inside: Five health messages for COP 19 Strengthening the health system's capacity to become resilient to climate change
a daily multi-stakeholder magazine on climate change and sustainable development
out reach. 15 November 2013
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pic: UNICEF/Iman Morooka
contents. 1 Five health messages for COP 19 2
The Global Climate and Health Alliance: Creating a strong alliance between health and climate change communities
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The most vulnerable
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4 Strengthening the health system's capacity to become resilient to climate change
5 Linking National Adaptation Plans to health for sustainable development in LDCs
6 Reduce short-lived climate pollutants for health, development and climate cobenefits: COP 19 events focus on synergies
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Understanding climate change impacts on global diarrhoeal disease burden
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Climate and mental health: Impacts and inequalities
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Coal in the heart of Europe
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10 Climate change impacts on health in Bangladesh 11 Health-related side events
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12 The Global Climate and Health Alliance 2013 Summit 13 COP19 side event calendar 14 Reflections from COP 19, Thursday 14th November pic: UNICEF/Iman Morooka
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Outreach is a multi-stakeholder publication on climate change and sustainable development. It is the longest continually produced stakeholder magazine in the sustainable development arena, published at various international meetings on the environment; including the UNCSD meetings (since 1997), UNEP Governing Council, UNFCCC Conference of the Parties (COP) and World Water Week. Published as a daily edition, in both print and web form, Outreach provides a vehicle for critical analysis on key thematic topics in the sustainability arena, as well as a voice of regional and local governments, women, indigenous peoples, trade unions, industry, youth and NGOs. To fully ensure a multiAbout Stakeholder Forum Stakeholder Forum is an international stakeholder perspective, we aim to engage organisation working to advance sustainable a wide range of stakeholders for article development and promote democracy at a contributions and project funding. global level. Our work aims to enhance open, If you are interested in contributing to accountable and participatory international Outreach, please contact the team decision-making on sustainable development (acutter@stakeholderforum.org or through enhancing the involvement jcornforth@stakeholderforum.org) of stakeholders in intergovernmental processes. For more information, visit: You can also follow us on Twitter: @stakeholders www.stakeholderforum.org
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WHO and IFMSA
CONTRIBUTING WRITERS Ali Shafqat Akanda University of Rhode Island Isobel Braithwaite
Healthy Planet UK
Dr Diarmid Campbell-Lendrum
WHO
Dr. Kristie L. Ebi
WHO
Elaine Ruth Fletcher Dr. Renzo Guinto, Charlotte Holm-Hansen & Lucas Scherdel Leena Hasan & Nick Watts
IFMSA
The Global Climate and Health Alliance
West Virginia University
Antarpreet Jutla Dr Iqbal Kabir
Ministry of Health & Family Welfare, Bangladesh IFMSA
Rachael Purcell Abdur Rahaman Rana Olga Rostkowska Daniele Saguto & Giovanni Cunico
Bangladesh Youth Environment Safeguard European Medical Students’ Association
Youth News Agency, Italy
Five health messages for COP 19 Dr Diarmid Campbell-Lendrum World Health Organization 1. Human lives are the ‘bottom line’ that needs protection from climate risks. Infrastructure can be rebuilt, economies can recover, but human lives are irreplaceable. Whether it is typhoons, heatwaves, or outbreaks of infectious diseases, our first responsibility is to protect the lives of the most vulnerable. It is no surprise that surveys from around the world have shown that when people are made aware of the many connections between weather, climate and health, they place health protection at the top of their climate change concerns. 2. Continuing climate change is an unacceptable risk to global health. The World Health Organization (WHO) estimates that climate change is already causing over 140,000 excess deaths every year, and the latest research indicates that even if socioeconomic development and medical progress continue, this burden will gradually increase in coming decades. Of greater concern is the potential for climate change to undermine the environmental determinants of health; air, water and food supplies; with unpredictable, but potentially severe consequences. If a patient had a temperature chart that resembled that of the planet, there would be no hesitation in intervening.
5. The health sector needs to work with others. Health workers are often described as being on the frontline in protecting human lives. It may be more accurate to say that they are the last line of defence – many of the most important decisions that affect health occur in other sectors, determining our exposure to environmental risks, and our vulnerabilities. For this reason, true disease prevention is intersectoral. WHO is supporting its partners in Ministries of Health to play their appropriate roles in defining national climate change policies, and working with key sectors, such as water and sanitation, nutrition, and energy supply, to increase climate resilience and promote healthy mitigation policies. The Organization is also a partner in global initiatives such as the Climate and Clean Air Coalition to reduce Short-Lived Climate Pollutants, and the Global Framework on Climate Services. We are committed to playing our role in the response to the global challenge of climate change
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ABOUT THE AUTHOR Dr Diarmid Campbell-Lendrum is a Scientist and Team Leader in the Climate Change and Health Unit of the World Health Organization.
3. The world has made great progress in health, and is now organising to meet the climate challenge. While much remains to be done, poverty alleviation, socioeconomic development, and health programmes have combined to deliver longer life expectancies, lower burdens of infectious disease, and reduced death tolls from extreme weather events across the globe. The health community is alert to the risk that climate change may slow or halt this progress. The health community has also been among the first to define political agreements with environmental bodies, to produce sectoral guidance on National Adaptation Plans under the UNFCCC, and to identify the key health systems functions that need to be strengthened to address climate risks. Investment of bilateral and multilateral climate funds into health adaptation – which was previously very low – has increased rapidly in recent years. 4. Health ‘co-benefits’ can provide motivation for mitigation. The challenge of connecting long-term, global climate change to people’s everyday priorities is widely recognised. Quantifying and promoting the rapid, local health gains that should result from the shift away from fossil fuels is a critical piece of the puzzle. For example, the latest research suggests that over 3.5 million people die each year from household air pollution from solid fuels, and some 3.2 million from outdoor air pollution. Overall, this places air pollution in the top rank of global health risks, with a death toll comparable to that of tobacco smoking. There is a huge opportunity for more costeffective, socially beneficial and widely-supported policy if the related challenges of air quality, energy security and climate change are addressed together.
