Report of the regional conference of parliamentarians on protecting human health from climate change, Thimphu, Bhutan, 5-7 October 2010

World Health House Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110002, India Website: www.searo.who.int Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change Thimphu, Bhutan, 5-7 October 2010 SEA-EH-571 The Regional Conference of Parliamentarians on Protecting Human Health from Climate Change was held in Thimphu, Bhutan from 5-7 October 2010. It was attended by parliamentarians from seven countries of the South-East Asia Region (Bangladesh, Bhutan, India, Indonesia, Nepal, Sri Lanka and Timor-Leste). Several WHO staff from country offices, the Regional Office and Headquarters also participated in the conference. The conference was organized to create awareness amongst politicians on the health impacts of climate change and garner their support in addressing the health concerns in Member States. The conference concluded with the endorsement of the “Parliamentarians' Call for Action for Protecting Human Health from Climate change in the South-East Asia Region.” This is a summary report of the meeting discussions and recommendations. SEA-EH-571 Distribution: General Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change Thimphu, Bhutan, 5-7 October 2010 Regional Office for South-East Asia © World Health Organization 2011 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from Publishing and Sales, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: publications@searo.who.int). 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. 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. 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. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India iii Contents Page 1. Introduction................................................................................................1 2. Inaugural session .......................................................................................1 3. Technical sessions ......................................................................................3 3.1 Health impacts of climate change ........................................................ 4 3.2 Climate change and disasters............................................................... 7 3.3 Health impact evaluation and current status in the Region................... 9 4. Presentations by countries and development partners .........................11 4.1 Presentation by MPs - Country experiences and best practices........... 11 4.2 Support from bilateral, multilateral and UN agencies in Bhutan to address health impacts of climate change. ......................................... 15 5. Field visit...................................................................................................17 6. Adoption of call for action.......................................................................17 7. Closing session ........................................................................................17 iv Annexes 1. Parliamentarians’ Call for Action on Protecting Human Health from Climate Change in the South-East Asia Region.............................19 2. Programme ...............................................................................................22 3. List of participants....................................................................................26 4. Welcome address by His Excellency Lyonpo Zangley Dukpa, Minister of Health, Royal Government of Bhutan .................................32 5. Keynote Address by the Hon’ble Prime Minister, Lyonchhoen Jigmi Y. Thinley...................................................................35 6. Address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia..............................................................................40 1 1. Introduction The Regional Conference of Parliamentarians on Protecting Human Health from Climate Change was held in Thimphu, Bhutan from 5 - 7 October 2010. It was attended by parliamentarians from seven countries of the South-East Asia Region including Bangladesh, Bhutan, India, Indonesia, Nepal, Sri Lanka and Timor-Leste. Several WHO staff from country offices, the Regional Office and Headquarters also participated in the conference (for complete list of participants please see Annex 3). The conference consisted of technical sessions, country presentations, panel discussions, and a field visit and concluded with a Call for Action. This report includes the Call for Action and highlights of the discussions held under each agenda item. It also includes the output of the panel discussions and the major conclusions and recommendations which were presented at the closing session. Objectives The objectives of the conference were: (1) To increase the level of information or awareness on the human health impacts of climate change; and (2) To identify opportunities as well as constraints and discuss the way forward for protecting human health from climate change. 2. Inaugural session The conference was inaugurated by H.E. Lyonchhoen Jigmi Y Thinley, Honourable Prime Minister of Bhutan. Several Ministers of the Royal Government of Bhutan, the Regional Director and Deputy Regional Director, WHO-SEARO, delegates and representatives of UN agencies in Bhutan attended the inaugural session. The session began with the Marchang ceremony, an invocation of the holy spirits seeking blessings for the success of this high level conference. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 2 H.E. Lyonpo Zangley Dukpa, Minister of Health, Royal Government of Bhutan, welcomed the parliamentarians and delegates from Member States. He thanked the Prime Minister for gracing the occasion and expressed his gratitude to the Regional Director, WHO-SEARO, parliamentarians and delegates for attending the meeting. He stated that although Bhutan has hosted several meetings on climate change, this is the first meeting on climate change and health. In recent years, Bhutan is increasingly experiencing glacial lake outburst floods and other natural disasters. Vector- borne diseases such as malaria, dengue and encephalitis are now reported from otherwise non-endemic areas and an increase in the incidence of water- and sanitation-related diseases. Bhutan is initiating a new project with the support of WHO, UNDP and the Global Environmental Facility to consolidate programmes related to climate sensitive diseases using a multi- sectoral approach. The Ministry of Health will continue to work together with the UN, bilateral and multilateral agencies to develop comprehensive action plans and strategies to address the health problems due to climate change. (Full text of the address in Annex 4). Dr. Samlee Plianbangchang, WHO Regional Director for South-East Asia, welcomed the participants and thanked the Royal Government of Bhutan for hosting this conference in Thimphu. He said that the reality of global warming due to human actions is now universally accepted. Climate change affects the basic elements of health security; clean air, water and food security. He also noted that if climate change is not addressed in a timely manner, it will jeopardize the Millennium Development Goals related to health. Climate change will affect all the countries of the Region; for example in Bhutan it will cause increased incidents of glacial lake outburst floods as well as climate-sensitive diseases such as vector-borne illnesses and diarrhoeal diseases. The health outcomes in Bhutan or elsewhere are not inevitable and can be modulated by timely action consisting of appropriate policies and actions of sectors dealing with energy, transport, social justice and equity, environment and health. The importance of placing research at the top of the agenda was emphasized. He emphasized strengthening of the health system, prioritizing national programmes on climate-sensitive diseases and the improvement of the adaptive capacity of vulnerable populations. WHO will facilitate knowledge-sharing and networking on climate change and human health within the health sector as well as between disciplines. In addition, the health sector should be aided in actively participating in national communications to the United Nations Framework Convention on Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 3 Climate Change and health issues should be the core elements in the negotiation process (Full text of the address in Annex 5). H.E. Lyonchhoen Jigmi Y. Thinley, Honourable Prime Minister of the Royal Government of Bhutan in his keynote address congratulated the Regional Director, and his team for their outstanding success in bringing so many parliamentarians from Member States to discuss the health impact of climate change. The participation of so many distinguished parliamentarians reflected the growing recognition of the threat that climate change poses to humanity. Warming, that we least polluting nations experience today, is the result of stupendous amounts of carbon that our highly industrialized and consumerist generation is currently belching out in the atmosphere. Bhutan is experiencing increasing incidents of glacial lake outburst floods, shortages of drinking water and water for agriculture and increasing threats of diseases like diarrhoea and vector-borne diseases. Protection of the natural environment including conservation of forests is one the pillars of the principle of Gross National Happiness to which the Royal Government of Bhutan is deeply committed. Bhutan is committed to remain carbon neutral forever. There is a need to strengthen efforts to integrate climate change policies and action plans in the key sectors to improve public health and happiness. (Full text of the address in Annex 6). Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO-SEARO, while proposing the vote of thanks expressed her gratitude to the parliamentarians of the Region for sparing their valuable time and appreciated the Royal Government of Bhutan’s efforts in hosting the conference. 