World Health Organization (WHO) · Publications

Methods of assessing human health vulnerability and public health adaptation to climate change

January 1, 2003 World Health Organization

The full text is hosted by the publishing organisation. lawenc.com indexes the metadata and links to the official source.

Full text

Health and Global Environmental Change SER IES No. 1

UNEP

Methods of assessing human health vulnerability and public health adaptation to climate change

WMO

Health and Global Environmental Change SER IES No. 1

UNEP

Methods of assessing human health vulnerability and public health adaptation to climate change

WMO

Lead authors:

Sari Kovats, Kristie L. Ebi and Bettina Menne

Contributing authors:

Diarmid Campbell-Lendrum, Osvaldo F. Canziani, Andrew Githeko, Katrin Kuhn, David Le Sueur, Pim Martens, Anthony J. McMichael, Anna Rosa Moreno, Jonathan Patz, Dieter Riedel, Joel Scheraga, Elisabeth Seymour, Michael Sharpe and Roger Street

Steering Committee:

Carlos Corvalan, Hiremagalur Gopalan, Buruhani Nyenzi and Jacinthe Seguin

Abstract

The fact that climate is changing has become increasingly clear over the past decade. Recent evidence suggests that the associated changes in temperature and precipitation are already adversely affecting population health.The future burden of disease attributable to climate change will depend in part on the timeliness and effectiveness of the interventions implemented. In response to these changing risks, the Third Ministerial Conference on Environment and Health in London in 1999 recommended developing the capacity to undertake national assessments of the potential health effects of climate variability and change, with the goal of identifying: 1) vulnerable populations and subgroups and 2) interventions that could be implemented to reduce the current and future burden of disease.The need to facilitate the transfer of expertise among countries was recognized.This publication is designed to address this need by providing practical information to governments,health agencies and environmental and meteorological institutions in both industrialized and developing countries on quantitative and qualitative methods of assessing human health vulnerability and public health adaptation to climate change.An integrated approach to assessment is encouraged because the impact of climate is likely to transcend traditional sector and regional boundaries, with effects in one sector affecting the coping capacity of another sector or region. Part I describes the objectives and the steps for assessing vulnerability and adaptation and Part II discusses the following issues for a range of health outcomes: the evidence that climate change could affect mortality and morbidity; methods of projecting future effects; and identifying adaptation strategies,policies and measures to reduce current and future negative effects.The health outcomes considered are: morbidity and mortality from heat and heat-waves, air pollution, floods and windstorms and food insecurity; vector-borne diseases; waterborne and foodborne diarrhoeal diseases; and adverse health outcomes associated with stratospheric ozone depletion.

Keywor ds

ENVIRONMENTAL HEALTH CLIMATE

ENVIRONMENTAL EXPOSURE RISK ASSESSMENT

RISK MANAGEMENT DISEASE SUSCEPTIBILITY

HEALTH POLICY PUBLIC HEALTH

ISBN 92 890 1090 8

Address requests about publications of the WHO Regional Office to: • by e-mail publicationrequests@euro.who.int (for copies of publications)

permissions@euro.who.int (for permission to reproduce them) pubrights@euro.who.int (for permission to translate them)

• by post Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark

translate its publications, in part or in full.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever

on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or

concerning the delimitation of its frontiers or boundaries.Where the designation “country or area”appears in the headings of tables, it covers

countries, territories, cities, or areas.Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the

World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of

proprietary products are distinguished by initial capital letters.

The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be

liable for any damages incurred as a result of its use.The views expressed by authors or editors do not necessarily represent the decisions or

the stated policy of the World Health Organization.

Contents

FOREWORD 4

PREFACE 6

ACKNOWLEDGEMENTS 7

PART I. CONTEXT 9

1. Introduction 10 2. Vulnerability and adaptation to climate change: key concepts 16 3. The framework for the assessment 29

PART II. METHODS AND TOOLS 37

4. Quantitative health impact assessment 40 5. Direct effects of heat and heat-waves 54 6. Air pollution 59 7. Disasters: floods and windstorms 63 8. Vector-borne diseases 68 9. Waterborne and foodborne diarrhoeal diseases 85 10. Stratospheric ozone depletion 88 11. Food security 91 12. Vulnerable populations 94

REFERENCES 96

ANNEX 1. KEY TERMS USED IN THIS REPORT 105

ANNEX 2. SOURCES OF DATA AND INFORMATION 106

Climate change is one of several unprecedented, large-scale, environmental changes that are affecting our planet.These changes reflect the overload of several of the Earth’s biophysical and ecological systems caused by the combined impact of growing human population and economic activities. Environmental changes are now affecting the whole planet and disrupting earth’s life-supporting mechanisms, but the extent to which this affects human well-being and health varies substantially in different parts of the world.

Many research activities have been carried out in recent years to improve understanding of climate change patterns as well as their effects on human health.Thanks to this extensive effort, these changes can now be better understood and scenarios for the future developed that allow the policy community to identify adequate strategies for response and adaptation.

In general, climate change does not and will not cause novel environmental exposure, but global warming and the increasing variability of weather patterns will tend to intensify the effects of climate- related environmental determinants of health. For instance, as Europe has experienced during the floods in 2002 and the heat-waves in 2003, climate change will increase the number and intensity of extreme weather events.This will cause excess death, injury, disability and disease. It is now time to identify these health effects on the population and to plan and take appropriate measures to prevent the effects, especially among the most vulnerable groups.

At the WHO Third Ministerial Conference on Environment and Health in London in 1999, countries recommended developing the necessary capacity to undertake national health assessment of vulnerability and adaptation to climate change with the aims of identifying the vulnerability of populations and subgroups and ensuring the necessary transfer of expertise among countries.

This publication is a response to this call. It is a result of an extensive consultation process involving many institutions. It provides an overview of the methods available to assess vulnerability to climate change and includes practical, real-life information for governments, health agencies and environmental and meteorological institutions in both industrialized and developing countries. We hope that the world community will take the necessary steps to address the causes of climate change. In the mean time, we are confident that this work will help public authorities at all levels to identify and implement measures that will facilitate adaptation to climate change and protect human populations from the most serious and preventable health effects in each context.

Foreword

Roberto Bertollini

Director Division of Technical Support Health Determinants

WHO Regional Office for Europe

Foreword

There is growing evidence that global climate is changing and will have profound effects on the health and well-being of citizens in countries throughout the world.As the climate changes in Canada, we may experience more extreme weather events, an increase in contamination of our air, water and food and a greater number of emerging infectious diseases. Other countries may find themselves to be anticipating even greater risks than this.As a result, Health Canada, together with departments of health in other countries, will need to have a better understanding of the health effects expected from climate change and of those who may be the most vulnerable in our respective societies in order to be able to manage the risks.

For many countries, adapting to the effects of climate change will necessitate strengthening existing capacity and applying new approaches to examining the risks associated with a changing climate and increased climate variability. For health departments, this also means an increasing need to collaborate with other sectors of society that can play a critical role in managing the risks to health and well- being. Expanding national and international partnerships, particularly cross-sectoral ones, needs to be supported by a solid base of evidence and knowledge of the health effects and vulnerability resulting from a changing environment.

Health Canada is pleased to contribute to ongoing efforts aimed at adapting to climate change by providing a report that outlines the tools and methods available to conduct vulnerability and adaptation assessments in a manner that is adaptable to all levels of development.We hope that countries will find the content useful in their efforts to identify the health concerns that will require their attention in the coming years.

My Department looks forward to using the publication as we examine more closely the climate change related health effects which are of concern in Canada. Health Canada has appreciated the opportunity to work closely with WHO and other international experts in developing this publication and would like to thank all collaborators for their dedication over the past 2 years.

Paul Glover

Director General Safe Environments Programme

Health Canada

This publication provides practical information to governments, health agencies and environmental and meteorological institutions in both industrialized and developing countries on how to assess vulnerability and adaptation to climate variability and change at the regional, national and local levels. Flexible methods and tools are described to achieve better understanding of the current and future vulnerability of specific populations.This will help institutions and agencies to identify appropriate and effective adaptation strategies, policies and measures.

The proposed methods and tools are designed to fit into current international frameworks for assessing the potential impact of environmental change on sectors other than health.This includes the guidance provided by the Intergovernmental Panel on Climate Change (IPCC) for assessing the impact of and adaptation to climate change, developing scenarios and dealing with uncertainty.

In presenting this publication,WHO,Health Canada,UNEP and WMO offer governments and their health agencies an opportunity to join a wider collaborative effort to identify and develop strategies for reducing the potential health impact of an emerging worldwide environmental problem that will profoundly affect all of us.

Finally, we dedicate this publication to the memory of David Le Sueur.

Carlos Corvalan, Hiremagalur Gopalan, Buruhani Nyenzi and Jacinthe Seguin

Preface

The process of developing this publication started in 2001, thanks to the financial, scientific and technical contribution of Health Canada. Bettina Menne from the WHO Regional Office for Europe coordinated the overall development of this publication, the numerous meetings, the writing process and the review process in close cooperation with Dieter Riedel, Jacinthe Seguin, Michael Sharpe and Anita Walker from Health Canada. Carlos Corvalan from WHO, Hiremagalur Gopalan from UNEP and Buruhani Nyenzi from WMO advised throughout the whole process.

Sari Kovats (Centre on Global Change and Health, London School of Hygiene and Tropical Medicine, United Kingdom), Kristie L. Ebi (Global Change and Health,WHO Regional Office for Europe; currently Exponent Health Group, USA) and Bettina Menne (Global Change and Health,WHO Regional Office for Europe) were the main authors.

