Potential Relationships between exposure situations and disease conditions

1. Potential Relationships between exposure situations and disease conditions Health condition of Exposure situations concern Polluted Excreta and Polluted water or Polluted Unhealthy Global Air household deficiencies in water food housing environmental wastes management change ‚ ‚ ‚ Acute respiratory infections ‚ ‚ ‚ ‚ Diarrhoeal diseases ‚ ‚ ‚ ‚ Malaria and other vector-borne diseases ‚ ‚ ‚ ‚ ‚ Other infections ‚ ‚ ‚ Cancer ‚ ‚ Cardiovascular diseases ‚ ‚ Mental disorders ‚ ‚ Chronic respiratory diseases ‚ ‚ ‚ ‚ ‚ Injuries and poisonings Source: The World Health Report 1998. Life in the 21st Century – A Vision for All (NB: last column modified )

2. Source Activities Traditional hazards Modern hazards Driving force Development Human activities activities Natural phenomena Emissions Pressure A c t I o n s Environmental Concentration Air Water Food Soil State Exposure External Exposure Exposure Dose Health Effects Effect Early/ Subclinical Moderate/ Clinical Advanced/ Permanent Health and environment cause-effect framework

3. Driving forces Population growth Development policies Transport, Energy policies Actions Pressure GHG emissions State Climate variability and change Heatwaves windstorms, floods, droughts Food shortage Air pollution Food, water- vector-borne infections Exposure DPSEEA: Climate and Health International agreements; National policies Global, national, monitoring National, international agency mitigation, adaptation strategies Treatment CVD Respiratory Infectious diseases Mal- nutrition Injuries Drownings Mental health Effect

4. Climate change Human health impacts and vulnerability to climate change Water resources impacts Impacts on coastal areas Species and natural areas Agriculture impacts Forests impacts Adaptive Health impacts capacity

5. Health effects Pathways by which climate change affects health Temperature related illness and death Extreme weather related health effects Air pollution related health effects Water and food borne diseases Vector and rodent borne Diseases Psychological effects Malnutrition Moderating influences • Regional weather • changes • Heatwaves • Extreme weather • Temperature • Precipitation • Contamination • pathways • Transmission • dynamics • Food • availability • Migration Climate Change Adaptation measures Research Adapted from Patz et al, 2000

6. Causal web: Climate variability and diarrheal disease Unsafe and limited water Drought Hygiene difficult Nutritional deficiencies Contamination from pit latrines, septic tanks and sewage systems Diarrheal Climate Floods Debris and carcasses in disease variability rivers Failure of water treatment facilities Food spoilage Temperature increase Algal blooms

7. Current and future actions: • Global, regional burden of disease assessment • Assessing early health impacts of climate change • National health impact assessment guidelines • National adaptation strategies for health • Pilot warning system projects (e.g. heatwaves) • Joint WHO/UNEP/WMO activities: • Capacity building • Information exchange • Research promotion

8. Adaptive actions for the health sector: primary adaptive measures: actions taken to prevent the onset of disease arising from environmental disturbances, in an otherwise unaffected population (e.g. supply of bed nets to all members of a population at risk of exposure to malaria, early warning systems, integrated environmental management) secondary adaptive measures: preventive actions taken in response to early evidence of health impacts(e.g. strengthening disease surveillance and responding adequately to disease outbreaks) tertiary adaptive measures: health-care actions taken to lessen the morbidity or mortalitycaused by the disease (e.g. improved diagnosis and treatment of malaria)

9. Examples of primary and secondary adaptive measures to reduce health impacts Impact Primary adaptive measures Secondary adaptive measures Heat -Heatwave warning systems -Health personnel educated to stress -Urban planning detect and treat heat stress Extreme -Disaster preparedness and mitigation -Disaster response weather -Early warning systems events -Disaster protection measures Infectious -Integrated environmental -Disease surveillance and diseases management monitoring -Control of vector-, food- and water- borne diseases

10. Examples of primary and secondary adaptive measures to reduce health impacts Impact Primary adaptive measures Secondary adaptive measures Food -International mechanisms of -Monitoring and surveillance security agriculture, trade and finance -Implementation of nutrition -Seasonal climate forecasting action plans -Famine early warning systems -National and local agriculture measures Water -Pollution reduction and control policies -Monitoring and surveillance -Demand management and water -Capacity building allocation policies -Waste water treatment -Economic and regulatory measures to increase irrigation efficiency -Capacity building

11. climate Change and Adaptation Strategies for Human health (cCASHh) Outreach V A E W E , ulnerability to xtreme eather vents ssessment V B D , W F b D of orn ector iseases of ater ood orn iseases E E P I olicy ntegrated pidemiologal conomic A A A Evaluation nalysis ssessment ssessment WHO Feem WHO ICIS LSHTM dWd NIPH SU dWd Framework for adaptation Pik Current available datasets, Monitoring results Research results