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Climate Change and Health Reference Manual 2012

Climate Change and Health Reference Manual 2012

Š Department of Health & World Health Organization 2012 The preparation and publication of this document was made possible through the assistance of the Millenium Development Goal Funds (MDG-F) 1656 Climate Change Project.

This document is published by the Department of Health and the World Health Organization (WHO).

There are two documents embodied in this piece of work: The first document is the Facilitator’s Guide which will help the Trainors on how to conduct the course.

The second is a companion document the Reference Manual, which serves as an aid to trainees.

Likewise, a CD pocket is provided, which holds the Powerpoint presentations that will help facilitate the delivery of the course.

All rights reserved. Subject to the acknowledgement of DOH and WHO, the Training Manual may be freely abstracted, reproduced or translated in part or in whole for non-commercial purposes only. Otherwise, permission should be requested from the Climate Change Unit of EOHO NCDPC, Department of Health, San Lazaro Compound, Rizal Avenue corner Tayuman, Sta. Cruz, Manila.

The Department of Health (DOH) and the World Health Organization (WHO) does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damage incurred as a result of its use.

Printed in the Republic of the Philippines. ii

Table of Contents

Table of Contents MESSAGES …………………………………………………………… iv ACKNOWLEDGEMENT……………………………………………… vi GLOSSARY………………..................................................................... vii BACKGROUND ..……………………………………………….......... 1 INTRODUCTION………………………………………………………. 5 MODULE 1 SCIENCE OF CLIMATE CHANGE………...…………… 7 Session 1 Key Concepts of Climate Change Variability Session 2 Global Climate TrendsChallenges Session 3 Philippine Climate Scenario MODULE 2THREATS, VULNERABILITIES AND IMPACTS OF CLIMATE CHANGE………………………………..…………………36 Session 1 Sectoral Impacts of Climate Variability and Change Session 2 Assessing Threats and Vulnerabilities of Climate Change to Health Session 3 Capacity Assessment in Climate-related Health Risks MODULE 3 CLIMATE CHANGE INITIATIVES AND ADAPTATION STRATEGIES ……………………………………..…….115 Session 1 Climate Change Initiatives for Health Session 2 Vulnerability and Adapation Framework Session 3 Capacity Assessment in Climate - related Health Risks MODULE 4 PLANNING ON CLIMATE CHANGE AND HEALTH ..127 Session 1 Local Climate Change and Health Planning

BIBLIOGRAPHY ………………………………………………………130

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Republic of the Philippines Department of Health OFFICE OF THE SECRETARY

Building 1, San Lazaro Compound, Rizal Avenue Sta. Cruz, Manila, Philippines Tel. Nos. (632) 711-9502, 711-9703; Fax No. 743-1829

Message Heartfelt greetings and congratulations to the Climate Change and Health Technical Working Group and the Project Technical Management Team on its effort to develop the “Facilitator’s Guide and Reference Manual on Climate Change and Health”.

Climate change is one of the defining challenges of the century, and increasingly recognized as a public health priority. It has brought to the front, unpredictable changes to global environments, particularly the nature and severity of climate-sensitive diseases.

The nature of diseases, in terms of their vectors, distribution, and severity of infection, extent of adaptability has been harshly affected. Consequently, leading to increased burden in the public health infrastructure and services.

The Department of Health constantly aims to equip the health-sector and stakeholders with an up-to-date knowledge and competencies related to the prevention and control of climate sensitive diseases. The World Health Organization in collaboration with the DOH Climate Change Unit and the - Climate Change Technical Working Group, commissioned the Development Academy of the Philippines thru the MDGF 1656 JP to design these manuals to provide field health workers basic information on the science of climate change, its concepts, trends, threats, vulnerabilities and impacts on health; initiatives and adaptation strategies; as well as planning on climate change and health.

In our aim to achieve our goal of “Kalusugang Pangkalahatan” or Universal Health Care, I commend the DOH technical working group on Climate Change and Health for their ceaseless efforts in coming up with the first published training manual on Climate Change and Health to help in regional and local capacity building thereby ensuring sustainable preparedness and response to the impact of climate change on health.

Mabuhay!

ENRIQUE T. ONA, MD, FPCS, FACS Secretary of Health

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Message Climate change is one of today’s most serious global threats requiring urgent action.

If left unattended, the basic requirements for maintaining health such as clean air and water, sufficient food and adequate shelter will be inevitably affected.

Climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations.

Health effects are expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions. The most vulnerable groups of the resulting disease burden are the children and the poor, especially the women. Major diseases that are sensitive to climate change include diarrhea, malaria, dengue and infections associated with under nutrition will become more widespread.

The World Health Organization, guided by a World Health Assembly resolution, has a long-standing programme on protecting health from climate change. One of the key areas and work identified in climate and health is building capacity to strengthen the health system response to climate change, and be able to assess and monitor vulnerability to climate-related health risks.

The “Climate Change and Health Training Manuals� are developed primarily to enhance capacity of our public health workers in addressing issues of climate change.

It will hopefully enhance capacity for assessing and monitoring health vulnerability, risks and impacts due to climate change.

The training manuals will eventually contribute to the attainment of improved adaptation of health systems and better health outcomes for the Filipinos. An improved awareness will facilitate behavioural change and motivate health sector professionals in supporting strategies for mitigation and adaptation.

Dr. Soe Nyunt-U WHO Representative to the Philippines

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Acknowledgement This Manual is a joint effort of the Department of Health and the World Health Organization – Philippine Country Office. The preparation and publication of this document was made possible through the assistance of the Millenium Development Goal Funds (MDG-F) 1656 Climate Change Project We wish to acknowledge the contributions of the men and women from said institutions.

The Department of Health: Office of the Secretary; Environmental and Occupational Health Office (EOHO), Infectious Disease Office (IDO), Degenerative Disease Office (DDO), Family Health Office (FHO) of the National Center for Disease Prevention and Control (NCDPC); Health Human Resource Development Bureau (HHRDB); Health Policy Development and Planning Bureau (HPDPB); Health Emergency Management Services (HEMS); Bureau of International Health Cooperation (BIHC); Bureau of Health Facilities and Services (BHFS); Bureau of Local Health Development (BLHD); National Center for Health Facility Development (NCHFD); National Center for Health Promotion (NCHP); National Epidemiology Center (NEC); National Center for Pharmaceutical Access and Management (NCPAM); Bureau Quarantine and International Health Surveillance (BOQ); Food And Drug Administration (FDA); Information Management Service (IMS); Philippine Health Insurance Corporation (PHIC); Commission on Population (POPCOM); Research Institute for Tropical Medicine (RITM); National Nutrition Council (NNC); all Center for Health Development (CHD’S).

Local Government Units: Provincial Health Offices (PHO’s); City Health Offices (CHO’s); Municipal Health Offices (MHO’s) With Special gratitude to the Climate Change and Health Technical Working Group and the Project Technical Management Team: Dr. John Juliard Go – WHO; Engr. Bonifacio Magtibay – WHO; Dr. Cecile Magturo – DOH and Cynthia Jane P. Dimaano – WHO The Development Academy of the Philippines: Director Alan Cajes, Ms. Socorro delos Santos and to all its staff.

The Meralco Management Learning and Development Center Foundation Inc. (MMLDCFI): Ms. Maria Vivien Arnobit; Ms. Ma. Amor Curaming; Ms. Corazon dela Paz; Ms. Beatriz Carmela Quilingan; Mr. Owen Dacanay; Mr. John Paul Paragile and to all its staff.

We also would like to acknowledge the WHO Regional Office for Southeast Asia “Protecting our Health from Climate Change: WHO Training Course for Public Health Professionals” for some of the training materials which were adapted in this Manual. vi

Reference Manual

Glossary of Terms Actual net greenhouse gas removals by sinks The sum of the verifiable changes in carbon stocks in the carbon pools within the project boundary of an afforestation or reforestation project, minus the increase in GHG emissions as a result of the implementation of the project activity. The term stems from the Clean Development Mechanism (CDM) afforestation and reforestation modalities and procedures.

Adaptation Initiatives and measures to reduce the vulnerability of natural and human systems against actual or expected climate change effects. Various types of adaptation exist, e.g. anticipatory and reactive, private and public, and autonomous and planned.

Examples are raising river or coastal dikes, the substitution of more temperature shock resistant plants for sensitive ones, etc.

Adaptive capacity The whole of capabilities, resources and institutions of a country or region to implement effective adaptation measures.

Aerosols A collection of airborne solid or liquid particles, typically between 0.01 and 10 Îźm in size and residing in the atmosphere for at least several hours. Aerosols may be of either natural or anthropogenic origin. Aerosols may influence climate in several ways: directly through scattering and absorbing radiation, and indirectly through acting as condensation nuclei for cloud formation or modifying the optical properties and lifetime of clouds.

Afforestation Direct human-induced conversion of land that has not been forested for a period of at least 50 years to forested land through planting, seeding and/or the human-induced promotion of natural seed sources.

Ancillary benefits Policies aimed at some target, e.g. climate change mitigation, maybe paired with positive side effects, such as increased resource-use efficiency, reduced emissions of air pollutants associated with fossil fuel use, improved transportation, agriculture, land-use practices, employment, and fuel security. Ancillary impacts are also used 5

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Climate Change and Health when the effects may be negative. Policies directed at abating on an ancillary benefit, but this perspective is not considered in this assessment.

Annex I countries The group of countries included in Annex I (as amended in 1998) to the UNFCCC, including all the OECD countries and economies in transition.

Under Articles 4.2 (a) and 4.2 (b) of the Convention Annex I countries committed themselves specifically to the aim of returning individually or jointly to their 1990 levels of greenhouse gas emissions by the year 2000. By default, the other countries are referred to as Non-Annex I countries.

Annex II countries The group of countries included in Annex II to the UNFCCC, including all OECD countries. Under Article 4.2 (g) of the Convention, these countries are expected to provide financial resources to assist developing countries to comply with their obligations, such as preparing national reports. Annex II countries are also expected to promote the transfer of environmentally sound technologies to developing countries.

Annex B countries The countries included in Annex B to the Kyoto Protocol that have agreed to a target for their greenhouse-gas emissions, including all the Annex I countries (as amended in 1998) except for Turkey and Belarus.

Anthropogenic emissions Emissions of greenhouse gases, greenhouse-gas precursors, and aerosols associated with human activities. These include the burning of fossil fuels, deforestation, landuse changes, livestock, fertilization, etc. that result in a net increase in emissions.

Assigned Amount (AA) Under the Kyoto Protocol, the assigned amount is the quantity of greenhouse-gas emissions that an Annex B country has agreed to as its ceiling for its emissions in the first commitment period (2008to 2012). The AA is the country’s total greenhousegas emissions in 1990 multiplied by five (for the five-year commitment period) and by the percentage it agreed to as listed in Annex B of the Kyoto Protocol (e.g. 92% for the EU; 93% for the USA).

Barrier Any obstacle to reaching a goal, adaptation or mitigation potential that can be overcome or attenuated by a policy, program, or measure. Barrier removal includes 6

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Reference Manual correcting market failures directly or reducing the transactions costs in the public and private sectors by e.g. improving institutional capacity, reducing risk and uncertainty, facilitating market transactions, and enforcing regulatory policies.

Baseline The reference for measurable quantities from which an alternative outcome can be measured, e.g. a non-intervention scenario is used as a reference in the analysis of intervention scenarios.

Benchmark A measurable variable used as a baseline or reference in evaluating the performance of an organization. Benchmarks may be drawn from internal experience that of other organizations or from legal requirement and are often used to gauge changes in performance over time.

Benefit transfer An application of monetary values from one particular analysis to another policydecision setting, often in a geographic area other than the one in which the original study was performed.

Biochemical Oxygen Demand (BOD) The amount of dissolved oxygen consumed by micro-organisms(bacteria) in the biochemical oxidation of organic and inorganic matter in waste water.

Biocovers Layers placed on top of landfills that are biologically active inoxidizing methane into CO2.

Biofilters Filters using biological material to filter or chemically process pollutants like oxidizing methane into CO2.

Biodiversity The variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems.

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Climate Change and Health Biofuel Any liquid, gaseous, or solid fuel produced from plant or animal organic matter. E.g. soybean oil, alcohol from fermented sugar ,black liquor from the paper manufacturing process, wood as fuel, etc. Second-generation biofuels are products such as ethanol and biodiesel derived from ligno-cellulosic biomass by chemical or biological processes.

Biological options Biological options for mitigation of climate change involve one or more of the three strategies: conservation - conserving an existing carbon pool, thereby preventing CO2 emissions to the atmosphere; sequestration - increasing the size of existing carbon pools, thereby extracting CO2 from the atmosphere; substitution – substituting biomass for fossil fuels or energy-intensive products, thereby reducing CO2 emissions.

Biomass The total mass of living organisms in a given area or of a given species usually expressed as dry weight. Organic matter consisting of, or recently derived from, living organisms (especially regarded as fuel) excluding peat. Biomass includes products, by-products and waste derived from such material. Cellulosic biomass is biomass from cellulose, the primary structural component of plants and trees.

Black Carbon Particle matter in the atmosphere that consists of soot, charcoal and/or possible light absorbing refractory organic material. Black carbon is operationally defined matter based on measurement of light absorption and chemical reactivity and/or thermal stability.

Bottom-up models Models represent reality by aggregating characteristics of specific activities and processes, considering technological, engineering and cost details.

Bubble Policy instrument for pollution abatement named for its treatment of multiple emission points as if they were contained in an imaginary bubble. Article 4 of the Kyoto Protocol allows a group of countries to meet their target listed in Annex B jointly by aggregating their total emissions under one ‘bubble’ and sharing the burden (e.g. the EU).

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Reference Manual Carbon Capture and Storage (CCS) A process consisting of separation of CO2 from industrial and energy-related sources, transport to a storage location, and long-term isolation from the atmosphere.

Carbon cycle The set of processes such as photosynthesis, respiration, decomposition, and air-sea exchange, by which carbon continuously cycles through various reservoirs, such as the atmosphere, living organisms, soils, and oceans.

Carbon dioxide (CO2) CO2 is a naturally occurring gas, and a by-product of burning fossil fuels or biomass, of land-use changes and of industrial processes. It is the principal anthropogenic greenhouse gas that affects Earth’s radiative balance. It is the reference gas against which other greenhouse gases are measured and therefore it has a Global Warming Potential of 1.

Carbon intensity The amount of emissions of CO2 per unit of GDP. Carbon leakage The part of emissions reductions in Annex B countries that maybe offset by an increase of the emissions in the non-constrained countries above their baseline levels.

This can occur through (1)relocation of energy-intensive production in nonconstrained regions; (2) increased consumption of fossil fuels in these regions through decline in the international price of oil and gas triggered by lower demand for these energies; and (3) changes in incomes(thus in energy demand) because of better terms of trade. Leakage also refers to GHG-related effects of GHG-emission reduction orCO2-sequestration project activities that occur outside the project boundaries and that are measurable and attributable to the activity. On most occasions, leakage is understood as counteracting the initial activity. Nevertheless, there may be situations where effects attributable to the activity outside the project area lead to GHG emission reductions. These are commonly called spill-over. While (negative) leakage leads to a discount of emission reductions as verified, positive spill-over may not in all cases be accounted for.

Carbon pool Carbon pools are: above-ground biomass, belowground biomass, litter, dead wood and soil organic carbon. CDM project participants may choose not to account one or more carbon pools if they provide transparent and verifiable information showing 9

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Climate Change and Health that the choice will not increase the expected net anthropogenic GHG removals by sinks.

Carbon price What has to be paid (to some public authority as a tax rate, or on some emission permit exchange) for the emission of 1 ton of CO2into the atmosphere. In the models and this Report, the carbon price is the social cost of avoiding an additional unit of CO2 equivalent emission.

Cap Mandated restraint as an upper limit on emissions. The Kyoto Protocol mandates emissions caps in a scheduled timeframe on the anthropogenic GHG emissions released by Annex B countries. By2008-2012 the EU e.g. must reduce its CO2equivalent emissions of six greenhouse gases to a level 8% lower than the 1990level.

Capacity building In the context of climate change, capacity building is developing technical skills and institutional capabilities in developing countries and economies in transition to enable their participation in all aspects of adaptation to, mitigation of, and research on climate change, and in the implementation of the Kyoto Mechanisms, etc.

Certified Emission Reduction Unit (CER) Equal to one metric ton of CO2-equivalent emissions reduced or sequestered through a Clean Development Mechanism project, calculated using Global Warming Potentials. In order to reflect potential non-permanence of afforestation and reforestation project activities, the use of temporary certificates for Net Anthropogenic Greenhouse Gas Removal was decided by COP 9.

Chemical oxygen demand (COD) The quantity of oxygen required for the complete oxidation of organic chemical compounds in water; used as a measure of the level of organic pollutants in natural and waste waters.

Chlorofluorocarbons (CFCs) Greenhouse gases covered under the 1987 Montreal Protocol and used for refrigeration, air conditioning, packaging, insulation, solvents, or aerosol propellants.

Because they are not destroyed in the lower atmosphere, CFCs drift into the upper atmosphere where, given suitable conditions, they break down ozone. These gases

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Reference Manual are being replaced by other compounds, including hydrochlorofluorocarbons and hydrofluorocarbons, which are greenhouse gases covered under the Kyoto Protocol.

Clean Development Mechanism (CDM) Defined in Article 12 of the Kyoto Protocol, the CDM is intended to meet two objectives: (1) to assist parties not included in Annex I in achieving sustainable development and in contributing to the ultimate objective of the convention; and (2) to assist parties included in Annex I in achieving compliance with their quantified emission limitation and reduction commitments. Certified Emission Reduction Units from CDM projects undertaken in Non-Annex I countries that limit or reduce GHG emissions, when certified by operational entities designated by Conference of the Parties/Meeting of the Parties, can be accrued to the investor (government or industry) from parties in Annex B. A share of the proceeds from certified project activities is used to cover administrative expenses as well as to assist developing country parties that are particularly vulnerable to the adverse effects of climate change to meet the costs of adaptation.

Climate Change (CC) Climate change refers to a change in the state of the climate that can be identified (e.g. using statistical tests) by changes in the mean and/or the variability of its properties; and that persists for an extended period, typically decades or longer.

Climate change may be due to natural internal processes or external forcings, or to persistent anthropogenic changes in the composition of the atmosphere or inland use.

Note that UNFCCC, in its Article 1, defines “climate change” as “a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods”. The UNFCCC thus makes a distinction between “climate change” attributable to human activities altering the atmospheric composition, and “climate variability” attributable to natural causes.

Climate feedback An interaction mechanism between processes in the climate system is a climate feedback when the result of an initial process triggers changes in secondary processes that in turn influence the initial one. A positive feedback intensifies the initial process; a negative feedback reduces the initial process. Example of a positive climate feedback: higher temperatures as initial process cause melting of the arctic ice leading to less reflection of solar radiation, what leads to higher temperatures.

Example of a negative feedback: higher temperatures increase the amount of cloud cover (thickness or extent) that could reduce incoming solar radiation and so limit the increase in temperature.

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Climate Change and Health Climate sensitivity In IPCC Reports, equilibrium climate sensitivity refers to the equilibrium change in annual mean global surface temperature following a doubling of the atmospheric CO2-equivalentconcentration. The evaluation of the equilibrium climate sensitivity is expensive and often hampered by computational constraints. The effective climate sensitivity is a related measure that circumvents the computational problem by avoiding the requirement of equilibrium. It is evaluated from model output for evolving non-equilibrium conditions. It is a measure of the strengths of the feedbacks at a particular time and may vary with forcing history and climate state. The climate sensitivity parameter refers to the equilibrium change in the annual mean global surface temperature following a unit change in radiative forcing (K/W/m2). The transient climate response is the change in the global surface temperature, averaged over a 20-year period, centered at the time of CO2 doubling, i.e., at year 70 in a 1% per year compound CO2 increase experiment with a global coupled climate model. It is a measure of the strength and rapidity of the surface temperature response to greenhouse gas forcing.

Climate threshold The point at which the atmospheric concentration of greenhouse gases triggers a significant climatic or environmental event, which is considered unalterable, such as widespread bleaching of corals or a collapse of oceanic circulation systems.

CO2-equivalent concentration The concentration of carbon dioxide that would cause the same amount of radiative forcing as a given mixture of carbon dioxide and other greenhouse gases.

CO2-equivalent emission The amount of CO2 emission that would cause the same radiative forcing as an emitted amount of a well-mixed greenhouse gas, or a mixture of well mixed greenhouse gases, all multiplied with their respective Global Warming Potentials to take into account the differing times they remain in the atmosphere.

Co-benefits The benefits of policies implemented for various reasons at the same time, acknowledging that most policies designed to address greenhouse gas mitigation have other, often at least equally important, rationales (e.g., related to objectives of development, sustainability, and equity). The term co-impact is also used in amore generic sense to cover both positive and negative side of the benefits.

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Reference Manual Cost-benefit analysis Monetary measurement of all negative and positive impacts associated with a given action. Costs and benefits are compared in terms of their difference and/or ratio as an indicator of how a given investment or other policy effort pays off seen from the society’s point of view.

Cost-effectiveness analysis A special case of cost-benefit analysis in which all the costs of a portfolio of projects are assessed in relation to a fixed policy goal. The policy goal in this case represents the benefits of the projects and all the other impacts are measured as costs or as negative costs(co-benefits). The policy goal can be, for example, a specified goal of emissions reductions of greenhouse gases.

Crediting period The CDM crediting period is the time during which a project activity is able to generate GHG-emission reduction or CO2 removal certificates. Under certain conditions, the crediting period can be renewed up to two times.

Deforestation The natural or anthropogenic process that converts forest land to non-forest.

Ecosystem A system of living organisms interacting with each other and their physical environment. The boundaries of what could be called an ecosystem are somewhat arbitrary, depending on the focus of interest or study. Thus, the extent of an ecosystem may range from very small spatial scales to the entire planet Earth ultimately.

Emissions Direct / Indirect Direct emissions or “point of emission” are defined at the point in the energy chain where they are released and are attributed to that point in the energy chain, whether a sector, a technology or an activity. E.g. emissions from coal-fired power plants are considered direct emissions from the energy supply sector. Indirect emissions or emissions “allocated to the end-use sector” refer to the energy use in end-use sectors and account for the emissions associated with the upstream production of the end-use energy. E.g. some emissions associated with electricity generation can be attributed to the buildings sector corresponding to the building sector’s use of electricity.

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Climate Change and Health Emission factor An emission factor is the rate of emission per unit of activity, output or input. E.g. a particular fossil fuel power plant has a CO2 emission factor of 0.765 kg/kWh generated.

Emission standard A level of emission that by law or by voluntary agreement may not be exceeded.

Many standards use emission factors in their prescription and therefore do not impose absolute limits on the emissions.

Emissions trading A market-based approach to achieving environmental objectives. It allows those reducing GHG emissions below their emission cap to use or trade the excess reductions to offset emissions at another source inside or outside the country. In general, trading can occur at the intra-company, domestic, and international levels.

The Second Assessment Report by the IPCC adopted the convention of using permits for domestic trading systems and quotas for international trading systems. Emissions trading under Article 17 of the Kyoto Protocol is a tradable quota system based on the assigned amounts calculated from the emission reduction and limitation commitments listed in Annex B of the Protocol.

Energy The amount of work or heat delivered. Energy is classified in a variety of types and becomes useful to human ends when it flows from one place to another or is converted from one type into another. Primary energy (also referred to as energy sources) is the energy embodied in natural resources (e.g., coal, crude oil, natural gas, uranium) that has not undergone any anthropogenic conversion. It is transformed into secondary energy by cleaning (natural gas),refining (oil in oil products) or by conversion into electricity or heat. When the secondary energy is delivered at the end-use facilities it is called final energy (e.g., electricity at the wall outlet), where it becomes usable energy (e.g., light). Daily, the sun supplies large quantities of energy as rainfall, winds, radiation, etc. Some share is stored in biomass or rivers that can be harvested by men. Some share is directly usable such as daylight, ventilation or ambient heat. Renewable energy is obtained from the continuing or repetitive currents of energy occurring in the natural environment and includes non-carbon technologies such as solar energy, hydropower, wind, tide and waves and geothermal heat, as well as carbon-neutral technologies such as biomass. Embodied energy is the energy used to produce a material substance (such as processed metals or building materials), taking into account energy used at the manufacturing facility (zero order), energy used in producing the materials that are used in the manufacturing facility (first order), and so on.

