Abstract

In Brazil, the history of droughts has been marked by constant social and health tragedies, with estimates of up to 3 million deaths from the early 19th century until the late 20th century. There is a record of nearly 32,000 events related to the above and more than 96 million people were affected between 1991 and 2010. Although droughts have historically brought disasters to Brazil, which was noted in the scientific expeditions of Arthur Neiva and Belisario Penna that documented these droughts, there have not been many studies on them. The objective of this paper is to present a revision of the scientific articles related to droughts and public health. The following databases were used: PubMed, the Preparation and Response to Disasters Portal from BVS and the Capes Periodical Portal. The descriptors drought and health were used to search titles and summaries of articles in English, Portuguese and Spanish. Among the repercussions related to health that were discovered: malnutrition and nutritional deficiencies, mental health problems, issues relating to water and air quality and commitments made concerning access to health services. As there is a trend for more intense droughts and a scarcity of water until 2030, there is an urgent need for more research and studies in these areas.

Disasters; Natural disasters; Drought; Climate change

Introduction

In Brazil the history of droughts has been marked by periods of social tragedy and public health problems. The drought that occurred between 1877-1879 caused the death of approximately 500,000 people (deaths were also due to a smallpox epidemic) and 3 million people were displaced and made refugees. In the drought of 1914-1915, approximately 100,000 people died¹1. Villa MA. Vida e morte no sertão: histórias das secas no nordeste nos séculos XIX e XX. Rio de Janeiro: Editora Ática; 2001. Histórias do Brasil. Instituto Teotônio Vilela, série temas, Vol. 75.. It was between these two droughts that Arthur Nevia and Belisario Penna²2. Neiva A, Penna B. Viajem cientifica pelo Norte da Bahia, sudoeste de Pernambuco, sul do Piauhí e de norte a sul de Goiaz. Mem. Inst. Oswaldo Cruz 1916; 8(3):74-224. from the Oswaldo Cruz Institute carried out, in 1912, their scientific trip to the areas affected by the droughts (their report was completed in 1915 which was the year when the drought was very serious, and it was published in 1916). The trip was done on the request of the Inspectorate for Action Against Droughts that was created in 1909. During their journey they identified a number of diseases that came about as a consequence of poor living conditions and minimal health care in the regions far from the main cities. Using the terms that were in the report, there were a number of diseases that were identified and were related to the living conditions in these remote regions such as: spasmodic dysphagia, a disease known as ‘vexame do coração’ characterized by persistent heart palpitations, malaria (owing to the construction of large dams), tuberculosis, diphtheria, dysentery, eye infections (mainly in children up to the age of 12) and typhus, amongst others²2. Neiva A, Penna B. Viajem cientifica pelo Norte da Bahia, sudoeste de Pernambuco, sul do Piauhí e de norte a sul de Goiaz. Mem. Inst. Oswaldo Cruz 1916; 8(3):74-224..

From the two droughts that occurred at the end of the 19th century and those throughout the 20th century, there were registers of outbreaks and epidemics for the following diseases: daytime blindness (hemeralopia), trachoma, cholera, diarrhea, dysentery, typhus, paratyphoid, yellow fever, smallpox, bubonic plague, leishmaniasis and influenza. Those that migrated to the amazon region, due to having been forced to do so or through fleeing the drought, became ill because of: leprosy, tuberculosis, malaria and beriberi. Suicides by heads of families were registered in drought stricken areas, as many were not able to deal with the consequences of this natural disaster. There were also other problems such as the proliferation of rattlesnakes and rats which led to venomous poisoning and other diseases¹1. Villa MA. Vida e morte no sertão: histórias das secas no nordeste nos séculos XIX e XX. Rio de Janeiro: Editora Ática; 2001. Histórias do Brasil. Instituto Teotônio Vilela, série temas, Vol. 75.^,33. Souza I, Medeiros Filho J. Os degredados filhos da seca. 2a ed. Petrópolis: Editora Vozes; 1984.. Apart from the diseases and deaths that were directly related to the drought stricken regions, there were other indirect effects such as outbreaks of: leprosy, tuberculosis, malaria and beriberi. These diseases affected many who migrated to the amazon region being either forced to do so, or having to flee disasters. It is estimated that 3 million people died during drought spells from 1825 to 1983, in Brazil¹1. Villa MA. Vida e morte no sertão: histórias das secas no nordeste nos séculos XIX e XX. Rio de Janeiro: Editora Ática; 2001. Histórias do Brasil. Instituto Teotônio Vilela, série temas, Vol. 75..

In spite of Brazil’s history of having gone through disasters related to droughts (which have been occurring with ever more frequency and with greater intensity) since Neiva and Penna’s report in 1916, we were not able to find other publications on the connections between this type of natural disaster and public health⁴4. Rocha V, Ximenes EF, Carvalho ML, Alpino TMA, Freitas CM. O tema desastre na área da saúde: perfil da produção técnico-científica na base de dados especializada em desastres da Biblioteca Virtual em Saúde (BVS). Cien Saude Colet 2014; 19(9):3775-3790.. In light of the aforementioned, the objective of this article is to present a revision of the published scientific literature on the connections between droughts and public health. This study can be considered as opportune because such natural disasters are a current concern for us in both the scientific and social arena. This is due to the negative impacts on living conditions and health for affected people.

Droughts as a public health problem

Droughts occur due to a lack of precipitation which affects the agricultural ecosystem, nature and general human activities⁵5. Bernardy K, Fagundes LS, Brandão VJ, Keller L, Bortolini, JG, Copatti, CE. Impactos ambientais diante das catástrofes naturais – secas e queimadas. XVI Seminário Interinstitucional de Ensino, Pesquisa e Extensão. Cruz Alta: Universidade de Cruz Alta; 2011.

6. Favero E. A seca na vida das famílias rurais de Frederico Westphalen – RS [dissertação]. Santa Maria: Universidade Federal de Santa Maria; 2006.^-77. Favero E, Diesel V. A seca enquanto um hazard e um desastre: uma revisão teórica. Aletheia 2008; 27:198-209.. According to the available literature⁸8. Buss R, Crockett J, Greig J, Kelly B, Roberts R, Tonna A. Improving the mental health of drought-affected communities: an Australian model. Rural Society 2009; 19(4):296-306.

