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2 CEDARS | ICF Macro “The Center for Design and Research in Sustainability (CEDARS) pursues excellence in planning and measuring sustainability in health and social development initiatives. We are committed to learning from praxis through evaluation to inform ongoing debates about global health and the expanding challenges of community health for vulnerable groups in a globalized and changing world.” Part I: An Introduction to CEDARS

3 What is CEDARS? CEDARS: A community of practice A think tank A partner forum  HOST OF SUSTAINABILITY DISCUSSION FORUM CEDARS hosts the Sustained Health Outcomes Group (SHOUT), which is a community of practice for health practitioners and researchers interested in advancing practical learning about sustainability in community-oriented health and development programs.  REPOSITORY OF SUSTAINABILITY RESOURCES houses resources and short descriptions of projects by ICF but also by other partners whose work is relevant to our learning objectives.  A TEAM OF PROFESSIONALS WHO CAN PROVIDE TA The CEDARS team can offer advice and technical assistance to internal and external clients. We would be happy to refer you to other colleagues sharing similar interests and relevant experience. CEDARS | ICF Macro

4 How is CEDARS involved in “sustainable health and human development”? CEDARS | ICF Macro  Many colleagues involved in “sustainability” work take on a global / climate change / energy / environment perspective  CEDARS’s perspective is a bit different (and complementary) and is grounded in human and social development  Takes into account complexity and cross-cutting nature of “sustainability”  To date, core competencies of CEDARS have focused on community health and health systems strengthening but are seeking to pursue broader/global issues involving food security and social-ecological issues  Application of the Sustainability Framework: conceptual and practical framework for integration of sustainability into program implementation

5 CEDARS’ Three Strategic Interests Sustainability in Community Health Improving Sustainability Design, Implementation and Evaluation in Community Health Projects & Programs Global challenges to sustainable health &human development Studying and Improving Social and Policy Determinants of Sustainable Human Development, from Food Security, to Community Resilience and Adaptive Capacity to Climate Change Complexity & Human Development Improving Evaluation and Study Designs on Complex Adaptive Systems (Communities, Civil Society, Health, Governance, and Donor Systems) and their Impact on Sustainable Human Development CEDARS Center | ICF Macro


7 Sustainability Manual  “Taking the Long View”  Can be found at  Key Features Introduces a theoretical framework Describes practical implementation steps Tips from practitioners (FAQs) Toolbox CEDARS | ICF Macro

8 Projects  What can we learn from projects?  How project teams used the SF?  What were the results?  Where can I find this?   Summaries, links to tools and/or charts, contact information  Upload your projects! CEDARS Center | ICF Macro


10 Fora  CEDARS Critical Issues Forum  Two or three hot topics per year  Currently, you can join the conversation about Food Security and Climate Change  CEDARS Café  “Water-cooler” style forum  Post a question or comment to the group anytime  Both can be accessed at CEDARS Center | ICF Macro


12 Other Resources  Articles  Latest: “Pro-Sustainability Choices and Child Deaths Averted”  Reports  Post-project sustainability assessment—CWI Bangladesh  Elluminate training  Tools/aids used by practitioners  CRWRC Malawi Workshop Agenda CEDARS Center | ICF Macro


14 Do Community Health Professionals Have Anything to Say At this Stage about Building Adaptive Capacity Against Climate Change and Food Insecurity? Starting a Discussion… Available on: Part 3:

15 Context-IPCC 4 th Assessment Report CEDARS | ICF Macro  High probability for global events  Uncertainty about the localized effects of climate change

16 Potential Impact of 3 Types of Climate Change Scenarios Climate Change ScenarioPotential Health/Food Security and Other Impacts 1. Progressive climate change (e.g., shifts in mean temperatures and rainfall amounts, changes in lengths of growing seasons) Probability profile: Irregular (high variability) over short term; incrementally significant over long term. a.Loss of coastal habitats reduce some food production activities. b.Increased rainfall variability leads to decrease in water resources in some locations and decreases irrigation potential with reduced food production. c.Increasing temperatures in many locations lead to more demand for water for irrigation, thus leading to lower yields. d.Mitigation efforts drive up input costs, reducing agricultural productivity. e.Change in range of infectious disease vectors. f.Increase in respiratory illness due to changes in air quality. g.Increased conflict due to resource competition h.Increasing temperatures lead to heat stress on animal and fish stocks, reducing fertility and increasing mortality. 2. Extreme events (e.g., floods, destructive wind storms, droughts, climate induced fires) Probability profile: Already observable; increased frequency expected. Likely for certain geographic profiles (lower elevation coastal areas, etc.). a.Heat-related deaths (heat wave). b.Deaths and injury (flood, fire, storms). c.Spread of infectious disease post-event (flood). d.Spread of pests reducing food production (flood following drought). e.Loss of cultivable land (flood/drought). f.Loss of water resources (drought). g.Heat-related stresses reduce cattle reproduction and increase deaths. 3. Threshold events or tipping points (e.g., negative synergies with multi-system failures) Probability profile: Unpredictable—High Impact a.Epidemics (cattle or human). b.Crop failure (large scale). c.Broad ecosystem collapse (leading to uninhabitable zones). d.Economic crash due to systemic and multi-system spiraling effects. e.Massive out-migration from affected zones. f.Conflict (violence) due to migration and resource scarcity.

