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Section 2. The effects of climate change on people and the environment 2.5. Climate Change and Human Health USAID LEAF Regional Climate Change Curriculum Development Module: Basic Climate Change (BCC) Basic Climate Change (BCC) Module Team Basic Climate Change Module Team Name Affiliation Name Affiliation Developers Michael Furniss; Co-Lead US Forest Service David Ganz, Chief of Party Bunleng Se; Co-Lead Royal University of Phnom Penh, Cambodia Chi Pham, Project Coordinator USAID LEAF Bangkok Chan Hoy Yen Universiti Kebangsaan Malaysia Naroon Waramit Kasetsart University, Thailand Kalyan Ly Royal University of Agriculture, Cambodia Phi Thi Hai Ninh Vietnam Forestry University, Vietnam Somvang Phimmavong National University of Laos Lam Ngoc Tuan Dalat University, Vietnam Latsamy Boupha National University of Laos Le Hai Yen Dalat University, Vietnam Sokha Kheam Royal University of Phnom Penh, Cambodia Nguyen Le Ai Vinh Vinh University, Vietnam Ahmad Makmom Bin Abdullah Universiti Putra Malaysia Nguyen Thi Viet Ha Vinh University, Vietnam Jirawan Kitchaicharoen Chiang Mai University, Thailand Nicole Kravec USAID LEAF Bangkok Thaworn Onpraphai Chiang Mai University, Thailand Hour Limchhun USAID LEAF Cambodia Patthra Pengthamkeerati Kasetsart University, Thailand Le Nhu Bich Dalat University, Vietnam Kieu Thi Duong Vietnam Forestry University, Vietnam Somsy Gnophanxay National University of Laos Truong Quoc Can Vietnam Forests and Deltas Program Karen Castilow University of Virginia Nguyen Thi Kim Oanh Asian Institute of Technology, Thailand Geoffrey Blate US Forest Service Mokbul Morshed Ahmad Asian Institute of Technology, Thailand Elizabeth Lebow US Forest Service Ly Thi Minh Hai USAID LEAF Vietnam Kent Elliott US Forest Service Danielle Morvan Tulane University, New Orleans Ann Rosecrance California State University., Northridge USAID LEAF Bangkok Reviewers Andrea Tuttle Freelance consultant Somsy Gnophanxay National University of Laos Sermkiat Jomjunyoug Chiang Mai University, Thailand Jamil Tajam Universiti Kebangsaan Malaysia Sampan Singharajwarapan Chiang Mai University, Thailand Ajimi Bin Jawan Universiti Kebangsaan Malaysia Chea Eliyan Royal University of Phnom Penh, Cambodia Ratcha Chaichana Kasetsart University, Thailand I. HOW AND WHY THE CLIMATE IS CHANGING 1.1. 1.2. 1.3. 1.4. Introduction to Climate Science and Climate Change The Causes of Climate Change Climate Intensification: Floods and Droughts Climate Modeling II. THE EFFECTS OF CLIMATE CHANGE ON PEOPLE AND THE ENVIRONMENT 2.1. 2.2. 2.3. 2.4. Introduction to Climate Change Impacts Sea Level Rise Climate Change and Water Resources: Effects Climate Change and Food Security 2.5. Climate Change and Human Health 2.6. Climate Change and Terrestrial Ecosystems III. REPONSES AND ADAPTATION TO CLIMATE CHANGE 3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7. Climate Change and Forest Management Climate Change and Water Resources: Response and Adaptation Principles and Practice of Climate Vulnerability Assessment Dealing with Uncertainties in Climate Change Introduction to Ecosystem Services Introduction to REDD+ Bioenergy and the Forest 3.8. Communications and Engagement IV. CURRICULUM MODUL RESOURCES AND TOOLS 4.1. 4.2. 4.3. 4.4. Curated Video Collection Literature – Annotated Bibliography Climate Change Glossary Reading and Video Assignments and Problem Sets At the end of this session, learners will be able to: Describe the diseases likely to be exacerbated by climate change - from local, regional, and global perspectives Identify the most vulnerable people and populations whose health could be affected by climate change Propose possible adaptations to climate change-related human health issues, risks, and problems 4 1. South East Asia is disaster prone 2. The most vulnerable people 3. Climate-sensitive health outcomes 4. Exacerbating current burden of disease 5. General adaptation for health sector 6. Discussion questions 5 Portier CJ, Thigpen Tart K, Carter SR, Dilworth CH, Grambsch AE, Gohlke J, Hess J, Howard SN, Luber G, Lutz JT, Maslak T, Prudent N, Radtke M, Rosenthal JP, Rowles T, Sandifer PA, Scheraga J, Schramm PJ, Strickman D, Trtanj JM, Whung P-Y. 2010. A Human Health Perspective On Climate Change: A Report Outlining