Protecting our Health from Climate Change: a Training Course for Public Health Professionals Chapter 5: Policy Responses to Address the Health Risks of Climate Change

Overview: This Module  Overview of mitigation and adaptation policies to manage the health risks of climate change

IPCC 2007a

Urgent Action Is Needed

CO 2 Emissions and Equilibrium Temperature Increases for a Range of Stabilization Levels IPCC 2007a

Achievable Mitigation Options Exist for All Key Emission Sectors  Energy supply  Transport  Buildings  Industry  Agriculture  Forestry/forests  Waste

Mitigation Can Provide Significant Health Co-Benefits  Estimates of the co-benefits of reducing air pollution from coal-fired power plants and transport suggest that the immediate health benefits will be significant  These co-benefits need to be included in a comprehensive assessment of mitigation options.  Examples include –Cleaner vehicles can reduce urban air quality, reducing morbidity and mortality from air pollutants –Transport policies can increase public transport and create more walkable-friendly cities

Climate Change and Air Quality Policies Bell et al. 2008

Developed Countries Have Emitted Most of the Greenhouse Gases IPCC 2007b

UK Climate Iimpacts Program 2006 Mitigation and Adaptation as Risk Management

Vulnerability  The degree to which individuals and systems are susceptible to or unable to cope with the adverse effects of climate variability and change. Vulnerability is a function of: –Sensitivity to changes in weather and climate (exposure-response relationship), including population characteristics –Exposure –Adaptation baseline

Adaptation Actions taken by individuals, institutions, and governments  Anticipatory (actions taken in advance of climate change effects)  Responsive The severity of impacts will depend on the capacity to adapt and its effective deployment

Adaptation Baseline  What is being done now to reduce the burden of disease? How effective are these policies and measures?  What could be done now to reduce current vulnerability? What are the main barriers to implementation (such as technology or political will)?  What measures should begin to be implemented to increase the range of possible future interventions?

Adaptation vs. Prevention  Adaptation is the term used by the climate change community to describe the process of designing, implementing, monitoring, and evaluating measures intended to reduce climate change-related impacts  Adaptation is analogous to public health prevention –Primary prevention aims to prevent the onset of disease (such as by providing access to safe drinking water) –Secondary prevention entails preventive action in response to early evidence of health effects (including strengthening disease surveillance programs) –Tertiary prevention consists of measures (often treatment) to reduce suffering caused by existing disease

Context for Adaptation  Climate change is one of many factors influencing human health and social well- being  Public health challenges presented by climate change need to be addressed within the context of issues such as access to clean water and sanitation, inadequate nutrition, and diseases such as HIV/AIDS  Poverty is a major factor

Effective Interventions are Designed with Stakeholders

Questions for Designing Adaptation Policies and Measures  Adaptation to what?  What is currently being done to reduce the burden of disease? –How effective are these policies and measures? –Are additional interventions needed?  What are the projections for the outcome? –Who is vulnerable?  Who adapts? How does adaptation occur?  When should interventions be implemented?  How good or likely is the adaptation?  Apply win/win or no-regrets strategies.

Adaptation Measures to Reduce Vectorborne Diseases  Decision support tools –Early warning systems  Technology development –Vaccines and more rapid diagnostic tests  Surveillance and monitoring –Effective vector surveillance and control programs that incorporate climate change concerns  Infrastructure development –Consider possible impacts of infrastructure development, such as water storage tanks

Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Biological Adaptive Behavioral Useof bednets Biological Adaptive immunity Social Surveillance Hlthsystems Social Surveillance Hlthsystems Behavioral Useof bednets Mode intervention National Stage of intervention Level of intervention Community or group Individual Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Primary Vaccination, dams Secondary Early warning Tertiary Early treatment Biological Adaptive Behavioral Useof bednets Biological Adaptive immunity Social Surveillance healthsystems Social Behavioral Useof bednets National intervention Level of intervention Community or group Individual Other institutions intervention ofMode Global Stage of Based on McMichael and Kovats 2000 National Adaptation Mode, Level, and Stage (examples shown are for malaria)

Lowest malaria incidence years Highest malaria incidence years Use of Climate-Health Data for Early Warning Systems Thomson et al Observed summer (Dec-Feb) rain Forecast (November- modeled) summer rain Derived relationship between summer rainfall and subsequent annual malaria incidence  used successfully for forecasting malaria

Anticipatory Adaptation Should Meet Two Criteria  Flexibility –Performs well under a variety of climates Current climate Hotter and drier Hotter and wetter  Efficiency –Benefits exceed costs –Consider Timing of climate change benefits Benefits under current climate (benefits independent of climate change)

Process Is as Important as Outcome  Need to include stakeholders and policy-makers –This is an expression of values, not a purely analytic exercise  Constraints and barriers need to be explicitly addressed  Adaptation will affect and be affected by development pathways –Within the context of other pressing health needs  Taking a risk management approach likely to be the most effective –Monitoring and evaluation important components

Residual climate change-related health impacts Public Health Responses to the Risks of Climate Change  Reduce exposures –Legislative policies –Alterations in built environment –Alterations in natural environment  Prevent onset of adverse outcomes –Early warning systems –Surveillance and monitoring –Vector control programs –Public education and outreach  Response / treatment –Medical training and awareness –Treatment –Emergency response