Climate Change and Liver Diseases in Pakistan: A Threat to Human Well-being

Vol. 29, Issue 4 (December 2024)

Farhana Kayani, MD, FCPS (Gastroenterology)
Assistant Professor, Gastroenterology Department
Sheikh Khalifa Bin Zayed Hospital
Quetta, Pakistan

 

Jalal Khan, MD, FCPS (Internal Medicine)
Assistant Professor, Medicine Department
Bolan Medical College
Quetta, Pakistan

 

Climate change poses a fundamental threat to global health, affecting the social and environmental factors influencing the health of the human system. An attempt is being made by a few societies to tackle this neglected link between climate change and health. An increase in the global burden of disease due to polluted air, polluted drinking water, food insecurity, etc., is found to have an intricate relationship with liver diseases also.

Liver disease accounts for 4% of all annual deaths globally.¹ Risk factors such as human behavior, geography, social and economic context, and environmental exposure are likely to increase the incidence of liver diseases, thus contributing to the anticipated increase in the global burden of liver disease. Climate change influences liver diseases through various mechanisms, leading to rising figures in metabolic dysfunction-associated liver disease (MASLD), viral hepatitis, liver cancers, and deterioration of chronic conditions, as all these are susceptible to the effects of climate change. 

Pakistan lies in the world within the latitude and longitude of 30o 00 N and 70o 00 E. It is the third-largest country by area in Asia and the sixthlargest country in the world, with a population of approximately 220 million people. It has the second-highest peaks in the world, with large glaciers at one end and plains of the Indus and deserts at the other end. Nearly one-third of the population has an income of less than USD 3.00 per day (poverty threshold).²

Pakistan is one of the five most affected countries in the world due to climate change from the year 1999- 2018.³ The main reason for climate change is greenhouse gas emissions (CO2 , CH4 , N2 O, and H2 O), particularly due to continuous migration of people from rural to urban areas (urbanization), the increased use of fossil fuels for economic growth, production of increased industrial waste, transportation, and scanty of clean and pure water.

Because of Pakistan’s geographical location, the effects of climate change are quite severe. The melting of glaciers at a faster rate and the shortage of water resources lead to an increased blow to the economy due to its effect on agricultural and energy security. Deforestation over the decades with unseasonal rains, unpredictable flooding droughts, varying temperature, intense heat waves, hurricanes, landslides, etc., led to the loss of livestock and human lives, decreased agricultural produce, soil erosion, and contributed to the waterborne and vector-borne illnesses.⁴

An increase in the frequency of viral hepatitis, especially those related to waterborne and foodborne infections (hepatitis A and E), occurs after the rainy and flooding season.⁵ Due to the increasing prevalence of extreme weather events, frequent flooding in different areas of Pakistan has exacerbated the spread of both hepatitis A and E. Besides the potential for an increasing number of infections, rising temperatures have been shown to increase viral pathogenicity, inducing viral replication and mutations, thus increasing infectivity. Not only hepatotropic, but the incidence of non-hepatotropic viral infections is also growing as dengue infection, malaria, and typhoid infections are found to affect the liver in severe cases. Moreover, mass population movements from people living in more endangered areas, generating large settlements with poor sanitation, also predisposes to the spread of hepatitis A and E.

The incidence of hepatitis B and C is also increasing because of social and economic instability due to climate issues. The poor healthcare systems and decreased facilities expose them to increased risk factors for hepatitis B and C, namely the use of intravenous drugs and increased transmission in healthcare facilities due to improper disposal of injections and syringes.

The increase in the prevalence of MASLD is due to obesity and metabolic syndrome. Due to erratic weather conditions, exposure to droughts, and increased floods with the recent locust attacks in 2020, a big blow to the agricultural economy was made in Pakistan. These dietary patterns are expected to be severely impacted by human-induced climate change, leading to limited natural and organic food product supply, causing consumption of highly processed foodstuffs to be less expensive, contributing greatly to worse outcomes, thus increasing the obesity epidemic (MASLD).⁶ Further, air pollution promoting oxidative stress with impaired insulin resistance increases the risk of MASLD. Increased use of motorized transportation and decreased outdoor physical activity, increased depression with a feeling of being helpless leads to increased steroid release in the body, which are also contributing factors.

Many scientific societies are taking a strong stance by engaging patients and healthcare staff to promote better healthcare habits, as medical practice has a significant impact on climate change.  The World Gastroenterology Organisation is working with members of other organizations to help the digestive health community meet the challenge.⁷

The first step would be to educate the masses by advertising and holding seminars/webinars. Education and knowledge about proper diet are important; as with decreased use of highly processed food and proper exercise with physical activity, the emerging issue of MASLD can be dealt with. By saving energy and using the concept of green endoscopy, we can reduce the threat imposed secondary to climate change. Masses should be encouraged to drink boiled water. Moreover, proper handwashing and following proper hygiene should become a routine exercise. Another challenge that needs to be addressed is air pollution, as control of air pollution by switching from fossil fuel to renewable sources of energy (wind, solar) is necessary for the health and well-being of the Pakistani population.

Acknowledging the pivotal relationship between climate change and liver diseases is essential for promoting a healthier and more sustainable future.

References

1. Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. (2023) 79:516–37. doi: 10.1016/j. jhep.2023.03.017
2. A. Neelam, M.A. Khan, Omme-Hany, F.S. Hussain, K. Abid, and F.A. Khan. Repercussions of climate change on human health in Pakistan. A mini-review. Journal of Chemical, Biological and Physical Sciences Sec D, 7(1):008-013 (2016).
3. Germanwatch. Global Climate Risk Index 2020. Germanwatch, COP25, Madrid, December 4 (2019)
4. Government of Pakistan. Pakistan Economic Survey 2017-2018. Economic Advisor’s Wing, Finance Division, Government of Pakistan, Islamabad (2017-2018)
5. A. S. Butt. Epidemiology of viral hepatitis and liver diseases in Pakistan. Eurosian Journal of Hepatogastroenterology 5(1):43-48 (2015).
6. Ribeiro T and Macedo G (2024) Climate change and liver disease: a mini review. Front. Gastroenterol. 3:1334877.GUT
7. Leddin D, Omary MB, Metz G, et al.Climate change: a survey of global gastroenterology society leadership.Gut 2022;71:1929- 1932