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CGE Training materials - VULNERABILITY AND ADAPTATION Assessment CHAPTER 8. Human Health. 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

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Cge training materials vulnerability and adaptation assessment chapter 8

CGE Training materials - VULNERABILITY AND ADAPTATION AssessmentCHAPTER 8

Human Health


Objectives and expectations

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


Outline

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


Topics

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.


Overview of the potential health impacts of climate variability and change

Overview of the Potential Health Impacts of Climate Variability and Change


Climate change and health

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.


Cge training materials vulnerability and adaptation assessment chapter 8

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


Cge training materials vulnerability and adaptation assessment chapter 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


Potential health impacts from environmental changes

Potential Health impacts from Environmental Changes


Temperature

Temperature


Cge training materials vulnerability and adaptation assessment chapter 8

Temperature

CSIRO 2006: Climate Change in the Asia/Pacific Region


Temperature1

Temperature


Cge training materials vulnerability and adaptation assessment chapter 8

Temperature

Temperature Extremes in Bhutan, 1800s –2010


Direct impacts to health from heat

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.


Cge training materials vulnerability and adaptation assessment chapter 8

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


Impacts to health from increased temperatures

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.


Storms floods

STORMS/FlooDS


Storms flooding

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


2012 flood in pakistan september

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


Health impacts of floods

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.


Flooding direct health effects

Flooding: Direct Health Effects


Flooding indirect health effects

Flooding: Indirect Health Effects


Drinking water

Drinking Water


Climatic change drinking water supply

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.


Climatic change drinking water supply1

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


Air quality

Air Quality


Air quality1

Air quality


China haze 10 january 2003

China Haze 10 January 2003

Source: NASA


Climatic change air quality

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.


Climatic change air quality1

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.


Cge training materials vulnerability and adaptation assessment chapter 8

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.


Vector borne disease

Vector-borne disease


Malaria in vanuatu

Malaria in Vanuatu

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


Mosquito borne disease environmental changes

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.


Mosquito borne disease human factors

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.


Mosquito borne disease water management

Mosquito-borne-disease: Water Management

Breeding is also influenced by:

  • Water hoarding/storage:

    • Rainwater tanks

    • Uncovered containers

  • Dams

  • Irrigation

  • Groundwater recharge.


Climate change and malaria under different scenarios 2080

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


Food security

Food security


Food production land

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


Food production fisheries

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.


Food safety

Food Safety


Food safety1

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.


Diarrhoeal diseases

DiarrhOealdiseases


Effect of temperature variation on diarrheal incidence in lima peru

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


Cge training materials vulnerability and adaptation assessment chapter 8

El Nino Events and the possible impact on diseases: Cholera

El Nino starts

El Nino stops


Social impacts

Social Impacts


Social impacts1

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


Social impacts2

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.


Social impacts3

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.


Resources

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 >


Assessing the vulnerability of human health to climate change

Assessing the Vulnerability of Human Health to Climate Change

Predictive Tools for the Future


Methods required to assess the vulnerability of human health

Methods Required to Assess the Vulnerability of Human Health

  • 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.

Source: Kovats, et al., 2003


Issues to be considered

Issues to be Considered

  • 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 may come from existing conditions such as diarrhoea, malnutrition, and vector-borne diseases

  • Uncertainties need to be considered and include:

    • Uncertainties in projections

    • Effectiveness of interventions

    • Changes in non-climatic factors.

Source: Campbell-Lendrum, et al., 2003


Health impact assessment hia

Health Impact Assessment (HIA)

  • The World Health Organization (WHO) defines a Health Impact Assessment (HIA) as:

    “A combination of procedures or methods by which a policy, programme or project may be judged as to the effects it may have on the health of a population.”

    • The HIA was initiated worldwide to facilitate the assessment of health issues in new proposals


The aim of the hia

The Aim of the HIA

“To enhance the potentially beneficial health effects of a policy, programme or proposal and to mitigate potentially negative health risks and costs.”


The benefits of the health impact assessment hia

The Benefits of the Health Impact Assessment (HIA)

  • It facilitates a comprehensive assessment of the impact of climate change on human health

  • The ability to forecast the potential health impacts of new developments, policies and plans

  • It is a process incorporating predictive and evaluativeelements

  • This tool can be easily incorporated into current impact assessment procedures.


