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Climate and health country profile - 2015: Cambodia

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CLIMATE AND HEALTH COUNTRY PROFILE – 2015 CAMBODIA

OVERVIEW Cambodia, located in Southeast Asia, has a tropical climate characterised by an annual monsoon cycle and two distinct seasons, a rainy season from May to early October and a dry season from November to April [Cambodia’s Initial National Communication to the UNFCCC, 2002]. Cambodia is highly vulnerable to the impacts of climate change and in recent years has experienced an increase in severe floods, droughts and windstorms that impact socioeconomic development and human health [Cambodia’s INDC, 2015]. Agriculture, infrastructure, forestry, coastal areas and health have been identified as the key sectors that are threatened by climate change [Cambodia’s INDC, 2015]. For example, flash floods, in October 2013, affected over half a million people with damage and loss estimated at 356 million US dollars.a Cambodia has developed and implemented the Climate Change Strategic Plan 2014–2023 [CCCSP]. Currently, Cambodia has three guiding documents on climate and health; the National Climate Change Strategic Plan for Public Health [2012], the Climate Change Action Plan for Public Health [2014-2018] and the National Strategic Plan for Disaster Risk Management for Public Health [2015-2019]. Under the lead of the Ministry of Health, these documents are currently being reviewed and integrated into two documents, the National Strategic Plan on Climate Change Adaptation and Disaster Risk Reduction for Health, and the National Action Plan on Climate Change Adaptation and Disaster Risk Reduction.

between 2070 and 2100. If global emissions decrease rapidly and there is a major scale up in protection the annual affected population could be limited to under 100 people [page 3]. • In Cambodia, under both high and low emissions scenarios, the risk of malaria and dengue fever are estimated to increase towards 2070 [page 3]. • In Cambodia, under a high emissions scenario heat-related deaths in the elderly (65+ years) are projected to increase to about 56 deaths per 100,000 by 2080 compared to the estimated baseline of about 4 deaths per 100,000 annually between 1961 and 1990. A rapid reduction in global emissions could limit heat-related deaths in the elderly to about 11 deaths per 100,000 in 2080 [page 4].

OPPORTUNITIES FOR ACTION: Cambodia has conducted a vulnerability assessment under the National Climate Change Strategic Plan which included health indicators. Additionally, a specific climate change and health vulnerability and adaptation assessment was carried out by the Ministry of Health with WHO in 2010/2011. Country reported data [see section 6] indicate there are further opportunities for action in the following areas:

1) Adaptation • Develop an integrated disease surveillance and response (IDSR) system which includes climate information. • Implement activities to increase the climate resilience of health infrastructure. • Estimate the costs to implement health resilience to climate change and include these costs in planned allocations.

SUMMARY OF FINDINGS • In Cambodia, under a high emissions scenario, mean annual temperature is projected to rise by about 4.2°C on average from 1990 to 2100. If global emissions decrease rapidly, the temperature rise is limited to about 1.2°C [page 2]. • In Cambodia, under a high emissions scenario, and without large investments in adaptation, an annual average of 30,700 people are projected to be affected by flooding due to sea level rise

2) Mitigation • Develop a national strategy for climate change mitigation that includes consideration of the health implications (health risks or co-benefits) of climate change mitigation actions. • Conduct a valuation of the health co-benefits of climate mitigation policies.

DEMOGRAPHIC ESTIMATES Population (2013)b Population growth rate (2013)b Population living in urban areas (2013)c Population under five (2013)b Population 65 years or over (2013)b 15.08 million 1.6% 20.3% 11.7% 3.9% 1025 USD 7.5% 8.5 0.584  73 years 32.9 e f g h Global Health Expenditure Database, WHO (2014) United Nations Development Programme, Human Development Reports (2014) Global Health Observatory, WHO [2014] Levels & Trends in Child Mortality Report 2015, UN Inter-agency Group for Child Mortality Estimation [2015]

ECONOMIC AND DEVELOPMENT INDICATORS GDP per capita (current US$, 2013)d Total expenditure on health as % of GDP (2013)e Percentage share of income for lowest 20% of population (2010)d HDI (2013, +/- 0.01 change from 2005 is indicated with arrow)f

HEALTH ESTIMATES Life expectancy at birth (2013)g Under-5 mortality per 1000 live births (2013)h a Cambodia 2013: Post-Flood Early Recovery Need Assessment Report, RGC, as cited in Cambodia’s Intended Nationally Determined Contribution, 2015. b World Population Prospects: The 2015 Revision, UNDESA (2015) c World Urbanization Prospects: The 2014 Revision, UNDESA (2014) d World Development Indicators, World Bank (2015)

1

CURRENT AND FUTURE CLIMATE HAZARDS

Due to climate change, many climate hazards and extreme weather events, such as heat waves, heavy rainfall and droughts, could become more frequent and more intense in many parts of the world. Outlined here are country–specific projections up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions. Most hazards caused by climate change will persist for many centuries.

