Health in a changing climate The Red Cross Red Crescent Climate Centre was established in 2002 and became an independent foundation in 2004. We are the reference centre on climate change of the Red Cross Red Crescent family. The Climate Centre supports the Red Cross and Red Crescent Movement to understand and address the humanitarian consequences of climate change and extreme weather events. The humanitarian mission of the Red Cross Red Crescent is to improve the lives of the vulnerable people, and their health plays a central role. National Societies around the world are already grappling with new health emergencies which are likely to be linked in some part to risks caused by climate change and variability. Proactive health risk reduction strategies and programmes can be taken to reduce health related risks affecting the most vulnerable groups.

How will climate change affect health? Climate change will cause changes worldwide, such as more floods, droughts and disasters How will climate change affect health? One of the main routes through which climate related risks affect health is through an increase in the frequency and intensity of extreme events such as flooding or drought. There is more and more certainty that these climate related risks for health will rise. However there is also more and more uncertainty about when and where these changes will happen and have an impact. This is a complexity that we can not avoid.

Both extremes can have health effects Water Too little Too much water – health effects Infectious diseases, e.g. cholera Physical injuries Too little water – health effects Drought – impact on water and food supply Impact on vector-borne diseases Too much Both extremes can have health effects

Too much water... Flooding Diarrhoeal diseases Vector-borne diseases Rodent borne diseases Food borne diseases Mental health Floods cause drownings and physical injuries. After flood events, infectious diseases become more common. This includes diarrhoeal diseases, vector-borne diseases such as malaria, as well as rodent-borne diseases. Floods also damage homes and disrupt the supply of essential medical and health services.

More intense tropical storms: Higher sea surface temperatures, caused by global warming, increase the strength and duration of tropical cyclones/hurricanes/typhoons. Scientists expect less or a similar number of cyclones/hurricanes/typhoons, although this might vary around the world. But scientists do expect that when they do form, it is likely that on average they will be more intense in terms of rainfall and wind speed. An increase in the number of strong tropical cyclones/hurricanes/typhoons has already been observed. Strong cyclones/hurricanes/typhoons are likely to have major disruptive impacts on health: injuries and death, disruption of health services, flood and stagnant water-related diseases. Injuries and death Flood-related disease

Rain - more frequent and heavy Heavy rainfall, even without flooding, may increase rates of diarrhoeal disease as latrines or sewage systems overflow in areas with poor sanitation. Increases in soil run-off may contaminate water sources. With heavy rainfall events expected to become more common, rates of diarrhoeal diseases may increase and it is likely that the most vulnerable populations will suffer the most. Diarrhoea / cholera

Too little water... Drought Diarrhoea Skin - scabies Eye - trachoma Malnutrition Water scarcity on the other hand is also likely to increase and to have consequences for public health. A lack of availability of water for personal hygiene and washing of food may lead to an increase in diarrhoeal disease and other diseases such as skin and eye diseases associated with poor hygiene. Cholera outbreaks in the Amazon have been linked to low river flows in the dry season, which lead to higher bacterial contamination of pools. A high concentration of bacteria may also overload water treatment plants. Droughts increase the risk of food shortages and malnutrition and diseases spread by contaminated food and water.

Heat Vulnerable people: Climate change is expected to increase average temperatures as well as the number and intensity of heatwaves. Heatwaves are associated with increased mortality in the short term, especially among populations who are not adapted to extremely hot weather. The extreme heat adds an additional stress to vulnerable elderly people and to those who already have weak heart, brain and lung conditions. Heat stress can rapidly become life threatening, especially among those with limited access to immediate medical attention. People with severe heat stroke symptoms have little time to seek emergency treatment. Vulnerable people: Elderly people with other diseases (heart, respiratory)

Heatwaves Air quality Ground-level ozone The formation of many air-pollutants is determined in part by climate factors such as temperature and humidity. Climate change may therefore influence pollutant concentrations, which in turn may affect health as air pollution is related to cardio-respiratory health. Exposure to high levels of ground-level ozone, for example, which is formed from the exhaust of transport vehicles, increases the risk of exacerbations of respiratory diseases such as asthma, leading to hospital admissions or increased mortality.

Heatwaves Manual labourers Cardio-respiratory diseases Dehydration Manual labourers, who are exposed to heat and sunlight, are facing increased risk of cardio-respiratory diseases and dehydration.

Heatwaves Diarrhoeal diseases Food-borne diseases Bacteria multiplying faster High temperatures are an independent risk factor of increased rates of diarrhoeal diseases, including salmonella and cholera due to increased proliferation of bacteria.