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Reference Manual Environmentally sustainable technologies Technologies that are less polluting, use resources in a more sustainable manner, recycle more of their wastes and products, and handle residual wastes in a more acceptable manner than the technologies that they substitute. They are also more compatible with nationally determined socio-economic, cultural and environmental priorities.

Externality / External cost / External benefit Externalities arise from a human activity, when agents responsible for the activity do not take full account of the activity’s impact on others’ production and consumption possibilities, while there exists no compensation for such impact. When the impact is negative, so are external costs. When positive they are referred to as external benefits.

Forecast Projected outcome from established physical, technological, economic, social, behavioral, etc. patterns.

Forest Defined under the Kyoto Protocol as a minimum area of land of0.05-1.0 ha with treecrown cover (or equivalent stocking level)of more than 10-30 % with trees with the potential to reach a minimum height of 2-5 m at maturity in situ. A forest may consist either of closed forest formations where trees of various storeys and undergrowth cover a high proportion of the ground or of open forest. Young natural stands and all plantations that have yet to reach a crown density of 10-30 % or tree height of 2-5 m are included under forest, as are areas normally forming part of the forest area that are temporarily un-stocked as a result of human intervention such as harvesting or natural causes but which are expected to revert to forest.

Fossil fuels Carbon-based fuels from fossil hydrocarbon deposits, including coal, peat, oil and natural gas.

General circulation (climate) model (GCM) A numerical representation of the climate system based on the physical, chemical and biological properties of its components, their interactions and feedback processes, and accounting for all or some of its known properties. The climate system can be represented by models of varying complexity, i.e. for any one component or combination of components a hierarchy of models can be identified, differing in such aspects as the number of spatial dimensions, the extent to which physical, chemical or biological processes are explicitly represented, or the level at which the parameters are assessed empirically. Coupled atmosphere/ocean/sea-ice General Circulation Models provide a comprehensive representation of the climate 15

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Climate Change and Health system. There is an evolution towards more complex models with active chemistry and biology.

General equilibrium analysis General equilibrium analysis considers simultaneously all the markets and feedback effects among these markets in an economy leading to market clearance.

Geo-engineering Technological efforts to stabilize the climate system by direct intervention in the energy balance of the Earth for reducing global warming.

Global warming Global warming refers to the gradual increase, observed or projected, in global surface temperature, as one of the consequences of radiative forcing caused by anthropogenic emissions.

Global Warming Potential (GWP) An index, based upon radiative properties of well mixed greenhouse gases, measuring the radiative forcing of a unit mass of a given well mixed greenhouse gas in today’s atmosphere integrated over a chosen time horizon, relative to that of CO2.

The GWP represents the combined effect of the differing lengths of time that these gases remain in the atmosphere and their relative effectiveness in absorbing outgoing infrared radiation. The Kyoto Protocol is based on GWPs from pulse emissions over a 100-year time frame.

Greenhouse effect Greenhouse gases effectively absorb infrared radiation, emitted by the Earth’s surface, by the atmosphere itself due to the same gases and by clouds. Atmospheric radiation is emitted to all sides, including downward to the Earth’s surface. Thus, greenhouse gases trap heat within the surface-troposphere system. This is called the greenhouse effect. Thermal infrared radiation in the troposphere is strongly coupled to the temperature at the altitude at which it is emitted. In the troposphere, the temperature generally decreases with height. Effectively, infrared radiation emitted to space originates from an altitude with a temperature of, on average, –19°C, in balance with the net incoming solar radiation, whereas the Earth’s surface is kept at a much higher temperature of, on average, +14°C. An increase in the concentration of greenhouse gases leads to an increased infrared opacity of the atmosphere and therefore to an effective radiation into space from a higher altitude at a lower temperature. This causes a radiative forcing that leads to an enhancement of the greenhouse effect, the so-called enhanced greenhouse effect.

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Reference Manual Greenhouse gases (GHGs) Greenhouse gases are those gaseous constituents of the atmosphere, both natural and anthropogenic, that absorb and emit radiation at specific wavelengths within the spectrum of infrared radiation emitted by the Earth’s surface, the atmosphere and clouds. This property causes the greenhouse effect. Water vapor (H2O), carbon dioxide (CO2), nitrous oxide (N2O), methane (CH4) and ozone (O3) are the primary greenhouse gases in the earth’s atmosphere. Moreover, there are a number of entirely human-made greenhouse gases in the atmosphere, such as the halocarbons and other chlorine and bromine-containing substances, dealt with under the Montreal Protocol.

Besides carbon dioxide, nitrous oxide and methane, the Kyoto Protocol deals with the greenhouse gases sulphur hexafluoride, hydrofluorocarbons, and perfluorocarbons.

Hydrofluorocarbons (HFCs) One of the six gases or groups of gases to be curbed under the Kyoto Protocol. They are produced commercially as a substitute for chlorofluorocarbons. HFCs are largely used in refrigeration and semiconductor manufacturing. Their Global Warming Potentials range from 1,300 to 11,700.

Kyoto Protocol The Kyoto Protocol to the UNFCCC was adopted at the Third Session of the Conference of the Parties (COP) in 1997 in Kyoto. It contains legally binding commitments, in addition to those included in the FCCC. Annex B countries agreed to reduce their anthropogenic GHG emissions (carbon dioxide, methane, nitrous oxide, hydrofluorocarbons, perfluorocarbons and sulphur hexafluoride) by at least 5% below 1990 levels in the commitment period 2008-2012. The Kyoto Protocol came into force on 16 February 2005.

Landfill A landfill is a solid waste disposal site where waste is deposited below, at or above ground level. Limited to engineered sites with cover materials, controlled placement of waste and management of liquids and gases. It excludes uncontrolled waste disposal.

Land-use The total of arrangements, activities and inputs undertaken in a certain land-cover type (a set of human actions). The social and economic purposes for which land is managed (e.g., grazing, timber extraction, and conservation). Land-use change occurs when, e.g. forest is converted to agricultural land or to urban areas.

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Climate Change and Health Methane (CH4) Methane is one of the six greenhouse gases to be mitigated under the Kyoto Protocol.

It is the major component of natural gas and associated with all hydrocarbon fuels, animal husbandry and agriculture.

Methane recovery Methane emissions, e.g., from oil or gas wells, coal beds, peat bogs, gas transmission pipelines, landfills, or anaerobic digesters, are captured and used as a fuel or for some other economic purpose(e.g., chemical feedstock).

Millennium Development Goals (MDG) A set of time-bound and measurable goals for combating poverty, hunger, disease, illiteracy, discrimination against women and environmental degradation, agreed at the UN Millennium Summit in 2000.

Mitigation Technological change and substitution that reduce resource inputs and emissions per unit of output. Although several social, economic and technological policies would produce an emission reduction, with respect to climate change, mitigation means implementing policies to reduce GHG emissions and enhance sinks.

Mitigative capacity This is a country’s ability to reduce anthropogenic GHG emissions or to enhance natural sinks, where ability refers to skills, competencies, fitness and proficiencies that a country has attained and depends on technology, institutions, wealth, equity, infrastructure and information. Mitigative capacity is rooted in a country’s sustainable development path.

Montreal Protocol The Montreal Protocol on Substances that Deplete the Ozone Layer was adopted in Montreal in 1987, and subsequently adjusted and amended in London (1990), Copenhagen (1992), Vienna (1995),Montreal (1997) and Beijing (1999). It controls the consumption and production of chlorine- and bromine-containing chemicals that destroy stratospheric ozone, such as chlorofluorocarbons, methylchloroform, carbon tetrachloride, and many others.Net anthropogenic greenhouse gas removals by sinks.

For CDM afforestation and reforestation projects, ‘net anthropogenic GHG removals by sinks’ equals the actual net GHG removals by sinks minus the baseline net GHG removals by sinks minus leakage.

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Reference Manual Nitrous oxide (N2O) One of the six types of greenhouse gases to be curbed under the Kyoto Protocol.

Non-Annex I Countries/Parties The countries that have ratified or acceded to the UNFCCC but are not included in Annex I. Non-Annex B Countries/Parties The countries not included in Annex B of the Kyoto Protocol.

Ozone (O3) Ozone, the tri-atomic form of oxygen, is a gaseous atmospheric constituent. In the troposphere, ozone is created both naturally and by photochemical reactions involving gases resulting from human activities. Troposphere ozone acts as a greenhouse gas. In the stratosphere, ozone is created by the interaction between solar ultraviolet radiation and molecular oxygen (O2). Stratosphericozone plays a dominant role in the stratospheric radiative balance. Its concentration is highest in the ozone layer.

Perfluorocarbons (PFCs) Among the six greenhouse gases to be abated under the Kyoto Protocol. These are by-products of aluminum smelting and uranium enrichment. They also replace chlorofluorocarbons in manufacturing semiconductors. The Global Warming Potential of PFCs is 6500–9200.

Precautionary Principle A provision under Article 3 of the UNFCCC, stipulating that the parties should take precautionary measures to anticipate, prevent or minimize the causes of climate change and mitigate its adverse effects. Where there are threats of serious or irreversible damage, lack of full scientific certainty should not be used as a reason to postpone such measures, taking into account that policies and measures to deal with climate change should be cost-effective in order to ensure global benefits at the lowest possible cost.

Precursors Atmospheric compounds which themselves are not greenhouse gases or aerosols, but which have an effect on greenhouse gas or aerosol concentrations by taking part in physical or chemical processes regulating their production or destruction rates.

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Climate Change and Health Pre-industrial The era before the industrial revolution of the late 18th and 19th centuries, after which the use of fossil fuel for mechanization started to increase.

Reforestation Direct human-induced conversion of non-forested land to forested land through planting, seeding and/or the human-induced promotion of natural seed sources, on land that was previously forested but converted to non-forested land. For the first commitment period of the Kyoto Protocol, reforestation activities will be limited to reforestation occurring on those lands that did not contain forest on31 December 1989.

Reservoir A component of the climate system, other than the atmosphere, which has the capacity to store, accumulate or release a substance of concern, e.g., carbon, a greenhouse gas or a precursor. Oceans, soils, and forests are examples of reservoirs of carbon. Stock is the absolute quantity of substance of concerns, held within a reservoir at a specified time.

Scenario A plausible description of how the future may develop based on a coherent and internally consistent set of assumptions about key driving forces (e.g., rate of technological change, prices)and relationships. Note that scenarios are neither predictions nor forecasts, but are useful to provide a view of the implications of developments and actions.

Sequestration Carbon storage in terrestrial or marine reservoirs. Biological sequestration includes direct removal of CO2 from the atmosphere through land-use change, afforestation, reforestation, carbon storage in landfills and practices that enhance soil carbon in agriculture.

Shadow pricing Setting prices of goods and services that are not, or incompletely, priced by market forces or by administrative regulation, at the height of their social marginal value.

This technique is used in cost-benefit analysis.

Sinks Any process, activity or mechanism that removes a greenhouse gas or aerosol, or a precursor of a greenhouse gas or aerosol from the atmosphere.

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Reference Manual Social cost of carbon (SCC) The discounted monetized sum (e.g. expressed as a price of carbon in $/tCO2) of the annual net losses from impacts triggered by an additional ton of carbon emitted today. According to usage in economic theory, the social cost of carbon establishes an economically optimal price of carbon at which the associated marginal costs of mitigation would equal the marginal benefits of mitigation.

Source Source mostly refers to any process, activity or mechanism that releases a greenhouse gas, aerosol or a precursor of a greenhouse gas or aerosol into the atmosphere. Source can also refer to, e.g., an energy source.

Standards Set of rules or codes mandating or defining product performance (e.g., grades, dimensions, characteristics, test methods, and rules for use). Product, technology or performance standards establish minimum requirements for affected products or technologies. Standards impose reductions in GHG emissions associated with the manufacture or use of the products and/or application of the technology.

Storyline A narrative description of a scenario (or a family of scenarios) that highlights the scenario’s main characteristics, relationships between key driving forces, and the dynamics of the scenarios.

Sulphur hexafluoride (SF6) One of the six greenhouse gases to be curbed under the Kyoto Protocol. It is largely used in heavy industry to insulate high-voltage equipment and to assist in the manufacturing of cable-cooling systems and semi-conductors. Its Global Warming Potential is 23,900.

Supplementarity The Kyoto Protocol states that emissions trading and Joint Implementation activities are to be supplemental to domestic policies (e.g. energy taxes, fuel efficiency standards) taken by developed countries to reduce their GHG emissions. Under some proposed definitions of supplementarity (e.g., a concrete ceiling on level of use), developed countries could be restricted in their use of the Kyoto Mechanisms to achieve their reduction targets. This is a subject for further negotiation and clarification by the parties.

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Climate Change and Health Sustainable Development (SD) The concept of sustainable development was introduced in the World Conservation Strategy (IUCN 1980) and had its roots in the concept of a sustainable society and in the management of renewable resources. Adopted by the WCED in 1987 and by the Rio Conference in 1992 as a process of change in which the exploitation of resources, the direction of investments, the orientation of technological development and institutional change are all in harmony and enhance both current and future potential to meet human needs and aspirations. SD integrates the political, social, economic and environmental dimensions.

Tax A carbon tax is a levy on the carbon content of fossil fuels. Because virtually all of the carbon in fossil fuels is ultimately emitted as CO2, a carbon tax is equivalent to an emission tax on each unit ofCO2-equivalent emissions. An energy tax - a levy on the energy content of fuels - reduces demand for energy and so reduces CO2 emissions from fossil fuel use. An eco-tax is designed to influence human behavior (specifically economic behavior) to follow an ecologically benign path.

An international carbon/emission/energy tax is a tax imposed on specified sources in participating countries by an international authority. The revenue is distributed or used as specified by this authority or by participating countries. A harmonized tax commits participating countries to impose a tax at a common rate on the same sources, because imposing different rates across countries would not be costeffective. A tax credit is a reduction of tax in order to stimulate purchasing of or investment in a certain product, like GHG emission reducing technologies. A carbon charge is the same as a carbon tax.

Technology The practical application of knowledge to achieve particular tasks that employs both technical artifacts (hardware, equipment) and (social) information (‘software’, knowhow for production and use of artifacts).

Technology transfer The exchange of knowledge, hardware and associated software, money and goods among stakeholders, which leads to the spreading of technology for adaptation or mitigation. The term encompasses both diffusion of technologies and technological cooperation across and within countries.

Tolerable windows approach (TWA) This approach seeks to identify the set of all climate-protection strategies that are simultaneously compatible with 1) prescribed long-term climate-protection goals, 22

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Reference Manual and 2) normative restrictions on the emissions mitigation burden. The constraints may include limits on the magnitude and rate of global mean temperature change, on the weakening of the thermohaline circulation, on ecosystem losses and on economic welfare losses resulting from selected climate damages, adaptation costs and mitigation efforts. For a given set of constraints, and given a solution exists, the TWA delineates an emission corridor of complying emission paths.

Top-down models Models applying macroeconomic theory, econometric and optimization techniques to aggregate economic variables. Using historical data on consumption, prices, incomes, and factor costs, top-down models assess final demand for goods and services, and supply from main sectors, such as the energy sector, transportation, agriculture, and industry. Some top-down models incorporate technology data, narrowing the gap to bottom-up models.

Trace gas A minor constituent of the atmosphere, next to nitrogen and oxygen that together make up 99% of all volume. The most important trace gases contributing to the greenhouse effect are carbon dioxide, ozone, methane, nitrous oxide, perfluorocarbons, chlorofluorocarbons,hydrofluorocarbons, sulphur hexafluoride and water vapor.

Uncertainty An expression of the degree to which a value is unknown (e.g. the future state of the climate system). Uncertainty can result from lack of information or from disagreement about what is known or even knowable. It may have many types of sources, from quantifiable errors in the data to ambiguously defined concepts or terminology, or uncertain projections of human behavior. Uncertainty can therefore be represented by quantitative measures (e.g., a range of values calculated by various models) or by qualitative statements (e.g. reflecting the judgment of a team of experts).

United Nations Framework Convention on Climate Change (UNFCCC) The Convention was adopted on 9 May 1992 in New York and signed at the 1992 Earth Summit in Rio de Janeiro by more than150 countries and the European Economic Community. Its ultimate objective is the ‘stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system’. It contains commitments for all parties. Under the Convention parties included in Annex I aimed to return greenhouse gas emission not controlled by the Montreal Protocol to 1990 levels by the year 2000. The convention came into force in March 1994.

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Reference Manual Climate Change and Health

Background Climate Change and Health: “Facilitator’s Guide” and “Reference Manual” for health professionals and practitioners is developed by the World Health Organization (WHO) Philippines Office and the Department of Health (DOH).

The primary objective of these two documents is to enhance current understanding of local health professionals of the associations and implications of climate change on human health. It is critical to understand the risks and adverse impacts of climate change as these impacts, which include tropical cyclones, increased flooding, coastal erosion, saltwater intrusion and drought, will exacerbate the current effects of environmental degradation on communities and affect vulnerabilities to such impacts. Knowing the risks and vulnerabilities of communities specifically in the area of human health is not enough. Coupled to knowing the vulnerabilities is examining the adaptive capacities of communities to cope with the risks posed by climate change.

The Project is anchored on the National Framework for Action of the Department of Health (DOH) for climate change and is focused on installing an effective surveillance system for early detection of “unusual increases” in frequency of major public health events and in adopting early detection schemes about possible outbreaks through the use of the Health Vulnerability and Adaptation Capacity Assessment (HVACA) tool developed by the WHO and piloted in 11 municipalities and cities in the National Capital Region and the Province of Albay.

There are two documents embodied in this piece of work, first is the “Facilitator’s Guide” and second is the “Reference Manual” both contain four modules and each module contains two to three sessions.

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Climate Change and Health Reference Manual The “Facilitator’s Guide” is to be taken with the“Reference Manual” in order to deliver the course effectively. The “Reference Manual” contains explanation of the topics that pertain to a discussion of key concepts of climate change and climate change variability, the global climate trends and challenges, and Philippines scenario on climate change and the necessary and selected reading materials and references for each session.

The “Facilitator’s Guide” is a step-by-step instruction on how to conduct each module and session. Each module includes a summary and session titles. Each session contains learning objectives, key points to remember, methods to be used, process to undertake in delivering the session, needed materials, duration or time to effectively deliver the session, some tips, and required readings. The learning points maybe modified, simplified or enhanced depending on the competency of the trainer and the participants.

A “CD pocket” at the end is provided, which holds the Powerpoint presentations that will help facilitate the delivery of the course.

General Learning Objectives After the sessions, the participants are able to: 1. Discuss and understand the key concepts of climate change variability and the different trends of climate change 2. Explain the effects and impacts of climate change to health and other sectors an relate it to current health and environmental problems in their locality and in the Philippine setting;

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Reference Climate Change andManual Health 3. Share information on the global, national, and local initiatives on climate change; 4. Examine adaptive capacities to cope with health risks posed by climate change 5. Assess their own locality and determine the extent of health problems caused by climate change; 6. Determine the activities and strategies that will aid them in managing the current and future effects of climate change.

Course Coverage Module 1. Science of Climate Change This module has two sessions: Session 1 Key Concepts of Climate Change and Variability; Session 2 Global Climate Trends and Challenges; and Session 3 Philippine Climate Change Scenario. The key objective of this module is for the participants to understand and differentiate climate change from global warming to greenhouse effect, to climate variability and to gain knowledge on the different trends of climate change and the current facts and figures related to it.

Module 2. Threats, Vulnerabilities, and Impacts of Climate Change This module has three sessions: Session 1 Sectoral Impacts of Climate Variability and Change; Session 2 Assessing threats and Vulnerabilities of Climate Change to Health; and Session 3 Capacity Assessment in Climate-related Health Risks. The module deals with the threats, impacts, and vulnerability to climate change on various sectors and that vulnerability is a function of exposure, sensitivity, and adaptive capacity. The main objective is to inculcate the effects and impacts of climate change to health and other sectors and relate it to the current health and environmental problems in their own locality. The module will also provide an update on the different diseases brought about by climate change, to look into the initial capacities of the health professionals on climate change adaptation and in disease surveillance.

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Climate Change and Health Reference Manual Module 3. Climate Change Initiatives and Adaptation Strategies This module contains two sessions: Session 1 Climate Change Initiatives for Health; and Session 2 Vulnerability and Adaptation Frameworks. The module pertains to an overview of various initiatives towards managing climate change adverse effects at the different sectors both at the global and local perspectives. It also dwell on assessing human health vulnerability and interventions to adapt to climate change.

The module objective is to provide information on the global and national initiatives on climate change and to enable comprehension on the susceptibility of climate change to people and environment to yield a realistic assessment and management.

Module 4. Planning on Climate Change and Health This module deals with Action Planning determine extent of health issues and concerns that are probably caused by climate change as well as determine activities and strategies that can aid health professionals in managing current and future effects of climate change on human health. The key objective is for participants to appreciate the value of taking into their own hands as health personnel the course of the present and future health safety of the communities through planning and implementing climate risk reduction measures. It helps participants to plan utilizing the adaptation strategies they will determine during the planning workshop.

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Introduction When we talk about climate change, we are talking about one of the effects of the interrelationship between the earth systems and the human systems. Our human activities affect the planet and vice versa. Our type and level of socio-economic development, for example, creates greenhouse gas emissions that, in turn, change our temperature as well as the frequency and the amount of rainfall.

Depending on our level of exposure, or our vulnerability, to the effects of climate change such as rise in the sea level and other extreme events, we need to initiate measures to protect ourselves from these hazardous consequences using appropriate mitigation and adaptation measures.

Let us take for example how human systems affect the earth systems and vice versa. When the sun rises, the water from the rivers, streams, plants, trees, etc. rises in the air through a process called evaporation. When the water vapor gets cold, it changes back to liquid and then forms clouds through a process called condensation. When so much water has condensed and the air cannot hold it anymore, the clouds get heavy and water falls back to the earth in the form of rain. This is the process of precipitation.

All in all, the process of evaporation, condensation and precipitation make up the water cycle. The water cycle is a natural phenomenon. It is among the important services of nature.

It is a natural process of making water clean over and over again.

Rain benefits us because it recharges the aquifers or the stone holes underground.

The aquifers are our source of water for drinking and for many other uses.

However, the natural process of water cycle can be altered by human systems. If we have denuded our forests and converted our lands to concrete pavements, then there is less water that would evaporate. If there is less water vapour, then it 28

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would take a longer time for water in the air to become heavy and fall as rain. If rain does not come as often as it should, then we will have a problem with our water supply for drinking and for other needs. This lack in water supply greatly affects our well-being and productivity and triggers undesirable consequences such as drought that seriously damages crops among others.

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Module 1: Science of Climate Change Session 1: Key Concepts of Climate Change and Variability Let us start by clarifying and distinguishing some important terms that we will use in the discussion of climate change.

The first word is weather. It is defined as a set of meteorological conditions at a particular time and place. A set of meteorological conditions refers to the prevailing environmental conditions as they influence the prediction of weather.

Such condition is determined by wind, rain, sunshine, temperature, etc. Take note that weather is time and place specific. The weather at this time can be different in other parts of the country. You can take a look at it in daily newspapers or on TV. The second word is climate. It is defined as the overall long-term characteristics of the weather experienced at a place. It is also referred to as the average meteorological conditions and variability that prevail in a particular region.

We can say that climate is the pattern we draw from daily weather condition over a long period of time.

To further differentiate climate from weather, climate is what we expect based on 30-year averages while weather is what we experience day-to-day.

In the case of the Philippines, our climate is tropical and maritime. We experience, on the average, relatively high temperature, high humidity, and abundant rainfall throughout the year. We do not, however, experience the same weather every day.