COUNTRY-SPECIFIC CLIMATE HAZARD PROJECTIONS The model projections below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 [RCP8.5] (in orange) and a low emissions scenario, [RCP2.6] (in green).a The text boxes describe the projected changes averaged across about 20 models (thick line). The figures also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and, where available, the annual and smoothed observed record (in blue).b,c

MEAN ANNUAL TEMPERATURE 34 32

DAYS OF WARM SPELL (‘HEAT WAVES’)

300

°C

34 30 32 28

Days

200 300 100

°C

30 26 28 26 1900 1950 2000 2050 2100

Days Year

200 0 100 1900 1950 2000 2050 2100

Under a high emissions scenario, mean annual temperature is projected to rise by about 4.2°C on average from 1990 to 2100. 1900 1950 2000 2050 2100 If global emissions decrease rapidly, the temperature rise is limited to about 1.2°C. Year 80

0 Under a high emissions scenario, the number of days of warm spelld is projected to increase from about 10 days in 1990 to 1900 1950 2000 2050 2100 about 240 days on average in 2100. If global emissions decrease rapidly, the days of warm spell are limited to about 75 on average. 120

Year

Year

DAYS WITH EXTREME RAINFALL (‘FLOOD RISK’) 60

CONSECUTIVE DRY DAYS (‘DROUGHT’)

100

Days

80 40 60 20

Days

120 60 100 40 80 20 60 0 40 20 0 1900 1950 2000 2050 2100

80

Days

40 0 20 0 1900 1950 1900 1950 2000 2050 2100

Days Year 2000 2050 2100

Year 1900 1950 2000 2050 2100

Year Under a high emissions scenario, the number of days with very heavy precipitation (20 mm or more) could increase by about 10 days on average from 1990 to 2100, increasing the risk of floods. Some models indicate increases outside the range of historical variability, implying even greater risk. If global emissions decrease rapidly, the risk is much reduced. a b c d

Year Under a high emissions scenario, the longest dry spell is indicated to increase by about 5 days on average, from about 55 days on average in 1990, with continuing large year-to-year variability. If global emissions decrease rapidly, the increase is limited to less than 1.5 days on average.

Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed. Observed historical record of mean temperature is from CRU-TSv.3.22; observed historical records of extremes are from HadEX2. Analysis by the Climatic Research Unit and Tyndall Centre for Climate Change Research, University of East Anglia, 2015. A ‘warm spell’ day is a day when maximum temperature, together with that of at least the 6 consecutive previous days, exceeds the 90th percentile threshold for that time of the year. 2

2

CURRENT AND FUTURE HEALTH RISKS DUE TO CLIMATE CHANGE

Human health is profoundly affected by weather and climate. Climate change threatens to exacerbate today’s health problems – deaths from extreme weather events, cardiovascular and respiratory diseases, infectious diseases and malnutrition – whilst undermining water and food supplies, infrastructure, health systems and social protection systems.

AVERAGE ANNUAL EXPOSURE TO FLOODING DUE TO SEA LEVEL RISE, CAMBODIA (2070–2100) Severity of climate change scenario RCP2.6 Without Adaptation 9,800 30,700 With Adaptation < 100 100

KEY IMPLICATIONS FOR HEALTH Cambodia also faces inland river flood risk. It is projected, that by 2030, an additional 69,800 people may be at risk of river floods annually as a result of climate change and 41,200 due to socio economic change above the estimated 89,700 annually affected population in 2010.a In addition to deaths from drowning, flooding causes extensive indirect health effects, including impacts on food production, water provision, ecosystem disruption, infectious disease outbreak and vector distribution. Longer term effects of flooding may include post-traumatic stress and population displacement.

