Climate Change and Health in South Africa: The Hidden Cost of Extreme Weather Events

Climate change is no longer a distant threat but a present and escalating challenge, affecting global ecosystems, societies, and human health. South Africa is experiencing the brunt of these changes more acutely than many regions due to its geographical location, socioeconomic inequalities, and pre-existing health burdens.

Changes in climatic patterns including increased frequency of extreme weather events such as droughts, floods, heatwaves, and storms are having a growing impact on the physical and mental health of the population (Wright et al., 2021).

The country’s vulnerability to these threats is compounded by deep-seated poverty, inadequate infrastructure, and a fragmented health system. Climate-induced health risks are increasing and challenging to manage within current resource constraints (Chersich et al., 2018). Despite growing awareness, there is still a policy lag in integrating climate resilience into healthcare systems.

This article seeks to explore the specific impacts of extreme weather events on health outcomes in South Africa, focusing on both direct and indirect consequences. It further evaluates adaptation strategies and policy needs to mitigate future risks.

Extreme Weather Events in South Africa

Over the past two decades, South Africa has witnessed a surge in climate-related disasters, many of which have devastated public health. The Intergovernmental Panel on Climate Change (IPCC) projects that Southern Africa will continue to warm at twice the global average, with temperature increases of 3–6°C by the end of the 21st century (Mbokodo et al., 2020). These changes are expected to increase the intensity and frequency of extreme events.

• KwaZulu-Natal Floods (2022): One of the most damaging recent climate disasters, the floods in KwaZulu-Natal displaced over 40,000 people and resulted in the deaths of more than 400. Health facilities were overwhelmed, sanitation systems failed, and clean water became scarce, contributing to the risk of cholera and other infectious diseases (Naidoo et al., 2022).
• Western Cape Drought (2017–2018): Dubbed the “Day Zero” drought, this crisis brought the city of Cape Town dangerously close to running out of water. The health impacts included increased gastrointestinal diseases due to compromised hygiene and food insecurity due to agricultural losses (Chersich et al., 2018).
• Urban Heatwaves: Gauteng and other inland provinces are experiencing unprecedented heatwaves. Projections suggest that parts of South Africa will see 30–40 more heatwaves days per year by 2100 (Mbokodo et al., 2020). This increases risks of heatstroke, cardiovascular disease, and mortality, especially among the elderly and infants.

South Africa’s climate is thus becoming increasingly volatile, with cascading effects on infrastructure, water systems, food production, and ultimately public health (Joubert, 2011).

The Direct Health Impacts of Extreme Weather

Extreme weather events lead to a range of direct health outcomes, from physical injuries and heat stress to disease outbreaks. These effects disproportionately affect those already facing socioeconomic disadvantages.

• Heat-Related Illnesses: Rising temperatures are linked with increased incidences of dehydration, renal stress, heatstroke, and cardiovascular complications. Outdoor workers, including farmers and construction workers, are at heightened risk. According to Kjellstrom et al. (2014), labour productivity declines during high-heat events, leading to economic strain and associated stress-related conditions.
• Injuries and Disease from Flooding: Floods often result in drowning, injuries from debris, and structural collapse. Additionally, waterborne pathogens thrive in flooded areas, leading to outbreaks of diseases like cholera and typhoid. Disruption of waste disposal systems and stagnant water also increases mosquito breeding, raising the risk of malaria and dengue fever (Chersich et al., 2018).
• Drought and Malnutrition: Drought diminishes crop yields and drives up food prices. The result is widespread malnutrition, especially among children in rural and agricultural communities. Drought also reduces water availability, further compounding health risks through poor hygiene and limited access to drinking water (Wright et al., 2021).
• The health burden from these events is amplified by already high rates of communicable diseases such as HIV/AIDS and tuberculosis, as well as a growing prevalence of non-communicable diseases like diabetes and hypertension.

Indirect Health Consequences

Beyond the immediate physiological impacts, climate change causes a ripple effect on mental health, healthcare infrastructure, and social stability.

• Mental Health Crises: Extreme weather events and the loss of homes, livelihoods, and family members cause deep psychological trauma. Anxiety, depression, and post-traumatic stress disorder (PTSD) are prevalent in displaced communities (Chersich et al., 2018). Mental health services in South Africa are already overstretched and underfunded, making post-disaster recovery even more difficult.
• Damage to Healthcare Infrastructure: Floods and storms often destroy roads, electricity lines, and medical facilities, disrupting emergency response and access to care. In rural areas, primary healthcare clinics are sometimes inaccessible for days or even weeks, increasing the risk of disease progression and maternal and infant mortality (Myers and Rother, 2012).
• Exacerbation of Inequality: Marginalized communities in informal settlements are more likely to be in flood-prone areas or regions without shade and green space, making them more vulnerable to both heatwaves and floods. These communities also face barriers to accessing public services, emergency alerts, and medical treatment (Dos Santos et al., 2022).

The interconnected nature of these vulnerabilities highlights the need for a multi-sectorial approach to public health and climate adaptation.

Public Health Response and Adaptation Strategies

Despite South Africa’s commitments to global climate agreements, the health system’s adaptation to climate change is still limited and uneven. While urban hospitals may have better infrastructure, rural health services are critically under-resourced (Chersich and Wright, 2019).

• Local Innovations: Encouragingly, some municipalities are piloting resilience strategies. For example, early warning systems and community alert platforms are being integrated with primary health services. These include mobile clinics, SMS alert systems, and awareness campaigns on how to stay safe during heatwaves and floods (Manyuchi et al., 2023).
• Policy Frameworks: Nationally, South Africa has developed a Climate Change and Health Adaptation Plan, yet execution at the provincial and local levels is still inconsistent. Many climate-related health risks are still not explicitly addressed in existing health policies (Quintana et al., 2024).
• Training and Capacity Building: Most health professionals lack training on climate-related health issues. Integrating climate adaptation modules into medical and nursing curricula would enhance the sector’s preparedness and response capability (Wright et al., 2019).

Recommendations

• Mainstream climate resilience into healthcare planning—especially in rural and underserved regions.
• Invest in climate-resilient infrastructure, such as elevated clinics, mobile health units, and solar-powered cooling systems.
• Expand mental health services for communities affected by displacement and disaster trauma.
• Develop multi-sector response teams, linking meteorologists, healthcare workers, social workers, and municipal leaders.

Conclusion

Climate change is one of the greatest threats to public health in South Africa. From floods and droughts to heatwaves and food insecurity, the impacts are multifaceted and deeply interconnected. The most vulnerable populations are also the most affected, and the country's healthcare system is still unprepared to manage these escalating challenges. A proactive, well-resourced, and equity-driven approach is urgently needed.

By investing in adaptive infrastructure, training healthcare workers, and integrating climate science into public health planning, South Africa can build a system capable of protecting its people in an era of environmental uncertainty. Failure to act, risks undermining decades of progress in health and development.

References

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Written By: Tshedza Matladi

Edited By: Thakane Hoeane