Climate Change, Vulnerability and Health: A guide to Assessing and Addressing the Health Impacts

Transcription

1 Curtin University Climate Change, Vulnerability and Health: A guide to Assessing and Addressing the Health Impacts Jeff Spickett, Dianne Katscherian, Helen Brown WHO Collaborating Centre for Environmental Health Impact Assessment School of Public Health Faculty of Health Sciences July 2012

2 Table of Contents Glossary of terms... 4 Preface... 6 Introduction... 7 Figure 1: Examples of potential direct and indirect health impacts of temperature increase in Summary of the Climate Change and Health process Table 1 Health Impact and Climate Change Summary of the process Part 1 Preliminary steps The Determinants of Health...13 Table 1.1 Health aspects and impacts which could be considered Developing a Communications Strategy Community Profiling Establishing a Stakeholder Engagement Strategy...17 Table 1.2 Consultation for Health Part 2 Climate variables and their influence on the environment and other factors that relate to human health Establishing a future scenario Predictions of environmental changes...19 Table 2.1 Climatic variables and their influence on environmental and other factors 20 Part 3 Determination of potential health impacts Vulnerability...22 Figure 2: Components of Vulnerability Figure 3: Adaptive Capacity and Coping Capacity Figure 4: Common Aspects of Vulnerability Adaptive Capacity...26 Table 3.1 Health Impacts - Physical Environment Table 3.2 Health Impacts - Infrastructure Table 3.3 Health Impacts Environmental Diseases Table 3.4 Health Impacts Social Environment Table 3.5 Coping Capacity Part 4 Risk Assessment and Ranking The Risk Assessment Process...33 Consequence Rating Likelihood Rating Risk priority Levels Evaluation Table 4.1 Risk Levels Table 4.2 Example of the structure for Table 4 for Water-borne risks Table 4.3 Example of table for ranking potential health impacts of climate change with their level of risk Part 5 Adaptation Measures Figure 5: Health Impact Pathway Opportunities for Adaptation Figure 6: Climate Change and coping capacity The Development of adaptation strategies...41 Adaptation strategies...42 Table 5.1 Direct Physical Impacts of Extreme Events Table 5.2 Direct Health Impacts of Temperature Related Changes

3 Table 5.3 Water-Borne Diseases and Water Quality Table 5.4 Vector-Borne Diseases Table 5.5 Air Quality and Associated Health Impacts Table 5.6 Food-borne Disease Table 5.7 Food Production Table 5.8 Social/Community/Lifestyle Table 5.9 General Adaptation Measures Part 6 Adaptation Strategy and Actions Table 6 Adaptation Strategy and actions Part 7 The Climate Change and Health Adaptation Strategies Report Report outline suggested format

4 Glossary of terms Adaptation Adaptive Capacity Biodiversity Climate Change Co-benefit Coping capacity Extreme Weather Event Hazard Health Impact Assessment Health Risk Assessment Adjustment in natural or human systems to a new or changing environment. Adaptation to climate change refers to adjustment in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities. Various types of adaptation can be distinguished, including anticipatory and reactive adaptation, public and private adaptation, and autonomous and planned adaptation. The ability of a system to adjust to climate change (including climate variability and extremes) to moderate potential damages, to take advantage of opportunities, or to cope with the consequences The numbers and relative abundances of different genes (genetic diversity), species, and ecosystems (communities) in a particular area Climate change refers to any change in climate over time, whether due to natural variability or as a result of human activity A climate change adaptation or mitigation strategy which has additional, positive effects on health or other areas (eg. reducing air pollution) The means by which people or organizations use available resources and abilities to face adverse consequences that could lead to a disaster. In general, this involves managing resources, both in normal times as well as during crises or adverse conditions. The strengthening of coping capacities usually builds resilience to withstand the effects of natural and human-induced hazards. An event that is rare within its statistical reference distribution at a particular place. By definition, the characteristics of what is called "extreme weather" may vary from place to place. An "extreme climate event" is an average of a number of weather events over a certain period of time, an average which is itself extreme (e.g., rainfall over a season) The capacity of an agent to produce a particular type of adverse health or environmental effect A systematic process to assess the actual or potential, and direct or indirect, effects on the health of individuals, groups or communities arising from policies, objectives, programs, plans or activities The process of estimating the potential impact of a chemical, biological, physical or social agent on a specified human population system under a specific set of conditions and for a certain time-frame 4