pic: Household air pollution from solid fuels; © Frederic NOY for UNHCR
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The Global Climate and Health Alliance: Creating a strong alliance between health and climate change communities Leena Hasan and Nick Watts The Global Climate and Health Alliance In 2009, the University College London (UCL)-Lancet Commission stated that ‘climate change is the biggest global health threat of the 21st century.’ In order to address this urgent threat, the Climate and Health Summit serves as a platform to coordinate action across all sectors. On Saturday, 16th November from 09:00-17:00 CET, the Global Climate and Health Alliance will host the second Climate and Health Summit at the Marriott Hotel Warsaw. In anticipation of questions potential participants may have, we have provided answers to some frequently asked questions. What is the Global Climate and Health Alliance? The Global Climate and Health Alliance (GCHA) was launched following the inaugural Climate and Health Summit, which took place during the 17th Conference of the Parties (COP 17) to the United Nations Framework Convention on Climate Change (UNFCCC) in 2011 in Durban, South Africa. The alliance was established to tackle climate change for the sake of protecting and promoting public health. It is made up of leading Health organisations working together to ensure that health impacts are integrated into global, national and local responses to climate change and to encourage the health sector to mitigate and adapt for climate change. What does the Climate and Health Summit cover? The Climate and Health Summit is a one day conference organised by GCHA that will provide delegates with the latest evidence, and will align both the health and nonhealth communities to coordinate efforts on a roadmap to 2015. Also included in the programme are expert-led discussions on the co-benefits of climate change mitigation to health, and discussions by national delegates from the least developed countries on lessons learned from their health national adaptation plans to build resilience to climate change. Drawing on the 2011 Durban Health Sector Call to Action, the summit will build a roadmap for the international health community to work towards in the run up to the 2015 climate negotiations in Paris.
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What is the Durban Health Sector Call to Action? The Durban Call to Action is a commitment that was made following the first Climate and Health Summit in 2011 by participating health organisations, which consists of six major actions to tackle climate change: 1. Provide leadership: to drive the agenda for climate and health, promoting this Call to Action throughout the world. 2. Engage and inform: to engage and inform constituencies of millions of doctors, nurses, public health workers, hospitals, health systems and health policy makers about the health risks from climate change, and the health benefits of climate action. As health professionals, to also serve as messengers to their patients, communities and governments about the major health impacts of climate change and the steps they can take to reverse their impact. 3. Mitigate: To lead by example and reduce the carbon footprint of their own institutions, practice and activities. To strive to make our hospitals greener and healthier by reducing waste, investing in energy efficiency and clean energy sources, while promoting sustainable transport and resource consumption. By doing so, commit to demonstrating how our societies can move toward carbon neutrality. 4. Adapt: To strive to make health systems more resilient and capable of withstanding and responding to the human toll of natural disasters and the shifting burden of disease. 5. Advocate locally and nationally: To work within their countries to advocate for emissions reductions and/or low-carbon development strategies that promote both a healthy climate and public health. To call for solutions that reduce the local health impacts of fossil fuels; solutions that foster clean energy and social justice; solutions that save lives and money while protecting public health from climate change. 6. Advocate globally: To advocate for a fair and binding global agreement, as articulated in the Durban Declaration on Climate and Health found here:
http://www.climateandhealthalliance.org/news/the-doha-declarationon-climate-health-wellbeing We hope to engage new members to join in this commitment as progress is made towards creating a roadmap to the 2015 climate negotiations that puts health front and centre. We hope you will join us in building a strong and united voice for protecting human health from the impacts of climate change. For more details, please visit
http://www.climateandhealthalliance.org/summit
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The most vulnerable Dr. Renzo Guinto, Charlotte Holm-Hansen and Lucas Scherdel International Federation of Medical Students’ Association
pic: EU/ECHO, Arlynn Aquino - Leyte, Philippines, November 2013
It seems no coincidence that the UNFCCC Conference of Parties (COP 19) is unfolding in the midst of environmental disaster once again – affecting, unfortunately, the Philippines for the second time in as many years. Last weekend, the land mass of the central Philippines was struck by a typhoon regarded as the most powerful in recorded history – reducing an entire city to rubble, and causing severe destruction in dozens of Filipino towns. Roughly 10 million Filipinos were affected, with a death toll projected to reach 10,000. At present, food, water, and health care are limited, while relief operations remain delayed due to impassable roads, destroyed airports, disrupted telecommunication lines and lack of electricity. This story is reminiscent of last year’s typhoon, which happened during the final phase of COP 18 in Doha, claiming nearly 2,000 lives in the Southern Philippines. Last year, despite the Filipino negotiator’s pleas and cries, nothing meaningful came from the COP. Whilst we know that in a warming planet, every country is vulnerable, this recent tragedy serves as a reminder that some can be more vulnerable than the others as a result of their geography, economic status, and other influencing factors. Evidence has taught us that climate change is the biggest threat to global health in the 21st century, but it has also demonstrated that the effects of climate change on human health can be varied and often unevenly distributed. From Africa to Asia At present, sub-Saharan Africa is at great risk to the impacts of climate change – with risk of food scarcity as a
result of crop failure, minimal sources of clean water and changes in precipitation that cause flooding and droughts. One should also consider the coupling of such with higher rates of vector-borne diseases. Similarly, Southeast Asia’s coastal cities are also among the most vulnerable; exhibiting susceptibility to sea-level rises and flooding, saltwater corrosion of crops and extreme weather events. What’s more, increasing ocean acidification can lead to a loss of coral reefs, subsequent decrease in fish habitation and the loss of corals’ natural protection against storms. Small island states are recognised by the Intergovernmental Panel on Climate Change (IPCC) as being particularly vulnerable to the adverse effects of climate change, with many of the small island states already suffering reduced adaptive capacity. The Pacific is one of the most vulnerable regions when it comes to risks of extreme weather events and the effects of climate change, especially the low-lying coral islands. Time to act Youth participation, education and awareness-raising on issues related to climate change and health are at the heart of what is required here. There is an especially vital need for activism in the more vulnerable countries of the developing world. It may be true that student-led projects are undertaken all over the globe, but that the tendency for youth participation can often lean towards the Global North. The gap that this then presents in the minds of those most vulnerable to climate change is something that needs to be addressed. The questions then, are how do we mobilise the Global South? How do we facilitate sustainable projects, build on participation and better capacity building? How do we encourage and ensure the inclusion of youth from those countries most at risk?