The coordinator, authors and advisers would like to thank the following for contributing text: Diarmid Campbell-Lendrum, WHO, Geneva, Switzerland; Osvaldo F. Canziani, Co-chair, Working Group II of the Intergovernmental Panel on Climate Change, Buenos Aires, Argentina; Andrew Githeko, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya; Katrin Kuhn, London School of Hygiene and Tropical Medicine, United Kingdom; David Le Sueur, National Malaria Research Programme, Medical Research Council Durban, Congella, South Africa; Pim Martens, International Centre for Integrative Studies, Universiteit Maastricht, the Netherlands; Anthony J. McMichael, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia; Anna Rosa Moreno, Mexico Foundation for Sciences, Mexico City, Mexico; Jonathan Patz, Director, Program on Health Effects of Global Change, Department of Environmental Health Sciences, Bloomberg School of Public Health,The Johns Hopkins University, Baltimore, MD, USA; Dieter Riedel, Climate Change and Health Office, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada; Joel Scheraga, United States Environmental Protection Agency,Washington, DC, USA; Elisabeth Seymour, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada; Michael Sharpe, Climate Change and Health Office, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada; and Roger Street,Adaptation and Impacts Research Group, Meteorological Service of Canada, Environment Canada, Ottawa, Canada.

The coordinator, authors and advisers would like to thank the following people for the very useful suggestions, advice and assistance received during the several years during which this publication was prepared and for participating in several meetings: Houssain Abouzaid, WHO Regional Office for the Eastern Mediterranean,Cairo,Egypt;Martha Anker,WHO,Geneva,Switzerland;Elaine Barrow,Environment Canada, Ottawa, Canada; Rachid Bessaoud, Oran,Algeria; Åke Blomqvist, Health Canada, Ottawa, Canada; Robert Boss,WHO,Geneva,Switzerland; José Calheiros, Institute Ciências Biomédicas,Porto,Portugal;Elsa Casimiro, SIAM Project, Lisbon, Portugal; Aline Chiabai, Fondazione Eni Enrico Mattei, Milan, Italy; Ligia Castro de Doens, Cathalac Centre de Aqua del Tropico Humedo para America Latina y el Caribe, Panama City, Panama; Franck De Gruijl, Dermatology, University Medical Center Utrecht, the Netherlands; Carlos Dora,WHO, Geneva, Switzerland; Gretel Gambarelli, Fondazione Eni Enrico Mattei, Milan, Italy;Vladimir Kendrovski,Republic Institute for Health Protection, Skopje,The former Yugoslav Republic of Macedonia; Richard J.T. Klein, Potsdam Institute for Climate Impact Research, Germany; Paul Llanso,WMO, Geneva, Switzerland; Pierrette Miron, Health Canada, Ottawa, Canada; Charles Nhachi, WHO Regional Office for Africa, Brazzaville, Congo; Dorbrene O’Marde, Ministry of Health, St Johns, Antigua and Barbuda; Anna Paldy, National Institute of Environmental Health, Budapest, Hungary; Olga Pilifosova, United Nations Framework Convention for Climate Change, Bonn, Germany; Peter Scholefield, WMO, Geneva, Switzerland; Emilio Sempris, National Programme on Climate Change, National Environmental Authority, Panama City,Panama;Paul Sockett,Health Canada,Ottawa,Canada;Colin L.Soskolne,University of Alberta, Edmonton,Alberta, Canada; Elisaveta Stikova, Republic Institute for Health Protection, Skopje,The former Yugoslav Republic of Macedonia; Joel Tickner, Lowell Center for Sustainable Production, University of Massachusetts, Lowell, MA, USA; Peter Toft, Pan American Health Organization, Washington, DC, USA;

Acknowledgements

Thomas Voigt, European Environment Agency, Copenhagen, Denmark; and Anita Walker, Health Canada, Ottawa, Canada.

We received comments from the following reviewers: Shaheeda Adam, Maldives Water and Sanitation Authority, Malé, Maldives; Göran Aner, Swedish National Food Administration, Uppsala, Sweden; Sergio Bonini, Institute of Neurobiology and Molecular Medicine, Rome, Italy; Marianne Boysen, Swedish National Food Administration, Uppsala, Sweden; Paulo Ortiz Bulto, Centro Nacional del Clima, Instituto de Meteorología, Havana, Cuba; Tanja Cegnar, Hydrometeorological Institute of Slovenia, Ljubljana, Slovenia; Dominique Charron, Population Public Health Branch, Health Canada, Ottawa, Canada; Bernhard Clot, MeteoSwiss, Zurich, Switzerland; Marlies Craig, Medical Research Lead Programme, Medical Research Council, Durban, South Africa; Eva Falck, National Institute for Public Health, Stockholm Sweden; Hans-Martin Fuessel, Potsdam Institute for Climate Impact Research, Germany; Carmen Galan, University of Córdoba, Spain; Pierre Gosselin, Institut nationale de santé publique du Québec, Québec City, Canada; Simon Hales, University of Otago, New Zealand; Leif Hansen, Ministry of Health and Social Affairs, Stockholm, Sweden; Max Harry, HERRY Consult GmbH,Vienna,Austria; Britta Hedlund, Swedish Environment Protection Agency, Stockholm, Sweden; Baggier Hidayatov, Ministry of Ecology and Natural Resources, Baku,Azerbaijan; Mike Hulme, University of East Anglia, Norwich, United Kingdom; Rozlan Ishak, Ministry of Health, Kuala Lumpur, Malaysia;Thomas Jaenson, Uppsala University, Sweden; Gerd Jendritzky, Deutscher Wetterdienst, Freiburg, Germany; Michinori Kabuto, National Institute for Environmental Studies, Ibaraki, Japan; Christina Koppe, Deutscher Wetterdienst, Freiburg, Germany; Andy Kusi-Appiah, Health Canada, Ottawa, Canada; Kuulo Kutsar, Health Protection Inspectorate, Tallinn, Estonia; Roland Lindqvist, Swedish National Food Administration, Stockholm, Sweden; Wieslaw Magdzik, National Institute of Hygiene, Warsaw, Poland; Chantal Maheu, Health Care System Division, Health Canada, Ottawa, Canada; Leslie Malone, World Climate Programme, WMO, Geneva, Switzerland; Jim McIlwee, United Kingdom Climate Impacts Programme, London; Barb McKinnon, New Brunswick Lung Association, Fredericton, Canada; Michele Monteil, Faculty of Medical Sciences, University of the West Indies, St.Augustine,Trinidad and Tobago;Torsten Naucke, Institute for Medical Parasitology, University of Bonn, Germany; Ragnar Norrby, Swedish Institute for Infectious Disease Control, Solna, Sweden; Maggie Opondo, University of Nairobi, Kenya; Bo Petersson, Unit for Health Protection, National Board of Health and Welfare, Stockholm, Sweden; Karen Polson, Caribbean Epidemiology Centre, Port of Spain, Trinidad and Tobago; Samuel Rawlins, Caribbean Epidemiology Centre, Port of Spain,Trinidad and Tobago; Jeff Scott, Nova Scotia Health Department, Halifax, Canada; Emilio Sempris, National Programme on Climate Change, National Environmental Authority, CATHALAC, Panama City, Panama; Andriy M. Serdyuk, Marzwyev Institute for Hygiene and Medical Ecology of the Academy of Medical Sciences, Kiev, Ukraine; Colin Soskolne, University of Alberta, Edmonton, Canada; Leena Srivastava, Energy and Resources Institute (TERI), New Delhi, India; Goh Kee Tai, Ministry of Health,Singapore;Frank C.Tanser,Malaria Research Lead Programme,Medical Research Council,Durban, South Africa; Pat Troop, Health Protection Agency, London, United Kingdom; Stephan Weiland, University of Ulm, Germany; Magnus Wickman, National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Tania Wolf and Ken Wright, Department of Environment, Food & Rural Affairs, London, United Kingdom.

We thank David Breuer for excellent text editing and Emilio Dotto - Edb&Rdb for layout and graphic design and Roberto del Balzo for cover photo. Phil Jones kindly provided Fig. 1.1, Frank C.Tanser Fig. 8.2 and Neil de Wet Fig. 8.3.

This publication was printed by Colombo, Rome, Italy.

PART 1. CONTEXT

1. Introduction

2. Vulnerability and adaptation to climate change: key concepts

3. The framework for the assessment

Over the past decade, the fact that the world’s climate is changing has become clear.The assessment activities undertaken by the Intergovernmental Panel on Climate Change (IPCC) have found an increasing body of observations giving a collective picture of a world that is warming and is experiencing other changes in the climate system.The global average surface temperature has increased since 1861, and new analyses of proxy data from the Northern Hemisphere indicate that the increase in temperature during the 20th century is likely to have been the largest of any century during the last 1000 years (Fig.1.1).Similar conditions may be expected for the Southern Hemisphere,but less is known because sufficient data are lacking. This unprecedented warming has taken place in a time span far shorter than the spans paleoclimatic studies have shown for geological periods with similar changes. Further, temperatures have risen during the past four decades in the lowest 8 kilometres of the atmosphere.The global average sea level has risen, the heat content of the oceans has increased and the extent of snow cover and ice has decreased. Changes have also occurred in other important features of climate, such as the warm episodes of the El Niño Southern Oscillation.

Science has found that the climate is changing in response to numerous human activities that transfer gases into the atmosphere that enhance the natural greenhouse effect. For millennia, the greenhouse effect has facilitated a balance between incoming solar radiation and outgoing terrestrial radiation; a change in either incoming or outgoing radiation modifies the surface temperature of the Earth. Intensification of the greenhouse effect results in the observed warming that, in turn, brings changes in other climatic and weather variables.Apart from an increase in the natural greenhouse effect, some of these gases also deplete the stratospheric ozone layer, producing a net increase in the ultraviolet (UV) radiation reaching the ground. Both geophysical processes influence human health.

