1. Integrating Public Health and Adaptation Kristie L. Ebi, Ph.D., MPH Cities at Risk 28 February 2009

3. Prerequisites for Action  Awareness that a problem exists  Understanding of the causes  A sense that the problem matters  The capability to influence  The political will to deal with the problem Last 1998

4. Residual climate change-related health impacts Public Health Adaptation  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

5. Adaptation Mode, Level, and Stage (Examples shown are for malaria) 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 National

6. 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

7. Malaria in India Bhattacharya et al. 2006

8. Adaptation Measures to Reduce Health Outcomes Due to Floods  Legislative policies  Improve land use planning  Decision support tools  Early warning systems and emergency response plans  Technology development  Surveillance and monitoring  Alter health data collection systems to monitor for disease outbreaks during and after an extreme event  Infrastructure development  Design infrastructure to withstand projected extreme events  Other  Conduct research on effective approaches to encourage appropriate behavior during an extreme event

9. Climate Change Is About Children

10. Thank-you Krisebi@essllc.org