The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”.
Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing.
The fundamental tension appears right at the start.
The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.”
This framing privileges standardized, quantifiable data over other forms of knowledge.
Yet paradoxically, the report recognizes that “health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.”
This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.
Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.
When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.
Can we afford to wait?
As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?
Explore the value of health workers’ experiential knowledge: Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.
This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”
The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.
The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.
A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”
More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”
However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”
This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.
A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”
This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.
Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.
This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.
Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.
It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.
For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.
The seeds of this transformation are present in the 2024 report.
Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.
References
Romanello, M., et al., 2024. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
Image: The Geneva Learning Foundation Collection © 2024