Vulnerability and Adaptation Assessments Hands-On Training Workshop

1. Vulnerability and Adaptation Assessments Hands-On Training Workshop HUMAN HEALTH SECTOR

2. Outline • Overview of the potential health impacts of climate variability and change • Health data to determine the current burden of climate-sensitive diseases • Methods and tools for V&A assessment in the health sector • Methods for determining a health adaptation baseline

3. Overview of the Potential Health Impacts of Climate Variability and Change

4. Topics • Pathways for weather to affect health • Potential health impacts of climate change • Extreme weather events • Temperature • Floods • Vector-borne diseases • Diseases related to air pollution • Diarrheal diseases

5. Pathways for Weather to Affect Health: Example = Diarrheal Disease Distal Causes Proximal Causes Infection Hazards Health Outcome Temperature Humidity Precipitation Survival/ replication of pathogens in the environment Consumption of contaminated water Incidence of mortality and morbidity attributable to diarrhea Contamination of water sources Consumption of contaminated food Living conditions (water supply and sanitation) Contamination of food sources Contact with infected persons Food sources and hygiene practices Vulnerability (e.g. age and nutrition) Rate of person to person contact WHO

6. Pathways from Driving Forces to Potential Health Impacts Corvalan et al., 2003

7. Drivers of Health Issues • Population density • Urbanization • Public health infrastructure • Economic and technologic development • Environmental conditions • Populations at risk • Poor • Children • Increasing population of elderly residents • Immunocompromised

8. Climate Change May Entail Changes in Variance, as Well as Changes in Mean

9. Temperature Extremes in the Caribbean,1955-2000

10. DATE COUNTRY EVENT DEATH ESTIMATED COSTS (US$ million, 1998) 1974 Honduras Hurricane Fifi 7,000 1,331 1982/3 Bolivia, Ecuador, Peru El Niño 0 5,661 1997/98 Bolivia, Colombia, Ecuador, Peru El Niño 600 7,694 1998 Central America Hurricane Mitch 9,214 6,008 1998 Dominican Republic Hurricane Georges 235 2,193 Cuba Hurricane Georges 6 N/A 1999 Venezuela Landslide 25,000 N/A Fuente: ECLAC, América Latina y El Caribe: El Impacto de los Desastres Naturales en el Desarrollo, 1972-1999, LC/MEX/L.402; OFDA, Venezuela- Floods, Fact Sheet #10, 1/12/ 2000. Climate Variability and Change Impacts in the Caribbean

11. 2000 Flood in Mozambique • Heavy rains from Cyclones Connie and Eline in February 2000 caused large-scale flooding of the Limpopo, Incomati, Save, and Umbeluzi rivers • Environmental degradation and poor river system management and protection contributed to the crisis • 700 people died, 250,000 people were displaced, and 950,000 required humanitarian assistance (of which 190,000 were children under the age of 5) • 14,800 people were rescued by helicopter

12. Health Impacts of Floods • Immediate deaths and injuries • Nonspecific increases in mortality • Infectious diseases – leptospirosis, hepatitis, diarrheal, respiratory, and vector-borne diseases • Exposure to toxic substances • Mental health effects • Increased demands on health systems Philip Wijmans, LWF/ACT Mozambique, March 2000

13. A. Githeko, personal communication Dr. Githeko, personal communication

14. Climate Change and Malaria under Different Scenarios (2080) • Increase: East Africa, Central Asia, Russian Federation • Decrease: Central America, Amazon [within current vector limits] A1 A2 B1 B2 Van Lieshout et al. 2004

15. China Haze 10 January 2003 NASA

16. Effect of Temperature Variation on Diarrheal Incidence in Lima, Peru Daily Diarrhea Admissions Daily Temperature Diarrhea increases by 8% for each 1ºC increase in temperature Checkley et al., 2000

17. El Nino starts El Nino stops

18. Resources • McMichael, A.J., D.H. Campbell-Lendrum, C.F. Corvalan, K.L. Ebi, A. Githeko, J.D. Scheraga, and A. Woodward (eds.). 2003. Climate Change and Human Health: Risks and Responses. WHO, Geneva. • Summary pdf available at http://www.who.int/globalchange/publications/cchhsummary/ • Kovats, R.D., K.L Ebi, and B. Menne. 2003. Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change. WHO/Health Canada/UNEP. • Pdf available at http://www.who.dk/document/E81923.pdf

19. Health Data to Determine the Current Burden of Climate-Sensitive Diseases

20. Questions to be Addressed • What climate-sensitive diseases are important in the country or region? • What is the current burden of these diseases? • What factors other than climate should be considered? • Water, sanitation, etc. • Where are data available? • Are health services able to satisfy current demands?

21. Health Data Sources • World Health Report provides regional-level data for all major diseases • http://www.who.int/whr/en • Annual data in Statistical Annex • WHO databases • Malnutrition http://www.who.int/nutgrowth/db • Water and sanitation http://www.who.int/entity/water_sanitation_health/database/en • Ministry of Health • Disease surveillance/reporting branch

22. Health Data Sources – Other • UNICEF at http://www.unicef.org • CRED-EMDAT provides data on disasters • http://www.em-dat.net • Mission hospitals • Government district hospitals

23. Mozambique • Total population = 18,863,000 • Annual population growth rate = 2.4% • Life expectancy at birth = 45 years • Under age 5 mortality rate = 158/1,000 • 72% of 1-year-olds immunized with 3 doses of DTP • 5.8% of gross domestic product spent on health WHO, 2005

24. Seychelles National Communication

25. Methods and Tools for V&A Assessment in the Health Sector

26. Methods and Tools • Qualitative assessments • Methods of assessing human health vulnerability to climate change • MARA/ARMA – climate suitability for stable malaria transmission • WHO Global Burden of Disease Comparative Risk Assessment • Environmental Burden of Disease • Other models

27. Qualitative Assessments • Available data allow for qualitative assessment of vulnerability • For example, given current burden of diarrheal diseases and projected changes in precipitation, will vulnerability remain the same, increase, or decrease?

28. Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change Kovats et al., 2003

29. Methods for: • Estimating the current distribution and burden of climate-sensitive diseases • Estimating future health impacts attributable to climate change • Identifying current and future adaptation options to reduce the burden of disease Kovats et al., 2003

30. Estimate Potential Future Health Impacts • Requires using climate scenarios • Can use top-down or bottom-up approaches • Models can be complex spatial models or be based on a simple exposure-response relationship • Should include projections of how other relevant factors may change • Uncertainty must be addressed explicitly Kovats et al., 2003

31. Case Study: Risk of Vector-Borne Diseases in Portugal • Four qualitative scenarios developed of changes in climate and in vector populations • Vector not present • Focal distribution of vector • Widespread distribution of vector • Change from focal to potentially regional distribution • Expert judgment determined likely risk under each scenario for 5 vector-borne diseases Kovats et al., 2003

32. Sources of Uncertainty • Data • Missing data or errors in data • Models • Uncertainty regarding predictability of the system • Uncertainty introduced by simplifying relationships • Other • Inappropriate spatial or temporal data • Inappropriate assumptions • Uncertainty about predictive ability of scenarios Kovats et al., 2003

33. Estimating the Global Health Impacts of Climate Change • What will be the total potential health impact caused by climate change (2000 to 2030)? • How much of this could be avoided by reducing the risk factor (i.e. stabilizing greenhouse gas (GHG) emissions)? Campbell-Lendrum et al., 2003 (pdf available)

34. Time 2020s 2050s 2080s 2020s 2050s 2080s Comparative Risk Assessment Greenhouse gas emissions scenarios Global climate modelling: Generates series of maps of predicted future climate Health impact model: Estimates the change in relative risk of specific diseases Campbell-Lendrum et al., 2003

35. Criteria for Selection of Health Outcomes • Sensitive to climate variation • Important global health burden • Quantitative model available at the global scale • Malnutrition (prevalence) • Diarrhoeal disease (incidence) • Vector-borne diseases – dengue and falciparum malaria • Inland and coastal floods (mortality) • Heat and cold related CVD mortality Campbell-Lendrum et al., 2003

36. Exposure: Alternative Future Projections of GHG Emissions • Unmitigated current GHG emissions trends • Stabilization at 750 ppm CO2-equivalent • Stabilization at 550 ppm CO2-equivalent • 1961-1990 levels of GHGs with associated climate • Source: UK Hadley Centre models Campbell-Lendrum et al., 2003

38. Climate scenarios, as function of GHG emissions

39. Estimated Death and DALYs Attributable to Climate Change 2000 Floods 2020 Malaria Diarrhea Malnutrition 120 100 80 60 40 20 0 2 4 6 8 10 Deaths (thousands) DALYs (millions) Campbell-Lendrum et al., 2003

40. Conclusions • Climate change may already be causing a significant burden in developing countries • Unmitigated climate change is likely to cause significant public health impacts out to 2030 • Largest impacts from diarrhea, malnutrition, and vector-borne diseases • Uncertainties include: • Uncertainties in projections • Effectiveness of interventions • Changes in nonclimatic factors Campbell-Lendrum et al., 2003

41. Environmental Burden of Disease • A. Prüss-Üstün, C. Mathers, C. Corvalan, and A. Woodward. 2003. Introduction and Methods: Assessing the Environmental Burden of Disease at National and Local Levels [pdf available at http://www.who.int/peh/burden/burdenindex.html] • Climate change document will be published soon

42. The website [http://www.mara.org.za] contains prevalence and population data, and regional and country-level maps

44. Climate and Stable Malaria Transmission • Climate suitability is a primary determinant of whether the conditions in a particular location are suitable for stable malaria transmission • A change in temperature may lengthen or shorten the season in which mosquitoes or parasites can survive • Changes in precipitation or temperature may result in conditions during the season of transmission that are conducive to increased or decreased parasite and vector populations

45. Climate and Stable Malaria Transmission (continued) • Changes in precipitation or temperature may cause previously inhospitable altitudes or ecosystems to become conducive to transmission. Higher altitudes that were formerly too cold or desert fringes that were previously too dry for mosquito populations to develop may be rendered hospitable by small changes in temperature or precipitation.

46. MARA/ARMA Model • Biological model that defines a set of decision rules based on minimum and mean temperature constraints on the development of the Plasmodium falciparum parasite and the Anopheles vector, and on precipitation constraints on the survival and breeding capacity of the mosquito • CD-ROM $5 for developing countries or can download components from website: www.mara.org.za

47. Relationship between Temperature and Daily Survivorship of Anopheles

48. Relationship between Temperature and Time Required for Parasite Development

49. Proportion of Vectors Surviving Time Required for Parasite Development