1. Introduction

Source: Hadley Centre for Climate Research, Exeter, United Kingdom based on data from Jones et al., (1999) and Parker et al., (1995).

Fig. 1.1. Past and future changes in global mean temperature Global average near-surface temperatures, 1860–July 2003 from 1961 to 1990

Di ff

er en

ce in

( °C

) fr

om 1

96 1-

19 90

a ve

ra ge

0.6

0.4

0.2

0.0

-0.2

-0.4

-0.6 18801860 1900 1920 1940 1960 1980 2000

years

PART 1. CONTEXT

Aims

Global climate change is one of several unprecedented, large-scale, environmental changes now occurring around the world. These momentous changes reflect the overloading of several of Earth’s biophysical and ecological systems by the combined weight of human numbers and economic activity. Together with global climate change, loss of biodiversity, desertification, stratospheric ozone depletion and water resource depletion give rise to global environmental change.These environmental changes are disrupting Earth’s life-supporting infrastructure, posing risks to human well-being and health.

Three independent factors determine the scale of the human effects on the environment: consumption per capita, the size of the human population and the technologies used to produce and consume resources.The fact that human activities generate greenhouse gases, in addition to other pollutants of the air, water and soil, brought governments to adopt the United Nations Framework Convention on Climate Change (UNFCCC).The ultimate objective of the UNFCCC is to achieve

... , in accordance with the relevant provisions of the Convention, stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system.Such a level should be achieved within a time-frame sufficient to allow ecosystems to adapt naturally to climate change, to ensure that food production is not threatened and to enable economic development to proceed in a sustainable manner.

To achieve this objective, the Parties to the UNFCCC approved the Kyoto Protocol to the UNFCCC aiming to mitigate greenhouse gas emissions. Environmental changes are disrupting Earth’s life-support systems, which pose a number of risks to human health and well-being. Researchers are intensifying their studies of the relationship between climate and weather and of the rates and patterns of mortality and morbidity. Indeed, these are now a central focus of the IPCC,which since 1988 has been responsible for assessing the information on the science of climate change; the vulnerability to and effects of climate change; and the strategies to mitigate greenhouse gases and to adapt to global warming. Governments, international and regional programmes and projects have undertaken studies to analyse the vulnerability of human health to climate change and the effects of climate change on a range of health outcomes.

The UNFCCC’s efforts devoted to mitigate greenhouse gas emissions will not immediately reverse the current warming. In fact, the long lifetime of some greenhouse gases and the inertia of the climate system mean that, even if all emissions are stopped, the physical composition of the present atmospheres will continue to influence the climate system for decades or even centuries. The consequences of mitigation may therefore not become apparent until after a considerable time interval. These physical constraints have brought decision-makers to recognize that anticipated precautionary measures, designed to cope with the expected effects of climate change, are required. Adaptation strategies and measures should be developed to lessen the potential adverse effects and to take advantage of their potential beneficial effects. These actions should take into account the following factors.

• Climate change does not cause novel environmental exposures but may exacerbate the burden of climate-sensitive diseases, depending on the implementation of timely and effective interventions.

• Climate change results from both natural and human processes. Emissions of greenhouse gases affect human health at different scales.At the local scale, particulate matter emitted by vehicles has harmful effects. At the regional scale, transport of sulfur and nitrogen oxides cause acid deposition. At the global scale, the links between climate change and local environmental factors produce a range of hazards to human health.

• Intergovernmental agencies, nongovernmental and regional institutions and some national organizations have begun to assess the vulnerability of people to the potential health hazards resulting from climate variability (the El Niño Southern Oscillation) and change and to develop methods of assessing risk and enhancing adaptation.

1. Introduction

This publication will serve as a reference to many activities associated with the protection of the human environment, such as those stemming from the foci on water, energy,health, agriculture and biodiversity from the World Summit on Sustainable Development in Johannesburg in 2002 and Agenda 21 by describing a basic approach to assessing the vulnerability of human populations to changes in the climate system.

Why conduct a national assessment on human health vulnerability and public health adaptation to climate change?

Few industrialized and developing countries have conducted national assessments of the potential effects of climate change on human health to better understand current vulnerability and to evaluate the country’s capacity to adapt to climate change by modifying the health infrastructure or by adopting specific measures (Kovats et al., 2003a).

National assessments should be carried out to evaluate the risk of climate change for current and future generations and to enable policy-makers to plan for measures, strategies and policies to cope with climate change. In addition, more national information and assessments are needed to feed into the international policy processes, such as that of the national communications to the UNFCCC and those from other climate change assessments.

The importance of timely decision-making is indicated by the need to adapt to climate change long before the stabilization of greenhouse gas concentrations leads to the stabilization of temperature and mean sea level.This includes considering such issues as the time required to replace infrastructure.

Potential users of this document

Parties to the United Nations Framework Convention on Climate Change

In acting to achieve the ultimate objective of the UNFCCC (outlined earlier), the Parties to the UNFCCC must periodically communicate information related to its implementation to the Conference of the Parties.This information takes the form of national communications, including a national inventory of anthropogenic emissions by sources and removals by sinks of all greenhouse gases not controlled by the Montreal Protocol on Substances that Deplete the Ozone Layer and information that assesses the national vulnerability to the potential effects of climate change.

The UNFCCC (1999),with the scientific cooperation of the IPCC,has developed reporting guidelines on national communications.These guidelines are periodically revised for the preparation of ongoing sets of national communications. The current guidelines include only a few references to human health.

• Cl imate is the average s ta te o f the a tmosphere and the under ly ing land or water in a par t icu lar reg ion over a spec i f ic t ime per iod .

• Weather is the day- to-day mani fes ta t ion o f c l imate in a par t icu lar p lace a t a par t icu lar t ime .

• Cl imate change is a s ta t is t ica l l y s ign i f icant var ia t ion in e i ther the mean s ta te o f the c l imate or in i ts var iab i l i t y , pers is t ing over an extended per iod ( t yp ica l l y decades or longer) .

• Cl imate var iab i l i t y re fers to var ia t ions around the mean s ta te , inc lud ing the occurrence of ex t reme weather events .

Box 1.1. Definitions

PART 1. CONTEXT

Under Section 6, “Vulnerability assessment, climate change impacts and adaptation measures”, the guidelines specify the following:

A national communication shall include information on the expected impacts of climate change and an outline of the action taken to implement Article 4.1(b) and (e) with regard to adaptation. Parties are encouraged to use the Intergovernmental Panel on Climate Change (IPCC) Technical Guidelines for Assessing Climate Change Impacts and Adaptations and the United Nations Environment Programme (UNEP) Handbook on Methods for Climate Change Impacts Assessment and Adaptation Strategies. Parties may refer, inter alia, to integrated plans for coastal zone management, water resources and agriculture. Parties may also report on specific results of scientific research in the field of vulnerability assessment and adaptation.

Article 4 of the UNFCCC defines a number of “enabling activities” to support non-Annex I Parties (developing countries) in their efforts to undertake these assessments. Information on these activities may be obtained from the UNFCCC web site (Annex 2).

National adaptation programmes of action for climate change

International policy mechanisms for climate change are currently being directed towards implementing adaptation strategies,policies and measures in developing countries,where the effects of climate change are likely to be greatest.The need for national adaptation programmes of action for climate change was agreed under the UNFCCC process in 2001.

Least developed countries have contributed least to the emission of greenhouse gases but are the most vulnerable countries to the effects of climate change and have the least capacity to adapt to these changes, especially the impact of the increased damage from natural disasters. The least developed countries lack the necessary institutional, economic and financial capacity to cope with the impact of climate change and to rebuild their infrastructure when it is damaged by natural disasters.Adaptation has yet to become a major issue in developing countries.Although progress has been made in describing vulnerability to climate change in such populations, much more remains to be done to mainstream adaptation within the national policy-making processes (Huq et al., 2003). Several key lessons have been identified.

• Information on the impact of climate change needs to be translated from scientific research into language and time scales appropriate for policy-makers.

• Research on potential effects needs to be supported within countries to enable information to be improved and passed on to policy-makers.

• Sectoral-level decision-makers are relatively more likely to mainstream adaptation to climate change with ongoing and planned work, provided that information is given in a usable form.

Significant funds for implementing adaptation strategies are being made available, mainly through the Global Environment Facility of the United Nations Development Programme (UNDP).The Parties to the UNFCCC have agreed to develop the Least Developed Countries Fund to support the work programme, including preparing and implementing national adaptation programmes of action.

Regional programmes have also been developed to support developing countries in implementing the UNFCCC, as part of the Climate Change Training Programme of the United Nations.The South Pacific Regional Environment Programme developed the Pacific Islands Climate Change Program to be more appropriate to the needs of Pacific countries (Annex 2). The Special Climate Change fund was established under the UNFCCC Marrakesh Accords in 2001. Adaptation is one type of activity that is intended to be supported by the Special Climate Change fund and/or the Adaptation Fund of the Kyoto Protocol.

1. Introduction

Such activities include (Dessai, 2002):

• starting to implement adaptation activities promptly where sufficient information is available to warrant such activities, including water resources management; land management; agriculture; health; infrastructure development; fragile ecosystems, including mountainous ecosystems; and integrated coastal zone management;

• improving the monitoring of diseases and vectors affected by climate change and related forecasting and early-warning systems, and in this context improving disease control and prevention;

• supporting capacity-building, including institutional capacity, for preventive measures, planning, preparedness and management of disasters relating to climate change, including contingency planning, especially for droughts and floods in areas prone to extreme weather events; and

• strengthening existing and, where needed, establishing national and regional centres and information networks for rapid response to extreme weather events, using information technology as much as possible.

