World Health Organization

World Health Organization
31 March 2017 Health, climate change, and WHO Public Health and Environment Department, WHO-Geneva

31 March 2017 This Presentation What is climate change? What does it mean for health? What has been done? What still needs to be done? Image copyright of Elsevier/the Lancet (to be confirmed)

31 March 2017 What is climate change?

31 March 2017 Temperatures are rising rapidly, following increases in CO2 emissions and concentrations The three graphs on this chart show changes over the past 1,000 years. The bottom graph shows carbon emissions; the beige band shows emissions due to change in land use (such as deforestation to create agricultural land) and the pink band shows fossil fuel emissions. Fossil fuel emissions have increased dramatically since the Industrial Revolution. The middle, beige graph shows increasing atmospheric CO2 concentrations in response to increasing carbon emissions. The atmospheric concentration of CO2 prior to the Industrial Revolution was approximately 280 ppm; the current concentration is nearing 390 ppm. This concentration has not been exceeded during the past 420,000 years and probably not during the past 20 million years. The pink line shows that, although there has been variability, global average surface temperature has paralleled CO2 concentrations for the past 1,000 years. The global average surface temperature increased approximately 0.7ºC during the past century, with about 0.4ºC of that increase since the 1970s. Temperatures are now changing at 0.18ºC per decade. Surface temperatures now exceed the upper limit of natural (historic) variability. Image from ACIA (2004), reproduced with permission. What is climate change? 4

31 March 2017 Temperature increases cannot be explained by natural processes Given that records show that climate is changing, the next question is the degree to which human activities are responsible. The top figure shows global mean surface temperature anomalies relative to the period 1901 to 1950, as observed (black line) and from models that included anthropogenic and natural forcings. The thick red curve shows the means from the models and the thin lighter red curves show the individual model results. Vertical grey lines indicate the timing of major volcanic events. The bottom figure shows global mean surface temperature anomalies relative to the period 1901 to 1950, as observed (black line) and from models that included only natural forcings. The thick blue curve shows the means from the models and the thin lighter blue curves show individual model results. Image from IPCC 4th Assessment Report (2007) IPCC 2007: 4th assessment report What is climate change? 5

Temperatures will rise further
World Health Organization 31 March 2017 Temperatures will rise further These figures and maps show projected surface temperature changes for the early and late 21st century relative to the period 1980 to The left panel shows projections for the global average surface temperature for the next century. The central and right panels map projections of these values averaged over the decades 2020 to 2029 (center) and 2090 to 2099 (right). Image from IPCC 4th Assessment Report (2007) IPCC 2007 What is climate change? 6

Precipitation will also change, and become more extreme
World Health Organization 31 March 2017 Precipitation will also change, and become more extreme Annual mean precipitation change: 2071 to 2100 compared to 1990. IPCC, 2007 This map shows in more geographic detail changes in mean precipitation. Image from IPCC 4th Assessment Report (2007) What is climate change? 7

Many aspects of weather have changed, and will continue to do so
World Health Organization 31 March 2017 Many aspects of weather have changed, and will continue to do so This summarizes the conclusions of the IPCC on observed and projected trends in various climatic events. These changes could have significant impacts on human health. An asterisk in column D indicates that formal detection and attribution studies were used, along with expert judgment, to assess the likelihood of a discernible human influence. Source: IPCC 4th Assessment Report (2007) IPCC 2007 What is climate change? 8

How does climate change affect health?
World Health Organization 31 March 2017 How does climate change affect health?

Climate change undermines the environmental determinants of health
World Health Organization 31 March 2017 Climate change undermines the environmental determinants of health Without effective responses, climate change will compromise: Water quality and quantity: Contributing to a doubling of people living in water-stressed basins by 2050. Food security: In some African countries, yields from rain-fed agriculture may halve by 2020. Control of infectious disease: Increasing population at risk of malaria in Africa by 170 million by 2030, and at risk of dengue by 2 billion by 2080s. Protection from disasters: Increasing exposure to coastal flooding by a factor of 10, and land area in extreme drought by a factor of References for all figures given in WHO, Protecting Health From Climate Change: Connecting Science, Policy and People, World Health Organization, Geneva; page 7. How does climate change affect health?

31 March 2017 Climate change connects to many health outcomes Some expected impacts will be beneficial but most will be adverse. Expectations are mainly for changes in frequency or severity of familiar health risks Modulating influences Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement Human exposures Regional weather changes Heat waves Extreme weather Temperature Precipitation Contamination pathways Transmission dynamics Agroecosystems, hydrology Socioeconomics, demographics CLIMATE CHANGE Reference: Patz, J.A., Engelberg, D. and Last, J., The effects of changing weather on public health. Annual Review of Public Health, 21: Based on Patz et al, 2000 How does climate change affect health?

