**4.4. CASE STUDY 4: Climate risk management and health: A call for user friendly climate information (Alexander von Hildebrand)**

Climate change poses significant threats to climate-sensitive health outcomes, for example, through increasing the risk of malnutrition due to reduced access to food, waterborne diseases resulting from flood- or drought-related contamination of food and water, and physical and psychological from trauma following more frequent and hasher extreme events.

The appearance of infectious diseases in new geographical areas in response to warmer temperatures, increases in precipitation, and/or other climatologically-related changes, will increase the burden of malaria and dengue, and the *"combination of increasing vulnerability and risk of weather-related hazards are expected to result in more extreme events and disasters"*63*.*  Children, the elderly, the poor – and amongst them, women – are expected to suffer most.

To assess the risks to human health posed by climate change and take appropriate actions to reduce their impacts, national health authorities need to know the current and potential future burden of climate-sensitive health outcomes, in order to adapt to the resulting demand for more and climate resilient health services. For this purpose, WHO has developed a Vulnerability and Adaptation Assessment Tool63. In order to implement it, user friendly climate and meteorological information is vital. This section will therefore discuss the importance and the urgent need for the availability of science-based climate and meteorological information as a pre-condition for managing climate risks to protect health from climate change.

#### *4.4.1. Role of CRM in health*

While the effects of climate on health are becoming better known, more needs to be done to achieve stronger engagement of the health sector and health professionals in climate-change action66. One key issue is managing uncertainty in climate and health sensitivity information, which poses significant problems for the health community in decision making processes. "*Climate and meteorological information are a major component of climate adaptation. Tools and knowledge systems which clarify and reduce uncertainty about the climate sensitivity of diseases, will be essential inputs to disease control policies such as malaria elimination, as well as preventing health risks from extreme weather events and climate variability."*67. Therefore, to adapt well to predicted changes of the climate system, "*climate and meteorological information must be taken into greater consideration in health science, practice, and policymaking*"66. To this end, the World Health Organisation (WHO) works with partners and collaborating Centres to develop tools, information resources, and dialogs which facilitate climate informed management of health risks.

### *4.4.2. CRM in the World Health Organization*

516 Risk Management – Current Issues and Challenges

events.

from climate change.

*4.4.1. Role of CRM in health* 

enhance rice productivity and better communication.

**friendly climate information (Alexander von Hildebrand)** 

management option, but limited agronomic knowledge and uncertainty associated with the future climate and associated financial risk pose barriers to relocation. The displacement of an existing intensively-produced crop, such as sugar would result in a much larger net national loss, also meaning that there would be a net reduction in regional income and outputs. It is concluded that there is unlikely to be a rapid increase in rice production in the north without more reliable future climate assessment to build confidence for making informed relocation decisions, infrastructure support, and R&D and extension support to

**4.4. CASE STUDY 4: Climate risk management and health: A call for user** 

Climate change poses significant threats to climate-sensitive health outcomes, for example, through increasing the risk of malnutrition due to reduced access to food, waterborne diseases resulting from flood- or drought-related contamination of food and water, and physical and psychological from trauma following more frequent and hasher extreme

The appearance of infectious diseases in new geographical areas in response to warmer temperatures, increases in precipitation, and/or other climatologically-related changes, will increase the burden of malaria and dengue, and the *"combination of increasing vulnerability and risk of weather-related hazards are expected to result in more extreme events and disasters"*63*.*  Children, the elderly, the poor – and amongst them, women – are expected to suffer most.

To assess the risks to human health posed by climate change and take appropriate actions to reduce their impacts, national health authorities need to know the current and potential future burden of climate-sensitive health outcomes, in order to adapt to the resulting demand for more and climate resilient health services. For this purpose, WHO has developed a Vulnerability and Adaptation Assessment Tool63. In order to implement it, user friendly climate and meteorological information is vital. This section will therefore discuss the importance and the urgent need for the availability of science-based climate and meteorological information as a pre-condition for managing climate risks to protect health

