The integrated Assessment of Environmental Change and Public Health

1. 台大環衛上課講義05/22/95 The integrated Assessment of Environmental Change and Public Health

2. (Aron and Patz, 2001, Chap.13) Keep in mind “Population Vulnerability”, which includes individual, community and geographical factors

3. Integrated Assessment • A structured process of dealing with complex issues, using knowledge from various scientific disciplines and/or stakeholders, such that integrated insights are made available to decision makers • System modeling: simulation of the response of the physical, biological, and/or social system to changes in inputs, assumptions, and decisions • Decision evaluation: comparison of alternative decisions in terms of their risks and performance on important objectives and application of value judgments by users to rank or screen alternatives

4. Guidelines • Pose the question: what is the possible policy relevance of this model and this analysis? • Explicit consideration of those tradeoffs among multiple objectives • Pay attention to the analysis and communication of uncertainty • Begin simply. Refrain from focusing extensively on those feasible outcomes • 先著重科學課題之理解，再推衍至政策擬定

5. 科學問題研究方法 • 資料分析 • 現有長期資料庫 • 建立新資料庫 • 實際觀測 • 傳統觀測 • 新技術或新平台的觀測(飛機觀測、遙測) • 模式分析及預測 • 氣候模式 • 大氣化學模式(空氣污染模式) • 雲微物理模式

6. 步驟 • 提出台灣環境變遷對公共衛生衝擊的重要課題 • 為何重要? 影響層面多大? 影響人數多寡? 影響地區範圍? Health outcome嚴重性? • 何種研究方法最適合探討此一課題? • 有無合適資料庫? 若無，如何架構新資料庫? 有無新的技術? 與哪些領域重疊? 能否發展出新的技術或平台? • 與其他相關領域專家密集討論上述兩點，調整研究方向及研究方法 • 記住研究的是動態變化的環境

7. (Aron and Patz, 2001, Chap.5)

8. (Aron and Patz, 2001, Chap.9)

9. (Aron and Patz, 2001, Chap.9)

10. (McMichael 2001, Chap.10)

11. (Aron and Patz, 2001, Chap.5)

12. (Aron and Patz, 2001, Chap.5)

13. Table5.1(continue) (Aron and Patz, 2001, Chap.5)

14. Research Characteristics and Challenges (1) • Anticipated anthropogenic climate change will be a gradual and long-term process. This projected change in mean climate conditions is likely to be accompanied by regional changes in the frequency of extreme events • Changes in particular health outcomes already may be occurring or soon may begin to occur, in response to recent and ongoing changes in world climate • Identification of such health effects will require carefully planned epidemiological studies

15. Research Characteristics and Challenges (2) • In epidemiological studies, there often are difficulties in estimating the role of climateper se as a cause of change in health status. Changes in climate typically are accompanied byvarious other environmental changes • Because most diseases have multiple contributory causes, it often is difficult to attribute causation between climatic factors and other coexistent factors. For example, in a particular place, clearing of forest for agriculture and extension of irrigation may coincide with a rise in regional temperature • Because all three factors could affect mosquito abundance, it is difficult to apportion between them the causation of any observed subsequent increase in mosquitoborne infection. “confounding of effects”

16. Research Characteristics and Challenges (3) • It is equally important to recognize that certain factors can modify the vulnerability of a particular population to the health impacts of climate change or variability • This type of effect-modification (or “interaction”) can be induced by endogenous characteristics of the population (such as nutritional or immune status) or contextual circumstances that influence the “sensitivity” of the population’s response to the climate change (such as unplanned urbanization, crowding, or access to air conditioning during heat waves) • Deliberate social, technological, or behavioral adaptations to reduce the health impacts of climate change are an important category of effect-modifying factor

17. Research Characteristics and Challenges (4) • Simulation of scenario-based health risks with predictive models entails three challenges. These challenges relate to validity, uncertainty, and contextual realism: • Valid representation of the main environmental and biological relationships and the interacting ecological and social processes that influence the impact of those relationships on health is difficult • A balance must be attained between complexity and simplicity

18. Research Characteristics and Challenges (5) • There are various sources of (largely unavoidable) uncertainty. There is uncertainty attached to the input scenarios of climate change (and of associated social, demographic, and economic trends) • Subsequently, there are three main types of uncertainties in the modeling process itself: “normal” statistical variation (reflecting stochastic processes of the real world); uncertainty about the correct or appropriate values of key parameters in the model; and incomplete knowledge about the structural relationships represented in the model

19. Research Characteristics and Challenges (6) • Climate change is not the sole global environmental change that affects human health. Various largescale environmental changes now impinge on human population health simultaneously, and often interactively (Watson et al., 1998) • An obvious example is vector-borne infectious diseases, which are affected by climatic conditions, population movement, forest clearance and land-use patterns, freshwater surface configurations, human population density, and the population density of insectivorous predators (Gubler, 1998b) • each change in health outcome must be appropriately apportioned between climate and other influences, which is very difficult

22. The health impacts of natural disasters (Noji, 1997) • Physical injury • Decreases in nutritional status, especially in children • Increases in respiratory and diarrheal diseases resulting from crowding of survivors, often with limited shelter and access to potable water • Impacts on mental health, which in some cases may be long-lasting • Increased risk of water-related diseases as a result of disruption of water supply or sewage systems • Release and dissemination of dangerous chemicals from storage sites and waste disposal sites into floodwaters.

24. 台灣區域性氣候開始變化及其影響之時間 • 台灣的汚染物單位面積排放量1985年以後就達世界第一! • 對台灣區域性氣候的影響應發生在1975~1985。 • 對生態、公衛的影响也應在~1975以後最容易觀測到。

25. Local issues • From newspapers