This publication might help to focus some of the health-related adaptation activities within these plans.

Member States of WHO and the Climate Agenda

As a response to Agenda 21 and the UNFCCC, several organizations carrying out significant climate- related activities jointly developed the Climate Agenda, a comprehensive and integrating framework on all aspects of international climate-related programmes, including collecting and applying data, research on climate systems and studies of the socioeconomic,health and ecosystem effects of climate variability. The Fifty-first World Health Assembly endorsed WHO participation (resolution WHA 51.29).An informal Inter-Agency Network on Climate and Human Health was established in 1998 with a secretariat at WHO, to coordinate the relevant activities of the Climate Agenda.The work of WHO on climate change focuses on capacity-building, exchanging information and promoting research.

A first step was taken in the WHO European Region,where the European Ministers for Environment and Health welcomed the recommendations on the early health effects of climate change and stratospheric ozone depletion at the Third Ministerial Conference on Environment and Health in London in 1999. These included:

• developing the capacity, as necessary, to undertake national health impact assessments with the aim of identifying the vulnerability of populations and subgroups to ensure the necessary transfer of expertise among countries; and

• reviewing the social, economic and technical prevention, mitigation and adaptation options available to reduce the potential adverse impact of climate change and stratospheric ozone depletion on human health.

This publication can help health ministries and institutions in giving priority to climate change–related activities at the national, regional and local levels.

International reviews

Several international reviews have been undertaken.The scientists of the IPCC comprehensively assess the scientific literature on this and related issues in its reports.The First Assessment Report (IPCC, 1990) introduced the health effects of climate change under a general chapter on human settlements and linked them with air quality and ultraviolet B (UVB) radiation.The subsequent IPCC assessment reports devoted specific chapters to climate change and human health: the Second Assessment Report

PART 1. CONTEXT

(McMichael et al., 1996) and the Third Assessment Report (McMichael & Githeko, 2001). Further, the special report on the regional impact of climate change (Watson et al., 1997) included the human health issue in a number of regional chapters.The Third Assessment Report also includes chapters on impact of climate change by region.These global reviews make general statements about the types of effects climate change may have on human health outcomes. In theory, national assessments should provide important information for the global assessments on regional and local vulnerability. In practice, this has proved difficult to achieve because few national assessments have been undertaken. Assessments should be country-driven and reflect local environmental and health priorities.

A task group convened by WHO, the World Meteorological Organization (WMO) and the United Nations Environment Programme (UNEP) (IPCC,1996) comprehensively reviewed the literature on the potential health impact of climate change. In 2003, WHO collaborated with UNEP and WMO in publishing an updated volume (McMichael et al., 2003b) that describes the actual and likely impact of climate change on health and how human societies and their governments should respond,with particular focus on the health sector.

Both vulnerability and adaptation need to be understood to ensure effective risk management of the current and potential effects of climate variability and change. This chapter defines vulnerability and adaptation within the context of global climate change and discusses possible steps in conducting vulnerability and adaptation assessments.The terms vulnerability and adaptation are used by the climate change community and are analogous to concepts used in public health.The following definitions are provided to facilitate the communication between the public health and climate change communities.

The public health sector frames the interventions needed to reduce the potential negative impact of climate variability and change in terms of prevention. Public health prevention is classified as primary, secondary or tertiary. Primary prevention aims to prevent the onset of disease in an otherwise unaffected population (such as by supplying bed nets to all members of a population at risk of exposure to malaria). Secondary prevention entails preventive action in response to early evidence of health effects (including strengthening disease surveillance and responding adequately to disease outbreaks, such as the West Nile virus outbreak in the United States).Tertiary prevention consists of measures to reduce long-term impairment and disability and to minimize the suffering caused by existing disease. In general, secondary and tertiary prevention are less effective and more expensive than primary prevention. In terms of global climate change, the mitigation of greenhouse gas emissions could be considered as primary prevention. For any specific health outcome of interest, there are many possible types of primary, secondary or tertiary prevention, as discussed in Chapters 5–11.

Definitions of vulnerability and adaptation

The public health and climate change communities share the goal of increasing the ability of countries, communities and individuals to effectively and efficiently cope with the challenges and changes that are likely to arise because of climate variability and change. Realistically assessing the potential health impact of climate variability and change requires understanding both the vulnerability of a population and its capacity to respond to new conditions.The relationships between vulnerability, adaptive capacity and potential effects are discussed below and shown in Fig. 2.1.

The IPCC defines vulnerability as the degree to which individuals and systems are susceptible to or unable to cope with the adverse effects of climate change, including climate variability and extremes. The vulnerability of human health to climate change is a function of:

• sensitivity,which includes the extent to which health,or the natural or social systems on which health outcomes depend, are sensitive to changes in weather and climate (the exposure–response relationship) and the characteristics of the population, such as the level of development and its demographic structure;

• the exposure to the weather or climate-related hazard, including the character, magnitude and rate of climate variation; and

• the adaptation measures and actions in place to reduce the burden of a specific adverse health outcome (the adaptation baseline), the effectiveness of which determines in part the exposure–response relationship.

Populations, subgroups and systems that cannot or will not adapt are more vulnerable, as are those that are more susceptible to weather and climate changes. Understanding a population’s capacity to adapt to new climate conditions is crucial to realistically assessing the potential health and other effects of climate change. In general, the vulnerability of a population to a health risk depends on the local environment, the level of material resources, the effectiveness of governance and civil institutions, the

2. Vulnerability and adaptation to climate change: key concepts

PART 1. CONTEXT

quality of the public health infrastructure and the access to relevant local information on extreme weather threats (Woodward et al., 1998).These factors are not uniform across a region or country or across time and differ based on geography, demography and socioeconomic factors. Effectively targeting prevention or adaptation strategies requires understanding which demographic or geographical subpopulations may be most at risk and when that risk is likely to increase.Thus, individual, community and geographical factors determine vulnerability.

Adaptation includes the strategies, policies and measures undertaken now and in the future to reduce potential adverse health effects.Adaptive capacity describes the general ability of institutions, systems and individuals to adjust to potential damages, to take advantage of opportunities and to cope with the consequences.The primary goal of building adaptive capacity is to reduce future vulnerability to climate variability and change.Coping capacity describes what could be implemented now to minimize negative effects of climate variability and change. In other words, coping capacity encompasses the interventions that are feasible to implement today (in a specific population), and adaptive capacity encompasses the strategies,policies and measures that have the potential to expand future coping capacity. Increasing the adaptive capacity of a population shares similar goals with sustainable development – increasing the ability of countries,communities and individuals to effectively and efficiently cope with the changes and challenges of climate change.

Specific adaptation interventions arise from the coping capacity of a community, country or region.These interventions, similar to all interventions in public health, are designed to maximize the number of avoidable adverse health effects. Adaptation can be anticipatory (actions taken in advance of climate change effects) or responsive and can encompass both spontaneous responses to climate variability and change by affected individuals and planned responses by governments or other institutions. Examples of adaptation interventions include watershed protection policies and effective public warning systems for floods and storm surges such as advice on water use, beach closings and evacuation from lowlands and

Source: Ebi et al., (forthcoming).

Sensitivity Exposure-effect Population characteristics

Exposure

Adaptation baseline

TI M E 3

TI M E 2

TI M E 1

CURRENT VULNERABILITY

Coping capacity

A d a p t a t i o n

Avoidable

Unavoidable

ADAPTIVE CAPACITY FUTURE POTENTIAL IMPACTS

Fig. 2.1. Schematic of relationships between vulnerability, adaptive capacity and potential health impact

seashores. To explain the observed diversity in the ability of systems to adapt (primarily to natural hazards), the IPCC offered the hypothesis that adaptive capacity is a function of a series of determinants (Smit & Pilifosova, 2001):

• the range of available technological options for adaptation;

• the availability of resources and their distribution across the population;

• the structure of critical institutions, the derivative allocation of decision-making authority and the decision criteria that would be employed;

• the stock of human capital, including education and personal security;

• the stock of social capital, including the definition of property rights;

• the system’s access to risk-spreading processes;

• the ability of decision-makers to manage information, the processes by which these decision-makers determine which information is credible and the credibility of the decision-makers themselves; and

• the public’s perceived attribution of the source of stress and the significance of exposure.

A framework more familiar in public health is the prerequisites required for prevention (Last, 1998):

• awareness that a problem exists

• understanding of the causes

• a sense that the problem matters

• the capability to intervene or influence

• the political will to deal with the problem.

Table 2.1 compares the determinants of adaptive capacity with the prerequisites required for prevention (Yohe & Ebi, forthcoming). This comparison shows that the public health and climate change communities share similar perspectives but use somewhat different terms.

Human societies are currently adapted to some extent to weather and climate variability. It is therefore important to identify where populations are not able to cope with current climate variability and extremes, such as floods, droughts and heat-waves. This shows where additional interventions are needed now. Improving the capacity to cope with current climate variability will probably improve the capacity to cope with long-term climate change. An adaptation assessment describes specific strategies, policies and measures that can be implemented to reduce current and future vulnerability as well as the resources needed (financial, technological and human capital) to implement them.The information generated from an adaptation assessment can be combined with a cost–benefit or other economic analysis to inform priority-setting by policy-makers. The Adaptation Policy Framework developed under funding from the Global Environment Facility of UNDP further describes designing and conducting a project focused on identifying adaptation options for short- and long-term policy planning in developing countries (Annex 2).

