The unseen climate health risks of antimicrobial resistance in urban informal settlements

Abstract

Over a billion people worldwide live in informal settlements in developing cities¹ without basic infrastructure and services such as safe sanitation and clean water. Often located on marginal flood-prone or unstable land, these communities, which make up 20–40% of the urban population in low- and middle-income countries (LMICs), stand to be some of the most severely affected by a changing climate. More frequent and severe flooding, extreme and inescapable heat, storms, storm surges and episodes of water scarcity, as well as the existential threat of rises in sea level, are already having a disproportionate impact on the residents of these communities, who at the same time are some of the least resourced to deal with such adversities.

Beyond these visible physical threats, however, urban informal settlements (UISs) have many circumstantial factors that make them hotspots for health risks. Through six years of house-to-house surveys and microbiological, spatio–environmental sampling in 24 UIS communities in Makassar, Indonesia, and Suva, Fiji, as part of the Revitalising Informal Settlements and their Environments (RISE) program², we have gained deep insight into the many adversities and health challenges that these settlements face. These findings point to a perfect storm of factors that contribute to health risks in UIS communities, including: lack of effective sanitation resulting in the release of faecal waste into high-density urban communities; repeated flooding and poor drainage resulting in persistent ponding with pathogen-contaminated waters from local and upstream sewage discharge; lack of proper road and pathway access resulting in frequent pedestrian traffic through contaminated waters and sediments; poor quality housing, flooring and toilet facilities; poor or limited access to clean water; close exposure to domestic and wild animals, livestock, vermin and insects; and suboptimal health literacy. The lack of clean pathways and access to households creates a situation in which residents, especially children, are in repeated close contact and interaction with the external fecally contaminated environment, which may then be brought into the home. As a result, residents of these communities experience chronic, habitual exposure to disease-causing pathogens that manifests in high rates of frequent and recurrent locally contracted bacterial illness³. In children, there are long-term consequences related to the impacts of disease burden in early childhood in terms of anemia, stunting and poor cognitive development⁴.