1. Kristie L. Ebi, Ph.D., MPH NCAR Summer Institute July 2004
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

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

6. Exposure
Tmax
10 August 2003

7. Chicago 1995

8. 2003: The Shape of Things to Come?
.10
1947
2003
.08
Frequency
.06
.04
.02 5 10 15 20 25 30 35 40 45
Maximum Temperature [°C]: Basel
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 HeatwaveUK
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 excess heat-related deaths of which 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

24. Pohnpei

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
The major potential human health threats for the Caribbean are temperature-related illnesses and deaths; extreme weather events-related health effects; air pollution-related health effects; water-borne diseases; food-borne diseases; vector-borne diseases and rodent-borne diseases.
Increased hunger, scarce water supply, deteriorated water quality, damaged infrastructure and displaced coastal communities as a result of climate change induced sea-level rise and drought would further impact public health in the Caribbean

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
The above is but a brief overview of the potential impacts of climate variability and change on environmental health in the Caribbean. How then do countries in the region adapt and manage these potential health impacts? The following is proposed:
Establishment of Monitoring and Surveillance System
Create the enabling environment, including supporting mechanism and institutional arrangements
Strengthen and improve the Public Health infrastructure
Promote research
Promote awareness and education programmes aimed at medical and health professionals, politicians, policy and decision-makers and the general public.

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
Percentage Contribution of Gains
Income
Education adult females
Generation new knowledge
Under-5 mortality rate 17 38 45
Female adult mortality rate 20 41 39
Male adult mortality rate 25 27 49
Female life expectancy (birth) 19 32
Male life expectancy (birth) 30 50
Total fertility rate 12 58 29

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. 7th 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. Steps in Assessing Vulnerability and Adaptation
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

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. Framework for Adaptation
Published only last week
-> Needs to be evaluated!
Source: UKCIP, 2003

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: One approach is to use a panel of experts
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 -
Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions (Ebi KL, Smith J, Burton I)