Climate, Environmental Change, and Public Health in Brazil: Scenarios and Opportunities

1. First EUROBRISA Workshop: 17-19 March, Parati-RJ, 2008 Climate, Environmental Change and the Public Health in Brazil: Scenarios, Opportunities and Uncertainties for Improved Seasonal Forescasting Antonio Miguel V. Monteiro, INPE Trevor Bailey, Exeter University { miguel@dpi.inpe.br }

2. Health, Environment and Climate Change Studies: ACollective • Climate, Environment and Health • Multi-institutional Group • Christovam Barcellos, Marilia Sá Carvalho - CICT,ENSP/Fiocruz • A. Miguel, Virginia Ragoni e Helen Gurgel - DPI,CPTEC/INPE • Wayner de Souza, José Constantino - CPqAM-Recife/Fiocruz • Cáudia Codeço, Aline Nobre, Taynãna , Oswaldo Cruz – PROCC/Fiocruz • The SAUDAVEL Network • Paulo Justiniano – LEG/UFPR • Partially sponsored by: SVS-MS

3. About this Presentation • Based on slides prepared by Christovam Barcellos • Aquecimento global e sua relação com as doenças infecciosas no Brasil

4. Uma verdade inconveniente O dia depois de amanhã Katrina, 2005 Relatório IPCC, 2007 Ártico, 2006

5. Jaboatão- PE, 2005 Ciclone Catarina, RS e SC, 2004

6. Evolution of the Publications on Global Warming in Scientific Magazines Relatório IPCC 2007 BROECKER WS (1975) CLIMATIC CHANGE - ARE WE ON BRINK OF A PRONOUNCED GLOBAL WARMING? SCIENCE 189 (4201): 460-463. Criação do IPCC

7. O Impacto na mídia

8. Jornal do Brasil, fev./2007

9. Climate and Health: The Official View First driven by the Global Warming and Climate Change (Global) Agenda • Institutionalised by the Health Ministry as a Public Health issue: • Setting up of Comissions Technical&Scientific WS • Health Surveillance Office • The Climate and Health Observatory

10. Climate and Health: The Official View In its first steps it is looking into the long run: mitigation and adaptation on the center of the stage • But, it still have a lot of space for improvements and changes in orientation

11. Climate and Health: The (Un)official View The Collective was invited by the SVS-MS to write down a workingpaper to support the discussions at the Climate Change and Health Workshop at the 7ª ExpoEpi, the most important event of the Health Surveillance Office in Brazil. [November, Brasilia 2007] Climate, Environmental Changes and Infectious Diseases: Scenarios and Uncertainties for the Brazilian Health Surveillance Christovam Barcellos et al., 2007

12. Climate and Health: The (Un)official View A very good opportunity for Seasonal Forecasting ! • It can be fundamental for Alert Systems, the new generation for the Environmental and Epidemiological Health Surveillance in the 21st Centrury.

13. Climate and Health: The (Un)official View • But, Is Seasonal Forecasting Technology and Science ready for the challenge ??

14. Infectious Diseases and Endemies: Travelling around in Brazil

15. Malária 600.000 cases/year

16. schistosomiasis 50.000 cases/year

17. leptospirosis 3000 cases 300 deaths/year

18. Dengue 500.000 cases 40 deaths/year

19. Baixa amplitude de temperatura Chuvas constantes Chuvas no verão Baixas temperaturas Arroz Isoterma de 22oC Climate e endemies Esquistossomose Leptospirose Dengue

20. leptospirosisin Curitiba • Association with: • Poverty • Housing • Flooding De Paula, 2005. Leptospirose Humana: uma análise climato-geográfica de sua manifestação no Brasil, Paraná e Curitiba

21. Risk Assessment Risk = Danger * Vulnerability • Society • Degree of Adaptation • Social Territorial Inequalities • Space Heterogeneity • Nature • Environment • Amplitude of Events • Temporal&Spatial Resolution

22. Sanitation – The Scale Problem Landscape Cities Household Manual de Saneamento (Funasa, 2004)

23. The Hierarchical Structures of Dependency Water Basin Household Individual Comunity Water Services City

24. Connection-Delegation Individual Household Comunity Water Services City Water Basin

25. Individual Nutritional Condition Diseases Cultural Habits/Behaviour

26. Household Sanitary Instalations Income (Investment capacity)

27. Comunity Political Organisation Identity Localisation

28. Water Services Water Source Distribution and Quality

29. City Sanitation Public Policies Environmental Enforcement Laws and Regulations

30. Water Basin Rain Regimes Vegetation Climate

31. System of Dependencies Collapses Individual Household Comunity Water Services City Water Basin

32. Angra dos Reis, RJ, 2007

33. Water Crisis Santos, 1875 Rio de Janeiro, 1850

34. Mortality Rate by diarrhoeain Children for Municipalities with and without proper water Fonte de dados: SIM/MS, PNSB/IBGE e Censo 2000/IBGE

35. leptospirosisincidence rates - Rio de Janeiro after the 1996 Floodings around 1500 cases

36. Data Colection Notification for leptospirosis (SES-RJ) Georeferencing the data –Putting the Data into the Space Integration Census Tract (IBGE)

37. Identificação de áreas de risco Barcellos e Sabroza, 2002

38. Garbage Production Estimated Expected Concentration of leptospira before the flooding Expected Concentration of leptospira after the flooding Distance

39. New Cases Observed Seroprevalence expected before the flooding Seroprevalence expected after the flooding Distance

40. The Lessons from the Flooding The variability is inherent of the system, but we need prediction tools to know better and early The technical systems have large coverage but are more vulnerable to extreme events

41. The Lessons from the Flooding The Social Systems have Vulnerabilities. The Vulnerability is bigger amongst the poor and social excluded groups (usually excluded from the technical systems) However, the richest ones are not out-of-risk, on the contrary, their response capacity is immunological and socially lower than the other group.

42. Dengue: The SAUDAVEL Project SAUDAVEL: Bridging the Gap between Research and Services in Public Health Operational Programs by Multi-Institutional Networking Development and Use of Spatial Information Technology Innovative Tools

43. A Surveillance System for Alert, Control and Intervention for Dengue Fever Epidemics Based on Eggtraps for Aedes spp at the Intra-urban scale. SAUDAVEL 1.0 ALPHA: From Entomological Surveillance to Epidemiological Surveillance Recife

44. Engenho do Meio

45. Recife 3D – Morro da Conceição Slides: MNT e Animação 3D - Produzido pelos Projetos SAUDAVEL , Defesa Civil /Recife e Depto Cartografia UFPE Resp. José Constatino e José Luis Potugal

47. SAUDAVEL 1.0 ALPHA: Advancing the Surveillance System for Alarm and Prediction: More Data and Integrated Models INMET Parceria Clima Estação Simples- Leitura Diária Por Sítio Predictive Model

48. Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 103(1): 50-59, February 2008 Developing new approaches for detecting and preventing Aedes aegypti population outbreaks: basis for surveillance, alert and control system Regis at al.

49. Distribuição espacial do vetor, em Brasília Teimosa Brasília Teimosa

50. Engenho do Meio Abril 2004 Abril 2005 Spatial Distribution of Aedes aegypti in Engenho do Meio