Assessing vulnerability or health impact

Approaches to assessing the potential effects of climate variability and change on human health vary depending on the outcome of interest. Conventional environmental health impact assessment is based on the toxicological risk assessment model that addresses population exposure to environmental agents,

2. Vulnerability and adaptation to climate change: key concepts

PART 1. CONTEXT

such as chemicals in soil, water or air. Most diseases associated with environmental exposure have many causal factors, which may be interrelated.These multiple, interrelated causal factors, as well as relevant feedback mechanisms, need to be addressed in investigating complex associations between disease and exposure, because they may limit the predictability of the health outcome.

Historically, two important dynamics drive the design of public health interventions, including the management of environmental risks: 1) scientific and technical knowledge, including the level of confidence in that knowledge; and 2) public values and popular opinion. Environmental risk management is the process by which assessment results are integrated with other information to make decisions about the need for, approaches to and extent of reducing risk. Policy-makers decide what interventions to implement, if any, to address current vulnerability, including those resulting from climate variability and change, even as research continues to provide additional information. Policy- makers should consider the concerns and priorities of stakeholders, including the scientific community and the public. One important role of scientists in this regard is explaining the role of uncertainty in the scientific process and contrasting it to the role uncertainty may play in policy development (Moss & Schneider, 2000; Bernard & Ebi, 2001).

WHO has developed quantitative approaches to estimating the environmental burden of disease at both the global and the national levels (Ezzati et al., 2002). Climate change was included as one of the types of environmental exposure in relation to malnutrition, flood impact, vector-borne diseases and diarrhoeal disease. Quantitative risk assessment allows specific outcomes (diseases) to be estimated under a range of scenarios that describe alternative future climates and future socioeconomic growth. The environmental burden of disease project provided estimates using a standardized approach to facilitate comparison across multiple health outcomes. This method is applied in these guidelines, as appropriate.

Assessments of the potential health effects of climate variability and change have used a variety of methods (see Part II). Both qualitative and quantitative approaches may be appropriate depending on the level and type of knowledge; the outcome of an assessment need not be quantitative to be useful to stakeholders.An integrated approach is likely to be most informative, as the impact of climate is likely to transcend traditional sector and regional boundaries, with effects in one sector affecting the capacity of another sector or region to respond.

TABLE 2.1. DETERMINANTS OF ADAPTIVE CAPACITY AND THE PREREQUISITES FOR PREVENTION

Determinants of adaptive capacity Prerequisites for prevention

Availability of options Technically feasible; awareness; capability to influence

Resources Capability to influence

Governance Political will

Human and social capital Understanding of causes; political will

Access to risk-spreading mechanism Capability to influence

Managing information (including monitoring) Understanding of causes; problem matters

Public perception Awareness; problem matters

Source: adapted from Yohe & Ebi (in press).

Climate impact assessment

The IPCC has developed methodological guidelines for assessing climate impact (Carter et al., 1994; Parry & Carter,1998).The guidelines were developed primarily for the biophysical and economic sectors and were not intended to apply to the effects on health and social systems. However, it is desirable that health impact assessment follow IPCC practice to facilitate the inclusion and interpretation of health effects in the forthcoming Fourth Assessment Report. The Fourth Assessment Report is due to be completed in 2007, with research and assessments completed by mid-2005 considered in the assessment.The methods and tools in this publication are therefore consistent with IPCC guidance. In addition, this publication provides guidelines on the use of consistent scenarios of climate change and socioeconomic futures for comparison across assessments: across different countries and within a country or region over time (Chapter 4 discusses scenarios in more detail).

Another resource is the UNEP Handbook on methods for climate change impact assessment and adaptation (Feenstra, 1998), which includes a chapter on health.The aim of the UNEP country studies programme was to improve the methods for assessing the effects of climate change in developing countries or countries with economies in transition.

Health impact assessment should aim:

• to evaluate the impact of climate variability and change in a range of areas and populations, especially among vulnerable populations and, when possible, to determine the attributable burden of weather and climate, including extreme events, to climate-sensitive diseases (Chapters 5–11 discuss methods of achieving this);

• to evaluate possible threshold effects;

• to evaluate the effects of multiple stresses, including changes in socioeconomic systems;

• to evaluate uncertainty and its implications for risk management;

• to evaluate the effects of reducing emissions, such as by comparing impact under scenarios with business-as-usual and stabilization of emissions; and

• to measure coping capacity, especially under different socioeconomic futures (such as Nakicenovic & Swart (2000) or health-related scenarios) and in the context of sustainable development.

Risk management

Applying appropriate risk management principles, tools, and measures can reduce current and future vulnerability to climate variability and change. Numerous risk management frameworks have been developed that can be modified to address national, regional and local assessment needs (Annex 2).The first steps in these frameworks are identifying risks and assessing exposure and response. Risk identification involves evaluating whether a specific exposure is a risk to human health and well-being. Once a type of exposure is determined to be a risk (such as heavy rain causing rivers to overflow), the exposure and response are assessed to determine the consequences of exposure for the health and well- being of the affected population.This involves describing: the magnitude and frequency of the risk; the likelihood of exposure; who is or will be at increased risk of adverse health effects by level of exposure; and what is or will be at risk that could adversely affect health, such as damage to built infrastructure and/or interference with health and social services.

The risk identification and assessment of exposure and response should be followed by assessing capacity to identify the strengths and weaknesses of the human and material resources available to reduce (or manage) the risks. This might include assessing the ability of public health units, fire departments,emergency services and even military units to provide emergency services during weather-

2. Vulnerability and adaptation to climate change: key concepts

PART 1. CONTEXT

related disasters. It should also assess the ability to cope with risks that increase gradually, such as progressive droughts shrinking water supplies and increasing crop failures.Policy-makers and the public need to know whether public health services and other health and social infrastructure might be weakened by a deteriorating economy and by shrinking government income and resources.

Next, information is needed on the awareness and tolerance of risk at the local, regional and national levels. Information should be gathered on the risks the affected economic or social sectors,various levels of government and interest groups, experts, citizens and other appropriate sources perceive to be the most important and why. Priorities need to be established for how, by whom, how quickly, to what extent and in which order the risks should and could be reduced.This means that comprehensive and efficient information-gathering and consensus-building is essential.

The process of risk mitigation (risk management) focuses on the issues of highest priority. The adaptation assessment will have identified a range of possible strategies, policies and measures that could be implemented to address the risks of concern. These interventions have varying degrees of effectiveness, ease of implementation, expected disadvantages and cost in reducing the risk of adverse effects.These interventions are often analysed for costs and benefits.Decision-makers and policy-makers combine this information with factors such as current policy priorities and social values in determining a strategic direction and in implementing specific intervention. Finally, a mechanism for monitoring and evaluation needs to be established to determine whether the intervention has the desired effect and whether mid-course corrections are needed. Corrections may arise because of changes in social, economic, environmental and technological conditions over time. Significant changes may require initiating a new cycle of assessment and risk management to take these changes into account. Risk management is a process; this progression in time and the cyclical nature of the tasks can be represented by a clock face (Fig. 2.2).The United Kingdom Climate Impacts Programme has developed a decision- making framework for risk-based decision-making with respect to climate change (Willows & Connell, 2003).

Fig. 2.2. The risk management cycle

Source: Treasury Board of Canada Secretariat (2001).

CO NT

IN UO

LEA RNING AND COMM

UNICATION

Assessing key risk areas

Measuring likelihood and impacts

Ranking risks

Setting desired results

Developing options

Selecting a strategy

Implementing the strategy

Monitoring, evaluating and adjusting

Identifying issues; setting the context

INTEGRATED RISK MANAGEMENT

9 1 2

Steps in assessing vulnerability and adaptation

Assessment of vulnerability and adaptation uses similar concepts to those used in health impact assessment. Chapter 3 describes the process of conducting an assessment. Chapters 4 to 12 describe methods that can be used during the assessment process. Box 2.1 lists the recommended steps in conducting an assessment.The steps are consistent with the risk management framework; this report does not explicitly address the development of options, the selection of future strategies and the eventual implementation of the strategy as well as its monitoring, but they need to be considered in future policy development (Chapter 3).Not all steps may be possible or desirable,and the determination of which steps are included depends on the objectives and resources available for the assessment.

1. Determine the scope of the assessment

The first step is to specify the scope of the assessment in relation to:

• the health and community security issues of concern today and of potential risk in the future;

• the geographical region to be covered by the assessment; and

• the time period.

2. Vulnerability and adaptation to climate change: key concepts

Fig. 2.3. Climate change and health: pathway from driving forces through exposure to potential health effects. Arrows under research needs represent input required by the health sector

Source: adapted from McMichael et al., (2003b).

HEALTH EFFECTS

Temperature-related illness and death

Extreme weather-related health effects

Air pollution-related health effects

Water and food-borne diseases

Vector-borne and rodent-borne diseases

Effects of food and water shortages

Mental, nutritional, infectious and other health effects

Adaptive capacity

Modulating influences

Microbial contamination pathways

REGIONAL WEATHER CHANGES

Heat-waves

Extreme weather

Temperature

Precipitation

Transmission dynamics

Agro-ecosystems, hydrology

Socioeconomics, demographics

Health-specific adaptation measures

Evaluation of adaptationResearch needs

Mitigative capacity

Mitigation measures

Greenhouse gas emissions

Natural causes

Driving forces

Population dynamics

Unsustainable economic development

CLIMATE CHANGE

PART 1. CONTEXT

Fig. 2.3 shows the many mechanisms by which changes in climate may affect human health.Table 2.2 describes the association between well assessed health outcomes and climate risks. Part II further addresses the evidence of an association between a specific health outcome and weather or climate.

