CGE Training materials - VULNERABILITY AND ADAPTATION Assessment CHAPTER 8

1. CGE Training materials - VULNERABILITY AND ADAPTATION AssessmentCHAPTER 8 Human Health

2. Objectives and Expectations • Having read this presentation, in conjunction with the related handbook, the reader should: • Have an overview of drivers and their potential impacts on human health • Be familiar with commonly used methods and tools for assessing impacts of climate change on human health • Also be familiar with methods for determining appropriate adaptive responses. 2

3. Outline • Overview of the potential health impacts of climate variability and change • Predictive tools for the future • Health impact assessment (HIA) of climate change • Methods and tools for vulnerability and adaptation (V&A) assessment in the health sector • Methods for determining a health adaptation baseline • The following sections provide additional information that can be used during the V&A assessment: • Health data to determine the current burden of climate-sensitive diseases • Global projections of health impacts

4. Topics • Climate change and health • Pathways for weather to affect health • Potential health impacts of climate change • Extreme weather events • Temperature • Storms/floods • Drinking water supply • Air quality • Food production and security • Vector-borne diseases • Food and water borne disease • Diarrhoeal diseases • Other indirect impacts.

5. Overview of the Potential Health Impacts of Climate Variability and Change

6. Climate Change and Health • There is consideration worldwide on the potential health impacts from global climate change. • Three kinds of health impacts have been identified[1]: • Relatively direct impacts, usually caused by weather extremes • Consequences of environmental change and ecological disruption in response to climatic change • Consequences that occur when populations are demoralised and displaced by the following climate change induced factors: • economic dislocation, • environmental decline and conflict situations including traumatic, infectious, nutritional, psychological and other health consequences. [1] World Health Organisation (WHO). 2003. Climate change and human health: risks and responses.

7. Pathways for Weather to Affect Health Health System Conditions Social Conditions (upstream determinants of health Environmental Conditions Direct Exposures Indirect Exposures (Changes in food quality, disease vectors, ecosystem changes) Health Impacts Climate Change Modifying Influence Changes in Social Disruption

8. CLIMATE CHANGE Mapping Links Between Climate Change and Health • Most expected impacts will be adverse but some will be beneficial. • Expectations are not for new health risks, but rather changes in frequency or severity of familiar health risks Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement Modulating influences Human exposures Regional weather changes Heat waves Extreme weather Temperature Precipitation Contamination pathways Transmission dynamics Agro-ecosystems, hydrology Socioeconomics, demographics Source: based on Patz, et al., 2000

9. Potential Health impacts from Environmental Changes

10. Temperature

11. Temperature CSIRO 2006: Climate Change in the Asia/Pacific Region

12. Temperature

13. Temperature Temperature Extremes in Bhutan, 1800s –2010

14. Direct Impacts to Health from Heat • The human body maintains body temperature in ambient temperatures not exceeding 32 degrees C • Above this temperature, heat lost through the skin and sweating • Heat-related illness occurs when the body unable to adequately cool • Minimum ambient temperatures are also important: • Difficulties cooling when minimum temperature is greater than 22 degrees C • High humidity reduces effectiveness of sweating and increases the risk of heat-related illness at any given temperature.

15. Relative Atmospheric Temperature (°C) At an apparent temperature, (Ta) of: 32–40°C Heat cramps or heat exhaustion possible 41–54°C Heat cramps or heat exhaustion likely, heat stroke possible 54°C< Heat stroke highly likely Exposure to full sunshine can increase the heat index value by up to 8oC

16. Impacts to Health from Increased Temperatures Direct impacts to health: Heat cramps – muscular pains and spasms Heat exhaustion – body fluids are lost through heavy sweating Heat stroke – is life threatening. Indirect impacts: Range of areas that can potentially be affected with gradual and extreme temperature increases Includes impacts on ecosystems, water, food, disease-carrying vectors, lifestyle, community resilience.

17. STORMS/FlooDS

18. Storms/Flooding Flooding is heavily concentrated in Asia Most human exposure to flood is in Asia. The top ten countries – in absolute and relative terms - are in south and south east Asia. From: Environment Solutions: www.environmentsolutions.dk Source: 2009 Global Assessment report on Disaster Risk Reduction

19. 2012 Flood in Pakistan (September) • Monsoon floods in Pakistan during September, killed more than 400 people and affected more than 4.5 million others:  • Tens of thousands have been made homeless by heavy flooding in the provinces of Balochistan and Sindh – where 2.8 million were affected. • Pakistan has suffered devastating floods in the past two years. • The worst floods were in 2010, when almost 1,800 people were killed and 21 million were affected. • During 2011, many Asian countries experienced flooding, including Bangladesh, China, India, Japan, Laos, North Korea, Pakistan, Thailand, the Philippines and Singapore. BBC news: 28 Sept 2012

20. Health Impacts of Floods • Immediate deaths and injuries • Non-specific increases in mortality • Infectious diseases – leptospirosis, hepatitis, diarrhoeal, respiratory, and vector-borne diseases • Exposure to toxic substances • Mental health effects • Indirect effects • Increased demands on health systems.