Heatwave action Until 2006, the Netherlands did not have a heat wave plan. During a 2006 heat wave in Western Europe, 1,000 more people than normal died in the country, one of the most lethal disasters worldwide of that year. The Netherlands Red Cross had already in 2005 approached the health ministry to develop a heatwave plan. The disaster of 2006 accelerated this process and with 80 different organizations in different sectors, the preparation of a heatwave plan was set in motion and agreed in 2007. Proper warnings, early action and improved care for the elderly can lead to more effective heatwave response, as shown by French Red Cross.  Old and chronically ill people suffer the most during a heat wave.  What the Red Cross Red Crescent can do:   Volunteers can visit old and sick people: Help them to drink a lot of water Help them keep cool (cold towels, put the fan on, ) See how they are – take them to hospital if needed Include heatwave risks in preparatory planning and First Aid activities at large events like marathons, fairs, concerts, etc. Educate people in the community about what to do in a heatwave: keep your home cool keep out of heat keep the body cool and hydrated help others

Vector-borne diseases Infections transmitted by insect vectors are strongly affected by climatic conditions such as temperature, rainfall and humidity. These diseases include some of the most important current killers: malaria, dengue fever and yellow fever. Climate change may change the temporal and spatial patterns of many vector-borne diseases. Malaria Yellow Fever Dengue Fever

Let us look at dengue as an example Dengue fever is a mosquito-borne infection that is caused by a mosquito with white stripes called Aedes aegypti. Dengue fever can be dangerous because it spreads fast, there are no specific treatments for dengue fever and no available vaccines and it can lead to mortality. Children under 15 years old are the most vulnerable to dengue fever. Dengue

Climate Dengue Fever Urban dengue transmission water temperature 50M infections, 500k hospitalizations Immense burden on urban public health systems Continues to get worse with no end in site Household water security Climate Urban dengue transmission water temperature ambient temperature mosquito growth, development, metabolism Cases of dengue fever have risen dramatically in the last 40 years, as unplanned urbanization with standing water in waste and other places have created mosquito breeding sites, and movement of people and goods has spread both mosquito vectors and infections. The distribution of dengue is highly dependent on climate: warmer temperatures, higher humidity and more places where water can collect generally favour dengue transmission.

For dengue – higher temperature means mosquitoes: Develop faster Fly further Survive longer BITE more The dengue VIRUS (inside the mosquito) Replicates faster An increase in temperature can affect mosquito development. Mosquitos will fly further, survive longer and bite more. The virus inside the mosquito will also replicate faster.

Rain means: MORE rain Increase breeding sites for mosquitoes LESS rain Can also increase breeding sites for dengue mosquitoes Low, stagnant river flow Water storage in homes Increased levels of rainfall or flooding means that water collects in stagnant pools which provides conditions for mosquito breeding and therefore the risk of spreading dengue fever. Low rainfall can also increase infection rates as people store more water at home and these containers provide breeding sites.

Dengue Community clean up of breeding sites Aedes aegypti mosquitoes are found in dark and moist areas in the house, they bite during the day, mostly in early morning and late afternoon and they breed in still clean water environments, often in objects that hold water such as water tanks, containers, pots, vases, etc. It is important to clean potential breeding sites of these mosquitoes to prevent the spread of dengue fever.

Dengue Messages about water storage How to eliminate larvae of Aedes agypti mosquitoes… Tightly close and cover water containers Regularly scrub and change water in containers, pots; at least one a week Put fish in water containers to eat larvae Remove water stagnant from drainage areas, trees and plants Carry out environmental cleaning: collect, eliminate holding-water objects, trash, old tires, coconut shells, used cans, containers, etc.

EARLY WARNING EARLY ACTION For health effects? Flooding Drought Heatwaves Air quality Vector-borne diseases (malaria-dengue,etc) Early warning, early action means making use of climate and weather information before a health emergency strikes and act sooner than you would do without this information. We often have some information ahead in time of the upcoming disaster event such as flooding, tropical storms and heatwaves, and that information can be interpreted and used to prepare the emergency operation better. So in the ‘Early Warning, Early Action’ approach we make full use of climate information – and we act in a way that prepares us better as a whole, but also with a more strategic approach to health emergency response.

Early Detection, Early Action There are not yet early warning systems for everything, everywhere Dengue Non-flood related diarrhoea, cholera Better surveillance, preparedness Early Detection, Early Action However, there are currently no operational early warning systems for dengue that are based on climate information, allowing for early action. In the absence of such an early warning system, it is essential to have a good surveillance system to detect and address the changing disease patterns, and use it to guide preventive interventions. In order to enhance the use of surveillance data and detect changing patterns, it is important to strengthen existing links between the National Societies and Ministries of Health (responsible for surveillance) together with other partners such as the World Health Organisation country offices

Baseline resilience also important Water and sanitation Access to water, sanitation Knowledge about hygiene Vector-borne disease Vector control Knowledge, behaviour In order to minimize the additional health risks posed by climate change, it is important to strengthen the baseline level of resilience e.g. in water and sanitation (access and knowledge) as well as vector borne dieseases (vector control, behaviour, prevention, knowledge).