The third word is climate variability. It refers to the short-term fluctuations around the average weather. An example of climate variability is the aturally occurring phenomenon known as the El Ni単o/La Ni単a-Southern Oscillation (ENSO). The ENSO cycle displays changes in sea-surface temperatures, rainfall, air pressure, and atmospheric circulation across the equatorial Pacific.

El Ni単o refers to the warm phase of the cycle, in which above-average seasurface temperatures develop across the east-central tropical Pacific. It is associated with extreme climatic variability, i.e., devastating rains, winds, and droughts. It occurs because of the migration, from time to time, of warm surface 30

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waters from the western equatorial Pacific Basin to the eastern equatorial Pacific region, along the coasts of Peru and Ecuador. This condition can prevail for more than a year.

La Niña, on the other hand, is the cold phase of the ENSO cycle. It develops over the central and eastern equatorial Pacific and is characterized by unusually cold surface temperatures of the ocean. This condition can prevail for two to three seasons or an equivalent of six to nine months. The term La Niña (the Little Girl) was used by many scientists and meteorologists to differentiate it from El Niño.

It is sometimes called El Viejo (Old Man), Anti-El Niño, or simply "cold event" or "cold episode".

The fourth word is climate change. It happens over decades and is much longer than climatic variability. It is based on a general circulation model (GCM), which is also known as global climate model. This model uses the same equations of motion as a numerical weather prediction (NWP) model, but the purpose is to numerically simulate changes in climate as a result of slow changes in some boundary conditions (such as the solar constant) or physical parameters (such as the greenhouse gas concentration). NWPs are used to predict the weather in the short (1-3 days) and medium (4-10 days) range future. GCMs are run much longer, for years on end, long enough to learn about the climate in a statistical sense (i.e. the means and variability). The quality of a GCM is judged, amongst others, by the quality of the statistics of tropical or extratropical disturbances. Thus, in understanding climate change, we rely on scenarios, not predictions.

Introduction to El Niño, La Niña, ENSO As we have discussed earlier, weather is the condition of the atmosphere, that is to say, if it is hot or cold, wet or dry, calm or stormy, clear or cloudy. The state of the atmosphere is due to some factors, such as density.

Weather in different places can differ because of the difference in density or temperature and moisture between one place and another. The difference is attributed to the angle of the sun at any particular spot, which varies by latitude from the tropics.

Because of the strong temperature contrast between the polar and tropical air, jet stream is produced. A jet stream is a fast flowing but narrow air currents in the atmosphere. The main jet stream is near the area where the temperature decreases with altitude (troposphere) and where the temperature increases with altitude (stratosphere).

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The major jet streams on earth flow from west to east. Jet streams may start, stop, split, combine or flow in various, even opposing, directions. Weather systems, like extratropical cyclones, are caused by instabilities of the jet stream flow. But, it is important to remember that weather disturbances are actually natural phenomena.

Another important matter to keep in mind is that sunlight is incident at different angles at different times of the year. This is caused by the tilting of the Earth’s axis relative to its orbital plane. This condition causes surface temperature differences, which, in turn, cause pressure differences. For instance, higher altitudes are cooler compared to lower altitudes due to differences in compressional heating.

The constantly changing jet streams and the pressure differences, among others, cause what we normally consider as normal weather condition. Along this way of thinking, the El Niño and the La Niña are considered as the results of the natural ebb and flow of the trade winds over the tropical Pacific. El Niño and La Niña (the opposite phenomenon of El Niño), along with associated changes in the atmospheric pressure across the Pacific, are known as the Southern Oscillation.

The whole process is known as ENSO (El Niño / Southern Oscillation).

El Niño El Niño is an abnormal warming of surface ocean waters in the eastern tropical Pacific. It is one part of the ENSO. ENSO is the see-saw pattern of reversing surface air pressure between the eastern and western tropical Pacific. When the surface pressure is high in the eastern tropical Pacific, it is low in the western tropical Pacific, and vice versa. ENSO is the term that scientists use because the ocean warming and pressure reversals are, for the most part, simultaneous. South American fishermen called this phenomenon the El Niño (The Christ Child) because it comes about Christmas time.

Under normal conditions, that is to say without El Niño, the surface of the ocean, in general, is warmer than at the bottom because it is heated by the sun. In the tropical Pacific, winds generally blow in an easterly direction. These winds tend to push the warmer surface water toward the west. As the water moves west, it gets warmer because it is exposed longer to the sun.

While warm surface water moves west and gets warmer in the tropical Pacific, upwelling occurs in the eastern Pacific along the coast of South America.

Upwelling means that the deeper colder water from the bottom of the ocean moves up toward the surface away from the shore. This water is rich in nutrients.

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It supports the large fish population commonly found in this area, such as the Peruvian fishing grounds.

Recall that the winds push surface water westward. The direction is toward Indonesia. The sea level in this part is about half a meter higher compared to the eastern part. As a result, western Pacific has warmer and deeper waters, while the east near the coast of South America has cooler and shallower waters. The difference in water temperatures of these areas affects the types of weather in these two regions.

How doe differences in water temperatures affect precipitation? In the east, the water cools the air above it. As a result, the air becomes too dense to rise to produce clouds and rain. In the western Pacific, the air is heated by the water below it. As a result, the buoyancy of the lower atmosphere is increased, thus increasing the likelihood of rain. That is why heavy rain storms are typical near Indonesia. The opposite area, say Peru, is relatively dry.

An El Niño condition happens when the trade winds in the western Pacific Ocean near Indonesia weakens, thereby allowing the warmer water from the western Pacific to flow toward the east or South America. This makes the sea level flat (instead of uneven), builds up warm surface water off the coast of South America (instead of cooler surface water), and increases the temperature of the water in the eastern Pacific. As a result, the amount of nutrient-rich deep water, which is normally surfaced by the upswelling process, is limited.

The limited amount of nutrient-rich water affects the fish supply. It means less food for the fish. As a result, hundreds of fish die. This is the El Niño phenomenon, which the Peruvian fishermen call a bad fishing period around December.

As we have learned earlier, the condition of the ocean affects the atmosphere.

When the air over the oceans is hot and humid, it serves as fuel to tropical thunderstorms. The hotter the air, the stronger and bigger is the thunderstorm.

And the biggest thunderstorms move with the Pacific’s warmest water that spreads eastward. This means that the rains that normally would fall over the tropical rain forests, such as in the Philippines, would now fall over the deserts of Peru, causing forests fires and drought in the western Pacific and flooding in South America.

El Niño also affects the temperature of the planet. It causes, for instance, higher temperatures in western Canada and the upper plains of the United States, colder 10

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temperatures in the southern United States, and drought experiences in the east coast of southern Africa.

La Niña La Niña is the opposite of El Niño. During La Niña, the water in the Pacific Ocean, near the equator, gets colder than usual (hotter than usual during El Niño). This condition inhibits the formation of rain-producing clouds over the eastern equatorial Pacific region. However, it enhances rainfall over the western equatorial Pacific region, specifically in Indonesia, Malaysia, and northern Australia. These patterns affect the position and intensity (weakening) of jet streams and the behaviour of storms outside the tropics in both the Northern and Southern hemispheres.

The other known effects of La Niña cycles include the following: favourable environment for hurricane in the Atlantic; above normal temperatures throughout most of the Southwest and Southern Florida; cooler than normal winter temperatures in the Pacific Northwest and across the Great Lakes and Northeast later in the winter into spring; more water to the Philippines, especially when a storm makes landfall and combine with the monsoon, thereby bringing heavy rains.

The El Niño and La Niña events tend to alternate about every three to seven years. However, the time from one event to the next can vary from one to ten years.

What is Climate Change?

According to the Intergovernmental Panel on Climate Change (IPCC), climate change is defined as change in the state of the climate that can be identified (e.g., using statistical tests) by changes in the means and/or variability of its properties, and that persists for an extended period, typically decades or longer.

Under this definition, climate change refers to any change in climate over time, regardless whether the change is due to natural causes or to human activities.

The IPCC is a scientific intergovernmental body. Its mandate is to review and assess the most recent scientific, technical, and socio-economic information on climate change. It was first established in 1988 by the World Meteorological Organization and the United Nations Environment Programme. It was confirmed by the United Nations General Assembly in the same year.

As per the United Nations Framework Convention on Climate Change (UNFCCC), climate change is change of climate that is attributed directly or 34

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indirectly to human activity that alters the composition of the global atmosphere and that is in addition to natural climate variability observed over comparable time periods.

The UNFCCC is an international treaty to consider what can be done to reduce global warming and to cope with whatever temperature increases are inevitable.

In this session, it is important that we learn to distinguish between the levels of overall climate change from the level of climate change caused by human activity. As we have noted earlier, climate change can be attributed to natural causes. However, we have found out that human activity has contributed in increasing the degree of climate change. The contribution of human activity is significant enough to bring catastrophic effects to people and the environment worldwide.

To be able to fully understand climate change, one must be able to understand the concept of the Greenhouse Effect.

The greenhouse effect is important for our survival because without it, the average temperature on Earth would be colder by about 30 degrees Celsius. This temperature is far too cold to allow our current ecological systems to survive.

The atmosphere has a number of gases, often in tiny amounts, which trap the heat given out by the Earth. To make sure that the Earth's temperature remains constant, the balance of these gases in the atmosphere must be retained. The greenhouse gases (GHGs) are very important as they absorb and emit radiation.

The principal greenhouse gases in the earth’s atmosphere:  Carbon Dioxide (CO2)  Water vapour (H2O)  Nitrous Oxide (N2O)  Methane (CH4)  Ozone (O3) The Earth has a blanket of air called the atmosphere, which is made up of several layers of gases.

The much hotter sun gives off rays of heat in a process called radiation. These rays pass through the atmosphere and provide warmth while heat from the Earth then returns into the atmosphere. The greenhouse gases in the atmosphere stop some of the heat from escaping into space. Otherwise, Earth will experience a drop in temperature. The natural process of the sun releasing heat that travels through the Earth’s atmosphere is called the Greenhouse Effect because it is similar to what happens in a real greenhouse.

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The atmosphere reaches near or over 600 kilometers from the surface of the Earth. Quite near if you compare this distance with how far the sun, moon or star is from where we are standing.

The atmosphere, along with solar energy and our planet’s magnetic fields, supports life on Earth. The atmosphere absorbs the energy from the sun, recycles water and other chemicals, and works with the electrical and magnetic forces to provide a moderate climate. The atmosphere also protects us from high-energy radiation and the frigid vacuum of space.

The atmosphere is primarily composed of Nitrogen (N2, 78%), Oxygen (O2, 21%), and Argon (Ar, 1%). A myriad of other very influential components are also present which includes water (H2O, 0 - 7%), "greenhouse" gases or Ozone (O, 0 - 0.01%), and Carbon Dioxide (CO2, 0.01-0.1%).

The exosphere starts at the top of the thermosphere and continues until it merges with the interplanetary gases, or space. In this region of the atmosphere, Hydrogen and Helium are the prime components and are only present at extremely low densities.

Let us take a look at the greenhouse effect. A greenhouse is a small glass house that is used to grow plants, especially during winter. The glass panels of the greenhouse trap heat from the sun and prevent it from escaping, hence, keeping the plants warm enough to survive in the winter.

Similar to a greenhouse, when the sunrays travel through the Earth’s atmosphere, which is made up of several layers of gases, and reach the Earth’s surface – referring collectively to land, water and biosphere – the solar energy is absorbed.

Gases like water vapour, carbon dioxide, nitrous oxide, methane and ozone trap energy from the sun and prevent the heat from escaping back into space.

Though some of the energy returns back into space, most of it remains trapped in the atmosphere, which causes the Earth to heat up.

This allows living things to survive in the planet.

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Under the greenhouse effect, the planet’s surface absorbs half of the solar radiation, which makes the surface warm. The solar radiation is absorbed and reemitted in all directions by the GHG molecules and clouds. The other half is reflected back by the planet to the atmosphere. The effect is warming not just of the surface of the Earth but also that of the lower atmosphere. It is important to take note that solar radiation powers the climate system.

However, along with natural greenhouse gases, there are some man-made greenhouse gases that keep on increasing in the atmosphere. Human activities like burning of fossil fuel, coal, oil, natural gas or cutting down and burning trees, etc. generate a lot of carbon dioxide. The increasing GHGs destroy the balance of greenhouse gases in the atmosphere. In addition, the use of aerosols, hairspray cans, fridges, plastics, etc. produce a group of highly dangerous greenhouse gases called chlorofluorocarbons. These are so harmful that even small amounts can trap large quantities of heat, making the Earth extremely hot.

This phenomenon is known as global warming, which has a highly dangerous effect on Earth.

The major greenhouse gas that human beings produce in large quantities is carbon dioxide. This GHG is produced by the fossil fuel (gasoline, diesel) and used in transportation; building, heating and cooling; producing cement, deforestation, and by natural processes like the decay of plant matter.

Carbon dioxide constitutes about 76% of all the greenhouse gases in the Earth's atmosphere. Most of the increase in carbon dioxide has occurred in the last 50 years.

Since the Industrial Revolution, there was a sudden increase of CO2 although the time period is very short compared to the level of CO2 in the atmosphere before the Industrial Revolution that dates back to 400,000 years ago. For 650,000 years, the atmospheric CO2 has never been higher than 300 parts per million (ppm). In less than 60 years, the level of CO2 in the atmosphere is alarmingly higher than 300 ppm and is now estimated at 380 ppm. More simply, carbon dioxide is released into the atmosphere by forest fires, burning of oil, and disturbing the soil through construction activities, etc.

Part of the carbon dioxide, however, is absorbed by the planet and stored in ‘sinks’. A very important carbon sink is the forest because trees absorb carbon dioxide. Imagine what a healthy forest can do in terms of the volume of carbon dioxide that it can absorb and store. However, if a forest is degraded and 14

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eventually cleared, less and less carbon dioxide will be absorbed and stored and more carbon dioxide will be released in the atmosphere.

Methane (CH4) is a gas and an important fuel. If we burn one molecule of methane in the presence of oxygen, we will produce one molecule of carbon dioxide and four molecules of water. Methane is a potent greenhouse gas.

Although its quantity in the atmosphere is lower compared to carbon dioxide, its global warming potential is 21 times the warming ability of carbon dioxide.

Methane accounts for 20 percent of the additional greenhouse effects.

Methane is classified as a biogas. It is produced from natural, industrial, and livestock sources. The main sources of methane are decomposition of organic matters in the absence of oxygen, natural sources like marshes, fossil fuel extraction, the processes of digestion of animals, bacteria found in rice plantations, and biomass anaerobic heating or combustion.

Nitrous oxide (N2O) is also known as dinitrogen oxide or dinitrogen monoxide.

Under room conditions, nitrous oxide is a colourless, non-flammable gas with a pleasant and slightly sweet odor.

It is commonly known as ‘laughing gas’ or ‘sweet air’ due to the exhilarating effects of inhaling it. It is used in surgery and dentistry for its anaesthetic and analgesic effects. In motor racing, the gas is sometimes injected into the air intake to increase power. The gas is not flammable; however, it delivers more oxygen than air, thereby allowing the burning of more fuel.

Nitrous oxide is produced by the breakdown of nitrogen in soils and oceans. The production of the gas increases when more nitrogen fertilizer and pesticides are used in agriculture. The other sources are biomass burning, combustion process of vehicles, specifically in car racing, and acid production.

Data taken from the Intergovernmental Panel on Climate Change or IPCC show that in 2004, the greenhouse gas emissions caused by human beings per sector are as follows:

• • • • • • • 38

Energy supply - 25.9% Industry - 19.4% Forestry - 17.4% Agriculture - 13.5% Transport - 13.1% Residential and commercial buildings - 7.9% Waste and wastewater - 2.8% 15

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All these sectors are present in the Philippines although not in the same level of complexity and type as those in high-income countries. This means, however, that Filipinos contribute to the emission of greenhouse gases no matter how small compared to others.

Panel on Climate Change or IPCC show the concentration of carbon dioxide (represented by the red line), methane (blue line), and nitrous oxide (black line) from 2,000 years ago up to 2005.

Carbon dioxide concentration is expressed in parts per million (ppm) while methane and nitrous oxide are expressed in parts per billion (ppb). Note that after the industrial revolution (between 1500 and 2000), the concentration of the gases breached the 300 ppm level of carbon dioxide and the 300 pbb levels for the two other gases. This increase in the concentration of the three greenhouse gases coincided with the increase in industrial and related activities in the planet. As industrial and related activities continue, the concentration of greenhouse gases also continues to rise. Indeed, people have caused the sudden upsurge in the concentration of greenhouse gases in the atmosphere compared to the GHGs brought by natural causes.

In 2007, the concentration of atmospheric carbon dioxide was 37 percent higher than at the start of the industrial revolution. It is estimated that the carbon dioxide concentration in the atmosphere was 383 parts per million in 2007.

In the same year, the global emissions from the combustion of fossil fuel and land use change reached 10 billion tons of carbon. This is much higher than the recorded 2 billion tons of carbon in 1950. Land use changes refer to the clearing of vegetation and tropical forests and conversion of such areas into agricultural, residential, and industrial structures among others.

If we count 10,000 years backwards starting in 2005, you will notice that the increase in the concentrations of carbon dioxide, methane, and nitrous oxide follows the same pattern: a sharp rise at the start of the industrial revolution and steady progression thereafter.

In addition to forests, oceans and land also serve as carbon sinks. Oceans absorb about 29 percent of the anthropogenic (man-caused) emissions while land absorbs about 26 percent. The bad news is that the efficiency of the oceans and land to serve as natural carbon sinks has decreased over the past 50 years. This means that while there are more and more anthropogenic emissions, the natural carbon sinks have less and less capability to absorb the emissions. Nowhere to go, the excess emissions are left concentrated in the atmosphere.

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Session 2: Global Climate Trends and Challenges In this discussion, we will take a look at the findings based on the interpretation of the various data and information gathered throughout the world by the Intergovernmental Panel on Climate Change (IPCC). Though there are other findings done by other research institutions, we are using the IPCC findings as it is an international and intergovernmental body, hence, it is very likely that their conclusions are valid, credible, reliable and best approximate the science of climate change.

Let us first tackle the concept of Global Warming Potential or GWP. GWP is the relative ability of each greenhouse gas to absorb or trap heat in the atmosphere.

The baseline is the ability of carbon dioxide to absorb or trap heat (GWP). Along this line, the GWP of carbon dioxide is placed at 1. The same amount of methane as carbon dioxide, however, has more capability to absorb or trap heat. The GWP of methane is placed at 21, meaning to say that a ton of methane has 21 times capability to absorb or trap heat compared to one ton of carbon dioxide. But if you look at nitrous oxide, its GWP is 310 times more than that of carbon dioxide.

Put differently, one ton of nitrous oxide is equivalent to 310 tons of carbon dioxide in terms of GWP, while one ton of methane is equivalent to 21 tons of carbon dioxide.

In terms of the atmospheric lifetime of the three principal greenhouse gases, carbon dioxide has a lifetime of 50 to 100 years; methane has an average of 12 years; and nitrous oxide has about 120 years. This means that even if we stop emitting greenhouse gases to the atmosphere now, we will continue to feel the effects of the concentration of such gases in the next 12 to 120 years.

A significant finding of the IPCC is the unequivocal warming of the climate system. Regardless of the cause of the warming of the global climate system, the message is clear: with no doubt, global warming is real. Based on records for global surface temperature, the period 1995 to 2006 is considered as among the warmest years in history.

Another IPCC finding that proves significant to the Philippines is the rise in the average sea level. From 1961 to 2003, the global average rate of sea level rise is 1.8 mm per year. But if you look at the rate from 1993 to 2003, the rate is higher at 3.1 mm per year. A rise in sea level has a negative impact on archipelagic countries, like the Philippines, as well as in small island-states or islandprovinces.

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There is also evidence showing that the territory covered by the Arctic sea ice has been reduced over the years. Satellite data show that since 1978, the size of the Arctic sea ice has decreased by 2.7 percent per decade. Larger decreases have been observed during summer with an average rate of 7.4 percent. The shrinkage of the Arctic sea ice contributes immensely to the sea level rise.

Mountain glaciers and snow caps, on average, have also declined in both hemispheres. The maximum areal extent of seasonally frozen ground has decreased by about 7 percent in the Northern Hemisphere since 1900 with decreases in spring of up to 15 percent. In Japan, there are areas that used to be covered with snow but have not experienced it for a couple of years now. If you compare a photo of the Portage Glacier taken in the same month in 1914 and 2004, you will notice the big difference.

From 1900 to 2005, precipitation or rainfall increased significantly in eastern parts of North and South America, northern Europe and northern and Central Asia. On the other hand, rainfall declined in the Sahel, the Mediterranean, southern Africa and parts of southern Asia. Globally, the area affected by drought has increased since the 1970s. These changes in rainfall patterns are destructive to certain species that are highly dependent on the right amount of rainfall. For urban communities, too much rainfall could mean flooding while infrequent rainfall could mean less water to drink and even starvation.

Here in the Philippines, you can see previous farm lands that had been converted to industrial and residential areas. With less rainfall in some provinces, rice cultivation becomes difficult. So, a shift to other suitable crops is needed.

There is also observational evidence of an increase in intense tropical cyclone activity or hurricane in the North Atlantic as measured by both frequency and the Power Dissipation Index (which combines storm intensity, duration, and frequency). The increase, counting from the 1950s, is substantial in association with the warming Atlantic sea surface temperatures.

It is also likely that hurricane/typhoon wind speeds and core rainfall rates will increase in response to human-caused warming. Analyses of model simulations suggest that for each 1째C-increase in tropical sea surface temperatures, hurricane surface wind speeds will increase by 1 to 8 percent and core rainfall rates by 6 to 18 percent.

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Climate Change and Health What is Global Warming?

The phenomenon of global warming refers to two elements:

• •

an increase in the Earth’s mean temperature the increase is attributed to the enhanced greenhouse effect

As we have already learned, the earth is naturally warmed by rays (or radiation) from the sun that pass through the earth's atmosphere and are reflected back to space again. This system allows some of the rays to return to the atmosphere, keeping the earth at the right temperature at 60°F/16°C, just warm enough for animals, plants and humans to survive. If we think about it, yes, global warming is beneficial. However, if extra greenhouse gases are made, less radiation escapes and too much heat is kept in the earth's atmosphere. That is when global warming becomes destructive.

We have learned that the phenomenon of global warming is real. The question before us now is to what extent has the world become warmer?

Data show that the surface temperature of our planet has become hotter by 0.6°C, percent since the late 19th century. For the past 1,000 years, the 20th century is tagged the warmest. Over the next century, the projected increase in global temperature is 1.4°C to 5.8°C Of the three principal greenhouse gases, carbon dioxide contributes the most to global warming. And because we have no technology yet to capture greenhouse gases and store them somewhere without affecting the climate, the effects of the greenhouse gases will be felt over the next 100 years.

This picture shows the increase in temperature and how it is directly proportional to the increase in carbon dioxide concentration in the atmosphere, as well as the carbon emissions per year.

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It is clear from the illustration which causes what, i.e., increase in carbon emissions causing an increase in carbon dioxide concentrations and in turn causing temperature change.

According to projections, the global average temperature change in 2085 will be 3.1 degrees Celsius. Take note, however, that land areas will be warmer than oceans and the greatest warming will be in high latitudes. This situation will have a tremendous negative impact on the low lands.

Global temperature increase is clearly an upward trend, but the Global Ocean temperature change is lower than for Global Land.

An important question that we will need to answer given what we have discussed is this: given the phenomenon of mean temperature increase, what will be the effect on extreme temperatures?

Let us recall that climate is defined not simply as average temperature and precipitation but also by the type, frequency and intensity of weather events. And global warming will alter the prevalence and severity of extremes such as heat waves, cold waves, storms, floods and droughts. Our experience with tropical storm Ondoy is a case in point. Ondoy brought an unusually high volume of rain, so much so that during the 12-hour period starting at 8:00 am on September 26, the rainfall was recorded as approximately 450 mm at the Manila Observatory, an extremely rare occurrence.

Increase in mean temperature is likely to reduce the cold weather and increase the hot weather.

