1A.1

Vulnerability and Adaptation Assessments Hands-On

Training WorkshopHuman Health Sector

Kristie L. Ebi, Exponent Health Group

Outline

Qualitative exampleWHO Inter-Regional Workshop on Health Impacts from Climate Variability and Change in the Hindu Kush-Himalayan Region Mukteshwar, India 3-7 October 2005

Quantitative exampleWHO Global Burden of DiseaseSudan Initial National Communication

Steps in Assessing Vulnerability and Adaptation

Describe the current distribution and burden of climate-sensitive diseases Describe the association between climate and disease

outcomes Identify and describe current strategies, policies, and

measures to reduce that burden Review the health implications of the potential impact

of climate variability and change on other sectors Estimate future potential health impacts using

scenarios of climate change Identify additional adaptation measures to reduce

potential negative health effects

Climate-Sensitive Health Outcomes Mountain Regions

Heatwaves Flood deaths/morbidity

Glacial lake floods Flash Riverine (plain)

Vector-borne disease Malaria Japanese Encephalitis Kala-azar Filariasis Dengue

Water-borne diseases Water scarcity, quality Drought-related food insecurity

Current Burden of Disease in Bhutan

Flood deaths/morbidity Glacial lake floods 3 Flash 3

Vector-borne disease Malaria 1 Kala-azar 1 Filariasis 1

Water-borne diseases 2 Water scarcity, quality 2 Drought-related food insecurity 1

Particularly Vulnerable Populations

Glacial lake floods: Elderly, poor, nomadic, children, disabled or infirm, women, independently living ethnic groups in remote areas

Flash: Everyone in the path of the floods Riverine (plains): Elderly, poor, nomadic,

children, the disabled or sick, women, and people in poor housing, coastal areas, institutions, or on isolated islands

Steps in Assessing Vulnerability and Adaptation

Describe the current distribution and burden of climate-sensitive diseases Describe the association between climate and disease

outcomes Identify and describe current strategies, policies, and

measures to reduce that burden Review the health implications of the potential impact

of climate variability and change on other sectors Estimate future potential health impacts using

scenarios of climate change Identify additional adaptation measures to reduce

potential negative health effects

Adaptation Options

Climate-sensitive diseases are a problem today with programs in place to try to reduce their burden

Current programs will need to be revised and augmented to cope with climate change-related risks New programs may be needed to

address changes in the geographic range of some vector-borne diseases

1A.9

WHO Global Burden of Disease Approach

McMichael AJ, Campbell-Lendrum D, Kovats S, Edwards S, Wilkinson P, Wilson T, et al. 2004 Global Climate Change. In: Comparative Quantification of

Health Risks: Global and Regional Burden of Disease due to Selected Risk Factors. Eds. Ezzati M, Lopez A,

Rodgers A, Murray C. P 1543-1649. WHO, Geneva

Data Sources

WHO World Health Report Chapter 20 of the Global Burden of Disease

Study Output from MAGICC-SenGen

WHO World Health Report Annexes

1. Basic indicators for all WHO member states

2. Deaths by cause, gender, and mortality stratum for WHO regions

3. DALYs

4. Healthy life expectancy

5. National level indicators

6. National health accounts

7. Millennium Development Goals

WHO South-East Asia Region

B = countries with low child and low adult mortality Indonesia, Sri Lanka, Thailand

D = countries with high child and high adult mortality Bangladesh, Bhutan, Democratic People’s

Republic of Korea, India, Maldives, Myanmar, Nepal, Timor-Leste

Diseases Included in WHR

Diarrheal diseases In 2002, worldwide there were 1,798,000

deaths or 3.2% of all deaths Burden in SEAR-B was 41,000 deaths Burden in SEAR-D was 563,000 deaths

Malaria Schistosomiasis Dengue Protein-calorie malnutrition

GBD Health Outcomes Considered

Outcome Class Incidence / prevalence

Outcome

Direct effects of heat and cold

Incidence Cardiovascular disease deaths

Foodborne & waterborne diseases

Incidence Diarrhoea episodes

Vector-borne diseases Incidence Malaria cases

Natural disasters Incidence

Incidence

Deaths due to unintentional injuries

Other unintentional injuries

Risk of malnutrition Prevalence Non-availability of recommended daily calorie intake

McMichael et al., 2004

WHO Global Burden of Disease Exposure-Response Relationships

5% increase in diarrheal incidence per degree C increase in temperature

Central, low, and high relative risks estimated relative to baseline climate

For example, for 2030, the central estimate for unmitigated emissions for SEAR-B was 1.00 and for SEAR-D was 1.09

Calculating Potential Future Disease Burdens Using

Baseline burden of disease Relative risk increase per temperature

change Output from MAGICC-SenGen

Estimate qualitatively how much adaptation could decrease disease burden

Sudan National Communication

Using an Excel spreadsheet, modeled malaria based on relationships described in MIASMA

Calculated monthly changes in transmission potential for the Kordofan Region for the years 2030-2060, relative to the period 1961-1990 using the IPCC IS92A scenario, simulation results of HADCM2, GFDL, and BMRC, and MAGICC/SCENGEN

Sudan – Projected Increase in Transmission Potential of Malaria in 2030

Sudan – Projected Increase in Transmission Potential of Malaria in 2060

Sudan – Malaria Projections

Malaria in Kordofan Region could increase significantly during the winter months in the absence of effective adaptation measures The transmission potential during these months is

75% higher than without climate change Under HADCM2, the transmission potential in

2060 is more than double baseline Transmission potential is projected to decrease

during May-August due to increased temperature

1A.21

Thank you