While the effects of climate on health are becoming better known, more needs to be done to achieve stronger engagement of the health sector and health professionals in climate-change action66. One key issue is managing uncertainty in climate and health sensitivity information, which poses significant problems for the health community in decision making processes. "*Climate and meteorological information are a major component of climate adaptation. Tools and knowledge systems which clarify and reduce uncertainty about the climate sensitivity of diseases, will be essential inputs to disease control policies such as malaria elimination, as well as preventing health risks from extreme weather events and climate variability."*67. Therefore, to adapt *"Each year, about 3.5 million people die from malnutrition, 2.2 million from diarrhoea, 800 000 from causes attributable to urban air pollution, and 60 000 in climate-related disasters, mostly in low resource settings and also frequently in humanitarian emergency situations. Climate change brings new challenges and costs to the control of infectious diseases as some are highly sensitive to temperature and rainfall, including cholera and the diarrhoeal diseases, as well as vector borne diseases including malaria, dengue and schistosomiasis. Climate change threatens to reverse the progress that the global public health community has been making against many diseases, and increase the challenges for the humanitarian community to respond to natural, biological and social emergencies."64*.

It is clear that climate factors play an important role in the definition of some human diseases. For other diseases where climate is only considered as one of many determinants, WHO have stated that it is also important to understand the various causal pathways from climate change through to health outcomes, in order to identify opportunities to address the environmental determinants of poor health outcomes.

WHO promotes *"measures to reduce the health impacts from climate risks and associated climate change, such as strengthening public health systems based on partnerships with multi-sectoral actors, enhancing capacity of health systems to reduce risks and respond to public health emergencies, protecting hospitals and other health infrastructure from climate risks and effects of climate change, strengthening surveillance and control of infectious disease against climate risk, improving the use of early warning systems by the health secto and building public health interventions at local level to increase community resilience."*65. Climate information is needed and should be available in ways that users in each country can understand, especially at the local level. This would facilitate the development of, for example, *"health action plans to enhance early warning and effective response over a range of time scales: from hours or days (for flood or heat wave warnings), to weeks (for seasonal epidemics of vector-borne disease), to months (seasonal forecasts of precipitation anomalies allowing planning for flooding or drought), to years (for drought and associated food insecurity)."*63.

#### *4.4.3. The WHO's Vulnerability and Adaptation Assessment Tool*

The Vulnerability and Adaptation Assessment Tool was developed by WHO to help manage climate risks to health (Fig. 14). It departs from gathering information on the extent and magnitude of current and future importance of climate dependent health outcomes, in order to identify policies and programmes that can prevent or reduce the severity of future health impacts.

A basic premise for the effective definition and, more importantly, implementation of a CRM process is to ensure the involvement and empowerment of the various stakeholders who will be responsible for implementing and assessing the results of the various actions to be undertaken is to establish an iterative process for monitoring and managing the health risks of climate change. Furthermore, to establish plans for communicating the CRM process *"The credibility and legitimacy of the assessment results will be increased if stakeholders and the intended end-users have been informed of and included in discussions throughout*."63.

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impacts of climate change, including the most vulnerable populations and regions, over the next decades and in the longer term. The analysis of results will help determine how well the health system is, or is not, prepared for example to changes in demand due to changes in the geographical distribution, and incidence or timing of climate-sensitive health outcomes. Gaps in health system response identified earlier, in steps 1 and 2, may be expanded upon

The information provided from implementation of the Vulnerability and Adaptation Assessment Tool enables the appropriate health experts to define the nature of additional public health policies and programmes that will likely be needed for effective health management, in order to address possible additional burden of adverse health outcomes due to climate change, and to define what policies and programmes are needed in other

Throughout the assessments, it is important to take into account that "*Future vulnerabilities may be different from current vulnerabilities because of changes in public health and health-care policies, governance and institutions, socioeconomic development, availability of human and financial resources, and other factors. Impacts can change with both changing vulnerabilities and environmental changes. Public health policies, programmes and interventions to address vulnerabilities and impacts will need to be revisited regularly to ensure continuing effectiveness in a* 

*4.4.4. The need to improve integration of baseline health and climate data for CRM* 

To implement well the Vulnerability and Adaptation Assessment Tool climate and weather data resources are required that are appropriate for health sector applications. This information is key to enable adequate answers to be established for the following questions:

Which regions and populations in a country are the most vulnerable to climate and

What are the health risks posed by climate change over the next decades and the longer

 How well is the health system prepared for changes in demand due to changes in the geographical distribution, incidence or timing of climate-sensitive health outcomes? To enable the analysis of relationships between current and past weather/climate conditions and health outcomes, relevant data is required both on health and climate. To date there have been only a few studies which have combined the most appropriate health and weather/climate data available, for example, from ministries of health and national meteorological and hydrological services, respectively. Improved integration of these data and the expertise that their host organizations provide would significantly improve the

The Vulnerability and Adaptation Assessment Tool invites the use of spatial mapping to describe the geographical distribution of current or projected future vulnerabilities and

during this step.

sectors to protect health.

