHEERS in research infrastructures can advance climate change and health research, as large and longitudinal datasets have been scarce for LMICs. This data can inform health priorities, guide resource allocation to address climate change and health exposures, and protect vulnerable communities in LMICs from these exposures.

Keywords: climate change; climate change and health; digital health; health impacts; low and middle-income country; public health surveillance; response system.

Figure 1

This map depicts the global distribution of 56 Health and Demographic Surveillance Systems (HDSSs) across Asia and Africa. The color-coding scheme used in the map indicates the number of HDSSs in each country, with darker shades of blue representing a higher concentration of HDSSs in that region.

Figure 2

Overview of the CHEERS site data structure, which includes the routine HDSS data collection and the novel CHEERS components of climate-related data (1), reported and measured health status (2), as well as a novel sample size distribution over time and space (3) to optimize resources needed for data collection. The collected data of the CHEERS is managed with a graph-database which provides a flexible data storage and management system.

Figure 3

CHEERS data collection system comprising data collected at the individual level (wearable devices; routinely collected morbidity data), the household level (indoor temperature of houses), the community level (automated weather stations; satellite-based remote sensing including land use classification (LUC), land cover classification (LCC), surface water and wetlands) and the routine HDSS data collection (vital events registration).

Figure 4

Installed sensor that measures indoor temperature and humidity, which is part of the household-level data collection in CHEERS.

Figure 5

Map of Nouna CHEERS area in Burkina Faso indicating the distribution of five weather stations installed in March 2020. The weather stations provide comprehensive meteorological data for the region, measuring precipitation, temperature, solar radiation, wind speed and direction, and relative humidity (station locations encircled).

Figure 6

The CHEERS framework creates an integrated routine data collection system that encompasses several key modules: vital event registration (collected for all households within the CHEERS site), verbal autopsy (conducted in households reporting a death, with interviews carried out by a proxy household member), and reported morbidity data (including information on chronic and acute diseases, collected for 10% of households, up to a maximum of 1,500 households). Climate-related data is currently obtained from 500 households (indoor temperature) and 500 individuals (wearable devices measuring daily activity, sleep, and heart rate) in the Nouna CHEERS site. Presently, five weather stations are deployed in the Nouna CHEERS site, with ongoing evaluation to determine their sufficiency in covering the area.

Figure 7

Visual representation of health and demographic data in a graph database for the Nouna HDSS, showcasing the village of Moinsi, its compounds, households, and current household members.