Interactions between weather and climate and health are location-specific; using epidemiological evidence based on local data if they are available is therefore important. Evidence of an association between weather and health outcome may not imply an increased burden from climate change (see Chapter 4). Assessments should include current vulnerability to climate variability to inform understanding of what could occur with climate change.The extent to which an assessment addresses these issues depends on the goals of the assessment and the resources available.

The national boundaries may not be the most appropriate geographical framework for the assessment. Climate, diseases and vectors do not respect national boundaries, and other countries may therefore need to be considered to assess the national risk. Countries with similar health and climate problems may work together for a regional assessment. Many countries (such as the United Kingdom, the United States and Canada) have undertaken assessments at the subnational level. The geographical areas of interest are likely to vary by outcomes.

Box 2.1. Steps in assessing vulnerability and adaptation

1 Determine the scope of the assessment .

2 Descr ibe the current d istr ibut ion and burden of c l imate -sensit ive d iseases .

3 Ident i fy and descr ibe current strategies , pol ic ies and measures that reduce the burden of

c l imate -sensit ive d iseases .

4 Review the health impl icat ions of the potent ia l impact of c l imate var iabi l i ty and change on

other sectors .

5 Est imate the future potent ia l health impact using scenar ios of future c l imate change, populat ion

growth and other factors and descr ibe the uncertainty.

6 Synthesize the results and draft a scient i f ic assessment report .

7 Ident i fy addit ional adaptat ion pol ic ies and measures to reduce potent ia l negat ive health

effects , including procedures for evaluat ion after implementat ion .

2. Vulnerability and adaptation to climate change: key concepts

Health outcome Known effects of weather and cl imate

Card iovascu lar resp i ra tor y mor ta l i t y and heat s t roke mor ta l i t y • Shor t - term increases in mor ta l i t y dur ing heat-waves • V- and J-shaped re la t ionsh ip between temperature and morta l i t y in popula t ions

in temperate c l imates • Deaths f rom heat s t roke increase dur ing heat waves

Al lerg ic rh in i t is • Weather a f fec ts the d is t r ibu t ion , seasonal i t y and product ion o f aeroa l lergens

Respi ra tor y and card iovascu lar d iseases and morta l i t y • Weather a f fec ts concentra t ions o f harmfu l a i r po l lu tants

Deaths and in jur ies • F loods , lands l ides and windstorms cause death and in jur ies

In fec t ious d iseases and menta l d isorders • F lood ing d isrupts water supply and san i ta t ion sys tems and may damage t ranspor t sys tems and heal th care in f ras t ruc ture

• F loods may prov ide breeding s i tes for mosqui to vectors and lead to outbreaks o f d isease • Floods may increase post - t raumat ic s t ress d isorders

Star vat ion , malnut r i t ion and d iarrhoeal and resp i ra tor y d iseases • Drought reduces water ava i lab i l i t y for hyg iene • Drought increases the r isk o f forest f i res • Drought reduces food ava i lab i l i t y in popula t ions that are h igh ly dependent on household

agr icu l ture product iv i t y and/or economica l l y weak

Mosqui to , t ick-borne d iseases and rodent-borne d iseases • Higher temperatures shor ten the deve lopment t ime of pathogens in vectors and (such as malar ia , dengue , t ick-borne encephal i t is and Lyme d iseases) increase the potent ia l t ransmiss ion to humans

• Each vector spec ies has spec i f ic c l imate condi t ions ( temperature and humid i t y) necessary to be suf f ic ient ly abundant to main ta in t ransmiss ion

Malnutr i t ion and undernutr i t ion • Cl imate change may decrease food suppl ies (crop y ie lds and f ish s tocks) or access to food suppl ies

Waterborne and foodborne d iseases • Surv iva l o f d isease-caus ing organisms is re la ted to temperature • Cl imate condi t ions a f fec t water ava i lab i l i t y and qual i t y • Ext reme ra in fa l l can a f fec t the t ranspor t o f d isease-caus ing organisms in to the water

supply

The responsible national or regional health authority can identify the health outcomes to be included in collaboration with, when appropriate, (1) the authorities responsible for the social security, environmental affairs and meteorological offices; (2) the research community; and (3) other stakeholders, such as nongovernmental organizations, business and the public.The assessment of some health outcomes may be postponed for future consideration if either climate or epidemiological information is currently insufficient to evaluate exposure and response. However, when the outcome is of high societal importance, qualitative estimates could be made.

2. Describe the associations between disease outcomes and climate variability and change

Once health outcomes (the climate-sensitive diseases) are identified for inclusion in the assessment, the current evidence (published literature) should be reviewed.A variety of statistical methods are available

TABLE 2.2. SUMMARY OF THE KNOWN EFFECTS OF WEATHER AND CLIMATE

PART 1. CONTEXT

to analyse associations with exposure to weather or climate, taking into account modifying and/or interacting factors (described in detail in Part II).Adverse health outcomes associated with interannual climate variability, such as El Niño events, could also be considered. Meteorologists can provide input into how to define and describe the important types of weather exposure; for example, the severity and recurring periods of extreme weather events. For each chosen outcome, determining the factors that could modify its association with weather and climate variables is important. Modifying factors will vary by disease outcome and could include socioeconomic and other variables. Consideration should be given to interacting effects. For example, morbidity and mortality may be increased during periods with both extreme heat and high levels of air pollutants. If epidemiological analyses cannot be conducted, such as if data are not of sufficient quality and quantity, the available literature can be reviewed to produce a qualitative assessment. The current burden of the climate-sensitive diseases can be described using the following indicators and outcomes:

• the current incidence and prevalence of the disease and the trend (is the disease increasing or decreasing), which may be available from routine statistics from the appropriate national agency; and

• the attributable burden of a disease to climate and/or weather, such as what proportion of all cardiovascular deaths are attributable to high or low temperatures or the number of deaths caused by floods.

For vector-borne diseases, having a map showing the current geographical distribution of human cases and vectors may be useful. Finally, environmental and socioeconomic conditions also influence human vulnerability and need to be considered within the assessment.

3. Identify and describe current strategies, policies and measures that reduce the burden of climate-sensitive diseases

For each health outcome, activities and measures individuals, communities and institutions currently undertake to reduce the burden of disease should be identified and evaluated for effectiveness. Adaptation measures can be identified from: (1) review of the literature; (2) from information available from international and regional agencies (WHO, the Pan American Health Organization, UNEP and others) and from national health and social welfare authorities (ministries of health); and (3) from consultations with other agencies and experts that deal with the impact of the health outcome of concern (that is, agencies that deal with the effects of extreme weather events, such as river commissions). Identifying successful adaptations being undertaken to address the negative effects of climate variability and those implemented in anticipation of climate change is important. For example, is an early warning system for heat-waves in place? What activities are instituted during a heat-wave to reduce morbidity and mortality? Reviewing adaptation measures implemented in other regions with similar health concerns may be valuable.

Ideally, the effectiveness of adaptation measures should be evaluated. Information from the previously mentioned sources is needed to evaluate the effectiveness of measures, including the barriers to implementation for proposed interventions.An evaluation should consider approaches to monitor how the performance of a strategy, policy or measure may change over time compared with the baseline. For example, if an early warning system for heat-waves is in place, evaluation can determine whether morbidity and/or mortality is lower with the system based on comparable heat-wave.

The key questions to address for a specific health outcome include the following.

• 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 strategies, policies, and measures should begin to be implemented to increase the range of possible future interventions?

4. Review the health implications of the potential impact of climate variability an change on other sectors

Climate change is likely to affect natural and human systems.Assessments should therefore be integrated across the concerned scientific disciplines and non-health sectors included. International agencies (the IPCC) or regional or national authorities may have assessed the potential impact of climate change on the environment (habitat and land use) at the relevant spatial scale.These effects should be included in the assessments to better understand issues such as the health implications of the direct impact of climate change on the food supply and the risk of disasters (such as coastal or river flooding).The impact of implemented strategies, policies and measures in response to actual or projected climate change needs to be evaluated in terms of potential health effects. For example, in cases where domestic water storage is recommended, the implementation of this measure may have implications for vector breeding and the transmission of dengue. Water development projects should be subject to environmental and health impact assessment. Information at the regional, national or local scale about climate variability and change should be used whenever possible.

5. Estimate the future potential health impact

Climate variability and change are adversely affecting human health and well-being and will continue to do so. The inherent inertia in the climate system means that the impact of current greenhouse gas emissions will be delayed for decades to centuries.The IPCC projections for the increase in mean surface temperature for the 21st century range from 1.4°C to 5.8°C.As a consequence, anthropogenic warming is projected, on average, to range from 0.1°C to 0.5°C per decade during this century. Even larger changes may be expected beyond the 21st century. Greater climatic changes are expected in higher latitudes in both hemispheres, with increasing risks of heat-waves, flooding and drought events and the spread of infectious diseases.This emphasizes that health and civil defence authorities need to design and implement adaptation strategies, polices and measures to reduce potential health impact. The climate change community often chooses from the present until 2050 and until 2100 as the reference periods for projecting the impact of climate change.

This requires using climate scenarios. Climate scenarios are now available for a range of time scales (see Chapter 4). The time scale of the assessment depends on the scope and purpose of the assessment. However, addressing potential effects both in the near term (the next 20 years) and the long term (up to 2050 or 2080) is advisable.The focus on the near term provides relevant information within the usual planning horizon of health agencies. A further need is looking beyond the near term to develop comprehensive adaptation measures.

