1. Promoting health in an environment challenged by climate change: Water Dr Bettina Menne, Arezzo 23.11.2010 menneb@who.int

2. Dr Bettina Menne menneb@who.int

3. Dr Bettina Menne menneb@who.int McMichael et al. 2003 Multiple, complex, causal pathways

4. Dr Bettina Menne menneb@who.int Climate change and water: Too little, too much, too dirty

5. Dr Bettina Menne menneb@who.int Water resource management and access Total water abstraction in EU expected to decrease by 10% between 2000 – 2030 Precipitation decrease by 10% Differential access in Europe: e.g. urban rural; east west Adaptation requires: –Safe reuse of waste water –Desalinization practices –Increasing resilience of supply Projected change in mean annual and seasonal river flow between the climate change scenario (SRES A1B, 2071-2100) and the control period (1961-1990). Simulations with LISFLOOD based on an ensemble of 11 RCMs. Source: Rojas et al. 2012/JRC

6. Dr Bettina Menne menneb@who.int Less time between extreme events on average Projected return periods for the maximum daily temperature that was exceeded on average once during a 20-year period in the late 20th century (1981–2000) (IPCC, SREX, 2011). Projected return periods for a daily precipitation event that was exceeded in the late 20th century on average once during a 20-year period (1981–2000) (IPCC, SREX, 2011).

7. Dr Bettina Menne menneb@who.int Health and floods Disruption of routine hospital care Rise in infectious disease incidence Food shortages Safe water shortages Mental health problems Injuries Carbon monoxide poisoning

8. Dr Bettina Menne menneb@who.int Emerging water-related diseases

9. Dr Bettina Menne menneb@who.int 20%50%80% Adapted from Parry, 2008 An international challenge ahead

10. Dr Bettina Menne menneb@who.int Table 1. Estimated global annual cost of climate change adaptation (US$ billion): UNFCCC (2007 prices) World Bank (2005 prices) Sector 20302010-2050Period or time point 3.8 - 4.42.0Health sector 9.0 - 11.013.7Water supply 14.07.6Agriculture, forestry and fisheries -6.7Extreme weather 26.8 - 29.430.0Total health-related 56.8 - 193.489.6Total (all) 13.8 - 47.1%33.4% health-related Estimating resources for adaptation

11. Dr Bettina Menne menneb@who.int 11 Ministerial Conferences on Environment and Health: the pillars of the process The first Ministerial Conference was held in Frankfurt in 1989, followed by Helsinki in 1994, London in 1999 and Budapest in 2004 As an intermediate milestone, in 2007 an intergovernmental meeting reviewed progress in the implementation of the Budapest commitments The Fifth Ministerial Conference took place in Parma on 10-12 March 2010.

12. Dr Bettina Menne menneb@who.int Protecting health from climate change in an environment challenged by climate change 1. Health in other policies 2. Strengthen health systems 3. Raise awareness 4. Greening health services 5. Research, innovation, development

13. Dr Bettina Menne menneb@who.int Adaptation to climate change New? Better? More?

14. Dr Bettina Menne menneb@who.int Small scale water supply 80 % of health facilities in country do not have adequate quantity of running water 2 pilot sites chosen for developing Water Safety Plans One hospital site having water safety plan, including repair and installation of safe water delivery system Training on water safety planning Workshop for facilitators team of 13 professionals from Ministry of Health, for Water Safety Plan in pilot villages Training of trainers for hospital plumbing National advocacy seminar for 40 decision makers and potential donors

15. Dr Bettina Menne menneb@who.int Increasing expenditures on prevention Less than 5 % is spent on primary prevention despite huge potential to reduce the growth in health expenditures. Other Alcohol Unsafe Sex Tobacco Physical Inactivity Illicit drugs Environment Treatment & Overhead Prevention < 5% Factors influencing healthWorld-wide health expenditures US $ 5.3 Trillion Source: Estimated from OECD, WHO, and Prevention Institute data 1% life expectancy increase = 6% GDP growth (OECD) 10% decrease in CVD = 1% per capita income growth (2009)

16. Dr Bettina Menne menneb@who.int A few examples

17. Dr Bettina Menne menneb@who.int Thu 12 Jan 201217 Tackling the old and new Strengthen disease surveillance –Emerging diseases –Vaccine preventable diseases –Neglected diseases: helminthes Cooperation between ML Agreements –IHR and health security –Disaster preparedness and response –Water Protocol Focus on win – win – win - win

18. Dr Bettina Menne menneb@who.int

19. Dr Bettina Menne menneb@who.int Opportunities to link to other regional and global policy processes Health Prevention of NCDs European Environment and Health Process Rio +20 HealthEnvironment Prevention of NCDs Rio +20 European Environment and Health Process Health2020 Prevention of NCDs European Union MSs Environment for Europe Rio +20 European Environment and Health Process EnvironmentHealth Multilateral Environmental Agreements International Health Regulation

20. Dr Bettina Menne menneb@who.int Any questions? Contact details: Dr Bettina Menne Program Manager Climate change, green health services and sustainable development program WHO Regional Office for Europe + 39 2288150422 Email: menneb@who. int http://www.euro.who.int/globalchange@who. int http://www.euro.who.int/globalchange

21. Dr Bettina Menne menneb@who.int More than 894 million; 15% older than 65 years old; 70% live in cities 22% GDP growth fall of 28% in carbon emissions between 1990 and 2008 1/5 of burden of disease is caused by environmental pollution More than 86% of deaths are from non communicable diseases; Growing levels of obesity and infectious disease outbreaks Rising levels of inequalities Increasing financial pressures on health and welfare systems Important social and technological transformations Geopolitical shifts 21

22. Dr Bettina Menne menneb@who.int

23. www.euro.who.int menneb@who.int 23