1. Vulnerability in the South African context Presented at CSIR Innovation Conference Juanette John Environmental Health Scientist 28 February 2006

2. Slide 2 © CSIR 2006 www.csir.co.za Our focus Air pollution Exposure Impacts/ Health effects on humans External factors External factors

3. Slide 3 © CSIR 2006 www.csir.co.za Vulnerability: an introduction What is vulnerability? ’characteristics of a person or group in terms of their capacity to anticipate, cope with, resist and recover from the impact of natural or man made hazards’ The important question: Vulnerable to what? Why is vulnerability significant in the air pollution context?

4. Slide 4 © CSIR 2006 www.csir.co.za What is the focus of the presentation? Risk vs vulnerability Categories of vulnerability Some Vulnerability factors affecting SA communities in relation to air pollution. A conceptual framework for integrating health risk assessment and vulnerability Challenges associated with integrating these concepts

5. Slide 5 © CSIR 2006 www.csir.co.za Risk vs vulnerability Risk: likelihood of an event following exposure Determination of health impacts of air pollution through Epidemiology and toxicological studies Health risk assessments Environmental health impacts studies Data on risk factors lacking risk management Realisation that risks cannot be considered within the boundaries of traditional risk assessment framework Risk = f{Hazard, Vulnerability}

6. Slide 6 © CSIR 2006 www.csir.co.za Categories associated with vulnerability Susceptibility/sensitivity Differential exposure Differential preparedness Differential ability to recover

7. Slide 7 © CSIR 2006 www.csir.co.za Categories and factors associated with vulnerability SusceptibilityDifferential exposure Differential ability to recover/cope IntrinsicAcquired Life/developmental stage NutritionOccupationAccess to health care Immunisation GeneticsDrug/alcohol useCultural/behavioural practices Education RaceFitnessBackground exposure Socio-economic status GenderObesityBody burdenCultural practices Disease stateDiseaseFuel useEmployment

8. Vulnerability: The South African context

9. Slide 9 © CSIR 2006 www.csir.co.za Susceptibility factors Life/developmental stage (age) Genetics Race Gender Disease state Respiratory diseases HIV/AIDS and opportunistic infections Nutritional status

10. Slide 10 © CSIR 2006 www.csir.co.za Gender Source: DoH, MRC & MacroInt, 2001

11. Slide 11 © CSIR 2006 www.csir.co.za Differential exposure factors Fuel use Occupation Cultural and behavioural practices Background exposure Body burden

12. Slide 12 © CSIR 2006 www.csir.co.za Behavioural practices Source: DoH, MRC & MacroInt, 2001

13. Slide 13 © CSIR 2006 www.csir.co.za Differential ability to recover/cope Education Access to health care Socio-economic status Cultural practices Employment

14. Slide 14 © CSIR 2006 www.csir.co.za Education Source: DoH, MRC & MacroInt, 2001

15. Slide 15 © CSIR 2006 www.csir.co.za Integration of vulnerability and risk: a methodological framework

16. Slide 16 © CSIR 2006 www.csir.co.za Challenges Aim: to provide a true reflection of the health risks of community to environmental stressors Methodological challenges Pilot test challenges Standardisation challenges