5 Impacts Consequences of climate change on natural systems and human health Infrastructure The basic equipment, utilities, productive enterprises, installations, and services essential for the development, operation, and growth of an organization, city, or nation Mitigation Risk Sea-Level Rise Sensitivity Vector Vector-Borne Diseases Vulnerability The process of reducing the impact of climate change by reducing the driving forces thereof (ie. reducing greenhouse gas emissions) The probability that, in a certain timeframe, an adverse outcome will occur in a person, group of people, plants, animals and/or the ecology of a specified area that is exposed to a particular dose or concentration of a hazardous agent i.e. it depends on both the level of toxicity of the agent and the level of exposure An increase in the mean level of the ocean Sensitivity is the degree to which a system is affected, either adversely or beneficially, by climate-related stimuli The effect may be direct (e.g., a change in crop yield in response to a change in the mean, range, or variability of temperature) or indirect (e.g., damages caused by an increase in the frequency of coastal flooding due to sea level rise) An organism, such as an insect, that transmits a pathogen from one host to another Disease that is transmitted between hosts by a vector organism (such as a mosquito or tick) The degree to which a system is susceptible to, or unable to cope with, adverse effects of climate change, including climate variability and extremes. Vulnerability is a function of the character, magnitude, and rate of climate variation to which a system is exposed, its sensitivity, and its adaptive capacity 5

6 Preface The health impacts of climate change are significant, measurable and farreaching. Over the last decade it was estimated that, each year, between and deaths worldwide were attributable to the effects of climate change. Due to their unique geography, topography and climate, each country is likely to have sections of the community that are more vulnerable to the impacts of climate change; including risks to human health. The trends in climatic change will impact human populations through the effects on the physical and biological components of the environment. Global efforts are being made to mitigate climate change and reduce greenhouse gas emissions. However it has been accepted that some change will occur and that individuals and communities will need to adapt to these changed environmental circumstances to avoid adverse consequences. The severity of possible impacts on communities will be dependent on our ability to adapt to situations and environments that may be quite different from those we have now. The World Health Organisation Collaborating Centre for Environmental Health Impact Assessment at Curtin University, Western Australia recognised that the Health Impact Assessment process provides an appropriate means by which the potential impacts of climate change can be assessed. Health Impact Assessments of Climate Change project have been undertaken in collaboration with government and other stakeholders in several countries to consider the implications of climate change on the health of the community and to develop a range of adaptive responses to provide government with the basis for future decision-making. The process comprises six main parts: preliminary steps, identification of climate variables and influence on the environment, identification of potential health impacts and current controls, risk assessment and ranking, development of adaptation measures, development of strategies and action plans. It was recognised that the lack of detailed knowledge of future climatic conditions in different regions and countries, the future distribution and densities of populations and the development of associated infrastructure does not allow for a comprehensive and quantitative assessment of health impacts. It is expected that emerging from this process will be a good understanding of current activities, their adequacy with respect to health and a range of adaptations and required supporting research. The outcomes from applying this process should provide a proactive approach to the protection of the health of communities in the country or region concerned from any adverse environmental impacts associated with climate change. They form the basis for future planning and decision making by governments and other relevant sectors and adaptive responses that can be taken up by society. Jeff Spickett Dianne Katscherian 6

7 Introduction Management of climate change generally falls under two major areas: mitigation and adaptation. The long-term importance of mitigation is critical as the degree to which global climatic conditions will change is subject to the efforts that can be made in the near future to reduce greenhouse gas emissions to the atmosphere. However, even with the most optimistic mitigation scenarios, projections indicate significant changes to climatic conditions will occur, particularly over the next 50 to 100 years. Therefore it is important that adaptation to projected climate change over the next 30 years on a country or area basis can be developed and implemented. Uncertainty is a part of any planning for the future, perhaps more so with climate change than any other situation in recent history. While there is consensus on the broader potential health impacts of climate change on people, actual health outcomes for specific population groups are still largely unidentified. Regardless of the uncertainty, it is clear that we need to plan to protect our health from risks associated with climate change. This planning must be done in conjunction with all levels of society at each location. The World Health Organisation (WHO) definition for environmental health provides a basis on which to establish the range of health determinants that may be affected by climate change and the factors that require consideration. Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics (WHO, 2012) Health Impact Assessment (HIA) is a formal process that considers potential health issues during the planning stages of proposal development. HIA s aim to identify and examine both the positive and negative health impacts of activities and provide decision makers with information about the manner in which the activity may affect the health of people. The HIA framework follows the format of: o Screening o Scoping o Profiling o Risk assessment o Risk management o Decision making 7

8 o Evaluation The HIA framework has been modified to enable consideration of potential impacts to health from climate change. It uses the establishment of a single possible scenario rather than multiple predictions of future climatic conditions and biophysical changes in the specified location. The process used can then form the basis for updates in the development of strategies for the mitigation and adaptation with respect to the health impacts of climate changes in the location as more information becomes available on the predicted changes to climatic parameters. The key elements of this process include consideration of key potential health impacts, vulnerability, assessment of risk and planning for adaptation. The specific processes for these elements are described in more detail in the following chapters. A chain of events or pathways for each potential health impact can be constructed to provide a logical analytical framework to address the: Identification of vulnerable groups, regions or sectors Assessment of current coping capacity and the need for adaptation Identification and development of opportunities for adaptation Identification of gaps in current knowledge needed for assessment of coping capacity and/or development of adaptation Identification of the appropriate sectors involved in each link of the pathway Health impact pathways, such as shown in Figure 1, provide a simplified representation of the links between climate, the environment and health to demonstrate the complex relationships that can be used as a starting point for more in-depth analysis. This figure provides an example of some of the possible health impact pathways that might arise from gradual average increases in temperature by The impacts are likely to be positive and negative; direct or indirect. Direct physical impacts of high temperatures, such as heat exhaustion, are likely to increase, whilst physical impacts from cold temperatures such as the incidence of influenza may decrease. Indirect impacts on food production and mosquito breeding patterns are highly likely, but the extent and direction of such impacts is unclear at the moment. Other climatic variables, such as changes in rainfall and extreme weather events, will also play a role, as will non-climatic variables such as land cover changes, urbanisation and salinity. And, the potential health impacts of these variables will also depend on a wide range of other determinants. 8

