1. CLIMATE CHANGE AND PUBLIC HEALTH ADAPTATION IN INDONESIA Budi Haryanto Department of Environmental Health Faculty of Public Health – University of Indonesia The Nautilus Institute Workshop on Mapping Causal Complexity in Climate Change Impacts and Adaptation, Melbourne, 21-22 November 2008

2. INTRODUCTION Climatic changes have already affected numerous damaging impacts on human health. Spreading infectious disease, longer and hotter heat waves, and extreme weather claim thousands of additional lives nationwide each year. Warming climate is creating the ideal conditions for spread of infectious disease, putting millions of people at risk. Climate change has lead to increase the outbreaks and spread of Dengue Hemorrhagic Fever (DHF), malaria, cholera, encephalitis, hantavirus, and other diseases all over the world. Ironically, the countries which have less contributed to the global warming are highly susceptible and more outbreaks of diseases and deaths due to global warming impact

3. OUTLINE PRESENTATION 1. Introduction 2. Climate change and health impacts 3. Research in Indonesia 4. Public health adaptation 5. Strategic idea for public health adaptation in Indonesia

4. Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vectorborne and rodentborne diseases Health Effects Temperature-related illness and death Extreme weather- related (floods, storms) health effects Air pollution-related health effects Environment Impacts: Regional weather changes Heat waves Extreme weather Temperature Precipitation Regional weather changes Heat waves Extreme weather Temperature Sea-level rise Contamination pathways Transmission dynamics - - - -rodent Microbial changes: Contamination paths Transmission dynamics Water and food-borne diseases Vectorborne and borne diseases Climate Change Climate Change Changes in agro- ecosystems, hydrology Socioeconomic and demographic disruption Effects of food and water shortages Mental, nutritional, infectious-disease and other effects Moderating influences

6. EXTREME EVENTS HEALTH IMPACTS (DoH, WA)

7. Potential health impacts of gradual climatic changes

11. Trend of Temperature and DHF Cases in Indonesia 1968-Sept 2007

13. Dengue’s principal vector: Aedes aegypti Principal vector is female Aedes aegypti mosquito. Infected mosquito remains infective for life. Indonesia: reported dengue cases doubled in 2007 vs. 2005.

14. Malaria Cases

15. Malaria Endemic Areas >75 o/oo25-75 o/ooNon Endemis0-25 o/oo 1 dot = 100 kasus1 dot = 500 kasus

16. Effects of Temperature Rise on Dengue Transmission Effects of Temperature Rise on Dengue Transmission Shorten viral incubation period in mosquito Shorten viral incubation period in mosquito Shorten breeding cycle of mosquito Shorten breeding cycle of mosquito Increase frequency of mosquito feeding Increase frequency of mosquito feeding More efficient transmission of dengue virus from mosquito to human More efficient transmission of dengue virus from mosquito to human

17. IMPACTS CLIMATE CHANGE ON HUMAN HEALTH IN INDONESIA Direct effects: Increasing of injuries associated with extreme weather events Increasing of injuries associated with extreme weather events Indirect effects: Increasing of vector borne diseases (malaria, dengue, filariasis) associated with increasing of temperature, rainfall, humidity, and vector density. Increasing of vector borne diseases (malaria, dengue, filariasis) associated with increasing of temperature, rainfall, humidity, and vector density. Increasing of water borne diseases (diarrhea, cholera, typhoid, leptospirosis) associated with decreasing of water quality and water supply as well as floods and droughts. Increasing of water borne diseases (diarrhea, cholera, typhoid, leptospirosis) associated with decreasing of water quality and water supply as well as floods and droughts.

18. Indirect effects… Increasing of malnutrition cases is related to food production and land use shifts Increasing of malnutrition cases is related to food production and land use shifts Increasing of cardio cerebral vascular diseases, hypertension, and mental disorders are associated with urban stress, life style, displacements and conflicts. Increasing of cardio cerebral vascular diseases, hypertension, and mental disorders are associated with urban stress, life style, displacements and conflicts. Increasing of influenza (ARI) and respiratory diseases (asthma, pneumonia) are associated with increasing of air pollution outdoor as well as indoor Increasing of influenza (ARI) and respiratory diseases (asthma, pneumonia) are associated with increasing of air pollution outdoor as well as indoor Increasing of food borne diseases is associated with contamination, food handling, and poverty. Increasing of food borne diseases is associated with contamination, food handling, and poverty.

19. MAIN CONCERN: SPREADING OF DISEASES Unique transmission pathways Specific for every single disease outcome Once the impact occurred, the disease will spread from infected person to others and from the new infected people to broader population as snow ball phenomenon The spread of disease may not be controlled directly even by manipulating or modifying the environment Analysis of each of these steps allows a logical determination of vulnerability and subsequent development of adaptive measures that aim to decrease vulnerability It will need specific discipline of technology, method, and expert such as public health/environmental health, medical, and pharmacy to deal with the impacts.

20. CURRENT RESEARCH & REVIEWS Rainfall and rain date in Jakarta associated with Incidence Rate and Case Fatality Rate of Dengue Infection in 2002-2006 by Nainggolan L et al., UI ‘07. Rainfall and rain date in Jakarta associated with Incidence Rate and Case Fatality Rate of Dengue Infection in 2002-2006 by Nainggolan L et al., UI ‘07. Aedes aegypti density in Jakarta associated with climate change by Sungkar S et al., UI ‘07. Aedes aegypti density in Jakarta associated with climate change by Sungkar S et al., UI ‘07. The influence of climate change to the spreading of dengue virus serotypes and the increasing of cases in Jakarta by Adriansjah et al., UI ‘07. The influence of climate change to the spreading of dengue virus serotypes and the increasing of cases in Jakarta by Adriansjah et al., UI ‘07. Pulmonary tuberculosis and climate change in Indonesia by Burhan E et al., UI ‘07. Pulmonary tuberculosis and climate change in Indonesia by Burhan E et al., UI ‘07. The incidence of leptospirosis and its risk factors in Jakarta by Nainggolan L et al., UI ‘07. The incidence of leptospirosis and its risk factors in Jakarta by Nainggolan L et al., UI ‘07. Mental health of adolescents associated with climate change by Ismail RI et al., UI ‘07. Mental health of adolescents associated with climate change by Ismail RI et al., UI ‘07. Increasing morbidity and mortality caused by air pollution associated with climate change in City of Bandung 2002-2006 by Soemirat J & Dirgawati M, ITB ‘07. Increasing morbidity and mortality caused by air pollution associated with climate change in City of Bandung 2002-2006 by Soemirat J & Dirgawati M, ITB ‘07. Occupational dermatosis incident associated with climate change in Surabaya by Martiana T et al., Unair ‘07. Occupational dermatosis incident associated with climate change in Surabaya by Martiana T et al., Unair ‘07. Lung disorders associated with climate change in Jakarta by Andarini S et al., UI ‘07. Lung disorders associated with climate change in Jakarta by Andarini S et al., UI ‘07.

21. Research … Lung cancer associated with climate change in Jakarta by Syahruddin E et al., UI ‘07. Lung cancer associated with climate change in Jakarta by Syahruddin E et al., UI ‘07. Predicting the increasing of malaria cases in endemic area caused by climate change 2002-2003 by Yudhastuti R et al., Unair ‘07. Predicting the increasing of malaria cases in endemic area caused by climate change 2002-2003 by Yudhastuti R et al., Unair ‘07. Approach and method of studies on health and infectious diseases-related to climate change by Haryanto B, UI ‘07. Approach and method of studies on health and infectious diseases-related to climate change by Haryanto B, UI ‘07. Early warning system for malaria outbreak by Subirosa BS et al., UI ‘07. Early warning system for malaria outbreak by Subirosa BS et al., UI ‘07. The pattern of malaria distribution as impact of climate change in Pacitan regency 1998-2002 by Chatarina UW et al., Unair ‘07. The pattern of malaria distribution as impact of climate change in Pacitan regency 1998-2002 by Chatarina UW et al., Unair ‘07. Global warming ad public health impact in Indonesia by Sutomo S, UI ‘07. Global warming ad public health impact in Indonesia by Sutomo S, UI ‘07. Climate change and DHF in Tanah Laut District of South Kalimantan Province 2001-2006 by Basuki H et al, Unair ‘07. Climate change and DHF in Tanah Laut District of South Kalimantan Province 2001-2006 by Basuki H et al, Unair ‘07. Climate change and voice of public health association in Indonesia by Indonesian Public Health Association 2007. Climate change and voice of public health association in Indonesia by Indonesian Public Health Association 2007.

22. Health impact assessment to evaluate the impact of climate variability and change in a range of areas and populations; to evaluate the impact of climate variability and change in a range of areas and populations; to evaluate possible threshold effects; to evaluate possible threshold effects; to evaluate the effects of multiple stresses, including changes in socioeconomic systems; to evaluate the effects of multiple stresses, including changes in socioeconomic systems; to evaluate uncertainty and its implications for risk management; to evaluate uncertainty and its implications for risk management; to evaluate the effects of reducing emissions, such as by comparing impact under scenarios with business-as-usual and stabilization of emissions; and to evaluate the effects of reducing emissions, such as by comparing impact under scenarios with business-as-usual and stabilization of emissions; and to measure coping capacity, especially under different socioeconomic futures and in the context of sustainable development. to measure coping capacity, especially under different socioeconomic futures and in the context of sustainable development.

23. PUBLIC HEALTH RESPONSE AND ADAPTATION IN INDONESIA Infectious disease surveillance Infectious disease surveillance Health action in emergencies Health action in emergencies Safe drinking water Safe drinking water Integrated vector management Integrated vector management Environmental health capacity building Environmental health capacity building Healthy public policy (healthy housing, school, forest, industry, city) Healthy public policy (healthy housing, school, forest, industry, city)

24. WHO Adaptation Focus Health security Health security Strengthening health systems Strengthening health systems Health development Health development Evidence and information Evidence and information Delivery Delivery Partnership Partnership

25. PUBLIC HEALTH ADAPTATION IDEAS IN INDONESIA Empowering ecological-diseases surveillance system and developing public health early warning system Empowering ecological-diseases surveillance system and developing public health early warning system Development response to disaster effects of climate change Development response to disaster effects of climate change Enhancing capacity building for government, private sector, and civil society on managing prevention and control climate change on human health Enhancing capacity building for government, private sector, and civil society on managing prevention and control climate change on human health Increasing political awareness on climate change human health Increasing political awareness on climate change human health Empowering public health services system for disease prevention and control Empowering public health services system for disease prevention and control Generating research and method on epidemiology and medicine to find out the approach in breaking the disease transmission chains Generating research and method on epidemiology and medicine to find out the approach in breaking the disease transmission chains Preventing and eradicating climate change vector-related diseases Preventing and eradicating climate change vector-related diseases

26. Exposure Health Impact Actions in response to impact Characteristics of exposed group (location, wealth, resources, health status, culture, etc.) Vulnerability of group Adaptations Impacts, Vulnerability, Adaptations Mitigation: Reduced exposure Learning BREAKING TRANSMISSION CHAINS