*changing climate"63*.

climate change?

analyses necessary for CRM.

term?

**Figure 14.** *WHO Vulnerability and adaptation assessment tool* 

The three steps conducted in a particular assessment using the Vulnerability and Adaptation Assessment Tool will start with a description of the current burden of climatesensitive health outcomes and of the most vulnerable populations and region. It is important at this step to address the question: What factors other than weather and climate determine vulnerability of populations and health systems? The second step involves description of the current capacity of the health sector and other sectors to address these risks to climatesensitive health outcomes. The analysis of results from steps 1 and 2 will demonstrate gaps in the existing health system response. The third step tries to define how the burden of climate-sensitive health outcomes is likely to change over the coming decades, in order to asses the climate change vulnerabilities and their key drivers. This is done firstly irrespective of climate change, and then secondly taking into account the likely health impacts of climate change, including the most vulnerable populations and regions, over the next decades and in the longer term. The analysis of results will help determine how well the health system is, or is not, prepared for example to changes in demand due to changes in the geographical distribution, and incidence or timing of climate-sensitive health outcomes. Gaps in health system response identified earlier, in steps 1 and 2, may be expanded upon during this step.

518 Risk Management – Current Issues and Challenges

**Figure 14.** *WHO Vulnerability and adaptation assessment tool* 

A basic premise for the effective definition and, more importantly, implementation of a CRM process is to ensure the involvement and empowerment of the various stakeholders who will be responsible for implementing and assessing the results of the various actions to be undertaken is to establish an iterative process for monitoring and managing the health risks of climate change. Furthermore, to establish plans for communicating the CRM process *"The credibility and legitimacy of the assessment results will be increased if stakeholders and the* 

The three steps conducted in a particular assessment using the Vulnerability and Adaptation Assessment Tool will start with a description of the current burden of climatesensitive health outcomes and of the most vulnerable populations and region. It is important at this step to address the question: What factors other than weather and climate determine vulnerability of populations and health systems? The second step involves description of the current capacity of the health sector and other sectors to address these risks to climatesensitive health outcomes. The analysis of results from steps 1 and 2 will demonstrate gaps in the existing health system response. The third step tries to define how the burden of climate-sensitive health outcomes is likely to change over the coming decades, in order to asses the climate change vulnerabilities and their key drivers. This is done firstly irrespective of climate change, and then secondly taking into account the likely health

*intended end-users have been informed of and included in discussions throughout*."63.

The information provided from implementation of the Vulnerability and Adaptation Assessment Tool enables the appropriate health experts to define the nature of additional public health policies and programmes that will likely be needed for effective health management, in order to address possible additional burden of adverse health outcomes due to climate change, and to define what policies and programmes are needed in other sectors to protect health.

Throughout the assessments, it is important to take into account that "*Future vulnerabilities may be different from current vulnerabilities because of changes in public health and health-care policies, governance and institutions, socioeconomic development, availability of human and financial resources, and other factors. Impacts can change with both changing vulnerabilities and environmental changes. Public health policies, programmes and interventions to address vulnerabilities and impacts will need to be revisited regularly to ensure continuing effectiveness in a changing climate"63*.

#### *4.4.4. The need to improve integration of baseline health and climate data for CRM*

To implement well the Vulnerability and Adaptation Assessment Tool climate and weather data resources are required that are appropriate for health sector applications. This information is key to enable adequate answers to be established for the following questions:


To enable the analysis of relationships between current and past weather/climate conditions and health outcomes, relevant data is required both on health and climate. To date there have been only a few studies which have combined the most appropriate health and weather/climate data available, for example, from ministries of health and national meteorological and hydrological services, respectively. Improved integration of these data and the expertise that their host organizations provide would significantly improve the analyses necessary for CRM.