9 Figure 1: Examples of potential direct and indirect health impacts of temperature increase in Temperature Increase Increase in heat stress, dehydration. Decrease in cold-related illnesses. Change in available breeding sites for mosquitoes Changes in the incidence of mosquito-borne diseases Changes in food production Changes to cost of fresh food Changes in fresh food consumption Impacts on a range of health issues related to diet Possible income reduction for farmers Increase mental health issues for farmers 9

10 Summary of the Climate Change and Health process It is important that to undertake a project that assesses potential impacts to health from climate change and develop adaptation strategies, a Project Team is established for coordination. This Team does not need to be large but should comprise representatives from the health sector (public and private), the coordinating climate change group for the region plus others with particular interest in the outcomes of the project. These last could include representatives from decision-making groups, other government sectors, community and business representatives and research sectors. The Project Team would be responsible for: Development of the Project Team s Terms of Reference including: o The goals, aims, purpose and functions of the Project o The membership of the steering committee including the roles and responsibilities of members; o Confirmation of resource requirements (funding, time, budgets, staff etc) o Determination of the time lines for activities Establishment of decision making processes within the Team including agreement on methodologies for the Project Development of Communication Strategies Compilation of existing regional agreements, strategies and approaches for other sector climate change activities Organisation of workshops Development and distribution of relevant documents Development of recommendations for decision makers The following table (Table 1) outlines the overall process to be undertaken during the assessment of health impacts and development of adaptation strategies. A number of elements should be considered and addressed concurrently throughout the process. These include: Communication strategies for: o Ongoing communication amongst the Project Team guiding the o climate change and health adaptation project Communication with stakeholders within the designated location for consideration at specified stages throughout the Project Consideration of requirements to ensure the Project links with existing regional agreements, approaches and implementation plans for other sector activities in climate change.

11 Table 1 Health Impact and Climate Change Summary of the process Concurrent activities: Stage Process Component Issues for inclusion Communication Stakeholder Engagement Country/regional agreements, approaches and implementation plans Part 1 Table 1.1 Table 1.2 Part 2 Table 2.1 Preliminary The determinants of health Development of Communication Strategy Community Profiling Development of a stakeholder involvement process Identification of climate variables Identification of environmental impacts arising from climate change Creation of scenario for the country or region concerned for 2030 Addressed through identification of changes to: Physical environment Social environments Infrastructure Environmental diseases Part 3 Table Table 3.5 Identification of potential health impacts Identification of current controls Identification of health impacts arising from environmental changes Identification of vulnerable: People/groups Regions Infrastructure Services Identifying/determining gaps in knowledge Understanding current coping (controls) capacity and limitations Part 4 Table 4.1 Table 4.2 Table 4.3 Risk assessment Determine risks Risk prioritisation Undertake risk assessments of the identified health impacts Identifying experts to assist with expertise in: Risk assessments Specific fields List impacts according to level of risk Need to reach consensus based on expert knowledge 11

12 Part 5 Tables Part 6 Table 6 Development of adaptation responses Action Plans (strategies required to implement adaptations) Use of range of adaptation responses provided. Should consider other adaptations applicable to the country concerned Consideration of responses with respect to: General population Vulnerabilities Adequacy of control measures Other requirements Priorities for action How to address in country concerned Need to identify roles and responsibilities In addition Part 7 Recommendations Are different recommendations required for different groups of decision makers? Health sector responses How can each health sector reduce its own environmental footprint? The following Parts 1 to 7 provide detailed information on the knowledge and information to be considered and the activities to be undertaken. 12

13 Part 1 Preliminary steps The information outlined in Part 1 is provides guidance to the reader on the scope of issues to be considered as well as direct the reader to sources of information to assist in undertaking activities. 1.1 The Determinants of Health Our health provides us with the capacity to do what we want with our lives. Not only our activities and genetics contribute to our health: combinations of biological, behavioural, social, economic and environmental factors also determine it. The World Health Organisation (WHO) Constitution i defines health as: a (dynamic) state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Examples of these factors, or determinants, that influence health and that may give rise to positive and negative health outcomes are shown in Table 1.1. Table 1.1 Health aspects and impacts which could be considered Category Potential health aspect/impacts Perceived Nuisances (noise, sight, odour, taste etc.) environment Sensation Beliefs (e.g. of organisational inefficiency/exemplar role) Others Socio-economic Employment Access Social network Finance Other resources (e.g. time) Community profile (e.g. vulnerable groups) Crime Others Psychosocial Control Stress Anxiety Community well being Status Others Lifestyle Exercise Smoking (active) Diet Sexual activity Health behaviour Alcohol Drugs Others