3. Technical sessions H.E. Lyonpo Zangley Dukpa, Minister of Health, Royal Government of Bhutan, was elected as chairperson and H.E. Dr Capt (Rtd) Mozibur Rahman Fakir, State Minister of Health and Family Welfare, Government of the People’s Republic of Bangladesh as co-chairperson. Ms Viplove Thakur, Member of Parliament, Republic of India was nominated as the rapporteur. A summary of the presentations in the technical sessions followed by discussions is given below: Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 4 3.1 Health impacts of climate change Dr. Poonam Khetrapal Singh - Protecting Human Health from Climate Change – An overview The Twenty-fifth Health Ministers’ Meeting in 2007, held in Thimphu, recognized climate change as a major threat to health security and requested WHO-SEARO to support formulation of a strategy to address impacts of climate change on human health. SEARO developed a regional framework for action through a regional workshop in Bali in 2007 and selected “Protecting Health from Climate Change” as the theme for World Health Day in 2008 thus putting health at the centre of global dialogue on climate change. The Fourth Assessment Report of IPCC has presented unequivocal evidence of global warming due to greenhouse gases of anthropogenic origin. Global warming will continue for the next 100 years even if we drastically cut our emissions today. Climate change through well recognized pathways will significantly increase the burden of diseases due to malnutrition, vector-borne and diarrhoeal diseases and mental health problems. The increasing incidents of extreme weather events will result in injuries and deaths. Populations in the Region living in coastal areas, mountainous and water- stressed regions and dwellers of small islands are at higher risk of health impact due to climate change. Poor people and those unprotected by health services will bear the heaviest brunt. Countries need to undertake vulnerability and adaptation-assessment studies. Recent research in the Region has demonstrated impact of climate change on diarrhoeal and vector-borne diseases and malnutrition. It is interesting to note that recent studies in India reported huge health benefits resulting from climate mitigation policies in the sectors of household energy, urban land transport and electricity generation. The actions needed in Member States are (1) increase awareness on health impact of climate change through research, political commitment, and strengthening of institutional capacity for adaptation and mitigation; (2) strengthen health system’s capacity by developing and implementing national action plans on adaptation, developing integrated health strategies to incorporate health-related risks into existing national programmes and strengthening of public health systems and (3) adequately address health concerns in policies of key sectors such as energy, transport, agriculture and education and put health at the core of national communications in United Nations Framework Convention on Climate Change (UNFCCC). WHO will provide technical support for Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 5 research, support capacity building, facilitate knowledge sharing between Member States, assist in resource mobilization from donors and facilitate regional coordination to voice health concerns at UNFCCC. Dr Diarmid Campbell Lendrum - Protecting Human Health from Climate Change – A Global perspective Heat waves in Europe in 2003 and hurricane Katrina in USA in 2005 clearly showed that no country can claim safety from impacts of extreme weather events. The main concern is a likely increase in existing burdens of highly climate-sensitive diseases like under-nutrition, malaria and diarrhoeal diseases which are major killers in developing countries. Four key messages from WHO are (1) Health should be more central in the climate debate (2) Health actions can save lives now and protect from future climate change. (3) Well planned climate mitigation can improve health and, (4) the health sector can lead by example. WHO is documenting and disseminating scientific evidence on proven cost-effective interventions against every climate-sensitive health impact and supports vulnerability and adaptation assessments at country level. Recently, WHO helped studies providing scientific evidence of substantial benefits of mitigation policies in several sectors. Dr. A P Dash - Impact of climate change on vector-borne diseases There is serious concern about the impact of climate change on vector- borne diseases like malaria and dengue which are major public health problems in the SEA Region. During the last decade Member States have reported an increasing incidence and seasonal epidemics of dengue fever. Malaria is endemic in all SEAR countries except Maldives. There is clear evidence that parasite development and vector dynamics will favour disease transmission with rising temperatures in certain areas. Mosquitoes die at temperatures above 40oC, however, there is evidence of the emergence of temperature-resistant species. Around 30 malaria transmitting species of Anopheline mosquitoes have been reported from Asia. With climate change there is likelihood of the spatial expansion of these mosquito species. For example, in Bhimtal district of Uttrakhand in India, a 3.5oC rise in minimum temperature during the months of March and April in 2005-2008 over the baseline temperatures of 1981-1983 during the same period has been Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 6 reported. This corresponds with the first reports of malaria cases in 2008 along with high density of malaria transmitting mosquitoes in the district. There is a need for wider adoption of remote sensing techniques for ecological monitoring and GIS mapping at village and district levels. Dr. G. B. Nair (presented in absentia by Dr. Diarmid Campbell Lendrum) Climate Change and Diarrhoeal Diseases with Emphasis on Cholera Cholera epidemics are influenced by climate and several other environmental drivers. Recent research showed that copepods serve as hosts of Vibrio cholerae. These copepods use algae and other chlorophyll containing aqueous plants as nutrients. Their abundance is influenced by sea surface temperatures. Wavelet analysis of 33 years’ retrospective data on cholera outbreaks from Matlab (Bangladesh) highlighted that the outbreaks of cholera throughout this period were preceded by a rise in ambient temperature and increase in rainfall (with 3 months lag). Kolkata and New Delhi data also showed a similar relationship, although with a different (1 month) time lag. Also, a statistically significant relationship was observed between the nine-year cholera cases time series and both chlorophyll concentration and rainfall anomalies. Thus, rainfall and atmospheric temperature data help in prediction of a cholera epidemic 1 – 3 months in advance. Discussion points Ø While attributing impact on health to climate change, other factors should also be taken into account. Amongst non-climate factors, the response by the health sector plays a very important role. Ø There is a need for studies in places such as mountainous areas with unreported cases of vector-borne diseases. These studies should supplement operational research with a focus in high prevalence areas. Ø Examples of best practices in malaria were cited such as in the state of Orissa, India, where, with WHO support, it has been possible to reduce malaria transmission by more than two-thirds. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 7 Ø Uneven distribution of climate-sensitive diseases is related to the vulnerability of populations which is not uniform across the Region. Ø There is an urgent need for priority setting. Ø Mental health problems need greater attention. Ø It is important to view the whole issue holistically, from water and sanitation to waste management. 3.2 Climate change and disasters Dr. Roderico Ofrin - Emergency and Humanitarian Action All extreme weather events are not disasters but climate change can turn them into disasters in two ways. Firstly by increasing its severity and secondly by increasing the vulnerability of communities through ecosystem degradation, reductions in water and food availability and livelihoods. Asia’s sustainable development will be challenged as climate change compounds the pressures that rapid urbanization, industrialization, and economic development have placed on natural resources. All SEAR countries are signatories to the Hyogo Framework for Action which calls for mainstreaming risk reduction measures across all sectors. Certain examples of risk reductions in Asian countries are worth noting. Because of an initiative to establish cyclone shelters using a community-based approach, Bangladesh could significantly reduce mortality due to Cyclone SIDR in 2007. Bangladesh and Viet Nam both have started planting mangroves to protect coastal populations from typhoons and storms. In Nepal, several engineering methods were applied in various areas of the country to prevent floods/flash floods. It must be emphasized that the end point of climate change impact will often be a humanitarian emergency caused by an extreme weather event. Investing in risk reduction and preparedness measures will save lives and protect health. Mr Namgay Wangchuk - National Disaster Management Framework In recent years Bhutan experienced a series of disasters including earthquakes, GLOFs, floods/flash floods, landslides, forest fires, and windstorm, snowstorms and hailstorms. The Disaster Management (DM) Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 8 division created in 2005 was upgraded to a department in August 2008. It functions as the national coordinating agency for all DM-related activities carried out by all sectors, agencies and stakeholders. Its activities include - formulation of guidelines, codes and standards, setting up of emergency operation centres and disaster communications network; capacity building for preparedness, response and recovery and collaboration with relevant international, regional and national agencies. The national disaster risk management framework 2006 is based on the principles laid down in the Hyogo Framework for Action, 2005. Future priorities include enactment of the national DM bill by parliament, setting of standards for relief and compensation, standard operating procedures and updating and implementation of national disaster management and contingency plans. Dr. Ugen Dophu - Essence of Health Emergency Preparedness Plan in Bhutan The guiding principle of the emergency preparedness plan in Bhutan is “One country, one disaster management framework”. The health sector emergency preparedness plan was developed within the overall National Disaster Management Act. The course of action consisted of a consultative process, multi-sector collaboration and participation, integration into the existing health care delivery system i.e. the PHC approach and consideration of sustainable and immediate public health needs in the aftermath of any emergency and periodic review. The essential components of the plan are developing health sector district hazard maps; a district disaster contingency plan; establishing an emergency control room, transport and ambulance services, manpower planning, planning for skill development; and health sector administrative and financial management. Challenges consist of rugged terrain and scattered populations, shortage of health manpower, lack of technical expertise and competing priorities. Discussion points Ø Well planned efforts in disaster management are necessary as a pro-active measure since the evidence on climate change and disasters clearly indicates that extreme events will increase in severity and frequency. Ø Climate change should be viewed as a slow or insidious disaster. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 9 Ø Integration of the disaster risk reduction programme with the adaptation programme of protecting health from climate change is essential. Ø Disaster management needs a multifaceted approach. The tsunami was tragic but helped the Region to learn how to cope with such crises. Ø Mental health aspects of disaster management need to be prioritized. 3.3 Health impact evaluation and current status in the region Dr. Saiyed Habibullah - Ongoing Research and challenges in South-East Asia Groundbreaking research has been carried out in the Region in the field of cholera and climate change which has already been narrated. Research related to the health co-benefits of mitigation policy in the household energy sector by using improved stoves, low carbon electricity generation and urban transport showed significant health co-benefits. The study on improved stoves indicated that by 2020, the cumulative effect of the proposed Indian stove programme would be to lower the national burden of the diseases equivalent to elimination of nearly half the country’s entire annual cancer burden in addition to mitigating climate change. The co-benefits of offsetting the costs of climate change mitigation should be taken into account in international negotiations including COP16. Challenges for research in SEAR countries include - inadequate capacity resulting from lack of expertise and infrastructure and competing priorities for fund allocation, non-availability of baseline data and methodological issues inherent in climate change research. The Ministry of Health and WHO need to take steps to facilitate research on climate change and health. Dr. Kunal Bagchi - Impact of climate change on nutrition, food safety and food security in South-East Asia Climate change affects food availability, stabilization, access and utilization. Over time climate change will affect populations through fluctuations in seasons leading to a decline in agriculture production, thus resulting in a fall in household income and deterioration in livelihood at the household level. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 10 Food for prevention of hunger, education and services and safe drinking water are critical factors that affect availability, access and absorption of food. Climate change can affect each of these factors with disasters and migration compounding the situation. Climate change in the South-East Asia Region is projected to have an adverse impact on agriculture. Productivity of most crops would decrease between 10% – 40% by 2020. The Indian Council of Agricultural Research has estimated that in India, increased droughts and floods will lead to increased production variability, a negative impact on food trade, a loss of 1.5 million tons of milk by 2020 and increased water, shelter and energy requirements for livestock. Increasing sea and river water temperatures will affect pisciculture and the nutritional quality of food. Food safety issues include an increase of neurotoxins in adulterants for pulses, heavy metal contamination, mycotoxin production and milk adulteration as well as pesticide contamination. Traditional food safety practices like leaving cooked food at room temperature may not hold good with climate change. Interventions should include policies promoting research, an appropriate nutrition surveillance system, improved access to safe drinking water and sanitation, promoting appropriate food technology, monitoring and surveillance of contaminants and residues in water, soil, agriculture and veterinary products and establishing an effective food-borne diseases outbreak control mechanism. Dr. Nitish Dogra - Health vulnerability and adaptation assessment Compared to the different regions, the impact of climate change on human health is the worst in the South-East Asia Region in absolute terms. However, the impacts are expected to differ within the Region. Some populations are extremely vulnerable due to geographic, socio-economic and biological reasons such as highlanders, urban slum dwellers and children respectively. Political commitment is essential for vulnerability and adaptation assessments. Vulnerability and adaptation assessments are central to policy formulation with crucial linkages to research, inter-sectoral inputs, policy formulation and communication. National adaptation programmes of action for least developed countries including countries in the South-East Asia Region are supported by UNFCCC. In a review of these programmes it was found that only 11% represented health projects and the funding for the health sector in priority projects was just 3%. WHO has initiated systematic vulnerability and adaptation assessments in 30 countries with planned studies in Bangladesh, Bhutan, India and Indonesia. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 11 Discussion points Ø Climate change and food security is a major concern for the Region. Climate change gives the agriculture sector an opportunity to adapt to warmer temperatures by switching to crop patterns which are more conducive to warmer weather. Ø Addressing climate change and development should go hand-in- hand. Investing in green technologies has long-term cost-benefits including health. Ø Carbon-trading should be linked with health issues wherever appropriate. Ø Research is needed to know - · the exact contribution of climate change and non-climate factors in disease causation. · the quantification of relationship between the degree of climate change and a proportionate increase in climate - sensitive diseases. · vulnerability of the population and adaptive capacity of the health system. · health impact assessment of mitigation policies by other sectors. Ø Vegetarianism as a mitigation strategy should be considered in the light of high prevalence of under-nutrition in the Region. 4. Presentations by countries and development partners 4.1 Presentation by MPs - Country experiences and best practices Bhutan The impacts of climate change are part and parcel of life in Bhutan as brought out by GLOFs and landslides. Bhutanese society is closely knit and rapidly responds in times of need. Water scarcity is increasingly affecting Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 12 agriculture and drinking water quality thus contributing to adverse nutritional health and diarrhoeal diseases. Malnutrition is increasing. Bhutan has very powerful legislation to protect the natural environment. There is increasing concern over malaria cases in the country, especially since these were not seen earlier. Continuous efforts are being made to translate legislation into action. The environment is a central pillar of the nation’s development policy. There is a constitutional provision of a minimum of 60% forest cover. In fact the forest cover has increased over the years. Bhutan is actually carbon negative at present and acting as a net carbon sink. In COP15 the country pledged that it will remain carbon neutral for all times to come. The country is ready to sacrifice industrial development for the sake of the environment. It also has strong policies on health and education and has been an overachiever in these two fields. The challenges lie in sustaining what has been achieved. India India’s concern with climate change is mainly because it wants to keep the human race alive on this planet — therefore, the focus should be on “human health”. Poverty and inadequate education are two major obstacles. Poverty leading to unsafe shelters, poor nutrition, higher frequency of diseases and inadequate healthcare also leads to increased susceptibility to health impact due to climate change. Rapid economic growth to combat poverty is putting extra stress on the environment. Dependency on Himalayan snow and glaciers for water resources and its long coastal line make India one of the most vulnerable countries to climate change. The Prime Minister of India released a national action plan on climate change in 2008. It consists of eight mission projects namely: national solar mission; national mission for enhanced energy efficiency; national mission on sustainable habitat; national water mission; national mission for sustaining the Himalayan ecosystem; national mission for a “Green India”, national mission for sustainable agriculture; and national mission on strategic knowledge for climate change. The ministries with lead responsibility for each of the missions are directed to develop objectives, implementation strategies, timelines, and monitoring and evaluation criteria, to be submitted to the Prime Minister’s Council on Climate Change. The Council is responsible for periodically reviewing and reporting on each mission’s progress. The National Rural Health Mission 2005 provides effective health care to rural populations across the country. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 13 Indonesia Meteorological data from 1950 to 2000 show 0.6 o – 0.7o C increase in the average annual temperatures of Indonesia. A further increase of 2o C is projected during the next 100 years. A rising trend in sea surface level by 0.57 cm per year and a rising trend in annual rainfall was also reported from 1950 to 2000. The main concerns regarding climate change-related health impacts are dengue fever, malaria, diarrhoeal diseases and mental health problems. A significant increase in the incidence of dengue fever has been reported from 1968 to 2007 with peak incidence reported between January and March. Malaria is endemic in most of the districts. An increasing incidence of diarrhoea amongst children has been reported since 2000. The health sector roadmap on climate change consists of four phases (1) preparation phase (2010 – 2014), (2) implementation phase (2015 – 2019), (3) implementation stability phase I (2020 – 2024) and (4) implementation stability phase II (2025 – 2029). Under a National Act, the government has constituted the National Council for Climate Change consisting of 17 members from ministries and national bodies, including the Ministry of Health. The health sector strategy on climate change consists of (1) socialization and advocacy at all levels of government and the private sector, (2) mapping on vulnerability, (3) promoting an early warning system for climate-sensitive diseases, (4) preparation of relevant legislation. (5) improving health system outreach to vulnerable populations, (6) organizing training programmes on climate change adaptation in health for communities at all levels (7) organizing prevention and controlling diseases caused by climate change, (8) strengthening partnership and (9) enhancing community development. Survey on disaster-related mental health problems A mental health survey was carried out in one of the worst-affected tsunami areas of Aceh and Nias to determine the magnitude of psychological problems among the survivors, to identify factors that influence their resiliency and to provide recommendations for psychosocial programmes for the tsunami survivors. At the end of the study it was concluded that - mental health problems among internally displaced persons (IDP) existed significantly both in adults and children, women had more mental health problems and IDPs in all areas of Aceh and Nias had mental health problems similar to those who lived in camps or barracks. It was Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 14 recommended that psychological interventions should be available in every disaster-affected area. Programmes should take into consideration the good IDPs resiliency factors, addressing children’s mental health problems through mental health community programmes and clinical research to explore the clinical and cultural factors that could contribute to the recovery process. Nepal Nepal is categorized as a least developed country. Its rich biodiversity contributes to nutrition, health care and livelihood. Exploitation of natural resources associated with a growing population has led to several environmental problems which are now compounded by climate change. A parliamentary group on Environment, Climate change and Disaster risk reduction (PACED) was formed in February 2009. A team of 14 constitutional assembly members affiliated with PACED participated in a climate change impact study visit to Mustang from 21 - 23, September 2009. The team concluded that climate change has already affected people in remote parts of the country where communities are finding it hard to manage changing weather patterns, growing incidence of extreme weather events such as frequent droughts and floods, crop diseases, livestock diseases and conflicts over water sharing. A Disaster Risk Reduction (DRR) Toolkit, a concise information kit on disaster risk reduction for Nepal was released in Kathmandu in February, 2010 with a view to inform and sensitize the constituent assembly members on disasters, risks and the need for strengthening the policy framework to address disaster risks. About 12 MPs have used their parliamentary development fund on projects like improved cooking stoves, water harvesting, bio-briquette, tree plantation and training villagers on climate change and its risks and possible adaptation. Sri Lanka Dengue, diarrhoea and leptospirosis cases are increasing along with rodent- borne leptospirosis possibly due to climate change. The nutrition situation has not improved much due to extended periods of droughts and floods. An increase in respiratory diseases and road-traffic accidents has also been noted. Of particular concern is an increase in kidney diseases associated with heavy metal contamination of water. The link between climate change/sea-level rise is being explored. Thermal stress has increasingly been seen especially in garment workers. One of the positive consequences of the tsunamis is a good epidemiological surveillance system which is proving Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 15 useful in outbreak management. A multi-sector assessment for climate change and health is urgently needed. Discussion points Ø Countries in the Region are acutely aware of the health impacts of climate change. Ø The focus is on multi-sector collaboration involving all concerned stakeholders. Ø Disaster management and health system strengthening are identified as important priorities by all countries. 4.2 Support from bilateral, multilateral and UN agencies in Bhutan to address health impacts of climate change. Ms. Vathinee Jitjaturunt - UNICEF Support in Bhutan – Climate Change and Children It is estimated that about 175 million children could be affected annually by climate-related disasters over the next 10 years with the largest number in South-East Asia. International efforts to achieve the MDGs by 2015 could be at risk, particularly those targeted at reducing poverty, child mortality and morbidity and ensuring universal primary education. UNICEF in Bhutan supports projects on climate change and nutrition, water and sanitation, national disaster and response. UNICEF also promotes the Ministry of Education’s initiative in promoting Gross National Happiness values in all schools. UNICEF believes that children have the right to participate in decisions affecting them (UN Convention on the Rights of the Child, Article 12). Mr. Karma Lodey Rapten - UNDP’s Climate Change Strategy UNDP works on the principle that climate change is not only an environmental issue but also a development issue. Reducing poverty and mitigating the effects of climate change go hand-in-hand. UNDP activities in Bhutan include – country-level capacity building to address climate change by providing a set of integrated support services; complement policy change and capacity development efforts at the national level by facilitating action at Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 16 the provincial, municipal and community levels. The support addresses both mitigation and adaptation towards achieving the MDGs. UNDP diversifies the funding sources that countries can access and enables them to effectively combine and sequence different financing sources. It promotes public- private partnerships at all administrative levels and helps mainstream climate change into all core development areas including energy, agriculture, health, water resources and infrastructure. Mr. Prakash Lamichhane – Biogas Technology and Biogas Support Programme (BSP) in Nepal In Nepal, biogas is produced from cattle dung in household biogas plants and used mainly for cooking. It provides a smoke-free kitchen atmosphere and its byproduct - bio-slurry and bio-compost have been shown to significantly improve agriculture yield. Another important benefit is elimination of respiratory health hazards resulting from biomass fuels. Currently, nearly 504 000 households use biogas plants of which BSP has constructed about 224 000. Biogas plants reduce greenhouse gas emission and come under the purview of clean development mechanisms (CDM) projects of the Kyoto protocol. Under CDM it is expected to generate revenue worth several hundred thousand Euros. Discussion points Ø Several good technologies can be adapted to mitigate the health impacts of climate change. Ø Development partners are now mainstreaming climate change into their plans. Ø Poverty alleviation and health are inextricably linked and climate change strikes at the core of these goals. Ø The Millenium Development Goals (MDGs) could be compromised due to climate change. It is imperative to go beyond the MDGs and not be satisfied with attaining them. Ø The biogas programme needs to be encouraged. Possible exploration of its use for managing sewerage in cities also needs to be explored. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 17 5. Field visit On the second day, the delegates of the Conference visited Lholing village in Paro district to see ecologically friendly toilets using urine-diversion dehydration (UDD) technology. The faeces are collected in a chamber below the toilet pedestal (or squatting pan) and are dried with the help of natural evaporation and ventilation and require no water for flushing. UDD toilets can be successfully used in all climatic conditions. They are most beneficial in arid climates where water is scarce and faeces can be effectively dried. The ventilation also reduces odours due to air currents, which flow towards the vent pipe out of the chamber. Both faeces and urine could be used as fertilizer. The piloting of these toilets was supported by WHO through the Ministry of Health, Royal Government of Bhutan. The delegates were first apprised of the technology and then divided into two groups. They visited toilet sites and interviewed households to know the user perspective. Some of the delegates used the toilets to check the user- friendliness of such a technology. The delegates were appreciative of the project and found the technology very useful and appropriate especially in places where there is water scarcity as well as in places which are flooded. Most of the delegates expressed interest to try out such technologies in their constituencies. During interaction with the communities, some of the users could recall a drastic decrease in intestinal worms and diarrhoea in the village. 6. Adoption of call for action The draft for the call for action was presented by Ms. Payden. It was debated at great length and unanimously adopted after incorporating modifications suggested by the parliamentarians. The parliamentarians expressed their commitment to the call for action (see Annex 1). 