31 March 2017 Some of the largest disease burdens are climate-sensitive Each year: Undernutrition kills 3.5 million Diarrhoea kills 2.2 million Malaria kills 900,000. - Extreme weather events kill 60, WHO estimates that the climate change that has occurred since the 1970s already kills over 140,00 per year. References for all figures given in WHO, Protecting Health From Climate Change: Connecting Science, Policy and People, World Health Organization, Geneva; page 7. Image from CDC Public Health Image Library. How does climate change affect health?

31 March 2017 Weather-related disasters kill thousands in rich and poor countries References: 1) European Environment Agency: , based on data from IVS (2003): Impact sanitaire de la vague de chaleur en France survenue en aout 2003, Rapport d'etape, 29 aout Saint-Maurice, Institut de Veille Sanitaire. 2) NASA: Deaths During Summer Heatwave. Paris Funeral Services (2003) Hurricane Katrina, 2005 How does climate change affect health?

31 March 2017 Increases in diseases of poverty may be even more important Diarrhoea is related to temperature and precipitation. In Lima, Peru, diarrhoea increased 8% for every 10C temperature increase. (Checkley et al, Lancet, 2000) Reproduced with permission from Elsevier/Lancet. Checkley, W. et al., Effects of El Nino and ambient temperature on hospital admissions for diarrhoeal diseases in Peruvian children. Lancet, 355(9202): How does climate change affect health?

Health impacts are unfairly distributed
World Health Organization 31 March 2017 Health impacts are unfairly distributed Cumulative emissions of greenhouse gases, to 2002 WHO estimates of per capita mortality from climate change, 2000 References: McMichael, A. et al., Climate Change. In: M. Ezzati, A. Lopez, A. Rodgers and C. Murray (Editors), Comparative Quantification of Health Risks: Global and Regional Burden of Disease due to Selected Major Risk Factors. World Health Organization, Geneva. Patz, J., Gibbs, H., Foley, J., Rogers, J. and Smith, K., Climate Change and Global Health: Quantifying a Growing Ethical Crisis. Ecohealth, 4: 397–405. WHO, Protecting Health From Climate Change: Connecting Science, Policy and People, World Health Organization, Geneva. Map projections from Patz et al, 2007; WHO, 2009. How does climate change affect health?

31 March 2017 What has been done?

International community has given clear direction
World Health Organization 31 March 2017 International community has given clear direction UNFCCC, Article 1, paragraph (1) states need to minimize adverse effects on "natural and managed ecosystems or on the operation of socio-economic systems or on human health and welfare” . World Health Assembly Resolution WHA/61.R19, and Executive Board Resolution EB124.R5, request WHO to develop capacity to assess the risks from climate change for human health and to implement effective response measures, and support countries through Awareness raising, Partnerships, Evidence, and health system strengthening. What has been done? International Mandates

Awareness raising: High public concern over climate risks to health
World Health Organization 31 March 2017 Awareness raising: High public concern over climate risks to health Globescan poll in 30 countries (UNDP 2007): “Now I would like to ask you some questions about climate change, which is sometimes referred to as global warming or the greenhouse effect. Which ONE of the following possible impacts most concerns you personally, if any?” Reference: UNDP World Development Report, 2007. What has been done? Awareness raising

31 March 2017 Awareness Rising: Governments request international support 193 countries endorse WHA resolution calling for action to protect health from climate change. 95% (39/41) of National Adaptation Programmes of Action (NAPAs) from least developed countries identify health as a priority sector affected by climate change. 73% (30/41) of the NAPAs have included health interventions within adaptation needs. Reference for NAPA review: Manga, L., Bagayoko, M., Meredith, T. and Neira, M., Overview of health considerations within National Adaptation Programmes of Action for climate change in least developed countries and small island states. What has been done? Awareness raising

31 March 2017 Awareness raising: WHO achievements Among health leaders: WHA resolution, backed by regional Ministerial declarations and frameworks for action. Among health and metorological professionals: Workshop series, covering over 50 countries across all WHO regions. Among climate leaders: Representation of health in the UNFCCC, formation of "Friends of Public Health" network of negotiators and NGOs. Among the general public: World Health Day 2008 on "Protecting health from climate change, supported by advocacy products and key messages. What has been done? Awareness raising