the Research Needs on the Human Health Effects of Climate Change. Research Triangle Park, NC:Environmental Health Perspectives/National Institute of Environmental Health Sciences. doi:10.1289/ehp.1002272 Available: www.niehs.nih.gov/climatereport 6 2013. Turn down the heat : climate extremes, regional impacts, and the case for resilience Chapter 4 – South East Asia pages 82-86 Washington DC ; World Bank. http://documents.worldbank.org/curated/e n/2013/06/17862361/turn-down-heatclimate-extremes-regional-impacts-caseresilience-full-report Read this report: http://www.niehs.nih.gov/climatereport Questions: What are the most important human health impacts to your area or region? Why? What can be done to reduce or mitigate the risks to human health of these impacts? Who is responsible for making the adaptations? 8 More extreme weather events: storms, cyclones, flooding Heat waves: more frequent, hotter, and longer Rapid glacier melting: landslides, flash floods, and reduced water availability Disturbed rainfall patterns: more droughts, more extreme precipitation events, more intense rainfall, floods, and disrupted water supply Sea-level rise: inundation, saltwater intrusion, loss of land and assets, increased coastal flood frequency/severity Air pollution: increase in levels of ground ozone, more allergens 9 Southeast Asia region Nature (2005; 488:310-317) McMichael et al. (2003) and WHO (2008) 12 Direct effect: Injuries, disability, drowning Heat stress Indirect effect: Water and food–borne diseases Malnutrition Vector–borne diseases Air pollution (e.g., particulate matter, ozone) and allergy (e.g., pollen season) Psychological stress Photo: http://southasia.oneworld.net/ImageCatalog/ climatepicture.jpg 1996-2005: 57% of people killed globally in natural disasters were from SEAR (South East Asia Region) countries. Indonesia: 2007, 3 flood events; 4 landslides; 2 tornadoes. Maldives: May 2007, high tide floods Bangladesh: November 2007: Super cyclone SIDR: 4,000 dead, millions affected. Myanmar: May 2008, Cyclone Nargis, 135,000 perish. Philippines: November 2013, Typhoon Haiyan, >6,000 dead. Photo: http://cache.daylife.com/imageserve/02fA d1d1tWeAW/340x.jpg 14 15 Source: http://climatechange.thinkaboutit.eu/think4/post/why_always_the_poorests 16 17 2005: 3.9 million people in SEA Region exposed to flooding caused by storm surges and sea-level rise 2070s: Estimated 28 million people to be affected in SEA Region by projected 50 cm sea-level rise Asset exposure projection: 2,100 – 4,600% increase between 2005-2070, with no adaptation measures Flooding projections: Ho Chi Minh City: 60-77% built up area exposed to 100 cm rise Bangkok: 43-69% flooding in 2025-2100 Manila: 24% damage in 100-year return period flood 18 Additional reason for SEA Region is population factors. Population factors affecting the risks/impacts of extreme weather events include population size, age, health status, wealth, and type of settlement. The most vulnerable are those who have less capacity to cope with climate change effects. WHO (2008) 19 The most vulnerable are: children, women, the elderly, pregnant women disabled and sick people the poor (including slum dwellers, those in informal settlements, the landless and marginalized, and informal open air workers, but also displaced communities and individuals). Image: http://www.caritas.org.au/images/cambodia/cam_ss pr_july04_2.JPG?sfvrsn=7 20 The most vulnerable people in the SEA Region will be: The poor (fewer resources to adapt to the rapid environmental changes) In rural areas, women are increasingly becoming household heads and have the double burden of social reproduction and agricultural work Pregnant women are especially vulnerable People living in substandard housing or water systems will experience greater risks to life and health with severe weather events Informal settlements: 79% of population in Cambodia, 44% of population in Philippines and 41% of population in Vietnam 21 Vulnerability will be greater in highly dense populations Vulnerability will be greatest in areas of low resources for health care Vulnerability will be greatest in areas of low resources for disaster and emergency response Vulnerability will be greatest in areas of over allocated, polluted, and inadequate water supplies Vulnerability will be greatest