Vulnerability and Adaptation Assessments HandsOn Training Workshop Human
Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector Kristie L. Ebi, Exponent Health Group 1 A. 1
Outline 1. 2. 3. 4. Overview of the potential health impacts of climate variability and change Health data to determine the current burden of climate-sensitive diseases Methods and tools for V&A assessment in the health sector Methods for determining a health adaptation baseline
Overview of the Potential Health Impacts of Climate Variability and Change 1 A. 3
Topics n n Pathways for weather to affect health Potential health impacts of climate change n Extreme weather events n n n El Nino and disease Temperature Floods Vector-borne diseases Diseases related to air pollution Diarrheal diseases
Pathways from Driving Forces to Potential Health Impacts Corvalan et al. , 2003
Pathways for Weather to Affect Health: Example = Diarrheal Disease Distal Causes Temperature Humidity Precipitation Living conditions (water supply and sanitation) Food sources and hygiene practices Proximal Causes Infection Hazards Survival/ replication of pathogens in the environment Consumption of contaminated water Contamination of water sources Consumption of contaminated food Contamination of food sources Contact with infected persons Rate of person to person contact WHO Health Outcome Incidence of mortality and morbidity attributable to diarrhea Vulnerability (e. g. age and nutrition)
IPCC TAR–Potential Health Impacts of Climate Change n n Any increase in climate extremes (storms, floods, cyclones) could increase the risk of infectious disease epidemics, particularly in low-income countries Increase in heatwaves, often exacerbated by increased humidity & urban air pollution Increase in the geographic range of potential transmission of malaria & other vector-borne diseases Increase in water- and food-borne diseases The severity of impacts will depend on the capacity to adapt & its effective deployment
Drivers of Health Issues n n n Population density Urbanization Public health infrastructure Economic and technologic development Environmental conditions Populations at risk n n Poor Children Increasing population of elderly residents Immunocompromised
ENSO and Disease Kovats et al. , 2003
Exploring Linkages Between ENSO and Human Health
Dengue Epidemics in South Pacific 1970 -1999
El Nino starts Dr. Githeko, personal communication El Nino stops
Climate Change May Entail Changes in Variance, as Well as Changes in Mean Folland et al. , 2001
Temperature Extremes in the Caribbean, 1955 -2000
Climate Variability and Change Impacts in the Caribbean DATE COUNTRY EVENT DEATH ESTIMATED COSTS (US$ million, 1998) 1974 Honduras Hurricane Fifi 7, 000 1, 331 1982/3 Bolivia, Ecuador, Peru El Niño 0 5, 661 1997/98 Bolivia, Colombia, Ecuador, Peru El Niño 600 7, 694 1998 Central America Hurricane Mitch 9, 214 6, 008 1998 Dominican Republic Hurricane Georges 235 2, 193 Cuba Hurricane Georges 6 N/A 1999 Venezuela Landslide 25, 000 N/A Fuente: ECLAC, América Latina y El Caribe: El Impacto de los Desastres Naturales en el Desarrollo, 1972 -1999, LC/MEX/L. 402; OFDA, Venezuela- Floods, Fact Sheet #10, 1/12/ 2000.
Mechanisms by Which Above Average Rainfall Can Affect Health Event Description Potential Health Impact Heavy precipitation “Extreme event” Increased or decreased mosquito abundance Flood River/stream over Above plus contamination of tops its banks surface water Property or crops damaged Flood Catastrophic flood/disaster Kovats et al. , 2003 Above plus increased risk of respiratory and diarrhoeal disease, injuries, etc.
Health Impacts of Floods n n n Immediate deaths and injuries Nonspecific increases in mortality Infectious diseases – leptospirosis, hepatitis, diarrheal, respiratory, and vector-borne diseases Exposure to toxic substances Mental health effects Increased demands on health systems Philip Wijmans, LWF/ACT Mozambique, March 2000
Mechanisms by Which Drought Can Affect Health Description Potential Health Impact Soil moisture decreases Changes in vector abundance Decreased crop production Depends on socioeconomic factors Reduction in food or water supply and quality Food shortage, illness, malnutrition, increased risk of disease Food shortage leading to deaths Death, starvation, risks associated with population displacement Kovats et al. , 2003
Examples of Environmental Changes and Possible Effects on Infectious Diseases Environmental Change Example Disease Pathway of Effect Dams, canals, irrigation Malaria Increase breeding sites for mosquitoes Urbanization Cholera Decreased sanitation & hygiene, increased water contamination Reforestation Lyme disease Increase tick hosts, outdoor exposure Ocean warming Red tide Increase toxic algal blooms Patz et al. , 2003 Wilson 2001
Factors that Influence the Range and Prevalence of Infectious Diseases n Sociodemographic influences n n n Human travel, trade, and migration Disease control efforts Drug resistance Nutrition Environmental influences n n Land-use, including deforestation, agricultural development, and urbanization Ecological influences
Temperature and Precipitation Effects on Vector- and Rodent-Borne Diseases n n n Survival and reproduction rate of the vector Time of year and level of vector activity, specifically the biting rate Rate of development and reproduction of the pathogen within the vector
Main Types of Transmission Cycles for Infectious Disease Patz et al. , 2003