The health impact assessment process

The Health Impact Assessment Process

  • The strength of the process comes from its underlying principles and values:

    • Sustainability

    • Equity

    • Democracy

    • Ethical use of evidence

    • Promotion of health

  • The process can be applied to a wide range of activities such as new policies, projects, plans etc.


Hia the health determinants

HIA: the Health Determinants

  • Health is more than the absence of illness or disease; it includes the physical, mental, social and spiritual well-being of people.

  • It is affected by social, economic and environmental factors, as well as individual behaviours and heredity.


Hia the health determinants1

HIA: the Health Determinants

  • Individual/family:

    • Biological factors

    • Lifestyle

    • Personal circumstances

  • Environment:

    • Physical

    • Social

    • Economic/financial

  • Institutional access:

    • Health and other services

    • Economic conditions

    • Public policy.


The steps in the process of a hia

The Steps in the Process of a HIA

  • The HIA, like other forms of impact assessment, is a formalized collaborative process used to consider potential impacts (positive and negative) from activities during their planning stages

  • The process includes the following:

    • Screening

    • Scoping

    • Profiling

    • Risk assessment

    • Risk management

    • Decision-making

    • Evaluation.


Use of the hia process for climate change

use of the HIA process for climate change


Cge training materials vulnerability and adaptation assessment chapter 8

The HIA Process in the Vulnerability Assessment

SCREENING

  • Does the situation require a HIA?

  • Identify health impacts

  • Set boundaries

  • Population

  • Vulnerable groups

  • What are the risks/benefits?

  • Minimize risks

  • Maximize benefits.

SCOPING

PROFILING

RISK ASSESSMENT

RISK MANAGEMENT


Project elements

Project Elements

Requires:

  • Identification of potential direct and indirect health impacts from environmental change, assuming current controls and 2030 projections of climate variables

  • Understanding of the key current controls or coping strategies:

    • Assessment of their effectiveness in terms of general population, vulnerable groups and vulnerable regions

  • Determination of current knowledge and gaps

  • Identification of linkages with other sectors

  • Identification of opportunities for adaptation.


Climate change and health v a project components

Climate Change and Health V&A Project Components

  • Identify key stakeholders and project range

  • Determine sectors and data requirements

  • Establish climate change scenario

  • Provide background information for participants

  • Undertake workshops:

    • Scope of impacts:

      • Environmental changes

      • General population

      • Vulnerability: groups, services and regions

    • Current activities (coping capacity)

    • Risk assessment

    • Adaptation responses.


Climate change and health v a project

Climate Change and Health V&A Project

  • A step by step guidance to undertaking climate change and health vulnerability assessments has been developed:

    • Climate Change, Vulnerability and Health: A Guide to assessing and addressing health impacts.

    • This document can be obtained from <http://ehia.curtin.edu.au/>


Consultative approach

Consultative Approach

  • Consult stakeholders representing as many sectors as possible

  • Important to recognize that most activities that impact on health are not actually addressed by the health sector

  • Need to establish integrative processes.


Health impact assessment of climate change

Health impact assessment OF climate change


Questions that w ill be addressed

Questions That Will be Addressed

  • What is the current population profile of the country or region?

  • What diseases are important in the country or region including climate-sensitive disease?

    • 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?


  • 1 understanding populations

    1. Understanding Populations


    Population data sources

    Population Data Sources

    • United Nations: Thematic Area - Population, provides population statistics for every country.

      • <http://www.un.org/en/development/progareas/population.shtml>

    • Economic Commission for Africa, provides specific population data.

      • <http://www.uneca.org/popia/>

    • Both provide extensive demographic information which can be used to assess vulnerability.

    • Others:

      • US AID: <http://www.measuredhs.com/>

      • City Population: <http://www.citypopulation.de/Africa.html>


    Population data

    Population data

    • The implications of country numbers and distribution are important in determining health impacts and their responses.

