kristie l. ebi, ph.d., mph ncar summer institute july 2004

Assessing Human Health Assessing Human Health Vulnerability and Public Health Vulnerability and Public Health

Adaptation to Climate Adaptation to Climate Variability and ChangeVariability and Change

Kristie L. Ebi, Ph.D., MPHNCAR Summer Institute

July 2004

Vulnerability and AdaptationVulnerability and Adaptation

Ebi et al. forthcoming

VulnerabilityVulnerability

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?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

-Poor-Children-Increasing population

of elderly residents-Immunocompromised

Vulnerable PopulationsVulnerable Populations

ExposureExposure

Tmax10 August 2003

Chicago 1995Chicago 1995

1947

2003: The Shape of Things to 2003: The Shape of Things to Come?Come?

5 10 15 20 25 30 35 40 45Maximum Temperature [°C]: BaselMaximum Temperature [°C]: Basel

0

.02

.04

.06

.10

.08

Fre

qu

en

cy

Fre

qu

en

cy

1961-1990 2071-2100

2003

Beniston 2004

Climate Climate change change may entailmay entailchanges in changes in variance, variance, as well as as well as changes in changes in mean mean valuesvalues

Both Heat & Air Pollution Both Heat & Air Pollution Contributed to Excess Mortality Contributed to Excess Mortality

in 2003 Heatwavein 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)

FloodsFloods

Climate and Stable Malaria Climate and Stable Malaria Transmission, ZimbabweTransmission, Zimbabwe

20252025

20502050

Adaptation Needed Because: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

AdaptationAdaptation

Actions taken by individuals, institutions, and governments

• Anticipatory– Actions taken in advance of

climate change effects• Responsive

AdaptationAdaptation

•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)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 NiñoEl Niño

PEAC: 1997-1998 El NiñoPEAC: 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 ImpactsENSO 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 Drought Areas from Areas from 1997-19981997-1998

Pohnpei 1997-98Pohnpei 1997-98

Assumptions (2)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 Potential Human Health Impacts from Weather- Impacts from Weather- Related Disasters in Related Disasters in

Caribbean StatesCaribbean 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 Managing Potential Health Impact in the Caribbean - Impact in the Caribbean -

An EH PerspectiveAn EH Perspective

• Establishment of monitoring & surveillance system

• Create the enabling environment• Strengthen the public health

infrastructure• Promote research• Promote awareness & education

Assumptions (3)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 Sources of Mortality Reduction 1960-1990Reduction 1960-1990Reduction Percentage Contribution of Gains

  Income Education adult females

Generation new

knowledge

Under-5 mortality rate

17 38 45

Female adult mortality rate

20 41 39

Male adult mortality rate

25 27 49

Female life expectancy (birth)

19 32 49

Male life expectancy (birth)

20 30 50

Total fertility rate 12 58 29

Adaptation a Function of: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 Questions for Designing Adaptation Policies & MeasuresAdaptation 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 AdaptationPrinciples for Adaptation Policies and MeasuresPolicies 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 non-linearities may be encountered

Public Health ResponsesPublic 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

77thth Inning Inning StretchStretch

Aims of a Health Impact Aims of a Health Impact Assessment: EvaluateAssessment: 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 Steps in Assessing Vulnerability and AdaptationVulnerability 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)

•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

Steps in Assessing Steps in Assessing Vulnerability and AdaptationVulnerability and Adaptation

Risk Management CycleRisk 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

Source: UKCIP, 2003

FrameworkFrameworkfor Adaptationfor Adaptation

Levels of AssessmentLevels 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

MethodsMethods

•Qualitative•QuantitativeIntegrated 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 Determine the Scope of the Assessmentthe 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 Identification of Health OutcomesOutcomes

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 Describe Current Burden of Climate Sensitive DiseasesClimate 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 BaselineDescribe 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 Review the Health Implications of the Potential Impacts of of the Potential Impacts of Climate on Other SectorsClimate 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 Estimate Future Potential Health ImpactsHealth 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 ResultsSynthesize 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 UncertaintySources 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 Identify Additional Adaptation Strategies, Policies & MeasuresStrategies, 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 AssessmentFramework 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 InformationFor 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)