14 Technological factors Accidents (mechanical, chemical etc.) Fire, explosions Others Environmental factors Air quality including passive smoking Water quality Soil quality Food contamination Passive smoking Health and safety at work Radiation Temperature Noise levels Traffic Pathogens Vector-borne disease factors /Vermin/ Broader environmental issues (CO2 emissions) Others Services Resource availability Access to emergency services Routine access to health services (primary/secondary) Routine access to other services (schools, shops etc) Access for specific groups (e.g. vulnerable, social exclusion) Others 1.2 Developing a Communications Strategy Development of an appropriate Communications Strategy should enable members of the Project Team to communicate activities and knowledge and reduce the potential for disagreement as well as to enhance participation of stakeholders involved in workshops and other related activities. Effective communication can: Foster motivation and involvement Improve performance Provide information Assist with identification of activities Influence attitudes Assist management of operational processes Development of the Communication Strategy should provide for and enhance: Clarity Consistency Opportunities Networking Maintaining/Improving relationships with stakeholders Responsibilities Accountability Gathering relevant information 14

15 A Communication Strategy requires: 1. Aims and objectives A Communication Strategy should identify what communication is and why it is to be used. The overarching objective of the Communication Strategy should be to assist in achieving the objectives of the Climate Change and Health Project. a. Communication types range across the spectrum of: Providing information Obtaining feedback Working together on issues of concern Establishing partnerships Releasing decision making to others b. Communication can be used for: Government or specialised group business Providing information Stakeholder engagement Public Relations Social activities Other 2. Strategies for achieving objectives a. The forms of communication should be determined for both internal and external stakeholders. These can include: External Ministerial and other Government briefings Letters Reports Newsletter List server Website Meetings Workshops s Social Media Other Internal As for External Verbal Notes Web portals and shared sites Existing internal communication strategies Phone calls/teleconferences Other b. The stakeholders who should be involved in the Project need to be identified. These include but are not limited to: Within Health Sector All public health groups within Government Ministry/Department of Health representatives External All Government Ministers Government representatives from all sectors Local Governments 15

16 Medical specialists in climate specific fields Other health groups: Non-Government Organisations (NGOs) Universities and research institutions Other institutions NGOs Media Industry/Business Community Other specific groups as identified c. Existing communication activities should be reviewed and, where relevant, updated and incorporated into the Communication Strategy. Issues for consideration include understanding of: Various components of current activities The issues associated with each o What works? o What can be improved? o What else might be needed? Who is involved in? o Initiation o Implementation o Responsibility o Accountability d. Timeframes need to be considered including: Reporting requirements Specific deadlines Other? 1.3 Community Profiling As in other forms of impact assessment, it is important to have a good understanding of the biophysical environment and the people within. Profiling includes assessment of the demographic details of the potentially affected community to identify characteristics that play an important role in determining health status as well as identify vulnerable groups. Data about the community that should be considered include its size, density, physical distribution, age and sex distribution, birth rate, ethnicity, socioeconomic status and identification of at-risk groups ii. Information on the health status of the population is also collated to provide baseline data against which any actions implemented can be assessed. Specific attention should be given to health parameters such as to levels of employment, indicators of lifestyle behaviours affecting health and the distribution of vulnerable groups. Efforts should be made to try to identify and understand all stakeholder groups, particularly sub-groups such as those listed below, which are often not included in consultation programs. Children Youth (aged 13 18) 16

17 Older people People with disabilities People with mental health problems People with long-term illnesses Indigenous people Other ethnic and cultural communities Unemployed Women s groups Men s groups Migrants Fly in/fly out workers. Community demographic and health data are available through many sources including data collected by country Bureaus of Statistics, various local and international institutions, local governments, non-government agencies and other representative bodies and the regional, State or National Ministries or Departments for Health. 1.4 Establishing a Stakeholder Engagement Strategy Publications are available to assist with the Stakeholder engagement process. The Department of Health in Western Australia produced the Public Health consultation: A guide for developers iii, framework to assist groups engaged in consultation on health issues. Much of the information with respect to sourcing information provided in this document refers to the Australian context but the Framework is applicable anywhere. The steps for engagement as outlined in the Framework are: 1. Identifying 2. Profiling 3. Contacting 4. Discussing 5. Planning 6. Incorporating 7. Consolidating Stakeholder consultation and engagement requires consideration of a number of factors as indicated in Table 1.2. This Table can be copied for use in planning discussions. 17

18 Table 1.2 Consultation for Health Issues for consideration Who should take responsibility for consultation? Potential responses Who are the key stakeholder groups? National, regional and local How are the needs of and consultation with vulnerable groups to be addressed? Can representation for the needs of particular groups be obtained and is this useful? What should the outcomes of the consultation be used for? Are there different time frames that should be considered for consultation/communication? 18

