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1A.1 Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector Kristie L. Ebi, Exponent Health Group.

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Presentation on theme: "1A.1 Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector Kristie L. Ebi, Exponent Health Group."— Presentation transcript:

1 1A.1 Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector Kristie L. Ebi, Exponent Health Group

2 Outline 1. Overview of the potential health impacts of climate variability and change 2. Health data to determine the current burden of climate-sensitive diseases 3. Methods and tools for V&A assessment in the health sector 4. Methods for determining a health adaptation baseline

3 1A.3 Overview of the Potential Health Impacts of Climate Variability and Change

4 Topics Pathways for weather to affect health Potential health impacts of climate change Extreme weather events El Nino and disease Temperature Floods Vector-borne diseases Diseases related to air pollution Diarrheal diseases

5 Corvalan et al., 2003 Pathways from Driving Forces to Potential Health Impacts

6 Pathways for Weather to Affect Health: Example = Diarrheal Disease Temperature Humidity Precipitation Distal Causes Proximal CausesInfection HazardsHealth Outcome Living conditions (water supply and sanitation) Food sources and hygiene practices Survival/ replication of pathogens in the environment Contamination of water sources Rate of person to person contact Consumption of contaminated water Consumption of contaminated food Contact with infected persons Incidence of mortality and morbidity attributable to diarrhea Vulnerability (e.g. age and nutrition) Contamination of food sources WHO

7 IPCC TAR–Potential Health Impacts of Climate Change 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

8 Drivers of Health Issues Population density Urbanization Public health infrastructure Economic and technologic development Environmental conditions Populations at risk Poor Children Increasing population of elderly residents Immunocompromised

9 ENSO and Disease Kovats et al., 2003

10 Exploring Linkages Between ENSO and Human Health

11 Dengue Epidemics in South Pacific

12 El Nino starts El Nino stops Dr. Githeko, personal communication

13 Climate Change May Entail Changes in Variance, as Well as Changes in Mean Folland et al., 2001

14 Temperature Extremes in the Caribbean,

15 Climate Variability and Change Impacts in the Caribbean DATE COUNTRYEVENTDEATHESTIMATED COSTS (US$ million, 1998) 1974HondurasHurricane Fifi7,0001, /3Bolivia, Ecuador, PeruEl Niño05, /98Bolivia, Colombia, Ecuador, Peru El Niño6007, Central AmericaHurricane Mitch9,2146, Dominican RepublicHurricane Georges2352,193 CubaHurricane Georges6N/A 1999VenezuelaLandslide25,000N/A Fuente: ECLAC, América Latina y El Caribe: El Impacto de los Desastres Naturales en el Desarrollo, , LC/MEX/L.402; OFDA, Venezuela- Floods, Fact Sheet #10, 1/12/ 2000.

16 Mechanisms by Which Above Average Rainfall Can Affect Health EventDescriptionPotential Health Impact Heavy precipitation “Extreme event”Increased or decreased mosquito abundance FloodRiver/stream over tops its banks Property or crops damaged Above plus contamination of surface water FloodCatastrophic flood/disaster Above plus increased risk of respiratory and diarrhoeal disease, injuries, etc. Kovats et al., 2003

17 Health Impacts of Floods 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

18 Mechanisms by Which Drought Can Affect Health DescriptionPotential Health Impact Soil moisture decreasesChanges in vector abundance Decreased crop productionDepends 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

19 Examples of Environmental Changes and Possible Effects on Infectious Diseases Environmental Change Example Disease Pathway of Effect Dams, canals, irrigation MalariaIncrease breeding sites for mosquitoes UrbanizationCholeraDecreased sanitation & hygiene, increased water contamination ReforestationLyme disease Increase tick hosts, outdoor exposure Ocean warmingRed tideIncrease toxic algal blooms Wilson 2001 Patz et al., 2003

20 Factors that Influence the Range and Prevalence of Infectious Diseases Sociodemographic influences Human travel, trade, and migration Disease control efforts Drug resistance Nutrition Environmental influences Land-use, including deforestation, agricultural development, and urbanization Ecological influences

21 Temperature and Precipitation Effects on Vector- and Rodent-Borne Diseases 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

22 Main Types of Transmission Cycles for Infectious Disease Patz et al., 2003

23 Potential Transmission of Schistosomiasis, Jiangsu Province Yang et al., 2005

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

25 China Haze 10 January 2003 NASA

26 Daily Temperature Daily Diarrhea Admissions Diarrhea increases by 8% for each 1ºC increase in temperature Checkley et al., 2000 Effect of Temperature Variation on Diarrheal Incidence in Lima, Peru

27 Resources McMichael, A.J., D.H. Campbell-Lendrum, C.F. Corvalan, K.L. Ebi, A. Githeko, J.D. Scheraga, and A. Woodward (eds.) Climate Change and Human Health: Risks and Responses. WHO, Geneva. Summary pdf available at mary/ Kovats, R.D., K.L Ebi, and B. Menne Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change. WHO/Health Canada/UNEP. Pdf available at

28 1A.28 Health Data to Determine the Current Burden of Climate- Sensitive Diseases

29 Questions to be Addressed What climate-sensitive diseases are important in the country or region? 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?