Preparedness: Good baseline status Deal with increasing baseline risk Capacity to respond to ‘peaks’ of increased risk Early warning/early detection Efficient health emergency preparedness should include: Good baseline status: strengthen the current level of knowledge, awareness and preparedness Deal with increasing baseline risk: Once the level of baseline preparedness is established, the focus should be on coping with additional risks posed by climate change, surveillance of climatic and weather conditions as well as their effects on human health Capacity to respond to peaks of increased risk: A health emergency plan has to be put in place to develop capacity to respond effectively to climate change, e.g. strengthening of the health system, awareness raising among all stakeholders, community-based preparedness Early warning/early detection: With climate and meteorological information ahead of an upcoming disaster, we can link them to the incidence of climate sensitive diseases for early action

Read more in the Climate Guide! From the how-to guide: Collect background info in contact with correct partners. Monitor! Integrate climate change into National Society awareness, health or disaster programmes. Consider priority areas, impacts Need to train more volunteers? More resources? Read more in the Climate Guide! Step 1: Collecting general background information Get a good understanding of the changing risks as part of the national climate risk assessment. Identify all possible health related impacts in your country and gather extra information from partners, such as the Ministry of Health and professional healthcare institutions. Step 2: Assessing priorities and integrating climate change into the strategy of the National Society Raising awareness internally will be a good start. Listing the main disease burden within the different target areas will help prioritize operations. Priorities are related both to disaster-management response and risk-reduction activities as well as health and social-care programmes. It is important to integrate activities linked to climate change into other existing healthcare programmes as well: community based health and first aid (CBHFA) or participatory health promotion, for example. To help prioritize and prepare for the risks, do we: • Make full use of all possible weather and climate information that may help predict health impacts? • Need to intensify capacities within our health programmes? • Know which areas are most vulnerable to drought or flooding? • Have capacity to deal with the impacts identified, for example malnutrition? • Direct medication supplies to the right disease-prone areas? Step 3: Enhancing preparedness for response and contingency planning Identify new activities or intensify existing ones that might be effective interventions, such: • Can we promote public health interventions at different levels within the National Society? • Is new funding needed? • What has been done in other countries or organizations to address our priorities? • Do we regularly monitor surveillance data from the Ministry of Health, so we know when climate-sensitive diseases appear in new places or at different times of the year? • Do we need extra training for volunteers? Is education on new health threats integrated into ongoing community awareness programmes?

What preventive actions can you take with early warning information? The next table shows examples of some early warning information that might be available for flooding Different information is available at different time scales Think about what actions you can take with each piece of information!

Timeframe Forecast Action? Years Increased risk of rainfall due to climate change Months Forecast of strongly above average rainfall for coming season Weeks High ground saturation Forecast of continued rainfall. High risk of floods Days High water levels upstream, more rain. Hours Flood water moving to affected areas

Timeframe Forecast Action? Years Increased risk of rainfall due to climate change Map risk-areas. Planning Improve watsan coverage Months Forecast of strongly above average rainfall for coming season Recruit/train more volunteers Stockpiling Weeks High ground saturation Forecast of continued rainfall. High risk of floods Refresher training for volunteers. Preposition stocks Days High water levels upstream, more rain. Equipment is ready for dispatch. Mobilize volunteers. Hours Flood water moving to affected areas Evacuate? Assess needs in evacuation shelters.

The 2008 actions of the West and Central Africa Zone (WCAZ) provide a model for the Movement to improve and scale-up the use of climate information, allowing translation of early warnings into early action for better disaster management and response. Some of the great ways the WCAZ utilized seasonal forecasts for life saving early action include: Employing “no-regrets” strategies to focus and plan for probable (but not certain) events. Monitoring forecasts on multiple time-scales, to reduce uncertainty in longer-term outlooks. Consulting multiple sources of forecast information for greater scientific consensus, including ACMAD (African Centre of Meteorological Application for Development) Utilizing tools that combined the seasonal precipitation forecast with hydrology for flood risk mapping (important since a precipitation forecast is not a flood forecast). Holding a meeting with key stakeholders to develop preparedness strategies. Issuing the first-ever Preliminary Emergency Appeal, and initiating changes that now make funds from the Disaster Response Emergency Fund (DREF) available for preparedness activities.

Early detection, early action Summary Same problems - changing patterns Combine detection, surveillance and baseline with the use of climate information to enhance early action Early detection, early action As a takeaway message: Climate change does not cause new diseases but will enhance the incidence and spreading of climate-sensitive diseases. The pattern of diarrheal, vector-, rodent- and food-borne diseases will change with increased occurrence of flooding, drought, heatwaves and heavy rain. We need to link the available climate information with disease patterns to improve surveillance and baseline preparedness. Early detection, early action across different time scales is essential to work a step ahead of natural disasters and disease outbreaks to protect human health.