1. Assessing Human Health Vulnerability and Public Health Adaptation to Climate Variability and Change Kristie L. Ebi, Ph.D., MPH NCAR Summer Institute July 2004

2. Vulnerability and Adaptation Ebi et al. forthcoming

3. Vulnerability The degree to which individuals and systems are susceptible to or unable to cope with the adverse effects of climate variability and change. Vulnerability is a function of : –Sensitivity to changes in weather and climate (exposure-response relationship), including population characteristics –Exposure –Adaptation baseline

4. Who is Vulnerable? Populations, subgroups & systems that –cannot or will not adapt –are more susceptible to weather and climate Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change. Kovats, Ebi, Menne. 2003

5. - Poor -Children -Increasing population of elderly residents -Immunocompromised Vulnerable Populations

6. Exposure Tmax 10 August 2003

7. Chicago 1995

8. 1947 2003: The Shape of Things to Come? 51015202530354045 Maximum Temperature [°C]: Basel 0.02.04.06.10.08 Frequency 1961-1990 2071-2100 2003 Beniston 2004

9. Climate change may entail changes in variance, as well as changes in mean values

10. Both Heat & Air Pollution Contributed to Excess Mortality in 2003 Heatwave UK –Temperature record of 38.5 ºC –2045 excess deaths in England and Wales of which 21-38% were estimated to have been due to elevated ozone and PM10 concentrations (Stedman 2004) Netherlands –No temperature records broken; highest temperature 35ºC –Estimated 1000-1400 excess heat-related deaths of which 400-600 may have been due to elevated ozone and PM10 concentrations (Fisher et al. 2004)

11. Floods

12. Climate and Stable Malaria Transmission, Zimbabwe

13. 2025

14. 2050

15. Adaptation Needed Because: Climate change can not be totally avoided Climate change may be more rapid and more pronounced than current estimates The severity of impacts will depend on the capacity to adapt and its effective deployment Immediate benefits can be gained from better adaptation to climate variability and extreme events

16. Adaptation Actions taken by individuals, institutions, and governments Anticipatory –Actions taken in advance of climate change effects Responsive

17. Adaptation Includes the strategies, policies, and measures undertaken now and in the future to reduce potential adverse health effects Adaptive capacity – general ability of institutions, systems, and individuals to adjust to potential damages and to cope with the consequences Coping capacity – what could be implemented now to minimize negative effects of climate variability and change

18. Assumptions (1)  Adaptation matters. Adaptation to climate change will increase in importance to policymakers and the public as evidence regarding unacceptable climate impacts continues to accumulate.

19. El Niño

20. PEAC: 1997-1998 El Niño January-June 1998 Governments Respond –Continue Public Education –Water Rationing –Emergency Water Supply –Disaster Impact Assessments –Relief Food –Wildfire Control

22. ENSO Impacts Water rationing in Majuro — seven hours of water every 15 days in February 1998 Crop and job losses Environmental impacts — steams drying up, wild fires, coral bleaching

23. Drought Areas from 1997-1998

24. Pohnpei 1997-98

25. Assumptions (2)  Adaptation should focus on pragmatic strategies, policies and measures that aim to prevent possible adverse impacts, and to take advantage of opportunities that arise. Research should include the search for measures to achieve some control over the more dire consequences expected in addition to the evaluation of whether (or not) near-term impacts from climate change are likely.

26. Potential Human Health Impacts from Weather- Related Disasters in Caribbean States Direct injuries & death, including animal bites Vector- and rodent-borne diseases (dengue, leptospirosis, malaria?, yellow fever) Water-borne diseases (schistosomiasis, cryptosporidium, cholera) Food-borne diseases (diarrheal diseases, food poisoning, salmonella, typhoid) Anxiety & stress

27. Managing Potential Health Impact in the Caribbean - An EH Perspective Establishment of monitoring & surveillance system Create the enabling environment Strengthen the public health infrastructure Promote research Promote awareness & education

28. Assumptions (3)  Modern levels of wealth, technology, and social organization provide a basis for substantial improvements in adaptation to climate change. The greatest difficulties are likely to be encountered in the developing countries, especially the least developed, because poverty, lack of development, and inequity are obstacles to adaptation.

