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Approaching Adaptation: Parallels and Contrasts between the Climate and Health Communities

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Carnegie Mellon

Approaching Adaptation:Parallels and Contrasts between the Climate and Health Communities

Center for Integrated Study of the Human Dimensions of Global Change,

Carnegie Mellon University

National Science Foundation, ExxonMobil, API and CMU

Context and Introduction

  • Public health prevention and climate change adaptation share the goal of increasing the ability of nations, communities and individuals to cope effectively and efficiently with challenges and changes.

  • Public health researcher approach from the perspective of protecting and enhancing the health and well-being of individuals and communities

  • Climate researchers approach adaptation from a perspective that can trace its roots to the natural hazards community.

Public Health

  • Public health is “the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all people through collective or social actions. The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature deaths, and disease-produced discomfort and disability in the population (Last 2001).”

Three Stages of Prevention

  • Public health aims to achieve its goals through prevention (adaptation).

  • Measures to reduce disease and save lives are categorized into primary, secondary and tertiary prevention (Last 2001).

Three Stages of Prevention

  • Primary prevention is the “protection of health by personal and community wide efforts.”

  • Secondary prevention includes “measures available to individuals and populations for the early detection and prompt and effective intervention to correct departures from good health.”

  • Tertiary prevention “consists of the measures available to reduce or eliminate long-term impairments and disabilities, minimize suffering caused by existing departures from good health, and to promote the patient’s adjustment to irremediable conditions.”

Climate Community and Adaptation

  • Human and natural systems adapt autonomously to

    • gradual change, if it can be detected, and

    • variability (or change in variability).

  • Human systems can plan to adapt and implement their plans

Public Health and Vulnerability

  • Public health uses the concept of vulnerability in two different senses.

  • One acknowledges that advances in public health are not permanent and that deterioration of the public health infrastructure could permit the return of adverse health outcomes that are currently controlled. As a result, vulnerability depends on maintaining and improving health systems.

Public Health and Vulnerability

  • The second sense relates to specific health outcomes.

  • The classic approach to evaluating environmental health risks is a four-step assessment paradigm: hazard identification, dose (exposure) cum response assessment, exposure assessment, and risk characterization.

  • The evaluation of information on the hazards of environmental agents and exposure of sensitive receptors (e.g., humans, animals, and ecosystems) produces quantitative or qualitative statements about the probability and degree of harm.


  • To a climate researcher, vulnerability is a function of exposure and sensitivity; and exposure and sensitivity are themselves functions of adaptive capacity. In general, it is a statement about future conditions after adaptations have been implemented.

  • In the health community, vulnerability is a function of exposure to an agent and the exposure-response relationship between that exposure and a particular health outcome. In general, it is a statement about current conditions. It is preferable to have the exposure-response relationship determined before preventative measures (i.e. adaptations), are implemented.

Determinants of Adaptive Capacity

  • The range of available technological options for adaptation;

  • The availability of resources and their distribution;

  • The structure of critical institutions and the derivative allocation of decision-making authority;

  • The stock of human capital (e.g. education and personal security;

  • The stock of social capital;

  • The system’s access to risk spreading processes;

  • The ability of decision-makers to manage information; and

  • The public’s perceived attribution of the source of stress and the significance of exposure to its local manifestations.

Prerequisites for Prevention

  • An awareness that a problem exists;

  • A sense that the problem matters;

  • Understanding of what causes the problem;

  • Capability to deal with the problem; and

  • Political will to control the problem.

Table 1: Determinants of Adaptive Capacity and the Prerequisites for Prevention

Determinants of Adaptive CapPrerequisites for Prevention

Availability of OptionsCapability to control

Resources Capability to control

GovernancePolitical will

Human and social capitalUnderstanding of causes; political will

Access to risk spreading mechanismCapability to control

Managing informationUnderstanding of causes; problem matters

Public perceptionAwareness; problem matters

Table 2: Trends in Selected Health Indicators and Their Determinants in Costa Rica and the former USSR, 1960-1990

Costa Rica Former USSR

Health Indicator 1960 1990 % to Tech 1960 1990 % to Tech

Under 5 Mortality 124 14 55 39 27 40

Female Adult Mortality 203 73 48

Male Adult Mortality 246 122 59

Female Life Expectancy 65 79 59 72 74 43

Male Life Expectancy 62 74 60 65 6346

Total Fertility Rate 7 3.3 38 2.7 2.225


Income Per Capita 2001 3381 2397 7453

Female Education (yrs) 4.0 5.6 7.6 10.3

Male Education 4.1 5.5 8.5 10.8

Table 3: Socioeconomic and Health Services and Finance Indicators for Costa Rica and the Russian Federation, 1960-1990

Socioeconomic Indicator Costa Rica Russian Federation

Malnutrition (children under 5)

Males6 12

Females7 13

Health Services/Finance Indicator

Children Immunized for Measles 99% 92%

Health Expenditure

Total (% of GDP)8.5 4.8

Public Sector (% of GDP)6.3 4.1

Public Sector (% of total)74 87

Figure 1aHistorical Context – Adaptation Baseline

Figure 1bAmplifying the Historical Trend - Baseline Revisited

Figure 1c

Figure 2Building a Levy in the Fifth Period

Figure 3Smoothing Variation with an Upstream Dam

Figure 4Reducing Flood Threat by Dredging

Figure 5a:Initial Conditions

Variable 2



Variable 1

Figure 5b:Conditions in 50 Years

Variable 2


B 50

Variable 1

Figure 5c: Trajectories of Sustainability Indices

Figure 6Sustainability Indices for the Hypothetical River Example

Public Health Perspective

  • Public health seeks to identify and reduce both the background level of disease and any epidemics or outbreaks.

