Out from Under the Weather: Using Meteorological Data to ... · Out from Under the Weather: Using...
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National Institutes of Health • U.S. Department of Health and Human Services
Out from Under the Weather:Using Meteorological Data to Protect
Public HealthJohn Balbus, MD, MPH
Senior Advisor for Public HealthDirector, NIEHS-WHO Collaborating Centre for Environmental Health Sciences
National Institute of Environmental Health Sciences
Annual Monsoon WorkshopIndian Meteorological Society-IITM Pune
February 23, 2016
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National Institutes of HealthU.S. Department of Health and Human Services
The National Institute of Environmental Health Sciences
• One of the 27 National Institutes of Health
– Located in Research Triangle Park, North Carolina
• Wide variety of programs supporting our mission of environmental health:
‒ Intramural laboratories ‒ Clinical research program
‒ Extramural funding programs ‒ National Toxicology Program
‒ Disease Prevention ‒ Public Health Focus
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National Institutes of HealthU.S. Department of Health and Human Services
NIEHS Strategic Plan
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National Institutes of HealthU.S. Department of Health and Human Services
GeoHealth Hubs
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National Institutes of HealthU.S. Department of Health and Human Services
WHO-NIEHS Collaborating Centre for Environmental Health Sciences: Objectives
Promote Research Collaborations
Translate Research into Actionable Science
Build Capacity through Training Partnerships
Raise Global Awareness of Issues
WHO-NIEHS Collaborating Centre
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National Institutes of HealthU.S. Department of Health and Human Services
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National Institutes of HealthU.S. Department of Health and Human Services
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National Institutes of HealthU.S. Department of Health and Human Services
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National Institutes of HealthU.S. Department of Health and Human Services
The right to health…Regional cooperation on adaptation…Paris committee on capacity building….
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Slide courtesy of Dr. George Luber, CDC
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National Institutes of HealthU.S. Department of Health and Human Services
Climate, extremes and health in India
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Climate Drivers
Exposure Pathways
Health Impacts
Health Outcomes/Burden
Reduced Adaptive Capacity
Increased exposure
Increased sensitivity
Poor access to care and preventive services
Elements of Vulnerability
Vulnerability and the causal chain of climate impacts
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IPCC 5th AR and prospects for health adaptation
https://ipcc-wg2.gov/AR5/images/uploads/WGII_AR5_Fig11-6.jpg
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DAY
CASES
LabConfirmation
Current Epidemic Detection and Response Curve
ResponseDetection/Reporting
First Case
Adapted from J. Davis, Climate Adaptation Workshop, Nov. 2003
Opportunity for Control
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Getting ahead of the Curve: Integrating Ocean, Climate and Public Health Information
First Case
Detection/Reporting
Response
Adapted from J. Davis, Climate Adaptation Workshop, Nov. 2003
Enhancing Public Health Engagement, Outreach, and Feedback throughout
Predictive Tools andServices`
Engage Public Health
DecisionMakers
Integrated Health,
Ocean and Coastal Obs, Monitoring & Surveillance Information
Lab Confirmation
CASES
DAY
Opportunity for Control
Sensor, Tool and Methods
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National Institutes of HealthU.S. Department of Health and Human Services
Early warning for infectious diseases
• Systems are more complex– Vibrio- multiple water parameters, human behaviors
influence exposure
– Dengue- 4 serotypes, complex breeding behaviors
• Statistical correlative models have been developed– Different parameters significant in different places
– Best within range of observations
• Mechanistic models also developed, but they are not as useful for predictions– Currently used more to explore future scenarios,
mechanisms in more depth
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National Institutes of HealthU.S. Department of Health and Human Services
Heat warnings- simple in theory, complex in practice
• Data shows large variation in thresholds among US cities
• Time of year, past year’s experience all influence impact of a given heat wave
• Morbidity is not the same as mortality- lower threholds in some cases
• Nonetheless, early warning and adaptation saving lives in the US and elsewhere
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National Institutes of HealthU.S. Department of Health and Human Services
Evidence of effectiveness (Toloo, et al., 2013)
• 7 studies referenced- 6 asserted effectiveness– 2006 heat wave in France with 4400 estimated fewer
deaths
– 1300 fewer deaths in 65+ in Hong Kong after EWS implemented
– 49-73% decline in ambulance calls in Milwaukee
• Unable to analyze which specific measures were most effective
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20Oceanic and Atmospheric Research | Climate Program Office
Kicking Off the NIHHIS : 2015 Chicago WorkshopInternational Engagement
NOAA, in conjunction with CDC, WMO, WHO, DeutscherWetterdienst, and GFCS convened a Workshop on the Development of Climate Information Systems for Heat Health Early Warning– incl. India participants.
• Establishing learning network of heat health activities, practitioners, and partners
• Bridge the gap between meteorological and public health(and other) practitioners
• Bridge the gap between weather and climate prediction
• Understanding and informing needs of vulnerable populations
• Understanding and developing communication needs
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21Oceanic and Atmospheric Research | Climate Program Office
NIHHIS: US Pilots and International Network
Ahmedabad
Surat
Bhubaneswar
Nagpur
Northeast & NYCWestern Region
Rio Grande/Bravo
Chicago & Midwest
Carolinas RISA
Senegal
Burkina Faso
Mozambique
Tanzania
Bangladesh
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22Oceanic and Atmospheric Research | Climate Program Office
Common Characteristics of NIHHIS Pilots• A well defined health problem or question• Institutional buy in and commitment• Capacity Building: climate and health data, human
resources (time), funding, knowledge and training.• A process for selecting and evaluating heat health
parameters depending upon climate & vulnerability.
