1. Social Vulnerability Sandy A. Johnson, Ph.D. 2006 Summer Colloquium on Climate & Health Boulder, CO

2. Definitions Risk – probability that a negative outcome will occur Risk factor – increases probability of a negative outcome Vulnerability – Ability to mitigate risk “In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.” - Eric Hoffer

3. Vulnerability Physical Environment Socioeconomic Sociocultural Political Environment Agency

4. Vulnerability Climate Pattern Relationship of climate pattern to well- being Identification of vulnerable populations Building sustainable adaptation

5. Effects of climatic events on malaria incidence Ave. rainfallEvent LowEpidemic – El Nino high temp. and rainfall in cool dry, high altitude areas Pakistan (37) Epidemic – high rainfall, arid/semiarid areas Kenya (6), Gujarat (3), Punjab (41) Epidemic – high temp. and rainfall, tropical highlands w/little moisture deficit Africa (234, 184) Epidemic – high rainfall with La Nina 1988, extend area of endemicity NE Venezuela (23) Lapse in transmission – flooding; hot-wet areas, flooding washes away breeding sites in southern African (190) (24) HighEpidemic – drought, humid areas w/ponding of rivers in Sri Lanka (41), Colombia (39, 256), drought in Venezuela (36) Source: Sutherst 2004

6. Health Resources Lost work Lost income Lost resources Health care expenses Death rites Increased poverty Decreased Productivity Increased Poverty Higher reproduction Social welfare Healthcare

7. Vulnerability Resources Risk Exposure

8. Mitigating health impacts Scale Accurate identification of the vulnerable (Mis)match of priorities Communication Sustainable, culturally competent strategy Time perspective Change in vulnerability over time Ethical considerations

9. Scale Population Neighborhood Household Individual

10. Identify the vulnerable National Vulnerabilities –Low income, especially rural –Women –Haitians Vulnerabilities in La Altagracia –Sugarcane workers, but less so than construction workers –Construction workers –Permanent residents near construction/tourist facilities

12. Priority Mismatch

13. Communication Know the audience Frame the issue –Cultural competency Semantic networks Priority match Appropriate messenger Build trust Positive communication Source: Moser 2006, Rogers 1962

14. Sustainable, Culturally Competent Strategy

15. Time Horizons To a man, a butterfly has but a short life. To a tree, a man’s life is but the blink of an eye. Taoist adage

16. Vulnerability in Flux Time Incidence Sources: Aral 2002, Suthrest 2004

17. Vulnerability in Flux

18. Ethical Dimensions Who are the winners and who are the losers? Will desired outcomes be achieved? What are foreseeable consequences? Are we harming anyone? Are we reducing suffering? Who is driving the agenda? Is the solution equitable and just?

19. Louisiana’s Katrina Mortality, July 20, 2006 RaceMortality based on 835 Total mortality is 1,577 African American -451 (53%) Caucasian334 (39%) Other33 (4%) Unknown 35(5%) Gender Male432 (53%) Female421 (47%) Age0 - 157 (< 1%) 16 - 205 (< 1%) 21 - 3013 (2%) 31 – 4026 (3%) 41 - 5075 (9%) 51 - 60119 (14%) 61 - 75196 (23%) 0ver 75388 (45%) Unknown24 (3%) Source: State of Louisiana Dept. of Health and Hospitals

20. FemaleMaleAfrican American Caucasian Proportion state 51%45%33%66% Proportion city 53%46%68%28% Female 47% Male 53% African American 53% Caucasian 39% Rate per 100,000 (Orleans Parish) 86899369 Age over 50 145 per 100,000

21. Source: Times Picayune, Oct. 2006

22. Tools Mixed methodologies Translational research Community-based Participatory Research / Participatory Action Research