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Strengthening the health system's capacity to become resilient to climate change Dr. Kristie L. Ebi Public health has an impressive history of identifying and reducing health threats, as evidenced by the dramatic increase in life expectancy over the past century. With more than 150 years of experience in identifying and responding to health threats, public health is well placed to avoid, prepare for, and respond to the health risks of climate change. Enhancing health protection to climate-sensitive health outcomes is vital to increase resilience, but may not be sufficient to address the current and future risks of climate change. Public health policies and measures have been designed with the implicit assumption that climate is stationary (e.g. current weather patterns will continue into the future). Ongoing climate change and development mean that current activities could be positive, neutral, or, in the worst case, maladaptive under new weather patterns. Therefore, modifications are needed to explicitly consider risks changing over spatial and temporal scales, with high degrees of uncertainty as to the rate and magnitude of changes in a particular location at a particular time; this includes risks from a changing climate as well as from changes in other factors that determine the distribution and incidence of climate-sensitive health outcomes. Adaptive management is an effective approach to handling these uncertainties; doing so requires moving beyond business-as-usual approaches in public health. Adaptive management is an iterative process that includes assessing the effectiveness of current policies and measures to manage climate-sensitive health outcomes; understanding the implications of projected climate change for health-related development goals; developing a national strategy with priority adaptation options; implementing new or modifying policies and measures to address health risks at appropriate regional and national scales; and monitoring and evaluation to identify future modifications to address new projections and new risks associated with climate change and development.
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All steps should be undertaken in collaboration with stakeholders from local to national scales. Underlying the process is the need to build the capacity to engage in the process within and across sectors; to implement priority policies and measures; and to identify lessons learned for improving the process in the next iteration.
Although most of these steps are familiar to public health, adding consideration of climate change makes new demands, not just in technical knowledge and capacities, but also in engagement across all sectors where climate change-related impacts may affect human health (such as water and food security, and infrastructure development) and whose adaptation and mitigation actions could bring health co-benefits or co-harms. Additional capacity in particular is needed in: • Assessing and managing risk from a systems perspective, taking into consideration the multiple environmental and social drivers of the geographic range, seasonality, and incidence of health outcomes, such as how weather patterns, land use, and demographic and socioeconomic changes influence the burden of vector-borne diseases; • Designing and implementing interventions using projections of health impacts under different climate and socioeconomic futures, putting into place surveillance, early warning systems, and other programs to enhance current capabilities while preparing for the changes and new threats expected to arise; and • Explicitly incorporating learning (informed by monitoring and evaluation) into iterative management, building capacity for further adaptation as the climate continues to change. Robust health systems are required to meet the goal of having healthy people living in resilient communities that anticipate risks; reduce vulnerability to those risks; prepare for and respond quickly and effectively to threats; and recover faster, with increased capacity to prepare for and respond to the next threat. Based in part on a framework for public health adaptation to climate change agreed by ministers of health and environment in Africa in 2011 and on experience in the Pilot Program on Climate Change Adaptation to Protect Human Health (funded by the Special Climate Change Fund, and includes Barbados, Bhutan, China, Fiji, Jordan, Kenya, and Uzbekistan), technical guidance is available from World Health Organization (WHO) that ensures the health sector follows a systematic process to identify national strategic goals for building health resilience to climate change, develop a national plan with prioritized activities to achieve these goals, and engage with national adaptation planning processes
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ABOUT THE AUTHOR Dr Ebi is one of the world's leading authorities on health adaptation to climate change, authoring numerous book chapters and journal papers, and testifying to the United States Congress. She was lead author of the health chapter of the 4th Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), and from 2007-2012 was Executive Director of the Technical Support Unit for Working Group II of the IPCC.
Linking National Adaptation Plans to health for sustainable development in LDCs Dr Iqbal Kabir Ministry of Health & Family Welfare, Bangladesh The section of the Intergovernmental Panel on Climate Change’s (IPCC) Fifth Assessment Report (AR5) recently produced by Working Group I, along with the opening presentation at the COP19 from the IPCC president have both made it clear to policy makers that the current trends in the Earth system’s carbon cycle, including ocean acidification, will lead to continuing – and more severe – climate change. The changing climate will inevitably affect the basic requirements for maintaining health: clean air and water, sanitary environments, sufficient food and adequate shelter. Many diseases and health problems may be exacerbated by climate change. We are waiting for the projections of AR5 Working Group II on human health, well-being and security to be completed by March 2014. As per the request of the Subsidiary Body for Implementation (SBI) 37, the Least Developed Countries Expert group (LEG) conducted four regional training workshops in 2012-13 to build capacities for these countries to address the implementation of National Adaptation Programmes of Action (NAPA) and National Adaptation Plans (NAP) process in collaboration with the Global Environment Facility (GEF) and its agencies. A recent World Health Organisation (WHO) review concluded that less than 3 per cent of the international funding for climate change adaptation has been directed to projects with the specific aim of protecting health. Bangladesh is among the most vulnerable to the adverse effects of climate change due to its geographical and socio-economic conditions, despite that fact that it has, along with many other similar countries, made only a small contribution to overall greenhouse gas emissions. As a disaster prone country, Bangladesh is frequently experiencing extreme weather events like floods, cyclones, and salinity intrusion, which have direct and indirect adverse health impacts. The Climate Change and Health Promotion Unit (CCHPU) of the Ministry of Health and Family Welfare of the People's Republic of Bangladesh believes NAPs should incorporate the Health sector in adaptation approaches and be based on the Vulnerability and Adaptation assessment and a National Health Adaptation Strategy.
pic: Cholera hospital, Bangladesh; by Mark Knobil
Results from CCHPU pilots provide evidence for resiliencebased approaches, community-based approaches, public-private-partnership at community level, risk reduction approaches, risk management approaches, integrated surveillance approaches and child–centred health adaptation approaches. CCHPU also emphasises calculating the ‘health sector burden’ for adaptation, which includes climate-attributed diseases, health status and the loss and damage of health care facilities. Health is a precondition for all three dimensions of sustainable development. So it is crucial for NAP to always include health components to provide countries relevant and stable access to a health adaptation mechanism for the sustainable development agenda beyond 2015. CCHPU is focused on sustaining current Millennium Development Goals (MDGs) achievements in health but is also moving forward by putting ‘H-NAPs’ for LDCs on the table in discussions on setting new Sustainable Development Goals (SDGs)
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ABOUT THE AUTHOR Dr. Kabir is the Coordinator of the Climate Change and Health Promotion Unit in the Ministry of Health & Family Welfare of Bangladesh. He is also a PhD candidate, at the University of Newcastle, Australia, and a member of the Bangladesh Delegation at COP 19 in Warsaw.
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Reduce short-lived climate pollutants for health, development and climate cobenefits: COP 19 events focus on synergies Elaine Ruth Fletcher World Health Organization Fast action to reduce short-lived climate pollutants (SLCPs) could slow the rate of global warming while saving millions of lives over the next several decades from outdoor and indoor air pollution – which together now kill more than 6 million people a year. The potential synergies, described by prominent climate scientists as ‘win-wins’ for both developing and developed countries, are being highlighted by major side events at this year’s COP in Warsaw. Short-lived climate pollutants such as black carbon (soot) and methane are responsible for a substantial fraction of global warming as well as air-pollution related deaths and diseases that are an increasingly severe problem in many developing country cities – but also persist at worrisome levels in higher income settings. Along with causing air pollution, these pollutants are dangerous for agriculture and ecosystems. Earlier this year, WHO joined the Climate and Clean Air Coalition to Reduce Short-Lived Climate Pollutants (CCAC), comprising of 72 partners, including governments, international organisations and NGOs. Speaking at a highlevel CCAC event in Oslo in September 2013, Hans Troedsson, Executive Director of WHO’s Director General's Office, lauded the new partnership between health and climate actors. ‘Interventions to reduce SLCPs can yield major health benefits and prevent child pneumonia as well as non-communicable diseases like heart and chronic lung disease,’ said Troedsson. SLCPs cause a particular burden on women and children in developing countries. A partnership between health, environment and other actors to reduce SLCPs, as facilitated by the Coalition, can bring synergies and enable multiple benefits for development, health and climate. Now that we are partners in the Coalition we welcome the opportunity to help expand the Coalition’s public health efforts. Inefficient use and burning of biomass and fossil fuels for transport, housing, power production, waste disposal and industry cause most SLCP emissions – as part of overall air pollution. Black carbon is a major component of health-harming particulate emissions while methane is a key ingredient in ground-level ozone formation, a contributing factor to asthma illness and deaths. Since short-lived climate pollutants persist in the atmosphere for weeks or months while CO2 emissions persist for years, significant reductions of SLCP emissions could generate very rapid climate benefits – helping to
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reduce near-term climate change by as much as 0.5°C before 2050. Beyond the mitigation of the most health-harmful air pollutants, SLCP reduction would have multiple other near-term health and development benefits. For instance, significantly reducing methane and black carbon emissions could avoid annual crop losses of over 30 million tons annually, according to recent estimates by the UN Environment Programme. Reducing SLCPs could also help moderate climate change impacts in many vulnerable regions - such as elevated snow and ice-covered regions, where black carbon accelerates snow-melt. Finally, reducing black carbon emissions could help mitigate regional disruption of traditional rainfall patterns. There is wide scientific agreement that actions to reduce SLCPs, however, must still be complemented by immediate deep and persistent cuts in carbon dioxide emissions if temperature increases over the 21st century are to be held below 2°C. The key side events covering these issues include: Saturday, 16 November: a World Health Organization co-sponsored Climate and Health Summit at the Warsaw Maririott Hotel, which includes a 13:30 afternoon session on how short-lived climate pollutants. Monday, 18 November: a Climate and Clean Air Coalition co-sponsored event on Short-lived Climate Forcers, the work of the CCAC, at the National Stadium. This event, 18:30 - 20:00, organised by UNEP, the Government of Norway, and other CCAC partner countries, will highlight the climate, development and health co-benefits that can be obtained from reducing SLCPs, along with a review of new and existing initiatives for doing so. Two other events touch upon air pollution and health aspects of climate mitigation and adaptation with respect to agriculture. These are: Climate Benefits of Reducing Short-Lived Climate Pollutants, Tuesday, 19 November 2013, 13:15 - 14:45, National Stadium, Torun Room; and Build Resilience and Reduce Climate Risks to support NAPS – with focus on Food Security and Health, also on 19 November, 18:30 - 20:00.
ABOUT THE AUTHOR
Elaine Ruth Fletcher is Science Editor at the Department of Public Health, Environmental and Social Determinants of Health, World Health Organization.