The potential future impact of climate variability and change on health may be estimated using a variety of methods, as described in Part II.These methods imply a top-down approach in which scenarios of climate change (and other changes) are used as inputs into a model on climate and health. Such models can be complex spatial models or be based on a simple relationship between exposure and response.

Models of climate change should include projections of how other relevant factors may change in the future, such as population growth, income, fuel consumption and other relevant factors.Projections may be incorporated from models developed for other sectors, such as flood risk, food supply and land-use changes (see step 4). An assessment needs to address uncertainty explicitly.Scientists,policy-makers and the public must recognize the existence of multiple sources of uncertainty, from climate projections to the potential future public health effects. This step should be realistic about the likelihood that the uncertainty can be resolved in a meaningful time frame. Carefully estimating uncertainty can further understanding of the level of confidence in what is known and can provide input into future research

2. Vulnerability and adaptation to climate change: key concepts

PART 1. CONTEXT

directions and to policy-making.

Future capacity to adapt to the effects of climate change depends on the future levels of economic and technological development, local environmental conditions and the quality and availability of health care and of public health infrastructure. Social, economic, political, environmental and technological factors strongly influence health. These determinants of health are complex enough that future projections about stresses on population health, including but not limited to projections of the potential effects of climate variability and change on health, become increasingly uncertain with expanding timelines. Future projections must make explicit their assumptions about adaptive capacity.

6. Synthesize the results and draft a scientific assessment report

This step synthesizes the quantitative and qualitative information collected in the previous steps to identify changes in risk patterns and opportunities and to identify links between sectors, vulnerable groups and stakeholder responses. Convening an interdisciplinary panel of experts with relevant expertise is one approach to developing a consensus assessment. Chapter 6 provides guidance for describing the level of evidence behind a consensus statement. Once synthesized, the information should be peer-reviewed and published.

Assumptions that underlie any quantitative estimates should be clearly described.Quantitative estimates should be clearly identified with a climate scenario.Vague statements about potential impact should be avoided. In particular, it should not be stated that climate change “may affect” a given disease, as this is virtually meaningless.The degree of certainty of a statement should be provided (see Chapter 4).The most vulnerable population groups should be identified (see Chapter 12).

Value judgements have to be made in summarizing the assessment. In particular, decisions should be taken about (Lehto & Ritsatakis, 1999):

• how to balance near-term and long-term effects;

• how to weight the different potential effects in different population groups;

• how to balance the more certain,quantifiable potential effects with those that are less certain and not quantifiable, as well as the qualitative effects; and

• how to balance the interests of the various stakeholder groups: experts, people potentially affected and decision-makers.

7. Identify additional adaptation policies and measures, including procedures for evaluation after implementation

Identify possible adaptation measures that could be undertaken over the short term to increase the capacity of individuals, communities and institutions to effectively cope with the weather or climate exposure of concern.These measures should be possible to institute within the population’s access to material resources, technology and human and social capital. For example, if heat-related morbidity and mortality are health issues in an urban area and if an early warning system for heat-waves is not in place, then would implementing such a system be likely to benefit population health? Strengths and weaknesses as well as opportunities and threats to implementation should be evaluated and priorities set.

Every country needs to adapt to long-term climate change.The aim of this step is to identify possible measures that can be taken today and in the future to increase the ability of individuals, communities and institutions to effectively cope with future climate exposure, including extremes.

Consideration should be given to the lessons learned from past public health policies, including the

effectiveness of various measures, such as vector control and early warning systems.

Many of the possible measures for adapting to climate change lie primarily outside the direct control of the health sector.They are rooted in areas such as sanitation and water supply, education, agriculture, trade, tourism, transport,development and housing. Intersectoral and cross-sectoral adaptation strategies are needed to reduce the potential health impact of climate change. A policy analysis will determine the feasibility of and priorities among these options. In general,many of the policies and measures identified also promote sustainable development.

Criteria should be established in advance for evaluating possible adaptation measures.Evaluation should be an ongoing process both to identify opportunities for improving the effectiveness of the measures but also to identify maladaptation and unintended consequences as quickly as possible.The traditional public health methods for evaluating the efficacy and effectiveness of a particular intervention should be applied, with appropriate consideration of the local circumstances.Table 2.3 summarizes again the terms used in this assessment and provides some examples.These concepts should be included as part of the synthesis of the assessment of vulnerability and adaptation.

2. Vulnerability and adaptation to climate change: key concepts

Def in i t ion

Vu lne r ab i l i t y : t h e deg ree t o wh i ch ind iv idua ls and sys tems are suscept ib le to or unab le to cope wi th the adverse e f fec ts o f c l imate change

Adaptat ion basel ine: the adapta t ion measures and act ions in p lace in a reg ion or communi t y to reduce the burden of a par t icu lar heal th outcome

Cop ing capac i t y : t h e adap t a t i on st ra teg ies , po l ices and measures that cou ld be implemented now. Spec i f ic adapta t ion p lans ar ise f rom a reg ion or communi t y ’s cop ing capac i t y

Adapt ive capaci ty : the genera l ab i l i t y o f ins t i tu t ions , sys tems and ind iv idua ls to ad jus t t o po t en t i a l ha rm , t o t a ke advan t age o f oppor tun i t ies or to cope wi th the consequences of c l imate var iab i l i t y and change

Current

Popula t ions l i v ing in areas on the f r inge o f the current d is t r ibu t ion o f malar ia are a t r isk for ep idemics i f the range of the Anopheles vector changes

The exposure–response re la t ionsh ip is in f luenced by the current prevent ion measures a imed at reduc ing the burden of a d isease . For example , the number o f e lder ly people adverse ly a f fec ted by a heat-wave depends on the numbers who have access to and who use space coo l ing and rehydrat ion

Severa l c i t ies in midd le- la t i tude countr ies have the leve l o f mater ia l resources , e f fec t i ve ins t i tu t ions and qual i t y o f pub l ic hea l th in f ras t ruc ture to es tab l ish and main ta in ear ly warn ing sys tems for heat-waves . Unt i l implemented , these sys tems are wi th in a c i t y ’s cop ing capac i t y

Adapt ive capac i t y is the theoret ica l ab i l i t y o f a reg ion or communi t y to respond to the threats and oppor tun i t ies presented by c l imate change . I t is a f fec ted by a number o f fac tors (see Table 2 .1) . I t encompasses cop ing capac i t y and the s t ra teg ies , po l ic ies and measures that have the potent ia l to expand fu ture cop ing capac i t y

Future

Whether or not these popula t ions might be vu lnerab le in the fu ture depends , in par t , on the implementat ion of t imely and e f fec t i ve prevent ion act iv i t ies

Increas ing access to and use o f space coo l ing wi l l reduce the percentage of the e lder ly popula t ion who could be adverse ly a f fec ted by fu ture heat-waves . For example , the 1995 heat-wave in the midwestern Uni ted Sta tes had greater e f fec ts than a s imi lar heat- wave i n 1999 , i n pa r t because o f p rog rammes estab l ished in the in ter im

Over t ime , s t ra teg ies , po l ic ies and measures can move f rom being poss ib le to be ing implemented ( that i s , be ing par t o f t he adap ta t i on base l i ne) . Fo r example , un iversa l access to adequate quant i t ies o f c lean water is not ye t poss ib le , a l though s ign i f icant progress has been made

Over t ime , i t is hoped that reg ions and communi t ies wi l l increase the i r adapt ive capac i t y : that they wi l l increase the i r res i l ience to what the fu ture c l imate wi l l br ing

TABLE 2.3. EXAMPLES OF CURRENT AND FUTURE VULNERABILITY AND ADAPTATION

PART 1. CONTEXT

Assessments need to be informative and timely. Experiences from many developing and industrialized countries that have carried out assessments (WHO, 2001a) have shown that including various stakeholders in the assessment planning, implementation and evaluation from the beginning is very important.

Assessment requires an adequate management structure, to carefully plan the process, implement the assessment and to evaluate both the process and the outcome. Before, during and after the assessment, an adequate communication strategy needs to be planned, hand in hand with risk communication.

Assessments can have different levels of in-depth analysis. This often depends on the objectives, the interest of stakeholders and the funding available.

This chapter briefly describes the involvement of stakeholders, the management structure, the communication, the level of assessment, peer review and risk management.

Involvement of stakeholders

The stakeholders in a health assessment are people within governments, nongovernmental organizations, research institutions and private entities that focus on public health. If the ultimate goal of vulnerability assessment is to provide useful information to these stakeholders, then they must be engaged throughout the assessment process.

For an assessment to be informative, the assessors must know the issues and questions of greatest concern to the stakeholders. This does not imply that relevant issues – otherwise not identified or known as important to stakeholders – would be left out of the assessment.A comprehensive assessment could identify “surprises”not expected by stakeholders. Stakeholders should be engaged from the outset of the assessment process, including ongoing involvement in the analytical phase. Assessors and stakeholders are not necessarily distinct communities. In many cases, the stakeholder community can offer data, analytical capabilities, insights and understanding of relevant problems that can contribute to the assessment. Openness and inclusiveness enable different participants to bring a diversity of views and information that may benefit the assessment process. Involving all interested parties makes the assessment process more transparent and credible.

For an assessment to be timely, the assessors must understand how relevant stakeholders will use the information generated and understand the time frame within which the information is needed. Even with stakeholder involvement, researchers are often reluctant to make any statements policy-makers might use because scientific uncertainty still exists. Nevertheless, policy-makers make decisions under uncertainty, whether or not scientists are prepared to inform those decisions.Assessors strive to answer decision-makers’ questions to the extent possible given uncertain science based on the assumption that informed decisions are better than uninformed decisions. They also characterize the uncertainty and explore what it implies for various policy or resource management decisions in the belief that improving the understanding of the quality and implications of scientific information leads to more informed decisions.