* Medium ice melting scenario

RCP8.5

** Values rounded to nearest ‘00

Under a high emissions scenario, and without large investments in adaptation, an annual average of 30,700 people are projected to be affected by flooding due to sea level rise between 2070 and 2100. If emissions decrease rapidly and there is a major scale up in protection (i.e. continued construction/raising of dikes) the annual affected population could be limited to under 100 people. Adaptation alone will not offer sufficient protection, as sea level rise is a long-term process, with high emissions scenarios bringing increasing impacts well beyond the end of the century. Source: Human dynamics of climate change, technical report, Met Office, HM Government, UK, 2014.

INFECTIOUS AND VECTOR-BORNE DISEASES Population at risk of malaria in Cambodia (in millions) 25 Population at risk (millions) 20 15 10 5 0 RCP8.5 RCP2.6

KEY IMPLICATIONS FOR HEALTH Some of the worlds most virulent infections are also highly sensitive to climate: temperature, precipitation and humidity have a strong influence on the life-cycles of the vectors and the infectious agents they carry and influence the transmission of water and foodborne diseases.b Socioeconomic development and health interventions are driving down burdens of several infectious diseases, and these projections assume that this will continue. However, climate conditions are projected to become significantly more favourable for transmission, slowing progress in reducing burdens, and increasing the populations at risk if control measures are not maintained or strengthened.c

Baseline 1961–1990

2021–2050

2041–2070

By 2070, under both a high and low emissions scenario about 22 million people are projected to be at risk of malaria. Population growth can also cause increases in the population at-risk in areas where malaria presence is static in the future. Source: Rocklöv, J., Quam, M. et al. 2015.d

Mean relative vectorial capacity for dengue fever transmission in Cambodia 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0 Mean relative vectorial capacity

The mean relative vectorial capacity for dengue fever transmission is projected to increase from about 0.82 to about 0.91 towards 2070 under both a high and low emissions scenario. Source: Rocklöv, J., Quam, M. et al., 2015.d

Baseline 1961–1990

RCP26 RCP85 2021–2050

RCP26 RCP85 2041–2070

a World Resources Institute, http://www.wri.org. Aqueduct Global Flood Analyzer. Assumes continued current socioeconomic trends (SSP2) and a 25-year flood protection. b Atlas of Health and Climate, World Health Organization and World Meteorological Organization, 2012. c Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. d Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. The mean of health impact estimates for three global climate models are presented. Models assume continued socioeconomic trends (SSP2 or comparable). 3

HEAT-RELATED MORTALITY Heat-related mortality in population 65 years or over, Cambodia (deaths / 100,000 population 65+ yrs) 60 Deaths/100,000 population 65+ years 50 40 30 20 10 0 Baseline 1961–1990 RCP2.6 RCP8.5 RCP2.6 RCP8.5 RCP2.6 RCP8.5 2030 2050 2080

KEY IMPLICATIONS FOR HEALTH Climate change is expected to increase mean annual temperature and the intensity and frequency of heat waves resulting in a greater number of people at risk of heat-related medical conditions. The elderly, children, the chronically ill, the socially isolated and at-risk occupational groups are particularly vulnerable to heat-related conditions.

Under a high emissions scenario heat-related deaths in the elderly (65+ years) are projected to increase to about 56 deaths per 100,000 by 2080 compared to the estimated baseline of about 4 death per 100,000 annually between 1961 and 1990. A rapid reduction in emissions could limit heat-related deaths in the elderly to about 11 deaths per 100,000 in 2080. Source: Honda et al., 2015.a

UNDERNUTRITION Climate change, through higher temperatures, land and water scarcity, flooding, drought and displacement, negatively impacts agricultural production and causes breakdown in food systems. These disproportionally affect those most vulnerable people at risk to hunger and can lead to food insecurity. Vulnerable groups risk further deterioration into food and nutrition crises if exposed to extreme climate events.b Without considerable efforts made to improve climate resilience, it has been estimated that the global risk of hunger and malnutrition could increase by up to 20 percent by 2050.b In Cambodia, the prevalence of stunting in children under age 5 was 32.4% in 2014, the prevalence of underweight children and wasting in children under 5 was 23.9% and 9.6%, respectively, in 2014.c

a Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. The mean of impact estimates for three global climate models are presented. Models assume continued socioeconomic trends (SSP2 or comparable). b World Food Project 2015 https://www.wfp.org/content/two-minutes-climate-change-and-hunger c World Health Organization, Global Database on Child Growth and Malnutrition [2015 edition]. Please see source for definitions of child malutrition measures. Note that the estimates for underweight children are pending re-analysis. 4