7. Closing session The closing function was graced by the Speaker of Bhutan’s Parliament, the Minister of Health, Royal Government of Bhutan, parliamentarians from the Member States, representatives of UN and international agencies and high- Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 18 level dignitaries of the Royal Government of Bhutan. The Speaker appreciated the commitment and enthusiasm by the members of the parliament in participating in the conference during all the sessions. Dr. Abdul Sattar Yoosuf, Assistant Regional Director, WHO, South-East Asia Region emphasized the need for a follow-up of the recommendations and to keep the channels of communication open. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 19 Annex 1 Parliamentarians’ Call for Action on Protecting Human Health from Climate Change in the South-East Asia Region We, the Parliamentarians of Member States of the WHO South-East Asia Region, participating in the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change, appreciate the efforts being made by countries and development partners in the South-East Asia Region to address the challenges posed by global warming and climate change. We are concerned that the health risks from climate change are real and increasing, and knowledge and understanding of the impacts of climate change on human health have not reached many segments of society, including those most affected. We are also concerned that extreme weather events, increasing in frequency and intensity in the Region, can overwhelm the already overstretched health sector's capacity to respond, and also jeopardize the achievement of the Millennium Development Goals, and in particular the health-related goals. Furthermore, we take cognizance of the findings of the World Health Report 2002 that the WHO South-East Asia Region has experienced high morbidity and mortality resulting from climate change. RECOGNIZING that recent research has shown increasing rates of global greenhouse gas emissions, temperature rise, and sea level rise, indicating that climate change has proceeded faster than anticipated; AWARE that the most vulnerable populations in the SEA Region are the poor and those living on islands, in mountainous regions, in water-stressed areas, in urban slums and in plain, tribal and coastal areas; MINDFUL that climate change will have an adverse impact on food production, livelihoods and economic productivity; RECOGNIZING that climate change will amplify the existing major public health risks in the Region, necessitating urgent accelerated actions to strengthen health systems and especially the capacity of programmes aimed at reducing climate-sensitive diseases; Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 20 UNDERSTANDING that developed countries are mainly responsible for greenhouse gas emissions that will affect the developing countries, which are least responsible for emissions and therefore developed countries should provide technological and financial support for mitigation and adaptation measures to developing countries; AWARE that the measures to reduce output of greenhouse gases will also result in public health co-benefits, and thereby indirectly reduce the cost of mitigation; NOTING the need for improving the capacity of the health sector in the Region for research and strengthening of the health workforce to adequately address the challenges from climate change; ACKNOWLEDGING the strategic role of primary health care to support local communities in becoming more resilient to climate change; REITERATING commitment to World Health Assembly resolution WHA 61.19, on climate change, and to the regional framework for action to protect human health; RECALLING the New Delhi Declaration on the impact of climate change on human health by the health ministers of the South-East Asia Region; CONCERNED that there is an urgent need for more emphasis on health- related issues at the United Nations Framework Convention on Climate Change (UNFCCC) negotiations; Call up on all Member States: Ø To increase awareness of the health consequences of climate change; Ø To strengthen health and education systems capacity and infrastructure to provide protection from climate-related risks and accelerate ongoing programmes aimed at reducing climate - sensitive diseases; Ø To ensure that adequate resources and appropriate technologies are available to protect health from climate change, especially for vulnerable groups such as women, children, disabled, elderly people and indigenous populations; Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 21 Ø To develop and support policies that will substantially reduce greenhouse gases; Ø To ensure that health concerns are addressed in decisions related to climate change taken in other sectors; Ø To promote applied research and pilot projects to assess the scale and nature of the vulnerability of health to climate change with special consideration for indigenous populations; Ø To advocate for consideration of health protection as one of the criteria for judging successful mitigation at the UNFCCC- Conference of Parties; Ø To enact necessary legislation and strengthen the existing legal mechanism to effectively achieve the aforementioned objectives; and Ø To periodically share legislative experiences and concerns related to climate change among all parliamentarians of the South-East Asia Region. We, the Parliamentarians from Member States of the South-East Asia Region, pledge our full support towards the realization of our Call for Action in the interest of regional solidarity on legislative and policy actions to promote health in the WHO South-East Asia Region. Thimphu, Bhutan, 7 October 2010 Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 22 Annex 2 Programme Tue, 5 October 2010: Inaugural Session (0900-1100 hrs) (Royal Government of Bhutan) 0830-0900 hrs Arrival of guests/participants registration 0900 hrs Arrival of the Chief Guest – H.E. Lyonchhoen Jigmi Y. Thinley, Honourable Prime Minister Royal Government of Bhutan 0905 hrs MARCHANG CEREMONY 0915 hrs Welcome address – H.E. Lyonpo Zangley Dukpa Minister, Ministry of Health Royal Government of Bhutan 0930 hrs Address – Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Region 0950 hrs Keynote address – H.E. Lyonchhoen Jigmi Y. Thinley Honourable Prime Minister Royal Government of Bhutan 1000 hrs Vote of thanks – Dr Poonam Khetrapal Singh Deputy Regional Director WHO/SEARO Introductory Session (1045-1100 hrs) (Dr Samlee Plianbangchang Regional Director, WHO South-East Asia, in Chair) Introduction of the distinguished participants 1045-1100 hrs Nomination of Chairperson, Co-chair and Rapporteur SESSION-1: Health Impacts of Climate Change 1100 hrs Welcome remarks - Chairperson 1110 hrs Protecting Human Health from Climate Change – An overview Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO/SEARO Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 23 1120 hrs Protecting Human Health from Climate Change – A Global perspective Dr Diarmid Campbell-Lendrum, WHO/HQ 1135 hrs Impact of Climate Change on Vector-borne Diseases – Dr A.P. Dash, Regional Adviser Vector-Borne and Neglected Tropical Diseases Control WHO/SEARO 1150 hrs Climate change and diarrheal diseases – Dr G. Balakrish Nair, Director National Institute of Cholera and Enteric Diseases, Kolkatta, India (Presented by Dr Diarmid Campbell-Lendrum, WHO/HQ) 1200 hrs Discussions (Session-1) SESSION-2: Climate change and disasters 1400 hrs Climate change and disaster risk reduction – Dr Roderico Ofrin, Regional Adviser Emergency and Humanitarian Action WHO/SEARO 1410 hrs National Disaster Management framework - Mr Namgay Wangchuk, Director Department of Disaster Management Ministry of Home and Cultural Affairs Royal Government of Bhutan 1420 hrs Health Sector Emergency preparedness and contingency plan – Dr Ugen Dophu, Director Department of Public Health Ministry of Health Royal Government of Bhutan 1430-1500 hrs Discussions (Session-2) SESSION-3: Country experiences and best practices – Presentations by Parliamentarians) 1530-1700 hrs Bhutan India Indonesia Nepal Sril Lanka 1700-1730 hrs Discussion Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 24 Wed, 6 October 2010: Field Visit – to get first hand information on adaptation measures at the community level 0915 hrs Delegates to assemble in hotel lobby. Leave for field visit 1015 hrs - Arrive at Shaba Community School -Paro Dzongkhag Administration and community of Shaba Gewog to receive the delegation 1030 hrs Welcome speech by Dr. Dupthop, DMO, Paro 1045 hrs Briefing on EcoSan Project by Mr. Ugyen Rinzin, Chief Executive Engineer, Public Health Engineering Division, Department of Public Health, Ministry of Health 1100 hrs Serving of Refreshments 1130 hrs - Visit EcoSan Project Site - Interaction with the communities 1230 hrs Leave for Sasam Chorten 1400 hrs Leave for National Museum, Paro 1430 hrs Visit Museum 1630 hrs -Leave for Thimphu Thu, 7 October 2010 0900-0915 hrs Insights from the field visit – One of the parliamentarians SESSION-4: Health Impact Evaluation and Current Status in the Region 0915 hrs Impact of climate change on nutrition, food safety and food security in South-East Asia - Dr Kunal Bagchi, Regional Adviser Nutrition and Food Safety WHO/SEARO 0925 hrs Ongoing research and challenges in South-East Asia – Dr Habibullah Saiyed,Temporary International Professional Environmental Health and Climate Change WHO/SEARO 0935 hrs Health vulnerability and adaptation assessment – Dr Nitish Dogra, Consultant Environmental Health and Climate Change WHO/SEARO Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 25 0945-1030 hrs Discussions (Session-3) SESSION-5: Way forward 1100 - 1200 hrs Panel discussion – Support from bilateral, multilateral and UN agencies in Bhutan to address health impacts of climate change – Moderator: Dr Roderico Ofrin, Regional Adviser Emergency and Humanitarian Action WHO/SEARO 1200 – 1300 hrs Round table session – Challenges and way forward for the Region – Moderator: Dr Abdul Sattar Yoosuf Assistant Regional Director WHO/SEARO SESSION-6: Adoption of the South-East Asia Regional Parliamentarians’ Call for Action on protecting human health from climate change 1500 – 1530 hrs Presentation, discussion and endorsement of Call for Action Ms Payden Ag. Regional Adviser, Environment Health and Climate Change, WHO/SEARO 1530 hrs - Arrival of guests - Serving of refreshments to the invitees and the meeting delegates Closing Session 1600 hrs Welcome Address by – Dasho Nima Tshering Secretary, National Assembly of Bhutan 1610 hrs Presentation of the recommendations and Call for Action of the Regional Conference by Rapporteur 1630 hrs Closing remarks – Chairperson, Parliamentarians’ Conference 1630 hrs Address by – Hon’ble Chief Guest 1645 hrs Vote of thanks – One of the Parliamentarians (Delegates) Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 26 Annex 3 List of participants Delegations from Member States H.E. Dr Capt (Rtd) Mozibur Rahman Fakir State Minister Ministry of Health and Family Welfare Government of the People’s Republic of Bangladesh Mir Showkat Ali Badsha Member Parliament Government of the People’s Republic of Bangladesh Mr A.K.M. Fazlul Haque Member Parliament Government of the People’s Republic of Bangladesh Mr Md. Abdul Kader Khan Member Parliament Government of the People’s Republic of Bangladesh Bangladesh Mr Ghyas Uddin Ahmed Member Parliament Government of the People’s Republic of Bangladesh H.E. Lyonpo Zanglay Dukpa Health Minister and Member of Parliament Royal Government of Bhutan H.E. Lyonpo Minjur Dorji Home Minister and Member of Parliament Royal Government of Bhutan Mr Karma Rangdol Member Parliament Royal Government of Bhutan Dasho (Dr) Gado Tshering Secretary Ministry of Health Royal Government of Bhutan Bhutan Mr Nidup Zangpo Member Parliament Royal Government of Bhutan Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 27 Ms Karma Lhamo Member Parliament Royal Government of Bhutan Mr Rinchen Dorji Member Parliament Royal Government of Bhutan Mr Sangay Khandu Member National Council of Bhutan Ms Sangay Zam Secretary, Ministry of Education, Royal Government of Bhutan Mr. Sonam Dagay Environment Officer National Environment Commission, Royal Government of Bhutan Mr Nima Tshering Secretary, National Assembly, Royal Government of Bhutan Mr. Tshewang Norbu General Secretary National Council of Bhutan, Royal Government of Bhutan Mr. Ugyen Tenzin Member of Parliament, Royal Government of Bhutan Rinzin Rinzin Member of Parliament, Royal Government of Bhutan Dr. M.K. Rai National Council of Bhutan, Royal Government of Bhutan Mr. Sherab Gyeltshen, Secretary Ministry of Agriculture, Royal Government of Bhutan Mr. Namgay Wangchuk Director Disaster Management, Royal Government of Bhutan Mr. Chencho Norbhu Director Ministry of Agriculture, Royal Government of Bhutan Ms Viplove Thakur Member Parliament, Republic of India India Mr Manmohan Sharma Member Parliament, Republic of India Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 28 Ms Mabel Rebello Member Parliament Republic of India Mr Shantaram Laxman Naik Member Parliament Republic of India Mr Surinder Singla Member Parliament Republic of India Dr Surya Chandra Surapaty, MPS, Ph.D Member Parliament Republic of Indonesia Drs Gandung Pardiman, MM Member Parliament Republic of Indonesia Dr Ledia Hanifa Amallah, S. Si, M.Psi.T Member Parliament Republic of Indonesia Indonesia Dr Hj. Nova Riyanti Yusuf, Spkj Member Parliament Republic of Indonesia Mrs Sarita Giri Member Parliament, Federal Democratic Republic of Nepal Ms Pari Thapa Member Parliament, Federal Democratic Republic of Nepal Mr Sunil Babu Panta Member Parliament, Federal Democratic Republic of Nepal Nepal Mr Sant Kumar Tuladhar Under Secretary Parliament Secretariat, Federal Democratic Republic of Nepal Dr (Mrs) S. Fernandopulle Member Parliament, Democratic Socialist Republic of Sri Lanka Dr Ramesh Pathirana Member Parliament, Democratic Socialist Republic of Sri Lanka Sri Lanka Dr Rohana Puspakumara Member Parliament, Democratic Socialist Republic of Sri Lanka Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 29 Ms Tereza Maria de Carvalho Member Parliament, Democratic Republic of Timor-Leste Timor-Leste Ms Ilda Maria da Conceicao Member Parliament, Democratic Republic of Timor-Leste UN Agencies/ Bilaterals Ms Claire Van der Vaeren Resident Coordintro United Nations Development Programme (UNDP) Dremton Lam Thimphu, Bhutan Mr. Karma Rapten Assistant Representative Environment Unit , United Nations Development Programme UNDP Ms Vathinee Jitjaturunt Dy. Representative United Nations Children’s Fund (UNICEF) Ms Dechen Chime National Programme Officer United Nations Populations Fund (UNFPA) WHO Country Office Focal points DPR Korea Mr Norbu Wangchuk Programme and Administrative Officer Office of the WHO Representative to DPR Korea Indonesia Mr Sharad Prasad Adhikary Scientist Environmental Health Office of the WHO Representative to Indonesia Nepal Dr Nihal Singh Medical Officer Office of the WHO Representative to Nepal Kathmandu Sri Lanka Dr Harishchandra Yakandawala Temporary National Professional Emergency and Humanitarian Action Office of the WHO Representative to Sri Lanka Colombo Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 30 Resource Persons Dr Ugen Dophu, Director Department of Public Health Ministry of Health Royal Government of Bhutan Mr Namgay Wangchuk Director Department of Disaster Management Ministry of Home and Cultural Affairs Royal Government of Bhutan Mr Prakash Lamichane Senior Officer (Research & Development) Biogas Sector Partnership Lalitpur, Nepal Dr Pairoj Boonsirikamchai Assistant Secretary-General Emergency Medical Institute of Thailand, Bangkok WHO Secretariat Dr Samlee Plianbangchang Regional Director Dr Poonam Khetrapal Singh Deputy Regional Director Dr Abdul Sattar Yoosuf Assistant Regional Director Dr Roderico Ofrin Regional Adviser Emergency and Humanitarian Action Dr A.P. Dash Regional Adviser Vector-Borne and Neglected Tropical Diseases Control Dr Kunal Bagchi Regional Adviser Nutrition and Food Safety Ms Payden Ag Regional Adviser Environmental Health & Climate Change Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 31 Ms Vismita Gupta-Smith Public Information and Advocacy Officer Dr Habibullah Saiyed Temporary International Professional Environmental Health & Climate Change Dr Nitish Dogra Consultant Environmental Health & Climate Change Dr Rui Paulo de Jesus Technical Officer Country Cooperation Strategy & Governing Bodies Dr Diarmid Campbell-Lendrum WHO/HQs Mr U.S. Baweja Unit Administrative Secretary Country Cooperation Strategy & Governing Bodies Members-WHO Country Office Staff-Bhutan Dr Amaya Maw -Naing Ag WHO Representative to Bhutan & WHO Country Office Staff Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 32 Annex 4 Welcome address by His Excellency Lyonpo Zangley Dukpa, Minister of Health, Royal Government of Bhutan Your Excellency Lyonchhoen Jigme Y Thinley, the Hon’ble Prime Minister of Bhutan, Dr. Samlee Plianbangchang, the Regional Director, WHO South-East Asia Region, Hon’ble Ministers, Excellencies,Representatives of UN and bilateral agencies, Distinguished delegates from Bangladesh, Bhutan, India, Indonesia, Nepal, Sri Lanka and Timor-Leste Ladies and gentlemen. On behalf of the Ministry of Health and my own behalf, I would like to offer my sincere welcome and gratitude to the Hon’ble Chief Guest, the Prime Minister of Bhutan, for gracing the inaugural session of the Regional Parliamentarians Conference on Protecting Human Health from Climate Change. Your Excellency’s presence has given special encouragement to delegates and participants to this timely and important meeting. As always, it is my pleasure and privilege to welcome Your Excellency Dr Samlee Plianbangchang, the Regional Director, WHO-SEAR for being able to attend this conference despite several important engagements. Your Excellency’s presence is testimony to the importance of such a forum. In equal measures, may I welcome Your Excellencies, the Hon’ble Ministers and all the distinguished delegates to the Regional Conference. Indeed, we are highly honoured to have you with us to deliberate on the topical subject of climate change. Bhutan has hosted many meetings on climate change and environment. This is, however, the first conference to address the impacts of climate change on human health. We recognize that such a conference is timely and relevant. I would like to thank the WHO/SEARO and the organizers for choosing Bhutan to host the conference. There is sufficient evidence to show that the climate is changing and that it will impact the health of populations both directly and indirectly. The Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 33 people in our region including Bhutan are particularly at risk, due to inadequate health infrastructures and also because we are already struggling with many public health problems. We must remember that climate change will amplify many health risks, making it difficult to achieve the Millennium Development Goals. Bhutan is experiencing an increased disease burden from several climate-sensitive diseases. Risk to human lives from Glacial Lake Outburst Flood (GLOF), flash floods, earthquakes and landslides pose significant concerns. Similarly, public health vulnerabilities have accentuated with climate change. There has been an expansion of vector borne diseases such as malaria, dengue and encephalitis to otherwise non-endemic areas and increase in seasonal diseases related to water and sanitation. Climate change has also adversely impacted the available water resources due to drying up of water sources. In the past few decades, scientists and governments had been focusing more on the impact on the environment, thereby neglecting the impact on health. It is time to give a human face to climate change and high time to take actions now rather than wait for a disaster to happen and then react. Since the New Delhi Declaration on “the Impacts of Climate Change on Human Health” in 2008 of the Health Ministers in the Region, the Ministry of Health, the Royal Government of Bhutan, has taken steps to protect human health from climate change. We are now initiating a new project, with the support of WHO, UNDP, and the Global Environmental Facility. This is a project for consolidating several programs in the Ministry such as Vector Borne Disease Program, Rural Water Supply and Sanitation, Nutrition Program, Control of Diarrhoeal Disease Programme etc to