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Approaching Adaptation:
Parallels and Contrasts between the
Climate and Health Communities
Center for Integrated Study of the Human
Dimensions of Global Change,
Carnegie Mellon University
National Science Foundation, ExxonMobil, API and CMU
Context and Introduction
• Public health prevention and climate change
adaptation share the goal of increasing the ability of
nations, communities and individuals to cope
effectively and efficiently with challenges and
changes.
• Public health researcher approach from the
perspective of protecting and enhancing the health
and well-being of individuals and communities
• Climate researchers approach adaptation from a
perspective that can trace its roots to the natural
hazards community.
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Public Health
• Public health is “the combination of sciences, skills,
and beliefs that is directed to the maintenance and
improvement of the health of all people through
collective or social actions. The programs, services,
and institutions involved emphasize the prevention of
disease and the health needs of the population as a
whole. Public health activities change with changing
technology and social values, but the goals remain the
same: to reduce the amount of disease, premature
deaths, and disease-produced discomfort and
disability in the population (Last 2001).”
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Three Stages of Prevention
• Public health aims to achieve its goals through
prevention (adaptation).
• Measures to reduce disease and save lives are
categorized into primary, secondary and tertiary
prevention (Last 2001).
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Three Stages of Prevention
• Primary prevention is the “protection of health by
personal and community wide efforts.”
• Secondary prevention includes “measures available to
individuals and populations for the early detection and
prompt and effective intervention to correct
departures from good health.”
• Tertiary prevention “consists of the measures
available to reduce or eliminate long-term impairments
and disabilities, minimize suffering caused by existing
departures from good health, and to promote the
patient’s adjustment to irremediable conditions.”
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Climate Community and Adaptation
• Human and natural systems adapt autonomously to
» gradual change, if it can be detected, and
» variability (or change in variability).
• Human systems can plan to adapt and implement their
plans
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Public Health and Vulnerability
• Public health uses the concept of vulnerability in two
different senses.
• One acknowledges that advances in public health are
not permanent and that deterioration of the public
health infrastructure could permit the return of
adverse health outcomes that are currently
controlled. As a result, vulnerability depends on
maintaining and improving health systems.
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Public Health and Vulnerability
• The second sense relates to specific health outcomes.
• The classic approach to evaluating environmental
health risks is a four-step assessment paradigm:
hazard identification, dose (exposure) cum response
assessment, exposure assessment, and risk
characterization.
• The evaluation of information on the hazards of
environmental agents and exposure of sensitive
receptors (e.g., humans, animals, and ecosystems)
produces quantitative or qualitative statements about
the probability and degree of harm.
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Comparison
• To a climate researcher, vulnerability is a function of
exposure and sensitivity; and exposure and sensitivity
are themselves functions of adaptive capacity. In
general, it is a statement about future conditions
after adaptations have been implemented.
• In the health community, vulnerability is a function of
exposure to an agent and the exposure-response
relationship between that exposure and a particular
health outcome. In general, it is a statement about
current conditions. It is preferable to have the
exposure-response relationship determined before
preventative measures (i.e. adaptations), are
implemented.
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Determinants of Adaptive Capacity
∞
∞
∞
∞
∞
∞
∞
∞
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The range of available technological options for adaptation;
The availability of resources and their distribution;
The structure of critical institutions and the derivative
allocation of decision-making authority;
The stock of human capital (e.g. education and personal
security;
The stock of social capital;
The system’s access to risk spreading processes;
The ability of decision-makers to manage information; and
The public’s perceived attribution of the source of stress
and the significance of exposure to its local manifestations.
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Prerequisites for Prevention
An awareness that a problem exists;
∞
A sense that the problem matters;
∞
Understanding of what causes the problem;
∞
Capability to deal with the problem; and
∞
Political will to control the problem.
