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

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

storylines, suggesting that climate change is likely to have a limited impact. For the other diseases, the risk level varied across the storylines. For example, the risk of leishmaniasis varied from medium under current climate to high under both climate change storylines. The risk of schistosomiasis varied from very low (current climate and current vector distributions) to medium (climate change and focal introduction).68

Improving Climate Risk Management at Local Level –

Techniques, Case Studies, Good Practices and Guidelines for World Meteorological Organization Members 523

In collaboration with the Pan-American Health Organization (PAHO), the International Research Institute for Climate and Society, in partnership with the Center for International Earth Science Information Network (CIESIN) and the Mailman School of Public Health initiated a two-week course on Climate information for Public Health in 200869. It is held annually and "*provides a balance of concepts and methods from the health and climate communities using an approach deeply oriented toward methodology, gathering and using evidence for decisionmaking in order for the participants to get in-depth knowledge and skills in decision-making for* 

The course helps participants to recognize the role climate plays in driving the infectious disease burden and public health outcomes, understand management and data integration as an opportunity to improve the decision making process in Public Health and realize the benefits and limitations of different climate and environmental data sources including

As pointed out by the United Nations Task Team on Social Dimensions of Climate Change,

*"Global and regional one-size-fits-all climate analysis may not reflect the reality of a particular community or country and can under- or over-emphasize risks relevant to certain communities. The outcomes of downscaling should be incorporated where relevant and feasible, and combined with complementary mappings that may include social impact assessments and vulnerability maps, in order to identify social climate-induced hotspots (places where particularly severe problems may need to be addressed) and their intersection with other kinds of vulnerabilities such as lack of access to preventive and curative health services, that can reduce health vulnerability to climate change"71.* 

Health sectors in countries need to possess tools to conduct climate change vulnerability and adaptation assessments. "*The goal remains to better understand how climate variability and climate change can and do affect health risks today and in the future, in order to better inform policies and programmes that can protect public health"*70. However, once there is motivation for action*, "decision makers need to know the magnitude of potential risks and identify a range of options (including their feasibility, benefits, acceptability, effectiveness and costs); the availability of resources and their distribution across the population; and the structure of critical institutions, including the* 

The call for the production, availability, delivery and application of locally specific, sciencebased climate and meteorological information is a fundamental requirement for improving the application of CRM to address health risks. Integration of this information with appropriate health information and data will provide an opportunity, but also a challenge, to health authorities to demonstrate leadership within and outside the sector on mitigation

**Capacity building: Climate Information for Public Health:** 

remotely sensed data, meteorological data and climate predictions.

*health-care planning of climate sensitive diseases*"70.

*4.4.6. Lessons learned and the way forward* 

*allocation of* decision-making authority"72.

and adaptation to climate change in order to protect health.