3

CURRENT EXPOSURES AND HEALTH RISKS DUE TO AIR POLLUTION

Many of the drivers of climate change, such as inefficient and polluting forms of energy and transport systems, also contribute to air pollution. Air pollution is now one of the largest global health risks, causing approximately seven million deaths every year. There is an important opportunity to promote policies that both protect the climate at a global level, and also have large and immediate health benefits at a local level.

OUTDOOR AIR POLLUTION EXPOSURE

KEY IMPLICATIONS FOR HEALTH Outdoor air pollution can have direct and sometimes severe consequences for health. Fine particles which penetrate deep into the respiratory tract subsequently increase mortality from respiratory infections, lung cancer and cardiovascular disease.* Short-lived climate pollutants (SLCPs) such as black carbon, methane and tropospheric ozone result from inefficient use and burning of biomass and fossil fuels for transport, housing, power production, industry, waste disposal (municipal and agricultural) and forest fires. SLCPs are responsible for a substantial fraction of global warming as well as air-pollution related deaths and diseases. Since short lived climate pollutants persist in the atmosphere for weeks or months while CO2 emissions persist for years, significant reductions of SLCP emissions could reap immediate health benefits and health cost savings,a and generate very rapid climate benefits – helping to reduce near-term climate change by as much as 0.5oC before 2050.a In Cambodia, it is projected that a reduction in SLCPs** could prevent about 4,700 premature deaths per year from outdoor air pollution (PM2.5 and ozone), from 2030 onwards (Source: Shindell, D., Science, 2012).

* Ambient air pollution data for annual mean concentration of particulate matter of less than 2.5 microns (PM2.5) was not available for Cambodia (WHO ambient air pollution database, 2016) ** Through implementation of 14 reduction measures: 7 targeting methane emissions and the rest, emissions from incomplete combustion. See source for further detail.

HOUSEHOLD AIR POLLUTION Cambodia Percentage of population primarily using solid fuels for cooking (%), 2013

>95 Source: Global Health Observatory, data repository, World Health Organization, 2013.

RURAL AREAS

50

URBAN AREAS

NATIONAL TOTAL

88

Percent of total deaths from ischaemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease (18 years +) and acute lower respiratory infections (under 5 years) attributable to household air pollution, 2012.

KEY IMPLICATIONS FOR HEALTH Air pollution in and around the home is largely a result of the burning of solid fuels (biomass or coal) for cooking. Women and children are at a greater risk for disease from household air pollution. Consequently, household air pollution is responsible for a larger proportion of the of total number of deaths from ischaemic heart disease, stroke, lung cancer and COPD in women compared to men.b In Cambodia, approximately 61% percent of an estimated 2,400 child deaths due to acute lower respiratory infections is attributable to household air pollution (WHO, 2012).

Total Deaths: 20,400 [44%) Attributable to household air pollution

Source: Global Health Observatory, data repository, World Health Organization, 2012. a United Nations Environment Programme. Reducing Climate-related Air Pollution and Improving Health: Countries can act now and reap immediate benefits. http://www.unep. org/ccac/Media/PressReleases/ReducingClimate-relatedAirPollution/tabid/131802/language/en-US/Default.aspx b Annu. Rev. Public. Health. 2014.35:185-206. http://www.who.int/phe/health_topics/outdoorair/databases/HAP_BoD_results_March2014.pdf?ua=1 5

4

CO-BENEFITS TO HEALTH FROM CLIMATE CHANGE MITIGATION: A GLOBAL PERSPECTIVE

Health co-benefits are local, national and international measures with the potential to simultaneously yield large, immediate public health benefits and reduce the upward trajectory of greenhouse gas emissions. Lower carbon strategies can also be cost-effective investments for individuals and societies. Presented here are examples, from a global perspective, of opportunities for health co-benefits that could be realised by action in important greenhouse gas emitting sectors.a

Transport Transport injuries lead to 1.2 million deaths every year, and land use and transport planning contribute to the 2–3 million deaths from physical inactivity. The transport sector is also responsible for some 14% (7.0 GtCO2e) of global carbon emissions. The IPCC has noted significant opportunities to reduce energy demand in the sector, potentially resulting in a 15%–40% reduction in CO2 emissions, and bringing substantial opportunities for health: A modal shift towards walking and cycling could see reductions in illnesses related to physical inactivity and reduced outdoor air pollution and noise exposure; increased use of public transport is likely to result in reduced GHG emissions; compact urban planning fosters walkable residential neighborhoods, improves accessibility to jobs, schools and services and can encourage physical activity and improve health equity by making urban services more accessible to the elderly and poor.