9. United Nations (UN). Secretariat of the International Strategy for Disaster Reduction (UN/ISDR). Drought risk reduction framework and practices: contributing to the implementation of the Hyogo Framework for Action. Geneva: UM; 2009.^-1010. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5., information on droughts and their consequences is complex and can be divided into the following areas: meteorology (low rainfall), agriculture (short term droughts affecting the soil during the growth period for plantations), hydrology (a reduction in water currents and in river and lake levels controlled by dams), socioeconomics (effects on living conditions, property and the well-being of people), and the environment (fires, land degradation and sand storms).

Droughts affect the ecological, economic, social and cultural areas⁹9. United Nations (UN). Secretariat of the International Strategy for Disaster Reduction (UN/ISDR). Drought risk reduction framework and practices: contributing to the implementation of the Hyogo Framework for Action. Geneva: UM; 2009.^,1111. Castro ALC. Manual de Desastres: desastres naturais. Brasília: Ministério da Integração Nacional; 2003. causing significant damages and losses for the living conditions of those most affected. The main impacts are: problems in providing water to the population, losses in the agricultural and fishing sectors, populations deciding to migrate to other areas, forest fires, degradation in water quality, health problems, conflicts and increased poverty¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1212. Scandlyn J, Simon CN, Thomas DSK, Brett J. Theoretical Framing of worldviews, values, and strcutural dimensions of disasters. In Phillips BD, Thomas DSK, Fothergill A, Blinn-Pike L, editors. Social Vulnerability to disasters. Cleveland: CRC Press Taylor & Francis Group; 2010. p. 27-49.. Droughts often start slowly and can last from a few months to years, causing multiple impacts. They are considered different to other natural disasters in that they require actions that take into consideration all of its unique aspects.

The level of the impacts caused by droughts depends on the socio-environmental vulnerability of an area. This is connected to the nature and magnitude of the drought and the social structures of societies⁶6. Favero E. A seca na vida das famílias rurais de Frederico Westphalen – RS [dissertação]. Santa Maria: Universidade Federal de Santa Maria; 2006.^,1212. Scandlyn J, Simon CN, Thomas DSK, Brett J. Theoretical Framing of worldviews, values, and strcutural dimensions of disasters. In Phillips BD, Thomas DSK, Fothergill A, Blinn-Pike L, editors. Social Vulnerability to disasters. Cleveland: CRC Press Taylor & Francis Group; 2010. p. 27-49.^,1313. Freitas CMA, Carvalho ML, Ximenes EF, Arraes EF, Gomes JO. Desastres naturais e saúde: uma análise da situação do Brasil. Cien Saude Colet 2014; 19(9):3645-3656.. Where there is a disaster due to a drought, the magnitude of its impact depends on its duration and the socioeconomic conditions of the affected region and population⁶6. Favero E. A seca na vida das famílias rurais de Frederico Westphalen – RS [dissertação]. Santa Maria: Universidade Federal de Santa Maria; 2006.^,1313. Freitas CMA, Carvalho ML, Ximenes EF, Arraes EF, Gomes JO. Desastres naturais e saúde: uma análise da situação do Brasil. Cien Saude Colet 2014; 19(9):3645-3656..

Droughts affect different countries and regions in the world, mainly countries and continents such as: Canada, the United States, Western Europe, Africa, China, Asia, Australia and Brazil¹⁴14. Estrategia Internacional Para la Reduccion de Desastres de las Caciones Unidas (EIRD/ONU). Marco de Acción de Hyogo 2005-2015. Aumento de la resiliencia de las naciones y las comunidades ante los desastres: Introducción al Marco de Acción de Hyogo. Geneva: EIRD; 2005.. It is worth noting that Brazil lacks the technical and scientific body of work that can respond to the challenges brought about by droughts in relation to the collective health of the population⁴4. Rocha V, Ximenes EF, Carvalho ML, Alpino TMA, Freitas CM. O tema desastre na área da saúde: perfil da produção técnico-científica na base de dados especializada em desastres da Biblioteca Virtual em Saúde (BVS). Cien Saude Colet 2014; 19(9):3775-3790..

Recent data from the International Emergency Disasters Database (EM-DAT)¹⁵15. International Emergency Disasters Database (EM-DAT). The International Disaster Database. [internet]. Center for Research on the Epidemiology of Disasters-CRED. [acessado 2014 out 21]. Disponível em: http://www.emdat.be/database
http://www.emdat.be/database... (this is a database on disasters that have occurred in the world held by the Center for Investigations on the Epidemiology of Disasters (CRED)) has given an indication of the serious effects of droughts in different countries between 1900 and 2015. According to EM-DAT it estimates that 659 drought episodes occurred during the above period, resulting in 2.21 billion people being affected and 11 million deaths. In relation to economic losses due to the droughts during this period in the United States and Mexico, the losses were about 8 billion dollars. In China the losses were 2.4 billion dollars and in Brazil it was approximately 11 billion dollars¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1515. International Emergency Disasters Database (EM-DAT). The International Disaster Database. [internet]. Center for Research on the Epidemiology of Disasters-CRED. [acessado 2014 out 21]. Disponível em: http://www.emdat.be/database
http://www.emdat.be/database... .

Future predictions in relation to climate change state that drought occurrences will become ever more intense and frequent during the 21st century¹⁶16. Obrien L.V, Berry H.L, Hanigan, IC. Drought as a mental health exposure. Enviro Res 2014; 131:181-187. According to the United Nations Organization (UN)¹⁷17. Worsnip P. United Nations. [internet]. Action needed to avoid world water crisis, U.N. Reuters. [acessado 2014 jul 9]. Disponível em: http://www.reuters.com/article/2009/03/13/us-un-water-idUSTRE52B7 RT20090313?feedType=RSS&feedName=environmentNews.
http://www.reuters.com/article/2009/03/1... it’s prediction is that by 2030 nearly half the world’s population will live in areas where there will be a scarcity of water causing severe consequences for public health.

Methodology

Research on droughts and health in specialist journals was carried out using the following databases: PubMed (http://www.ncbi.nlm.nih.gov/pubmed), The Preparation and Response to Disasters Portal BVS (http://response.bvsalud.org/) and the Capes Periodical Portal (http://www-periodicos-capes-gov-br.ez68.periodicos.capes.gov.br/index.php?option = com_phome). On the last website above the databases that were used were called Scopus and Web of Science.

We commenced in March 2014 and concluded in June 2015. For this study we used a combination of descriptors [drought and health] in the title and we did summary searches on Pubmed. We searched just on titles in the portals Preparation and Responses to Disasters BVS and Capes. The inclusion criteria were: (1) only articles, (2) articles in Portuguese, English and Spanish, (3) direct connection with the subject of health.