    Ten Largest Countries in Population (2011)

    Source: U.S. Census Bureau, International Data Base


    The 20 largest urban areas in the world

    The 20 Largest Urban Areas in the World

    * DemographiaWorld Urban Areas and Population Projection. 7th Annual edition. April, 2011. www.demographia.com


    Nauru

    Nauru

    • Total expenditure on health per capita (Intl $, 2010)264

    • Total expenditure on health as % of GDP (2010)11.2

    Source: Nauru Bureau of Statistics


    Bhutan

    Bhutan


    Vulnerability

    Vulnerability


    Vulnerability1

    Vulnerability

    Degree to which individuals and systems are susceptible to, or unable to cope with, the adverse effects of climate change, including climate variability and extremes

    Integration of:

    Need to identify and address the vulnerability components individually and integrated for specific sectors and communities.

    Regional

    Economic

    Social

    Infrastructure

    & Services

    Overall Vulnerability


    Vulnerable populations

    Vulnerable populations

    • Elderly

    • Children (immature immune response)

    • Socio-economically disadvantaged

    • Women, especially pregnant and breastfeeding women

    • The obese

    • Those who are not acclimatized, e.g. new arrivals

    • Those who have underlying medical conditions or immuno-compromised especially cardiovascular disease

    • Athletes and other participants in outdoor recreational activities

    • Manual labourers, outdoor workers

    • Mentally ill, disabled and homeless

    • Physically unfit – reduced vital capacity


    Other drivers of vulnerability

    Other Drivers of Vulnerability

    • Population density

    • Urbanization

    • Public health infrastructure

    • Other infrastructure:

      • Energy

      • Water

      • Transport

    • Economic and technological development.


    2 health data

    2. Health Data


    Health data sources

    Health Data Sources

    World Health Organization Office for the region:

    <http://www.afro.who.int/>

    Health Situation Analysis in the African Region: Atlas of Health Statistics, 2011

    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>


    Health data sources other

    Health Data Sources – Other

    Ministry of Health:

    Disease surveillance/reporting branch

    UNICEF at <http://www.unicef.org>

    CRED-EMDAT provides data on disasters

    <http://www.em-dat.net>

    Mission hospitals

    Government district hospitals.


    3 establish a climate scenario

    3. Establish a climate scenario


    Establish scenario of potential climate projection

    Establish Scenario of Potential Climate Projection:

    • Obtain climate data from a range of sources including the IPCC:

      • Use 2030 as a starting point for health impacts

        Example:

    • Expected average temperature increases: (e.g. 10 to 30C)

    • Increases in the number of days over 350C (heatwave temp)

      • Choose regions if necessary

    • Rainfall changes in:

      • Seasonal changes across regions

    • Sea-level increases by x cm by 2030 and y cm by 2100

    • Extreme weather events such as:

      • Heatwaves – more per year

      • Droughts – more frequent and severe

      • Bushfires – increased risk

      • Flooding – increased intensity

      • Storms – increased intensity

      • Tropical cyclones – increased intensity.


    4 environmental changes

    4. Environmental changes


    Local changes a ffecting h ealth

    Local Changes Affecting Health

    It is important to have a good understanding of local predicted changes in relation to:

    • Biophysical environment:

      • Encompassing major impacts related to physical environment, including temperature, water quality, air quality and biodiversity

    • Social environment:

      • Encompassing the wide range of social impacts, population displacement and mental health impacts

    • Service and infrastructure:

      • The range of impacts as it relates to services, infrastructure and economics, including resource availability and access to a range of health, emergency and other services

    • Environmental diseases:

      • Impacts related to production of food, vector-borne and food-borne disease and other environmental diseases.


    5 determining health impacts

    5. Determining health impacts


    Determine health impacts assume only current controls

    Determine Health Impacts:- Assume only current controls


    6 coping capacity

    6. Coping Capacity


    Coping capacity

    Coping Capacity

    Describe what is being implemented now to minimize negative effects


    7 health risk assessment

    7. Health Risk Assessment


    Understanding risk

    Understanding Risk

    Risk is:

    • The potential for realization of unwanted negative consequences of an event

    • The probability of an adverse outcome

    • The downside of a gamble (the total gamble must be considered).

      Safe means “without risk”:

    • There is usually no such thing as zero risk.


