Vietnam is a low-middle-income country in Southeast Asia, with an area of 331,700 km2, a coastline of 3,444 km and a population of around 100 million, making it the world's fifteenth-most populous country. Being one of the countries most vulnerable to the risk of climate change impacts (1), Vietnam
Consultation on the Disease Prevention Law, which covers climate change and mental health, with local stakeholders from Ha Tinh province, one of Vietnam’s most climate-vulnerable regions (Photo courtesy of To Thi Lien)
Vietnam is a low-middle-income country in Southeast Asia, with an area of 331,700 km2, a coastline of 3,444 km and a population of around 100 million, making it the world's fifteenth-most populous country. Being one of the countries most vulnerable to the risk of climate change impacts (1), Vietnam has been suffering from extreme weather events such as storms and cyclones that lead to disastrous events such as floods and landslides. Vietnam also faces increasing heat, air pollution, clean water scarcity, food security and safety, vector and ecology distribution and sea level rise.
Approximately 70% of residents live in coastal communities with high exposure to storms and floods. Each year, floods affect an estimated 930,000 people with a Gross Domestic Product (GDP) loss of USD 2.6 billion. In recent years, most regions have witnessed droughts, heat waves, and extreme cold successively. As temperature rises, the increase in heat stress on the Vietnamese population is expected to lead to negative health outcomes, particularly for poorer communities and outdoor laborers (2). Meanwhile, most of the extensive low-lying coastline and delta regions in Vietnam are highly vulnerable to rising sea levels, which also are expected to bring about a wide range of socioeconomic and public health impacts (3).
The Vietnam Environment Management Agency (VIHEMA) acknowledges mental and psychosocial health as climate-related health outcomes. People affected by climate-related hazards do develop symptoms of anxiety and depression and are diagnosed with post-traumatic stress disorder. They often relive the situation that caused them trauma with panic. According to a survey assessing the socio-psychological impact of storms and floods in Central Vietnam, people's psychology is affected before, during and after the events, but most notable immediately after (first week), and these effects normally last for the first 2 weeks, but in some special cases they can last for months. Children, women, the elderly, people from low socio-economic backgrounds and the disabled are the most psychologically affected by these events (4). Box 1 presents some direct quotes capturing lived experiences of climate change and mental health in Vietnam.
Box 1. Lived experiences of climate change and mental health in Vietnam "After Storm No. 5/2020 and severe flooding, we received a number of cases (mostly women) coming to the clinic due to anxiety and depression. They said the symptoms often appear and get worse when it rains heavily or hear news about storms and floods. People in the areas of the central provinces have continuously experienced natural disasters, storms upon storms, floods upon floods, landslides... it haunts them." - Dr. Tran Nhu Minh Hang, Head of Mental Health and Psychotherapy Clinic and Department of Psychiatry, University of Medicine and Pharmacy, Hue University “This place is a village, houses and fields are growing crops and rice. Now all that remains is stone. The entire road of more than ten kilometers is full of rocks and ruins. My beloved daughter couldn't run in time and died. The house is no longer there. Now move, I don't know how I will live. I haven't had a good night's sleep since that day." - Lo Van Dieu, male victim of a 2017 flood from Hua Nam village, Son La province
Mental health issues in Vietnam are becoming more common and widely recognized, including climate-related mental disorders. In Vietnam, it is mainly psychiatric specialties that provide mental health care services. Vietnam currently has 605 psychiatrists, reaching 0.62 doctors/100,000 people, lower than the global average (1.7), and they are usually focused on patients with obvious mental illnesses. Meanwhile, as for mental health nurses, the country only has 3 per 100,000 people, while the global average is 3.8, and high -income countries is 29 (5). When it comes to mental health treatment, the emphasis is still on pharmacological interventions, while psychotherapy and non-pharmacological measures are not yet fully developed. Ultimately, there is an urgent need to develop a comprehensive mental health care system that emphasizes primary health care.
In January 2022, the Government of Vietnam issued the "National Plan to Prevent and Control Non-communicable Diseases and Mental Health Disorders for the Period 2022-2025." One of its important goals is "to strengthen risk factors for disease, promote prevention measures, early detection and treatment management of diseases and mental disorders to contribute to protecting, caring for and improving the health of people and economic and social development of the country." To achieve this goal, a comprehensive chapter on mental health disorder prevention is also included by the Vietnamese Ministry of Health in the draft law on Disease Prevention.
Considering the World Health Organization’s recommendations on addressing the nexus of climate change and mental health (6), VIHEMA’s experts (with the support from the Asian Development Bank) participated in the drafting of environmental health contentsthat will be included in the law. Box 2 shows the details of the proposed law’s Article 73, which acknowledges the emerging impacts of climate change on health, including mental health. Key stakeholders also resolved to add a reference to climate change to several provisions of the law related to mental health.
Box 2. Climate change and mental health in the draft Disease Prevention Law of VietnamArticle 73: Preventing risk factors affecting health due to climate change1. Climate change increases the frequency and severity of extreme and unusual weather such as floods, droughts, hurricanes, sea level rise, saltwater intrusion, heat waves and other risk factors that affect human health (including physical, mental and social).2. Measures to prevent risk factors include:a) Develop a monitoring and warning system of risk factors affecting health due to climate change;b) Sharing data on climate change;c) Improve the capacity of the health system in monitoring, detecting, preventing, providing first aid, and treating diseases and other health problems caused by climate change;d) Strengthen inter-sectoral coordination, community mobilization and international cooperation in preventing risk factors and responding to health problems caused by climate change.
There are two main obstacles encountered in developing and advocating for an integrated climate change and mental health policy. First, there is not enough data and scholarship on the effects of climate change on mental health problems in Vietnam. Therefore, it was challenging to advocate for greater integration of climate change into the country’s mental health policy.
Second, the mental healthcare delivery system in Vietnam remains very limited. Human resources for mental health care, especially non-psychiatrists, continue to be lacking. Facilities with mental health care services are concentrated at central and provincial levels, while the district level hardly can provide inpatient mental health examination and treatment services. There is still no integration of mental health into primary health care; this needs to be addressed, because many of the climate-driven mental health impacts can be addressed at the level of primary care.
Different stakeholders, including the Ministry of Health, discussing proposed policies related to climate change and human health (including mental health) at a consultation held on November 2023 in Da Nang City (Photo courtesy of To Thi Lien)
Other countries that are considering developing integrated climate change and mental health policies can learn a lot from Vietnam’s early experience. Below are some recommendations that can help in achieving this goal:
1.Eckstein D, Künzel V, Schäfer L, Winges M. GLOBAL CLIMATE RISK INDEX 2020 (2020). Who Suffers Most from Extreme Weather Events? Weather-Related Loss Events in 2018 and 1999 to 2018. Available here: https://www.germanwatch.org/sites/germanwatch.org/files/20-2-01e%20Global%20Climate%20Risk%20Index%202020_13.pdf
2. World Bank Group (2021). CLIMATE RISK COUNTRY PROFILE: VIETNAM. Available here:https://climateknowledgeportal.worldbank.org/sites/default/files/2021-04/15077-Vietnam%20Country%20Profile-WEB.pdf
3. Tran NQL, et al. Climate change and human health in Vietnam: a systematic review and additional analyses on current impacts, future risk, and adaptation. The Lancet Regional Health - Western Pacific 2023;40, Page: 100943.
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