This figure shows the projected impacts of climate change to food, water, ecosystems, extreme weather events, and the risk of abrupt and major irreversible changes if there is an increase of more than zero degrees Celsius to five degrees Celsius.

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Let’s take the case of water. With temperature increase of about one degree Celsius, the small mountain glaciers will disappear. With an increase of two to four degree Celsius, significant fall in water availability will be experienced, especially in the Mediterranean and South Africa. With an increase of more than four degrees Celsius, major cities that are located along coastal areas are in danger to sea level rise.

This picture shows another perspective of the impacts of global warming in terms of temperature increase and the year that the temperature increase is projected to happen.

This is under the assumption that there is continued intensive reliance on fossil fuels and emission increases.

By the year 2020s, the impacts includebleaching of corals, among others. This impact alone is very significant because coral reefs are the “rainforests of the sea”, and provide a home for 25 percent of all marine species. Coral bleaching or the paling of zooxanthellate invertebrates is expected to reduce the population of reef-dwelling fish and invertebrates and their predators, as well as small pelagics that inhabit reefs for a portion of their life cycle. This means not just less fish stock, but also depleted fish harvest. Hence, it affects food supply and security.

Heat wave is another significant impact associated with a one degree Celsius temperature increase. According to the BBC, “About 200 people have died in a heat wave sweeping the southern Indian state of Andhra Pradesh while many other states are experiencing severe drought. Temperatures have soared to as high as 47.2°C in the southern state. The high temperatures led to a shortage of drinking water and deaths caused by dehydration and sunstroke,” said DC Roshaiah, chief of Andhra Pradesh relief operations. Last year, a heat wave killed more than 1,000 people in the state and caused devastating drought.

On May 30, 2010, the Guardian reported that “Record temperatures in northern India have claimed hundreds of lives in what is believed to be the hottest summer in the country since records began in the late 1800s. The death toll is expected to rise with experts forecasting temperatures approaching 50°C (122°F) in the 44

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coming weeks. More than 100 people have died in the state of Gujarat where the mercury topped at 48.5°C last week. At least 90 died in Maharashtra, 35 in Rajasthan and 34 in Bihar.”

Now, imagine what will happen to us if we get that kind of heat wave given the data showing that the highest temperature nationwide in 2011 reached 39.2°C in Cabanatuan City in Nueva Ecija last May 3.

According to Science Daily, the thawing of Arctic permafrost or soil that normally remains at or below the freezing point for at least a two-year period and often much longer – is among “the worrisome environmental effects of global warming.” Permafrost soils are estimated to store almost twice as much carbon that is present in the atmosphere. If the greenhouse gases stored are exposed, then there will be more concentration of greenhouse gases in the atmosphere, which would cause more thawing (change from a frozen solid to a liquid by gradual warming) of permafrost, a cycle that will make the effects of global warming more difficult to counter.

The Himalayan glaciers are receding faster than in any other part of the world, according to the IPCC. At current rates of global warming, they could disappear altogether by 2035, if not sooner, affecting half a billion people in the HimalayaHindu-Kush region and a quarter billion people downstream who rely on glacial melt waters. Melt water lakes trapped behind thinning glaciers are an increasing hazard, posing a threat of glacial lake outburst floods.

This claim, however, has been questioned by other scientists who found evidence that the glaciers are either stable or increasing. What this implies is that there is no exact and absolute way of projecting into the future what will happen to the glaciers given the so-called controversy. The applicable principle, however, states that we should take precautionary measures even if there is lack of scientific information and certainty. Given the number of people who rely on the natural process of glacial melting for agriculture and drinking, we need to exercise maximum caution and restraint. As Jonathan Mitchell of the Ecologist wrote on July 13 this year: For Jason Gulley, a Karst Hydrogeologist at the Department of Geological Sciences at the University of Florida, their (glaciers) demise is certain. 'The debris-covered areas of the glaciers [in the Mount Everest region] are dead and no longer flowing,' he says. In effect this means the glacier has stopped grinding its way through the Gokyo valley as it should and is now in a state of terminal decline. This is largely due to high carbon dioxide emissions 22

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in our atmosphere which have resulted in rising temperatures across the world and partially due to brown haze air pollution.

The rapid melting of glaciers would mean less freshwater for about 1 billion people. An equally significant negative impact is the possibility of sea level rise due to such melting of glaciers.

In this figure, we are showing the shrinking of the Himalayan glaciers compared to other glaciers in the world. We took note of the controversy as regards the certainty that this is happening. Elizabeth Rosenthal, however, pointed out that a paper published recently in Nature Geoscience sets out to systematically and scientifically answer these questions.

Using new remote sensing methods and satellite images, Bodo Bookhagen of the University of California at Santa Barbara and Dirk Scherler of the University of Potsdam found that different parts of the Himalayas were reacting differently.

The researchers reported that “about half of the glaciers in the Karakoram region of the northwestern Himalayas were actually stable or even advancing, while two-thirds of the glaciers in the rest of the Himalayas were shrinking�.

Here we illustrate the impact of the melting of glaciers and ice caps, permafrost warming, reduction in snow cover, reduction of lake and river ice, reduction of sea ice, and thinning of ice shelves and ice sheets.

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This has a serious impact on the Philippines because our country is highly vulnerable to sea level rise.

According to IPCC, shrinking snow and ice coverage cause more of the sun's heat to be absorbed by land and polar oceans, which in turn may speed up global climate change.

Another potential threat from the melting of glaciers is glacial lake outburst flood (GLOF) or mountain tsunami. Imagine what will happen if instead of a landslide, which has been happening in the Philippines, water will suddenly burst out from the mountains. It could be a very tragic incident.

In the case of Bhutan, GLOFs occur with regularity in its valleys and low lying river plains. Flash floods, for instance, have occurred recently in the Thimphu, Paro and Punankha-Wangdue valleys. Of the 2,674 glacial lakes in Bhutan, 24 have been identified by a recent study as candidates for GLOFs in the near future.

We have discussed the role of carbon sinks like the oceans that store carbon dioxide. Oceans help in slowing down global warming. The problem is this: excessive carbon dioxide in ocean water changes ocean chemistry. Now, any change in ocean chemistry is bad news for marine life. The species that will be affected include corals, shellfish, and some types of plankton that have shells or skeletons made of calcium carbonate. Acid is corrosive to calcium carbonate.

Ocean acidification will make it harder for these plants and animals to build shells and skeletons, and those already built will tend to dissolve. Imagine a boneless bangus as a natural effect of ocean acidification.

The freshening of the Antarctic Bottom Water is the effect of the melting of ice sheets. More ice sheets melting means more freshwater mixing with the Antarctic Bottom Water. This freshening, coupled with other factors like decreasing salinity and density, could slow down the thermohaline circulation, thereby affecting global and regional climate patterns. The thermohaline circulation is the dominant mechanism responsible for ocean heat transport. It acts like a giant pump, its "engine" being the dense cold and salty waters sinking to the depths of Northern and Southern waters at both poles.

Accordingly, cold and salty water sinks to the depths in the far north Atlantic Ocean near Greenland and, together with the vast amount of water that sinks off 24

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Antarctica, this drives the ocean conveyor belt. This system brings warm water into the far north Atlantic, making Europe warmer than it would otherwise be, and also drives the large flow of upper ocean water from the tropical Pacific to the Indian Ocean through the Indonesia Archipelago. If these currents were to slow or stop, the world's climate would eventually be thrown into chaos. Recall the role that oceans play as regards the El Nino and La Nina phenomena.

Sea Level Rise in Asia This time we will discuss the phenomenon of sea level rise, a phenomenon that is very relevant to the Philippines. We will look at the projected effect of sea level rise to selected cities in Asia and in Metro Manila.

The global average sea level has been rising at an average rate of 1.8 mm per year since 1961. The rate has accelerated since 1993 to about 3.1 mm per year.

Expect higher rates in the coming decades. Sea level change is not geographically uniform, however, because it is controlled by regional ocean circulation processes. The largest losses expected from sea level rise are likely to be in the Atlantic and Gulf of Mexico coasts of the Americas, the Mediterranean, the Baltic and small island regions. Intertidal and coastal wetland habitats may be substantially reduced in the future as a result of sea level rise. This makes the Philippines part of the danger zone.

Why is sea level rise occurring? The answer is that as water gets warmer it takes up more space. Although each drop of water only expands by a little bit, if you multiply this expansion over the entire depth of the ocean, it all adds up and causes sea level to rise. Sea level is also rising because melting glaciers and ice sheets are adding more water to the oceans.

The figure illustrates the sea level change in mm from the year 1800 to 2100. The gray shaded area shows the estimates of sea level change from 1800 to 1870 when measurements were not yet available.

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The red line is a reconstruction of sea level change measured by tide gauges with the surrounding shaded area depicting the uncertainty. The green line shows sea level change as measured by satellite. The purple shaded area represents the range of model projections for a medium growth emissions scenario (IPCC SRES A1B). For a clearer reference, 100mm is equivalent to about 4 inches.

This illustrates the relationship among the following: global average temperature, global average sea level, and snow cover.

You will notice that the reduction of snow cover in the Northern Hemisphere is inversely proportional to the rise in global average sea level.

Notice also that the rise in global average sea level is directly proportional to the increase in global average temperature.

Changes in Rainfall Pattern and Extreme Events As we have discussed earlier, global warming could make the wet and dry periods happen frequently and for a longer period compared to the past years. If dry period is frequent and takes longer than before, then we will have less water to drink, less water for irrigation and more heat-related illnesses. If we have longer wet seasons, then we will have an increase in the incidence of flooding and more water-borne related diseases. If the sea level rises, the coastal communities will be flooded; hence, the residents in the lowland areas will have to transfer to upland areas. This will require enormous changes in the delivery of health and other social services.

At one time or another, we experience or hear of other people’s experiences with earthquakes, avalanches, and landslides. We see the victims on television, hear about them on radio, or read about the calamities in newspapers. Some of our relatives or maybe, us, have become victims of disasters in the Philippines. What we should take note is that the economic losses from climate-related disasters will be three times higher. Based on records, climate-related disasters have affected 55 times the number of people affected by geo-physical hazards.

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According to the United Nations, for the period from January to the end of November 2009, 224 of the 245 disasters were weather-related, and accounted for 55 million out of 58 million people affected. In terms of the economic losses, poorer nations have weather-related disasters cost of $10 billion to $15 billion annually, while wealthier countries have experienced a cost surge from $20 billion per year to well over $70 billion. In addition, most of the affected population come from low-income countries.

In the Philippines, Typhoons Ondoy and Pepeng caused considerable damage and losses, estimated to amount to some $4.4 billion US$, or 2.7 percent of GDP, according to the World Bank. The Bank also said that the loss is comparable in size with similar flooding and typhoon damages in other countries, and sufficiently large to have an impact on overall growth, poverty, and the fiscal position of the country, and affected regions.

We have seen pictures of victims of disasters. What do you think is a disaster?

Is disaster weather-related? If so, why?

Let us first understand the difference between hazards, risks and disasters.

Hazards are natural occurring or human-induced events with a potential to create loss, and may be a general source of future danger.

Risk is the actual exposure of something of human value to a hazard and is often regarded as the product of probability and loss.

So we may define: Hazard (cause) – a potential threat to humans and their welfare Risk (likely consequence) – the probability of a hazard occurring and creating loss.

When large numbers of people are killed, injured or affected in some way, this is a disaster. Disaster is an actual happening, rather than a potential threat, so we may define: Disaster (actual consequence) –the realization of a hazard Disasters are social phenomena that occur when a community suffers exceptional, non-routine, levels of disruption and loss.

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Note that a hazardous event can occur in an uninhabited area but a risk and a disaster can exist only where people and their possessions exist.

An example of a hazard that may turn into a disaster is a tropical cyclone. A tropical cyclone has a low pressure in the center and numerous thunderstorms causing strong winds and rains that cause flooding. It is commonly called as hurricane in the Caribbean. Tropical Cyclone Sidr (Nov 07) had a maximum winds of 240 km/hr at landfall. Sidr was the worst storm to hit Bangladesh since 1991. More than 8.5 million people affected and over 3,000 fatalities. Cyclone Nargis was also known as Very Sever Cyclonic Storm Nargis. It was a strong tropical cyclone. It caused the worst natural disaster in the recorded history of Myanmar. It caused catastrophic destruction and at least 138,000 fatalities. The super-cyclone that hit India earlier in 1999 affected the lives and livelihoods of 12 million people in Orissa. These are evidences showing that the strongest cyclones have become more intense in all storm-prone regions.

Another type of hazard associated to climate change that can turn into a disaster is droughts. In 2007, a drought affected about ten million people in sub-Saharan Africa. Argentina, Paraguay, and Uruguay (Jan-Sep 08) experienced the worst drought in over 50 years in some areas. Chile (2008) got the worst drought in 50 years in the central and southern parts.

Drought refers to a period or condition of unusually dry weather within a place where rainfall is normally present. It can cause food scarcity since most crops in places like the Philippines are dependent on abundant supply of water. Food scarcity could result in malnutrition, which is a social, economic, and health problem.

The latest official current world population estimate, for mid-year 2010, is estimated at 6,852,472,823. This year, 2011, the global population is expected to hit or exceed 7 billion. By year 2043, global population is projected exceed 9 billion. The increase in population clearly requires a corresponding increase in food production to feed an additional 3 billion people. The problem is climate change could result in decreases in the agricultural productivity, especially in the tropics. The challenge before us today is how to solve that problem?

In many regions of the world, water is already scarce. There is not enough water in view of the increased pressures from agriculture and urban expansion. With climate change, water scarcity would become a nightmare to decision makers and 28

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the affected populations. Thus, shortages of water for agriculture and for basic human needs are threatening communities around the world. According to projections, areas expected to be affected by persistent drought and water scarcity in coming years include the southern and northern parts of Africa, the Mediterranean, much of the Middle East, a broad band in Central Asia and the Indian subcontinent, southern and eastern Australia, Northern Mexico, and the Southwestern United States. In the case of the Philippines, sometimes we have an abundant supply of water due to the typhoons that hit the country every year. The problem is that we are not able to collect the excess water well. So when there is a dry spell, we experience water scarcity. But water scarcity is just part of the problem. The other is water quality. We are spending a lot of money for mineral water for drinking because the quality of our underground water has been compromised.

Excessive rainfall and improper land use planning, among others, lead to flooding. Flooding, in turn, causes more water borne diseases. In 2005, diarrheal diseases accounted for 20.1% of deaths in children less than five years. In some barangays in the Surigao provinces, flooding could last up to three months. In the Philippines, the common food or waterborne diseases are bacterial diarrhea, hepatitis A, and typhoid fever.

Studies done by the World Bank, Asian Development Bank, and other international and local research institutions point to at least 3 interlinked problems in the Philippines. The first is disaster. In 2000, a Brussels-based research center declared our country as “the most disaster-prone country on earth.� It cited typhoons, earthquakes, volcanic eruptions, floods, garbage landslides, and armed conflicts as bases. The Philippines placed third among countries in the world most frequently pummelled by natural calamities last year.

Citing records of the Belgium-based Centre for Research on the Epidemiology of Disasters (Cred), the Citizens' Disaster Response Center said the Philippines was hit 14 times by natural disasters last year, behind India and China.

The second problem is poverty. The latest official poverty data of NSCB show that in terms of poverty incidence among population, there was a very slight increase from 26.4% in 2006 to 26.5 in 2009. Incidentally, the most affected population by disasters are the poor.

The third problem is natural resources degradation. The Philippines used to have over 90% forest cover. Now, we barely have 25%, with numerous municipalities 52

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that have less than 10% forest cover. This problem increases the negative impacts of weather-related disasters. It also affects agricultural productivity. And the more poor people we have, the more stress there will be to our remaining natural resources. And the cycle continues.

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Session 3: Philippine Climate Change Scenario Given the 3 interlinked problems we are facing, let us now look at climate change, as well as its effects and impacts to the Philippines.

This is a visualization of the rapid decline of our forest cover in less than 100 years. With fewer trees that serve as our natural protection against climate change, we are under a clear and present danger. Not only that, after 1965, we have our bio-capacity, which is the ability to regenerate resources and absorb waste in a limited time period. We are now in an ecological deficit. In fact, at present, we are using an equivalent to 60% bio-capacity of another Philippines.

In terms of carbon dioxide emission per capita, we are among the lowest contributors. That is why we are more of a victim of climate change than a culprit. Nevertheless, we contribute, no matter how little, to climate change by emitting carbon dioxide. And by cutting down our trees, we significantly reduced the ability of our country to serve as carbon sink.

A large part of the Philippines belongs to the climate change hot spot. We are also part of the area where the coral reefs are at risk. (Recall our discussion on coral reef bleaching.) In addition, all of the country is part of the area where sea level rise is a concern. Moreover, we are projected to experience climate change effects like less precipitation, negative agricultural changes, and changes in ecosystems, depleting fish stock, increasing frequency and intensity of cyclone, and forest fires in areas where there are remaining sufficient forest cover.

In case of sea level rise, the communities near our coastal areas will be flooded and the residents will have to move up to areas with higher elevations.

Intertidal and coastal wetland habitats may be substantially reduced in the future as a result of sea level rise. Thus, our supply of seed stock for aquaculture species will also be affected.

Our children are among the most vulnerable to climate change and its effects, such as excessive rainfall and flooding. Children and teenagers are high-risk to drowning, and the children less than five years old are most at risk. If you look at the figures, drowning kills more children than road traffic injuries, suffocation, etc.

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Recall our discussion on water scarcity as an effect of climate change. In this picture, you could see that the Philippines is a high-risk country for water poverty. This problem is made more difficult by the fact that we are far from freshwater rich areas. Access to freshwater for agriculture and for human need is indeed a very serious problem.

Freshwater is a scarce resource especially in countries, like ours, that experience water poverty. According to the World Meteorological Organization, only 2.5 percent of the total water volume on the Earth is fresh water and the remainder is saline or salty. Our largest available source of fresh water lies underground because the availability of our surface water has become sparse. But our groundwater is used extensively to supplement available surface water to meet ever increasing water demand. In coastal areas, groundwater systems are in contact with saline water; hence, one of the major problems is saltwater intrusion.

Saltwater intrusion means the replacement of fresh water in coastal aquifers (underground water storage) by saltwater.

Studies show that there are areas that are considered high to very high risk areas to projected temperature increases. Thirteen (13) of twenty (20) high-risk provinces are in Mindanao. With regards to El Ni単o, Mindanao is also considered a high to very high risk area. The high risk areas in the Visayas are also the ones considered high to very high risk areas to projected temperature increases.

In terms of typhoons, Mindanao and some parts of the Visayas areas have an advantage. The risk is low to very low; most of the high to very high risk areas are located in Luzon. The high to very high risk areas to typhoons are also generally the ones that are threatened by projected rainfall change; more than half are in Luzon.

If we combine all the risks to climate change that the country is facing, more than half of the top high to very high risk areas are in Luzon.

We shall review the effects of Ondoy and Pepeng. Recall that in the late September and early October 2009, the Philippines was hit, in quick succession, by the 2 typhoons, which severely affected nearly 10 million people. Tropical storm Ondoy (international name Ketsana) hit the Philippines on September 26, 2009. It caused widespread flooding due to an unusually high volume of rain. It 32

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caused extensive flooding in the central part of Luzon, Metro Manila and the neighboring Rizal province.

Tropical storm Ondoy was quickly followed by typhoon Pepeng (international name Parma). Typhoon Pepeng affected the Philippines during October 3-9, 2009. It initially brought powerful winds with gusts of up to 230 km/hr then an extended period of heavy rains. The resulting river floods have been estimated to have a return period of around 50 years. This means that statistically speaking, such a rainfall event occurs on average once in every 50 years.

As we discussed earlier, children are among the most vulnerable to the effects of climate change. If the youth are the hope of the motherland, then we need to ask ourselves how we could best provide our children with the best possible future.

Given the enormous challenge posed by climate change, the most important question is: What can we do? If we believe that we are most intelligent species on the planet, then we have to have some degree of “faith� in our capacity to meet the challenge. Let us discuss two general ways to address the challenge.

The first approach is mitigation. Mitigation is defined by the IPCC as an anthropogenic intervention to reduce the anthropogenic forcing of the climate system; it includes strategies to reduce greenhouse gas sources and emissions and enhancing greenhouse gas sinks. It simply means reducing the damage we have caused to our climate by reducing what we have done to cause the damage or by putting in place a compensating action. For instance, if we have contributed carbon dioxide to the atmosphere, then we can reduce our carbon dioxide emission. We can also reforest our land so we that can establish carbon sinks that will sequester and store carbon dioxide from the atmosphere.

Climate change mitigation, therefore, refers to actions taken in order to 1) reduce the emissions of greenhouse gases (e.g., such as carbon dioxide, methane, nitrous oxide, etc.), 2) remove heat trapping gases from the atmosphere after they are emitted, or reduce the impact of greenhouse gases in terms of the global warming that alters climate.

There are a number of direct and indirect ways of doing climate change mitigation. For example, an indirect effect occurs when having built a home under the direct rays of the afternoon sun, we may site a tree to plant beside the structure to shade the place and reduce the absorption of heat. A direct effect 56

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would be to change our consumption of electricity by installing a new technology such as a solar electric (photovoltaic array) system of panels to generate electricity from ultraviolet radiation.

Climate change mitigation stands in contrast to climate change adaptation, which refers to actions taken to reduce the impact of climate change once it occurs. The IPCC defines adaptation as adjustment in ecological, social or economic systems in response to actual or expected climatic stimuli, or their effects, that moderates harm or exploits beneficial opportunities. In this course, we will focus on approaches, tools, and techniques on climate change adaptation.

Before we end this part of the course, let us review some important points that we have covered. These are as follows:

•

Climate-related disasters pose higher risks to certain groups of our population. As we have learned earlier, children are highly vulnerable to the effects of climate change. If you recall our maps, there are areas in the country that are highly vulnerable to certain types of threats, hazards, and risks.

•

Some communities could suffer long or short-term, and reversible or irreversible setbacks. Some barangays, for instance, suffer one day of flooding, while others experience flooding for a couple of months. Some farmers may not be able to harvest what they have planted when crops are destroyed by typhoons, but they can plant again, although with a little or more difficulty, and then harvest what they have planted when the weather is fine. Some families, however, suffer irreversible setbacks. A death in the family is an example of an irreversible effect.

•

The impacts that we have discussed clearly show how climate change can injure or kill human beings, animals, and other species. We have also discussed impacts that destroy or damage properties and livelihoods. We have also shown examples how such impacts could make some people poorer.

•

We have shown that the effects of rising temperatures and prolonged dry periods will cripple harvests in many parts of the world. Our rice fields are highly vulnerable to the ill effects of El Nino.

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As population increases and as extreme weather events become more frequent and higher in intensity, we could safely assume that more and more people face the threat of food scarcity in the near and far future.

Therefore, we need to act fast and well, now.

The signs of the time are clear. As the Stern Review found out: The poorest developing countries will be hit earliest and hardest by climate change, even though they have contributed little to causing the problem. We are the one of the countries with the lowest emission of carbon dioxide, but we are highly vulnerable to the effects of climate change.

The IPCC said that the adverse health impacts will be greatest in low-income countries. Those at greater risk include, in all countries, the urban poor, the elderly and children, traditional societies, subsistence farmers, and coastal populations (high confidence). We all have the high-risk populations and areas.

Now, the call of the times is for us to do what we can, and become heroes for our own families, our own communities, our own generation, and the generations yet to come.

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Module 2: Threats, Vulnerabilities and Impacts of Climate Change Session 1: Sectoral Impacts of Climate Variability and Change Our climate has changed and continues to, faster than usual. As the climate changes, it also introduces change. This is based on the principle of unity.

Everything is interconnected - I am here because you are here, you are here because others create the conditions for you to be here; those responsible for us to be here are also inspired or asked by other people to make this course possible.

As Joey Ayala sings, ang lahat ng bagay ay magkaugnay, magkaugnay ang lahat.