    Risk analysis activities

    Risk Analysis Activities:

    • Risk assessment:

      • The systematic characterization of potential adverse health effects resulting from human exposure to hazardous agents

    • Risk management:

      • The process of weighing policy alternatives and selecting the most appropriate regulatory action based on the results of risk assessment and social, economic, and political concerns

    • Risk communication:

      • The process of making risk assessment and risk management information comprehensible to lawyers, politicians, judges, business and labour, environmentalist and community groups (public).


    Risk assessments

    Risk Assessments

    Usually consider the relationship between the consequences that might arise from a particular activity and the likelihood of the activity actually occurring.

    Risk = Consequence x Likelihood

    The rankings may be of the form:

    Consequences- catastrophic, major, moderate, minor, insignificant

    Likelihood - almost certain, likely, possible, unlikely, rare.


    Risk perception

    Risk perception


    Risk perception1

    Risk Perception

    Perception of risk is related to many factors:


    Risk perception2

    Risk Perception


    Risk assessment aims

    Risk Assessment Aims

    • To carry out a qualitative risk assessment of the identified potential health impacts

    • To identify information that may still be required to improve or enable assessment of potential health impacts

    • To provide a comparison of the risks of health impacts to assist in prioritizing in decision-making processes.


    Health risk assessment process

    Health Risk Assessment Process

    • The potential health impacts of climate change have been identified

    • A risk assessment of each impact is carried out to determine level and likelihood of risk:

      • This should be undertaken by experts in each of the areas of impacts (see next slides)

    • Sufficient detail should be obtained to progress to health risk management responses:

      • These will be either adaptation responses or the need for further information.


    Health impacts less complex

    Health Impacts -Less Complex

    • These health impacts have clear climate-health relationships and supporting empirical observations:

      • Extreme events

      • Temperature related impacts

      • Water-borne

      • Vector-borne

      • Air quality

      • Food-borne.


    Health impacts indirect complex i mpacts

    Health Impacts - Indirect, Complex Impacts

    • These health impacts have complex relationships with other factors that must be taken into consideration:

      • Food production

      • Biodiversity and others

      • Infrastructure

      • Social

        • Dislocation

        • Mental health

        • Community impacts

        • Lifestyle/behavioural.


    Consequence scale

    Consequence Scale


    Likelihood scale

    Likelihood Scale


    Cge training materials vulnerability and adaptation assessment chapter 8

    Consequence x Likelihood = Risk Priority Level


    Example of table

    Example of Table


    Risk prioritization

    Risk prioritization


    Risk prioritization1

    Risk Prioritization

    • The risk levels are ranked from highest to lowest once the levels for each impact have been determined

    • The resultant list provides direction on priorities for action:

      • Provides clarity for decision makers.


    Management actions

    Management Actions


    8 adaptation measures

    8. Adaptation Measures


    Stages of adaptation

    Stages of Adaptation

    • Primary – prevent onset of health impact

    • Secondary – preventative measures taken in response to early evidence of impact

    • Tertiary – actions to lessen the health effects

    DECREASING EFFECTIVENESS


    Health impact pathway

    Health Impact Pathway

    Extreme rainfall and flooding

    Overflow of waste from septic tanks into flood waters

    Human contact with flood water

    Gastro intestinal diseases

    Prevent/reduce flooding

    Prevent/reduce overflow of waste

    Avoid human contact with water

    Correct medical treatment


    Health impact pathway1

    Health Impact Pathway

    • Each link in the chain is:

      • A potential for vulnerability

      • An opportunity for adaptation.

    • In terms of adaptation:

      • The higher up the chain the better

      • The more links we weaken the better.


    Types of adaptation

    Types of Adaptation

    Adaptation responses may be of the form:

    • Legislative or regulatory

    • Public education or communication

    • Surveillance and monitoring

    • Ecosystem intervention

    • Infrastructure development

    • Technological/engineering

    • Health intervention

    • Research/ further information


    Categories

    Categories

    The adaptation responses for health will fall into the following categories:

    • Direct impacts of extreme events

    • Direct impacts of heat events and temperature

    • Water related

    • Vector-borne

    • Air quality

    • Food-borne

    • Food production

    • Social

    • Generic.


