1. Climate Change and Health in the context of Emergencies/Fragile States Niall Roche, Member of the Irish Forum for Global Health Trinity Development Research Week 10 th November 2011

2. Perspective Observed perspective rather than research gained perspective Focus on the Environmental Health (including WASH) aspects of Health and Climate Change Viewing Climate Change as a cross cutting or mainstreaming issue

3. Climate Change and Health Direct Effects – European heatwave in 2003 resulting in 27,000 - 40,000 excess deaths. Indirect Effects

4. Climate Change and Health (Indirect) Changing patterns of disease – diarrhoea, malaria, dengue fever for example Food security threatened due to drought and unpredictable rainfall “East Africa is experiencing its worst drought in sixty years. Ten million people in Ethiopia, Kenya and Somalia are now dependent on food aid” (Trocaire communication 7 th Nov. 2011) Water Security problems due to decreased access to fresh water - ground water levels in Eritrea said to be dropping by as much as 1 metre per year.

5. Climate Change and Health (Indirect) Vulnerable shelter and human settlements ie due to sea level rises Extreme climatic events – floods,cyclones etc. Forced migration coupled with population growth

6. How is climate change mainstreamed into Primary Health Care programmatic activities?

7. Deh Poyon village, Ishkashim district, Badakhshan Province, Afghanistan. 18 th Oct 2011 Photo: Niall Roche

8. Southern Sudan, April 2011 Photo: Niall Roche How is climate change mainstreamed into these engineering activities that have a health objective?

9. Mainstreaming at the Policy Level Afghanistan - Strategic Plan for the Ministry of Public Health 2011- 2015 10 Strategic Directions listed 2 of those are Env. Health related

10. Mainstreaming at the Policy Level No. 8 Support health promotion and community empowerment No. 9 Advocate for and promote healthy environments Strategic plan developed through a highly participatory process A core value is Evidence based decision making!!

11. 9. Advocate for and promote healthy environments SO1- to strengthen the stewardship role of the MoPH in Env. Health SO2- to advocate for increased availability of safe drinking water in order to reduce the burden of disease from contaminated water SO3- to increase food safety practices to prevent food borne illnesses in food service and retail establishments SO4-to develop a systematic framework to lead a national process to reduce air pollution and promote clean air SO5- to create a national multisectoral radiation protection forum to agree on and advocate for safe levels of radiation in the country including increasing industry and public awareness on the issue SO6 – to create a national multi- stakeholder mechanism for the management of garbage and hazardous wastes SO7 – To improve hygiene and sanitation throughout the country among the general public and health workers SO8 – to build capacity and improve occupational health and safety among all workplaces

12. Evidence Base? No evidence base presented for the list of Strategic Objectives Radiation protection seems illogical and seems to have a higher priority purely from its positioning on the list No sense that climate change issues have been “mainstreamed” into the document. No conclusions developed about an increase in extreme climatic events (droughts, floods, landslides etc.) and how the health system should respond.

13. Role of Research To mainstream climate change externally (programmatic level) and internally (policies and people) including disaster risk management Challenge the evidence base for policy decisions through research. Engage in researching trends (on water availability for example) and modelling predicted changes

14. Thank You roche.niall@gmail.com