I work in Metro Savers Pharmacy in tropical Manila. Ours is a community pharmacy, located on a main street opposite a doctor’s clinic, so it gets very busy – especially with senior citizens who are more health conscious. Because we serve the residents who live around us, most of our patients are regulars – in fact, many are so regular that they’ve become like friends, and we end up knowing their medicines (and health conditions) by heart. Over the last few years, I’ve seen first-hand how climate change affects our health and even kills in some cases. I’m not just talking about natural disasters, I’m talking about climate change on ‘normal’ days, where you don’t even notice, or think about it. 

It was the summer of 2020 that opened my eyes to just how dangerous global warming is.  In tropical cities, it’s become an accepted fact that on hot summer days those with hypertension (high blood pressure) temporarily see their blood pressure shoot up.[1] Living in tropical Manila, the summer months are normally hot; but that year was an anomaly – the heat index stayed in the 40C+ range.

That summer, I saw a spike in uncontrolled hypertension. Many of our patients who take their maintenance medicines religiously started to complain that they couldn’t manage their blood pressure anymore. I was surprised when senior patients’ children began asking to buy medicine for strokes; when I asked about it, each one would tell me that a parent had been hospitalized. Lots of patients were buying emergency medicines that can lower blood pressure within minutes, and sometimes spell the difference between having a stroke or not. During the summer months, patients experiencing hypertension walk into the pharmacy panting heavily after walking in the sun for 15 minutes. Often these patients complain about a throbbing pain in the neck – a warning sign that their blood pressure is dangerously high. We ask these patients to sit in the cool, air-conditioned pharmacy for a while to get it to go down – thankfully, this usually does the trick. All these incidents finally led me to connect the dots: global warming is creating heat conditions we aren’t ready for. 

Hypertension is only one example of a health issue that is getting worse with global warming. Climate change is also responsible for rising sea levels that are causing our city to sink by 10 cm a year.[2] Combine this with any ‘normal’ rainy season and half of Manila is regularly plunged into floodwaters. With the city drowning, thousands of people have no choice but to wade in knee-deep, murky water to get around, and many get exposed to an infection called leptospirosis because of rat faeces in the flood water.[3] Thankfully, leptospirosis is easily treatable with doxycycline antibiotics; many patients even now take doxycycline antibiotics as prophylaxis before getting into the water.

Global warming is already impacting health and killing people in the Philippines, but we’re taking too long to realise it. Our health services and our government are not warning people that climate change is making flooding worse and exposing us to diseases like leptospirosis. Many of my patients don’t make the connection, and when they do they feel powerless: ‘we can’t do anything about global warming, it’s out of our control. The issue is out of our hands, what will happen will happen, nothing can stop it. If you want to live, you just take your medicine and leave those issues to the experts and the government.’ Others just shrug and are resigned to the fact that they’ll need to take additional medicine to get them through.

Climate forecast models say that what we currently consider the hottest years on record will seem relatively cool in a few years. Will this change how we manage health issues like hypertension? Will our maintenance medicines be enough to protect patients during summer months? We can only hope. What lies ahead is uncharted territory for both the planet and our healthcare systems.