21. Flooding: Direct Health Effects

22. Flooding: Indirect Health Effects

23. Drinking Water

24. Climatic Change: Drinking Water Supply • Drying climate causes: • Changes to land cover and run-off patterns (erosion) • Increased bushfire risk • Increased sediment, nutrient and debris. • Flooding can also affect drinking water supplies: • Coastal intrusion • Contamination.

25. Climatic Change: Drinking Water Supply • Reduction in flows to dams and groundwater aquifers • Increased evaporation from surface water storages • Salt water intrusion into coastal aquifers • Acidification of susceptible inland aquifers • Increased risk from the: • Concentration of nutrient and chemical contaminants • Formation of toxic algal bloom

26. Air Quality

27. Air quality

28. China Haze 10 January 2003 Source: NASA

29. Climatic Change: Air Quality • Weather has a major role in the development, transport, dispersion and deposition of air pollutants • Air pollution episodes are often associated with stationary or slowly moving air masses • Air pollutants and fine particulate matter may change in response to climate change.

30. Climatic Change: Air Quality • Airflow on edges of a high-pressure system can transport ozone precursors. Ozone levels are increasing in many areas • An increase in fire events will mean increased toxic gases and particulates • Changes in wind pattern may increase long-range transport of air pollutants • Weather patterns can enhance urban “heat islands” which can lead to elevated pollution levels.

31. Potential health Impacts • Ozone – pneumonia, COPD, asthma, allergic rhinitis and others – premature mortality • Particulate matter (PM) – known to affect morbidity and mortality • Toxic gases and PM from fires contribute to acute and chronic respiratory illness. Evidence from 1997 Indonesia fires – transboundary impacts • Wind blown dust (respirable particles, trace elements) from desert regions can affect populations in remote areas. Evidence that mortality is increased in the days after a dust storm.

32. Vector-borne disease

33. Malaria in Vanuatu Wet season in Vanuatu is from November until April, temperatures very between 24 to 30oC

34. Mosquito-borne-disease: Environmental Changes Distribution of vectors will change arising from: • Increasing temperature • Changing rainfall: • Increase or decrease • Seasonality • Cyclones, flooding • Changes in animal host/reservoir populations • Rising sea levels • Extreme tides • Loss of coastal margins.

35. Mosquito-borne-disease: Human Factors Location of population: • Geographic location • Proximity to water bodies Urban environment: • Peri-domestic breeding Mobility of population • Arrival of infected people • International • Interstate • Intrastate Living standards: • Insect screens, air conditioning • Social/political breakdown.

36. Mosquito-borne-disease: Water Management Breeding is also influenced by: • Water hoarding/storage: • Rainwater tanks • Uncovered containers • Dams • Irrigation • Groundwater recharge.

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

38. Food security

39. Food Production: Land Land based agriculture: • Food production, loss of soil fertility, erosion and salinization: • Changes in crop yields and protein levels (+/-) • Effects on feed intakes and animal reproduction • Changes to pests, weeds and diseases • Changes to use of agrochemicals • Dietary and nutritional changes

40. Food Production: Fisheries Oceanic and coastal fisheries: • A change in coastal circulation patterns can affect: • Nutrient supply • Lagoon flushing • Coastal erosion • Ocean acidity and coral bleaching • Decline in productivity.

41. Food Safety

42. Food Safety • Food borne disease may cause food poisoning: • May increase the proliferation of bacterial pathogens including Salmonella, Campylobacter and Listeria spp. • May increase mycotoxins and aflatoxins in seafood.

43. DiarrhOealdiseases

44. Effect of Temperature Variation on Diarrheal Incidence in Lima, Peru Daily diarrhoea admissions Daily temperature Diarrhoea increases by 8% for each 1ºC increase in temperature Source: Checkley, et al., 2000

45. El Nino Events and the possible impact on diseases: Cholera El Nino starts El Nino stops

46. Social Impacts

47. Social Impacts Lifestyle and behaviour are likely to be affected in the following ways: • Increased temperatures: • Increases in crime - particularly involving aggression • Accidents - workplace and traffic • Decline in physical health • Hot nights may cause sleep deprivation • Recreational opportunities - changes to exercise patterns • Changes in alcohol consumption • Stress • Lack of cold water- reduced ability to cool down

48. Social Impacts • Mental Health can be impacted as follows: • Anxiety and depression • Post traumatic stress disorder • Insecurity • Grief • Stress, self harm and possible suicide • Drug and alcohol misuse • Impacts on individuals, communities • Loss of social cohesion • Dislocation • Specific impacts on children, women and elderly.

49. Social Impacts Economic impacts may be as follows: • Loss of income and/or assets • Reduction of goods and services • Higher costs of insurance, food, water and energy • Financial strain for Governments and others • Impacts on provision of health services.

50. Resources • McMichael AJ, Campbell-Lendrum DH, Corvalan CF, Ebi KL, Githeko A, Scheraga JD, and Woodward A. (eds.). 2003. Climate Change and Human Health: Risks and Responses.Geneva, WHO. • Summary PDF available at <http://www.who.int/globalchange/publications/cchhsummary/> • Kovats RD, Ebi KL, and Menne B. 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> • PAHO and WHO. 2011. Protecting Health from Climate Change: Vulnerability and Adaptation Assessment. • PDF available at <www.who.int/entity/globalchange/VA_Guidance_Discussion.pdf >