Community resilience to climate change and non-communicable disease vulnerability in Yaoundé, Cameroon: insights from community-based systems dynamics (CBSD)

Felix Assah¹Blanche Nfondoh¹Edwin Ngwa¹Tchouaffi Awah Kum¹Boris Elouna¹Yves Wasnyo¹Lidia Morais²Meelan Thondoo³Feyisayo Wayas⁴Gladys Odhiambo⁵Janel Phillips⁶Nina Abrahams³Tolullah Oni³Estelle Lambert⁴Waleska Caiaffa²Leandro Garcia⁷Georgiana Gordon-Strachan⁶Lambed Tatah^3*

• ¹Universite de Yaounde I, Yaoundé, Cameroon
• ²Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
• ³University of Cambridge, Cambridge, United Kingdom
• ⁴University of Cape Town, Rondebosch, South Africa
• ⁵Kenya Medical Research Institute, Kisumu, Kenya
• ⁶The University of the West Indies Caribbean Institute for Health Research, Kingston, Jamaica
• ⁷Queen's University Belfast Centre for Public Health, Belfast, United Kingdom

Background: Climate change and rapid urbanisation have intensified flood risk in Global South cities, exacerbating health inequities, especially through non-communicable diseases (NCDs). However, little is known about how community resilience strategies to key climate change consequences like flooding affect NCD risk in rapidly growing cities of the Global South. Methods: We used a Community-Based System Dynamics (CBSD) approach to examine flood resilience strategies, the determinants, and health implications of these strategies in Yaoundé, Cameroon. The study included semi-structured interviews and a participatory modelling workshop with 12 purposively sampled community stakeholders (including from the municipality, urban planning, civil society organisation, local leadership, and people affected by flooding), accompanied by an iterative development and analysis of a causal loop diagram (CLD) to capture key variables, relationships, and feedback loops. Findings: The finalised CLD incorporated 14 key variables and featured five major feedback loops (four reinforcing, one balancing) that shape flood resilience. Community-led strategies—such as waste management, tree planting, drainage maintenance, and the construction of flood-resistant infrastructure—were driven by municipal support, enforcement of planning rules, and adaptation within informal settlements. Particpants described how these strategies improved hygiene, enhanced access to food and physical activity spaces, and reduced immediate health risks. However, political interests and inadequate enforcement constrained long-term resilience. Importantly, the study identified plausible pathways through which community actors perceived flood resilience strategies influenced diet and physical activity, the main NCD risk factors, thus highlighting the climate change-NCD syndemic in an urban African context. Conclusion: Participatory CBSD provided novel, systems-level insights into community resilience, revealing dynamic feedback between local action, governance, and health. Integrating community-led approaches into formal disaster risk management and urban health policy is essential for sustainable, equitable resilience.