Climate change and health outcomes by Indigenous identity: Exploring factors that modify climate change effects on health in Uganda

Climate change can impact health outcomes, including acute respiratory infections (ARI), acute gastrointestinal illness (AGI), and malaria. These climate change impacts on health outcomes are often rooted in the social determinants of health and health inequities. This research explored how the social determinants of health and inequity influenced potential climate-health relationships for Indigenous peoples. A systematic search of the global literature was conducted to identify research that investigated how Indigenous identity modified associations of ARI with meteorological patterns or season. Twelve articles were identified: all articles described research conducted in middle or high-income countries (n=12 articles) and most articles identified ARI associations with meteorological parameters and/or season that were significantly different in magnitude and/or direction for Indigenous and non-Indigenous peoples (n=11 articles). To investigate associations of hospital admissions with meteorological parameters and season for Indigenous peoples in low-income countries, research was conducted in partnership with Bwindi Community Hospital (BCH) in Uganda. Associations between all-cause hospital admissions and meteorological parameters were estimated using multilevel, multivariable Poisson regression models. The most common diagnoses at BCH were ARI, AGI, and malaria. All-cause admissions increased during extremely warm temperatures. BCH data were then used to explore the effect of meteorological parameters on ARI for Bakiga and Indigenous Batwa peoples, using stratified Poisson regression models. The direction and magnitude of associations between temperature and admission counts for pneumonia differed for Bakiga and Indigenous Batwa. Finally, BCH data were used to explore the potential for under- or over-representation of Indigenous peoples in research examining associations of AGI and malaria hospital admissions with season. Logistic regression models with AGI or malaria as the dependent variable in the wet and dry season produced associations of different magnitudes or directions when models were built with hospital data compared to models that were built with questionnaire participant’s data. The direction and magnitude of associations between health outcomes and meteorological patterns vary across social gradients in health. When associations between climate-sensitive health outcomes and meteorological parameters and/or season differ across social gradients, health-related climate change adaptation strategies, programs, and policies should be designed to be population specific, including for Indigenous peoples.