The Vulnerability and Adaptation Assessment Tool invites the use of spatial mapping to describe the geographical distribution of current or projected future vulnerabilities and

hazards. "*A geographical perspective and the use of geographical information systems (GIS) offer opportunities to show current distributions of, for example, vulnerable populations and the spatial relationship to disease vectors, river basins prone to flooding, health facilities, and other important variables of interest to public health officials*"63.

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qualitative assessment was conducted as a first step to generate this information. Expert judgment was used to determine the extent to which climate-sensitive diseases could be a concern in populations in mountainous and non-mountainous regions of six countries

Country Afghanistan Bangladesh Bhutan China Nepal India

Heatwaves M-P P - P P P

deaths/morbidity P P P P P P Glacial lake floods M-P - M-P M-P M-P M-P Flash floods M-P P M-P M-P M-P M-P Riverine floods P P - P P P Vector-borne disease P P P P P P Malaria P P P P M-P P Japanese encephalitis - P - P P P Kala-azar P - - - P P

Waterborne diseases M-P M-P M-P M-P M-P M-P Water scarcity, quality M-P P P M-P M-P M-P

insecurity M-P P – M-P – M-P

Source: Kristie L. Ebi, Rosalie Woodruff, Alexander von Hildebrand and Carlos Corvalan (2007). Climate change-

**Table 8.** Current climate-related health determinants and outcomes in the Hindu Kush–Himalaya

**Qualitative estimates of future health impacts of climate change using expert** 

During the assessment of health risks and responses in the first Portuguese national assessment, a qualitative assessment was conducted of the possible impacts of climate change on vector-borne diseases, including malaria, West Nile virus, schistosomiasis, Mediterranean spotted fever and leishmaniasis; the latter two are endemic to Portugal.

Although human cases of vector-borne diseases have generally decreased over recent decades, many competent vectors are still present in Portugal. Disease transmission risk was categorized qualitatively based on vector distribution and abundance and pathogen prevalence. Four brief storylines of plausible future conditions were constructed based on current climate and projected climate change, and assuming either the current distribution and prevalence of vectors and parasites, or the introduction of focal populations of parasite infected vectors. These storylines were discussed with experts to estimate transmission risk levels. For Mediterranean spotted fever, the risk of transmission was high under all

M-P health determinant or outcome occurs in mountainous and non-mountainous (i.e. plains) areas;

P health determinant or outcome occurs only in non-mountainous areas;

related health impacts in the Hindu Kush-Himalayas. Ecohealth, 4:264–27067

– health determinant or outcome is not present in the country (WHO/SEARO, 2006).

(Table 8).

Flood

regions

**judgment:**

Dengue – P P P – P

Drought-related food

It is important to keep in mind the following caution when models are used to project the health risks of climate change. "*Modeling can be a complex undertaking requiring highly technical expertise and specific data inputs that take time and effort to acquire. The capacity to design and run models to project health impacts can be developed through training courses and other mechanisms. A goal of the assessment could be to build research capacity and increase the availability of models to project health impacts in future studies*"63.

It is all about what happens locally. "*Risk management works best when tailored to local circumstances. Combining local knowledge with additional scientific and technical expertise helps communities reduce their risk and adapt to climate change (robust evidence, high agreement)*"63.

The health impacts that may occur in a particular location will depend on the actual climate and climate changes experienced and the vulnerability of the community and region. Qualitative data may allow changes to be assessed over short time periods, but, it is clear that "*Models are generally used to quantitatively estimate how the health risks of climate change could increase or decrease over time, particularly for longer time periods*"70. Indeed, "*models can explore the range of potential impacts of a changing climate in the context of other drivers of population health to better understand where, when and in what population groups' negative health outcomes could occur*."63.

For decision-makers, it is important to have certainty that their decisions are "climateproof". The availability and use of locally specific *c*limate and meteorological information relevant to health outcomes is vital for these decisions63.

## *4.4.5. Examples of good practice in CRM for health*

WHO developed a Technical Document on Vulnerability and Adaptation Assessment Tool with input from over 20 countries that designed to provide basic and flexible guidance on conducting national or sub-national vulnerability and adaptation assessments. The document provides examples and references for users63. Some examples of practice provided in this document that would benefit from better access to climate information are the following:
