1. 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

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

3. You have seen this figure before
You have seen this figure before. Again, the yellow/gold line shows the climate change to which the Earth is committed. The temperature pathway the Earth follows over the century will depend on how quickly greenhouse gas emissions are reduced (mitigation). The degree to which this change will affect human health will depend on effective and timely interventions to manage risks (adaptation). Mitigation and adaptation are the two main policy responses to the risks of climate change. Each are equally important.
IPCC 2007a 3

4. Urgent Action Is Needed
Global environmental changes are affecting climate, which in turn will impinge on, in profoundly adverse ways, some of the most fundamental pillars of life: food, air and water.
The main drivers behind these global changes are both natural and, increasingly, human pressure. The disruption of environmental factors will have most significant impacts on health. By adapting we will reduce those adverse impacts. At the same time, we need to reduce our pressure on the environment, through mitigation measures. 4

5. CO2 Emissions and Equilibrium Temperature Increases for a Range of Stabilization Levels
The left figure shows the global CO2 emissions for 1940 to 2000 and emissions ranges for categories of stabilization scenarios from 2000 to The right figure shows the corresponding relationship between the stabilization target and the likely equilibrium global average temperature increase above pre-industrial.
Approaching equilibrium can take several centuries, especially for scenarios with
higher levels of stabilization. Colored shadings show stabilization scenarios grouped according to different targets (stabilization category I to VI). The right figure shows ranges of global average temperature change above pre-industrial, using (i) a “best estimate” climate sensitivity of 3°C (black line in middle of shaded area), (ii) an upper bound of the likely range of climate sensitivity of 4.5°C (red line at top of shaded area), and (iii) a lower bound of likely range of climate sensitivity of 2°C (blue line at bottom of shaded area). The black dashed lines in the left panel give the emissions range of recent baseline scenarios. Emissions ranges correspond to the 10th-90th percentile of the full scenario distribution.
Stabilising CO2 at 450 ppm by 2100 would require global emission reductions of about 55-60% by 2050.
IPCC 2007a 5

6. Achievable Mitigation Options Exist for All Key Emission Sectors
Energy supply
Transport
Buildings
Industry
Agriculture
Forestry/forests
Waste
Examples of mitigation options include:
Energy – improved supply and distribution efficiency; fuel switching from coal to gas; renewable heat and power
Transport – More fuel efficient vehicles; hybrid vehicles
Buildings – Efficient lighting and day lighting; more efficient electrical appliances and heating and cooling devices; improved cook stoves
Industry – More efficient end-use electrical equipment; heat and power recovery
Agriculture – Improved crop and grazing land management to increase soil carbon storage; restoration of cultivated peaty soils and degraded land
Forestry/forests – Afforestation; reforestation; forest management
Waste – Landfill methane recovery; waste incineration with energy recovery
Public health can make significant contributions to greenhouse gas emission reductions through more energy efficient infrastructure, reducing waste, and other actions. 6

7. 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
“There is high agreement and much evidence that mitigation actions can result in near-term co-benefits (e.g. improved health due to reduced air pollution) that may offset a substantial fraction of mitigation costs”, IPCC, 2007.
Most sources of GHG emissions also emit ‘conventional’ air pollutants which have negative impacts on human health. Many, but not all GHG mitigation measures reduce these air pollutants. According to the 2002 WHO Global Burden of Disease Report, urban air pollution causes annual deaths
According to the 2002 WHO Global Burden of Disease Report, there is an annual loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity. Mass marketing and availability of junk food and ‘supersized’ portions, (production of which also leads to GHG emissions) as well as sedentary lifestyles lead to obesity. Globally, physical inactivity accounted for 21.5% ischaemic heart disease cases; 11% of ischaemic stroke cases; 14% cases of diabetes; 16% cases of colon cancer and 10% cases of breast cancer. Urban planning and transport policies at the local level can be part of the answer. Short trips made in cars covering distances of less than 3 km. can be covered in 15 – 20 minutes by bicycle or in minutes by brisk walking. This corresponds to the recommended daily dose of at least 30 minutes of regular, moderate-intensity physical activity.
Co-benefits of GHG mitigation on human health can be substantial, especially in respect of measures in the domestic sector in developing countries. These co-benefits need to be included in a comprehensive assessment of mitigation options.

