1. Potential Relationships between exposure situations and disease conditions Health condition of concern Exposure situations Polluted Air Excreta and household wastes Polluted water or deficiencies in water management Polluted food Unhealthy housing Global environmental change Acute respiratory infections ‚‚ Diarrhoeal diseases ‚‚‚ Malaria and other vector-borne diseases ‚‚‚‚ Other infections ‚‚‚‚ Cancer ‚‚‚ Cardiovascular diseases ‚‚ Mental disorders ‚ Chronic respiratory diseases ‚‚ Injuries and poisonings ‚‚‚‚‚ Source: The World Health Report 1998. Life in the 21st Century – A Vision for All (NB: last column modified ) ‚ ‚ ‚ ‚

2. Source Activities Emissions Environmental Concentration AirWaterFoodSoil Exposure External Exposure Dose Early/ Subclinical Moderate/ Clinical Advanced/ Permanent Health Effects Traditional hazards Modern hazards Human activities Natural phenomena Development activities Driving force Pressure State Exposure Effect ActIonsActIons Health and environment cause-effect framework

3. Actions Pressure GHG emissions State Climate variability and change Exposure Heatwaves windstorms, floods, droughts Food, water- vector-borne infections Food shortage Air pollution Effect CVD Respiratory Mal- nutrition Infectious diseases Injuries Drownings Mental health Global, national, monitoring National, international agency mitigation, adaptation strategies Treatment International agreements; National policies DPSEEA: Climate and Health Driving forces Population growth Development policies Transport, Energy policies

4. Health impacts Human health impacts and vulnerability to climate change Agriculture impacts Forests impacts Water resources impacts Impacts on coastal areas Species and natural areas Adaptive capacity

5. Regional weather changes Heatwaves Extreme weather Temperature Precipitation Contamination pathways Transmission dynamics Food availability Migration Temperature related illness and death Extreme weather related health effects Air pollution related health effects Water and food borne diseases Vector and rodent borne Diseases Psychological effects Malnutrition Research Moderating influences Adaptation measures Climate Change Pathways by which climate change affects health Adapted from Patz et al, 2000 Health effects

6. Causal web: Climate variability and diarrheal disease Drought Floods Unsafe and limited water Hygiene difficult Nutritional deficiencies Temperature increase Contamination from pit latrines, septic tanks and sewage systems Debris and carcasses in rivers Failure of water treatment facilities Food spoilage Algal blooms Climate variability Diarrheal disease

7. Current and future actions: Global, regional burden of disease assessment Assessing early health impacts of climate change National health impact assessment guidelines National adaptation strategies for health Pilot warning system projects (e.g. heatwaves) Joint WHO/UNEP/WMO activities: Capacity building Information exchange Research promotion

8. Adaptive actions for the health sector: primary adaptive measures: actions taken to prevent the onset of disease arising from environmental disturbances, in an otherwise unaffected population (e.g. supply of bed nets to all members of a population at risk of exposure to malaria, early warning systems, integrated environmental management) secondary adaptive measures: preventive actions taken in response to early evidence of health impacts (e.g. strengthening disease surveillance and responding adequately to disease outbreaks) tertiary adaptive measures: health-care actions taken to lessen the morbidity or mortality caused by the disease (e.g. improved diagnosis and treatment of malaria)

9. Impact Primary adaptive measures Secondary adaptive measures Heat -Heatwave warning systems -Health personnel educated to stress -Urban planning detect and treat heat stress Extreme -Disaster preparedness and mitigation -Disaster response weather -Early warning systems events -Disaster protection measures Infectious -Integrated environmental -Disease surveillance and diseases management monitoring -Control of vector-, food- and water- borne diseases Examples of primary and secondary adaptive measures to reduce health impacts

10. Impact Primary adaptive measures Secondary adaptive measures Food -International mechanisms of -Monitoring and surveillance security agriculture, trade and finance -Implementation of nutrition -Seasonal climate forecasting action plans -Famine early warning systems -National and local agriculture measures Water -Pollution reduction and control policies -Monitoring and surveillance -Demand management and water -Capacity building allocation policies -Waste water treatment -Economic and regulatory measures to increase irrigation efficiency -Capacity building Examples of primary and secondary adaptive measures to reduce health impacts

11. climate Change and Adaptation Strategies for Human health (cCASHh) V ulnerability A ssessment to E xtreme W eather E vents, of V ector B orn D iseases, of W ater F ood b orn D iseases E pidemiologal Evaluation WHO LSHTM NIPH SU dWd E conomic A ssessment Feem P olicy A nalysis WHO Current available datasets, Monitoring results Research results I ntegrated A ssessment ICIS dWd Outreach Framework for adaptation Pik