    Exercise format

    Exercise Format

    A series of possible adaptation measures have been provided.

    A number of questions need to be addressed:

    • Are these adaptation measures relevant?

    • What is our current status of each relevant adaptation measure, particularly with reference to vulnerable regions or groups?

      • Inadequate

      • Adequate

      • Being developed

      • Not in place.

    • For each adaptation measure:

      • How can these be implemented?

        • Adjustment of existing measures

        • Development of new measures

      • Who should be involved in implementation?

        • Lead agency/sector

        • Supporting agencies/sectors

    • What other adaptations are needed?

      • Current status?

      • How and who to implement?


    Example of table1

    Example of Table


    Health report and action plan

    Health Report and Action Plan

    • Compilation of the outcomes from each of the eight stages of the V&A assessment.

    • The Report should include:

      • Documentation of the methodologywhich provides enough details to enable readers to understand the process used

      • Acknowledgement of all participants/stakeholders during consultation

      • Text to explain the content of each section

      • Development of an action plan to progress the identified adaptations.


    Tools available for use for specific diseases

    Tools available for use for specific diseases

    Methods to Determine the Current Burden of Climate-Sensitive Diseases


    Cge training materials vulnerability and adaptation assessment chapter 8

    Malaria in Africa

    The Mapping Malaria Risk in Africa (MARA/ARMA) website <http://www.mara.org.za> contains prevalence and population data, and regional and country-level maps.


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA Environmental Data for Malaria


    Climate and stable malaria transmission

    Climate and Stable Malaria Transmission

    • Climate suitability is a primary determinant of whether the conditions in a particular location are suitable for stable malaria transmission

    • A change in temperature may lengthen or shorten the season in which mosquitoes or parasites can survive

    • Changes in precipitation or temperature may result in conditions during the season of transmission that are conducive to increased or decreased parasite and vector populations.


    Climate and stable malaria transmission continued

    Climate and Stable Malaria Transmission (continued)

    • Changes in precipitation or temperature may cause previously inhospitable altitudes or ecosystems to become conducive to transmission. Higher altitudes that were formerly too cold, or desert fringes that were previously too dry for mosquito populations to develop, may be rendered hospitable by small changes in temperature or precipitation.


    Mara arma model

    MARA/ARMA Model

    • Biological model that defines a set of decision rules based on minimum and mean temperature constraints on the development of the Plasmodium falciparum parasite and the Anopheles vector, and on precipitation constraints on the survival and breeding capacity of the mosquito.

    • CD-ROM $5 for developing countries or can download components from website: www.mara.org.za


    Relationship between temperature and daily survivorship of anopheles

    Relationship between Temperature and Daily Survivorship of Anopheles


    Relationship between temperature and time required for parasite development

    Relationship between Temperature and Time Required for Parasite Development


    Proportion of vectors surviving time required for parasite development

    Proportion of Vectors Surviving Time Required for Parasite Development


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA: Distribution of Endemic Malaria in Africa


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA: Duration of the Malaria Transmission Season in Africa


    Mozambique endemic malaria season length

    Mozambique – Endemic Malaria Season Length


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA: predicted Prevalence Rates of Malaria in West Africa


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA: Populations at Risk From Malaria in Africa


    Mozambique endemic malaria prevalence

    Mozambique – Endemic Malaria Prevalence


    Mozambique endemic malaria prevalence by age

    Mozambique – Endemic Malaria Prevalence by Age


    Cge training materials vulnerability and adaptation assessment chapter 8

    MARA/ARMA: Possible Applications


    Reference

    Reference

    • Ebi et al. Climate Suitability for Stable Malaria Transmission in Zimbabwe Under Different Climate Change Scenarios. Geneva: WHO, 2005

    Objective: to look at the range of responses in the climatic suitability for stable falciparum malaria transmission under different climate change scenarios in Zimbabwe


    Malaria in zimbabwe

    Patterns of stable transmission follow pattern of precipitation and elevation (which in turn influences temperature)

    > 9,500 deaths and 6.4 million cases between 1989 and 1996

    Recent high-altitude outbreaks

    Malaria in Zimbabwe

    Cases by Month

    Source: South African Malaria Research Programme

    Source: Ebi, et al., 2005


    Methods

    Methods

    • Baseline climatology determined

    • COSMIC was used to generate Zimbabwe-specific scenarios of climate change; changes were added to baseline climatology

    • Outputs from COSMIC were used as inputs for the MARA/ARMA (Mapping Malaria Risk in Africa) model of climate suitability for stable Plasmodium falciparum malaria transmission.