30 Health Data Sources World Health Report provides regional-level data for all major diseases Annual data in Statistical Annex WHO databases Malnutrition Water and sanitation alth/database/en Ministry of Health Disease surveillance/reporting branch

31 Health Data Sources – Other UNICEF at CRED-EMDAT provides data on disasters Mission hospitals Government district hospitals

32 Indonesia 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 70% of 1-year-olds immunized with 3 doses of DTP 3.2% of gross domestic product spent on health WHO, 2005

33 1A.33 Methods and Tools for V&A Assessment in the Health Sector

34 Methods and Tools Qualitative assessments Methods of assessing human health vulnerability to climate change WHO Global Burden of Disease Comparative Risk Assessment Environmental Burden of Disease MIASMA Other models

35 Qualitative Assessments 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?

36 1A.36 Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change Kovats et al., 2003

37 Methods for: 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

38 Estimate 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 Kovats et al., 2003

39 Case Study: Risk of Vector-Borne Diseases in Portugal Four qualitative scenarios developed of changes in climate and in vector populations 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

40 Portuguese National Assessment VectorParasite None PresentImported human cases only Low prevalence in vectors/hosts High prevalence vectors/hosts None Present Negligible Risk Negligible Risk Negligible Risk Negligible Risk Focal Distribu -tion Negligible Risk Very low Risk Low Risk Low Risk Regional Negligible Risk Very low Risk Low Risk Medium Risk Wide- spread Negligible Risk Very low Risk Medium Risk High Risk Casimiro & Calheiros 2002

41 Sources of Uncertainty Data Missing data or errors in data Models Uncertainty regarding predictability of the system Uncertainty introduced by simplifying relationships Other Inappropriate spatial or temporal data Inappropriate assumptions Uncertainty about predictive ability of scenarios Kovats et al., 2003

42 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 greenhouse gas (GHG) emissions)? McMichael et al., 2004

43 Comparative Risk Assessment 2020s 2050s 2080s Greenhouse gas 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 Time 2080s2050s2020s McMichael et al., 2004

44 Criteria for Selection of Health Outcomes Sensitive to climate variation Important global health burden Quantitative model available at the global scale McMichael et al., 2004

45 Health Outcomes Considered Outcome ClassIncidence / prevalence Outcome Direct effects of heat and cold IncidenceCardiovascular disease deaths Foodborne & waterborne diseases IncidenceDiarrhea episodes Vector-borne diseasesIncidenceMalaria cases Natural disastersIncidence Deaths due to unintentional injuries Other unintentional injuries Risk of malnutritionPrevalenceNon-availability of recommended daily calorie intake McMichael et al., 2004

46 Exposure: Alternative Future Projections of GHG Emissions 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 (WMO climate normal baseline) Source: UK Hadley Centre models McMichael et al., 2004

47 Estimated Mortality (000s) Attributable to Climate Change, 2000 Mal- nutrition DiarrheaCVDAll Causes Deaths / Million SEAR- B SEAR- D McMichael et al., 2004

48 Climate scenarios, as function of GHG emissions

49 Conclusions 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 from diarrhea, malnutrition, and malaria Uncertainties include: Uncertainties in projections Effectiveness of interventions Changes in nonclimatic factors McMichael et al., 2004

50 Environmental Burden of Disease A. Prüss-Üstün, C. Mathers, C. Corvalan, and A. Woodward Introduction and Methods: Assessing the Environmental Burden of Disease at National and Local Levels [pdf available at html] Climate change document will be published soon

51 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

52 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.

53 Relationship between Temperature and Daily Survivorship of Anopheles

54 Relationship between Temperature and Time Required for Parasite Development

55 Proportion of Vectors Surviving Time Required for Parasite Development

56 The website [] contains prevalence and population data, and regional and country-level maps


58 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:


60 MIASMA Modeling Framework for the Health Impact Assessment of Man-Induced Atmospheric Changes MIASA was written by Dr. Pim Martens A fee of US$ 5 is required for a self-extracting Includes modules for thermal stress, malaria, dengue, and schistosomiasis Select IPCC scenario and GCM

61 Other Models 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

62 India’s Initial National Communication: Goals 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

63 India’s Initial National Communication Temperature-related mortality Vector-borne diseases Changing patterns of diseases – malaria, filaria, kala-azar, Japanese encephalitis, dengue Health effects of extreme weather 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

64 Malaria in India

65 Projected Changes in Number of Months Malaria Can Be Transmitted

66 Factors Affecting Malaria Distribution and Prevalence in India Climate Urban settlements Poverty Irrigation Agricultural practices Land-use change

67 1A.67 Methods for Determining a Health Adaptation Baseline

68 Questions for Designing Adaptation Policies and Measures Adaptation to what? Is additional intervention needed? What are the future projections for the outcome? Who is vulnerable? On scale relevant for adaptation Who adapts? How does adaptation occur? When should interventions be implemented? How good or likely is the adaptation?

69 Current and Future Adaptation Options 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? Identify strengths and weaknesses, as well as threats and opportunities to implementation Kovats et al., 2003

70 Public Health Adaptation Existing risks Modifying existing prevention strategies Reinstitute effective prevention programs that have been neglected or abandoned Apply win/win or no-regrets strategies New risks

71 Options for Adaptations to Reduce the Health Impacts of Climate Change Health OutcomeLegislativeTechnicalEducational-advisoryCultural & Behavioral Thermal stressBuilding guidelinesHousing, public buildings, urban planning, air conditioning Early warning systemsClothing, siesta Extreme weather events Planning laws, economic incentives for building Urban planning, storm shelters Early warning systemsUse of storm shelters Vector-borne diseasesVector control, vaccination, impregnated bednets, sustainable surveillance, prevention & control programmes Health educationWater storage practices Water-borne diseasesWatershed protection laws, water quality regulation Screening for pathogens, improved water treatment & sanitation Boil water alertsWashing hands and other behavior, use of pit latrines McMichael et al. 2001

72 Screening the Theoretical Range of Response Options – Malaria Ebi and Burton, submitted

73 Analysis of the Practical Range of Response Options – Malaria Ebi and Burton, submitted

74 1A.74 Thank you

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