Download Assessing Human Health Vulnerability and Public Health Adaptation

Assessing Human Health
Vulnerability and Public Health
Adaptation to Climate
Variability and Change
Kristie L. Ebi, Ph.D., MPH
NCAR Summer Institute
July 2004
Vulnerability and Adaptation
Ebi et al. forthcoming
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
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. 2003
Vulnerable Populations
-Poor
-Children
-Increasing population
of elderly residents
-Immunocompromised
Exposure
Tmax
10
August
2003
Chicago 1995
2003: The Shape of Things to
Come?
.10
1947
Frequency
2003
.08
.06
.04
.02
1961-1990
2071-2100
0
5
10
15
20
25
30
35
40
45
Maximum Temperature [°C]: Basel
Beniston 2004
Climate
change
may entail
changes in
variance,
as well as
changes in
mean
values
Both Heat & Air Pollution
Contributed to Excess Mortality
in 2003 Heatwave
• UK
– 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 1000-1400 excess heat-related deaths
of which 400-600 may have been due to elevated
ozone and PM10 concentrations (Fisher et al.
2004)
Floods
Climate and Stable Malaria
Transmission, Zimbabwe
2025
2050
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
Adaptation
Actions taken by individuals,
institutions, and governments
• Anticipatory
– Actions taken in advance of
climate change effects
• Responsive
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
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.
El Niño
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
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
Drought
Areas from
1997-1998
Pohnpei 1997-98
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.
Potential Human Health
Impacts from WeatherRelated 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
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
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.
Sources of Mortality
Reduction 1960-1990
Reduction
Percentage Contribution of Gains
Income
Education
adult females
Generation
new
knowledge
Under-5 mortality
rate
Female adult
mortality rate
17
38
45
20
41
39
Male adult
mortality rate
Female life
expectancy (birth)
25
27
49
19
32
49
Male life
expectancy (birth)
20
30
50
Total fertility rate
12
58
29
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
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?
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 nonlinearities may be encountered
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
7th Inning
Stretch
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
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)
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
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
Framework
for Adaptation
Source: UKCIP,
2003
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
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
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
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
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?
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?
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
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
Synthesize Results
• Identify:
–
–
–
–
–
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
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
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
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
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 - http://www.euro.who.int/ccashh
• Integration of Public Health with Adaptation to
Climate Change: Lessons Learned and New
Directions (Ebi KL, Smith J, Burton I)