31 March 2017 Partnerships: UN system working together, and with others UNFCCC provides international framework for climate action, with health as a key justification. UNFCCC operational mechanisms include health; Nairobi Work Programme on Adaptation, Social Dimensions of Climate Change. "One-UN" country teams implementing health adaptation projects. Establishment of networks of health NGOs campaigning on climate change. What has been done? Partnerships

31 March 2017 Partnerships: WHO achievements Awareness raising partnerships: Establishment of "Friends of Public Health" network, coordination with major health NGOs. Policy partnerships: Representation of health in UNFCCC negotiations and support mechanisms; co-convenor of UN task team on Social Dimensions of Climate Change. Scientific and technical partnerships: Representing health on IPCC, technical guidance with WMO and UNEP. Operational partnerships for health adaptation: Projects implemented through UN country teams; with UNDP and GEF; with bilateral aid agencies. What has been done? Partnerships

31 March 2017 Evidence: Definition of health risks and responses Over 1000 papers on health and climate change in peer- reviewed journals. Research covering risks, costs, cobenefits of mitigation, resource requiremennts. Evaluations of health risks in three IPCC assessment reports. What has been done? Scientific evidence

31 March 2017 Evidence: Benefits of healthy mitigation measures documented Sustainable urban transport – could cut heart disease and stroke by up to 20%. Improved stoves could save 2 million lives over 10 years in India alone, and reduce warming from black carbon. Health benefits from actions to reduce greenhouse gas emissions could substantially offset mitigation costs. "while the climatic effects of mitigation measures are long-term and dispersed throughout the world, the health benefits are immediate and local" – WHO director-General Margaret Chan, 2009 References: Haines, A. et al., Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. Lancet, 374(9707): Chan, M., Cutting carbon, improving health. Lancet. 374(9707) What has been done? Scientific evidence

31 March 2017 Evidence: WHO achievements Over 50 books, reports and papers on climate change - health links. Guidance and systematic review of research output vs. requests of countries. Quantitative assessment of global health impacts of climate change. Technical guidance on vulnerability and adaptation assessment, and specific risks. Comprehensive review of health implications of mitigation policies across major sectors. What has been done? Scientific evidence

31 March 2017 Health system strengthening: Identification of principles for health adaptation We have proven, cost-effective interventions against every climate-sensitive health impact. Clean water and sanitation, vector control, disaster risk reduction, early warnings, humanitarian aid… All of these are "win-wins": saving lives now, and reducing vulnerability to climate change. Adaptation to climate change is part of a preventive approach to public health – not a distraction. WHO/Hans Everts What has been done? Health system strengthening

31 March 2017 Health system strengthening: Documentation of country needs Less than 30% of least developed countries have adequate health vulnerability assessments and health adaptation plans. Only 11% of proposed adaptation projects, and only 3% of requested funds, are for health protection. Health adaptation projects comprise just 1% of international climate finance, and less than 0.5% of estimated health damages from climate change. References: Adaptation Costs: Ebi, K.L., Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in Global Health, 4: 9. World_Bank, The Cost to Developing Countries of Adapting to Climate Change New Methods and Estimates: The Global Report of the Economics of Adaptation to Climate Change Study, Washington, D.C. Both based on applying unit costs to health impacts in: WHO, The World Health Report WHO, Geneva. McMichael, A. et al., Climate Change. In: M. Ezzati, A. Lopez, A. Rodgers and C. Murray (Editors), Comparative Quantification of Health Risks: Global and Regional Burden of Disease due to Selected Major Risk Factors. World Health Organization, Geneva. Reference for NAPA review: Manga, L., Bagayoko, M., Meredith, T. and Neira, M., Overview of health considerations within National Adaptation Programmes of Action for climate change in least developed countries and small island states. What has been done? Health system strengthening