17 Elements of GCC Risk Analysis  Multiple pathways in Climate Change all converge on threats to Food Security (i.e. Table 2 P.6) [Lessons from mixed effects crisis of 2007-2008 (UNICEF MENA) Shocks on top of preexisting chronic food insecurity Vulnerability and poverty more critical than urban-rural divide Risk of competition for the same pot of resources]  Communities that will be Most Vulnerable To GCC are Largely Already the “Most Vulnerable” (IPCC; Ayers)  Global Action Will be Taken, but Local Status Quo is a Possible Scenario – Particularly in Vulnerable Communities CEDARS Center | ICF Macro

18 Communities Vulnerable to Climate Change are already ‘Vulnerable’  Given that a community that is vulnerable in an existing climate is likely to be vulnerable to future climate change, it is not necessary to wait for climate change data to become available to start building adaptive capacity. Rather, the starting point for vulnerability reduction is development, and so the priorities for any development agency must first be meeting their existing aid commitments and focusing on community priorities in the near-term. Mainstreaming will not be effective if existing development trajectories are inconsistent with the objectives of adaptation, so first and foremost a “more of the same” approach to development must form the underlying basis for any adaptation program undertaken by development agencies. (Ayers, 2009)  “Climate-change models project that those likely to be adversely affected are the regions already most vulnerable to food insecurity, notably Africa, which may lose substantial agricultural land… Weak public-health systems and limited access to primary health care contribute to high levels of vulnerability and low adaptive capacity for hundreds of millions of people.” (IPCC) CEDARS Center | ICF Macro

19 Adaptation / Building Resilience (Smit & Pilifosova, 2001)  “Adaptation refers to adjustments in ecological, social, or economic systems in response to actual or expected climatic stimuli and their effects or impacts. It refers to changes in processes, practices, and structures to moderate potential damages or to benefit from opportunities associated with climate change.” CEDARS Center | ICF Macro

20 Thoughts on Adaptation  “Underdevelopment fundamentally constrains adaptive capacity” (Smit & Pilifosova)  “Some people regard the adaptive capacity of a system as a function not only of the availability of resources but of access to those resources by decision makers and vulnerable subsectors of a population”  “The presence of power differentials can contribute to reduced adaptive capacity.”  “Our combined experience suggests that the best way to address climate change impacts on the poor is by integrating adaptation measures into sustainable development and poverty reduction strategies… Many adaptation mechanisms will be strengthened by making progress in areas such as good governance, human resources, institutional structures, public finance, and natural resource management. Such progress builds the resilience of countries, communities, and households to all types of shocks, including climate change impacts…” (The World Bank. 2009)  Value of ‘No Regrets’ Strategies CEDARS Center | ICF Macro

21  “Soft* adaptation”: early warning systems, community preparedness, watershed management, etc.,  Relies on collective action and effective institutions Adaptation Measures  “Hard* adaptation”: acts of engineering i.e. port upgrades, improvement of health infrastructure, etc.  Relies on hardware * (The World Bank. 2009) CEDARS Center | ICF Macro

22 Local Level Assessment of Status Quo 1- Progressive Effects of Climate Change Human migration from most affected areas Well-off and middle-income groups will be able to adapt at individual level, but poorer individuals and communities will be highly affected. All health indices will either remain largely unchanged or regress in these populations. Stress on middle-income groups will deplete resources and push some into poverty. Any increased conflict is likely to fall more heavily on women and children. High pre-existing morbidity likely to impact co-morbidity and excess mortality Local resources for basic services will be further reduced 2- Extreme Events Wealthier individual parts of affected populations will be able to leave or recover from extreme events in ways that poorer groups cannot. Stress on groups will bring them to lower economic strata. Short-term problems of injury and loss of livelihood and assets will be compounded by potential increased risks of infectious disease and pest infestations. Medium- or longer-term loss of productive assets will be a problem for poorer parts of the population. Global resources required in new directions (away from basic services) 3- Threshold Events Mass out-migration would result with the wealthier groups most likely to survive. Poorer groups would face very high mortality and/or experience IDP or refugee status in poor health Global economic consequences