Exclusion criteria: (1) articles that did not directly relate to health, such as biology, engineering, hydrology, botany and meteorology, (2) languages different to the designated ones.

Results

In total we reviewed 586 articles in the different databases: 402 (Pubmed), 16 (the Preparation and Responses to Disasters portal) and 168 (the Capes portal). Of the above, 456 were excluded based on the aforementioned criteria, leaving 130 articles.

In the second part of the selection process, from the 130 articles, it was shown that 72 were duplicates from other databases and 6 were found to be unavailable. 52 were subsequently included in the revision (Figure 1) covering the first publication in September 1931 and the last in June 2015.

After reading the summary and the accompanying information, a more thorough and complex review was done. In this second phase of the research it was possible to categorize, from the diseases that were connected with the drought occurrences, the risk factors for the diseases and the groups and services that were vulnerable due to the droughts, as seen in Chart 1. In terms of the diseases, an identification was made of: malnutrition and nutritional deficiencies, mental health disorders, diseases related to inadequate sanitation and the diseases transmitted by vectors/hosts, respiratory diseases and cancer. Apart from the above effects, themes related to vulnerability of health services impacting both quality and access, were identified.

Malnutrition and nutritional deficiency

Morbidity that was connected to the nutritional state of the population that was exposed to this type of natural disaster, was analyzed in a large number of publications, 24¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1818. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).

19. Arlappa N, Venkaiah K, Brahmam G. Severe drought and the vitamin A status of rural pre-school children in India. Disasters 2011; 35(3):577-586.

20. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843.

21. Nichols EK, Tally LE, Birungi N, Mc Clelland A, Madraa E, Chandia AB, Nivet J, Flores-Ayala R, Serdula MK. Suspected outbreak of riboflavin deficiency among populations reliant on food assistance: a case study of drought-stricken Karamoja, Uganda, 2009-2010. PloS one 2013; 8(5):e62976.

22. Singh MB, Lakshminarayana J, Fotedar R. Chronic energy deficiency and its association with dietary factors in adults of drought affected desert áreas of Western Rajasthan, India. Asia Pac J Clin Nutr 2008; 17(4):580-585.

23. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India. Public Health Nutr 2006; 9(8):961-967.

24. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India. J Commun Dis 2006; 38(1):88-96.

25. Leads from the MMWR. Rapid nutritional and health assessment of population affected by drought-associated famine-Chad. JAMA 1985; 254(20):2878-2880.

26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.

27. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.

28. Ravenel MP. Drought and Malnutrition. A J Public Health Nations Health 1931; 21(3):279-280.

29. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.

30. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.

31. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202.

32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.

33. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.

34. Friel S, Berry H, Dinh H, O’Brien L, Walls HL. The impact of drought on the association between food security and mental health in a nationally representative Australian sample. BMC Public Health 2014; 14:1102.

35. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.

36. Khan N, Yousuf Ul Islam M, Siddiqui M, Iqbal Mufti BA. Thar drought: A complete public health failure. J Infect Public Health 2015; 8(5):506-507.

37. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.

38. Ahlgren I, Yamada S, Wong A. Rising oceans, climate change, food aid, and human rights in the marshall islands. Health Hum Rights 2014; 16(2):69-81.

39. Lechtenfeld T, Steffen L. The effect of drought on health expenditures in Rural Vietnam. Courant Research Centre 2014; 154:1-29.^-4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.. From the above total, 11 analyzed the nutritional state of the population as a whole¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,2525. Leads from the MMWR. Rapid nutritional and health assessment of population affected by drought-associated famine-Chad. JAMA 1985; 254(20):2878-2880.

26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.

27. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.

28. Ravenel MP. Drought and Malnutrition. A J Public Health Nations Health 1931; 21(3):279-280.

29. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.^-3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3434. Friel S, Berry H, Dinh H, O’Brien L, Walls HL. The impact of drought on the association between food security and mental health in a nationally representative Australian sample. BMC Public Health 2014; 14:1102.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,3838. Ahlgren I, Yamada S, Wong A. Rising oceans, climate change, food aid, and human rights in the marshall islands. Health Hum Rights 2014; 16(2):69-81.. In relation to the vulnerable groups, an identification was made of three groups: pregnant women²⁰20. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843.^,3232. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^,3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,3636. Khan N, Yousuf Ul Islam M, Siddiqui M, Iqbal Mufti BA. Thar drought: A complete public health failure. J Infect Public Health 2015; 8(5):506-507., children between the ages of 0 to 5²⁰20. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843.^,2323. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India. Public Health Nutr 2006; 9(8):961-967.^,2424. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India. J Commun Dis 2006; 38(1):88-96.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3232. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^,3636. Khan N, Yousuf Ul Islam M, Siddiqui M, Iqbal Mufti BA. Thar drought: A complete public health failure. J Infect Public Health 2015; 8(5):506-507.^,3939. Lechtenfeld T, Steffen L. The effect of drought on health expenditures in Rural Vietnam. Courant Research Centre 2014; 154:1-29.^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194. and people living in shelters and temporary makeshift accommodation²⁶26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985..

In relation to nutritional deficiencies, the following deficiencies were identified: vitamin A¹⁹19. Arlappa N, Venkaiah K, Brahmam G. Severe drought and the vitamin A status of rural pre-school children in India. Disasters 2011; 35(3):577-586.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985., complex B (riboflavin and nicotinic acid²¹21. Nichols EK, Tally LE, Birungi N, Mc Clelland A, Madraa E, Chandia AB, Nivet J, Flores-Ayala R, Serdula MK. Suspected outbreak of riboflavin deficiency among populations reliant on food assistance: a case study of drought-stricken Karamoja, Uganda, 2009-2010. PloS one 2013; 8(5):e62976.^,3131. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202.) and chronic energy²²22. Singh MB, Lakshminarayana J, Fotedar R. Chronic energy deficiency and its association with dietary factors in adults of drought affected desert áreas of Western Rajasthan, India. Asia Pac J Clin Nutr 2008; 17(4):580-585.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985..

Mental Health

The effects on people’s mental health and emotions was analyzed in 20 articles¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1616. Obrien L.V, Berry H.L, Hanigan, IC. Drought as a mental health exposure. Enviro Res 2014; 131:181-187^,1818. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).^,3434. Friel S, Berry H, Dinh H, O’Brien L, Walls HL. The impact of drought on the association between food security and mental health in a nationally representative Australian sample. BMC Public Health 2014; 14:1102.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.

