Introduction

As noted by the United Nations Framework Convention on Climate Change (UNFCCC) [1], women, especially those in poverty, face higher risks and experience a greater burden of climate change impacts. This is notably true for health impacts, making climate change a risk multiplier for gender-based health disparities. Both men and women are at risk for amplified health impacts. Women have distinct health needs, such as nutritional demands during pregnancy, which places them at risk of suffering from climate-sensitive diseases. Men experience other risks, such as suicide and severe depression in the face of drought [2] and resulting agricultural losses, and may be at higher risk of drowning during severe weather [3]. Compounding women’s health vulnerabilities are cultural constructs, which amplify risk on a regional scale. Globally, a total of 1.3 billion people in low- and middle-income countries live below the poverty line, and 70% are female [4]. Yet while the interactions between poverty, gender-based social discrimination, and climate change threaten to amplify gender-based health disparities, women’s social roles and potential for agency afford opportunities for promoting solutions to sustainability, disaster risk reduction, and solutions to health threats. Ensuring that policies move beyond traditional separations of health, gender, and environment and embrace proactive and gender-based solutions is paramount to protecting women’s health and mobilizing their vast social potential to mitigate, adapt to, and respond to climate threats.

Health impacts

Climate change affects health through a multitude of mechanisms, including heat, poor air quality, and extreme weather events, as well as through meteorological changes that alter vector-borne disease, reduce water quality, and decrease food security [5]. The health risks associated with these exposure pathways are mediated through physiologic, cultural, and socioeconomic vulnerabilities, which differ substantially between men and women (Table 1). The lack of gender-disaggregated health data restricts conclusive understanding of thresholds of exposure for harm and may result in a lack of awareness by local, national, and even global decision makers and healthcare personnel. Many examples exist, including the following:

• Globally, women suffer from higher rates of anemia and malnutrition and are sensitive to climate-driven food insecurity due to increased nutritional needs during menstruation and childbirth. Anemia is associated with cognitive impairments including poor attention span, diminished working memory, and poor educational outcomes [6]. Additionally, a majority of the world’s smallholder farmers are women, and therefore women’s livelihoods are at risk from climate-related crop failure, which threatens to increase poverty as well as poor health outcomes.
• Respiratory and cardiovascular disease secondary to exposure to poor air quality preferentially impacts women due to a greater proclivity for higher deposition of particulate matter in lung tissue and higher rates of anemia [7]. Poor air quality is also associated with negative birth outcomes [8] and affects maternal/child health in that it is associated with stillbirth, intrauterine growth restriction, and congenital defects [9]_. Women spend greater amounts of time in the home and thus are disproportionately exposed to particulate matter from the use of traditional indoor stoves for cooking and heating [10].
• During climate-related disasters, women suffer disproportionate mortality [10], and survivors experience decreased life expectancy [11].
• Women and girls are at a higher risk of physical, sexual, and domestic violence in the aftermath of disasters [12] and are at a higher risk for mood disorders and poor economic recovery [13]. These impacts are amplified when women have a lower socioeconomic status [4].
• Forced migration and repeated short-distance moves are especially significant for poorer people, as well as for groups such as women, who are often excluded from migration analysis [13].

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Table 1. Examples of disparate climate-related health impacts on women and relevant physiologic, cultural, and socioeconomic risk factors.

https://doi.org/10.1371/journal.pmed.1002603.t001

Policy frameworks

Climate change, poverty, and gender inequality are increasingly recognized as global problems; however, achieving the integration of policies, surveillance, and program creation and implementation necessary to make progress in solving these interrelated issues has proven challenging. For example, the Sustainable Development Goals (SDGs) contain separate targets for poverty (SDG 1), gender equality (SDG 5), sustainability (SDG 11), and climate action (SDG 13). Opportunities to interconnect these separate targets through subtargets and indicators that bridge sectors were largely lost during the development of the SDGs. Thus, while there are energy-related indicators in the health goal (related to household use of biomass fuels), there are no health-related indicators in the energy or climate goals. Disaggregation and failure to explicitly link health with these other goal areas leads to discordant efforts, inefficiencies, and communication barriers between involved agencies tasked with solving these multisectoral problems.

Similarly, some advances have been made within the UNFCCC and the United Nations International Strategy for Disaster Reduction (UNISDR). UNFCCC decision 21/CP.22 (2017) calls for a “gender action plan” to incorporate a gendered perspective in all elements of mitigation, adaptation, capacity, technology, and finance. Although this framework sets the stage for action, systematic integrative procedures are lacking, as are indicators to monitor progress. The Sendai Framework—an international covenant adopted in 2015 to establish common goals and standards for disaster risk reduction—formalizes climate change as a disaster-risk multiplier to women and recognizes women as important stakeholders in risk reduction [43]. Furthermore, it calls on adopters to “prepare, review and periodically update preparedness policies, plans and programmes with the involvement of all relevant institutions, considering climate change scenarios and their impact, and to facilitate the participation of all sectors and stakeholders” [43]. Strong accountability is fundamental to the framework, which contains 38 indicators to track progress in implementing the 7 targets, which aim to reduce disaster mortality and damage to critical infrastructure and economies through increased multihazard early-warning systems, improved national and local mitigation strategies, and enhanced international cooperation. The framework also incorporates the related dimensions of SDGs related to poverty, sustainability, and climate action. The Sendai Framework Monitor will also function as a management tool to help countries develop disaster risk reduction strategies, make risk-informed policy decisions, and allocate resources to prevent new disaster risks. It will also target disaggregated data collection with formal biannual reporting via the Sendai Framework Monitoring Process.

Towards integration

Gender mainstreaming throughout all climate targets has been recognized by the UNFCCC as critical to increasing effectiveness. Women play a vital role in the societal response to climate change; their participation at all levels has been shown to result in greater responsiveness to citizens’ needs and often increases in cooperation across party and ethnic lines, generally resulting in sustainable outcomes [23,44]. In order to support this action, we propose that effective engagement and communication with women and girls throughout society must be included at all levels and within the following practices to support an integrative policy approach (Table 2).

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Table 2. Examples of multisectoral solutions to climate change impacts on women’s health.

https://doi.org/10.1371/journal.pmed.1002603.t002

Conclusions

While gender has been increasingly factored into climate change projects and policy, progress has still been slow to reduce gender-based health disparities and to involve women in climate change mitigation, adaptation, and disaster risk reduction and management. The need for compliance with the monitoring processes advocated by the SDGs and the Sendai Framework are critical to address the complex interactions between poverty, gender-based social discrimination, and climate change that threaten to amplify gender-based health disparities. To support monitoring, effective mechanisms to gather and analyze data are needed. Women’s distinct social roles and potential for agency afford opportunities for promoting effective solutions to sustainability, disaster risk reduction, and solutions to health threats. High-level political engagement with the implementation of the UN landmark agreements is necessary to ensure that policies and programs move beyond traditional separations of health, gender, and environment and embrace proactive and gender-based solutions that protect women’s health.

Acknowledgments

The authors would like to thank Kevin Blanchard of Public Health England for his important contributions to this manuscript.