  • Public health does not use the terminology or the concept of a “coping range.” Use of the term suggests a range within which significant consequences are not observed.

  • Adaptation policies and measures are needed now to address current conditions.

  • Public health has recognized thresholds for centuries.

Public Health and Thresholds

  • It is difficult to generalize approaches to thresholds because each is specific to a particular exposure-response relationship.

  • Exposures that exhibit J- or U-shaped relationships with health outcomes, where either too little or too much is detrimental to health (i.e., ambient temperature and oxygen).

  • Exposures that have threshold relationships with health outcomes, where low doses are not associated with increased morbidity and mortality (i.e., arsenic and dose required to develop a case of cholera).

  • Exposures that have linear relationships with health outcomes (e.g., tobacco smoking and asbestos).

Example with A Zero Threshold:Eradication of Smallpox

  • Smallpox is a highly infectious viral disease

  • Repeated epidemics have decimated populations

  • Spread is person-to-person

  • Case fatality rate up to 25%

  • No effective treatment

  • No carrier state and no animal reservoir

  • Potent and stable vaccine available

  • 1967 eradication campaign launched

  • 1980 smallpox eradicated

    • Budget: $81 million (WHO) + ~ $232 million (country-level and bilateral assistance)

Example with a Positive Threshold:Arsenic

  • Arsenic is a metalloid that is abundant in the earth’s crust

  • Environmental exposures are primarily through food & water

    • Average daily intake 20-300 ug

  • Adverse health effects begin once an individual’s threshold body burden is exceeded

  • Groundwater standards:

    • WHO 10 ug/L

    • Bangladesh 50 ug/L

  • In Bangladesh, 28-57 million people consuming water above the standard

  • 1/100-300 people who consume water containing >50 ug/L may suffer an arsenic-related cancer (lung, bladder, liver)

Issues of Scale

  • Determinants of Adaptive Capacity operate on different scales from site to site.

    • Some are truly macro in scale - provide handles for national and even international intervention

    • This can be true even if their relevant manifestations are micro in scale

  • Prerequisites for Prevention do the same

Relationship Between Vulnerability to Natural Disasters and Income

Relationship Between Vulnerability to Natural Disasters and Income

Relationship Between Vulnerability to Natural Disasters and Income

A Caveat - Incorporating the “Second Best” into the Adaptation Baselines

  • Local scale implications are most critical.

  • Determinants and prerequisites can work to support or impede specific adaptations.

  • Relating adaptations to their efficacy in reducing exposure or sensitivity can be accomplished.

  • Looking for patterns here can uncover the macro scale implications.

  • BUT adaptation baselines must reflect existing distortions; analysis can investigate the implications of reducing their power.

  • Public Health can be a natural laboratory for examining how to do this.

A Template for Adaptation Analysis in Either Context

  • Proper vulnerability cum adaptation analyses must confront these issues directly by comparing results from a series of runs into the future.

  • One might, for example, look at the future with a given adaptation baseline (with existing distortions and impediments) and no extra stress.

  • A second set of runs into the future might then persist with the no extra stress assumption but include adjustments in adaptation that could be anticipated to reduce exposure or sensitivity to present vulnerability.

A Template for Adaptation Analysis in Either Context

  • A third set of runs could then impose the extra stress on the adaptation baseline (the first set) to see how they might work.

  • A fourth collection could repeat the analysis with anticipated adjustments (the adjusted baseline for the second set of runs).

A Template for Adaptation Analysis in Either Context

  • In every case, however, it is critical that the analysis presumes neither dumb actors who will not respond to any changes in environment nor clairvoyant actors who know everything from the very beginning.

  • The future will be fraught with uncertainty, just like the present; and any considerations of adaptation must recognize this fact.

  • A complete vulnerability cum adaptation analysis of a particular region or sector would contemplate a range of “not-implausible”.

Applying the Template - Coastal Storms and Sea Level Rise

  • S1 - Storm scenarios with current practices

  • S2 - Storm scenarios with enlarged set-backs

  • S3 - Rerun S1 with climate induced sea level rise and changes in storm patterns - frequency and/or intensity

  • S4 - Rerun S2 with climate change

  • S3 vs S1 - Cost of climate change along current baseline

  • S2 vs S4 - Cost of climate change with modified baseline

  • S1 vs S2 - Value of modification absent climate change

  • S3 vs S4 - Value of modification with climate change

Synthesis and Conclusions

  • Vulnerability means different things in the two communities.

  • Approaches can still be comparable.

  • Determinants hypotheses supported by health understanding of the prerequisites for prevention.

  • Any thoughts?

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