41. Stain HJ, Carr VJ, Kelly B, Lewin TJ, Ftizgerald M, Fragar L. The psychological impact of chronic environmental adversity: Responding to prolonged drought. Soc Sci Med 2011; 73(11):1593-1599.

42. Alston M. Rural male suicide in Australia. Soc Sci Med 2012; 74(4):515-522.

43. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health 2011; 19(5):249-254.

44. Horton G, Hanna L, Kelly B. Drought, drying and climate change: emerging health issues for ageing Australians in rural areas. Australas J Ageing 2010; 29(1):2-7.

45. Polain JD, Berry HL, Hoskin JO. Rapid change, climate adversity and the next ‘big dry’: older farmers’ mental health. Aust J Rural Health 2011; 19(5):239-243.

46. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154.

47. Berry HL, Hogan A, Owen J, Rickwood D, Fragar L. Climate change and farmers’ mental health: risks and responses. Asia Pac J Public Health 2011; 23(2):119-132.

48. Carnier TL, Berry HL, Blinkhorn AS, Hart CR. In their own words: young people’s mental health in drought-affected rural and remote NSW. Aust J Rural Health 2011; 19(5):244-248.

49. Dean JG, Stain HJ. Mental health impact for adolescents living with prolonged drought. Aust J Rural Health 2010; 18(1):32-37.

50. Guiney R. Farming suicides during the Victorian drought: 2001-2007. Aust J Rural Health 2012; 20(1):11-15.

51. Gunn KM, Kettler LJ, Skaczkowski, GL, Turnbull DA. Farmers’ stress and coping in a time of drought. Rural and remote health 2012; 12:2071.

52. Hanigan IC, Butler CD, Kolin PN, Hutchinson MF. Suicide and drought in New South Wales, Australia, 1970-2007. Proc Natl Acad Sci USA 2012; 109(35):13950-13955.^-5353. Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N. Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Health 2008; 8(3):950.. The most amount of studies¹⁶16. Obrien L.V, Berry H.L, Hanigan, IC. Drought as a mental health exposure. Enviro Res 2014; 131:181-187^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.^,4242. Alston M. Rural male suicide in Australia. Soc Sci Med 2012; 74(4):515-522.^,4545. Polain JD, Berry HL, Hoskin JO. Rapid change, climate adversity and the next ‘big dry’: older farmers’ mental health. Aust J Rural Health 2011; 19(5):239-243.

46. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154.^-4747. Berry HL, Hogan A, Owen J, Rickwood D, Fragar L. Climate change and farmers’ mental health: risks and responses. Asia Pac J Public Health 2011; 23(2):119-132.^,5050. Guiney R. Farming suicides during the Victorian drought: 2001-2007. Aust J Rural Health 2012; 20(1):11-15.

51. Gunn KM, Kettler LJ, Skaczkowski, GL, Turnbull DA. Farmers’ stress and coping in a time of drought. Rural and remote health 2012; 12:2071.

52. Hanigan IC, Butler CD, Kolin PN, Hutchinson MF. Suicide and drought in New South Wales, Australia, 1970-2007. Proc Natl Acad Sci USA 2012; 109(35):13950-13955.^-5353. Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N. Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Health 2008; 8(3):950. were done on elderly farmers and other elderly people that worked in agriculture. Their worries centered on what would happen in the future and thoughts of suicide. A small number of articles concerned teenagers, women and people from aboriginal descent. It was identified that the teenagers experienced social and economic isolation due to fears of the financial situation in their country and their own future. This was particularly the case because in periods with prolonged droughts they had to stop attending school or university and help their parents in relation to their family income⁴⁸48. Carnier TL, Berry HL, Blinkhorn AS, Hart CR. In their own words: young people’s mental health in drought-affected rural and remote NSW. Aust J Rural Health 2011; 19(5):244-248.^,4949. Dean JG, Stain HJ. Mental health impact for adolescents living with prolonged drought. Aust J Rural Health 2010; 18(1):32-37.. For women⁴¹41. Stain HJ, Carr VJ, Kelly B, Lewin TJ, Ftizgerald M, Fragar L. The psychological impact of chronic environmental adversity: Responding to prolonged drought. Soc Sci Med 2011; 73(11):1593-1599., it was noted that they experienced more anxiety than men when in drought periods. This was because they had to increase their responsibilities in order to meet the basic needs of their families such as in obtaining water and food. This was particularly the case when husbands had to leave home in order to find a job to guarantee their family income. Lastly it analyzed the effects of the prolonged drought on the emotional well-being of the aboriginal communities in New South Wales which is one of the most populous states in Australia⁴³43. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health 2011; 19(5):249-254..

Diseases Transmitted by Vectors

17 articles analyzed diseases transmitted by vectors ¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,2626. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,2929. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3232. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^,3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,5454. Souza AQ, Person R. Drought, smallpox, and emergence of Leishmania braziliensis in northeastern Brazil. Emerg Infect Dis 2009; 15(6):916-921.

55. Kalis MA, Wilson R. Public Health And Drought. J Environ Health 2009; 72(1):10-11.

56. Epstein P, Defilippo C. West Nile Virus and Drought. Global Change Human Health 2001; 2(2):105-107.

57. Trewin BJ, Kay BH, Darbri JM, Hurst TP. Increased container-breeding mosquito risk owing to drought-induced changes in water haversting and storage in Brisbane, Australia. Int Health 2013; 5(4):251-258.

58. Tian HY, Bi P, Cazelles B, Zhou S, Huang SQ, Yang J, Pei Y, Wu XX, Fu SH, Tong SL, Wang HY, Xu B. How environmental conditions impact mosquito ecology and Japanese encephalitis: An eco-epidemiological approach. Environ Int 2015; 79:17-24.

59. United Nation Children’s Fund (Unicef). Drought followed by wetness increases probability of West Nile vírus epidemic. Geneva: Unicef; 2005.