∞
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Table 1: Determinants of Adaptive Capacity and the
Prerequisites for Prevention
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Determinants of Adaptive Cap
Prerequisites for Prevention
Availability of Options
Capability to control
Resources
Capability to control
Governance
Political will
Human and social capital
Understanding of causes;
political will
Access to risk spreading mechanism
Capability to control
Managing information
Understanding of causes;
problem matters
Public perception
Awareness; problem
matters
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Table 2: Trends in Selected Health Indicators and Their
Determinants in Costa Rica and the former USSR, 19601990
Costa Rica
Health Indicator
Former USSR
1960 1990 % to Tech
Under 5 Mortality
124
14
55
Female Adult Mortality
203
73
48
246
122
59
Female Life Expectancy
65
79
Male Life Expectancy
62
7
Male Adult Mortality
Total Fertility Rate
1960 1990
% to Tech
39
27
40
59
72
74
43
74
60
65
63
46
3.3
38
2.7
2.2
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Determinants
Income Per Capita
13
2001 3381
2397 7453
Female Education (yrs)
4.0
5.6
7.6
10.3
Male Education
4.1
5.5
8.5
10.8
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Table 3: Socioeconomic and Health Services and Finance
Indicators for Costa Rica and the Russian Federation,
1960-1990
Socioeconomic Indicator
Costa Rica
Russian Federation
Males
6
12
Females
7
13
Malnutrition (children under 5)
Health Services/Finance Indicator
Children Immunized for Measles
99%
92%
Health Expenditure
14
Total (% of GDP)
8.5
4.8
Public Sector (% of GDP)
6.3
4.1
Public Sector (% of total)
74
87
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Figure 1a
Historical Context – Adaptation Baseline
Annual River Flow (milliards)
100
90
80
70
60
Flow
50
Upper
40
Low er
30
20
0
10
20
30
40
50
Year
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Figure 1b
Amplifying the Historical Trend - Baseline Revisited
Annual River Flow (milliards)
100
90
80
70
Flow
60
Upper
50
Low er
40
30
20
0
10
20
30
40
50
Year
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Figure 1c
Annual River Flow (milliards)
100
90
80
70
Flow
60
Upper
50
Low er
40
30
20
0
10
20
30
40
50
Year
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Annual River Flow (milliards)
Figure 2
Building a Levy in the Fifth Period
100
90
80
70
Flow
Upper
Low er
60
50
40
30
20
0
10
20
30
40
50
Year
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Annual River Flow (milliards)
Figure 3
Smoothing Variation with an Upstream Dam
100
90
80
70
60
50
40
30
20
Flow
Upper
Low er
0
10
20
30
40
50
Time Period
19
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Figure 4
Reducing Flood Threat by Dredging
Annual River Flow (milliards)
100
90
80
70
Flow
60
Upper
50
Lower
40
30
20
0
10
20
30
40
50
Time Period
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Figure 5a: Initial Conditions
Variable 2
»A0
»B0
Variable 1
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Figure 5b: Conditions in 50 Years
Variable 2
»A50
»B 50
Variable 1
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Figure 5c: Trajectories of Sustainability Indices
1
Sustainability Index
0.8
0.6
Locus I
Locus II
Locus III
0.4
0.2
0
0
10
20
30
40
50
60
Year
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Figure 6
Sustainability Indices for the Hypothetical River Example
1.2
Sustainability Index
1
0.8
Baseline
Levy
0.6
Dam
Dredging
0.4
0.2
0
0
10
20
30
40
50
60
Years
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Public Health Perspective
• Public health seeks to identify and reduce both the
background level of disease and any epidemics or
outbreaks.
• Public health does not use the terminology or the
concept of a “coping range.” Use of the term suggests
a range within which significant consequences are not
observed.
• Adaptation policies and measures are needed now to
address current conditions.
• Public health has recognized thresholds for centuries.
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Public Health and Thresholds
• It is difficult to generalize approaches to thresholds because
each is specific to a particular exposure-response relationship.
• Exposures that exhibit J- or U-shaped relationships with health
outcomes, where either too little or too much is detrimental to
health (i.e., ambient temperature and oxygen).
• Exposures that have threshold relationships with health
outcomes, where low doses are not associated with increased
morbidity and mortality (i.e., arsenic and dose required to
develop a case of cholera).
• Exposures that have linear relationships with health outcomes
(e.g., tobacco smoking and asbestos).