Potential Transmission of Schistosomiasis, Jiangsu Province Yang et al. , 2005
Climate Change and Malaria under Different Scenarios (2080) n n Increase: East Africa, Central Asia, Russian Federation Decrease: Central America, Amazon [within current vector limits] Van Lieshout et al. 2004 A 1 A 2 B 1 B 2 Van Lieshout et al. 2004
China Haze 10 January 2003 NASA
Effect of Temperature Variation on Diarrheal Incidence in Lima, Peru Daily Diarrhea Admissions Daily Temperature Diarrhea increases by 8% for each 1ºC increase in temperature Checkley et al. , 2000
Resources n Mc. Michael, A. J. , D. H. Campbell-Lendrum, C. F. Corvalan, K. L. Ebi, A. Githeko, J. D. Scheraga, and A. Woodward (eds. ). 2003. Climate Change and Human Health: Risks and Responses. WHO, Geneva. n n Summary pdf available at http: //www. who. int/globalchange/publications/cchhsum mary/ Kovats, R. D. , K. L Ebi, and B. Menne. 2003. Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change. WHO/Health Canada/UNEP. n Pdf available at http: //www. who. dk/document/E 81923. pdf
Health Data to Determine the Current Burden of Climate. Sensitive Diseases 1 A. 28
Questions to be Addressed n What climate-sensitive diseases are important in the country or region? n n What factors other than climate should be considered? n n n What is the current burden of these diseases? Water, sanitation, etc. Where are data available? Are health services able to satisfy current demands?
Health Data Sources n World Health Report provides regional-level data for all major diseases n n n WHO databases n n n http: //www. who. int/whr/en Annual data in Statistical Annex Malnutrition http: //www. who. int/nutgrowth/db Water and sanitation http: //www. who. int/entity/water_sanitation_he alth/database/en Ministry of Health n Disease surveillance/reporting branch
Health Data Sources – Other n n UNICEF at http: //www. unicef. org CRED-EMDAT provides data on disasters n n n http: //www. em-dat. net Mission hospitals Government district hospitals
Indonesia n n Total population = 219, 883, 000 Annual population growth rate = 1. 4% Life expectancy at birth = 67 years Under age 5 mortality rate = 41/1, 000 n n WHO, 2005 70% of 1 -year-olds immunized with 3 doses of DTP 3. 2% of gross domestic product spent on health
Methods and Tools for V&A Assessment in the Health Sector 1 A. 33
Methods and Tools n n n Qualitative assessments Methods of assessing human health vulnerability to climate change WHO Global Burden of Disease Comparative Risk Assessment n n n Environmental Burden of Disease MIASMA Other models
Qualitative Assessments n n Available data allow for qualitative assessment of vulnerability For example, given current burden of diarrheal diseases and projected changes in precipitation, will vulnerability remain the same, increase, or decrease?
Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change Kovats et al. , 2003 1 A. 36
Methods for: n n n 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 Kovats et al. , 2003
Estimate Potential Future Health Impacts n n Requires using climate scenarios Can use top-down or bottom-up approaches n n n 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 Kovats et al. , 2003
Case Study: Risk of Vector-Borne Diseases in Portugal n Four qualitative scenarios developed of changes in climate and in vector populations n n n Vector not present Focal distribution of vector Widespread distribution of vector Change from focal to potentially regional distribution Expert judgment determined likely risk under each scenario for 5 vector-borne diseases Casimiro et al. , 2006
Portuguese National Assessment Vector Parasite None Present Imported human cases only Low prevalence in vectors/hosts High prevalence vectors/hosts None Present Negligible Risk Focal Distribution Negligible Risk Very low Risk Low Risk Regional Negligible Risk Very low Risk Low Risk Medium Risk Widespread Negligible Risk Very low Risk Medium Risk High Risk Casimiro & Calheiros 2002
Sources of Uncertainty n Data n n Models n n n Missing data or errors in data Uncertainty regarding predictability of the system Uncertainty introduced by simplifying relationships Other n n n Kovats et al. , 2003 Inappropriate spatial or temporal data Inappropriate assumptions Uncertainty about predictive ability of scenarios
Estimating the Global Health Impacts of Climate Change n n 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 greenhouse gas (GHG) emissions)? Mc. Michael et al. , 2004
Comparative Risk Assessment Greenhouse gas emissions scenarios Time 2020 s Global climate modelling: 2050 s 2080 s Generates series of maps of predicted future climate Health impact model: Estimates the change in relative risk of specific diseases Mc. Michael et al. , 2004 2020 s 2050 s 2080 s
Criteria for Selection of Health Outcomes n n n Sensitive to climate variation Important global health burden Quantitative model available at the global scale Mc. Michael et al. , 2004
Health Outcomes Considered Outcome Class Incidence / prevalence Outcome Direct effects of heat and cold Incidence Cardiovascular disease deaths Foodborne & waterborne diseases Incidence Diarrhea episodes Vector-borne diseases Incidence Malaria cases Natural disasters Incidence Deaths due to unintentional injuries Other unintentional injuries Risk of malnutrition Prevalence Non-availability of recommended daily calorie intake Mc. Michael et al. , 2004