19 Part 2 Climate variables and their influence on the environment and other factors that relate to human health This section commences the specific Climate Change and Health Project. Each component (Part) reflects those indicated in Table Establishing a future scenario To progress with the assessment of the impacts on health from climate change, a scenario of potential climatic conditions as predicted to 2030 needs to be established. This should be cited in terms of the predicted: Gradual changes such as temperature, rainfall, sea level Extreme events such as heatwaves, droughts, bush/forest fires, flooding, storms, cyclones/typhoons, landslides This information can be obtained from government departments or other meteorological reference sources. The conditions listed above will need to be adapted to the predictions for the country or region that is being considered in the investigation. 2.2 Predictions of environmental changes When these predicted conditions have been determined the next step in the process is to determine the influence these predicted changes could have on the environmental and other factors. These are categorised into the following: Physical, Social, Service and Infrastructure and Environmentally Related Illness. To ensure that this is completed comprehensively, it is important that representatives from key sectors with understandings of these changes are consulted. It is recommended that stakeholders are brought together and the information obtained through a workshop(s). Table 2.1 can be used to guide this process.

20 Table 2.1 Climatic variables and their influence on environmental and other factors Climatic Variable Temperature increase Environmental and Other Factor Impacts Physical Social Service and infrastructure Gradual changes Environmentally related illness Change in Rainfall Sea level change Heatwaves Extreme events

21 Droughts Bushfires Flooding Storms Cyclones Landslides Other 21

22 Part 3 Determination of potential health impacts The outcomes of the consultation on the four Environmental and Other factors given in Table 2.1 are used as the basis for understanding potential health impacts. The experts from the relevant sectors in collaboration with experts in these areas in the health sector (environmental and social health) should be consulted to determine potential health impacts. Four separate groups should be established comprising experts in the following: Factors Groups Physical environments Air, water, soil and other environmental Infrastructure environment Energy, transport, telecommunication, water and waste Environmentally related illnesses Food borne, vector borne, water borne and other environmentally related illness Social environment Lifestyle, housing, workforce, service provision, population displacement and mental health For each of these factors Tables 3.1 to 3.4 below can be used to guide the process of predicting the impacts to communities and individuals in terms of both direct and indirect impacts on health. These tables also include a section on identifying potential vulnerabilities (exposure, sensitivity and adaptive capacity) on a regional basis, economic basis, social and other (e.g. occupational health and safety) and on an infrastructure basis. Vulnerability The Intergovernmental Panel on Climate Change (IPCC) defines vulnerability as the degree to which a system is susceptible to or unable to cope with, adverse effects of climate change (IPCC 2001). Vulnerability is a function of exposure, sensitivity and adaptive capacity (Figure 2). These vulnerabilities can be experienced from a regional or systemic level to community, household and individual levels.

23 Figure 2: Components of Vulnerability Exposure Sensitivity Potential Impact Adaptive Capacity (Australian Greenhouse Office, 2005) Vulnerability If we return to the concept of a health-impact pathway, it can be noted that each step has a set of unique circumstances that will determine vulnerability. Analysis of each of these steps allows a logical determination of vulnerability and subsequent development of adaptive measures that aim to decrease vulnerability. Figure 3: Adaptive Capacity and Coping Capacity TODAY FUTURE Adaptive Capacity Potential Impacts Coping Capacity ADAPTATION Avoidable Unavoidable An important component of this investigation is the identification of the various aspects of vulnerability: regional, economic, social and infrastructure and services. There are several types of vulnerabilities that 23

24 need to be considered which are common to a wide range of potential health impacts. Regional Vulnerabilities Regional vulnerabilities can occur in terms of exposure, sensitivity and adaptive capacity. The projections have indicated that changes to climate may not be experienced equally across the country or area. For example, reductions in rainfall could be greater in some areas. Communities in coastal regions, particularly low-lying areas, could be identified as potentially vulnerable to sea-level rise, storms and sea-surges. In terms of sensitivity and adaptive capacity, regions with a high proportion of rural or isolated communities may be identified as more vulnerable to a range of potential health impacts of climate change. Reduced access to essential services and a greater reliance on climatic factors for economic prosperity may be identified as the potentially major contributors to vulnerability. Economic Vulnerability Economic vulnerability is likely to be a common theme for a wide range of potential health impacts. Areas or communities, where there is a strong link between economic prosperity and climate were considered more sensitive to climate change than others. For example farmers and touristbased industries may be identified as vulnerable, primarily through reduction in or loss of income. Flow-on effects in these communities include reduction of available goods and services, a decrease in community resilience and reductions in population, all contributing to a decline in quality of life and adverse changes to mental and social health. Economic vulnerability is likely to be strongly linked to adaptive capacity. Communities, households or individuals with low socio-economic levels will be less likely to afford adaptive measures and possible price increases in a range of goods and services. Examples include lack of access to adaptive strategies for temperature increases and heat waves, such as energy efficient housing and air-conditioning. Low-income families will be more vulnerable to price increases in a wide range of goods and services, including fresh food, water, energy and insurance. Regions with greater exposure to the impacts from climate change may have economic difficulty in adapting to climate change. Some coastal communities may require major infrastructure expenditure to adapt to sealevel rises and storm surges. Financial difficulties are likely for small regional communities faced with such expenditures. Inhabitants of particularly vulnerable regions may suffer financial losses as property devalues. Higher insurance premiums, restricted coverage and withdrawal of insurance may occur in high-risk areas, leading to negative impacts on business, investment and the community. 24