The surface temperature of the planet has increased, and is projected to increase more in the future. As surface temperature increases, together with other factors, extreme weather events happen more often than before and with more force or power. The greater the intensity of the extreme events, like typhoons and drought, the more devastating their effects become.

Rainfall patterns have also changed. There are places where rainfall does not come as often as expected and in some areas, rainfall occurs more often than usual. Normally, rainy season in the Philippines is from June to September, but as we have experienced in the past years, this has changed. As a result, food production is affected. In response, some farmers have shifted to planting other crops that has better chance to survive with less rain.

Sea level rise is also happening. In a coastal town in Barobo, Surigao del Sur the residents have to make their houses higher because when they built their houses a few years back, the high tide would not reach their floors. Now, the high tide is higher than it used to be.

The climate is changing. We changed the climate. And the changing climate is now changing us, so to speak.

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Threats, Impacts and Vulnerability Threat is an indication of imminent harm, danger, or pain. Threat is not necessarily real, it may or may not come, but the potential harm that it can cause makes us afraid of it. We cannot possibly predict when or when a typhoon may happen, nor can we predict its intensity. But because of the potential harm that it may cause, based on our previous experiences or the experiences of other people, we become afraid.

When people who were badly affected by Ondoy and Pepeng hear of a typhoon coming, they leave their houses and move to safer places – evacuation centers; returning only when it is safe. Climate change threats, such as accelerated sea level rise, may not happen. But we fear it; hence, we need to be ready for it.

Impact is not the same as threat, but related to threat. Impact is the result of a threat that became real, a threat that has happened and has caused harm or pain.

What make us afraid of the threat are the impacts that it could bring. Too much rainfall and prolonged droughts are threats that can cause change in the distribution of carriers of diseases (such as mosquitoes). The potential impact if these threats are the increase in the occurrence of sickness or death brought about by these changes. In some barangays in Mindanao that are near big rivers, the threat is too much rainfall and the impacts include displacement of people and destruction of farms and properties.

Vulnerability is a possible future state that implies high risk combined with an inability to cope. The measure of vulnerability incorporates: 1) the degree to which one is exposed to the impacts of climate change (exposure), 2) how much one is affected, directly or indirectly, and adversely or beneficially by the climate change impacts (sensitivity), and 3) one’s potential to cope with climate change impacts, recover and adjust (adaptive capacity).

As discussed in the previous Module, climate change does not affect everyone in the same manner and degree. So, if too much rainfall and prolonged drought are threats, and change in the distribution of carriers of disease is an impact in case these threats happen, then not everyone has the same level of vulnerability. Those 60

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who have resources to buy cure for mosquito borne diseases, for instance, are less vulnerable than those who could not afford such cure.

Exposure is the degree to which you are exposed to the impacts of climate change. It is a key element of vulnerability. Exposure to climate hazards encompasses both the frequency (how often) and severity (how intense) of a hazard. People living in the coastal areas have high exposure to flooding brought about by sea level rise compared to people living in the uplands, but upland dwellers may have high exposure to landslides brought about by heavy rainfall.

The more people are exposed to a particular hazard, the more vulnerable they are to that particular hazard. The more frequent and severe the hazard, the more and more vulnerable the exposed people become. People living in the Bicol region are more exposed to typhoons now than the people living in Northern Samar. The more frequent and intense the typhoons hitting the Bicol region, the more vulnerable the Bicolanos become.

Sensitivity refers to the degree to which a place is affected either adversely or beneficially by climate change. Yes, climate change can have adverse or beneficial effect. Climate change can bring too much rainfall in a place that is easily flooded. It can also bring increase rainfall to a place that is in need of more water for grain crops.

Sensitivity to climate change hazards is influenced by factors, such as culture, tradition, gender, social networks, equity and governance. These factors are broadly grouped into social, economic and geo-physical factors. These factors determine who is affected, how they are affected, and the degree to which they are affected.

Social factors include population size, density, and distribution. These factors determine who is affected by hazards. People living in informal settlements along rivers or coastal areas, for instance, are highly vulnerable to flooding.

Economic factors like access to food supply, transportation, and markets determine sensitivity to climate change impacts. If a disaster happens, for example, in a geographical isolated and depressed area (GIDA), and relief goods could not be brought to the victims on time, then the victims suffer more.

Geo-physical conditions, such as high residential and infrastructural density in a low lying zone, also determine sensitivity. Certain parts of Marikina City, for 38

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instance, were badly affected by Ondoy and Pepeng than, say, the elevated areas of Pasig City.

Adaptive capacity is the ability of a system to adjust to climate change (including climate variability and extremes) to lessen the potential harm, seize the opportunities, or cope with the consequences. It is a function of several factors, such as wealth. As we have discussed earlier, climate change will make the poor more vulnerable, and will make poverty reduction efforts difficult. The options available to the poor in the face of climate variability are collectively called as their adaptive capacity.

In the context of this example, we can say that the wealthy individuals have a higher level of adaptive capacity. They can build stronger houses. They can move to areas where they can be less exposed to hazards. Or they can help provide funds for the construction of evacuation centers. However, having that higher level of adaptive capacity does not mean that it is always used well. Not all wealthy individuals are aware of the level of their vulnerability to hazards; hence, they become victims just like the poor.

Vulnerability assessment, therefore, necessarily includes a systematic analysis of exposure, sensitivity, and adaptive capacity. Vulnerability of people or communities to climate change threats increases if they have a high level of exposure and sensitivity. Conversely, vulnerability decreases if adaptive capacity increases.

Impacts of Climate Change We talked about impacts as the results of the climate change threats that materialize. Biological systems, such as the habitats and communities of plants and animals, can be impacted by climate change. The impacts can be in terms of productivity (decreased capacity to absorb greenhouse gases by degraded forests), quality (polluted water bodies due to wastes), and population (depleted fish stock due to coral reef bleaching), among others.

For societal systems, the impacts can change income (less harvest due to destructive typhoons), morbidity (infections due to water borne diseases), mortality (deaths due to flooding), and hunger (food scarcity due to prolonged droughts), among others.

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In this picture you could see the impacts of surface temperature increase, sea level rise, and heavy rainfall on the different sectors, such as health, agriculture, water, etc. The impacts may be sector-specific, but such impacts can collectively damage a single community.

Let us look at the impact of climate change on the agricultural sector. The significant impacts include decreased agricultural production due to frequent and longer droughts. Projections point to the possibility of 15% drop in rice yield per hectare if temperature increases by 1 degree Celsius.

Reduced farm production is also caused by frequent floods, as well as increased incidence in pests and related plant diseases.

If temperature increases by 2-6 degrees Celsius, projections show a potential decline in agricultural production by 29-60%. Such negative impact will cause hunger and misery to our increasing population. Regardless of the level of warming, the decrease in agricultural productivity in the tropics and subtropics appears to be certain.

The impacts of changes in rainfall patterns to forestry include drought or flood conditions. Such conditions could make forest management more difficult due to pests and fires. With fewer trees, people who are dependent on wood fuel will be badly affected. With the increasing demand for wood, forest protection becomes harder to implement.

We have discussed that global sea levels rose at 1.8 ¹ 0.5 mm/year through the 20th century, and that global mean Sea Surface Temperatures (SST) have risen about 0.6°C since 1950, with associated atmospheric warming in coastal areas.

Increase Sea Level Rise (SLR) will lead to increase in water depths (aggravating floods in low-lying areas), changes in tidal and water movement, sea water 40

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intrusion into rivers and estuaries resulting in lesser mangrove production, and disruption of salt and fresh water balance. Since a large number of our urban population is in the coastal zone, more and more people are vulnerable to the impacts.

We talked about the threat of global warming to coral reefs. The impacts on coastal zones will necessarily affect our remaining coral reefs, which in turn will affect our fish production. One important source of protein for our people will be severely degraded.

It is important to recognize important factors that determine our level of vulnerability to impacts on coastal zones. Being archipelagic, we are highly exposed and sensitive to the impacts. In the next slide, we will briefly analyse our adaptive capacity.

The figure illustrates our typical coastal zone. We have small watersheds. As a result, we need frequent rainfall to recharge our aquifers or underground water storage. In this context, typhoons are actually blessings. But since we only have very little forest cover, our natural protection against strong winds and heavy rains is now reduced.

Without sufficient vegetation, water flows from the uplands to the natural water ways, bringing with it topsoil that is important to our farms. With siltation our water bodies become shallow, as a result, it could hold or contain less water. This is why we experience severe flooding in the lowland areas. In addition, with heavy siltation, our estuarine areas, mangrove areas, and coral reefs (the breeding grounds for fish) are destroyed. With less fish, fisherfolks are forced to use destructive fishing practices in order to harvest from a depleting fish stock. Such practices destroy coral reefs and other important coastal resources. With decreasing food supply and income in the coastal zones, the socio-economic 64

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well-being is affected. So people will start looking for other areas, like the uplands, in order to start a livelihood. And the cycle of poverty continues.

Climate change impacts could hasten this process of destruction if appropriate adaptation measures are not put in place.

We learned about the causes of heavy rainfall and longer dry periods. With higher temperatures, evaporation increases. Together with the ENSO factors, we are facing increased climate variability, with more intense precipitation and more droughts. Recall that the Philippines is on the part of the world that experiences water poverty.

Higher temperature implies a demand for more water for irrigation. Decreasing rainfall implies less ground water. Less ground water means higher probability of saltwater intrusion.

The Philippines is one of the few countries that have high species diversity. And biodiversity underlies all ecological goods and services. However, we are now a hot spot. Excessive loss of forest cover decreased our species diversity. And climate change could lead to species extinction.

As early as 2003, the World Health Organization (WHO) issued a press release stating that “there is growing evidence that changes in the global climate will have profound effects on the health and well-being of citizens in countries throughout the world�. The direct health impacts of climate change are through temperature extremes of heat or cold resulting in morbidity and mortality.

Extreme weather events, such as more frequent and intense typhoons result in death, injury and other harmful effects.

Climate change is also expected to affect human health less directly by affecting the environment and ecosystems. These indirect effects will occur through insectand rodent-transmitted diseases, increased smog and air pollution, waterborne and food-related illnesses, and stronger UV radiation, which is a leading cause of skin cancer and cataracts.

Water-borne diseases are caused by pathogens (disease-causing microorganisms, such as viruses, bacteria and protozoa) spread through contaminated water. Since most of the viruses, bacteria and protozoa that cause water-borne diseases thrive 42

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in warm water and weather, increased water and air temperatures could stimulate the growth of harmful pathogens.

Climate-related disasters can also disrupt the delivery of health services and may even destroy health infrastructures. In such events, people will become more vulnerable to the human health impacts.

More hot days could increase the risk of heat-stress-related health problems, especially among the very old, the very young, and those with chronic lung diseases, such as asthma. Hotter days will also allow the formation of more ground-level ozone — the main component in smog. Recent health studies have suggested that there is no safe level of human exposure to ground-level ozone and particulate matter. In fact, negative health outcomes are associated with very low levels of exposure, even for healthy individuals.

Because climate change could cause terrestrial changes, infectious diseases may increase. Altered marine ecology could also result in heat-related diseases and illnesses. Microbial contaminants in marine waters could cause eye, ear, nose, skin, respiratory, gastrointestinal and other infections.

We have learned in the previous Module, typhoons could directly cause death, injuries, and intestinal illnesses, while droughts could result in food scarcity, and then malnutrition. Flooding could displace people, such displacement could increase the risk to diseases. Saltwater intrusion in underground water could also increase the risk of intestinal illnesses.

Changes in climate and incidence of extreme events and sea level rise are results of a changing environmental condition. Increased temperature and changes in rainfall decreases agricultural and natural resources for these events. Also, changes in rainfall and run-off lead to more water stress. Flooding and typhoons are also increased in intensity due to climate change.

Food security is lowered if agricultural and natural resources are decreased due to climate change, while water security is also lowered due to increased water stress. Distribution of diseases is also affected. Increased water-borne disease incidence like cholera and typhoid are associated with flooding and forced population movements; vector-borne diseases like dengue and malaria have developed a change of distribution due to climate variation; and there is also a

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potential increase in the incidence of air-borne diseases because of changes in dust distribution.

There can be a potential increase in the number of underweight children and an increase in population having minimum dietary consumption. Also susceptibility and occurrence of infectious diseases associated with extreme events may also increase. Another outcome of the varying climate environmental condition is the appearance of vector-borne diseases in new areas in developing countries.

The Philippines is in a state of clear and present danger, given its high vulnerability to climate change and climate impacts, low adaptive capacity, and vulnerability to vector-borne diseases and heat-related illnesses. Many of our people are dependent on irrigated agriculture and marine resources for livelihoods. Given this situation, we need a healthy, well-educated population with access to social protection so that we can better cope with climate shocks and climate change. If that is not possible in the near future, we need to come up and implement climate adaptation strategies and programs that will at least provide a sense of security for our future and the future of our children.

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Session 2: Assessing Threats and Vulnerabiliites of Climate Change to Health Type of Analysis The types of study that are used to investigate climate-health or weather-health relationships may be divided into observational studies of past weather patterns, and modelling studies that try to predict changes by combining epidemiological data with climate predictions.

The simplest type of observational study is the study of individual, extreme, meteorological events: deaths and injuries during severe wind storms, floods, heat waves, droughts.

Time-series studies use data for longer periods, and attempt to define more general relationships between, for example, temperature and mortality, but observation of daily or weekly data over several years.

Some analyses focus on the length of the season within each year that health events occur, for example the timing and duration of periods of aero-allergens (pollens), the seasonal patterns of diarrheal illness.

Changes in the geographical distribution of disease are often of interest in relation to vector-borne disease, such as malaria and dengue, but require extensive data about disease occurrence over time and space.

Model-based studies include ones that try to predict future burdens by assuming current weather-health patterns applied to future possible scenarios with altered climate, and decision-analysis studies that look at the potential risks and benefits of particular health protection measures.

The approach used in episode analyses, has two major advantages: its transparency and its relevance to public health warning systems. It suggests the kind of impact that might be expected of a similar heat wave in future. However, it also has several disadvantages: the difficulties in defining what a heat wave period is, and the fact that it uses only part of the data and does not provide further evidence about the broader relationships between temperature and mortality (or other health endpoint) as alluded to in the previous slide. A more detailed form of analysis is represented by time-series studies.

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Time-series studies of health-endpoints, in relation to meteorological parameters, typically use data from across several years and they analyse the short-term associations at the daily or weekly level.

Thus, they are usually a form of regression analysis in which the outcome is the daily count of deaths (or other health-endpoint), and the explanatory factors, such as, daily weather variables. They are suitable for analysing the general relationship between e.g. temperature and mortality, which can include quantification of the effect of specific episodes of heat etc.

Results for studies of temperature-mortality relationships usually show U- of Vshaped curves (as described earlier), with ‘thresholds’ for cold and heat effects.

Such analysis is normally adjusted for time-varying confounding factors, and they can take account of time-lags.

One of the additional features is the need for and the ability to allow for time lags.

This can be done in the regression analysis simply by including terms to represent the values of the meteorological variables for yesterday, the day before that, the day before the day before yesterday and so on. For example, we might write, T[t-i] to indicate the temperature on day t-i (i.e. a lag of i days).

Empirically, it is found that heat effects are generally quite prompt, so if it is hot today, people die today or tomorrow, or perhaps the day after. But evidence of an effect of heat lagged by more than a few days is very rare.

Cold effects, in contrast, can be delayed by up to several weeks, so that cold today may continue to have an effect on mortality in two or three weeks’ time.

For cold effects, in particular, the time lag appears somewhat different for different causes of death. Cardiovascular deaths occur comparatively promptly, peaking within a few days, while respiratory deaths continue to rise for around two weeks.

In any time-series regression analysis, is it a good practice to include terms to capture all time lags that may be relevant for a particular exposure and cause of death.

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It is important to keep in mind various cautions about the sort of calculations shown in the previous slide. There are many reasons why the calculations may not give an accurate picture of the actual future burdens. Among the key factors are the following:

• Extrapolation.

Almost by definition, these calculations often have to extrapolate exposure-response functions beyond the range of current exposures (temperatures, rainfall patterns etc.), and it is difficult to know how risks may look under those extreme conditions.



There is often very great variation in the shape of exposure-response functions in different populations which may arise for many reasons.

Without better understanding of the reasons for those variations, it is difficult to be confident how patterns may look in future under climate change.



Adaptation. Populations will, of course, learn to adapt to climate change, which may well reduce the impacts that might otherwise be expected based on current observation.



Effect modification. A whole variety of factors have the potential to influence vulnerability to climate sensitive diseases. These include very broad factors, such as, levels of socio-economic development, and more specific factors, such as, housing quality.

As yet, we have little quantification of the degree to which such factors modify the risks of climate-sensitive diseases and how important they may be in determining future burdens.

For these and other reasons, estimates of future burdens should be treated as broadly indicative only. Remember also that current epidemiological studies mainly focus on short-term influences and extrapolations based on them are unlikely to capture all forms of health effects relevant to climate change.

There are multiple factors that influence vulnerability to climate change, it is worth remembering that over the long term there may be dramatic changes in some of these factors, just as there may be in the climate itself.

The population may change (typically growing older, and often changing the prevalence of climate-sensitive disease as the epidemiological patterns change,

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often towards more chronic disease).

There may also be deliberate environmental changes, such as flood protection.

Then there are the various categories of adaptation, which may include: physiological habituation or acclimatization ( ‘getting used to’ the new climatic conditions), behavioural changes (learning to behave in ways that reduce risks of adverse effects), structural adaptation (infrastructure and other changes to meet new conditions, e.g. wider use of air conditioning in homes), and public health interventions, including ones specifically aimed at protecting vulnerable members of the community through warning systems and direct support/protection.

These various forms of adaptation may considerably modify the scale of impact for particular climatic changes by comparisons with what might be expected on the basis of simple extrapolation from current epidemiological evidence.

In conclusion, a variety of methods may be used to try to understand the influence of the climate/weather on health. Most such studies focus on weatherhealth relationships, and have only partial bearing on the effect of climate change for several reasons, including: 

The fact that climate change may give rise to many forms of change in addition to the effects quantified in studies of short-term weather-health relationship.



The fact that many changes will occur over time, in factors other than the climate itself, and these changes are likely to have important influence on the vulnerability to weather effects and hence on the burden of climate changeattributable disease.

Models of climate change impacts on health are intrinsic to the assessment of adaptation and mitigation options, but they entail many uncertainties and their evidence should be treated with caution.

Climate is a primary determinant of whether the conditions in particular locations are suitable for stable malaria transmission. Small changes in temperature or precipitation can result in large changes in malaria transmission in areas that are currently marginal for transmission.

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Some areas of Zimbabwe, particularly the northern and southern lower regions, have year round malaria transmission with peaks in the austral summer months.

Stable transmission is partially defined by temperature and precipitation, with altitude as a proxy indicator of temperature. Zimbabwe has dramatic elevation ranges that correlate with maximum and minimum temperatures. This heterogeneity, coupled with inter-annual climatic variability, results in constantly shifting fringe areas that are prone to malaria outbreaks, similar to many countries in southern and eastern Africa. High altitude regions, which are also the areas of densest human population, are currently malaria-free due to climatic constraints and to a long policy of “barrier spraying� in the transitional elevation zone.

These maps show the results for changes in the seasonal length of the malaria transmission season. The red areas show the areas where there may be a more than 2-month increase in the length of the malaria transmission season; orange shows an approximate 2month increase; blue shows areas where there may be a 2-month decrease; and green areas show where there may be a more than 2month decrease.

Overall, the study projected increases in the seasonal transmission season in East Africa, Central Asia, and the Russian Federation. Decreases are projected in Central America and the Amazon.

A critical element for evaluating thermal extremes is to remember that the focus is on short term weather anomalies vs. longer term changes in seasonal conditions.

Thermal extremes, which include extremely cold as well as hot events, need to reflect conditions that are relatively rare in any location. This is almost a 72

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requirement of labelling these conditions extreme. The local focus though allows for what is extreme in one location to be common somewhere else.

The focus of excess health outcomes is also a critical concept when considering extreme thermal events. The idea is that not all the observed health outcomes during an event could be attributed to the weather conditions as there is always a baseline level of health outcomes to account for.

Differences from that baseline during and shortly after the extreme thermal event are where the focus should be directed. These differences will provide a means to measure the event’s severity and an opportunity to evaluate whether the health burden was borne mostly by those already likely to experience the outcome or by a wider mix of “healthy” members of the population.

As previously noted, extreme thermal conditions, by definition, need to represent some significant departure from typical conditions.

With seasonal variations in weather that result in hotter and cooler seasons in many areas within the WHO’s SEA Region, there is possibility for both extremely hot and cold conditions. As a result, seasonal measures should generally be used to define “typical” conditions, seasonal variation in conditions can and should also be taken into account.

Different approaches can be used to assess when conditions become extreme.

These assessment approaches could range from the informal (e.g., informal survey of local residents to see if conditions are usual for the time of year) to more formal assessments of meteorological data or meteorological data with health outcome incidence information (e.g., daily temperature and daily all-cause mortality data).

The underlying premise is that there is some range of temperatures that local residents are likely to be able to or already have adapted to but that, outside of these conditions, a notable public health impact (i.e., increases from baseline levels of impacts) will result. These “normal” conditions, in turn, might be classified as “hot” or “cold” by non-residents depending on the season.

The need to constantly calibrate conditions against local seasonal norms is an important element of identifying thermal extremes that will be repeated throughout the presentation.

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 Fixed threshold criteria Extreme thermal conditions exist when criteria are exceeded at any point in time, for example:

o Extreme heat if temperature > 40°C o Extreme cold if temperature < -10°C Exceed a seasonal distribution value (e.g., 5th or 95th percentile) Relative criteria use threshold measures that vary by location and time of season to identify extreme thermal conditions. In areas with minimal thermal variation, where there is also generally low health risk and minimal health impacts from extreme thermal events, there might be no effective difference in a fixed or relative threshold. In areas where “normal” conditions vary over the course of a season, the use of relative thresholds can result in criteria that also vary considerably within a season.

This hypothetical example shows how the use of fixed and relative thresholds would result in different periods within a summer meeting the criteria for being identified as extremely hot.

In this example, the relative threshold is based on the daily maximum temperature.

The threshold value initially increases in the early part of the summer season and then declines from roughly mid-July through the end of September. As a result, in this example a number of days in September that would fail to satisfy the established fixed threshold criteria would satisfy the relative threshold criteria for being considered extremely hot.

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Climate change projections have concluded that the countries in the SEA region are likely to experience more extreme heat events in the future. The impact on extremely cold events has not been addressed specifically.

The net impact of possible increases in adverse health outcomes from more extremely hot weather with possible reductions in extremely cold weather is a question of on-going interest that has only begun to be addressed and where the conclusions are still uncertain (IPCC, 2007a).

This figure shows possible impact of climate change on the distribution of temperatures in a location.

In this case, the distribution maintains its variance but shifts to the right consistent with higher average temperatures, indicating that each day would be slightly warmer than before.

This is the general scenario envisioned by those who suggest that there might be a trade-off from climate change between the health impacts from extremely cold (reduced) and extremely hot (increased) temperatures.

If the variance shifted, a difference in the outcomes could be possible; including more impacts from each temperature extreme (achieved with a shift of the mean to warmer temperatures by elongating the tails of the distribution, with slightly more weight to the warmer side of the distribution).

In considering future health impacts of extreme thermal conditions there is a need to recognize that anticipated trends ( e.g., for many of the factors that affect the risk of experiencing adverse health outcomes in a population would support conclusions of more total adverse health outcomes in the future.

Among these critical factors is the expectation of larger populations experiencing more severe extreme thermal events.

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An open question is whether current extreme events in the SEA region, and elsewhere, are pushing populations to the edge of physical adaptation. If so, assuming there will be no other changes, and, if future extreme events are more severe in terms of the conditions they are associated with, there is a possibility that significant increases in the number/rate of adverse health outcomes will be experienced.

A major issue in projecting future health outcomes from extreme thermal conditions is that the nature and effectiveness of future adaptation to these events is uncertain.