60. United Nation Children’s Fund (Unicef). After two years of drought, Ethiopian children are facing new disease. Geneva: Unicef; 2006.^-6161. Brown L, Medlock J, Murray V. Impact of drought on vector-borne diseases--how does one manage the risk? Public Health 2014; 128(1)29-37.. When there are droughts it is often the case that water is stored or left in a stagnant state which becomes the ideal breeding ground for mosquitos³²32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^,3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,5858. Tian HY, Bi P, Cazelles B, Zhou S, Huang SQ, Yang J, Pei Y, Wu XX, Fu SH, Tong SL, Wang HY, Xu B. How environmental conditions impact mosquito ecology and Japanese encephalitis: An eco-epidemiological approach. Environ Int 2015; 79:17-24.^,6161. Brown L, Medlock J, Murray V. Impact of drought on vector-borne diseases--how does one manage the risk? Public Health 2014; 128(1)29-37.. This is particularly the case for the Aedes aegypti mosquito which can transmit dengue fever²⁹29. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5. and the Anopheles mosquito which transmits malaria²⁶26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,6060. United Nation Children’s Fund (Unicef). After two years of drought, Ethiopian children are facing new disease. Geneva: Unicef; 2006.. At the same time it was identified that a lack of surface water affects the behavior of mosquitos where they are forced to reproduce in marshland areas and in areas that have many bird species and other types of wild life. This convergence of mosquitos and birds allows the mosquito to act as vectors for these diseases to survive and can cause outbreaks of certain diseases which include: St. Louis Encephalitis⁶¹61. Brown L, Medlock J, Murray V. Impact of drought on vector-borne diseases--how does one manage the risk? Public Health 2014; 128(1)29-37., Eastern Equine Encephalitis and West Nile Virus disease³⁷37. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,5555. Kalis MA, Wilson R. Public Health And Drought. J Environ Health 2009; 72(1):10-11.^,5656. Epstein P, Defilippo C. West Nile Virus and Drought. Global Change Human Health 2001; 2(2):105-107.^,5959. United Nation Children’s Fund (Unicef). Drought followed by wetness increases probability of West Nile vírus epidemic. Geneva: Unicef; 2005.^,6161. Brown L, Medlock J, Murray V. Impact of drought on vector-borne diseases--how does one manage the risk? Public Health 2014; 128(1)29-37.. Lastly, the focus of the article was on the main drought in Brazil that occurred in Ceará between 1877-1879 where millions of people died and others migrated to large capitals, taking with them the Cutaneous Leishmaniasis (or Tegumentary Leishmaniasis) disease.

Diseases related to inadequate sanitation

In relation to diseases related to poor sanitation, 17 articles¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1818. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).^,2626. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.

27. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.

28. Ravenel MP. Drought and Malnutrition. A J Public Health Nations Health 1931; 21(3):279-280.

29. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.

30. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.

31. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202.

32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^-3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,3838. Ahlgren I, Yamada S, Wong A. Rising oceans, climate change, food aid, and human rights in the marshall islands. Health Hum Rights 2014; 16(2):69-81.^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.^,4646. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154.^,6262. Burr ML, Davis AR, Zbijowski AG. Diarrhea and the drought. Public Health 1978; 92(2):86-87.^,6363. McIver LJ, Chan VS, Bowen KJ, Iddings SN, Hero K, Raingsey PP. Review of Climate Change and Water-Related Diseases in Cambodia and Findings From Stakeholder Knowledge Assessments. Asia Pac J Public Health 2014. were identified which covered restrictions on the supply of water and the different ways of storing it (i.e wells, dams, water supply lorries, portable water, rivers and waters storage tanks). According to these articles, a lack of adequate hygienic conditions and poor water quality for human consumption¹⁸18. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).^,6262. Burr ML, Davis AR, Zbijowski AG. Diarrhea and the drought. Public Health 1978; 92(2):86-87., resulted in fecal-oral transmission of diseases (such as cholera²⁶26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5., dysentery²⁶26. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3131. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202., typhoid fever²⁸28. Ravenel MP. Drought and Malnutrition. A J Public Health Nations Health 1931; 21(3):279-280.^,2929. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.^,3131. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202.^,3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424., diarrhea¹⁸18. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).^,2626. Henderson PL, Biellink RJ. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. Int J Health Serv 1983; 13(2):289-306.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,2929. Ravenel MP. Our correspondent speaks of the american public health association metting at Pasadena- The Poliomyelitis Situation- The Drought and Typhoid - Dengue Fever in Florida - and Medical Insurance. Public Health 1934; 48(2):77-78.^,3131. Ravenel MP. Drought and Health. A J Public Nations Health 1931; 21(11):1198-1202.

32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991.^-3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.^,4646. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154.^,6262. Burr ML, Davis AR, Zbijowski AG. Diarrhea and the drought. Public Health 1978; 92(2):86-87. and hepatitis A³³33. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.). In relation to a lack of hygiene, problems with conjunctivitis³²32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991. and skin diseases³²32. Bolívia. Ministerio de prevision social e salud publica. Guía de atención en salud y en otros aspectos sociales en sequías: Versión preliminar. La Paz; Bolivia. Ministerio de Previsión Social y Salud Pública; 1991. were noted. Also an identification was made of diseases transmitted through contact with water such as leptospirosis⁴⁶46. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154..

Respiratory diseases

Other effects related to droughts are respiratory diseases and this was analyzed in 8 publications¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,3737. Franchini M, Mannucci PM. Impact on human health of climate changes. Eur J Intern Med 2015; 26(1):1-5.^,4646. Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. Health consequences of drought on the Canadian Prairies. Ecohealth 2004; 1(2):144-154.^,5555. Kalis MA, Wilson R. Public Health And Drought. J Environ Health 2009; 72(1):10-11.^,6464. Smith LT, Aragão LE, Sabel CE, Nakaya T. Drought impacts on children’s respiratory health in the Brazilian Amazon. Sci Rep 2014; 4(3726):1-8.. Smith et al.⁶⁴64. Smith LT, Aragão LE, Sabel CE, Nakaya T. Drought impacts on children’s respiratory health in the Brazilian Amazon. Sci Rep 2014; 4(3726):1-8. used the Amazon region in Brazil to demonstrate forest fires caused by droughts could result in a rise in respiratory diseases in children.

Neoplasms

Only one article⁶⁵65. Wu K, Li K. Association between esophageal cancer and drought in China by using Geographic Information System. Environ Int 2007; 33(5):603-608. analyzed cancer as possibly being related to droughts. This article associated esophagus cancer with areas that had droughts in China. It also noted that climatic factors as well as genetic and biological factors need to be considered when analyzing influences in people’s lives and their health. That is why it is necessary to study the connection between climates and health.