Finally, re-evaluating the level of stakeholder concern and identifying any new issues of concern to stakeholders as they are informed of assessment results are especially important. Once an assessment is completed and the stakeholders informed of the results, assessors should elicit from the stakeholders any new interests and concerns the assessment raises. Engaging stakeholders in the process and especially keeping stakeholders engaged throughout the assessment is not easy. The management structure should include the need to design strategies to achieve this.

3. The framework for the assessment

Management structure

Before health impact assessment is begun, a management structure has to be established to supervise each stage of the assessment. Identifying one leading institution is useful to ensure that the assessment is supervised until completion. In countries, the national health ministry has primary responsibility for assessing and promoting the health of the population. It would therefore be advisable to identify a health institution to take the lead. However, other departments and organizations may have various responsibilities for protecting human health and may need to participate in the management structure as well (such as those within environment, transport and industry).The national health ministry should have the necessary expertise and capacity to manage an assessment of potential risks to public health resulting from climate change and to integrate climate change considerations into public health policy. The national health ministry or joint health ministries at the regional level, in conjunction with other environmental, social and security authorities, need to identify branches of responsibility within their organizations that will facilitate the development of the assessment.The health ministry has two primary tasks: to establish a management structure within the ministry with various responsibilities and to facilitate the development of the assessment.

As the project leader, the health ministry needs to identify branches of responsibility within its organization to undertake each of the tasks outlined below and to work together in an integrated fashion. Generally the tasks fall into three categories: developing partnership, generating knowledge and developing policy. Different offices within the organization should carry out these tasks through collaborative work.This forms the basis of the administrative operation.

Many of the aspects of the assessment process, such as synthesizing results, developing policy and engaging stakeholders, will have implications after the assessment is completed. Research gaps and information needs identified during the assessment will feed into the future development, selection and implementation of policy options and into further monitoring and surveillance work that typically constitute the risk management phase of an assessment.This publication focuses on the assessment of vulnerability and adaptation, although a strong management structure will plan ahead and identify the necessary resources and expertise required to make the transition to risk management activities.

Partnership development

The health ministry needs to work with international funding agencies, government and nongovernmental organizations and representatives of other sectors within and outside the country to secure access to the resources, expertise and training materials needed to conduct the assessment.The assessment process requires extensive and diverse human, financial and technical resources. For most industrialized countries, these resources are readily accessible or at least available within the country itself. For developing countries, these resources may need to be obtained from external sources (see Chapter 1 on national adaptation programmes of action and adaptation funds).

Relationships should be established and fostered with international organizations, such as WHO, the World Bank, UNEP, UNDP, the Food and Agriculture Organization of the United Nations (FAO) and international nongovernmental organizations.

The health ministry will also facilitate the identification and organization of key partners within the country or region being assessed to participate in various fora, including an overarching steering group, various working groups and peer review committees.Other important considerations are what and how information will be documented.The leading organization should keep records and make them available upon request, which requires resources. Proper documentation enhances transparency and accountability, aids in decision-making processes and provides a reference for future assessments.

The leading institution should set up a coordination and steering team. Core coordination can help to manage the process and to assist and advise the health, welfare and other relevant authorities.

3. The framework for the assessment

PART 1. CONTEXT

The process design includes:

• the timing and scale of the assessment;

• the language: for example, indigenous or other minority languages might be needed;

• the information requirements;

• the peer review process;

• the terms of reference of the assessment; and

• the procedures for internal and external communication mechanisms, meetings and decision-making processes (if applicable).

Generating and exchanging knowledge

A primary task of the health ministry is to facilitate the successful building of a foundation of interdisciplinary evidence and action to identify and manage the potential risks to human health from climate change. Government and nongovernmental organizations, public health organizations, scientific researchers and policy-makers collaboratively identify possible human health impact from climate change and adaptation strategies, policies and measures to minimize potential adverse consequences. These feed into future monitoring and surveillance work to create an iterative cycle of assessment and policy development (see below). The health ministry facilitates the organization of the assessment, so that the assessment conclusions and recommendations are useful for scientific studies, for giving priority to and implementing adaptation measures and for the needs of policy research.

The results of the assessment of vulnerability and adaptation need to be synthesized and communicated to decision-makers and policy-makers.The objectives include identifying changes in risk patterns and opportunities, identifying links between sectors, vulnerable groups and stakeholder responses and identifying adaptation measures and policies. Ideally, the individuals or groups conducting the assessment coordinate and collaborate throughout the assessment, so that the results can be easily integrated into a single product, such as a report.

Policy development and recommendations

The health ministry, together with experts and stakeholders, collectively develops the country’s assessment of health vulnerability and adaptation. Based on this process, the health ministry collaboratively develops integrated health and well-being strategies, policies and measures for climate change at the national, regional and community levels that effectively manage the risks to health identified in the assessment. This collaborative process encourages all other partners in promoting health and well-being to develop and incorporate integrated collaborative adaptation policies and measures for climate change into their policies. Although this is fundamentally a risk management activity,policy implications should be considered throughout the assessment process.Risk managers and policy-makers should therefore be identified as relevant stakeholders and involved throughout the assessment.

Steps 1 to 7 described in Chapter 2 lead to the identification of current and future vulnerability to climate variability and change and to the identification of desirable adaptation options. For risk management and policy development, risks need to be ranked, policy options identified and a strategy selected and implemented. Assessment should proactively analyse the costs and benefits of the policy measures recommended for adaptation to climate change.The assessment should not only inform policy-makers but also enable them

to make evidence-based decisions (Table 3.1). Decision-making is a social and political process that the assessment aims to inform.Assessment should help:

• to make the problem and the potential impact explicit and clear;

• to identify strategies,policies and measures that could reduce the potential adverse effects for a range of time frames;

• to establish programmes to evaluate specific strategies, policies and measures;

• to identify research gaps; and

• to assist decision-makers in choosing between competing alternatives.

Setting the research agenda

Assessments are iterative in nature.Key research gaps that are identified should guide the priority-setting of research to fill these gaps, and new research findings can advance future assessment.When different sectors are part of assessing vulnerability and adaptation, exchange of findings should be encour

3. The framework for the assessment

TABLE 3.1. ASSESSMENT OF HEALTH VULNERABILITY AND ADAPTATION: PLANNED KEY MANAGEMENT DELIVERABLES

Pol icy development

Fac i l i ta te the organiza t ion o f in terd isc ip l inar y fora of po l icy-makers and dec is ion-makers to ident i f y po l icy quest ions and research needs

Fac i l i ta te the deve lopment o f comprehens ive , in terd isc ip l inar y assessment o f hea l th vu lnerab i l i t y and adapta t ion a t the nat iona l leve l

Organize in terd isc ip l inar y fora to set up a s t ruc tured dia logue to br ing research resu l ts forward to in form pol icy on heal th and wel l -be ing

Deve lop in tegrated heal th and wel l -be ing po l ic ies for c l imate change that e f fec t i ve ly manage the r isks to heal th

Fac i l i ta te the deve lopment o f moni tor ing and eva luat ion mechanisms to respond to changing c l imate condi t ions , evo lv ing heal th impact concerns and oppor tun i t ies for adapta t ion

Par tnership development

Secure externa l fund ing , techn ica l ass is tance and data sources to in i t ia te and conduct in terd isc ip l inar y assessment o f hea l th vu lnerab i l i t y and adapta t ion

Fac i l i ta te the organiza t ion o f key nat iona l and in ternat iona l s takeholders for an overarch ing s teer ing group and in terd isc ip l inar y fora o f researchers , po l icy analys ts and dec is ion-makers for work ing groups

Prov ide t ra in ing resources and ser v ices for work ing group assessors and researchers

Fac i l i ta te e lec t ron ic access to the knowledge generated , sur ve i l lance and moni tor ing data , in format ion sources and oppor tun i t ies for d ia logue

Fac i l i ta te the organiza t ion o f a mul t id isc ip l inar y network o f researchers to conduct peer rev iew of assessment f ind ings

Knowledge generation and exchange

Assess the u t i l i t y and e f f ic iency o f var ious methods and too ls to conduct the assessment and ident i f y capac i t y l imi ta t ions , resource needs and in format ion gaps

Fac i l i ta te the organiza t ion o f in terd isc ip l inar y fora o f researchers , po l icy ana lys ts and dec is ion-makers to ident i f y research needs for generat ing knowledge and for promot ing formal and in formal d ia logue

Develop e f fec t i ve ways o f communicat ing research resu l ts to fac i l i ta te dec is ion-making

Assess and synthes ize research f ind ings

Deve lop mechanisms for s tor ing and re t r iev ing in format ion

PART 1. CONTEXT

aged across disciplines. Several health issues relate to impact in a variety of other sectors, such as coastal zones, water and agriculture.

Assessment teams

Because the issues involved are complex, insight is required from multiple and diverse disciplines. Assessment teams must therefore comprise researchers from a variety of disciplines working together to integrate their results, such as public health, climatology, economics, social sciences, environmental science and ecology. Each discipline alone is complex, and extra incentives should therefore be in place to encourage assessors to reach across established boundaries.

Assessment also entails considering how human behaviour might contribute to or ameliorate the risks. The extent to which climate change may harm h

Key facts

Organisation World Health Organization (WHO)

Document type Publications

Adoption date January 1, 2003

Source World Health Organization