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Example with A Zero Threshold:
Eradication of Smallpox
• Smallpox is a highly infectious viral disease
• Repeated epidemics have decimated populations
• Spread is person-to-person
• Case fatality rate up to 25%
• No effective treatment
• No carrier state and no animal reservoir
• Potent and stable vaccine available
• 1967 eradication campaign launched
• 1980 smallpox eradicated
» Budget: $81 million (WHO) + ~ $232 million (country-level and
bilateral assistance)
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Example with a Positive Threshold:
Arsenic
• Arsenic is a metalloid that is abundant in the earth’s crust
• Environmental exposures are primarily through food & water
» Average daily intake 20-300 ug
• Adverse health effects begin once an individual’s threshold body
burden is exceeded
• Groundwater standards:
» WHO 10 ug/L
» Bangladesh 50 ug/L
• In Bangladesh, 28-57 million people consuming water above the
standard
• 1/100-300 people who consume water containing >50 ug/L may
suffer an arsenic-related cancer (lung, bladder, liver)
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Issues of Scale
• Determinants of Adaptive Capacity operate on different scales
from site to site.
» Some are truly macro in scale - provide handles for national
and even international intervention
» This can be true even if their relevant manifestations are
micro in scale
• Prerequisites for Prevention do the same
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Relationship Between Vulnerability to Natural
Disasters and Income
Vulnerability to Natural Disasters and Per Capita Income
8
y = -0.3858x + 4.7271
R2 = 0.0771
Ln(Fraction of population killed per decade)
7
6
5
4
3
2
1
0
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
-1
-2
Ln(Income per capita in US dollar)
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Relationship Between Vulnerability to Natural
Disasters and Income
Vulnerability to Natural Disasters and Per Capita Income
Ln(Annual damage in percentage of GDP)
4
2
0
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
-2
-4
-6
-8
y = 0.1443x - 3.4473
R2 = 0.005
-10
Ln(Income per capita in US dollar)
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Relationship Between Vulnerability to Natural
Disasters and Income
Vulnerability to Natural Disasters and Per Capita Income
Ln(Fraction of population affected per decade)
2
0
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
-2
-4
-6
-8
-10
y = -1.0196x + 4.7624
R2 = 0.2105
-12
Ln(Income per capita in US dollar)
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A Caveat - Incorporating the “Second Best” into the
Adaptation Baselines
• Local scale implications are most critical.
• Determinants and prerequisites can work to support or impede
specific adaptations.
• Relating adaptations to their efficacy in reducing exposure or
sensitivity can be accomplished.
• Looking for patterns here can uncover the macro scale
implications.
• BUT adaptation baselines must reflect existing distortions;
analysis can investigate the implications of reducing their power.
• Public Health can be a natural laboratory for examining how to do
this.
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A Template for Adaptation Analysis in Either Context
• Proper vulnerability cum adaptation analyses must
confront these issues directly by comparing results
from a series of runs into the future.
• One might, for example, look at the future with a
given adaptation baseline (with existing distortions
and impediments) and no extra stress.
• A second set of runs into the future might then
persist with the no extra stress assumption but
include adjustments in adaptation that could be
anticipated to reduce exposure or sensitivity to
present vulnerability.
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A Template for Adaptation Analysis in Either Context
• A third set of runs could then impose the extra
stress on the adaptation baseline (the first set) to
see how they might work.
• A fourth collection could repeat the analysis with
anticipated adjustments (the adjusted baseline for
the second set of runs).
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A Template for Adaptation Analysis in Either Context
• In every case, however, it is critical that the analysis
presumes neither dumb actors who will not respond to
any changes in environment nor clairvoyant actors who
know everything from the very beginning.
• The future will be fraught with uncertainty, just like
the present; and any considerations of adaptation
must recognize this fact.
• A complete vulnerability cum adaptation analysis of a
particular region or sector would contemplate a range
of “not-implausible”.
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Applying the Template - Coastal Storms and Sea Level
Rise
• S1 - Storm scenarios with current practices
• S2 - Storm scenarios with enlarged set-backs
• S3 - Rerun S1 with climate induced sea level rise and changes in
storm patterns - frequency and/or intensity
• S4 - Rerun S2 with climate change
• S3 vs S1 - Cost of climate change along current baseline
• S2 vs S4 - Cost of climate change with modified baseline
• S1 vs S2 - Value of modification absent climate change
• S3 vs S4 - Value of modification with climate change
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Synthesis and Conclusions
• Vulnerability means different things in the two
communities.
• Approaches can still be comparable.
• Determinants hypotheses supported by health
understanding of the prerequisites for prevention.
• Any thoughts?
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