23 Local Level Assessment of ‘Hard’ Adaptation Strategies 1-Progressive Effects of Climate Change Given time and resources, these strategies could help various communities adapt to change. At issue here is moving research rapidly from theoretical to practical application and finding ways to bring stakeholders together to problem solve around local management (a soft strategy). Those working in the subsistence or informal sectors may benefit only secondarily if investments target most “productive” sectors/approaches. Progressively increasing cost 2- Extreme Events The fact that most of the kinds of events envisioned here have already occurred or occur with some regularity around the world provides a blueprint for action, but hard strategies are likely to be used after the fact. In a sense this scenario would lead to “reactive” hard strategies being employed: after a disaster one rebuilds and reinforces to avoid similar problems again. However, this type of adaptation could also consist of better warning systems and ways to move people out of harm’s way (as is the case for hurricane or tornado warning systems in the United States). Extreme events can damage basic services infrastructure, in addition to drain resources If resources are available, large-scale responses can target not only rebuilding but also reinforcing structures. Can “miss” the most vulnerable due to lack of political voice 3- Threshold Events May be difficult to reverse but will depend on rushing, perhaps largely untested, strategies to the field. Such “macro-level” interventions would require massive investments and be essentially enormous “terraforming” engineering marvels (e.g., dropping iron in the sea). Will have to prioritize mass-interventions and blunt instruments Global economic consequences

24 Local Level Assessment of ‘Soft’ Adaptation Strategies 1- Progressive Effects of Climate Change Arguably, even the ‘hard strategies’ will benefit from investment in soft strategies that build on community decision-making structures. If they benefit traditionally underrepresented populations (poor, women, minorities), they will reduce isolation and excess vulnerability of these groups To the extent they can draw on or expand traditional/local adaptation strategies, they will provide for easier adaptation of solutions. Will raise the baseline status of communities. Building of adaptive capacity anchors local and national resources to essential services and activities 2- Extreme Events As above, strong social networks and decision-making structures can help streamline decision- making post-event. Using preexisting networks as early warning channels is also a possibility, as is using such networks to collect data rapidly after events on those most affected so aid can be rushed to them (immediately) and rehabilitation can be targeted after the fact. Local services and structures more resilient 3- Threshold Events Such large-scale events are outside the experience base of communities. While collective action may be unable to enable appropriate responses to them, soft adaptation does move communities to a better baseline. It connects vulnerable groups to information. It increases their resource base and increases resilience and capacity to respond to a disaster. Starting from a higher baseline may ensure survival, whereas baseline vulnerability leads to higher mortality. Social capital also helps put the pieces back together.

25 What Community Approaches Can Do CEDARS Center | ICF Macro

26 Importance of Social Capital and “Social Infrastructure”  “The potential embedded in social relationships that enables residents to coordinate community action to achieve shared goals, such as adaptation to climate change.” (Ebi and Semenza. 2008)  Bonding capital – homogeneous groups  Bridging capital – heterogeneous groups  Linking capital – centers of power CEDARS Center | ICF Macro

27 Building Social Capital The Non-Negotiables Local Information to guide Local Action Clarity of outcomes Learn about existing adaptation strategies Focus data collection on food security (& community health) Orientation to action Consistency and unity of purpose – Time! The Keys 1. Information-based decision making  Community diagnosis  Local collection/use of primary data - Community based information systems  Multi-dimensional assessments 2. Multi-level decision making  Community-based management  Co-management between private actors and government agents 3. Lateral learning and sharing  Information sharing  Already existing adaptation strategies  Building bridging capital through joint learning 4. Attention to Equity  Ensuring the participation of all groups  Appropriately managing power imbalances 5. Conflict Resolution Mechanisms CEDARS Center | ICF Macro CEDARS | ICF Macro

28 Three Conclusions 1-A lack of local, sustainable community development associated with a poor social infrastructure represents the most widely shared source of insecurity and inadaptability among poor communities of developing countries. CEDARS Center | ICF Macro

29 Three Conclusions 2-Even context-specific, ‘hard’ adaptation strategies will be hindered in their effectiveness and impact in the absence of effective development processes which emphasizes ‘soft’ adaptation. (And multiple competing costs may take further away from under-resourced efforts at sustainable community development approaches.) CEDARS Center | ICF Macro

30 Three Conclusions 3-In the face of uncertainty, progressiveness, complexity, and randomness of GCC threats, sustainable adaptation processes should emphasize the building of a responsive and capable social infrastructure. We suggest that proper respect for time as a factor of social processes, unity and consistency of purpose demonstrated through appropriate local information systems and metrics, and equity in bringing stakeholders around decisionmaking processes will be central to these efforts. CEDARS Center | ICF Macro

31 Questions Continue the Discussion on -> Register & Visit the Discussion Forums Area -> Critique, Revise, Provide Examples to Inform Global Agenda 1. What are your general thoughts and questions about the need for investing in sustainable social capital formation as a priority for addressing current vulnerability to GCC and building adaptive capacity? [Are current project approaches capable of this investment?] 2.What specific examples do you have of programs or projects (health, education, food security, agriculture) that combined elements proposed and led to demonstrable positive change? 3.In what ways do these examples support or not the case for prioritizing such local social processes through our development approach, in order to build adaptive capacity in the face of GCC? CEDARS | ICF Macro

32 Interests &Needs Survey Please assist us in improving our approach to supporting sustainability initiatives and fill out our quick Interest & Needs Survey. THANK YOU! CEDARS Center | ICF Macro


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