Vulnerability and Adaptation to Climate Change Impacts In the Health Sector

1. Vulnerability and Adaptation to Climate Change Impacts In the Health Sector Munjed Al-Sharif, PhD. Water and Environmental Engineering Dept. German Jordanian University Environmental Health Workshop, 5 – 9 Mach, 2014 Crowne Plaza, Amman

2. Vulnerability to Climate Change Impacts • The degree to which a system is susceptible to, or unable to cope with, adverse effects of CC including climate variability & extremes. • Function of: • Magnitude, • Rate of change • Sensitivity of the system, and • System adaptive capacity.

3. CLIMATE VULNERABILITY “sustainable development can reduce vulnerability to climate change” (IPCC 2007 in UNDP 2008)  WHAT IS ‘VULNERABILITY? Climate Vulnerability= BiophysicalVulnerability + SocialVulnerability GEO-4 (UNEP 2007)

4. CLIMATE VULNERABILITY Biophysical Vulnerability= “the degree to which a [physical] system is… unable to cope with, adverse effects of climate change” IPCC Social Vulnerability = measure of a society to adapt to hazards

5. AND…. Harsh climate + High exposure  High Physical Risk • High Risk + High coping mechanisms, but Low Adaptation • High Social Vulnerability

6. SOCIO - POLITICAL VULNERABILITY = the political component of vulnerability. Are national adaptation plans applied evenly? Does ‘political cover’ extend selectively to some communities? How does the marginalisation of a community or people affect their ability to adapt?? Financial mobility? Physical mobility?

7. Non Climatic conditions contributing to vulnerability • Chronic poverty • Increasing population • Weak institutions and physical infrastructure • Low access to technology and information, • Political and social Instability • Lack of political commitments, access to resources and management capabilities • High illiteracy rates and lack of skills

8. Developing Countries Most At Risk Low Income Source: World Bank Middle Income

9. ? Framework for mainstreaming CC within development strategies Climate Change Development Climate Change Factors Social and Gender Inclusion Mainstreaming Framework Temp Variation R/Fall Variation Sea Level rise Economic and Social Systems Eco Systems Critical infrastructure Natural Hazards Livelihoods other Risk Database NAPA Monitoring Loop Sector wide planning and development Cross cutting Inputs (examples): Knowledge Management Information Management Capacity Development Advocacy and awareness-raising Policy and Planning Impact Analysis Economic and Development Planning Disaster Management/DRR Early warning systems Preparedness Planning Awareness Relief and Recovery Management Poverty Reduction and MDG Goals Lessons learned feedback loop

10. Adaptation or Development?? Gap between existing coping capacity and existing/future risk may be so great that only long term development strategies may have an impact on reducing risk and vulnerability CC Future Risk Predictions Predicted Adaptation Gap Existing Risk Levels Existing Adaptation Gap Existing adaptive/coping capacity Eroded Capacity

11. Progressive process at several levels simultaneously from local to national to global; Support of enabling national policies, regulations and institutional setups. Accurate and reliable data Technical and technological capacity Financial resources Institutional setup Adaptation Determinants

12. Water Resources (Has taken a top priority among all adaptation measures): The challenge of making an optimal water allocation for a growing number of competing water management options (e.g. agriculture, public consumption, industry, hydro-energy, ecosystems, etc.) under a changing climate system places a heavy burden on water managers. Improve efficiency, develop new water resources. Food Production: Develop new varieties of crops that can adapt with the new conditions. Infrastructure and buildings: Choice of construction materials and techniques used for buildings, roads, and utility Biodiversity:develop mechanisms for coordinating conservation actions across political boundaries and agency jurisdiction. Human Health: Adapt human health systems and prepare them to respond to the consequences of climate change, Examples of needed adaptation in our region

13. Projected Impacts of GlobalTemperature Change 0°C 1°C 2°C 3°C 4°C 5°C Food Falling crop yields in many areas, particularly developing regions Falling yields in many developed regions Possible rising yields in some high latitude regions 450 ppm CO2 eq Water Significant decreases in water availability in many areas, including Mediterranean and Southern Africa Small mountain glaciers disappear – water supplies threatened in several areas Sea level rise threatens major cities Ecosystems Extensive Damage to Coral Reefs Rising number of species face extinction 650 ppm CO2 eq Extreme Weather Events Rising intensity of storms, forest fires, droughts, flooding and heat waves Risk of Abrupt and Major Irreversible Changes Increasing risk of dangerous feedbacks and abrupt, large-scale shifts in the climate system Source: L. Rudolph, 2008

14. Health Sector

15. Climate Change and Health: Pathways 1 Direct impacts e.g. heatwaves, floods, bushfires Changes to physical systems/processes 3 Climate change Social, economic, demographic disruptions Urban air pollutant formation Freshwater supplies Health impacts 2 Changes to biological processes, timing Indirect impacts, via changes to mediating systems and processes Mosquito numbers, range Photosynthetic activity  reduced food yields Changes to ecosystem structure and function Fisheries: composition, yield Nutrient cycles Forest productivity (McMichael, 2005)