In cases of events that do not destroy infrastructure and are of relatively short duration, there is an opportunity that adaptive responses, including public education, notification and response programs, could help mitigate the anticipated adverse health outcomes. The success of similar programs in other locations and awareness of the health risk of these events, in general, and of the increase risk which future events may pose as a result of climate change, means they are likely to be targeted for development, implementation, and refinement of public health intervention programs.

A critical element of these programsâ&#x20AC;&#x2122; future success will revolve around on how well any messaging and program activities reach the most vulnerable. As wide recognition of the risk of the events may have little impact, in terms of reduced health outcomes, if those that are already disproportionately impacted do not receive the message, follow recommendations, or receive any program assistance that is provided.

This figure shows graphs of daily mortality levels against mean of current and previous dayâ&#x20AC;&#x2122;s mean temperature in a number of locations addressed in the ISOTHURM project.

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Differences in the shape of these curves reflect different sensitivity, in the associated populations, to changes in temperature as well as temperatures at different levels.

The curves also reflect differences in the whole suite of physical, structural, and social adaptations in the locations to the thermal extremes being experienced.

An open question with respect to adaptation and extreme thermal events is if and/or how quickly a population could change the nature of its response to the health stresses posed by the extreme temperatures it will face in the future.

Let us focus on the Delhi graph found on the top right. Will this curve flatten out over time, as a result of increased social wealth providing a higher standard of living, on average, so that individuals have their exposure during extreme thermal events reduced and have a wider range of response options through personal choices and/or public programs? Or, could the curve get increasingly steep as temperatures push to levels that are currently extremely rare where the most vulnerable are just overwhelmed by conditions?

Recognizing the potential for effective programs to minimize the future public health impact of extreme thermal conditions, elements of successful programs that have been identified from current reviews and summaries of these programs are provided in this slide. (see for example: U.S. EPA, 2006; World Health Organization Regional Office for Europe, 2008) There are additional elements that have been recognized as playing a key role in extreme temperature notification and response programs which have demonstrated success in limiting anticipated adverse health outcomes.

While this session has emphasized the health impacts of extreme thermal events, there is likely to be a broader social impact through reduced worker productivity during these events (Kjellstrom et al., 2008). To the extent the economy is based on the productivity of outdoor laborers this impact could be particularly important, especially, as one of the adaptation measures would be to try and encourage these workers to limit their exertion during these events.

The concept that while successful adaptation efforts, spurred by the threat climate change through extreme thermal events, may help limit increases in total numbers of excess health outcomes attributable to these events, these successes 54

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will come with a cost. Specifically, resources committed to addressing extreme thermal event might otherwise have been used to address other pressing or anticipated public health threats in the region.

Extreme Weather Events In this part of our discussion, we will talk about the categories of extreme weather events, how extreme weather events threaten public health, the nature of public health impacts with extreme weather events, current health risks and impacts from extreme weather events in South East Asia, and future risks and potential health impacts from climate change.

Countries in the South East Asia region with low-lying islands, extended coastal areas, mountains and large river basins have a history of experiencing a wide range of extreme weather events.

The first cyclone of the 2008, in the northern Indian Ocean, was a devastating one for Myanmar. The category 4 cyclone killed more than 84,530 persons and over 53,000 were reported missing. In the areas affected, two-thirds of health facilities suffered some damage, one out of five was totally destroyed. Most of them were small, rural primary care centers. The estimated cost for rebuilding health facilities was estimated at US$2 billion.

After the cyclone, 60% of people had no access to clean water as traditional sources of water in villages became contaminated with seawater. In addition, many water sources became polluted due to the breakdown of sanitation facilities in the flooded areas.

The average reported number of deaths per household was 2.2 where 66% of the victims were women.

The most significant health need was support for psychological stress: 23% of people reported psychological problems after the cyclone.

While countries in Southeast Asia experience a wide range of extreme weather events, there is a smaller group of these events that has had, and will likely continue to have, a disproportionate health impact, and will be a focus of research and adaptation efforts aimed towards understanding and controlling public health risks and impacts. This group includes cyclones, extreme 78

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precipitation/floods, wildfires and thermal extremes (addressed in a separate presentation).

The health impacts of an extreme event are not defined by the mere occurrence of an event. Instead, they are determined, to a large extent, by physical factors that define the event and how it is experienced by exposed populations.

In addition, while there may be general differences in these factors between categories of extreme weather events, the differences between individual events are equally important in evaluating the source and nature or the associated health risks and impacts.

In short, from a public health perspective, not all extreme weather events are equal.

This presents trends in the number of all disasters compared to earthquakes and the number of floods and cyclones combined compared to earthquakes.

Earthquakes are not sensitive to climate change so the increase in all disasters and floods and cyclones relative to earthquakes is suggestive that climate change may play some role in the increase.

This is not conclusive, as noted in the text, the reporting of non-earthquake disasters may also play a role in the changes in the figures. But, this may be an indication of a potential increased future risk as a result of climate change.

In addition to the importance of physical characteristics, an eventâ&#x20AC;&#x2122;s public health risk and impact is shaped by the characteristics of the affected population.

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In general, any characteristic that limits the ability of individuals or communities to respond to, or prepare for, an extreme event’s conditions will increase public health risks.

In addition, the chance for large numbers of adverse health impacts will clearly increase with the size of the exposed population exposed, all else equal.

Wealth is an especially important social factor to address because it can affect exposure conditions and duration during and after the event (e.g., presence of floodwaters with a cyclone). In addition, wealth clearly affects individuals’ and communities' access and ability to redirect resources to address adverse conditions.

Types of Public Health Impacts from Extreme Weather Events Direct health impacts of an extreme event are characterized by the outcomes that are clearly attributable to the event itself (e.g., drowning from a cyclone). These impacts typically provide the information that is subsequently used to describe the event (e.g., so many dead and so many hospitalized).

Mental health impacts of extreme weather events are increasingly being recognized as a significant category of direct health impacts.

Indirect health impacts result from the conditions left behind from the extreme weather event. Most importantly, these can be health impacts associated with a loss of shelter and loss of access to food and clean sources of water.

One could argue about the criteria for distinguishing between direct and indirect effects for any category of extreme weather events or for a specific event.

However, the more important point is that these additional types of “follow-on” impacts should not be overlooked when considering the public health burden of an individual extreme weather event or category of events or in preparing for future events.

Some key issues to remember:

• Extreme weather events have a history of significant health impacts in many Asian Countries

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• Impact summaries focus on mortality but significant morbidity os associated with the underlying events

• Totals and “average” event impacts obscure the skewed nature of impacts data  Results can be driven by impacts by a single event  Impacts from repeated, smaller events can be as significant as a major extreme event Most importantly, extreme weather events are already a fact of life in countries of Southeast Asia. The region regularly experiences a wide range of these events and has a history of them resulting in catastrophic health impacts.

The module will typically present data that focuses on lives lost in these events.

However, this is only one component of the health impact of these events as they, typically, also have an even larger morbidity impact in terms of the number of people affected. Finally, in reviewing the information it will be important to remember that not all extreme weather events have the same health impact and to try and understand what role specific notable events play in influencing impacts that are presented as either a total or average over time.

These results, developed using data from the EMDAT database (EMDAT, 2008) highlight several important elements about the health impacts, as reflected by reported deaths, from extreme weather events in Southeast Asia.

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The main conclusions from this data are: 

The region has a high vulnerability to extreme weather events based on estimates of associated mortality



The mortality impacts are not evenly distributed across the types of events or across countries even when differences in population are accounted for



Storms and floods account for the vast majority of the reported mortality.

This figure presents a summary of the data from the previous slide showing the extreme weather event related mortality from 19702008 by country. Based on this period, Bangladesh, India, and Myanmar would be highlighted as countries with the highest vulnerability to extreme weather events within this group.

However, it is worth noting that because of the relative magnitude of the impacts in these three countries, other countries in Southeast Asia appear in this figure as though they have had no impacts when in most cases the total mortality from these events over this period is reported in terms of thousands of deaths (Bhutan and Timor Leste excluded).

Finally, it is worth noting that Myanmar’s relative importance in this figure is solely the result of cyclone Nargis in 2008 which is estimated to be responsible for over 138,000 deaths. This highlights the earlier discussion of the importance of single events in summarizing the health impacts of extreme weather events and raises a “who might be next” question for the countries in the region.

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Reference Manual This is yet another presentation of the earlier summary data on lives lost to extreme weather events of countries of in Southeast Asia from 1970-2008. This slide focuses on the distribution of the lives lost in the region during this period according to the type of event.

The slide highlights the clear domination of this impact data by storm events followed by floods and then extreme temperatures. These three categories of events all have clear ties to physical processes that raise the possibility of increased frequency and/or severity of future events as a result of climate change.

Specifically, storms are linked to warming sea surface temperatures, floods to increased evaporation and ultimately precipitation as a result of warmer temperatures, and extreme high temperature events with the anticipated warming.

Importance of Single Events in Health Impacts of Extreme Weather Events: 

  

While appropriate to summarize health impacts of extreme weather events it would be inappropriate to try and convey a sense of “average” impacts over time These events have extremely variable health impacts Totals are driven by few events The strongest events may not have the highest health impact

Health impacts from extreme weather events are highly variable over time and may have only a weak correlation with the absolute intensity of an event.

More generally this observance highlights that any estimates of future health impacts from extreme weather events are likely to be highly uncertain because of all the non-meteorological factors that affect health impact totals and the significance of single events in summaries of impacts over time.

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In Southeast Asia seventy-three per cent (73%) of all reported extreme weather event deaths, roughly 77,000, from 1970 to 2008 are from these three cyclones: ď&#x201A;ˇ ď&#x201A;ˇ ď&#x201A;ˇ

November, 1970 (unnamed): 300,000 killed in Bangladesh April, 1991(Gorky): 139,000 killed in Bangladesh May, 2008 (Nargis): 137,500 killed in Myanmar

Given the above facts, consider the factors that contributed to the high mortality totals from these discrete events in relation to predicted trends both for the underlying extreme weather events and for the vulnerable populations when considering the potential future impact of these events that would be attributable to climate change.

Cartograms provide one option for visually presenting the distribution of a variable of interest over multiple countries. (Specifics of the methods and approaches used in the cartograms are available from the World Mapper website http://www.sasi.group.shef.ac.uk/worldmapper/index.html).

Climate Change and Future Health Impacts of Extreme Weather Events Climate change-based predictions about the nature of future extreme events are only part of the information that is needed to accurately estimate the associated change in future health impacts. More specifically, while some sociodemographic changes over time can be forecast with some precision (e.g., populations, age distribution), others are much more difficult to predict (e.g., health status, wealth) and these factors are critical to health impact estimation. In particular, because the poor most often bear a disproportionate share of health impacts, relevant questions will include how many poor are there, where are they located, and what is their standard of living. The last is particularly important; noting that poverty can be based on both relative and absolute measures; and that improving the quality of life of the poor over time may also provide health benefits.

The role of adaptation must also be recognized and accounted for in predicting future health outcomes. The difficulty with this element is in drawing conclusions about what the pressure for adaptation will be, how much of that demand may be driven by climate change, and how effective any adaptive responses will be in addressing future extreme weather events.

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Because extreme weather events are already a part of life in countries of in Southeast Asia climate change will not be introducing a new category of health risks to the regionâ&#x20AC;&#x2122;s populations.

In addition, the historical variation in the frequency and intensity of these events means that, it may be possible to identify marginal changes in the characteristics of these events which can be attributed to climate change. However, this variation makes it extremely unlikely that researchers will be able review a series of events over time and say that any one was solely attributable to climate change.

The implications of this complicate identifying the marginal health impacts of climate change on these events based on a history of impacts where totals are skewed to individual events and the elements of where an event occurs and who experiences it are as important to determining health impacts as the actual physical characteristics of the event itself.

Water Quality and Quantity Issues Both water quality and water quantity are significant issues. Across large areas of the globe, many of which include lesser developed nations, freshwater sources are already vulnerable due to a combination of contamination and inadequate supply.

Many of the predicted trends point to increased areas of drought leading to desertification, decreased crop production and food scarcity, along with increasing water sanitation problems associated with an increasing demand placed on a diminishing supply of water.

While many areas of the globe will experience increasing periods of drought under a changing climate, other areas may be more susceptible to increasing precipitation. In particular, the number of intense storms is expected to increase and with it an increase in the chance for floods. Floods, in turn, increase the 62

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chance for contamination from run off or sewage over flows. Additionally, flash floods are associated with drowning, which continues to be a significant cause of mortality worldwide, especially among children (World Health Organization, 2008c).

Overlaying the issues of water stress, both from flooding and drought, is the fact that water-borne and food-borne diseases continue to be significant causes of morbidity and mortality world-wide.

Among the wide spectrum of diseases that are associated with food and, especially, water, gastroenteritis is the most commonly identified. These diarrheal diseases contribute to as many as 4 million cases annually and 1.8 million deaths. Of these cases, 88% can be linked to poor water quality (World Health Organization, 2009).

DALYs = Disability Adjusted Life Years.

Diarrheal diseases are a significant global health problem and, as this chart shows, they are the largest contributor to water-borne disease burden world-wide.

Given the global problem associated with diarrheal diseases and its common association with water, our discussion of climate and water-borne disease will focus primarily on enteric pathogens and gastroenteritis.

Despite the global burden of diarrheal diseases, they remain vastly underreported, even in nations with highly developed surveillance systems. This is related to multiple factors including lack of diagnosis, lack of specimen collection, lack of reporting, and lack of treatment sought. This translates into what is known as the â&#x20AC;&#x153;tip of the icebergâ&#x20AC;? scenario where very few of the actual number of cases of gastroenteritis are ever reported and etiology determined. For something like salmonellosis, among the most common bacterial sources of gastroenteritis world-wide, the actual number of cases is estimated to be 38-fold greater than the numbers that are reported.

The lack of good health data for diarrheal diseases is a common problem for investigating food and water-borne disease, especially when attempting to find associations with environmental and climate drivers. As we begin to shift to a discussion of how water-borne diseases may be impacted by climate variability and change, we need to focus a bit on climate change scenarios and which

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climate parameters are expected to have the greatest impact on waterborne pathogens and diseases.

Climate change scenarios predict:   



Rising temperatures, Changes in the hydrological cycles (especially frequency of high intensity storms and drought), Other extreme events, including tropical cyclones and inter-annual variability associated with pressure shifts over large areas of oceans, which result in far reaching changes in precipitation and temperature patterns (e.g., El Niño Southern Oscillation, Pacific Decadal Oscillation, North Atlantic Oscillation, among others) Sea level rise.

These expected changes will certainly impact many sectors, but these parameters are expected to impact water-borne pathogens both directly (i.e., temperature) indirectly (i.e., rainfall and flooding). In fact the IPCC 4th Assessment Report (Working Group II) indicates that the burden of diarrheal disease will increase as climate changes over the next century.

While projections include increasing diarrheal disease as the global climate changes, at local levels we are already witnessing disease events that can be linked to climate. This map and descriptions (figure from Hall et al., 2002) indicate some of these weather or climate linked waterborne disease events from around the world.

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Montana, USA (1980): Water-borne outbreak of giardiasis associated with heavy rainfall (980 cases).

New York State, USA (1999): Water-borne outbreak of E. coli O157:H7 related to heavy rainfall Milwaukee, USA (1993): Water-borne outbreak of cryptosporidiosis associated with heavy rainfall and run-off (403,000 cases, 54 deaths).

Florida (1997–1998): Human enteroviruses; greater fecal contamination of waters and shellfish associated with heavy rainfall caused by El Niño.

Peru (1991): Water-borne cholera epidemic associated with El Niño (250,000 cases).

Peru (1997–1998): Increase in hospital admissions for diarrhea in Lima associated with El Niño United Kingdom (1982–1991): Food poisoning associated with increase in average monthly temperature (estimated potential extra 179,000 cases with 2.1°C temperature rise).

Bangladesh (1980–1996): Rise in cholera cases during El Niño.

Pacific countries (1986–1996): Incidence of diarrhea related positively to average annual temperature and negatively to water availability.

Fiji (1978–1998): Incidence of diarrhea increased with temperature and extreme rainfall Eastern Australia (2001): Increased rates of Salmonella infection with decreasing latitude (corresponding to higher ambient temperatures).

Victoria, Australia (1997): Increased outbreaks of food-borne disease during hottest summer on record.

While the first goal of determining human health end points (morbidity) in relation to climate change parameters, can be measured in the absence of information about specific factors in transmission, an understanding of the specific mechanisms that link the climate parameter to the pathogen and transmission route, require an understanding of how a climate parameter acts on specific pathways.

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This flow chart illustrates the points at which we might start to investigate the mechanisms that provide the link between a climate signal and a disease.

It is evident even in this relatively simple chart that the pathways from source to exposure can be complex.

While we are interested in the human health end points (at the far right of the chart), many of these diarrheal diseases are zoonotic and, therefore, transmission pathways must include both human and animal contamination. The pathogens can be transmitted from person to person (in some cases), or indirectly through contamination of food products, groundwater, and surface water.

Factors that likely influence the indirect pathways described above (i.e., transmission by food or water) include climate or weather phenomena as experienced at the local or regional level.

Specific parameters within climate change scenarios that are likely to affect water-borne disease were mentioned earlier. Now we will take those parameters and narrow them down to specific impacts, which include: Local temperature â&#x20AC;&#x201C; this can directly affect pathogens by increasing replication in the environment or in non-human hosts (especially bacteria); conversely, warmer temperatures may decrease the persistence of some microbes (many enteric viruses).

Local rainfall â&#x20AC;&#x201C; During flooding events, pathogens can be washed into both surface and groundwater, increasing the risk of exposure by recreational contact, ingestion, and incidental exposure to contaminated flood waters. During drought conditions, contaminants may become concentrated in increasingly limited water supplies.

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Sea level rise â&#x20AC;&#x201C; in areas prone to inundation (low lying coastal areas and deltas), the influx of seawater can reduce supplies of freshwater (due to saltwater intrusion) and may carry marine pathogens (such as Vibrio spp.) inland.

Another issue that is more difficult to measure or predict is range expansion, either for a specific pathogen or for hosts in zoonotic pathogens.

As we investigate specific disease patterns, it is important to keep in mind that many of these water-borne/diarrheal diseases often display marked seasonal patterns. In some cases, the evidence of seasonality and information related to the drivers of seasonality can be used as a starting point to inform further investigations into the longer-term trends associated with climate change.

This chart of hospitalization rates for children with rotavirus infections shows the powerful trends in seasonality that is evident in many enteric (diarrheal) diseases. Here we can see trends by latitude for the Americas, Europe and Africa, and Asia and Oceania. Data are presented for each column from north to south; the line across all columns shows the position of the equator, the shaded areas indicate the tropics.

In all regions, rotavirus rates become increasing modal (to bi-modal) as latitudes increase, with the highest rates in the winter months for temperate zones in both the northern and southern hemispheres. In the lower latitudes of the tropics, this marked seasonality is damped down and finally, in the equatorial zones, there is almost no seasonality.

Another bacteria, Vibrio species, also show a strong seasonal trend, with the highest cases reported in summer months, and had a direct relationship with increasing temperatures.

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This genus includes common marine species, only a few of which are pathogenic to humans; however, among this group are three significant pathogens – V. vulnificus, V. parahaemolyticus, and V. cholera.

All of these replicate in the marine or estuarine environment, especially at warm water temperatures (growth begins at temperatures > 15°C). Both V. vulnificus and V. parahaemolyticus infections are commonly associated with shellfish. V. cholerae is unique in its ability to grow in fresh waters and can be transmitted through drinking water. Additionally, V. cholerae is unique in its ability to be transmitted person-to-person.

Because these are primarily “environmental” bacteria rather than primarily “enteric” and they proliferate easily in the environment, more is known about the mechanisms linking climate drivers to the pathogen itself.

Until 1991, during the 7th pandemic, the Americas had been free of cholera for more than 100 years.

When the disease reemerged in Peru (and later throughout South and Central America), it coincided with an El Niño event that resulted in much warmer than normal coastal waters.

Among the many hypotheses about the re-emergence of cholera in this part of the world, is that V. cholerae was able to proliferate in these unusually warm waters, which then set the stage for increased exposure and transmission to humans.

While cholera is now re-established in south America, inter-annual variability in seawater temperatures continues to influence disease trends.

This chart shows seasonal cholera case rates (bars) for 4 coastal regions in Peru and associated seawater temperatures (lines) for 1997 through 2000. The striking 68

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feature in this chart is the very large increase in cases during the summer of 1998 (December). During this same time period, the sea water temperatures were much higher than normal. This period reflects the strong El Niño event of 1997/1998 and illustrates the link between temperatures in the environment, where V. cholerae replicate, and human illness.

Another important temperature-Vibrio association is shown in this outbreak of V. parahaemolyticus in Alaska in 2004. This outbreak, which was due to contaminated oysters harvested in Prince William Sound, extended the known range of V. parahaemolyticus infections by more than 1,000 km.

This outbreak was preceded by unusually warm seawater. In particular, sea surface temperatures exceeded 15°C during the outbreak period. 15°C is a common threshold temperature for the replication of many Vibrio spp. and is rarely reached in these waters.

Impacts from changes in the hydrological cycle have already been documented in the IPCC 4th Assessment Report, with many regions experiencing serious water quantity and quality issues.

In this map, areas experiencing very high water stress are noted in orange.

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Predicted changes in precipitation and snowmelt patterns will also be evident in stream flow and run-off measures.

This map shows the projected changes in run-off under one of the climate change scenarios (A1B). Areas in blue denote projected increase in run-off, while areas in red show projected decrease in run-off.

Of particular note to understanding the dynamics of water-borne disease is the projection of rainfall patterns.

These panels show trends in high intensity storm events.

The top panel indicates the % per decade contribution of very wet days (> 95th percentile) to total precipitation for 1951 to 2003, with blues and purples indicating the increasing importance of these very wet days.

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The middle panel shows the change in contribution of very wet days to the total global annual precipitation. Here, you can see that the anomalies (i.e., difference from baseline) are becoming more and more positive with time – in other words, very wet days are becoming more significant.

Finally, the last panel shows the documented local trends in very heavy precipitation events. (+) indicates increasing heavy precipitation events and (–) indicates fewer events.

Collectively, these charts illustrate that much of the globe rainfall is occurring as very heavy events. This is significant for the contribution of pathogens to water bodies due to increased run-off and flooding.

The major issues associated with flooding that influence water-borne disease include:  Direct exposure/contact with contaminated water. Following large flood events, sewage overflows and failed septic systems are common and can result in contaminated standing water. Direct exposure to flood waters commonly lead to infections of the skin, respiratory system, eyes, and ears.  Floods can also result in contaminated water sources and gastroenteritis due to ingestion of untreated or insufficiently treated water.  Floods can also facilitate the secondary spread of disease due to poor hygiene following flood events and the displacement of people.

In looking at the end point of outbreaks of water-borne diseases in association with rainfall, Curriero et al. (2001) reported that 51% of drinking water outbreaks in the United States between 1948 and 1994 occurred following rainfall events in the 90th percentile and 68% were preceded by rainfall events in the 80th percentile, on a watershed level. Associations were noted for both surface water and groundwater.

An example of the effects of extreme precipitation on water-borne disease which best illustrates some of the mechanisms, in addition to the health end points, is the Walkerton, Ontario outbreak of May 2000.

Rainfall levels were historically high in the days preceding the disease outbreaks.

Near the outbreak area, rainfall reached up to 150 mm within a 4-day period.

This was estimated to be a 60- to 100-year event for this area.

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Over a short timeframe, 2,300 people became ill in a community with a total population of 4,800. Of these, 7 deaths were reported (mostly children). The outbreak was primarily due to Campylobacter and E. coli O157:H7 infections.

This outbreak was linked to fecal contamination in a groundwater well. Although inquiries showed a breakdown in the multiple barrier approach to water protection, the outbreak was ultimately related to extremely high rainfall amounts preceding the outbreak, which resulted in contamination of the well.

Heavy rainfall events could lead to flooding and run-off. Note the shown increased pathogen loads related to these events.