Vulnerable Groups

Seventeen publications identified vulnerable groups with the effects of droughts on people’s health¹⁶16. Obrien L.V, Berry H.L, Hanigan, IC. Drought as a mental health exposure. Enviro Res 2014; 131:181-187^,2020. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843.^,2323. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India. Public Health Nutr 2006; 9(8):961-967.^,2424. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India. J Commun Dis 2006; 38(1):88-96.^,3939. Lechtenfeld T, Steffen L. The effect of drought on health expenditures in Rural Vietnam. Courant Research Centre 2014; 154:1-29.^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.^,4242. Alston M. Rural male suicide in Australia. Soc Sci Med 2012; 74(4):515-522.^,4444. Horton G, Hanna L, Kelly B. Drought, drying and climate change: emerging health issues for ageing Australians in rural areas. Australas J Ageing 2010; 29(1):2-7.^,4545. Polain JD, Berry HL, Hoskin JO. Rapid change, climate adversity and the next ‘big dry’: older farmers’ mental health. Aust J Rural Health 2011; 19(5):239-243.^,4747. Berry HL, Hogan A, Owen J, Rickwood D, Fragar L. Climate change and farmers’ mental health: risks and responses. Asia Pac J Public Health 2011; 23(2):119-132.

48. Carnier TL, Berry HL, Blinkhorn AS, Hart CR. In their own words: young people’s mental health in drought-affected rural and remote NSW. Aust J Rural Health 2011; 19(5):244-248.

49. Dean JG, Stain HJ. Mental health impact for adolescents living with prolonged drought. Aust J Rural Health 2010; 18(1):32-37.

50. Guiney R. Farming suicides during the Victorian drought: 2001-2007. Aust J Rural Health 2012; 20(1):11-15.

51. Gunn KM, Kettler LJ, Skaczkowski, GL, Turnbull DA. Farmers’ stress and coping in a time of drought. Rural and remote health 2012; 12:2071.

52. Hanigan IC, Butler CD, Kolin PN, Hutchinson MF. Suicide and drought in New South Wales, Australia, 1970-2007. Proc Natl Acad Sci USA 2012; 109(35):13950-13955.^-5353. Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N. Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Health 2008; 8(3):950.^,6666. Rich JL, Wright SL, Loxton D. ‘Patience, hormone replacement therapy and rain!’ Women, ageing and drought in Australia: narratives from the mid-age cohort of the Australian Longitudinal Study on Women’s Health. Aust J Rural Health 2012; 20(6):324-328.. The groups were: elderly agricultural workers¹⁶16. Obrien L.V, Berry H.L, Hanigan, IC. Drought as a mental health exposure. Enviro Res 2014; 131:181-187^,4040. Edwards B, Gray M, Hunter B. The impact of drought on mental health in rural and Regional Australia. Social Indicators Research 2015; 121(1):177-194.^,4242. Alston M. Rural male suicide in Australia. Soc Sci Med 2012; 74(4):515-522.^,4444. Horton G, Hanna L, Kelly B. Drought, drying and climate change: emerging health issues for ageing Australians in rural areas. Australas J Ageing 2010; 29(1):2-7.^,4545. Polain JD, Berry HL, Hoskin JO. Rapid change, climate adversity and the next ‘big dry’: older farmers’ mental health. Aust J Rural Health 2011; 19(5):239-243.^,4949. Dean JG, Stain HJ. Mental health impact for adolescents living with prolonged drought. Aust J Rural Health 2010; 18(1):32-37.

50. Guiney R. Farming suicides during the Victorian drought: 2001-2007. Aust J Rural Health 2012; 20(1):11-15.

51. Gunn KM, Kettler LJ, Skaczkowski, GL, Turnbull DA. Farmers’ stress and coping in a time of drought. Rural and remote health 2012; 12:2071.

52. Hanigan IC, Butler CD, Kolin PN, Hutchinson MF. Suicide and drought in New South Wales, Australia, 1970-2007. Proc Natl Acad Sci USA 2012; 109(35):13950-13955.^-5353. Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N. Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Health 2008; 8(3):950.^,6767. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012., teenagers⁴⁸48. Carnier TL, Berry HL, Blinkhorn AS, Hart CR. In their own words: young people’s mental health in drought-affected rural and remote NSW. Aust J Rural Health 2011; 19(5):244-248.^,4949. Dean JG, Stain HJ. Mental health impact for adolescents living with prolonged drought. Aust J Rural Health 2010; 18(1):32-37., pregnant women²⁰20. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843., and children under the age of 5²⁰20. Gitau R, Makasa M, Kasonk L, Sinkala M, Chintu C, Tomkins A, Fiteau S. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public Health Nutr 2005; 8(7):837-843.^,2323. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India. Public Health Nutr 2006; 9(8):961-967.^,2424. Singh MB, Fotedar R, Lakshminarayana J, Anand PK. Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India. J Commun Dis 2006; 38(1):88-96.^,3939. Lechtenfeld T, Steffen L. The effect of drought on health expenditures in Rural Vietnam. Courant Research Centre 2014; 154:1-29.. The effects that received the most amount of attention were those related to: mental health, malnutrition and nutritional deficiencies. Aside from these groups and the effects, one article analyzed the subject of women in their menopause who live in rural areas. Due to the financial pressures in drought stricken areas, these women had difficulties in accessing health services in order to obtain hormone replacement therapy⁶⁶66. Rich JL, Wright SL, Loxton D. ‘Patience, hormone replacement therapy and rain!’ Women, ageing and drought in Australia: narratives from the mid-age cohort of the Australian Longitudinal Study on Women’s Health. Aust J Rural Health 2012; 20(6):324-328.. The situation was made worst due to the absence of emotional support which in turn led to depression.

Migratory Processes

Historically prolonged droughts contributed to the mass movement of populations to urban centers because people were not able to sustain their families in these rural areas¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,1818. Span P, Ameya H, Sinha S, Jena S. Drought (2009): a public health change in India. Internet J Third World Med 2010; 9(1).^,2727. Dondero TJ. Nutrition and health needs in drought-stricken Africa. Public Health Rep 1985; 100(6):634-638.^,3030. World Health Organization (WHO). Health conditions in the Ethiopia drought emergency. Geneva: WHO; 1985.^,3333. Abu Ahmed. Effects of the drought in the health and social life in the Sudan. World Health Forum 1990; 11(4):424.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,4343. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health 2011; 19(5):249-254.. This was due to: a reduction in the production of food, loss of harvest, death of animals and loss or absence of work and income.

