Deterioration of respiratory health following changes to land cover and climate in Indonesia

Air pollution associated with agricultural activities and land-cover change poses significant health problems in developing countries. However, studies on the respiratory health impacts of these activities are scarce. Sumatra, Indonesia, is a region well known for its frequent land fires and haze. Here, we link data on healthcare attendances for respiratory illnesses between 2001 and 2018 with biophysical and socioeconomic variables known to be important drivers of respiratory ailments. We show that the prevalence of respiratory illnesses increased by 8.5% during dry years over the last two decades. This was largely attributed to changes in rainfall patterns and land cover. Increasingly severe drought during El Niño events, combined with reduced forest cover and increased land degradation on peatland, has further escalated fires with concomitant air pollution impacts on respiratory health. Our study highlights the need to explicitly incorporate health costs of environmental damage into land-use planning and public health interventions.