Electricity Generation Reliable electricity generation is essential for economic growth, with 1.4 billion people living without access to electricity. However, current patterns of electricity generation in many parts of the world, particularly the reliance on coal combustion in highly polluting power plants contributes heavily to poor local air quality, causing cancer, cardiovascular and respiratory disease. Outdoor air pollution is responsible for 3.7 million premature deaths annually, 88% of these deaths occur in low and middle income countries. The health benefits of transitioning from fuels such as coal to lower carbon sources, including ultimately to renewable energy, are clear: Reduced rates of cardiovascular and respiratory disease such as stroke, lung cancer, coronary artery disease, and COPD; cost-savings for health systems; improved economic productivity from a healthier and more productive workforce.

Household Heating, Cooking and Lighting Household air pollution causes over 4.3 million premature deaths annually, predominantly due to stroke, ischaemic heart disease, chronic respiratory disease, and childhood pneumonia. A range of interventions can both improve public health and reduce household emissions: a transition from the inefficient use of solid fuels like wood and charcoal, towards cleaner energy sources like liquefied petroleum gas (LPG), biogas, and electricity could save lives by reducing indoor levels of black carbon and other fine particulate matter; where intermediate steps are necessary, lower emission transition fuels and technologies should be prioritized to obtain respiratory and heart health benefits; women and children are disproportionately affected by household air pollution, meaning that actions to address household air pollution will yield important gains in health equity; replacing kerosene lamps with cleaner energy sources (e.g. electricity, solar) will reduce black carbon emissions and the risk of burns and poisoning.

Healthcare Systems Health care activities are an important source of greenhouse gas emissions. In the US and in EU countries, for example, health care activities account for between 3–8% of greenhouse gas (CO2-eq) emissions. Major sources include procurement and inefficient energy consumption. Modern, on-site, low-carbon energy solutions (e.g. solar, wind, or hybrid solutions) and the development of combined heat and power generation capacity in larger facilities offer significant potential to lower the health sector’s carbon footprint, particularly when coupled with building and equipment energy efficiency measures. Where electricity access is limited and heavily reliant upon diesel generators, or in the case of emergencies when local energy grids are damaged or not operational, such solutions can also improve the quality and reliability of energy services. In this way, low carbon energy for health care could not only mitigate climate change, it could enhance access to essential health services and ensure resilience.

a For a complete list of references used in the health co-benefits text please see the Climate and Health Country Profile Reference Document, http://www.who.int/globalchange/en/

6

5

EMISSIONS AND COMMITMENTS

Global carbon emissions increased by 80% from 1970 to 2010, and continue to rise.a,b Collective action is necessary, but the need and opportunity to reduce greenhouse gas emissions varies between countries. Information on the contribution of different sectors, such as energy, manufacturing, transport and agriculture, can help decision-makers to identify the largest opportunities to work across sectors to protect health, and address climate change.

Cambodia ANNUAL GREENHOUSE GAS EMISSIONS (metric tonnes CO2 equivalent) 14,000,000

Metric tonnes CO2 equivalent

1994

12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 Energy Industries Manufacturing and ­Construction Transport Agriculture

A 2ºC upper limit of temperature increase relative to pre-industrial levels has been internationally agreed in order to prevent severe and potentially catastrophic impacts from climate change. Reductions are necessary across countries and sectors. In order to stay below the 2ºC upper limit it is estimated that global annual CO2-energy emissions, currently at 5.2 tons per capita, need to be reduced to 1.6 tons per capita.c

Waste

Other

Total excl ­LULUCF/LUCF

Source: UNFCCC Greenhouse Gas Data Inventory, UNFCCC [2015].