Health services

In relation to health services, three articles analyzed the connection between these services and the theme of droughts¹⁰10. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the evidence. PLoS Curr 2013; 5.^,3535. Sena A, Barcellos C, Freitas C, Corvalan C. Managing the health impacts of drought in Brazil. Int J Environ Res Public Health 2014; 11(10):10737-10751.^,4343. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health 2011; 19(5):249-254.^,6868. Pouria S, Andrade A, Barbosa J, Cavalcanti RL, Barreto VT, Ward CJ, Preiser W, Poon GK, Neild GH, Codd GA. Fatal microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet 1998; 352(9121):21-26.. The focus was on aboriginal Australians that were considered a vulnerable group as they could not get access to some services or even health care professionals from their own background. In times of droughts their situation worsened as it directly affected the group’s health⁴³43. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health 2011; 19(5):249-254..

Discussion

In Figure 2 we systemized the implications of droughts on people’s health and during drought occurrences there were changes in morbidity and mortality rates in the affected regions. Some effects on health can be felt in the short term, however, some impacts are indirect and have long term effects such as, for example, malnutrition that can last for months or years during drought periods. The sum of these impacts and effects of drought occurrences on people’s health, compounds people’s social and economic situations and environments. For example existing health problems are made worse and are compounded by any poor socioeconomic conditions or malnutrition. This is also the case in relation to access to sanitation services and health care which creates new scenarios and socio-environmental vulnerabilities⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.^,7070. World Health Organization (WHO), United Nations Convention to Combat Desertification (UNCCD). Our Planet, Our Health, Our Future. Human health and the Rio Conventions: biological diversity, climate change and desertification. Geneva: WHO, UNCCD; 2012..

Prolonged droughts can affect agricultural, livestock and fishing activities either partially or completely. This in turn affects food consumption. Food can be compromised in respect of its quality and quantity owing to: the scarcity and or the contamination of the water, a lack of sanitation, or an increase in demographic density (due to population displacement). Another factor refers to economic losses due to total or partial loss of sources of income and work, which affects people’s purchasing power for food. This has direct results on the nutritional states of individuals. A poor nutritional state can lead to a weakened immune system and a tendency to fall ill easily⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.

70. World Health Organization (WHO), United Nations Convention to Combat Desertification (UNCCD). Our Planet, Our Health, Our Future. Human health and the Rio Conventions: biological diversity, climate change and desertification. Geneva: WHO, UNCCD; 2012.

71. Patz JA, Engelberg D, Last J. The effects of changing weather on public health. Annu Rev Public Health 2000; 21:271-307.

72. Greenough G, Mcgeehin M, Bernard SM, Trtanj J, Riad J, Engerberg D. The Potential Impacts of Climate Variability and Change on Health Impacts of Extreme Weather Events in the United States. Environ Health Perspect 2001; 109(Supl. 2):191-198.^-7373. Ravindranath M, Venkaiah K, Vishnuvardhana Rao M, Arlappa, N, Gal Reddy CH, Mallikharjuna Rao K, Sharad K, Brahman GNV, Vijayaraghavan K. Effects of drought on nutritional status of rural community in Karnataka. J Hum Ecol 2005; 18(3):245-252..

On the one hand it was clear that the lack of food protection and nutrition are some of the effects caused by droughts. It was also identified that there were mental health effects for the exposed Australians. Based on the observations of some authors⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.^,7474. Coelho AEL, Adair, JG, Mocelin, JSP. Psychological responses to drought in northeastern Brazil. Rev Interam Psicol 2004; 38(1):95-103., droughts can affect the mental health of individuals causing: stress, suicides, anxiety, increases in alcohol consumption and depression. The above is also caused by: loses in agricultural productivity (including productivity from livestock) and falls in land values. The pressure increases with financial difficulties. There is a loss of social and family support and the environment becomes vulnerable.

Beside from the quantity of water that is reduced, the quality of the water can end up being affected by different factors such as: long periods of droughts where the temperature is high, contamination of the soil by cyanobacterias, the accumulation of toxic products and chemicals in the soil and animal feces. These factors can adversely affect the water for human consumption, the soil, and hygiene practices. With reference to the availability of water, the reduction in water levels in the supply system, coupled with the scarcity of rain means that there is a need for other water supplies. This is the case even though the water is not fit for human consumption⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.^,7575. Moran P, Nhandara C, Hove I, Charimari L, Katito C, Bradley M, Williams MA. Contamination of traditional drinking water sources during a period of extreme drought in the Zvimba communal lands, Zimbabwe. Cent Afr J Med 1997; 43(11):316-321..

It should be reiterated that diseases transmitted by vectors do not stopped being related to a lack in the supply of water or the storage of water in an inappropriate way. It is also connected to infectious diseases. According to the literature⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010., droughts cause environmental problems and harm the health of the population. This type of natural disaster alters the cycles for vectors, hosts, and reservoirs which can contain diseases and has environmental impacts mainly related to water.

Droughts that last for long periods have negative impacts on air quality owing to: the amount of particles suspended in the air (pollen, fluorocarbons), the low air humidity, the dry air, and the formation of aerosols and dust particles. The air also ends up being contaminated due to forest fires and toxins that accumulate in the soil⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010..

With reference to populations, certain people that fall into certain age groups and sexes are considered to be more vulnerable when droughts occur such as: children, the elderly, women and people with special needs. The following factors for the above groups can contribute towards making their situation of vulnerability worst: the extent of their cognitive and physical development (for children and the elderly), their motor skills (for people with special needs) their socioeconomic status and access to basic health resources⁶⁹69. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.^,7676. Peek L. Age. In Phillips BD, Thomas DSK, Fothergill A, Blinn-Pike L, editors. Social Vulnerability to disasters. Cleveland: CRC Press Taylor & Francis Group; 2010. p. 155-185.^,7777. Phillips BD, Fordham M. Introduction. In: Phillips BD, Thomas DSK, Fothergill A, Blinn-Pike L, editors. Social Vulnerability to disasters. Cleveland: CRC Press Taylor & Francis Group; 2010. p. 27-49.. The root of their vulnerability lies in the social, economic and cultural processes of the territories in which they live⁶⁶66. Rich JL, Wright SL, Loxton D. ‘Patience, hormone replacement therapy and rain!’ Women, ageing and drought in Australia: narratives from the mid-age cohort of the Australian Longitudinal Study on Women’s Health. Aust J Rural Health 2012; 20(6):324-328..