    Source: Ebi, et al., 2005


    Data inputs

    Data Inputs

    • Climate data:

      • Mean 60 year climatology of Zimbabwe on a 0.05° lat/long grid (1920–1980)

      • Monthly minimum and maximum temperature and total precipitation

    • COSMIC output:

      • Projected mean monthly temperature and precipitation (1990–2100).

    Source: Ebi, et al., 2005


    Climate in zimbabwe

    Climate in Zimbabwe

    • Rainy warm austral summer October-April

    • Dry and cold May-September

    • Heterogeneous elevation-dictated temperature range

    • Strong inter-annual and decadal variability in precipitation

    • Decrease in precipitation in the last 100 years (about 1% per decade)

    • Temperature changes 1933–1993:

      • Increase in maximum temperatures +0.6°C

      • Decrease in minimum temperatures -0.2 °C.

    Source: Ebi, et al., 2005


    Global climate models

    Global Climate Models

    • Canadian Centre for Climate Research (CCC)

    • United Kingdom Meteorological Office (UKMO)

    • Goddard Institute for Space Studies (GISS)

    • Henderson-Sellers model using the CCM1 at NCAR (HEND).

    Source: Ebi, et al., 2005


    Scenarios

    Scenarios

    • Climate sensitivity:

      • High = 4.5°C

      • Low = 1.4°C

    • Equivalent carbon dioxide (ECD) analogues to the 350 ppmv and 750 ppmv greenhouse gas (GHG) emission stabilization scenarios of the IPCC second assessment report (SAR)

    Source: Ebi, et al., 2005


    Assumptions

    Assumptions

    • No change in the monthly range in minimum and maximum temperatures

    • Permanent water bodies do not meet the precipitation requirements

    • Climate did not change between the baseline (1920–1980) and 1990

    Source: Ebi, et al., 2005


    Fuzzy logic value

    Fuzzy Logic Value

    • Fuzzy logic boundaries established for minimum, mean temperature, and precipitation

      • 0 = unsuitable

      • 1 = suitable for seasonal endemic malaria .

    Source: Ebi, et al., 2005


    Assignment of fuzzy logic values to climate variables

    Assignment of Fuzzy Logic Values to Climate Variables


    Climate suitability criteria

    Climate Suitability Criteria

    • Fuzzy values assigned to each grid:

      • For each month, determined the lowest fuzzy value for precipitation and mean temperature

    • Determined moving 5-month minimum fuzzy values

    • Compared these with the fuzzy value for the lowest monthly average of daily minimum temperature

    • Assigned the lowest fuzzy value.

    Source: Ebi, et al., 2005


    United kingdom met office ukmo

    United Kingdom Met Office (UKMO)

    • S750 ECD stabilization scenario with 4.5˚C climate sensitivity

    • Model output :

      • Precipitation:

        • Rainy season (ONDJFMA) increase in precipitation of 8.5% from 1990 to 2100

      • Temperature:

        • Annual mean temperature increase by 3.5°C from 1990 to 2100, with October temperatures increasing more than July temperatures.

    Source: Ebi, et al., 2005


    Baseline

    Baseline

    Source: Ebi, et al., 2005


    Cge training materials vulnerability and adaptation assessment chapter 8

    2025

    Source: Ebi, et al., 2005


    Cge training materials vulnerability and adaptation assessment chapter 8

    2050

    Source: Ebi, et al., 2005


    Cge training materials vulnerability and adaptation assessment chapter 8

    2075

    Source: Ebi, et al., 2005


    Cge training materials vulnerability and adaptation assessment chapter 8

    2100

    Source: Ebi, et al., 2005


    Conclusions

    Conclusions

    • Assuming no future human-imposed constraints on malaria transmission, changes in temperature and precipitation could alter the geographic distribution of stable malaria transmission in Zimbabwe

    • Among all scenarios, the highlands become more suitable for transmission

    • The low-veld and areas currently limited by precipitation show varying degrees of change

    • The results illustrate the importance of using several climate scenarios.

