Health systems in the age of polycrisis

The recent release of the World Risk Index 2024 report highlighting the Philippines as the No. 1 disaster risk hotspot around the world for the third straight year should shame us enough to find out why and do something about it. The report focuses on two spheres being studied to gauge the degree of risk: exposure and vulnerability.

The Philippines is highly exposed to multiple hazards that are happening with increasing frequency and intensity. Our huge population and dangerous geography are perennially exposed to hydrometeorological hazards that occur without warning and are exacerbated by climate change.

Our vulnerability is worsened by our lack of capacity to cope and adapt. From a socioeconomic perspective, poverty and social disparities have led to the lack of immediate and long-term sociopolitical, health, and disaster preparedness measures to counter these shocks.

But while we must accept the conventional narrative of our susceptibility to disasters and health emergencies, focus should also be given to other types of crises that can complicate and interact with these geophysical hazards. These complex humanitarian crises include economic, political, ecological, and social aspects.

The World Economic Forum’s Global Risks Report 2024 has ranked the following as the top five global risks: extreme weather, artificial intelligence-generated misinformation/disinformation, societal and political polarization, cost-of-living crisis, and cyberattacks. This report also includes the environmental and technological dimensions of such risks.

For the Philippine health sector, these analyses convey two important messages that invite attention and require action: First, the age of polycrisis has already emerged and is now in our midst. Polycrisis is a buzzword defined as a “cluster of related global risks with compounding effects, such that the overall impact exceeds the sum of each part.”

These human-induced disasters are not arcane global developments but are unfortunate realities that amplify the risks attributed to commonly invoked “natural” disasters.

They include the Russia-Ukraine war that is causing food security issues in the country due to the rise in prices of food, fertilizer, and fuel. The El Niño and La Niña phenomena that generate extreme weather events cause disasters that displace poverty-stricken Filipinos and communities. Vital but vulnerable agriculture, water, and energy sectors are impacted, shifting the burden to destitute farmers, poor consumers, and small businesses.

The ongoing dispute in the West Philippine Sea is not only a national security issue that threatens world order, but one that causes collateral damage to the environment and the health of our marine ecosystem. Illegal fishing practices kill fish species and coral reefs that are crucial to the livelihood of Filipino fisherfolk.

Political instability, apart from causing social unrest and triggering armed conflicts, contributes to inflation and aggravates social issues. Technology is being deployed as a nascent tool for disinformation and to commit crimes against human rights.

These crises also trigger and amplify health crises by themselves, individually or in unison. Risks to our health-care system can impact other sectors, as illustrated by the COVID-19 pandemic that hurt our economy, changed the social fabric, and even affected global governance.

Against this backdrop, the second message is for us to address these health crises strategically and to do things differently now. To address the top five risks in the Philippines, namely extreme weather events, economic downturn, energy scarcity, inflation, and infectious diseases, we must vigorously implement universal health care and secure investments to build a resilient health system.

We must also strengthen our coping and adaptive capacities for health crises. We must use our understanding of polycrisis to be more anticipatory and resilient so as to manage extreme weather events, natural and human-induced crises, and other similar risks that contribute to epidemics and infectious diseases.

The health community and its constellation of actors should get their act together and involve multiple disciplines in the fight against health inequality, climate change, pandemics, and other diseases.

It is also high time for the Philippine health sector to pivot to the prevention-oriented and population-based public health approach that addresses the social and other equally important determinants of health and well-being. Producing more doctors, constructing more hospitals and procuring more medicines to treat more patients will certainly help in risk reduction.

Short of inciting a revolution, a polycrisis orientation can help build our health system resilience and in turn, change our country’s global risk standing for the better.

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Ronald Law is a medical doctor, public health practitioner, and academic focused on investigating the multifaceted concept of health system resilience as it influences the health and well-being of communities and populations.