In relation to populations, droughts tend to force people to migrate with the hope of better conditions for their families particularly through obtaining jobs, better incomes, food and water¹¹11. Castro ALC. Manual de Desastres: desastres naturais. Brasília: Ministério da Integração Nacional; 2003.^,6767. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010.^,7878. Centro de Desenvolvimento e Planejamento Regional da Universidade Federal de Minas Gerais (Cedeplar/UFMG), Fundação Oswaldo Cruz (Fiocruz). Mudanças Climáticas, Migrações e Saúde: cenários para o Nordeste Brasileiro 2000-2050. Belo Horizonte: Cedeplar/UFMG, Fiocruz; 2008.. Nevertheless it should be pointed out that due to migration there is tendency for transmittable diseases to be spread which can cause more health problems in other areas.

Droughts not only affect the health of the population and access to services, it can also cause disruptions to health services due to medical instruments and equipment becoming contaminated owing to poor hygiene⁶⁸68. Pouria S, Andrade A, Barbosa J, Cavalcanti RL, Barreto VT, Ward CJ, Preiser W, Poon GK, Neild GH, Codd GA. Fatal microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet 1998; 352(9121):21-26.. Other effects include: loss of vaccines and medications, lack of hygienic water for human consumption and an inability for health care professionals to do their jobs. This makes some areas even more vulnerable⁶⁷67. World Health Organization (WHO), World Meterological Organization (WMO). Atlas of Health and Climate. Geneva: WHO, WMO; 2012.^,6969. Centers for Disease Control and Prevention (CDC). Environmental Protection Agency. National Oceanic and Atmospheric Agency, and American Water Works Association. When every drop counts: protecting public health during drought conditions: a guide for public health professionals. Atlanta: U.S Departament of Health ah Human Services; 2010..

In Chart 1 we have systemized the articles we analyzed using mechanisms related to risk factors (compromised services, products or environmental quality) and their effects on health. We noted that for both health services and sanitation, both had been compromised, having direct and indirect effects. A lack of water not only has hygiene effects with the consequences being diseases, but people start to store water in different areas which can lead to other diseases such as dengue fever. In Sao Paulo, for example, comparing the first bimester for 2014 with 2015 (the period when there was a water crisis) the number of dengue fever cases jumped from 11,876 to 94,623 ( an increase of 697%)⁷⁹79. Organização Pan-Americana da Saúde (OPAS), Ministério da Saúde (MS). Atuação do setor saúde frente a situações de seca. Brasília: OPAS, MS; 2015.. The lose of plantations and animals or jobs in affected areas, apart from having direct economic and financial impacts, can also result in the following: an increase in food prices and available water that can be bought. This in turn affects people’s mental health and the nutrition of the family. The environmental quality of the water, the air and other consequences can occur. These can be overlaid with other consequences.

In Figure 3 we organized and demonstrated the interactions between the diseases highlighted in the articles. We focused on effects and we grouped together vulnerable groups with the process of migration of populations and health services which is not in the diagram. One of the important aspects of Figure 3 is that it not only shows us the interactions between the diseases in the articles, it gives us the elements to identify overlaps with risks and diseases that droughts produce in relation to the health conditions for populations.

The Brazilian Atlas for Natural Disasters⁸⁰80. Universidade Federal de Santa Catarina (UFSC). Centro Universitário de Estudos e Pesquisas sobre Desastres (UFSC – CEPED). Atlas Brasileiro de Desastres Naturais 1991 a 2010: volume Brasil. Florianópolis: CEPED UFSC; 2012., that covers recently registered data on natural events in the country (from 1991 to 2010) showed that out of 31,913 natural events and 96,368, 789 of those that affected the country in 20 years, droughts and similar natural phenomena accounted for 53% and 49% respectively⁸⁰80. Universidade Federal de Santa Catarina (UFSC). Centro Universitário de Estudos e Pesquisas sobre Desastres (UFSC – CEPED). Atlas Brasileiro de Desastres Naturais 1991 a 2010: volume Brasil. Florianópolis: CEPED UFSC; 2012.. For mortality (n = 3.414) and morbidity (n = 486.638) droughts and similar natural phenomena account for 7.5% and 33.5% of the total. This reflects a tendency of their being a reduction in deaths by this type of natural disaster. Out of the more that 6 million people that have been directly affected (including disappearances, being displaced, being made homeless and with the majority forced to abandon their homes and run the risk of exposure to diseases) 21% were affected because of this type of disaster. Also out of the 1.2 million people forced to migrate, 65% did so due to issues related to droughts our similar occurrences. With this data, even though it does not show the total effects of droughts, it does show the magnitude and complexity of these types of disasters. They can cause risks of diseases which we endeavored to systemize in this article showing overlaps, even though there were no monitoring systems and structures in place to prevent these diseases. Nor were there provision in place to provide care so that populations could recover from the aforementioned diseases.

Final considerations

The first recorded drought in the country lasted for 4 years, between 1552 and 1555. After this period the number of droughts over the years increased. In the 19th century there were 12 drought episodes. Then in the 20th century there were 19 drought occurrences which in total summed up to 36 years of droughts⁸¹81. Alpino TMA, Freitas CM, Costa AM. Seca com um desastres. Rev Ciência e Trópico 2014; 8(2)109-134.. In spite of millions of Brazilians having been affected by droughts in the past, others recently and still other that will be affected in the future on a more frequent basis, the only study that exists that associates life conditions and health with droughts was done by Arthur Nevia and Belisario Penna 100 years ago. This means that more in depth and current studies are needed.

This year Brazil experienced a continuation of one of the most severe droughts in the last 50 years in relation to meteorological, water and agricultural aspects of the country. The worst part of the drought was between 2012 and 2014. In spite of this its impact on living conditions it was less severe than some of the great droughts of recent times such as the one that occurred between 1998 and 1999. A number of emergency public policies to reduce their impacts were implemented which included: the use of water delivery trucks, the construction of cisterns and wells, selling corn for animal flocks and opening lines of credits. We grouped together all of these policies and programs which included: drought relief aid for agricultural families, pensions for farm workers, and a number of financial benefits for families that allowed them to buy food and water. With all of the above health measures and strategies, the idea is to reduce infant mortality rates. There are no doubts that these policies have lessen the negative impacts of droughts but they have not totally immunized the population from risks and diseases. Many of these are often both complex and not directly visible.

If there are more in depth and wider reaching studies on the effects of droughts on living conditions, this will go a long way in breaking the common cycle of impacts that have become the norm when droughts occurs which is: a resultant rise in poverty, the suffering and agony of populations in the social ambit, and problems in semi-arid parts of Brazil.

References

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