MORE INFORMATION
Air Pollution and Health: http://www.who.int/phe/health_topics/
outdoorair/en/index.html SLCPs: http://www.unep.org/ccac
Understanding climate change impacts on global diarrhoeal disease burden Ali Shafqat Akanda University of Rhode Island
Antarpreet Jutla West Virginia University
Diarrhoeal diseases remain a critical public health problem in the developing world, killing over 1.5 million children annually and putting millions more at considerable risk.
pic: Pierre Holtz for UNICEF | www.hdptcar.net
With the ever-expanding geographic reach and spread of the disease burden, as well as alarming fatality rates in newly affected regions, it is apparent that global prevention strategies are failing. With rapid changes taking place in the global environment and climate patterns, there is an urgent need to identify the potential impacts of climate change on future diarrhoeal outbreaks, such as its spread and seasonality in affected regions, and strengthen prevention efforts aimed at protecting vulnerable populations. Most of the world’s poor endure water scarcity on a daily basis and live with high water-related risks and climate hazards, such as floods – inflicting a terrible toll on public health in developing nations. With climate change, the risks of water-related hazards are expected to increase in many vulnerable regions of the planet. The need for clean water in sanitation and hygiene is unquestionable as a preventative measure; consumption of contaminated drinking water is probably the most vital transmission pathway for majority diarrheal diseases such as Rotavirus, Cholera, and Shigella. Many of these pathogens are natural inhabitants of ecosystems, and thus their abundance and virulence are directly enhanced in conducive environmental conditions such as salinity, temperature, pH, and nutrients. Thus, hydrologic and climatic drivers
can greatly influence the seasonal nature and the location of the outbreaks by altering the environmental conditions necessary for the growth and proliferation of the bacteria and contamination of water resources in natural disasters. Recent research has shown that droughts, floods and seasonal climatic variability can significantly impact water and sanitation access at local scales, and public health burdens over large areas. For example, recent studies show extreme climatic events, such as droughts and floods, contribute to seasonal cholera outbreaks in the Bengal Delta region of South Asia, a vast region endemic to a number of diarrhoeal diseases. It is also important to note that the projected climatic changes will be distinctly different in dry and wet seasons. According to Global Climate Model (GCM) simulations, Central India is likely to have longer dry spells and an increasing number of extreme precipitation events in the 21st century, thus leading to lower freshwater flow from upstream and higher risk of droughts in the Ganges basin. On the other hand, monsoon precipitation is expected to increase in the Brahmaputra basin region and the number of people flooded annually is likely to increase from 13 million to 94 million in South Asia by 2080. Such changes are expected to significantly exacerbate the diarrhoeal disease problem in South Asia, further compounded by rapid urbanisation and growth of slums around city peripheries with inadequate water and sanitation infrastructure. Significant knowledge gaps remain on issues of climate change and plausible impact on water-related diarrhoeal disease patterns in many vulnerable regions, especially in newly affected countries in Sub-Saharan Africa. Lack of continuous disease records from these regions and field data on pathogens hinders the understanding and quantification of the climate-diarrhoea connection. A significant problem also remains in resolving the discrepancies in scale between disease observations, sampling of pathogens, and related climatic drivers. For example, impacts of El NiĂąo or GCM simulations cannot be directly linked to rotavirus incidence in a village in rural India, with a few orders of magnitude difference in spatial scale between climate simulations and disease surveillance. Consequently, it is important to develop a reliable way to downscale climate information and relate with regional and local outbreak data. In addition, innovative tools are needed to estimate population vulnerability to climate change and effectively communicate to public health departments to deploy proven intervention methods
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ABOUT THE AUTHORS Ali Shafqat Akanda is an Assistant Professor at the University of Rhode Island in Kingston, RI, USA. Antarpreet Jutla is an Assistant Professor at West Virginia University in Morgantown, WV, USA.
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Climate and mental health: Impacts and inequalities Isobel Braithwaite Healthy Planet UK The health impacts of climate change, and the importance of integrating health into adaptation planning, have become increasingly prominent in recent years - though arguably not prominent enough.
For example,
there have been several declarations from health organisations – the World Health Organization (WHO) has this year trained a number of Ministers of Health in climate policy, who are attending in their country delegations – and many adaptation initiatives now prioritise the health sector. Often the health impacts which are highlighted are things like heat deaths, malnutrition associated with food insecurity, changing distributions of infectious diseases, such as dengue fever, and the direct deaths and injuries caused by extreme weather events. All are important, and are likely to pose a significant threat to health – especially without an ambitious and equitable global deal, and successfully closing the pre-2020 emissions gap. What is less often considered, but equally important, is that climate change not only affects physical health but also mental health – and dramatically so. It matters because of the immense detriment to people’s wellbeing, and because the other impacts of mental health are wide-reaching. They have knock-on effects on physical health and life expectancy, people’s ability to work and to participate actively in their communities, and of course on healthcare costs.
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After climate-related disasters such as floods, tropical storms and forest fires, affected communities have been documented to suffer rates of mental health problems such as depression, anxiety and posttraumatic stress disorder (PTSD) many times higher than 'control' communities with similar socioeconomic conditions and baseline levels of mental health. For example, a 2001 study by Dr. Armen Goenjian and colleagues after Hurricane Mitch in Nicaragua found that estimated rates of PTSD and/or depressive disorders in the worst-affected town of their study, Posoltega, reached 80-90%, compared to levels around a third as high in the least severely affected town, Leon. Slow-onset crises, such as those caused by droughts or sea-level rise, can also impact mental health adversely, and uncertainty about the future is a particularly important factor.
