1. Stakeholder (SH) Engagement and Links to Decision- Making: Adaptation to Climate Change / Variability Impacting on Dengue Fever in Caribbean Countries Sam Rawlins

2. Project SIS 06 The University of the West Indies (UWI), Climate Unit, Mona, Kingston, Jamaica. The Caribbean Epidemiology Centre (CAREC), Port of Spain, Trinidad and Tobago. UWI Dept of Pathology, Trinidad. 21 Caribbean Countries anti-DF programs.

3. Introduction Dengue Fever (DF) is endemic in virtually all Caribbean Countries. There has been a significant increase of prevalence and severity in the last two decades. There has been greater occurrences in El Nino and El Nino+1 years, suggesting a Climate Change (CC) correlation.

4. Map of the Caribbean countries

5. Dengue in the Caribbean: In light of the temperature trend (previous diagram), the increase in dengue since 1992 could be due to increasing temperatures - See black circles El Nino El Nino + 1

7. Decisions which may be influenced by this project Reduction of Dengue fever cases (occurrence), related to CC/V Thro’ the reduction of mosquito vectors (Aedes aegypti) Thro’ the reduction of potential habitats increased thro’ appropriate climate conditions Thro’ Environmental Sanitation (ES)

8. Decision-Makers Include:- Public Health authorities (Ministries of Health) in our 21 Member countries Focal Points in public health – Vector Control Staff, Epidemiologists, Educators Local Govt. staff who facilitate anti-DF action Contd.

9. Decision-Makers contd. Communities who are at risk for DF and who must implement anti-DF action Families who are at risk and must participate in anti-vector action Individuals who are at risk and must be part of the solution The scientific community who must be sensitized for positive influence.

10. Research is Relevant as follows To confirm a link between CC/V and DF vector production and DF Cases Predict which CC conditions are most appropriate for DF transmission Inform what ES actions are necessary to prevent increase in vectors and DF cases Provide results useful for public education programs for mitigation and adaptation.

11. Stakeholders engaged in the Project Ministries of Health: Participation in Epid. and CC data collection Scientific community will evaluate the evidence. Communities in the Caribbean are the at- risk group for the DF From these, information is required on:-

12. Stakeholders information on CC Understanding of the concept of CC Perception of how CC affects us Sources of info on CC Self-reported action on DF prevention Willingness to act further on DF prevention if CC link could be demonstrated Actual proof of current action (inspection).

13. Reported Causes of CC in Trinidad communities Criteria%Comm.Sch Greenhouse Gases4.85.2 Holes in the Ozone Layer23.85.2 Burning Vegetation14.30 Automobile Exhaust Fumes 4.8 10.5 All of the Above47.6 57.9 Don’t know4.8 15.8

14. How Climate Change Affects Two Trinidad Communities Criteria(%) Comm. Sch., Health37.5 7.1 Water Resources12.5 0 Agriculture12.5 14.3 Biodiversity4.2 7.1 Coastal degradation etc.4.2 14.3 All Equally29.2 50

15. Health Factors affected by CC/CV in Trinidad Communities Criteria%Comm.% Sch. Food-Borne Dis.14.35.5 Water-Borne Dis.14.311.1 Vector-Borne Dis.14.311.1 Respiratory Dis.011.1 Heat Stresses9.516.7 All Equally47.638.9 None05.5

16. Benefits (B) and Costs (C) of Researchers working with Stakeholders Bringing a Global concept Local (B) Empowering the local scientific – climate and epidemiologic – community (B) Brining a new practical tool to Public Health (B) Spending time and other resources on the project (C)

17. Benefits (B) and Costs (C) to the Stakeholder Accessing modern technology tools for DF prevention (B) Possibility of applying this tool to other areas of health (B) Possible application of CC tools to other areas e.g. Water res., Biodiversity, Agric., Coastal Degradation (B) Scarce resources now being utilized without a clear assurance of outcome (C)

18. Appropriate Role of SHs in assessing CC vulnerability Data collection for research (MoHs; Cl.Gp) Appropriate response to prediction info e.g. ES improvement at risk times (MoHs Comm.) Health education and promotion (MoH) Participation of Scientific Research Gp. on interpretation of Disease & CC info.

19. Assessment Design and Implementation for better service In a manner that is clear (to the layman) & convincing of CC & vulnerability If Stakeholders can be comfortable enough with the concepts to accept this as their own project, if The benefits (adaptation) can be clearly discernible and demonstrated.

20. Information Sources on CC in 2 Communities in Trinidad Sources% Comm. % Stud Peers06.7 Family50 News/Journals 3013.3 Elec. Media206.7 All Above4026.7 None526.7 Personal Obs. 020

21. Attitudes and Practices of 2 populations on CC regarding DF and its prevention Criteria% Comm. %Students Do Nothing05.3 Organize an E.S. Campaign68.263.2 Leave to PH31.815.8 Don’t Know015.8

22. Willingness to Participate in Vector Control Action re CC Criteria% Comm. % Students Yes10094.1 No0 5.9

23. Current Personal Involvement in VC activities, related to CC Criteria% Comm. % Students Yes8031.3 No2062.5 Don’t Know06.3

24. Conclusion There is a need for appropriate info to show to our SHs, the link of VBDs & CC; only 11 – 14% now are aware. Such health Promotion for the younger sector is very important. Results of this study could stimulate all SHs into action.