Exposure: Alternative Future Projections of GHG Emissions n n Unmitigated current GHG emissions trends Stabilization at 750 ppm CO 2 -equivalent by the year 2210 Stabilization at 550 ppm CO 2 -equivalent by the year 2170 Average climate conditions for 1961 -1990 (WMO climate normal baseline) Source: UK Hadley Centre models Mc. Michael et al. , 2004
Estimated Mortality (000 s) Attributable to Climate Change, 2000 Malnutrition Diarrhea CVD All Causes Deaths / Million SEARB 0 1 1 2 7. 9 SEARD 52 22 7 80 65. 8 Mc. Michael et al. , 2004
Climate scenarios, as function of GHG emissions
Conclusions n n 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 n n Largest impacts from diarrhea, malnutrition, and malaria Uncertainties include: n n n Mc. Michael et al. , 2004 Uncertainties in projections Effectiveness of interventions Changes in nonclimatic factors
Environmental Burden of Disease n n A. Prüss-Üstün, C. Mathers, C. Corvalan, and A. Woodward. 2003. Introduction and Methods: Assessing the Environmental Burden of Disease at National and Local Levels [pdf available at http: //www. who. int/peh/burdenindex. h tml] Climate change document will be published soon
Climate and Stable Malaria Transmission n 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) n 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.
Relationship between Temperature and Daily Survivorship of Anopheles
Relationship between Temperature and Time Required for Parasite Development
Proportion of Vectors Surviving Time Required for Parasite Development
The website [http: //www. mara. org. za] contains prevalence and population data, and regional and country-level maps
MARA/ARMA Model n n 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 $5 for developing countries or can download components from website: www. mara. org. za
MIASMA n n Modeling Framework for the Health Impact Assessment of Man-Induced Atmospheric Changes MIASA was written by Dr. Pim Martens (p. martens@icis. unimaas. nl). A fee of US$ 5 is required for a self-extracting CD Includes modules for thermal stress, malaria, dengue, and schistosomiasis Select IPCC scenario and GCM
Other Models n Ci. MSi. M and DENSim for dengue n n 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
India’s Initial National Communication: Goals n n To identify, analyze, and evaluate the impacts of climate variability and change on natural ecosystems, socioeconomic systems, and human health To assess the vulnerabilities, which also depend on the institutional and financial capacities of the affected communities To assess the potential adaptation responses To develop technical, institutional, and financial strategies to reduce vulnerability
India’s Initial National Communication n n Temperature-related mortality Vector-borne diseases n n Health effects of extreme weather n n Changing patterns of diseases – malaria, filaria, kala-azar, Japanese encephalitis, dengue Diarrhea, cholera, and poisoning caused by biological and chemical contaminants in water Damaged public health infrastructure due to cyclones/floods Social and mental health stress due to disasters and displacements Health effects due to insecurity in food production
Malaria in India 1976 -2001
Projected Changes in Number of Months Malaria Can Be Transmitted
Factors Affecting Malaria Distribution and Prevalence in India n n n Climate Urban settlements Poverty Irrigation Agricultural practices Land-use change
Methods for Determining a Health Adaptation Baseline 1 A. 67
Questions for Designing Adaptation Policies and Measures n n n Adaptation to what? Is additional intervention needed? What are the future projections for the outcome? Who is vulnerable? n n On scale relevant for adaptation Who adapts? How does adaptation occur? When should interventions be implemented? How good or likely is the adaptation?
Current and Future Adaptation Options n n n What is being done now to reduce the burden of disease? How effective are these policies and measures? What measures should begin to be implemented to increase the range of possible future interventions? When and where should new policies be implemented? n Kovats et al. , 2003 Identify strengths and weaknesses, as well as threats and opportunities to implementation
Public Health Adaptation n Existing risks n n Modifying existing prevention strategies Reinstitute effective prevention programs that have been neglected or abandoned Apply win/win or no-regrets strategies New risks
Options for Adaptations to Reduce the Health Impacts of Climate Change Health Outcome Legislative Technical Educational-advisory Cultural & Behavioral Thermal stress Building guidelines Housing, public buildings, urban planning, air conditioning Early warning systems Clothing, siesta Extreme weather events Planning laws, economic incentives for building Urban planning, storm shelters Early warning systems Use of storm shelters Vector control, vaccination, impregnated bednets, sustainable surveillance, prevention & control programmes Health education Water storage practices Screening for pathogens, improved water treatment & sanitation Boil water alerts Washing hands and other behavior, use of pit latrines Vector-borne diseases Water-borne diseases Mc. Michael et al. 2001 Watershed protection laws, water quality regulation
Screening the Theoretical Range of Response Options – Malaria Ebi and Burton, submitted
Analysis of the Practical Range of Response Options – Malaria Ebi and Burton, submitted
Thank you 1 A. 74
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