address health impacts with a holistic approach. The project will help us to develop early warnings, strengthen health system capacity, and implement community level interventions, to protect populations from threats such as floods, and outbreaks of infectious diseases. This conference will give further impetus for strengthening the preparedness and response to impacts of climate change. In Bhutan we are also very conscious of the need to have a multi- sectoral approach to dealing with the health issues. The health sector cannot address health problems all by itself. It needs cooperation and support from various other ministries and agencies. Good news in Bhutan is that we work Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 34 together. This is made possible because, all the Cabinet ministers belong to the same Party and also because of the size; small is still beautiful. We will continue to work together with the UN, bilateral and multilateral agencies to develop a comprehensive action plans and strategies to address the health impacts of Climate Change. We cannot implement all these plans and strategies without the blessing and support of all political leaders and parliamentarians. This is the reason why we gather here. It is important for politicians like us to understand the potential health impacts of climate change, and also the health benefits of following a sustainable development path. We must commit ourselves to support the various adaptation and mitigation plans for protecting health from climate change. Against this backdrop, it is my profound privilege to welcome honourable parliamentarians from several countries of the South-East Asia region to this historic conference. A little more effort on the part of every politician or legislator will make an immense impact on the implementation of the policies and programmes related to the protection of human health from climate. Obviously, this will make a big difference in the lives of our people in the region. I do not wish to take more time. Once again, may I wish your Excellencies and other distinguished delegates to have memorable stay in the land of gross national happiness. The Autumn Season has set in. Weather is fine, although the impact of climate change is visible as it is not as cold as it used be in the past. We hope, you will have a great opportunity to enjoy our pristine, natural environment and places of cultural interest, which will make you feel good and, therefore feel happy and healthy. Please bear with us if there are any shortcomings in the arrangement of your stay. Please feel free to share with us to serve you better. Thank you and Tashi Delek! Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 35 Annex 5 Keynote Address by the Hon’ble Prime Minister, Lyonchhoen Jigmi Y. Thinley Excellencies, Hon’ble Parliamentarians, Distinguished Guests, Ladies and Gentlemen, It is a great honour and pleasure for me to address this opening session of the “Regional Conference of Parliamentarians on Protecting Human Health from Climate Change”. On behalf of the Royal Government and the people of Bhutan, as well as on my own behalf, I extend a warm welcome to you to the Kingdom of Bhutan. I would like to commend my friend, Dr. Samlee Plianbanchang the Regional Director, WHO, South-East Asia and his team for their outstanding success in bringing so many parliamentarians of the member countries here to discuss the health impacts of climate change. I have no doubt that this conference will contribute meaningfully to enhancing their understanding of the diversity and nature of risks posed by climate change, and thereby facilitate the adoption of appropriate mitigation and adaptation policies and measures by their respective governments. The participation of so many distinguished parliamentarians is a reflection of the growing recognition of the threat that climate change poses to humanity. After too many years of denial and inaction, the world it seems is finally beginning to acknowledge that climate change is real, and that urgent actions need to be taken to deal with it before it is too late. This is not to say that we should be oblivious to the powerful voices that still insist on climate change being a bogey created by some evil geniuses to undermine industrial growth, market forces and western domination. Although some progress is being made to put climate change on the global agenda, much still remains to be done to undo the damages that have already been caused. Little or nothing in fact is being done by way of serious national policies and programmes to mitigate the effects of climate change. Resources committed or pledged by the OECD countries are largely of the Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 36 illusory kind and as such, remain mostly inaccessible. In the meanwhile, threats are growing just as their adverse potential impacts are looming larger on human and all other forms of life. According to the 4th Assessment Report of the Inter-governmental Panel on Climate Change (IPCC) of 2007, even if greenhouse gas emissions are stabilized now, the warming of the earth would continue for centuries. In other words, the global warming that we are experiencing is the result of the far lesser green house gases emitted into the atmosphere by the far less polluting and industrialized society of the past. It therefore, does not take much to imagine the devastating consequences of the stupendous amounts of carbon that our highly industrialized and consumerist generation is currently belching out into the atmosphere. Despite the obvious link between climate change and health, this is a subject that has, until now, been hardly discussed in the various climate change fora at the national, regional and international levels. I, therefore, take this opportunity to applaud the WHO for its timely step to raise global awareness and to promote concerted action on this very worrying issue. While no nation will be spared from the adverse impact of climate change, it will be felt disproportionately by the poor and the geographically vulnerable – such as the populations of small island countries, mountainous regions and the coastal areas. Some of the direct implications of climate change on public health range from alteration in the pattern of vector borne, water borne and airborne diseases that are particularly climate sensitive; re- emergence of the big killer diseases such as diarrhea and malaria; increased morbidity associated with water and food scarcity; deaths and injuries directly associated with extreme weather events and the consequent exposure of affected populations to epidemics. As in many countries throughout the world, we in Bhutan have also been troubled by the effects of climate change. As a result of global warming, our glaciers have been shrinking rapidly in recent decades. This has led to increased flow of meltwater into the glacial lakes which threaten to burst out of their loose moraine walls to cause what is known as glacial lake outburst floods (GLOF) – once a rare phenomenon, now a common danger that stalks many mountain valleys across the world. Such floods would have catastrophic consequences for life and property of communities living downstream, including millions of people in India and Bangladesh. A Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 37 glacial lake outburst flood in 1994 resulted in extensive and irreparable damage to crops, agricultural land, cattle and human life in the western valley of Punakha. An increasingly worrying trend is the visible depletion of our water resource. This may sound ironic for a country that is part of the high Himalayan water tower. Just as quickly as we build water supply schemes for agriculture and drinking water, their sources are rapidly shrinking or drying up altogether to present a major challenge for a government that has pledged safe and convenient drinking water for all by the year 2013. This not only has serious consequences for the health and hygiene of the people, but also results in the dislocation of entire communities. In addition, we are experiencing unpredictable and erratic rainfall making farming difficult and unreliable. Since an estimated seventy percent of our population is engaged in farming, this renders them extremely vulnerable to the impact of climate change. Crop failures and certainly yield reduction are occurrences that are driving our farmers away from the land and rural areas. Even though it is located at an elevation of 2800 meters, this city and even higher valleys are seeing increasing mosquito infestation that make their populations vulnerable to vector borne diseases as never before. Excellencies, Ladies and Gentlemen, In the ultimate analysis, climate change is the result of our way of life that is driven by insatiable human greed. Our GDP based economic development models founded on the notion of endless growth have promoted consumerism and materialism with little consideration for cultural and ecological costs. For too long these have conditioned human society to produce more and more of what we do not need at the cost of depleting our natural resources, creating mountains of polluting waste and emitting gases that have caused global temperature to rise. The resultant climate change now threatens us with not only health challenges but with the question of human survival on this planet. The rapid loss of bio diversity due to the environmental conditions no longer being fit enough to support the sustenance of the weaker plant, animal and insect species are clear signs of the devastating consequences of climate change. Indeed, epidemiological and morbidity changes and their social and economic consequences especially on the vulnerable populations of our poor and developing countries are only our immediate concerns. As Parliamentarians, we need to Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 38 also worry about the longer term impacts and gather the courage and will to fight climate change on all fronts. Here in our Himalayan kingdom, we have mindfully pursued a development process that is holistic in its approach to improving the living standard and well being of our people. Guided by our unique philosophy of Gross National Happiness, Bhutan has so far been free of the guilt of contributing to climate