While there are fewer specific studies relating water-borne disease incidence to drought and projection of changes in disease incidence with drier conditions, it is accepted that reductions in water supply can be expected to result in increasing pressures on limited water sources. Additionally, as water sources are more limited they potentially experience increasing concentrations of pathogens due to a variety of influences, including increased water use for multiple purposes and the contribution of wastewater (treated or untreated) to the total water volume.

The effects of reservoir storage volume on water quality in general are noted in this figure. When volume is at 20% or less of capacity, all users will experience water quality issues.

Because the Vibrio species are native marine bacteria, this group may be expected to be among the primary concerns with water-borne disease associated with sea level rise. In many areas of the world that are particularly prone to sea level rise (many parts of South Asia), cholera (V. cholerae) is already an ongoing problem.

Because cholera has both an environmental (water) and human host (gut) life stage, outbreaks can be initiated or perpetuated by either influx of estuarine water or by wastewater contamination (during outbreaks).

We know much about the mechanisms that result in V. cholerae growth in the environment and how it may intersect with various climate or weather parameters.

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V. cholerae proliferates: ď&#x201A;ˇ in warm waters ď&#x201A;ˇ in association with plankton Additionally, cholera outbreaks are linked tightly with monsoon seasons (which may be more related to spread from contaminated sources rather than influx from the environment) In 2000, Lobtiz et al. described the use of remote sensing to model the highest risk period for cholera in the Bay of Bengal. The authors investigated multiple types of remotely sensed data to attempt these models.

Here are the Advanced Very High Resolution Radiometer (AVHRR) satellite images that show changes in sea surface height by month. The red color indicates high water levels and blue indicates low water levels. These data act as a proxy for marine/estuarine water influx.

Sea surface temperature data were also captured over the same space and time scales. Higher temperatures are noted in orange and red.

By combining both sea surface height data and sea surface temperature data, trends with cholera rates begin to emerge.

Peaks in cholera cases over the study period (solid lines) correspond with peaks in either sea surface height or sea surface temperature (highlighted with blue circles).

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When peaks in sea surface height (marine water intrusion and proxy for sea level rise scenario) coincide with peaks in sea surface temperature (proliferation of the bacteria), we see the greatest peaks in cholera.

From this, we might speculate that increases in both temperature and sea level, as projected in climate change scenarios, would increase the burden from cholera.

In summary, evidence, although limited, suggests that water-borne diseases will increase under projected climate change scenarios due to effects from increased temperatures, heavy storm events, drought, and sea level rise.

As we move forward, it is important that we continue to collect basic surveillance data on these climate sensitive diseases as well as improve our understanding of the mechanisms by which climate influences these pathogens.

Our ability to adapt to and implement basic public health practices to protect water quality may mitigate the projected disease trends.

These measures include following the same sound practices that the public health community always uses to prevent disease including awareness of vulnerabilities, investments in the upkeep and development of infrastructure to ensure clean water, and focused attention on best management practices for treatment of water.

While trends suggest that the risk to human health due to water stress and water and food-borne disease, adequate attention and investment in sound sanitation practices and education of the public will go a long way in mitigating these risks.

Vector-borne diseases (VBDs) are among the major microbial causes of morbidity and mortality in the world today affecting nearly half of the worldâ&#x20AC;&#x2122;s population, the majority of who reside in developing countries located in the tropical and subtropical areas of the world.

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In countries that provide statistics to the WHO, VBDs collectively account for more than 1.5 million human deaths per year (Hill et al., 2005).

However, many diseases are under-reported, especially those that are rarely fatal like Onchocerciasis and Lymphatic filariasis.

When considering disease burden, it is important to also evaluate the morbidity it causes. Measures of DALY – or disability adjusted life years – are one measure that is often used to assess this. One DALY is defined as one lost year of healthy life and is a measurement of the gap between the current health of a population and an ideal situation where everyone lives to old age in full health.

The geographical distribution of VBDs is largely reflective of the geographical distribution of both vectors and their reservoir hosts (if they have reservoir hosts).

Many vectors are cold-blooded arthropod species unable to regulate their own internal temperature and therefore highly dependent on climate for survival and development.

VBDs are diseases that are spread by arthropod or small animal vectors.

Vectors act as the main mode of transmission of infection from one host to another and as such form an essential stage in the transmission cycle.

Two main types of VBD transmission exist:  Anthroponotic infections – or human-vector-human transmissions, where humans are the only reservoir of the disease  Zoonotic infections – or animal-vector-human transmission, where animals are the main reservoir of the disease and humans are considered secondary or spill-over hosts and do not generally contribute to the disease transmission cycle as their levels of circulating pathogen are often too low to help maintain transmission.

The type of transmission of a VBD has implications for control strategies.

Anthroponotic infections can theoretically be eradicated if all human cases of the disease can be treated, whereas zoonotic diseases are much more difficult to control since all animal reservoirs of the disease would need to be treated.

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There are many VBDs of concern, especially in developing countries, a number of which are on the WHO list of neglected tropical diseases (including Leishmaniasis, Trypanosomiasis, Chagas, Dengue, Lymphatic filariasis, and Onchocerciasis) because they occur in areas where poverty is the most significant risk factor for their occurrence.

The agents causing these diseases are protozoa, bacteria, viruses and filarial nematodes and are transmitted by a range of arthropod vectors.

There are 3 crucial elements which must co-exist for the occurrence of VBD: the susceptible population, the vector (most often arthropods), and the disease pathogen (e.g., bacteria, virus, parasite). In areas where VBD most frequently occurs, conditions must be suitable for vectors and pathogens, which imply physiologically suitable conditions for vector, host, and pathogen survival and reproduction/replication.

There are a number of areas in the world where conditions may be suitable for all three components; however, other factors have acted to prevent or eradicate disease transmission in these areas, perhaps as a result of improved health care services or vector control measures.

Global climate change is likely to affect all 3 of these components both directly and indirectly. As an example of direct effects: Arthropods are highly sensitive to changes in temperature and precipitation as they cannot regulate their own internal temperatures and are therefore critically dependent on climate for survival and development (Githeko et al., 2000).

Changes in climate may accelerate the development time of some arthropod species, for example. Similarly, many pathogens are climate sensitive as well, 76

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and changes in climate could result in increased reproduction rates of some pathogens.

Some example of indirect effects might include: Changes in livelihood conditions due to climate change, which could affect nutritional status of individuals, thereby potentially increasing susceptibility to disease.

How are climate and weather related?

Climate is the average weather in a location over a long period of time, while weather is the daily climate conditions at a given location. Weather will tend to fluctuate on a daily basis while climate is the long-term average of trends in a location and can affect the timing and intensity of a disease outbreak.

With respect to VBDs, climate acts to constrain the range of these diseases by limiting the geographical range of suitable habitats for vector and pathogen survival. In other words, climate determines what regions can potentially support one disease or another based on the physiological requirements of the vector, reservoir host, and/or pathogen.

The range of endemic malaria was believed to be constrained in altitude by the temperature threshold requirements of its Anopheline mosquito host. However, recent changes in climate are thought to have begun to shift these thresholds higher in altitude and be contributing to an increased incidence of endemic malaria in the Kenyan highlands.

For example, increased droughts followed by bursts of intense precipitation have been linked with mosquito-borne disease outbreaks, such as dengue, in countries like India and Bangladesh.

The link between climate and malaria in the Kenyan Highlands example will be discussed in further detail later in the presentation as will the link between weather and dengue outbreaks.

Environmental determinants of health are generally external factors which can be causally linked to changes in health status.

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For example:  An individual’s genetic makeup may determine their susceptibility or resistance to a disease, while the ability to make a living and adequately feed oneself may affect an individual’s immunity to infection.  Malnutrition may acerbate one’s ability to carry out daily tasks and make a living in the first place.  Social relationships may affect access to resources, including transport to health care facilities  Social and economic policies may determine the availability of such health care services.

All of these factors contribute both individually and collectively to individual and population health.

Climate is in itself a contributor to individual and population health and changes in climate are likely to have consequences on human health.

According to the Intergovernmental Panel on Climate Change or IPCC, human beings are exposed to climate change through changing weather patterns (such as more intense and frequent extreme weather events) and indirectly through changes in water, air, food quality and quantity, ecosystems, agriculture, and economy. As an example of indirect effects:  

   

Extreme weather events could cause social or economic disruption as a result of destruction of infrastructures Climate change could also result in poor growing conditions for crops or livestock causing increased household vulnerability to poverty, hunger, disease, mortality, or displacement – all with resultant implications on human health and well being Individual risk factors could also include location of housing in areas with higher risk of disease transmission Genetic factors could include higher susceptibility to certain diseases, which are exacerbated by climate change Pathophysiologic effects could include altered physiological responses such as changes in hormone regulation in response to stress Social relationships may be altered by climate change – perhaps as a direct result of absence due to death or migration 78

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The ways in which institutions react in the face of climate change will impact resources available for community members to cope with climate change effects.

It is important to keep these other factors in mind when planning disease intervention strategies.

Another thing to keep in mind is the close relationship between human and animal health. Many of the pathogens which affect animals can also affect humans.

Climate effects which are likely to increase the burden of animal disease, especially livestock disease, are likely to have both direct and indirect effects on human health as well.

Links between animals and humans are such that vectors which can carry pathogens that are infectious to animals may also be infectious to humans and vice versa.

For example: Animal trypanosomiasis and sleeping sickness are caused by same pathogen (Typanosoma brucei) and carried by the same vector (the tsetse fly).

If climate change effects result in an increased incidence of the disease in animal populations, as these are mostly cattle, this will have implications for human livelihood. Additionally, this will likely increase the risk of human incidence of the disease as a result of an increased abundance of the disease in an animal reservoir.

In terms of direct effects, climate has the potential to: 1. Increase the range or abundance of both animal reservoirs and arthropod vectors.

There is some emerging evidence of this occurring with lyme disease in North America, malaria in the Kenyan Highlands, and bluetongue in Europe.

2. Climate change may also prolong the length of the transmission cycles of disease or the transmission season of diseases West Nile virus (WNV), which has recently appeared in North America, has an amplification cycle involving mosquitoes and avian reservoir hosts.

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Human risk of infection is highest late in the summer when mosquito population densities are highest. Warmer spring and fall temperatures could increase the transmission season of the disease, thereby shifting the risk of human infection of the disease earlier in the summer.

3. Climate could also increase the likelihood of successful importation of disease vectors and animal host reservoirs.

For example, the global spread of the Asian tiger mosquito, Aedes albopictus, which has been linked to the sale of used tires around the world, was linked to an outbreak of chikungunya virus, a dengue-like virus in Italy in 2007. Importation of a suitable animal reservoir is believed to be one of the possible methods of introduction of WNV to North America in the late 1990s.

4. As mentioned previously, climate change effects resulting in increased animal incidence of disease are likely to increase the risk of human disease as well.

Temperature can affect both the distribution of the vector and the effectiveness of pathogen transmission through the vector.

Gubler et al. (2001) list a range of possible mechanisms whereby changes in temperature impact on the risk of transmission of VBD: Temperature may act to:  Increase or decrease vector survival  Change the rate of vector population growth  Change the feeding behavior of vectors  Change the susceptibility of vector to pathogens  Change the incubation period of pathogens in vectors  Change the seasonality of vector activity  Change the seasonality of pathogen transmission  Vector is infective.

Precipitation can also have a number of effects on both the vector and pathogens.

Gubler et al. 2001 highlight that: Precipitation effects could include:  Increased surface water thereby providing increased breeding sites for vectors  Decreased rainfall could also increase breeding sites by slowing river flow 80

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Increased rain could increase vegetation and allow expansion in populations of vertebrate host Flooding could eliminate habitat for both vectors and vertebrate hosts Flooding could also force vertebrate hosts into closer contact with humans.

Humidity and precipitation can also have a significant role in vector activity. A greater relative humidity can increase vector activity, but heavy rainfall can actually decrease vector activity.

Increased activity = increases transmission rates.

Relationship between temperature and vector mortality is quadratic: mortality rates increase at high and low temperatures.

Temperature effects on development may affect mortality rates: particularly high rates of development of mosquitoes can result in small adults with poorer survival. This is one example where the terms in epidemiological models of VBDs interact with one another.

Another important interaction is the dependence of transmission coefficients for tick-borne pathogens on the numbers of vectors feeding on the host. The understanding of such interactions is, however, largely rudimentary.

When relative humidity is low, ticks have to make more frequent, energyexpensive trips to the litter layer to rehydrate. High “monsoon” rainfall knocks ticks off the herbage and prevents them from finding a host.

Lower humidity ↑ the energy requirement for host seeking by ticks shortening their lives.* Lower rainfall ↓ breeding areas for mosquitoes, compounded by densitydependent intraspecific competition amongst larvae.

More complex community-associated changes (habitat structure, predator abundance).

Many VBDs are zoonotic and have life cycles that are fully maintained in wildlife.

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In these diseases, seasons often play a very important role in the relationships between vectors and hosts.

Both vectors and hosts have seasonal variations in their life cycles driven by seasonal changes in climate and climate independent effects such as day length. ď&#x201A;ˇ Vectors can be affected by the way in which temperature can change from season to season, with resultant impacts on their development, activity, and disease transmission role. ď&#x201A;ˇ The lifecycle and activity level of the host can be affected as well, e.g., affecting how fast infected or immune animals die and how fast uninfected animals are borne, with resultant impacts on the epidemiology of vector-borne zoonoses.

Evidence for climate change has been controversial because we need to rule out, or account for, the effect of climate-independent factors before ascribing climate as a determinant of observed changes in VBD. Trend analysis has been nagged by the scarcity or inconsistency of long-term health records and numerous confounding factors. Despite these difficulties, some studies have developed innovative ways to examine long-term data and provide some evidence of the effects of climate warming on human health.

The latest IPCC report has stated with medium confidence that evidence exists showing an altered distribution of some infectious disease vectors.

In the next section, we will be looking at evidence of climate change effects. We will review some specific examples that provide some potential evidence of the effects of climate change on VBD. Our examples will include malaria, and schistosomiasis.

A study by Pascual et al. (2006) reviewed temperature data for the past 50 years in East Africa to examine the role of climate in exacerbating incidence of endemic malaria in the Eastern highlands of Kenya where increases in malaria have been observed since the 1970s.

Their analysis found evidence for significant warming at all sites and an applied dynamic model suggested that biological responses, such as those by the vector and pathogen, would also be magnified by at least 1 order of magnitude under climate warming.

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Reference Manual The map you see shows the different areas of Kenya and the different incidence rates.

The bright red portion of the map shows an area with endemic malaria. The pink area on the coast also shows an area with endemic malaria. The aqua section of the map that abuts the red endemic area is the “Highlands” area, where incidence has been increasing.

There has been a northwards extension of potential transmission (limited by “freezing zone”), in Jiangsu Province, due to a rise in the average temperature in January since 1960.

The study by Yang et al. (2005) noted an increase in the reported incidence of Schistosomiasis over the past decade which may reflect the recent warming.

The northwards expansion of the “freeze line” (which limits survival of water snails) puts 21 million extra people at risk.

As a quick recap: The major ways in which climate change is likely to impact VBD include:  Increasing the range or abundance of animal reservoir and arthropod vectors  Prolonging the transmission cycle of disease  Increasing the likelihood of successful importation of disease vectors or animal reservoirs  Increasing the animal disease risk and potential human risks of disease.

Another way in which climate change can have an effect on VBD is through emerging infectious diseases, as well as re-emerging infectious diseases. There are different ways in which an infectious disease can be said to “emerge” or “reemerge.” One way is through the introduction of exotic parasites into a suitable vector population that has contact with a suitable host population. An example of 106

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this is WNV. Another type of disease emergence or re-emergence is the spread of endemic transmission of a disease from one area to a new area that did not previously have endemic transmission levels. An example of this is Lyme disease moving from the United States into Canada.

Other forms of disease emergence include ecological changes which might cause a disease to move or “spill over” from an animal population into a human population, effectively introducing a new pathogen into a suitable population.

A fourth potential form of disease emergence involves genetic changes in pathogens. These mutations can create “new” variants of diseases.

Now we will move onto discussing several case studies of VBDs and how their transmission can be affected by climate.

Case Study 1: Malaria   

Approximately 40% of the world’s population lives in areas at risk for malaria.

Every year about 500 million people become severely ill from malaria.

Between 700,000 and 2.7 million – mostly children in sub-Saharan Africa – die each year of malaria.

Malaria is an extremely climate sensitive disease. Clearly transmission does not occur in climates where mosquitoes cannot survive. Optimal larval development occurs at 28°C and optimal adult development between 28 and 32°C. Transmission cannot occur below 16°C or above 33°C as sporogony (the production of sporozoites which comprises dissemination and development of the parasite in the vector) cannot take place.

The effect of global warming on malaria may be felt most in areas that are currently on the edges of the range of infected mosquitoes (Patz and Olson, 2006). These include many of the densely populated highland regions in Africa that are surrounded by lowland areas where malaria is endemic. Small changes may therefore lead to the exposure of many people to malaria.

Many global warming scenarios include an increase in the frequency and intensity of the El Niño phenomenon (Patz et al., 2002) such as storms, heavy rain, droughts, and warm temperature. El Niño seasons have been associated, 84

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although not always, with outbreaks of malaria in many areas (ref Atul).

Therefore it seems reasonable to speculate that the intensification of El NiĂąo effects due to global warming will facilitate local epidemics of malaria.

Case Study 2: Dengue Dengue is an important mosquito-born disease, with about 2.5 billion people at risk worldwide.

The Aedes spp. mosquito vectors are well adapted to the urban environment and thrive well in a warm, humid environment. Viral replication in the vector increases with temperature, with expected temperature-related effects on transmission. Minimal transmission temperature for the dengue virus is 12°C. Dengue hemorrhagic fever (DHF) outbreak in southern Sumatra was accompanied by more extreme weather due to El Niùo effects (Corwin et al., 2001).

Linked to future climate change projections, a small rise in temperature in temperate regions will increase the potential for future epidemics, given a susceptible population and introduction of the virus.

The typical transmission cycle of dengue follows the human-vector-human model, similar to malaria. However, there is also the potential for dengue to move from an animal transmission cycle into a human transmission cycle.

Global Change, Air Quality and Human Health Here, we will introduce you to climate and air quality, as well as characteristics and health effects of major anthropogenic air pollutants.

Fuel combustion is responsible for most of the air pollutants which adversely affect human health. Similarly, most anthropogenic climate change is due to fuel combustion.

So human health and climate change are inextricably linked at the level of emissions sources of air pollution. The picture of course is more complicated in that pollutants emitted by fuel combustion affect health and climate to varying degrees and even in different directions.

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This linkage between health and climate impacts of fuel combustion implies cobenefits of mitigation.

In addition, weather and climate can influence air quality in a variety of ways.

Horizontal and vertical air motions in the atmosphere transport and dilute air pollutants emitted by human activities. Temperature, humidity, rainfall, and winds also may influence the generation of some unwanted air contaminants, including smoke from wildfires and allergenic pollens.

Letâ&#x20AC;&#x2122;s now dig a bit deeper into what is known about the human health effects of these pollutants.

For acute mortality effects of PM10 (particulate matter less than 10 micrometers in diameter), the magnitude of the exposure-response relationship in terms of the percentage increase mortality per microgram per cubic meter increase in the ambient concentration of PM10. For example, the value for the United States is equivalent to a finding that the estimated relative risk per microgram per cubic meter increase in ambient PM10 concentrations is 1.0046.

More generally, the results for the different locations suggest that the impact of changes in ambient PM10 concentrations is similar in different continents.

In a classic Harvard prospective cohort study, 8,000 people were studied for 14-16 years in six small cities, which followed a pollution concentration gradient.

As particle concentrations increased, there was an almost directly proportional increase in the death rate in the residents studied.

The original study underwent a re-analysis, which included different statistical techniques and additional confounders â&#x20AC;&#x201D; results were nearly identical.

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Cities from left to right: P=Portage, Wisconsin W=Watertown, Massachusetts H=Kingston and Harriman, Tennessee

T=Topeka, Kansas L=St. Louis, Missouri S=Steubenville, Ohio

The six cities study was followed by a larger, nationwide study in the US American Cancer Society (ACS) cohort.

Results emerged just two years after the Six Cities study, in 1995. This was made possible because the cohort enrollment and follow up had already occurred.

The “air pollution” analysis simply involved finding historical PM2.5 data from 50 of the ACS cities and then doing the data analysis.

These are the main results of the mortality estimates, split by region and for the whole world. Results are expressed both in units of deaths and in units of Disability Adjusted Life Years.

Fuel combustion is responsible for most, though not all, of the air pollutants which adversely affect human health. Similarly, most anthropogenic climate change is due to fuel combustion. So human health and climate change are inextricably linked at the level of emissions sources of air pollution. The picture of course is more complicated in that pollutants emitted by fuel combustion affect health and climate to varying degrees and even in different directions, but we’ll leave those complications for later.

This linkage between health and climate impacts of fuel combustion implies cobenefits of mitigation… more later on that too.

Finally, weather and climate can influence air quality in a variety of ways.

Food Security and Right to Food The Food and Agriculture Organization (FAO) defines food security as a ‘‘situation that exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” This definition comprises four key dimensions of food supplies: availability, stability, access, and utilization (FAO, 2002).

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Right to adequate food is a human right, inherent in all people, to have regular, permanent, and unrestricted access (either directly or by means of financial purchases); and to quantitatively and qualitatively obtain adequate and sufficient food corresponding to the cultural traditions of people to which the consumer belongs, and which ensures a physical and mental, individual and collective fulfilling and dignified life free of fear (more at FAO, 2008d).

Entitlement means that in a well-governed society, people do not starve because the food that exists is distributed sufficiently and evenly to avoid famine. People may either be given food, vouchers, or provided with publicly funded work, which enables them to buy food.

Sen’s analysis originally focused on the famine in WWII in Bengal, which Sen witnessed as a child, and in which about 3 million people died. Although there had been poor harvests at the time, Sen showed that in the year of the maximum number of deaths, the harvest had improved. There are numerous other examples of national and regional famine which have occurred during times of adequate national or regional food production – among the best known are the Irish famine of the late 1840s and exports of food from India during periods of severe famine in the 19th century (see Davis, 2000), and appropriation of crops from occupied Vietnam by Japan, during WWII. Sen’s work was important in challenging an opinion which until then was overlyinfluential – that famines were most often caused by “natural” disasters. In reality the explanation is often more complex. The primary cause of the great Chinese famine (1959-1962) was social/political, but it also had secondary environmental factors. The more recent North Korean famine has complex social, political, and environmental causes, including recurrent flooding. However, the disconnection of North Korea from the global economy, including the global system of food relief, has been a major factor, together with a gross national mal-distribution.

An important cause of the lack of food entitlement is that the chronically hungry lack the cognition, social connections, and political influence to organise in ways that are sufficiently effective to remedy their situation. More “proximal” causes of lack of entitlement include scarcity of fertile land, water, seeds, credit, and access to markets.

There is no “single” cause of food insecurity. Instead, there are numerous causal factors, all of which are inter-connected. It is more accurate to think of these 88

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factors as a system – a network of related, connected factors, rather than a hierarchical list. Nevertheless, of the many factors which contribute, it is still necessary to list them in order. But the order used here does not mean that there is necessarily quantitative evidence to show that these causes are ranked in priority. The following slides will provide more detail about these factors.

Lack of “food entitlement” – inequality, appropriation, poor governance, and subsidies by powerful countries which distort production geography.

The “stork and plow” – struggle between increases in population and food. This theme is mentioned several times, but not in detail. Note, however, that a major cause of continuing population growth is poverty, poor education, poor nutrition, and inequality. Thus the causes contribute to the consequence, leading to what some commentators call “entrapment” (Ehrlich et al., 1995; King, 1990).

Total (growing) consumer demand combines with apparent proximity to further yield growth of key crops. Some scientists argue that there is apparent flattening in the yields of some crops – meaning additional land will need to be harnessed for further crop growth. Others argue that genetic engineering may overcome some of these limitations; however, to date, the success of GMO crops has not equaled hope.