25 Social Vulnerability A number of population sub-groups may be identified as particularly vulnerable to many of the potential health impacts of climate change. These groups consist of populations whose health status may already be compromised and include the aged, young, indigenous groups, disabled, homeless and those with compromised health. The extent of vulnerability within these groups will vary widely, dependent on the specific health impact and other factors such as socio-economic, health and mental-health status. Some groups may be more vulnerable because of existing health problems and lower standards of living than other groups. A lack of basic infrastructure in remote communities may contribute to a poor adaptive capacity and even greater vulnerability. Remote and coastal communities may also be seen as regionally vulnerable and more sensitive to changes in coastal ecosystems. Aged groups may be identified as vulnerable to a wide range of potential health impacts. Direct impacts from increases in summer temperatures and frequency of heat waves may be identified as major concerns. Other impacts for which aged groups may be considered vulnerable were food and water-borne diseases and respiratory effects of reduced air quality. An ageing population will increase the significance of impacts on this group. Children may be more sensitive to certain impacts for a range of reasons including higher metabolic and breathing rates than adults and an immature immune system. Pre-existing illnesses or disease and medication can increase vulnerability to a range of potential health impacts. Infrastructure and Services Vulnerabilities Many of the current infrastructures and services will probably have been planned using historical climate data. There is a risk that these may be inadequate for future climatic conditions. Vulnerability may occur from direct physical damage to existing infrastructure or from a combination of diminishing resources and increased demand for essential services. For example information from the insurance industry has shown that even small increases in the severity of extreme events (< 10%) can cause multiple increases in damages. The health of communities is dependent on the provision of reliable infrastructure and services. Changes in capacity to provide clean water, reliable energy, transport, communication, medical and other services will have direct and indirect impacts on health. Health services in regional and remote communities and outer metropolitan regions may be identified as having limited resources. 25

26 The potential impacts of climate change on coastal development and infrastructure may be identified as a major concern. Current planning guidelines in many areas have limited adjustments for projected increases in sea-level and this may be identified as a major concern. Specific Vulnerabilities In addition to the vulnerabilities outlined above, some potential health impacts applied to specific vulnerable groups. For example, people who spend large amounts of time outdoors, either through occupational or lifestyle activities were considered vulnerable to vector-borne diseases, UV exposure and heat-related illnesses. Those living in close proximity to mosquito breeding habitats may also be more vulnerable to vector-borne diseases. Figure 4 summarises the major aspects of vulnerability identified at the workshop. Individuals and communities that are vulnerable in more than one of these areas are of particular concern. Figure 4: Common Aspects of Vulnerability Regional Economic Social Infrastructure & Services Overall Vulnerability Adaptive Capacity Adaptive capacity describes the general ability of institutions, systems and individuals to adjust to potential damages, to take advantage of opportunities and to cope with the consequences. In health terms, coping capacity is a measure of what could be implemented now to minimize the negative health impacts of climate change that may arise in the future and maximize any positives that may occur. An assessment of coping capacity is necessary to determine current vulnerability and to plan appropriate adaptations. Assessment of coping capacity at all levels and for all relevant sectors will provide a thorough understanding of what is needed for management of potential health impacts from climate change. 26

27 Table 3.5 provides a guide for the assessment of current controls and their limitations and focuses on the likely effectiveness of those current controls in the light of the predictions for This then allows consideration to be given to the gaps in the current controls if they are to be upgraded to control the risks in Some consideration of the sectors to be involved can be made at this stage. 27

28 Table 3.1 Health Impacts - Physical Environment Air, water, chemicals, soil, other environmental Climate Variable Impacts to Communities and Individuals Vulnerability (exposure, sensitivity, adaptive capacity Evidence/ Uncertainties Environmental Health: - Direct - Indirect Regional Economic Social and other e.g.ohs Infrastructure Temperature increase Rainfall Change Sea level increase Extreme Events: - Heatwaves - Droughts - Bushfires - Floods - Storms - Tropical cyclones - Other

29 Table 3.2 Health Impacts - Infrastructure Energy, transport, telecommunications, water, waste Climate Variable Impacts to Communities and Individuals Vulnerability (exposure, sensitivity, adaptive capacity Evidence/ Uncertainties Environmental Health: - Direct - Indirect Regional Economic Social and other e.g.ohs Infrastructure Temperature increase Rainfall Change Sea level increase Extreme Events: - Heatwaves - Droughts - Bushfires - Floods - Storms - Tropical cyclones - Other 29

