Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector

1. Vulnerability and Adaptation Assessments Hands-On Training WorkshopHuman Health Sector Kristie L. Ebi, Exponent Health Group

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 • El Nino and disease • Temperature • Floods • Vector-borne diseases • Diseases related to air pollution • Diarrheal diseases

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

6. 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

7. IPCC TAR–Potential Health Impacts of Climate Change • Any increase in climate extremes (storms, floods, cyclones) could increase the risk of infectious disease epidemics, particularly in low-income countries • Increase in heatwaves, often exacerbated by increased humidity & urban air pollution • Increase in the geographic range of potential transmission of malaria & other vector-borne diseases • Increase in water- and food-borne diseases The severity of impacts will depend on the capacity to adapt & its effective deployment

8. 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

9. ENSO and Disease Kovats et al., 2003

10. Exploring Linkages Between ENSO and Human Health

11. Dengue Epidemics in South Pacific 1970-1999

12. El Nino starts El Nino stops Dr. Githeko, personal communication

13. Climate Change May Entail Changes in Variance, as Well as Changes in Mean Folland et al., 2001

14. Temperature Extremes in the Caribbean,1955-2000

15. DATE COUNTRY EVENT DEATH ESTIMATED COSTS (US$ million, 1998) Climate Variability and Change Impacts in the Caribbean 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.

16. Mechanisms by Which Above Average Rainfall Can Affect Health Kovats et al., 2003

17. 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

18. Mechanisms by Which Drought Can Affect Health Kovats et al., 2003

19. Examples of Environmental Changes and Possible Effects on Infectious Diseases Patz et al., 2003 Wilson 2001

20. Factors that Influence the Range and Prevalence of Infectious Diseases • Sociodemographic influences • Human travel, trade, and migration • Disease control efforts • Drug resistance • Nutrition • Environmental influences • Land-use, including deforestation, agricultural development, and urbanization • Ecological influences

21. Temperature and Precipitation Effects on Vector- and Rodent-Borne Diseases • Survival and reproduction rate of the vector • Time of year and level of vector activity, specifically the biting rate • Rate of development and reproduction of the pathogen within the vector

22. Main Types of Transmission Cycles for Infectious Disease Patz et al., 2003

23. Potential Transmission of Schistosomiasis, Jiangsu Province Yang et al., 2005

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

25. China Haze 10 January 2003 NASA

26. 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

27. 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

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

29. 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?

30. 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

31. 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

32. Indonesia • Total population = 219,883,000 • Annual population growth rate = 1.4% • Life expectancy at birth = 67 years • Under age 5 mortality rate = 41/1,000 • 70% of 1-year-olds immunized with 3 doses of DTP • 3.2% of gross domestic product spent on health WHO, 2005

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

34. Methods and Tools • Qualitative assessments • Methods of assessing human health vulnerability to climate change • WHO Global Burden of Disease Comparative Risk Assessment • Environmental Burden of Disease • MIASMA • Other models

35. 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?

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

37. 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

38. 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

39. 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 Casimiro et al., 2006

40. Vector Parasite Portuguese National Assessment None Present Imported human cases only Low prevalence in vectors/hosts High prevalence vectors/hosts None Present Negligible Risk Negligible Risk Negligible Risk Negligible Risk Focal Distribu-tion Negligible Risk Very low Risk Low Risk Low Risk Regional Negligible Risk Very low Risk Low Risk Medium Risk Wide-spread Negligible Risk Very low Risk Medium Risk High Risk Casimiro & Calheiros 2002

41. 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

42. 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)? McMichael et al., 2004

43. Comparative Risk Assessment Time 2020s 2050s 2080s 2020s 2050s 2080s 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 McMichael et al., 2004

44. Criteria for Selection of Health Outcomes • Sensitive to climate variation • Important global health burden • Quantitative model available at the global scale McMichael et al., 2004

45. Health Outcomes Considered McMichael et al., 2004

46. Exposure: Alternative Future Projections of GHG Emissions • Unmitigated current GHG emissions trends • Stabilization at 750 ppm CO2-equivalent by the year 2210 • Stabilization at 550 ppm CO2-equivalent by the year 2170 • Average climate conditions for 1961-1990 (WMO climate normal baseline) Source: UK Hadley Centre models McMichael et al., 2004

47. Estimated Mortality (000s) Attributable to Climate Change, 2000 McMichael et al., 2004

48. Climate scenarios, as function of GHG emissions

49. 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 malaria • Uncertainties include: • Uncertainties in projections • Effectiveness of interventions • Changes in nonclimatic factors McMichael et al., 2004

50. 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