Protecting our Health from Professionals Climate Change: a Training Course for Public Health

1. Protecting our Health from Professionals Climate Change: a Training Course for Public Health Chapter 15: What Makes Individuals and Populations Vulnerable to the Effects of Climate Change on Health?

2. Overview: This Module • Defines terms • Discusses the causes of vulnerability to disease and injury resulting from climate change • Describes current and past examples of vulnerability to effects of heat, famine and storms • Points to opportunities to reduce vulnerability and improve population health

3. Definition of Vulnerability • “The degree to which a system is susceptible to, and unable to cope with, adverse effects of climate change” Intergovernmental Panel on Climate Change, Fourth Assessment Report 2007 (IPCC AR4, 2007)

4. Definition of Vulnerability (cont.)

5. Determinants of Vulnerability • Character, magnitude, and rate of climate change • Sensitivity to climate change • Coping capacity (adaptation)

6. Example of Vulnerability to Climate Change — Coral Reefs Reasons • Exposed to rapid ocean warming • Sensitive to small increases in temperature • Limited adaptive capacity

7. Determinants of Health Vulnerability to Climate Change • Biological • Physical • Geographical • Social • Economical • Political

8. Heat wave — Europe • Heat index, Summer 2003

9. Heat-Related Deaths: Who Was at Greatest Risk? (England and Wales, 1993–2003) • Older people: age factor • Women: gender factor • People living in London: geographical factor Those in nursing and care homes: social and political factor Hajat et al., 2007

10. Adaptation: Heat Wave in France — 2006 Fouillet et al., 2008

11. Effects of 2006 Heat Wave in France • 2,065 excess deaths (July 11–28) • Number expected based on the rates seen during the 2003 heat wave: 6,452 • Possible explanations • Model imperfections (over-estimate of expected deaths) • Reduced vulnerability (e.g., heat warning system, better informed public, more responsive health services)

12. Climate Change and Pacific Ocean Sea Level Rise Sea level rise 28–43 cm Increase in tropical storm intensity likely

13. Vulnerability of Pacific Islands to Sea Level Rise Woodward et al., 1998

14. Typhoon Impacts by Classification: a Preparedness Evaluation Loss of life due to typhoons is decreasing owing to better preparedness (Fukuma,1993)

15. Cartogram: Greenhouse Gas Emissions in 2002

16. Cartogram: Climate Change Health Impacts Note: Uses only data on deaths from malaria and dengue fever, diarrhoea, malnutrition, drowning (and heatstroke for OECD countries)

17. Vulnerability to the Future Effects of Climate Change • “The rich will find their world to be more expensive, inconvenient, uncomfortable, disrupted and colorless — in general, more unpleasant and unpredictable, perhaps greatly so. The poor will die.” Kirk R. Smith, 2008 Professor: Environmental Health Sciences University of California, Berkeley

18. Hurricane Katrina Crossing the Gulf of Mexico

19. Diminishing Number of Death Due to Hurricanes Striking Cuba, 1998–2002 Oxfam America, 2004

20. Foundation of Low Storm Mortality in Cuba • Tangible preparedness assets — stockpiles, plans, equipment, early warning systems • Infrastructure — high levels of literacy, rural development, access to reliable health care • Social capital — engagement of local communities, high levels of participation, commitment to reconstruction and recovery Oxfam America, 2004

21. Vulnerability and Climate Variability: The Case of India 1876–1878 “The more one hears about this famine, the more one feels that such a hideous record of human suffering and destruction the world has never seen before.” Florence Nightingale, 1877

22. Effect of El Niño on Rainfall June–August 40 years of data to 2000 Red dots — drier than usual during El Niño Blue dots — more rainfall Size of circle — size of effect KNMI, 2009 El Niño events associated with weakening easterlies, warming of the western Pacific, and shift in rainfall patterns

23. The 1877 El Niño Was Not Particularly Severe … Davis, 2000

24. … But it Resulted in Intense Famine Davis, 2000

25. Famine in Relation to Food Production, India 1875–1878 Mid-1876 — monsoon fails, drought begins in SW India Late 1876 — price of food rises steeply, migrations begin Mid-1877 — famine deaths begin: total between 6 and 10 million 1877 record grain exports to UK No. Deaths Davis, 2000

26. Central India 1860–1890: Wheat Boom Made Mass Hunger More Likely • Aggressive promotion of wheat (for export) instead of millet and gram (for local consumption) • Production subsidised by destructive soil mining and high levels of household debt • Community-controlled reserves replaced by remote stockpiles with no moral or regulatory restraint on speculation • Neglect of public works (irrigation especially)

27. Pacific: Does Modern Agriculture Reduce Vulnerability to Climate Variability? Traditional Agriculture Modern Agriculture Cash cropping Reliance on imported staples (e.g., rice) Unreliable methods of food preservation (e.g., refrigerators) Attenuated social networks Trade systems global, not local • Crop diversity • Drought-resistant staples (e.g., taro, yam) • Robust methods of food preservation • Strong social networks • Inter-island trade systems

28. Conclusions • Vulnerability = susceptibility to adverse effects + inability to adapt • Causes of vulnerability include biological characteristics, the physical environment, social circumstances, and national and international politics • Opportunities to reduce vulnerability cover a correspondingly wide range • Reducing vulnerability to damage resulting from climate change will bring other substantial benefits, earlier