in areas of substandard housing and sanitation Vulnerability will be greatest in areas of low diversity of agricultural cropping systems Vulnerability will be greatest in areas of high proportion of women and children in the population Greater vulnerability for populations with serious existing problems Majority of Vector-borne Disease (VBD) burden borne by developing countries (including SEA Region) WHO (2008) 23 24 25 Negative Impact Positive Impact Very High Confidence • Malaria: Contraction and expansion, changes in transmission season High Confidence • Increase in malnutrition • Increase in the number of people suffering from deaths, disease and injuries from extreme weather events • Increase in the frequency of cardio-respiratory diseases from changes in air quality • Change in the range of infectious disease vectors • Reduction of cold-related deaths Medium Confidence • Increase in the burden of diarrheal diseases Source: WHO (2008) 27 Photo: ©Abir Abdullah/Still Pictures Photo: ©Abir Abdullah/Still Pictures More extreme South East Asian weather (e.g., Typhoon Haiyan (Philippines), Cyclone Nargis (Myanmar) 28 World Health Organization, 2008c More than 175,000 children and teenagers die from drowning each year. Children under the age of 5 years are most at risk. Most child drowning events happen in and around the home. 29 Heat-related Illnesses Heat Rash Heat Cramps Heat Exhaustion Heat Stroke Dehydration and exacerbation of chronic illness Photo: ABC News Risk factors for hyperthermia Age Underlying medical conditions / mental illness Income and poverty status Social isolation Access to health care and cooling facilities Neighborhood characteristics: land use/ land cover, crime rate, housing type, urban heat islands Substandard housing and water systems Average of 688 reported heat-related death per year in US and overall impact likely underestimated Every death is preventable! 2003 Andhra Pradesh, India heat wave, with temperatures of up to 54oC, resulted in death to 3,000 people. The number of heat strokes was not recorded. Refugee Study Centre (RSC), http://www.rsc.ox.ac.uk Photo: © T. Balabaadkan UNEP / Still Pictures 32 Maximum Temperature and Daily Summer Mortality Shanghai, China 1980-89 300 Scatter plot of daily maximum temperature and total mortality to help identify possible summertime threshold temperatures for extreme heat in Shanghai, China based on the mortality impact. 250 Daily Mortality 200 150 100 50 0 15 20 25 30 35 40 Maximum Temperature (C) (L. Kalkstein, personal communication, 2002) Source: WHO (2008) Air pollution Meeting increasing energy demands by greater use of fossil fuels will increase in particulate matter and air pollutants (e.g., ground ozone) => respiratory and cardiovascular diseases Increasing allergens (pollen and mold) due to the effect of climate change => allergy Asian brown cloud (India): Air particulates and pollutants and prolonging period of dry season (late raining) Photo: © Deb Kushal -UNEP / Still Pictures 34 Ragweed allergen production increases with increasing CO2 concentration Singer et al. (2005) http://msnbcmedia3.msn.com 36 In 2005, diarrheal diseases accounted for 20.1% of deaths in children less than five years Photo credit: © Shehzad Noorani/Still Pictures 37 Source: FAO Crop yields could decrease up to 30% in Central and South Asia by the mid-21st century. Population growth and urbanization will magnify the malnourished and the risk of hunger. Photo credit: © Shehzad Noorani / Still Pictures 39 Proportional mortality among children under five years of age − World 2002 http://www.goldenrice.org/Content3Why/why.php Susceptible Populations • Migration (forced) •Vector environment Vector Pathogen Survival, lifespan Survival Reproduction/breeding patterns Transmission Biting behavior Replication in host WHO (2008) Combined with altered rainfall patterns, hotter conditions may increase the spread of disease, such as malaria, dengue, and chikungunya, to new areas Warmer temperatures and disturbed rain patterns could alter the distribution of important disease vectors Aedes aegypti “Tend to increase in range and incidence … actual occurrence strongly influenced by local conditions.” (IPCC) Health impact Confidence Move to higher altitudes Medium - high Move to higher latitudes Medium - low