NIHHIS Pilots Characteristics and Outcomes
OutcomeCommunities that are resilient to heat extremes and health impacts.
Heat Action Plan detailing responsibilities and processes
Improved early warning & monitoring products customized for regional risks
Sectoral decision-making calendars and improved long-term heat outlooks
Communications strategies for and analysis of vulnerable populations
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Figure 1. Daily mortality counts in May 2010 heat wave, versus corresponding days in 2009 and 2011.
Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, et al. (2014) Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave. PLoS ONE 9(3): e91831. doi:10.1371/journal.pone.0091831http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0091831
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Forecasting in Ahmedabad HAP till 2015
• The Ahmedabad Heat Action Plan (HAP), piloted in April 2013, is the first comprehensive early warning system and preparedness plan for extreme heat events in India and South Asia.
• Till 2013, the Indian Meteorological Department (IMD) used to issue forecasts of extreme heat only one day in advance – not allowed enough window period for preparedness
• Moreover, no interphase between the health and meteorological department- The health authorities did not have any access to meaningful forecasting data
• HAP team generated an innovative hybrid dynamical-statistical temperature forecast system developed by the Georgia Institute of Technology (Georgia Tech, Atlanta, GA, USA) and the Climate Forecast Applications Network which was used for 2013-15
Slide courtesy Dr. Partha Ganguly
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Transition in heat forecasting by IMD• The HAP team worked in close collaboration with IMD
local and National teams during these years (2013-15)• This collaboration inspired IMD to work on longer (5-7)
day heat forecasting• Since 2014, IMD has developed the 5-day forecast,
which is also available IMD’s website http://www.imd.gov.in/pages/city_weather.php
• Over last two years (2014 & 2015) the HAP team analysed the variability between CFAN and IMD temperature forecast and found it within acceptable limit
Slide courtesy Dr. Partha Ganguly
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Comparison of CFAN and IMD
Forecasting - CFANIMD forecast for Ahmedabad city
Slide courtesy Dr. Partha Ganguly
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Forecasting in India-2016• In 2016, the HAP team in Ahmedabad is going to use the
IMD forecast
• Working out closely with IMD to ensure a smooth and effective transition
• As the HAP is scaled up to other cities in 2016, moving to IMD forecast is necessary because IMD forecast is only source in other cities across India
• Working out pathways to improve access of nodal implementing authorities to this forecasting
• A system is being devised through which the IMD local offices in each state will communicate 5 day temperature forecast with probability, to all implementing agencies every day
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National Institutes of HealthU.S. Department of Health and Human Services
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National Institutes of HealthU.S. Department of Health and Human ServicesReiner et al., PNAS, 2012
http://www.pnas.org/content/109/6/2033.full.pdf?with-ds=yes
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National Institutes of HealthU.S. Department of Health and Human Services
Understanding Climate and Health Associations in India Community of Practice
Vision of the UCHAI Community of Practice
• India’s health sector has capacity to adapt to climate change and its health impacts.
Goals of the UCHAI Community of Practice• Training
– Train-the-trainer workshops, curriculum, training modules, Web portal• Research
– Extreme heat and weather events, climate-related diseases, vulnerable populations, capacity of the health systems etc.
• Development of Tools – Including Heat Action Plans, Predictive Models
• Community Engagement – Stakeholder/public participation to increase efficacy and
impact of adaptation strategies.
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National Institutes of HealthU.S. Department of Health and Human Services
UCHAI Activities to Date
• Workshop in New Delhi
• Initiative kickoff
• September 22-24, 2015
• Webinar series in partnership with TERI
– Sustainable Development Goals – Hopes and Challenges was held on Dec 8, 2015
– Building the bridge between climate and public health: The use of meteorological forecasts for public health early warning systems
• March 1, 2016
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National Institutes of HealthU.S. Department of Health and Human Services
UCHAI Scientific Committee• India
– Dr. Sanjeev Kumar, Director, National Health Systems Resource Center
– Prof. Sanjay Zodpey, Director, Public Health Education, Public Health Foundation of India
– Anjali Singh, Indian Institute of Public Health, Delhi
– Dr. Ramesh Dhiman, National Institute of Malaria Research
– Prof. Anand Krishnan, Center for Community Medicine, All India Medical School
– Dr. Pawan Kumar Taneja, Indian Institute of Public Administration
– Ms. Suruchi Bhadwal, The Energy Resources Institute
– Dr. Shyamala Mani, National Institute of Urban Affairs
– Manu Prakash, TARU
– Dr. Nitish Dogra, TARU
• USA
– Dr. John Balbus, NIEHS
– Dr. Banalata Sen, NIEHS
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National Institutes of HealthU.S. Department of Health and Human Services
Climate Services User Forum: April 26-28, 2016
• In conjunction with South Asia Seasonal Climate Outlook Forum in Colombo, Sri Lanka
• First such meeting to focus on health sector
• Goals– raise awareness of health impacts;
– clarify types of climate services needed for health;
– knowledge transfer and community building to develop early warning systems and other public health interventions
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National Institutes of HealthU.S. Department of Health and Human Services
Summary
• Extremes of weather and climate variability have multiple serious health consequences
• Research is starting to provide capability to use forecasts health-relevant meteorologic parameters for interventions
• Growing momentum for large scale collaborations to enhance health resilience in setting of climate change
• This is a good time to develop collaborative group between public health and hydrometeorology
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National Institutes of HealthU.S. Department of Health and Human Services
THANK YOU!John M. Balbus, M.D., M.P.H.
http://www.niehs.nih.gov/gehhttp://toolkit.climate.gov/