Why immediate action on climate matters to eye health for all, but especially women and girls

For two weeks from October 31, the eyes of the world will be on Glasgow, Scotland and COP 26 – the UN’s ‘Conference of the Parties’.  COP is the apex decision-making body of the United Nations Framework on Climate Change Convention (UNFCCC), a body formed in 1994 to stabilize the greenhouse gas emissions and to protect the earth from the threat of climate change.

Many believe this year’s COP has a unique and urgent opportunity to push countries to go further than they did at COP 21 in Paris in 2015 (where every country agreed to work together to limit global warming to well below 2 degrees and aim for 1.5 degrees). In fact, many claim it is our last chance to make a significant global push to avoid irreversible climate change by 2030.

Our roles within the international eye health sector includes a focus on gender equity.  It might not seem obvious why climate change matters to gender and eye health; however, right now, the intersection between eye health, gender, disability, ethnicity and climate could not be more stark.

The economic, social, and cultural norms that make women and girls in low- and middle-income countries more susceptible to poverty, are the same factors that put them at greater risk of vision impairment and climate change related events. Conversely, the impacts of climate change and vision impairment, perpetuate the cycle of socioeconomic marginalisation of women and girls and impede progress towards gender equity.

By not addressing the intersectional root causes of eye health conditions within women, as well as their role in leadership within the eye health sector, they will continue to be vulnerable, trapped in poverty and disproportionately impacted by the challenges and hazards of climate change and natural disasters.

Climate Change and Eye Health

Gendered inequities that cause climate-related disparities between men and women, statistically mirror the disproportionate impact of eye health and vision impairment on women and girls. Evidence shows that women and girls are more likely to develop vision impairment and less likely to get treatment. Ninety percent of vision loss is in lower- and middle-income countries, with 55% of cases among women and girls. The most common conditions – cataract and refractive error – can be prevented and treated.

Climate change is likely to exacerbate this trend. The human eye is uniquely susceptible to minor changes in environmental factors:

• High temperatures and low rainfall are likely to increase the incidence of trachoma infections.
• Vitamin A deficiency is expected to rise with predicted increases in food insecurity.
• Rising UV exposure may lead to as many as 200,000 additional cases of cataract by 2050.
• Traffic-related air pollution and severe allergic eye diseases are associated with glaucoma and age-related macular degeneration.
• Extreme weather events and natural disasters will lead to an increase in acute and protracted eye injuries and disrupt eye health delivery.

Disaster Impact

In the face of a changing climate, extreme weather-related hazards have become more frequent and dangerous.  Deep-rooted gender inequity means that, despite the incredible resilience and capacity for survival that women often exhibit in the face of disaster, the resulting vulnerabilities put their overall health and survival at greater risk. Up to 80% of those displaced by climate change are women. Women and girls suffering vision impairment are at significantly high risk of injury or death in an emergency because their mobility is hampered, and they are predominantly caregivers for children and vision impaired family members. A study of 141 countries found that women were more likely to be killed during disasters, and at an earlier age; particularly in poor communities because of their isolation and responsibilities in the home.

Some communities are able to access primary healthcare services for the first time in the immediate aftermath of a natural disaster because of an influx of international emergency medical teams. However, despite Disaster Related Diagnoses for eye conditions being very common following an extreme climate-related weather event or natural disaster, emergency humanitarian response teams rarely include eye care specialists in their field operations. As a result, injuries are not properly treated and are more likely to develop into chronic conditions and lead to disability.

Women in Eye Health Leadership

The global eye health disparities women and girls face are not unrelated to those facing female health care professionals and caregivers. Despite growing recognition of the different vulnerabilities and experiences and skills women and men bring to development and environmental sustainability efforts, most women still lack the economic, political, and legal clout to become their own powerful agents of change.

• Women make up 75% of the healthcare workforce yet occupy fewer than 25% of the most influential leadership positions.
• While their contribution to health systems is monumental, the majority of work conducted by women is either underpaid or unpaid, leaving women with few opportunities for advancement or to care for their own health.

This inequitable health system impacts the health of all. The 2015 Paris Agreement called for gender equality and women’s empowerment, and its provisions on adaptation and capacity-building efforts urge member states to adopt gender-responsive approaches. Continued unequal health outcomes and structural gender inequity within the healthcare system will persist and be made worse by the impact of climate change if women’s perspectives are not included more intentionally in planning, policymaking, and programming.

What’s next?

Vision impairment keeps women and girls trapped in poverty and vulnerable to climate change and related disasters. In 2021, UN Resolution A/RES/75/310 – Vision for Everyone and The Lancet Commission on Global Eye Health made clear that planetary health is a key component to improving quality of eye care, and environmentally-sustainable eye health services are required to make progress towards the Sustainable Development Goals. We must make tangible efforts to disrupt the cause-and-effect cycle that perpetuates the vulnerable socioeconomic, environmental and health status of women and girls. Furthermore, it is imperative that gender equity and women’s empowerment continue to influence, shape, and drive the collective climate and human development efforts. We call for these actions:

• Prevention: Implement sustainable and inclusive health care services in high-risk environments and communities to address chronic eye health issues and reduce both the vulnerability of women and girls, as well as the impact of climate change.
• Response: Ensure eye health specialists are included in emergency humanitarian response teams to address disaster-related eye injuries and support patients with non-disaster related eye health conditions, particularly women and girls who often fall through the cracks.
• Inclusion: Ensure women are included in developing the prevention and response by giving women at all levels access to health care decision-making opportunities.

If you want to know more, The International Agency for the Prevention of Blindness (the global peak body for eye health of which The Fred Hollows Foundation is member) has initiated a call to action around climate change. The IAPB also has a Gender Equity Toolkit to support eye health organisations to increase gender equity in their programming, across their organisation and in their leadership.  And, there is also evidence of what can work, with the Regional Eye Health Centre in Solomon Islands being a great example of an eye health facility being planned with sustainability at its core.

When COP 26 starts on the 31^st of October we will hear that climate change is happening now. Our actions, therefore, must centre around preventing risk and avoiding future vulnerability for women and girls. We must adopt inclusive decision-making opportunities to increase women’s contributions to sustainable development and dismantle structural and sociocultural barriers.

Image on top: A young villager in rural India awaits her vision screening as part of Combat Blindness International’s Aadya Initiative/Deepanjali Chopra