The most recent greenhouse gas emissions data for Cambodia is from the year 1994. At that time, carbon emissions were highest in the agriculture sector. Through intersectoral collaboration, the health community can help to identify the best policy options not only to eventually stabilize greenhouse gas emissions, but also to provide the largest direct benefits to health.  

NATIONAL RESPONSE d

1995 2006 2011 2012 20142018

CAMBODIA RATIFIES THE UNFCCC NATIONAL ADAPTATION PROGRAMME OF ACTION TO CLIMATE CHANGE (NAPA) COASTAL ADAPTATION AND RESILIENCE PLANNING PROJECT NATIONAL CLIMATE CHANGE STRATEGIC PLAN FOR PUBLIC HEALTHE CLIMATE CHANGE ACTION PLAN FOR PUBLIC HEALTHE NATIONAL STRATEGIC PLAN ON CLIMATE CHANGE ADAPTATION AND DISASTER RISK REDUCTION FOR HEALTH NATIONAL ACTION PLAN ON CLIMATE CHANGE ADAPTATION AND DISASTER RISK REDUCTION FOR HEALTH

2016 2016

a Boden, T.A., G. Marland, and R.J. Andres (2010). Global, Regional, and National Fossil-Fuel CO2 Emissions. Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory, U.S. Department of Energy, Oak Ridge, Tenn., U.S.A. doi 10.3334/CDIAC/00001_V2010. b IPCC (2014) Blanco G., R. Gerlagh, S. Suh, J. Barrett, H.C. de Coninck, C.F. Diaz Morejon, R. Mathur, N. Nakicenovic, A. Ofosu Ahenkora, J. Pan, H. Pathak, J. Rice, R. Richels, S.J. Smith, D.I. Stern, F.L. Toth, and P. Zhou, 2014: Drivers, Trends and Mitigation. In: Climate Change 2014: Mitigation of Climate Change. Contribution of Working Group III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Edenhofer, O., R. Pichs-Madruga, Y. Sokona, E. Farahani, S. Kadner, K. Seyboth, A. Adler, I. Baum, S. Brunner, P. Eickemeier, B. Kriemann, J. Savolainen, S. Schlömer, C. von Stechow, T. Zwickel and J.C. Minx (eds.)]. Cambridge University Press, Cambridge, United Kingdom c Pathways to deep decarbonization, Sustainable development Solutions Network, 2014 report. d Columbia Law School, 'Climate Change Laws Of The World'. N.p., 2015. e Country reported data. 7

6

NATIONAL POLICY RESPONSE

The following table outlines the status of development or implementation of climate resilient measures, plans or strategies for health adaptation and mitigation of climate change (reported by countries).a

GOVERNANCE AND POLICY Country has identified a national focal point for climate change in the Ministry of Health Country has a national health adaptation strategy approved by relevant government body The National Communication submitted to UNFCCC includes health implications of climate change mitigation policies

HEALTH ADAPTATION IMPLEMENTATION Country is currently implementing projects or programmes on health adaptation to climate change Country has implemented actions to build institutional and technical capacities to work on climate change and health Country has conducted a national assessment of climate change impacts, vulnerability and adaptation for health Country has climate information included in Integrated Disease Surveillance and Response (IDSR) system, including development of early warning and response systems for climate-sensitive health risks Country has implemented activities to increase climate resilience of health infrastructure

FINANCING AND COSTING MECHANISMS Estimated costs to implement health resilience to climate change included in planned allocations from domestic funds in the last financial biennium Estimated costs to implement health resilience to climate change included in planned allocations from international funds in the last financial biennium

HEALTH BENEFITS FROM CLIMATE CHANGE MITIGATION The national strategy for climate change mitigation includes consideration of the health implications (health risks or co-benefits) of climate change mitigation actions Country has conducted valuation of co-benefits of health implications of climate mitigation policies

a Supporting monitoring efforts on health adaptation and mitigation of climate change: a systematic approach for tracking progress at the global level. WHO survey, 2015.

For further information please contact: World Health Organization 20 Avenue Appia 1211 Geneva 27 Switzerland Tel.: +41 22 791 3281 | Fax: +41 22 791 4853 http://www.who.int/globalchange/en/ © World Health Organization 2016 WHO/FWC/PHE/EPE/15.47

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. To ensure readability, health estimates and projections have been presented without the margins of uncertainty which are available upon request.

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