31 March 2017 Health system strengthening: Estimation of required resources for health adaptation Estimated global annual cost of climate change adaptation (US$ billion): UNFCCC (2007 prices) World Bank (2005 prices) Sector 2030 Period or time point 2.0 Health sector 13.7 Water supply 14.0 7.6 Agriculture, forestry and fisheries - 6.7 Extreme weather 30.0 Total health-related 89.6 Total (all) % 33.4% % health-related Guy's inputs on "Future countries and regions needs" To date, only few examples exist of costed health sector adaptation plans in the NAPA [1]. One study from Bangladesh estimates an average annual adaptation cost in the health sector, from 2010 to 2050, at US$ 18 million per year [2]. Under the NEEDS project, Ghana estimates additional resources of US$ 350 million by 2020 to adapt to climate change in the health sector [3]. Two global health adaptation cost assessments have been conducted as part of multi-sectoral assessments by the World Bank [4] and the UNFCCC [5]. A third global study focuses on health adaptation costs only [6]. All of these studies include diarrheal diseases, malaria and malnutrition. The cost estimates of these studies are compared in Table. Health adaptation costs are in the same order of magnitude in the three studies, largely because they are based on the same underlying health impact data [7]. While the World Bank study has the lowest health sector cost of the 3 studies at US$ 2 billion annually over the period , it omits the costs of malnutrition, which are instead covered in the agriculture sector (see table). In fact, as other major health impacts of climate change (e.g. disasters, other tropical diseases, …) are excluded from these studies, and cost inputs of the programmes and services have been underestimated, the annual global costs will likely to be significantly greater than US$ 5 billion. Majority of health costs are in EAP, SA and SSA. Table 2. All estimates derived by applying unit costs to WHO estimates of health impacts of climate change What has been done? Health system strengthening

31 March 2017 Health system strengthening: Definition of an essential public health package Most health risks in next years could be averted through: comprehensive assessments of climate risks to health and health systems; integrated environment and health surveillance; delivery of preventive and curative interventions for identified climate-sensitive public health concerns; preparedness and response to the public health consequences of extreme weather events; applied research; and strengthening of human and institutional capacities and inter-sectoral coordination. What has been done? Health system strengthening

31 March 2017 Health system strengthening: WHO achievements 17 major projects on health adaptation to climate change, in 14 countries, in all WHO regions. Assessments of health vulnerability to climate change in over 30 countries. Review of country requirements, clearinghouse of current adaptation projects. Guidance and pilot projects on green and safe health services. What has been done? Health system strengthening

What still needs to be done?
World Health Organization 31 March 2017 What still needs to be done?

31 March 2017 Goal: Policy makers and general public recognize health as a practical and positive argument for climate policy Requires: More effective engagement of health actors and messages in climate policy debate. WHO contribution: Production of targeted awareness-raising products for specific audiences. Mobilization of health networks on evidence-based advocacy messages. Sustained engagement with health and climate policy-makers. What is still needed? Awareness raising

31 March 2017 Goal: Coherent, evidence-based health and climate policy, matching demands of Governments and the public Requires: Sustained partnerships to design and implement climate and health policy, and health access to financial support. WHO contribution: Articulating health opportunities and resource requirements within the UN system response. Convening operational partnerships of health and climate actors at national, regional and global levels. Establishing and maintaining networks to guide, implement and monitor applied research, in response to country needs. What is still needed? Policy and partnerships

31 March 2017 Goal: Policy-relevant evidence on health adaptation, and healthy mitigation policy, accessible to decision-makers Requires: Greater emphasis on applied research, and on knowledge management for practical application. WHO contribution: Systematic review and guidance of research output to match the needs of decision-makers. Specific evidence products, on the benefits and costs of health adaptation interventions, and on health promoting mitigation. Translation of research into practical guidance for health protection from climate change, and health-enhancing mitigation policy. What is still needed? Evidence

31 March 2017 Goal: Populations protected from climate change by essential package of public health interventions Requires: Technical guidance, institutional collaboration mechanisms, and approximately US$1 billion/year financial support. WHO contribution: Country, regional, and global presence to convene and support intersectoral health and climate policy. Technical guidance, policy and capacity building support, building on established capacity in managing climate-sensitive disease risks. Project design and management, building on existing portfolio of climate change and health projects. Cost estimates are approximate, and based on extrapolation of per capita cost estimates from "Proposed Framework For An Integrated Health Sector Response For Public Health Adaptation To Climate Change In Africa": WHO/UNEP 2011. WHO/SEARO 2008 What is still needed? Policy and partnerships

31 March 2017 Conclusions Governments, the health community and the general public, agree on the importance of health within the response to climate change. A package of health protection from climate change is feasible, comparatively cheap, and likely to be effective. Well-designed mitigation measures could bring major health gains, giving local and immediate repayment on investments. Countries need additional policy, technical, capacity building, and (in many cases) financial support to protect and promote health. WHO has a unique contribution to make to achieve these goals.

31 March 2017 Thank you for your attention World Health Organization Health and climate change: Thanks to the following partners for generous financial and in-kind support: Governments of: Canada; Germany; Italy; Korea; Principality of Monaco; Spain; The United Kingdom; United States of America. The European Union, The Global Environment Facility and the UN Foundation.

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