Climate and Health

Vulnerability & Adaptation

Assessment Profile

Manaus - Brazil

Christovam Barcellos (ICICT/Fiocruz)

Diego Xavier Silva (ICICT/Fiocruz)

Rita Bacuri (CPqLMD/Fiocruz)

Assessment Objectives

• To identify the possible links between climate

change - more specifically hydrological regime -

and water related diseases.

• To suggest tools for monitoring changes in river

regime and water related diseases.

• To identify social actors and strategies to

implement adaptation plans.

• To contribute as a pilot study for the Brazilian

Climate and Health Observatory

Why Manaus?

• The city of Manaus,

Brazil, is situated at

the confluence of

Negro, Amazon and

Purus rivers that

determine the region’s

hydrology, together

with the Amazon

forest that surrounds it.

Since Manaus is an important regional harbor and the main Amazonian

metropolis, the city tends to act as a shelter for groups evaded from areas

submitted to environmental stress, ethnical struggles or economic crisis.

Why Manaus?

• The water level of Rio

Negro has been a strong

regulator of city’s

economic and social

dynamics, since its

foundation. The

persistence of wooden

houses built on stilts

(palafitas) is an example

of adaptation of the local

population to the climatic

variability.

Approach to Organization

Three steps:

Health problem definition/Climate factors

Gathering and analysis of secondary data

Discussion of results with stakeholders

Assessment Methods

• The first step in our study was to

focus on one health problem. This

choice may represent a major

change in the proposed guide.

Because of the city geographical

characteristics and the present

concern of local authorities and

general public, we selected water

as a key climate issue to be

addressed. Local researchers and

authorities have participated of

this decision.

Assessment MethodsQuantitative approach

• The second step was to collect and

gather routine data for the selected

indicators (at Fiocruz, Rio de Janeiro).

This activity produced a preliminary

report that was distributed among all

participants (stakeholders). We have

used time series to demonstrate the

seasonality and long term variability

of precipitation and river water level,

and to link them to the incidence of

water related diseases. GIS was also

used to identify vulnerable population

groups.

• Environmental data: Land use, altimetry, floodable

areas, river water level.

• Weather and climate: Temperature, precipitation,

seasonal and long term forecasts;

• Socioeconomic data: Census information (households,

sanitation, migration, education, income);

• Health data: Health service provision, mortality and

morbidity (hospitalization and disease notification.

Assessment MethodsQuantitative approach

Health outcomes

• Malaria incidence and hospitalization

• Dengue incidence and hospitalization

• Leptospirosis incidence

• Hepatitis A incidence and hospitalization

• Infant mortality by diarrhoea

Assessment Methods Qualitative approach

• The final activity was a

workshop during which

the preliminary report

was discussed by the

group. The report

brought evidences on

the relationship between

river water regime and

the transmission of

selected diseases but

avoided to pose an

explanation about the

causal link between

water regime and

diseases.

The explanation of the dynamics of

disease transmission was suggested by

the workshop participants.

Malaria incidence

Hepatitis A incidence

Social and

environmental

processes acting

between river water

level and disease?

Malaria: water

impoundment and flow

retention in creeks

Hepatitis: Water

contamination by

faeces

Leptospirosis in incidence and river water

level

Major Findings

• Changes in the river water level are assimilated by the inhabitants, if these variations occur within a range that does not compromise the operation of transportation systems, sanitation, water and food supply.

• Major changes, such as prolonged droughts as well as floodings, may cause the collapse of these systems.

• Both extreme climate events occurred in city during 2009, leading to a perception that climate changes are already affecting the city.

Extreme events in ManausRiver water level

Utility of Assessment & Meeting

Decision Needs • All used data (socioeconomic, epidemiological and

climate) are available for public use for free. It can be

employed in a CC monitoring system.

• Stakeholders were especially satisfied with the analysis

of health, environment, climate and socioeconomic

indicators. They were familiar with the problems

presented and felt comfortable to comment and interpret

the statistical results.

• The final report was built on reliable information and it

reflects the views of stakeholders on the current health

problems and climate scenarios. The study participants

declared that the final assessment report will be useful to

discuss adaptation strategies and to seek financial

sources for its implementation.

Major Challenges

• It would be useful to include primary data and insights from fieldwork.

Due to the limited budget and time it was not possible to incorporate

additional data.

• Stakeholders are concerned with the possibility of materialize plans

and benefits to the society. The assessment should point out project

opportunities and financial sources.

• The opinion of stakeholders varies substantially according to their

position in the institutional framework (governmental or non-

governmental, sector, political party and so on).

• The guidance should suggest methodologies of quantitative (graphs,

maps, indicators, etc.) and qualitative research (structured or semi-

structured interviews, focus group etc.). The stakeholder opinion

convergence in some aspects was difficultly achieved or even

impossible. A methodology for dealing with different points of view

would be welcome.

Vulnerability or vulnerabilities?

the different origins and vulnerabilities of deprived social groups, such as:

• Urbanized indigenous people

• Migrants from the eastern Amazon

• Migrants from other regions of the country

• traditional riverside inhabitants (ribeirinhos)

“Invasions” along the urban fringe

- Recent migrants from the eastern

Amazon

- Poor sanitation and housing

conditions

- Malaria hotspots

Houses on stilts along the riverside

- Traditional Amazonian population

- Subject to river changes and water

transmitted diseases

- More adapted to environmental

changes

Adaptation strategies for different

vulnerabilities

Adaptation strategies for different

vulnerabilities – Creek (Igarapés)

Thank you

Christovam Barcellos (ICICT/Fiocruz)

Diego Xavier Silva (ICICT/Fiocruz)

Rita Bacuri (CPqLMD/Fiocruz)

Yara, Queen of the Amazonian rivers