Extended transmission season Medium - high Increased population in areas of potential transmission Medium - high Decreased transmission where temperatures high Low - medium Relationship between temperature and malaria parasite development time inside mosquito (“extrinsic incubation period” or EIP). EIP shortens at higher temps, so mosquitoes are infectious sooner. Incubation period Survival probability Biting frequency 1 50 (per day) (days) 30 20 (per day) 0.3 40 0.2 0.1 0 15 20 25 30 35 40 Temp (°C) 0.6 0.4 0.2 10 0 0.8 0 10 15 20 25 30 35 40 10 15 20 25 30 35 40 Temp (°C) Temp (°C) TRANSMISSION POTENTIAL 1 P.vivax P.falciparum 0.8 0.6 0.4 0.2 0 14 17 20 23 26 29 32 35 38 41 Temperature (°C) Mode of intervention Stage Stage of of intervention intervention Biological Adaptive immunity Social Social Surveillance Surveillance Hlth systems Health systems Behavioral Use of of bednets Individual Individual Other institutions Community or group National Level of intervention Global Primary Vaccination Vaccination, Dams Tertiary Early treatment Secondary Early warning WHO (2008) Based on McMichael and Kovats, 2000 Photo credit: © Shehzad Noorani /Majority World / Still Picture In 2005, the estimated population at risk from dengue fever in the South East Asia Region was 1.3 billion. This is 52% of the global estimated 2.5 billion at risk. With the threat of a warmer, wetter world and a larger global population, scientists are researching how climate change may impact the spread of infectious diseases, such as cholera and dengue fever, and how outbreaks may be prevented. http://youtube.com/v/AiuYuf1IqJQ ~ 5 minutes Further develop emergency medical services. Further develop disaster response capacity. Improve climate-sensitive diseases surveillance and controls. Improve safe water supply and sanitation. Improve health services. Expand and ensure safe water supplies and improved sanitation. Educate citizens on the risks and responses to climate-related health issues. Address poverty, education, and gender inequalities. 49 The SEA Region has a large population that is currently vulnerable to a number of climate sensitive health stressors. These stressors are already having a significant adverse health impacts in the Region. Climate change is likely to increase the risks linked to these stressors, and introduce new sources of risk. Without adaptation and mitigation, climate change could result in dramatically increased health burdens in the Region. Much can be done now to adapt and prepare that will improve the health of millions. 50 Where is the most vulnerable area in your country that affected by climate change/natural disaters? Who are the most vulnerable in your communities/country? In your communities, what illnesses/diseases that always occurred/happened caused by climate change (flood, drought, storms, and so on)? 51 Four fundamental questions should be carefully considered in designing adaptation strategies: 1. What are we adapting to? 2. Who adapts? / Who is vulnerable? 3. How do we adapt? and 4. What do we want to achieve? 52 http://www.pbslearningmedia.org/resource/envh10.sci.life.eco.cchealth/clim ate-change-and-human-health/ http://ecohealth.wisc.edu/index.php?option=com_content&view=article&id= 181%3Ateachers-lp-birds-article&catid=130&Itemid=272 McMichael, Anthony J., Rosalie E. Woodruff, and Simon Hales. "Climate change and human health: present and future risks." The Lancet 367.9513 (2006): 859-869. http://laes.hcwh3.seguetech.com/sites/default/files/documentsfiles/151/Climate_Chg_Human_Health.pdf Climate change and human health - risks and responses. 2003. World Health Organization http://www.who.int/entity/globalchange/publications/climchange.pdf?ua=1 Summary of above document (Also available in Spanish, French, and Russian) http://www.who.int/globalchange/publications/cchhsummary/en/ McCarthy, James J., ed. Climate change 2001: impacts, adaptation, and vulnerability: contribution of Working Group II to the third assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, 2001. https://ipcc.ch/ipccreports/tar/wg2/pdf/wg2TARfrontmatter.pdf 55 What was useful? What is missing? How did you, or would you, modify the materials to make them better fit your instructional context? Please share your experience and modifications here: [email protected]