1. 1A.1 Vulnerability and Adaptation Assessments Hands-On Training Workshop Human Health Sector Kristie L. Ebi, Exponent Health Group

2. Outline Qualitative example WHO Inter-Regional Workshop on Health Impacts from Climate Variability and Change in the Hindu Kush-Himalayan Region Mukteshwar, India 3-7 October 2005 Quantitative example WHO Global Burden of Disease Sudan Initial National Communication

3. 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

4. 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

5. Current Burden of Disease in Bhutan Flood deaths/morbidity Glacial lake floods3 Flash3 Vector-borne disease Malaria1 Kala-azar1 Filariasis1 Water-borne diseases 2 Water scarcity, quality2 Drought-related food insecurity1

6. 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

7. 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

8. 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

9. 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

10. Data Sources WHO World Health Report Chapter 20 of the Global Burden of Disease Study Output from MAGICC-SenGen

11. 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

12. 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

13. 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

14. GBD Health Outcomes Considered Outcome ClassIncidence / prevalence Outcome Direct effects of heat and cold IncidenceCardiovascular disease deaths Foodborne & waterborne diseases IncidenceDiarrhoea episodes Vector-borne diseasesIncidenceMalaria cases Natural disastersIncidence Deaths due to unintentional injuries Other unintentional injuries Risk of malnutritionPrevalenceNon-availability of recommended daily calorie intake McMichael et al., 2004

15. 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

16. 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

17. 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

18. Sudan – Projected Increase in Transmission Potential of Malaria in 2030

19. Sudan – Projected Increase in Transmission Potential of Malaria in 2060

20. 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

21. 1A.21 Thank you