change and has in fact been more successful than most other countries in conserving our natural environment. Of the four pillars that support GNH, one is the conservation of the natural environment while the Constitution mandates that a minimum of 60% of the total land area must, for ever, remain under forest cover. In the five decades since Bhutan embarked on the path of planned development, we have consciously protected our natural environment, even at the cost of slower economic growth. As a result, we have been able to increase our forest coverage from 45% of the total land area in the early 1960s, to over 72% today. Moreover, more than 50% of our total land area has been designated as national parks and protected areas. Reflecting the Royal Government’s deep commitment to combating climate change, Bhutan committed itself to maintaining its status as a net absorber of greenhouse gases by remaining carbon neutral for all times, at the COP15 Summit in Copenhagen last year. Small as we may be, we are doing our part in fulfilling mankind’s common responsibility to tackle climate change. Ladies and gentlemen, we must focus on building public health systems that go beyond merely reacting to climate change, to systems that will ensure the development and maintenance of healthy environments. We must strengthen our efforts to integrate climate change policies and action plans in the key sectors to improve public health and happiness. We must collectively move towards accelerating the development of a comprehensive policy for mitigation of and adaptation to climate change that includes research, development, technology transfer, capacity building and awareness-raising through sustainable programs. To this end, I remain confident that the WHO will continue in its endeavour to take initiatives and provide the necessary support to our countries in the region. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 39 In concluding, I reiterate the expression of my trust that this conference will enable the Hon’ble Parliamentarians to share their knowledge and concerns on the impact of climate change on health and that they will return to their countries determined to make a difference not only in respect of dealing with emerging health challenges but by influencing climate change policies at the national, regional and global levels. I wish you a comfortable and enjoyable stay in our country. Thank you for your attention. Tashi Delek. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 40 Annex 6 Address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia With great pleasure I warmly welcome the honourable parliamentarians and other participants to this important conference. At the outset, I would like to thank the Royal Government of Bhutan for agreeing to host this conference in the picturesque landscape of the Himalayas. This setting reminds us of the fragilities of the environment and the subject of this meeting, the intersecting issues of health and climate change. It is increasingly recognized that health issues are multisectoral and require joint action. The Parliamentarians’ Conference is an appropriate platform for discussing various areas of concern, and an important forum for reaching consensus on priority public health concerns. Bhutan, like other developing countries has contributed least to greenhouse gas but is the victim of the resultant global warming. Bhutan is vulnerable to climatic events such as glacial melting and glacial lake outburst floods as well as climate-sensitive diseases such as vector-borne illnesses and diarrhoeal diseases. Bhutan is also one of seven countries approved for the UN Global Environment Facility project, focusing on increasing adaptive capacity to respond to climate-sensitive health risks. The reality of global warming and the part played by human actions are now universally accepted. The Intergovernmental Panel on Climate Change released its fourth assessment report in 2007, which cited a remarkable increase in global atmospheric concentrations of greenhouse gases as a result of human activities since 1750. The levels of these gases now far exceed pre-industrial values. Warming of the climate due to these greenhouse gases is unequivocal, and will continue even if greenhouse gases concentrations were to be stabilized. The effects of global warming are already felt in the form of more frequent and more intense heatwaves, cyclones, unusual patterns of rain and floods in some places and droughts in others. Average annual global temperatures and atmospheric carbon dioxide have continued to rise, setting new records. June 2010 was the hottest June on record and the year Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 41 2010 is projected to be the hottest year in history. The world is now experiencing more heatwaves, droughts, floods and storms. Sea levels are rising and the snow and glaciers that supply fresh water to many of our populations are receding. Climate as a determinant of health has been known since the time of Hippocrates, the father of medicine, in 400 B.C. Climate change threatens the basic elements of our health security: clean air, water, and food production. The World Health Report 2002 reported that in the year 2000, about 82 000 deaths in South-East Asia could be attributed to climate change, mainly from malnutrition and diarrhoeal diseases. Rising global temperatures and changes in the climate, if not addressed in a timely fashion, will jeopardize the Millennium Developmental Goals on child mortality, maternal health, water and sanitation, and malaria. Climate change will impact all the countries of our Region. Projected rapid glacial melting will increase flooding and rock avalanches initially. The shrinkage of glaciers will ultimately result in reduced water and food sources in large river basins. Rising sea levels will lead to large scale migration of populations of low-lying coastal areas and small islands, causing social disruption and mental health problems. Indeed, the report of the IPCC states that “coastal areas, especially the heavily-populated mega-deltas regions in South, East and South-East Asia, will be at greatest risk due to increased flooding from the sea and, in some mega-deltas, flooding from the rivers.” Scarcity of water and floods will affect agriculture and sanitation, resulting malnutrition and diarrhoeal diseases. Recent observations and results of research in the Region indicate that species of the mosquito transmitting malaria and dengue are now found at higher altitudes in the Himalayas. Bhutan and Nepal started reporting cases of dengue for the first time in 2004 and 2006 respectively. Climate change will thus exacerbate the existing health problems in the Region and climate-sensitive disease vectors may spread into new areas. Responding to climate change does not mean creating new programmes but expanding and improving the existing ones. None of the health outcomes due to climate change is inevitable. It can be modulated by appropriate policies and actions of sectors dealing with energy, transport, social justice and equity, environment and health. We need to re-emphasize that health is everyone’s concern and therefore health should be at the heart of the response to climate change. Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change 42 Generating awareness is an important step for planning and action. Member States need to reiterate their commitment to the Sixty-first World Health Assembly resolution on climate change and health, placing research at the top of the agenda. The issues for research include assessment of health impact, vulnerability, and available mitigation and adaptation options and their impact on health. Another step is to strengthen the public health system and prioritize ongoing national programmes on climate-sensitive diseases. In particular, the adaptive capacity of the most vulnerable and marginalized populations should be improved; this includes the poor, small farmers, urban slum dwellers, tribal populations and people living in the geographically vulnerable areas such as coastal regions and mountains. There is also a need to develop an integrated strategy incorporating current and projected climate change risks into existing policies, legislation, strategies and measures of key development sectors. The health sector should be aided in actively participating in national communications to the United Nations Framework Convention on Climate Change, and health issues should be the core elements in the negotiation process. WHO is committed to providing technical guidance to the Member States to improve their capacity to carry out health impact and vulnerability assessments. WHO will facilitate knowledge-sharing and networking on climate change and human health within the health sector as well as between disciplines. This Regional Conference of Parliamentarians aims to increase awareness and understanding of health-related climate change issues and to identify concrete actions for the protection of human health. I wish you fruitful deliberations and look forward to your recommendations so that we can move forward and respond to the most important challenge of the century to the health sector. World Health House Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110002, India Website: www.searo.who.int Report of the Regional Conference of Parliamentarians on Protecting Human Health from Climate Change Thimphu, Bhutan, 5-7 October 2010 SEA-EH-571 The Regional Conference of Parliamentarians on Protecting Human Health from Climate Change was held in Thimphu, Bhutan from 5-7 October 2010. It was attended by parliamentarians from seven countries of the South-East Asia Region (Bangladesh, Bhutan, India, Indonesia, Nepal, Sri Lanka and Timor-Leste). Several WHO staff from country offices, the Regional Office and Headquarters also participated in the conference. The conference was organized to create awareness amongst politicians on the health impacts of climate change and garner their support in addressing the health concerns in Member States. The conference concluded with the endorsement of the “Parliamentarians' Call for Action for Protecting Human Health from Climate change in the South-East Asia Region.” This is a summary report of the meeting discussions and recommendations.