At present the evidence base on the mental health impacts of disasters is sparse, because of the difficulties associated with conducting rigorous research in disaster contexts, the complexities and ambiguities that surround mental health in general, and the fact that – legitimately – research is not an immediate priority after a major disaster. However, the evidence we do have shows that the effects can last for months to years, and effective strategies exist to support mental health after disasters. This is a complex subject but evidence seems to suggest that the best approach is not necessarily to provide counselling for those affected, but instead to focus on resolving the main causes of distress, such as the need for shelter, social support and medical care, and in the longer-term, support to rebuild. The opportunity to rebuild elsewhere, or to migrate, can also be important, including to reduce future risks, and can be a form of adaptation – especially for those affected by sea-level rise or impacted by desertification. This issue has not yet been adequately addressed by the UNFCC framework or other international institutions. Mental health is already a major challenge in global health today, and it is rising. By creating the concept of a 'Disability-Adjusted Life Year' (DALY; comprised of years of life lost and years lived with disability, where weights are applied), the Global Burden of Disease study has enabled us to compare a wide range of conditions in terms of ‘healthy life years lost,’ including those which are generally non-fatal, such as mental health conditions, into priority-setting. According to the latest assessment in 2010, major depressive disorders have risen to become the second highest cause of DALYs lost worldwide; anxiety disorders are close behind. In both women and younger age groups, both rank higher still. Both are also particularly vulnerable to the impacts of climate change, particularly in the poorest communities: climate change creates a doubly uneven playing field for women’s and young people’s mental health. We also know that the levels of mental distress and conditions such as PTSD seen after disasters are influenced by factors such as the severity of the event, the damage caused, the existence of effective relief systems, and access to funds to enable people to rebuild their homes and for communities to recover. As well as strengthening the case for investment in adaptation, this is highly relevant to the ongoing discussions around Loss and Damage at COP 19, and – as the science of climate change grows stronger; the task of mitigating it ever more urgent – it is essential that wealthier countries, who have benefitted from their early industrialisation, support those who have contributed least to climate change to cope with and recover from its’ impacts
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Coal in the heart of Europe Olga Rostkowska European Medical Students’ Association pic: The Bełchatów coal mine in the centre of Poland; by Kamil Porembiński
Many Polish people eagerly visualise fields with electricitygenerating windmills and solar panels covering the roof-tops of their houses. Nearly every Polish citizen openly declares a willingness to enter the ‘green era’ of natural resources, extended recycling and more city parks. According to the Public Opinion Research Center (CBOS), almost 90 per cent of Poles enjoy the thought of using renewable energy sources. Over 70 per cent of the population wishes to see the government act to prevent climate change, which could help dissolve the grey clouds threatening our ecosystem. A heart-warming prognosis. Nowadays, being green is trendy, especially among the youth (it’s ‘cool’ to sip coffee from a fair-trade, recyclable cup or use a special pen which is 99 per cent recyclable). Keeping in touch with the novelties from Western colleagues has definitely paid off as those habits are becoming the gold (green?) standard and hopefully are here to stay. Unfortunately, all this might be a lonely shout in a desert. With the economy and industry deeply in love with coal, Poland remains far behind other EU countries in the rankings on air policies. We could be somewhere around the ice age or rather the ‘fossil age’ – a sad metaphor in the context of carbon-derived pollution. As long as 90 per cent of the energy comes from this source, there is heavy smog blurring the picture of a healthy and stable Polish environment. In this case, healthy applies not just to the environment. In terms of the health consequences of carbon-intensive industrial processes, those hit the hardest are the elderly and the young. The intense generation of polycyclic aromatic hydrocarbons (PAHs) associated with the combustion of fossil fuels has been taken into consideration in a study of mothers and children in Krakow who were permanently exposed to the toxic air components. According to the study, PAHs are now suspected of increasing a tendency toward neurobehavioral developmental problems in newborns among mothers under stress during pregnancy. In older patients, Poland’s national affection for coal increases risk of cancers and strokes. But back to Krakow: The suite of kings in the past and the architectural gem of Poland has the 3rd highest level of
air pollution among EU cities, according to the report ‘Air quality in Europe’ published by the European Environment Agency (EEA) in October 2013. Once more, the villain is carbon, in the form of volatile organic compounds (VOCs), which successfully turn Poland into a red spot on the maps published by EEA. Well done, coal... Still, no matter how critical the patient gets, our hope should die last. Perhaps some treatment options can be found only one click away. A joint publication ‘Acting NOW for better health’ released by the European groups Health Care Without Harm (HCWH) and Health and Environment Alliance (HEAL) has been designed to help policy makers, health-care professionals, environmentalists and regular citizens form an educated opinion on the importance of cutting down on air-contaminants. We like to say in Poland that there is no smoke without fire. But there could be quality energy without either of them. More focus and organisation needs to be dedicated to moving beyond the declarations into real action which can impact media and the government. The European Medical Students’ Association (EMSA) has a strong opinion on air pollution which. We want to see fewer people with chronic bronchitis, allergies, skin irritation and lymphatic problems by giving dirty energy sources a break. What else to do? Early education could be another key. In school kids should already understand that there are better sources of light and heat than burning the black rocks and that we do have cleaner, healthier and cooler alternatives to keep our houses warm. For young people, engagement in awareness-raising initiatives, such as COP 19, can move us quickly forward in improving the quality of air, soil and water. Otherwise, if the coal business remains as it is today, a country once dubbed the heart of Europe may develop an irregular heartbeat. And there might be no doctor in the room
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ABOUT THE AUTHOR Olga Rostkowska is President of the European Medical Students’ Association and a member of the Delegation of the Health and Environmental Alliance (HEAL) at COP19 in Warsaw. www.emsa-europe.org
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Climate change impacts on health in Bangladesh Abdur Rahaman Rana Bangladesh Youth Environment Safeguard Weather and climate have affected human health for millennia. Climate change is altering weather and climate patterns that have previously been relatively stable. Over a longer time period, increased temperatures have other effects ranging from drought to ecosystem changes that can affect health. Droughts can result in shortages of clean water and may concentrate contaminants that negatively affect the chemistry of surface waters in some areas. Drought may also strain agricultural productivity and can result in increased food prices and food shortages, worsening strain on those affected by hunger and food insecurity. Ecosystem changes include migration of the vectors (organisms that do not cause disease but transmit infection by carrying pathogens from one host to another) and animal hosts that increase the prevalence of certain diseases. The dynamics of disease migration are complex and temperature is just one factor affecting the distribution of these diseases. Winters will also be warmer, which is likely to lead to decreases in illness and death associated with exposure to cold, yet extreme weather and their direct health impacts, such as injuries and drowning from floods, will become more frequent. Indirect effects outnumber the direct effects and will likely be more costly. Potential indirect effects include aggravation of chronic diseases due to interruptions in health care service, significant mental health concerns both from interrupted care and relating to geographic displacement, and socioeconomic disruption resulting from population displacement and infrastructure loss. Sea level rise increases the risk from extreme weather events in coastal areas, threatening critical infrastructure and worsening immediate and chronic health effects. Salt-water entering freshwater drinking supplies is also a concern for these regions, and increased salt content in soil can hinder agricultural activity in coastal areas.