8. Climate Change and Air Quality Policies
Using this framework, Bell et al. evaluated publications on the co-benefits of greenhouse gas emissions. They found that most assessments relied more heavily on one aspect of the framework (e.g., economic analysis). While a wide range of methods was applied to various policies and regions, results from multiple studies provide strong evidence that the short term public health and economic benefits of ancillary benefits related to GHG mitigation strategies are substantial. Further, results of these analyses are likely to be underestimates because there are a number of important unquantified health and economic endpoints.
Bell et al. 2008 8

9. Developed Countries Have Emitted Most of the Greenhouse Gases
As shown in this graphic, high-income countries are responsible for nearly all atmospheric greenhouse gases. This raises issues of environmental justice, including what are the responsibilities of high-income countries to help low- and middle-income countries adapt to the observed and projected impacts of climate change.
IPCC 2007b 9

10. Mitigation and Adaptation as Risk Management
There are multiple frameworks for risk management; all have similar components. This framework was developed by the UK Climate Impacts Programme ( and illustrates the basic steps in managing climate risks.
UK Climate Iimpacts Program 2006 10

11. 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
Vulnerability is the degree to which individuals and systems are susceptible to or unable to cope with the adverse effects of climate change, including climate variability and extremes. The vulnerability of human health to climate change is a function of:
Sensitivity, which includes the extent to which health, or the natural or social systems on which health outcomes depend, are sensitive to changes in weather and climate (the exposure–response relationship) and the characteristics of the population, such as the level of development and its demographic structure
The exposure to the weather or climate-related hazard, including the character, magnitude and rate of climate variation
The adaptation measures and actions in place to reduce the burden of a specific adverse health outcome (the adaptation baseline), the effectiveness of which determines in part the exposure–response relationship. 11

12. 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 includes the strategies, policies and measures undertaken now and in the future to reduce potential adverse health effects. A primary goal of building adaptive capacity is to reduce future vulnerability to climate variability and change. Adaptation actions will be taken at all levels, including our individual actions as well as programs and activities implemented by national agencies and institutions. These actions can be proactive, anticipating adverse health outcomes, or in response to observed climate change. The severity of impacts actually observed will depend on the capacity to adapt and its effective deployment. 12

13. 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?
Answering these questions will provide a picture of current programs and activities to reduce the burden of climate sensitive-health outcomes, as well as what could be done to reduce the current and projected future risks of climate variability. 13

14. 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
Public health has extensive experience with prevention that will help with adapting to climate change. 14

15. 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
Of course, climate change is not the only driver of climate-sensitive health outcomes. These factors will interact in a variety of ways that can affect the health risks of climate change. 15

16. Effective Interventions are Designed with Stakeholders
It is critically important to include stakeholders in the design, deployment, and monitoring of adaptation measures. This photo is of a half-page alert from the Health Department in Delhi, India that was published in a newspaper in November Dengue fever is a public health problem in Delhi; the virus is carried by certain Aedes mosquitoes. This alert provides information what actions the public is required to take, and the consequences of inaction. Such alerts would not be effective in places where the public views vector control as the responsibility of the government or other entity. 16

17. 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.
These questions need to be addressed when designing adaptation policies and measures. Adaptation to what – is adaptation required to flooding, the spread of vector-borne disease, etc.? The policies and measures implemented must be specific to both the weather/climate hazard and the health outcome of concern.
The effectiveness of interventions needs to be determined before improving current programs or implementing new ones. Are there additional interventions that could reduce the current burdens of climate-sensitive health outcomes? Would a heat event early warning system be useful? Additional surveillance? Etc.
Using projections of changes in climate and socioeconomic conditions, what are the likely impacts? Which population groups are likely to be at the highest risk? For example, aging of populations in developed countries is likely to increase population vulnerability to heat events.
Who will undertake the adaptations – individuals, communities, nations? Will the adaptation be reactive to climate change or proactive? How can the process be facilitated?
When should the interventions be implemented? For example, there is concern about malaria spreading to highland areas of Africa. Surveillance systems should be established at the edges of the current distribution where changes in temperature and/or precipitation could provide a suitable climate for malaria vectors. Once surveillance has identified the presence of the vectors, then programs to distribute treated bednets could be implemented.
Finally, the effectiveness of all interventions should be monitored and evaluated to ensure that public health funds are being used effectively and efficiently. 17