30 Table 3.3 Health Impacts Environmental Diseases Food borne, vector borne, water borne, other environmentally related illness Climate Variable Impacts to Communities and Individuals Vulnerability (exposure, sensitivity, adaptive capacity Evidence/ Uncertainties Environmental Health: - Direct - Indirect Regional Economic Social and other e.g.ohs Infrastructure Temperature increase Rainfall Change Sea level increase Extreme Events: - Heatwaves - Droughts - Bushfires - Floods - Storms - Tropical cyclones - Other 30

31 Table 3.4 Health Impacts Social Environment Lifestyle, housing, workforce, service provision, population displacement, mental health Climate Variable Impacts to Communities and Individuals Vulnerability (exposure, sensitivity, adaptive capacity Evidence/ Uncertainties Environmental Health: - Direct - Indirect Regional Economic Social and other e.g.ohs Infrastructure Temperature increase Rainfall Change Sea level increase Extreme Events: - Heatwaves - Droughts - Bushfires - Floods - Storms - Tropical cyclones - Other 31

32 Table 3.5 Coping Capacity Description of what is being implemented now to minimise negative impacts Health Impacts Current Controls Limitations Effectiveness in 2030 Gaps for 2030 Sectors involved

33 Part 4 Risk Assessment and Ranking The objective of the part is to undertake risk assessments to provide a comparison of the relative health risks of the impacts identified in Part 3. It is beyond the scope of these guidelines project and in many instances beyond the capacity of available information, to carry out a quantitative assessment of risks. It is recommended that a group from the participants involved previously with expertise in health or risk assessment undertakes a qualitative risk assessment in their specific areas of knowledge. A comparative measure of risk is essential for the prioritisation of adaptation measures. The process developed has been based on that described in AS4360:1999 Risk Management. Health impacts can be divided into two broad groups: 1. Impacts with relatively well established relationships between climate and health 2. Indirect impacts with complex relationships between climate and health Impacts are assessed using a qualitative scale that considers the health consequences and the likelihood of the health impact occurring. Categories of risk are low, medium, high and extreme. The levels of uncertainty surrounding consequences and/or likelihood of the potential health impacts can often be high, particularly for indirect impacts. In these cases, uncertainties can be recognized and a preliminary assessment carried out on the potential impacts. In general a higher level of conservatism can be applied for those health impacts with a high degree of uncertainty. The format for assessing health impacts has been adapted from the Australian Greenhouse Office document Climate Change Impacts and Risk Management: A Guide for Business and Government and standard Health Impact Assessment procedures The Risk Assessment Process The objective of the risks assessment process was to ascertain the level and likelihood of risks to public health in WA communities of the identified potential health impacts. These impacts were grouped into key elements based on linked health issues as shown below. Key Elements 1. Health Impacts of Extreme Events 2. Health Impacts of Temperature Increase and Related Changes 3. Water-borne Disease and Water Quality 4. Vector-borne diseases 5. Air Quality and related health impacts 6. Food-borne diseases 7. Food Production

34 8. Social Impact/Community Lifestyle-Dislocation, Mental Health 9. General Principles and Adaptation Measures As a qualitative approach is used the risks for each specific health impact are to be based on the relationship between consequence and likelihood. Consequence x Likelihood = Risk Priority Level Two important assumptions are made for this assessment: 1. The year is 2030 and climate change projections have occurred 2. Only current controls for each health impact are taken into account Consequence Rating The consequences of potential health impacts are considered in terms of the magnitude of the impact: judged on the severity of the health impact, the number of people affected, the duration of the impact and the socioeconomic implications as shown below. Consequence Examples Catastrophic Large numbers of serious injuries, illnesses or loss of life Severe and widespread disruption to communities Long term inability to deliver essential goods and services Severe long-term reductions in quality of life Huge economic costs Major Small numbers of serious injuries, illnesses or loss of life Significant, widespread disruption to communities Significant decline in delivery of essential goods and services Significant long-term decline in quality of life Moderate Small number of minor injuries or illnesses Significant disruption to some communities Significant decline in delivery of essential goods and services Significant short-term or minor long-term reduction in quality of life Minor Serious near misses or minor injuries Isolated short-term disruption to some communities Isolated but significant reductions in essential goods and services Minor reductions in quality of life Insignificant Appearance of a threat but no actual harm Very minor disruption to small section of community Isolated, minor reduction in delivery of essential goods and services Insignificant impacts on quality of life 34