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A comparative assessment of flood, drought and salinity prone areas in Bangladesh has produced results which show correlation coefficients between climate factors and health disorders, which varied among the study locations. Incidence of diarrhoea was found to have positive correlation with total annual rainfall in Rajshahi (drought prone) and Patuakhali (saline prone). Total monsoon rainfall was also found to have positively correlated with diarrhoea in Rajshahi (+0.21) and Patuakhali (+0.27). In
contrast, dry seasonal rainfall was found to have a positive correlation with the study area. The difference between annual maximum and minimum temperatures was found to be positively correlated with the incidence of diarrhoea in two study locations, Rajshahi and Patuakhali. However, the correlation was found to be negative in Sirajganj (flood prone). A positive correlation implies that the incidence of diarrhoea increases as the variation of temperatures also increases. A negative correlation means a decrease in the incidence of diarrhoea when the temperature differential rises. Skin diseases and malnutrition are also found to be positively correlated with temperature differentials in both Rajshahi and Patuakhali, while these are negatively correlated in the study area of Sirajganj (flood prone). The negative correlation of diarrhoea and skin diseases with temperature variation might have been due to nonclimatic factors, as well as improved health services. The study shows that the households in Sirajganj have better access to safe water, sanitation and health services. In spite of the apparent discrepancy in the correlation in time series data among three study locations, variation in temperature has been identified as a major cause of diarrhoea, skin disease and malnutrition in all the three locations. The study also shows the climate-sensitivity of diarrhoea, skin disease and malnutrition as each of these diseases was found to have positively correlated with at least one of the climate variables. Moreover, skin disease and malnutrition are more or less highly (positively) correlated with all three climate variables (rainfall, temperature and salinity). The study also reveals that poor and marginalised people of the areas monitored are suffering most, as they have no opportunity to access safe drinking water facilities, improved sanitation, hygiene facilities, or improved health facilities. The people who live below the poverty line make up the majority of the victims of climate induced diseases. Moreover, the burden of under privileged people in the study areas is increasing due to climate change and extreme events. To overcome this worsening situation, safe drinking water supply, and improved sanitation and health facilities should be ensured for marginalised people in areas of Bangladesh prone to drought, flood and salinity
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ABOUT THE AUTHOR Abdur Rahaman Rana is convener of the Bangladesh Youth Environment Safeguard (B-YES)
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COP19 side event calendar
FRIDAY 15th NOVEMBER
DATE TIME
VENUE
TITLE
National Institute for Environmental Studies / University of Technology Malaysia
13:15—14:45 Room Torun
WBCSD / Climate Markets and Investment Association Limited (CMIA)
The GCF, to boldly go where no investor has gone before?
International Chamber of Commerce (ICC) Nature Code/ German NGO Forum on Environment and Development
13:15—14:45 Room Wroclaw Adaptation Stories: Lessons Learned
The Adaptation Fund Board / Observatoire du Sahara et du Sahel
13:15—14:45 Room Cracow
NAMA registry annual report
Secretariat of the UNFCCC
15:00—16:30 Room Torun
The Energy Trilemma – What is needed to balance the energy challenges?
World Energy Council
15:00—16:30 Room Wroclaw
Agriculture-transforming farming systems for food & climate security & sustainable rural development
International Federation of Organic Agriculture Movements / Environmental Defense Fund
15:00—16:30 Room Cracow
UNFCCC/PROVIA side event: National Adaptation Planning Guidance Tools
Secretariat of the UNFCCC
An Integrated Approach to Mitigation, Adaptation and Resilience in the Built U.S. Green Building Council / Business Council for Sustainable Energy Environment Progress and lessons learnt from the biomass measures and forest monitoring Room Cracow Commission des forêts d'Afrique Centrale systems in Congo Basin The Potential of Divestment: Changing the Landscape of Climate Politics and Room Wroclaw United Kingdom Youth Climate Coalition Limited (UKYCC) Its Relevance to 2015 International Petroleum Industry Environmental Conservation Room Torun Adapting to climate risks in the energy sector Association (IPIECA) Maximizing Resilience:Leveraging Health for Climate Change Resilient Room Cracow SeaTrust Institute / Nurses Across the Borders Communities Legal Preparedness and Sustainable Rural Development in LatAm, subInternational Development Law Organization / Democratic Republic Room Wroclaw Saharan Africa and Southeast Asia of the Congo
16:45—18:15 Room Torun 16:45—18:15 16:45—18:15 18:30—20:00 18:30—20:00 18:30—20:00
20:15—21:45 Room Torun
Perspectives on climate resilience: Revisiting the social role of insurance
Munich Climate Insurance Initiative (MCII)
20:15—21:45 Room Cracow
Agriculture in National Adaptation Plans (NAPs): experiences and lessons learned
Centro Internacional de Agricultura Tropical
20:15—21:45 Room Wroclaw Reducing emissions and growing the economy - the Nordic way The EU's new post-2020 climate package and the EU's role on the pathway to Paris Sustainable Transport & Low Emission Development Strategy, mitigation & 11:30—13:00 Room Wroclaw adaptation to climate change Lunch with the Experts: Encouraging Energy Efficiency in Established and 11:30—13:00 Room Torun Emerging Economies 11:30—13:00 Room Gdansk
11:30—13:00 Room Cracow
SATURDAY 16th NOVEMBER
ORGANISERS
Roadmap and Actions toward Low Carbon Societies in Malaysia and 11:30—13:00 Room Wroclaw throughout Asia Unleashing the potential for technology cooperation: challenges for efficient 11:30—13:00 Room Torun implementation Human Rights: How lessons learnt from the CDM can inform the design of 11:30—13:00 Room Cracow new market mechanisms
Low Carbon Development Pathways for Sustainable India