16. Climate Change’s Impacts on Health

17. HEALTH EFFECTS OF CLIMATE CHANGE Heat Stress Cardiorespiratory failure Respiratory diseases, e.g., COPD & Asthma Malaria Dengue Encephalitis Hantavirus Rift Valley Fever Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts Temperature/Heat Stress Air Pollution Vector-borne Diseases Water-borne Diseases Water resources & food supply Environmental Refugees CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes 13°C by yr. 2100 240 cm“ “ IPCC estimates

18. Vulnerable Populations Source: Derived from SAP 4.6, Chapter 2

19. Current levels of vulnerability are: • a function of the programmes and measures in place to reduce burdens of climate-sensitive health determinants and outcomes, • a result of the success of traditional public-health activities, including providing access to safe water and improved sanitation to reduce diarrhoeal diseases, and implementing surveillance programmes to identify and respond to outbreaks of malaria and other infectious diseases.

20. Adaptation: practices, options and constraints • Adaptation is needed: to reduce current vulnerability to the climate change that has already occurred • Additional adaptation is needed in order to address the health risks projected to occur over the coming decades.

21. How public health and other infrastructure will develop is a key uncertainty • Public awareness, effective use of local resources, appropriate governance arrangements and community participation are necessary to mobilize and prepare for climate change. These present particular challenges in low-income countries. • The status of and trends in other sectors affect public health, particularly water quantity, quality and sanitation, food quality and quantity, the urban environment, and ecosystems. • These sectors will also be affected by climate change, creating feedback loops that can increase or decrease population vulnerability, particularly in low-income countries

22. Approaches towards Adaptation at different scales • Pro-active adaptation strategies, policies and measures need to be implemented by regional and national governments, including Ministries of Health, by international organizations such as the World Health Organization, and by individuals.

23. National- and regional-level responses • Climate-based early warning systems (examples are for heat waves and malaria outbreaks) should be implemented at national and local levels to alert the population and relevant authorities that a disease outbreak can be expected based on climatic and environmental forecasts. • To be effective in reducing health impacts, such systems must be coupled with a specific intervention plan and have an ongoing evaluation of the system and its components. • Seasonal forecasts can be used to increase resilience to climate variability, including to weather disasters.

24. Adaptation in health systems • Health systems need to plan for and respond to climate change. • One way of promoting adaptation and reducing vulnerability to climate change is to promote the uptake of effective clinical and public-health interventions in high-need cities and regions of the world.

25. Adaptation in health systems (cont..) • Funding health programmes is a necessary step towards reducing vulnerability. • Strengthening public institutions; building health systems that work well, treating people fairly and providing universal primary health care; providing adequate education, generating demand for better and more accessible services; and ensuring that there are enough staff to do the required work. • Health-service infrastructure needs to be resilient to extreme events . Efforts are needed to train health professionals to understand the threats posed by climate change.

26. Integration of responses Adaptation responses to specific health risks cuts across many fields. ( for example, an integrated response to heat waves could aslo include, consideration of climate change projections in the design and construction of new buildings and in the planning of new urban areas). National energy efficiency programmes and transport policies could include approaches for reducing both urban heat islands and emissions of ozone and other air pollutants.

27. Constraints to adaptation interventions • When one or more of the prerequisites for public-health prevention have not been met: • an awareness that a problem exists; a sense that the problem matters; an understanding of what causes the problem; the capability to influence; and the political will to influence the problem. • Decision-makers will choose which adaptations to implement where, when and how, based on assessments of the balance between competing priorities. • Local laws and social customs may constrain adaptation options

28. Constraints to adaptation interventions (cont..) • Fundamental constraints exist in low-income countries where adaptation will partially depend on development pathways in the public-health, water, agriculture, transport, energy and housing sectors. • Poverty is the most serious obstacle to effective adaptation. • Therefore, adaptation strategies should be designed in the context of development, environment, and health policies.

29. Therefore….. Adaptation strategies should be designed in the context of development, environment, and health policies.

30. Finally,,,, A word of Caution….

31. Health implications of adaptation strategies, policies and measures • Adaptation strategies, policies and measures can have inadvertent short- and long-term negative health consequences. Thus, potential risks should be evaluated before implementation.

32. Health implications of adaptation strategies, policies and measures (Examples) • A micro dam and irrigation programme in Ethiopia developed to increase resilience to famine increased local malaria mortality by 7.3-fold. Increased ambient temperatures due to climate change could further exacerbate the problem. • In another example, air conditioning of private and public spaces is a primary measure used in the USA to reduce heat-related morbidity and mortality ; however, depending on the energy source used to generate electricity, an increased use of air conditioning can increase greenhouse gas emissions, air pollution and the urban heat island. • Wastewater reusefor irrigation, have implications for human health Irrigation is currently an important determinant of the spread of infectious diseases such as malaria. • Strict water-quality guidelines for wastewater irrigation are designed to prevent health risks from pathogenic organisms and to guarantee crop quality. • However, in rural and periurban areas of most low-income countries, the use of sewage and wastewater for irrigation, a common practice, is a source of faecal–oral disease transmission. The use of wastewater for irrigation is likely to increase with climate change, and the treatment of wastewater remains unaffordable for low-income population.

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