29. Sources of Mortality Reduction 1960-1990 ReductionPercentage Contribution of Gains IncomeEducation adult females Generation new knowledge Under-5 mortality rate 173845 Female adult mortality rate 204139 Male adult mortality rate 252749 Female life expectancy (birth) 193249 Male life expectancy (birth) 203050 Total fertility rate 125829

30. Adaptation a Function of: Availability of options Availability & distribution of resources Governance Human & social capitol Assess to risk-spreading mechanisms Ability of decision-makers to manage information Public perception

31. Questions for Designing Adaptation Policies & 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?

33. Principles for Adaptation Policies and Measures Measures must be based on an understanding of the multiple and interacting determinants of disease Climate variability may exacerbate or ameliorate disease determinants, with the possibility that thresholds or non- linearities may be encountered

34. Public Health Responses Known public health preventions that will need to be deployed in different ways or in different locations Modify existing prevention strategies Reinstitute effective prevention programs Apply no-regrets strategies Public health systems in the future could face new risks

35. 7 th Inning Stretch

36. Aims of a Health Impact Assessment: Evaluate The potential impacts of climate variability and change in a range of areas and populations –Determine attributable burden Possible threshold effects Effects of multiple stresses Uncertainty Effects of reducing emissions Coping capacity

37. Steps in Assessing Vulnerability and Adaptation Determine the scope of the assessment Describe the current distribution and burden of climate-sensitive diseases –Describe the association between climate and disease outcomes Identify & describe current strategies, policies, and measures to reduce that burden (adaptation baseline)

38. Review the health implications of the potential impact of climate variability and change on other sectors Estimate future potential health impacts using scenarios of climate change Synthesize the results Identify additional adaptation measures to reduce potential negative health effects Steps in Assessing Vulnerability and Adaptation

39. Risk Management Cycle Identify issues Assess key risk areas Measure likelihood of impacts Rank risks Set desired results Develop options Select a strategy Implement the strategy Monitor, evaluate, and adjust

40. Source: UKCIP, 2003 Framework for Adaptation

41. Levels of Assessment Basic assessment – use readily available information and data More comprehensive assessment – include some quantitative assessment using available data Even more comprehensive assessment – could include collecting new data and/or generating new models

42. Methods Qualitative Quantitative Integrated approach likely to be most informative because climate impacts are likely to transcend traditional sector and regional boundaries, with effects in one sector affecting the capacity of another sector or region to respond

43. Determine the Scope of the Assessment Health and community security issues of concern today and of potential risk in the future –Interactions between weather/climate and health are location-specific May not imply an increased burden of disease Geographic region to be covered –National boundaries may not be most appropriate Time period –Include time periods appropriate to planning

44. Identification of Health Outcomes National or regional health authority in collaboration with: –Authorities responsible for social security, environmental affairs, and meteorological offices –Research community –Other stakeholders, including NGOs, business, and the public

45. Describe Current Burden of Climate Sensitive Diseases What is the current incidence and prevalence of the disease? –What is the trend? What is the geographical distribution of vector-borne diseases? What is the attributable burden of disease to climate and/or weather? What are the other drivers of the disease outcome? –What are the modifying and interacting factors?

46. Describe Adaptation Baseline What is being done now to reduce the burden of disease? How effective are these policies and measures? What could be done now to reduce current vulnerability? What are the main barriers to implementation (such as technology or political will)? What measures should begin to be implemented to increase the range of possible future interventions?

47. Review the Health Implications of the Potential Impacts of Climate on Other Sectors Effects of climate variability and change on the food and freshwater supply Effects of policies such as domestic water storage Risk of disasters, such as coastal flooding

48. Estimate Future Potential 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

49. Synthesize Results Identify: –Changes in risk patterns –Links between sectors –Vulnerable groups –Stakeholder responses –Sources of uncertainty One approach is to use a panel of experts Results should be peer-reviewed and published

50. 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

51. Identify Additional Adaptation Strategies, Policies & Measures When and where to implement new policies? –Identify strengths and weaknesses, as well as threats and opportunities to implementation Lessons learned

52. Framework for the Assessment Involvement of stakeholders Management structure –Partnership development –Knowledge generation and exchange –Policy development and recommendations Peer review process Dissemination and risk communication

53. For Further Information Methods of Assessing Human Health Vulnerability and Public Health Adaptation to Climate Change (Kovats RS, Ebi KL, Menne B) Climate Change and Human Health: Risks and Responses (eds. Mc Michael et al.) cCASHh - http://www.euro.who.int/ccashhhttp://www.euro.who.int/ccashh Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions (Ebi KL, Smith J, Burton I)