35 Likelihood Rating This rating provides an estimate of the likelihood that a risk will occur, given that the proposed climate change scenario comes about. Likelihood Almost certain Likely Possible Unlikely Rare Description Is expected to occur in most circumstances Will probably occur in most circumstances Might occur at some time Could occur at some time May occur only in exceptional circumstances Risk priority Levels Results from consequence and likelihood assessments are checked against a risk priority matrix. Likelihood Consequences Insignificant Minor Moderate Major Catastrophic Almost Medium Medium High Extreme Extreme Certain Likely Low Medium High High Extreme Possible Low Medium Medium High High Unlikely Low Low Medium Medium Medium Rare Low Low Low Low Medium Evaluation Risk priority levels are compared and evaluated to provide for consistency across priority ratings and adjust for any risks that may have been under or over rated. The identified health impacts can be assessed for risk by completing a Table such as provided in Table 4.1: Table 4.2 provides an example of this format. The results from this process can then be presented in a prioritised form as shown in Table

36 Table 4.1 Risk Levels Climate Variable Consequence Likelihood Risk Evidence or Reason for Decision Further Information Required Extreme Events (identified health impacts) Use a similar table for other climate variables

37 Table 4.2 Example of the structure for Table 4 for Water-borne risks Water Borne Consequence Likelihood Risk Evidence/ Reason for Decision Further Information Required Gastro-intestinal diseases Diarrhoea, vomiting Extreme Events Contamination by pathogens such as Cryptosporidiosis. Contamination from wildlife and stock deaths in drought, bushfires Gradual Changes Recreational waters Change incidence of water -borne pathogens such as cryptospo campylobacter, amoeba Increase in harmful algal blooms Increased use of grey-water -increased contact with pathogens 37

38 Table 4.3 Example of table for ranking potential health impacts of climate change with their level of risk Potential health impacts Consequence Likelihood Risk Major Almost certain Extreme Major Almost certain Extreme Major Likely High Major Likely High Major Likely High Major Likely High Major Possible High Moderate Almost certain High Minor Almost certain Medium 38

39 Part 5 Adaptation Measures Adaptation to climate change in health terms can be broken down into primary, secondary or tertiary measures similar to those used for public health: primary adaptive measures: actions taken to prevent the onset of disease arising from environmental disturbances in an otherwise unaffected population secondary adaptive measures: preventive actions taken in response to early evidence of health impacts, and tertiary adaptive measures: health-care actions taken to lessen the morbidity or mortality caused by the disease (McMichael and Kovats, cited in WHO, 2000) Consideration of the chain of events from climate parameter to health impact is a useful method to identify opportunities for adaptation. In general, the earlier in the chain of events that adaptations are applied the better. The example in Figure 5 shows a possible health impact pathway from an extreme rainfall event to a case of gastrointestinal illness. Figure 5: Health Impact Pathway Opportunities for Adaptation Flood Zones Flood Prevention & Mitigation Improve design of waste water systems to reduce risk of Extreme Rainfall Flooding Overflow of Waste Water Reduce contact with flood water. Evacuation/ physical barriers/ education Human Contact with Flood Water Medical Treatment Gastrointestinal Each link in the chain of events is at once a potential for vulnerability and an opportunity for adaptation. The primary, anticipatory adaptation measures are the appropriate consideration of flood zones in land-use planning, flood mitigation measures in areas considered at risk and appropriate flood risk waste-water 39

40 infrastructure. This example also serves to demonstrate the importance of non-health sectors in the reduction of potential health impacts of climate change. Similarly, the benefits of these adaptations are not limited to health outcomes. There are obvious economic benefits of minimising physical damage to major infrastructure, property and agriculture. Secondary and tertiary adaptations are implemented in reaction to the contamination of floodwaters and are often referred to as reactionary adaptations. Minimising contact with floodwaters, through physical separation or improved education, is a secondary adaptation aimed at reducing the extent of the exposure to water-borne pathogens. Medical treatment is a tertiary adaptation taken in response to a health impact that has occurred. All measures aim to increase adaptive capacity. Adaptive measures may be targeted at the whole population, vulnerable regions or vulnerable subpopulations. Measures focused on vulnerable groups are likely to provide the greatest reductions in risk and therefore the greatest improvements in health outcomes. The following panels (Figure 6) depict the varying public health coping capacities for current and future climate attributes. A country or area will have varying levels of development in the public health systems and therefore potentially high coping capacity as demonstrated in the first panel. However, there are parallels with the second panel for vulnerable groups. The third panel provides the circumstances of a state that invests in adaptation responses and enables them to deal with future climate changes, while the final panel reflects the outcomes of little or no investment in adaptation. We need to ensure that with a changing climate our coping capacity can meet the needs of the all groups within the State and thus investment in adaptation is important. 40

41 Figure 6: Climate Change and coping capacity Source: WHO, 2003 The Development of adaptation strategies A range of possible adaptation measures that could be applied to each of the potential health impacts were identified and the following considerations applied: Relevance for country or area Current capacity in this area, inclusive of vulnerable groups/regions; current coping capacity rated as Not in Place (N), Inadequate (I), Being Developed (D) or Adequate (A) How adaptation could be implemented in the country or area (adjustment/modification of existing measures or the development of new measures) Identification of sectors that would be involved in the development and implementation of this adaptation Other possible adaptation measures, addressing the above issues The impact types for consideration were those used previously and identified as Key Components: 41