Nordic Council of Ministers (NCM) CAN - Europe / Réseau Action Climat - France International Union of Railways (UIC) / Centro de Transporte Sustentable de México Asociacion Civil (CTS México) The Carbon Trust / Responding to Climate Change (RTCC) Bread for the World (BfdW) / Welthungerhilfe
13:15—14:45 Room Gdansk Beyond the Green Growth: Lessons from Korea
Republic of Korea / Ibon Foundation Inc. (IBON)
13:15—14:45 Room Torun
Developing Countries in the Driving Seat for Accelerating Green Finance
Switzerland
13:15—14:45 Room Cracow
Combatting climate change through education and training
Secretariat of the UNFCCC
13:15—14:45 Room Wroclaw Mapping Population Vulnerability and Resilience for Adaptation
United Nations Population Fund (UNFPA)
18:30—20:00 Room Torun
International Cryosphere Climate Initiative (ICCI) / Clean Air Task Force (CATF) / Ev-K2-CNR Committee (Ev-K2-CNR)
Cryosphere Climate Change and Development: Risks and Solutions
18:30—20:00 Room Gdansk Peoples Alternative Energy Systems
Jubilee South Asia Pacific Movement, Inc.
Potential of Low-Carbon Transport to Deliver Equitable Sustainable Development Benefits Transparency, Accountability and Integrity: Building an Effective and Efficient Green Climate Fund
Institute for Transportation and Development Policy / Transport Research Foundation (TRF)
20:15—21:45 Room Torun
Pledges vs. implemented action - where are we really heading?
Climate Analytics GmbH / Vasudha Foundation
20:15—21:45 Room Wroclaw
Global Food Security+: Meeting Socio-Economic Goals in a Climate-Challenged Brighter Green, Inc. World
18:30—20:00 Room Wroclaw 18:30—20:00 Room Cracow
20:15—21:45 Room Gdansk Climate adaptation - who pays the bill?
Stockholm Environment Institute / Heinrich Böll Foundation
OXFAM International
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Reflections from COP 19, Thursday 14th November Rachael Purcell IFMSA
Daniele Saguto and Giovanni Cunico Youth News Agency, Italy
The first week of COP 19 has been an enlightening experience. A long way from the realm of clinical medicine and university study back home in Australia, the negotiations have provided insight into the high level decision-making processes that surround climate change. I believe that medical student participation at COP 19 is a valuable way to experience climate change policy in a global setting. The benefits of translating this into public health practice and advocacy in our home countries are clear. I also think that attending COP19 affords the opportunity to share our experiences with student colleagues back in our own countries.
The fourth day of negotiations has come to an end here at COP 19; the air is caustic both inside and outside the Narodowy Stadium. The ‘Young and Future Generations Day’ is also through.
There is an incredible amount of enthusiasm and energy being generated across the National Stadium – particularly by youth delegates, who offer a vibrant and passionate perspective on climate change issues, which transcend generational barriers. I have particularly enjoyed the perspectives offered by delegates from different backgrounds, cultures and experiences, and hope that this continues throughout the coming week. I have valued the warm reception given to delegates by many of the people of Warsaw, particularly those working across the conference venue, who greet us every morning with a smile. Being from a medical background, the majority of my experience with the topic of climate change has been healthrelated, focusing on the vulnerabilities of disadvantaged populations, and the preparedness of health systems and professionals. I especially look forward to the Climate and Health Summit, which will be held on Saturday 16th November at the Marriott Hotel, and I would encourage everyone who is available to attend. I believe that a consideration of the health impacts of climate change must remain at the fore of negotiations on climate change, and I hope that its importance is evident in the decisions to come at COP 19
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ABOUT THE AUTHOR Rachael Purcell is a final year Australian medical student and a representative of the International Federation of Medical Students’ Associations at COP 19.
The youth definitely stand out as one of the most active constituencies within the Conference. Nevertheless, their position inside the negotiations remains a pretty difficult one: they must achieve the goal of making their voice count among other stakeholders who can surely afford much more organised and financed lobbying activity. Many topics are being pushed forward by YOUNGO (the UNFCCC constituency of youth non-governmental organisations), but one stands out among all others: the principle of intergenerational equity (that is defined in both the Rio Convention and the Brundtland Report). This principle puts forward the idea of undertaking actions that do not compromise the potential activities and prosperity of future generations, and represents a legal and moral basis on which to build any arrangement on climate change. At about 09:30, a group of young people from different countries decided to organise a demonstration: they stood still for about half an hour with a piece of tape on their mouths and a poster with a future date and an imaginary baby tied around their neck. They were asking for intergenerational equity to be put into the COP agenda and for it to be officially affirmed like it is within the Durban Platform for Enhanced Action (ADP). Also, they called for all the promises made during the negotiations to be based on economic models not using the ‘discount rate’, which, if taken into account, would give a distorted picture of future environmental costs and impacts. In the afternoon, a side event organised by the UNFCCC Secretariat was held on the topic of intergenerational equity, providing a platform for young delegates from all over the world to connect with some of the most important actors at COP and impress upon them that this principle is a fundamental requirement for climate justice and an ambitious agreement for 2015. This crucial principle can be summarised through a Native American proverb: ‘This world has not been given to us as a heritage from our fathers, but as a loan from our children.’ We surely hope that the delegates will keep this in mind during the negotiations!
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