    Source: Ebi, et al., 2005


    Other models

    Other Models

    • MIASMA:

      • Global malaria model

    • CiMSiM and DENSim for dengue:

      • Weather and habitat-driven entomological simulation model that links with a simulation model of human population dynamics to project disease outbreaks

      • <http://daac.gsfc.nasa.gov/IDP/models/index.html>


    Sudan national communication

    Sudan National Communication

    • Using an Excel spreadsheet, modelled malaria based on relationships described in MIASMA

    • Calculated monthly changes in transmission potential for the Kordofan Region for the years 2030-2060, relative to the period 1961–1990 using the IPCC IS92A scenario, simulation results of HADCM2, GFDL, and BMRC, and MAGICC/SCENGEN.


    Sudan projected increase in transmission potential of malaria in 2030

    Sudan – Projected Increase in Transmission Potential of Malaria in 2030


    Sudan projected increase in transmission potential of malaria in 2060

    Sudan – Projected Increase in Transmission Potential of Malaria in 2060


    Sudan malaria projections

    Sudan – Malaria Projections

    • Malaria in Kordofan Region could increase significantly during the winter months in the absence of effective adaptation measures:

      • The transmission potential during these months is 75 per cent higher than without climate change

    • Under HADCM2, the transmission potential in 2060 is more than double the baseline

    • Transmission potential is projected to decrease during May-August due to increased temperature.


    Adaptation options for malaria

    Adaptation Options for Malaria


    Screening the theoretical range of response options malaria

    Screening the Theoretical Range of Response Options – Malaria

    Source: Ebiand Burton, 2008


    Analysis of the practical range of response options malaria

    Analysis of the Practical Range of Response Options – Malaria

    Source: Ebiand Burton, 2008


    Global projections of health impacts

    GLOBAL PROJECTIONS OF HEALTH IMPACTS


    Estimating potential future health impacts

    Estimating 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.

    Source: Kovatset al., 2003


    Example estimating the global health impacts of climate change

    Example: 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 GHG emissions)?

    Source: Campbell-Lendrumet al., 2003


    Comparative risk assessment

    Time

    2020s

    2050s

    2080s

    2020s

    2050s

    2080s

    Comparative Risk Assessment

    GHG 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

    Source: Campbell-Lendrumet al., 2003


    Selection of health outcomes

    Selection of Health Outcomes

    Criteria used can include diseases that are:

    • Sensitive to climate variation

    • Important global health burden.

      Quantitative models are available at the global scale:

      • Malnutrition (prevalence)

      • Diarrhoeal disease (incidence)

      • Vector-borne diseases – dengue and falciparum malaria

      • Inland and coastal floods (mortality)

      • Heat and cold-related cardiovascular diseasemortality

    Source: Campbell-Lendrumet al., 2003


    Cge training materials vulnerability and adaptation assessment chapter 8

    Projected Relative Risk of Flooding

    Source: WHO, 2003


    Cge training materials vulnerability and adaptation assessment chapter 8

    Projected Relative Risk of Diarrheoa

    Source: WHO, 2003


    Cge training materials vulnerability and adaptation assessment chapter 8

    Estimated Death and Disability Adjusted Life years Lost(DALYs) Attributable to Climate Change

    2000

    Floods

    2020

    Malaria

    Diarrhea

    Malnutrition

    120

    100

    80

    60

    40

    20

    0

    2

    4

    6

    8

    10

    Deaths (thousands)

    DALYs (millions)

    Source: Campbell-Lendrumet al., 2003


    Environmental burden of disease

    Environmental Burden of Disease

    • Prüss-Üstün A, Mathers C, Corvalan C, and Woodward A. 2003. Introduction and Methods: Assessing the Environmental Burden of Disease at National and Local Levels. available at <http://www.who.int/peh/burden/burdenindex.html>


    Cge training materials vulnerability and adaptation assessment chapter 8

    Additional Information: Vulnerability and Adaptation (V&A) Framework for Health

    Source: WHO, et al., 2008


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