Under-investment in agricultural research; excessive reliance on long hoped for “Gene Revolution.”

Conflict and poverty — this is often presented as an external factor which undermines food security or poverty relief. Instead, it can be argued that poverty and periodic conflict are highly likely, though temporally unpredictable manifestations of under-nutrition, and local, regional, and global inequality.

Diversion of human and other forms of energy to grow food crops for animal feed or vehicle fuels. This practice could become increasingly unacceptable in a food constrained world, unless there are major technological breakthroughs.

Global environmental change: climate change, plus + (atmospheric, water, and soil factors) climate change models are discussed in detail; many other cautionary elements are mentioned as caveats.

Global economic failure, rising cost of oil, fertiliser, transport, and other inputs contributed to the recent food price bubble. Given the long-term upward 112

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trajectory of these inputs is another reason to be concerned about future global food security.

Figure framework of the relationship between poverty, food insecurity, and other underlying and immediate causes to maternal and child under-nutrition, and its short-term and long-term consequences.

A framework developed by UNICEF recognizes the basic and underlying causes of under-nutrition, including the environmental, economic, and socio-political contextual factors, with poverty having a central role (UNICEF).

According to Black et al., 2008, in 2005 stunting, severe wasting, and intrauterine growth restriction, taken together, were responsible for 2.2 million deaths and 21% of DALYs for children younger than 5 years.

Deficiencies of vitamin A and zinc were estimated to be responsible for 0.6 million and 0.4 million deaths, respectively, and a combined 9% of global childhood DALYs. Sub-optimum breastfeeding was estimated to be responsible for 1.4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years).

In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden (Black et al., 2008).

Figure shows the distribution of stunting in children. Relatively high levels of stunting are seen throughout the Southeast Asia (SEA) region along with some countries in Africa.

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Session 3: Capacity Assessment in Climate-related Health Risks Capacity assessment simply refers to the process of determining the ability of our communities, local governments or institutions to implement climate change mitigation and adaptation strategies. It is important that we know what our capacity level is so that we will know what needs to be done to improve such capacity level.

The NEDA tool to assess capacity on climate change and health features two categories as shown in the slide: Functional Capacity - focusing on the engagement of stakeholders; and other category prioritizes the need to improve the detection of diseases, including the collection of data.

The ratings 1-5 as shown in the slides have qualitative equivalents. Take note that rating 1 actually means the absence of a capacity, strategy or approach. If the stakeholders claim otherwise, but no evidence or documentation is presented, then the rating is still at 1.

Engaging the stakeholders means making them take an active participation in integrating CCA into the vision and mandate of DOH, into the DOH programs, and in planning, programming and budgeting.

Capacity assessment does not mean looking at the defects, problem areas or persons to blame, but rather, the assessment should be able to identify the strengths (where are we good at) and areas for improvement (where we need to be good at).

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Module 3: Climate Change Initiatives And Adaptation Strategies Session 1: Climate Change Initiatives for Health The first session is on climate change initiatives for health. We would also like you to share the initiatives of your respective sector.

The Clean Development Mechanism (CDM) is established under the Kyoto Protocol. It aims Annex 1 countries (high income countries like Japan) to comply with their emission reduction commitments. The Annex 1 countries are expected to assist developing countries in achieving sustainable development, while also contributing to stabilization of greenhouse gas concentrations in the atmosphere.

According to the UNFCC: â&#x20AC;&#x153;The CDM allows emission-reduction projects in developing countries to earn certified emission reduction (CER) credits, each equivalent to one tonne of CO2. These CERs can be traded and sold, and used by industrialized countries to a meet a part of their emission reduction targets under the Kyoto Protocol. The mechanism stimulates sustainable development and emission reductions, while giving industrialized countries some flexibility in how they meet their emission reduction limitation targets.â&#x20AC;?

The CDM is the main source of income for the UNFCCC Adaptation Fund, which was established to finance adaptation projects and programmes in developing country Parties to the Kyoto Protocol that are particularly vulnerable to the adverse effects of climate change.

The Adaptation Fund is financed by a 2% levy on CERs issued by the CDM. As of 1 March 2009, 1,431 projects have been registered by the CDM Executive Board as CDM projects. These projects reduce greenhouse gas emissions by an estimated 220 million ton CO2 equivalent per year. There are about 4,000 projects yet to be certified. These projects would reduce CO2 emissions by over 2.5 billion tons until the end of 2012.

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Climate Change andManual Health Reference The joint programme is submitted under the MDG-F thematic window on Environment and Climate Change and is aligned to the outcome area on “Enhancing Capacity to Adapt to Climate Change”. It aims to help address a number of threats that are challenging the achievement of the MDGs because of emerging climate change pressures. These include the following: weak capacities of national agencies, local authorities and vulnerable communities to effectively develop coping mechanisms and strategies; lack of tools and systems to enable appropriate planning and implementation of climate change adaptation; and a general lack of information on technological adaptation and sustainable development options useful for addressing the impacts of climate change at the local level.

This joint programme seeks to assist the Philippines in addressing the above key strategic issues that have a direct bearing on the achievement of the MDGs. The MDG-F 1656 Programme pursues the following three (3) outcomes: Climate risk reduction (CRR) mainstreamed into key national & selected local development plans & processes; Enhanced national and local capacity to develop, manage and administer projects addressing climate change risks; and coping mechanisms improved through pilot adaptation projects. Specifically, it aims to: (1) determine the vulnerability of critical sectors of the Philippines to climate change, 2) strengthen the country’s adaptive capacity by enhancing the policy making, planning, programming and implementation capacities of key stakeholders, particularly the responsible national government agencies, and 3) implement adaptation demonstration projects that agencies and LGUs can replicate.

The Health Sector component of the project was commissioned by NEDA to the Institute of Health Policy and Development Studies (IHPDS) –NIH of UP Manila, the Health Sciences Center of the UPS with the Resource, Environment, and Economics Center for Studies (REECS) as its partner.

The objectives/outputs are as follows: 1) create a climate change vulnerability and adaptation framework including impact modelling and socio-economic projections, and refinement of the framework and tools, as needed; 2) develop a climate change monitoring and evaluation framework/system for the health sector, and 116

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create a compendium of good and innovative practices on climate change adaptation for the health sector.

The health sector component focuses on the following diseases that are considered most climate change sensitive: Malaria, Dengue, Leptospirosis, Diarrhea, Cholera and Typhoid.

The validation sites are chosen based on the following criteria: 1) Upland / Coastal / Low land; 2) Rural / Urban; 3) High Population Density / Low Population Density, and 4) Disease incidence. The validation sites are the Municipalities of Tanay and Teresa in Rizal, Municipality of Brookeâ&#x20AC;&#x2122;s Point in Palawan, and the Municipalities of Alaminos and Bolinao in Pangasinan.

The project makes use of the following Modelling Tools: Climate Change Impact Modeling, Epidemiological Modeling, Disability Adjusted Life Years (DALYs), and Disease Cost Effectiveness Analysis (CEA). The planning tools include the Breteau Index, Vulnerability Maps, and the Adaptation Evaluation Decision Matrix.

The potential vulnerabilities identified under the project include: vulnerabilities to individual/family/community, health system and infrastructure, pathogen/vector factors, and socio-economic factors. The potential vulnerabilities to individual/family/community include the following: extreme age (very young or old pop), presence of indigenous population/communities, access to safe water supply, access to sanitation facilities, access to health care/insurance, and individual susceptibility (immune system, genetic predisposition, pre-existing diseases.

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Climate Change andManual Health Reference Session 2: Vulnerability and Adaptation Frameworks What framework we will use to assess vulnerabilities and formulate adaptation strategies?

Recall our discussion on climate change impacts. Such impacts may not be the same for all local government units (LGUs). The impacts could also vary from one ecosystem to another. In addition, we have to consider the level of vulnerability of a community. That is why it is important to consider the areas of concern for vulnerability assessment and adaptation strategies. For example, given the primary and secondary data (profile) of a community, which concerns are of utmost importance. Will it be farm systems, water system or health? At this point, it is not necessary to identify concerns using climate science terms like extreme weather events, high surface temperature, etc. The concerns for vulnerability assessment and adaptation strategies are expressed in terms of consequences for people.

We also discussed that the effects of climate change are not the same for all people and not at the same level of intensity. We know that children are highly vulnerable to flooding. We also know that those whose adaptive capacity is very low will likely suffer first and much from climate change related disasters. Thus, it is very important that impacts are described in terms of their level of impact to particular groups of the population.

In determining how far into the future is of concern, at this point, assessments could focus on current risks that may be made worse by climate change in the future. It is also worth noting that the importance a community places on risks is likely to be influenced by the type and level of other everyday risks it faces. It is mandatory therefore to ensure that all key stakeholders are involved in the process of vulnerability assessment and adaptation strategy formulation.

Understanding the objective of the vulnerability and adaptation assessment will also influence the process and methods that will be used. If the assessment is for education or awareness raising, then it is critical to identify the intended audience and their level of understanding of the issues and concerns related to climate change and health. The saying â&#x20AC;&#x153;different strokes for different folksâ&#x20AC;? comes in handy as a guiding principle. If the assessment is for local decision makers, it is also critical to understand their capacity and willingness to process messages.

Some local chief executives and local political leaders have high level of 118

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The type of output that the vulnerability and adaptation assessment should produce must necessarily be supportive to the goals of the assessment. If the assessment is intended for the education of farmers, then the output could be in the form of information, education and communication materials that they will understand. Comics type of promotional materials and easy to understand video clips may be relevant.

Vulnerability and adaptation assessment requires resources. It is important to consider the level of resources available to an LGU before pursuing the assessment. Some LGUs send their concerned technical staff to relevant capability-building programs to ensure that they have the expertise to undertake the study. This will also ensure that costs associated with the assessment are at the lowest possible level. Some LGUs request technical staff of government agencies or NGOs to provide them with the needed technical services to undertake the assessment. There are also LGUs that hire technical experts to undertake the study, subject to the availability of resources to fund such activity.

In conducting studies like vulnerability and adaptation assessment, it is expected that the questions and points raised in the previous slides are taken into due consideration. The good practice is to develop the terms of reference for the conduct of the study rather than ask the technical experts to determine the terms of the study. In case an LGU has difficulty formulating the terms of reference, then it should at least request the assessment to team to discuss with the stakeholders the scope and method of the assessment.

As noted earlier, the objectives of the assessment should be determined first before identifying the methods and models to be used. The assessment objectives are largely influenced by the type of questions that the assessment would ask. For instance, questions on how climate change may affect the type of agricultural crops planted in an area may require studies that cover time periods of up to a hundred years. The corresponding adaptation questions may lead to an analysis of vulnerability within a planning horizon of 5 to 50 years.

Some stakeholders demand findings that are based on rigorous methods of data gathering and analysis. For this type of stakeholders, a detailed study involving 96

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Climate Change andManual Health Reference primary data collection may be required. Other stakeholders are comfortable with hands-on and participatory approaches. For this type of stakeholders, involving them in the assessment using well-established rapid appraisal techniques are acceptable.

As we have learned, vulnerability is the degree to which individuals and systems are susceptible to or unable to cope with the adverse effects of climate change, including climate variability and extremes. The vulnerability of human health to climate change is a function of:  The exposure to the weather or climate-related hazard, including the character, magnitude and rate of climate variation  Sensitivity, which includes the extent to which health, or the natural or social systems on which health outcomes depend, are sensitive to changes in weather and climate (the exposure–response relationship) and the characteristics of the population, such as the level of development and its demographic structure  The adaptation measures and actions in place to reduce the burden of a specific adverse health outcome (the adaptation baseline), the effectiveness of which determines in part the exposure–response relationship.

Adaptation includes the strategies, policies and measures undertaken now and in the future to reduce potential adverse health effects. A primary goal of building adaptive capacity is to reduce future vulnerability to climate variability and change. Adaptation actions will be taken at all levels, including our individual actions as well as programs and activities implemented by national agencies and institutions.

These actions can be in response to observed climate change or can be proactive, i.e., anticipating adverse health outcomes, The severity of impacts actually observed will depend on the capacity to adapt and its effective deployment.

Adaptation is the term used by the climate change community to describe the process of designing, implementing, monitoring, and evaluating measures intended to reduce climate change-related impacts. It is analogous to public health prevention that has 3 levels:  Primary prevention aims to prevent the onset of disease (such as by providing access to safe drinking water)  Secondary prevention entails preventive action in response to early evidence of health effects (including strengthening disease surveillance programs) 120

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Climate Change and Health Reference Manual Tertiary prevention consists of measures (often treatment) to reduce suffering caused by existing disease.

For this discussion, we will limit ourselves to selected frameworks that are relevant to our situation. It should be noted, at this point, that there is no single vulnerability and adaptation framework that fits all our requirements. In selecting a framework, we should have a clear understanding of the questions posed in the slide. ď&#x201A;ˇ

Following Desai and Hulme 2003(http://www.vatt.fi/file/ tolerate_scenarios_310107_ carter.pdf), general vulnerability assessment approach can be divided into top down frameworks and bottom up framework.

The impacts frameworks are sometimes referred to as the first generation or top down frameworks.

They aim to help understand the potential long-term impacts of climate change.

These are ways to gain a probabilistic understanding of future changes. These are usually used in national level assessments.

The bottom -up assessment approach addresses immediate and short-term concerns. The models used in such assessment focus on the technological options or project-specific climate change mitigation policies. The emphasis is on specific technologies and regulations. Such assessment approaches are useful for the assessment of specific policy options at the sectoral level; thus, assessing how to enhance local capacity. Bottom up approach involves community and private sector assessment initiatives and implementation mechanisms, encourage stakeholder consultations at each level of assessment, use more traditional knowledge, and use informal techniques for analysis.

The impacts frameworks are driven by the need to understand the long-term effects of climate change. The more long-term the horizon, the better for such frameworks. This way, more data can be processed, and more significant changes 98

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Climate Change andManual Health Reference in the climate can be captured. There is reliance on projections or scenarios derived from climate models.

Adaptation frameworks tend to address short-term and immediate concerns. The understanding of climate variability and climate change is within a specific socio-economic context. Such frameworks are applicable to the local or community levels where stakeholders can participate in the process of assessment. Given this, non-analytic techniques that are based on subjective judgments on the level of the vulnerability, degree of seriousness of the risks, and the need for adaptation strategies, are used.

The APF (Adaptation Policy Framework) provides guidance on designing and implementing projects that reduce vulnerability to climate change, by reducing potential negative impacts and enhancing any beneficial consequences of a changing climate.

It seeks to integrate national policy making efforts with a â&#x20AC;&#x153;bottom-upâ&#x20AC;? movement.

Principles: adaptation policy and measures are assessed in a developmental context; adaptation to short-term climate variability and extreme events are explicitly included as a step toward reducing vulnerability to long-term change; adaptation occurs at different levels in society, including the local level; the adaptation strategy and the process by which it is implemented are equally important; and building adaptive capacity to cope with current climate is one way of preparing society to better cope with future climate.

The APF is a flexible approach in which the following five steps may be used in different combinations according to the amount of available information and the point of entry to the project: (1) defining project scope and design, (2) assessing vulnerability under current climate, (3) characterizing future climate related risks, (4) developing an adaptation strategy, and (5) continuing the adaptation process.

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Reference Manual Climate Change and Health The framework focuses on the involvement of stakeholders at all stages. The APF is particularly applicable where the integration of adaptation measures into broader sector specific policies, economic development, poverty reduction objectives, or other policy domains is desirable.

The APF can be downloaded at http://www.undp.org/cc/whatsnew.htm It is also published in: Lim et al. (eds.) 2005.

An adaptation assessment can be considered as part of a health impact assessment (HIA), which the WHO defines as â&#x20AC;&#x153;a combination of procedures, methods and tools by which a policy, project or hazard may be judged as to its potential effects on the health of a population, and the distribution of those effects within the populationâ&#x20AC;?.

The standard list of elements in HIA include 1) integrated assessment of impacts, i.e., not concentrating on single risk factors and disease outcomes (a holistic view of health), 2) relation to policies and projects outside the health sector, 3) application of a multidisciplinary process, 4) provision of information for decision-makers (with information designed with needs of decision-makers in mind), and 5) quantification of the expected health burden due to an environmental exposure in a specific population.

Projecting the scenarios: Impact assessments typically refer to health impacts over the next 10 to 20 years (e.g. due to current smoking rates, obesity levels, or population ageing), rather than the 50 to 100 year time-scale appropriate toclimate change projections.

So there is need for scenario-based impact assessments that incorporate, and communicate, a higher level of uncertainty.Assessment of impacts and adaptation strategies: The primary objective of adaptation is to reduce disease burdens, injuries, disabilities, suffering and deaths.

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Climate Change andManual Health Reference Many impacts of climate change - including health impacts - can be reduced or avoided by various adaptations and along various sectors.

Integrative assessment: The key determinants of health – as well as the solutions – lie primarily outside the direct control of the health sector. They are rooted in areas such as sanitation and water supply, education, agriculture, trade, tourism, transport, development and housing. Unless these aspects are considered, it will be difficult to make improvements in population health. Primary and secondary adaptive measures, intersectoral and cross-sectoral adaptation strategies are needed to reduce the potential health impacts arisen from climate change.

It is not necessary, at this point, to determine which of the frameworks – adaptations and impacts – is better. Let us take note that the frameworks are used for specific purposes and in response to specific needs. As soon as we have gained enough experience in vulnerability and adaptation assessment, we will learn how to integrate the adaptations and impacts frameworks to suit the needs of our communities or respective LGUs. The ideal scenario is we that are able to identify short- and long-term vulnerabilities (and risks) and come up with appropriate and relevant adaptation strategies.

In using frameworks, it should be noted that adaptation projects, whether designed to address short-or long-term vulnerabilities, usually take longer to materialize the intended benefits, and also cost more than what was originally expected. Complex frameworks also tend to make the assessment process, including the analysis and presentation of findings, complicated and may lead to so much data and information that are not easy to digest and understand by the stakeholders concerned. And given the limited funds available, it may be more worthwhile to concentrate on what can be done immediately.

The impacts are to be categorized according to the critical vulnerable sectors or system, in addition to the health sector. A range of adaptation strategies can then be proposed for each impact given the fact that it is likely that a single adaptation strategy may not eliminate an impact. Finally, factors that might make the adaptation strategy difficult to implement can be determined to ensure that these will be considered in the action planning process.

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Reference Manual Climate Change and Health Session 3: Capacity Assessment in Climate-related Health Risks

As we have learned in our previous sessions, exposure and sensitivity are the two factors that will determine the potential for harm from climate change. Adaptive capacity determines whether “potential impact” is translated to “actual impact.”

If we take these three components – exposure, sensitivity and adaptive capacity – and put them together, the result is vulnerability.

In the Philippine setting, we are witnessing changing disease patterns. There is the double burden of disease, namely the infectious and lifestyle diseases. We are also observing climate sensitive diseases. In addition, we are seeing emerging and re-emerging diseases, for example: the multiple drug resistant tuberculosis and malaria.

Health-related problems have social determinants.

The non-health determinants include disasters, poverty (socio-economic aspects), geographical set up (multiple island archipelago) with geographically isolated and depressed areas, etc.

The potential vulnerabilities that we have identified to individual/family/community include extreme are, presence of indigenous populations/communities, access to safe water supply, access to sanitation facilities, access to health care/insurance, and individual susceptibility.

In considering the vulnerabilities that we have discussed in the previous slide, we need to consider the populations that are vulnerable to health effects: distant barangays; informal settlements; areas that are endemic to certain ‘climate sensitive’ diseases (i.e., malaria – multi-drug resistant strains) on top of a local health system that could not respond adequately to the risks and hazards.

Following Kovats et al. (2003), the scope of the assessment (in terms of geographic extent, temporal time scale, health outcomes of interest, and other factors) should be written up at the beginning of the process. Ideally, the scoping of the assessment will include stakeholders to make sure the assessment includes their key issues of concern. In any case, stakeholders should be involved throughout the process.

The next step involves the identification and description of the existing trategies, policies and measures that reduce the burden of climate-sensitive diseases.

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Climate Change andManual Health Reference Reviewing the health implications of the potential impacts of climate variability and change on other sectors, such as agriculture and food supply, water resources, disasters and coastal and river flooding is also important.

In estimating or projecting the future potential health impact, we can use scenarios of future climate change, population growth and other factors. A description of the uncertainty should also be included. If increased occurrence of heavy precipitation for instance occurs and flooding is longer than usual, the assessment should include the population that will be affected, including such factors as presence or absence of a plan.

Based on the data gathered, a synthesis of the result and a draft of a scientific assessment report should be prepared taking into consideration the intended readers of the report. The information should be processed in such a way that it is easy for the intended readers to understand the contents of the report and appreciate the significance of the findings.

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Module 4: Planning On Climate Change And Health In this part of the course, we will guide you in formulating an action plan based on what you have learned and the outputs of the previous workshops. The local plan on mitigating the health effects of climate change is a work-in-progress plan. When you go back to your respective LGUs, you can further improve on the plan, invite key stakeholders to provide inputs to the plan, and then integrate the plan in your annual investment plan.

Let us make use of this simple planning matrix in formulating your action plan.

The planning matrix covers the following elements: 

        

Critical Vulnerabilities in Human Health – you have identified this in your previous workshop. Review these and incorporate critical information not yet included.

Impacts – The impacts have also been identified. Review the impacts and improve on these, as may be necessary.

Adaptation Strategy – The range of adaptation options have also been identified. Review the appropriateness of the adaptation options.

Activity – The activities are tactics needed to attain the adaptation strategies.

At this point, list down the key activities, especially those that entail budgets.

Implementing Agency – the implementing agency should be provided for each of the critical activities.

Implementing partner – the implementing partner should also be identified, especially for the social determinant of health.

Measurable Target – specific performance targets should be identified per key activity Timeframe – this refers to the duration of activity implementation Estimated Budget Requirement – an estimate of the funding requirement for the key activities should be identified.

Social marketing is the planning and implementation of programs designed to bring about social change using concepts from commercial marketing.

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The ultimate objective of marketing is to influence action. Action is undertaken whenever target audiences believe that the benefits they receive will be greater than the costs they incur.

Programs to influence action will be more effective if they are based on an understanding of the target audience's own perceptions of the proposed exchange.

Target audiences are seldom uniform in their perceptions and/or likely responses to marketing efforts, and so should be segmented Recommended behaviors always have competition, which must be understood and addressed The marketplace is constantly changing and so program effects must be regularly monitored and management must be prepared to rapidly alter strategies and tactics.

4 P’s of Social Marketing Product refers to what we are selling to a target audience. An example of a product, in relation to our course, is the enactment of a municipal ordinance on Disaster Risk Reduction and Management, in which mitigating measures on the health effects of climate-related disasters are integrated. In selling this product, we are not just selling an ordinance. We should also sell the package of benefits if the ordinance is passed, funded and fully implemented.

Price means the relative difficulty that must be paid to buy the product. Coming up with an ordinance is not a simple task. It means fewer budgets for other expenditure items. It could also mean getting the support of other local politicians. In the case of other LGUs, they have to send some staff to training programs to learn how to develop this type of ordinance.

Place refers to the location where you sell the product properly. If you sell the idea to the local chief executive, then it is proper to formally visit the mayor in his or her office and present your proposal.

Promote means the strategy used to ensure that the target audience buys what you are selling. The saying “different strokes, for different folks” is instructive here. Admittedly, there is no single formula to successfully sell something to local politicians. Some local officials listen only to certain influential individuals.

This implies that if you want the local officials to buy your proposal, then you

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have to go through the process of selling the proposal to the persons that local officials listen to.

Take note that People is considered as the fifth P of Social Marketing.

In this session, we using the social marketing technique for advocacy due to the following reasons: one, when we do advocacy work, we are actually selling something (product); two, in advocacy work, we need to know and understand our target audience (people); three, when we advocate something, we are asking the target audience to do something for us or for the benefit of the community, but such action requires effort and resources (price); four, we need to conduct advocacy activities in areas where the target audience could listen and buy our product (place); and five, we need creative ways of selling and marketing our product (promotion).

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