18. 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
Here are some examples of adaptation measures to reduce the geographic spread and increased incidence of vectorborne diseases that are projected to occur in some areas. There are multiple categorization schemes for adaptation measures; this categorizes measures into those that are primarily decision support tools, those where technology development is needed, those requiring modification or implementation of surveillance and monitoring programs, and those where infrastructure development would increase resilience to vectorborne diseases. 18

19. Adaptation Mode, Level, and Stage (examples shown are for malaria)of
intervention
intervention
Stage of
Stage of
intervention
intervention
Social
Surveillance
Hlth
systems
Social
Social
Social
Social
Biological
Biological
Biological
Biological
Behavioral
Behavioral
Behavioral
Behavioral
Adaptive
Adaptive
Adaptive
Adaptive
Use
Use
Use
Use of of of of
Surveillance
immunity
immunity
bednets
health
systems
bednets
bednets
bednets
Other institutions
Primary
Primary
Primary
Primary
Tertiary
Tertiary
Tertiary
Tertiary
Vaccination
Vaccination,
Vaccination
Vaccination
Early
Early
Early
Early
Community
Community
Global
dams
Dams
Dams
Dams
treatment
treatment
treatment
treatment
or group
or group
Individual
Another categorization of adaptation measures is into the mode of intervention (i.e. biological, behavioral, or social), the level of intervention (i.e. individual, community, national, or global), and the stage of intervention (primary, secondary, or tertiary). There are advantages for all categorization schemes; the one that works best in a particular situation will depend on the needs of the stakeholders.
Individual
National
National
National
National
Secondary
Secondary
Secondary
Secondary
Early
Early
Early
Early
warning
warning
warning
warning
Level of
Level of
intervention
intervention
Based on McMichael and Kovats 2000 19

20. Use of Climate-Health Data for Early Warning Systems
Observed summer (Dec-Feb) rain
Forecast (November- modeled) summer rain
Highest malaria incidence years
Derived relationship between summer rainfall and subsequent annual malaria incidence  used successfully for forecasting malaria
Lowest malaria incidence years
There is increasing interest in early warning systems for climate-sensitive health outcomes. This is an example of an early warning system for malaria in Botswana. Malaria incidence is associated with summer rainfall and so can be used to forecast a probable epidemic with enough lead time for distribution of bednets and other interventions to reduce the impact of an epidemic.
Thomson et al. 2006 20

21. 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)
Planned adaptations should meet at least these two criteria. The program or measure should be flexible enough that it will be beneficial no matter how the climate changes; this means that the adaptation should perform well under current climatic conditions as well as be expected to perform well in a hotter and either wetter or drier climate.
The program or measure also should be efficient, in that the benefits should exceed the costs. Benefits and costs can be measured quantitatively or qualitatively, and should include consideration of intangible benefits and costs of importance to affected communities. This can be complex to evaluate because the timing of costs and benefits. 21

22. 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
When considering adaptation, the process often is as important as the outcome. Adaptation will be an ongoing process, thus ensuring that the process is appropriate will form an important basis for future efforts. As noted on the slide, adaptation is an expression of values, not just an analytic exercise. Constraints and barriers to implementation need to be explicitly addressed. The process needs to take into consideration that adaptation will affect and be affected by development pathways. As discussed earlier, taking a risk management approach will likely be most effective.
Risk management should consider both adaptation and mitigation, as both are needed to effectively manage the immediate and longer-term risks of climate change. 22

23. 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
As noted earlier, public health interventions are traditionally categorized as primary, secondary, and tertiary prevention; or reduce exposures, prevent the onset of adverse health outcomes, and effective response and treatment. There are a wide range of possible interventions to avoid, prepare for, and respond to the health risks of climate change; some of these address both mitigation and adaptation. Interventions will be discussed in more detail in a later lecture. It is important to note that even with effective and timely implementation of interventions, there may be residual health impacts due to climate change.
Recommended reading: IPCC 2007 report, Summary Report, Pages44 to 53; The Physical Science Basis, pages 81 to 91 (T.S 6)
Residual climate change-related health impacts 23