Out from Under the Weather: Using Meteorological Data to ... · Out from Under the Weather: Using Meteorological Data to Protect Public Health. John Balbus, MD, MPH. Senior Advisor

National Institutes of Health • U.S. Department of Health and Human Services

Out from Under the Weather:Using Meteorological Data to Protect

Public HealthJohn Balbus, MD, MPH

Senior Advisor for Public HealthDirector, NIEHS-WHO Collaborating Centre for Environmental Health Sciences

National Institute of Environmental Health Sciences

Annual Monsoon WorkshopIndian Meteorological Society-IITM Pune

February 23, 2016

National Institutes of HealthU.S. Department of Health and Human Services

The National Institute of Environmental Health Sciences

• One of the 27 National Institutes of Health

– Located in Research Triangle Park, North Carolina

• Wide variety of programs supporting our mission of environmental health:

‒ Intramural laboratories ‒ Clinical research program

‒ Extramural funding programs ‒ National Toxicology Program

‒ Disease Prevention ‒ Public Health Focus

Presenter

Presentation Notes

We at NIEHS are one of 27 institutes and centers of the National Institutes of Health, the only one not headquartered at the Bethesda, MD campus. Our campus and headquarters is located in Research Triangle Park, North Carolina. We are the premier environmental health sciences research institution in the world, with both intramural laboratories and extramural funding programs. Like most of our sister NIH institutes, the greatest share of our funding goes to support our extramural research and training activities in universities and research institutions across the nation. We also provide the headquarters and leadership, and most of the funding, for the National Toxicology Program. NIEHS is unique at the NIH because we are the only one whose research has a primary focus on preventing disease, rather than diagnosing and treating it. We do conduct clinical research as well, but we are different from the rest of NIH in our understanding of, and commitment to, prevention and public health. This means that we have a commitment to conducting outreach, education, training, and supporting community partnerships in addition to the highest quality, most rigorous laboratory-based science. And we believe that in order to fulfill our mission of reducing the burden of human illness and disability associated with environmental exposures, research must lead to public health action. This means that we have an obligation not only to produce the best science possible, but also to disseminate that science and bring it to bear on policy decisions and public health protection.


NIEHS Strategic Plan

Presenter

Presentation Notes

The mission of NIEHS is to “Discover how the environment affects people in order to promote healthier lives” Our vison is to provide global leadership for innovative research that improves public health by preventing disease and disability. Our strategic plan guides our actions and research priorities and emphasizes collaboration.


GeoHealth Hubs


WHO-NIEHS Collaborating Centre for Environmental Health Sciences: Objectives

Promote Research Collaborations

Translate Research into Actionable Science

Build Capacity through Training Partnerships

Raise Global Awareness of Issues

WHO-NIEHS Collaborating Centre

Presenter

Presentation Notes

Objectives of the collaborating centre





The right to health…Regional cooperation on adaptation…Paris committee on capacity building….

Slide courtesy of Dr. George Luber, CDC


Climate, extremes and health in India

Climate Drivers

Exposure Pathways

Health Impacts

Health Outcomes/Burden

Reduced Adaptive Capacity

Increased exposure

Increased sensitivity

Poor access to care and preventive services

Elements of Vulnerability

Vulnerability and the causal chain of climate impacts

Presenter

Presentation Notes

When considering the health impacts of climate change, a framework of vulnerability provides a good starting place to explore the intersections of health policy and climate policy.

IPCC 5th AR and prospects for health adaptation

https://ipcc-wg2.gov/AR5/images/uploads/WGII_AR5_Fig11-6.jpg

DAY

CASES

LabConfirmation

Current Epidemic Detection and Response Curve

ResponseDetection/Reporting

First Case

Adapted from J. Davis, Climate Adaptation Workshop, Nov. 2003

Opportunity for Control

Presenter

Presentation Notes

This slide shows a traditional generalized epidemic curve and a normal response scenario. The goal is to reduce morbidity and mortality -- and that is reflected by the total area under the curve. In a business as usual mode, the first step is to detect the first case, then to report it, then to gain laboratory confirmation whenever possible -- and finally to respond.��The red area under the curve indicates normal morbidity and mortality -- with the yellow area reflecting the only opportunity to mount a response and reduce health impact. The response is mounted only after the epidemic has already peaked and is on its often natural path out of a population. ��The key point is that the opportunity to control the epidemic in such a scenario is relatively small.

Getting ahead of the Curve: Integrating Ocean, Climate and Public Health Information

First Case

Detection/Reporting

Response

Adapted from J. Davis, Climate Adaptation Workshop, Nov. 2003

Enhancing Public Health Engagement, Outreach, and Feedback throughout

Predictive Tools andServices`

Engage Public Health

DecisionMakers

Integrated Health,

Ocean and Coastal Obs, Monitoring & Surveillance Information

Lab Confirmation

CASES

DAY

Opportunity for Control

Sensor, Tool and Methods

Presenter

Presentation Notes

Climate information and tools tailored for public health can help us get ahead of the curve. Look at the difference reflected in this slide! Days, weeks, even months of lead time are provided. The lead time provided by climate and ocean based predictive tools and information, observations, and monitoring give us the opportunity to shift the whole scenario forward. ��If the public health community and be better prepared for -- even anticipating -- the first case earlier, detection and monitoring will move up. So will laboratory confirmation when that is possible. The response can be mounted much earlier, whether through public outreach, a bed net program, or a vaccine campaign.��As show here, the red area under the curve is much smaller than in the previous slide, indicating a reduction in morbidity and mortality. By shifting the process forward in time, the opportunity to control an epidemic starts much earlier, allowing public health measures to reach a much greater number of people in a more timely, efficient way. This is reflected by the large yellow area under the curve.��A key element on this slide is the box on the left indicating Earth observations and monitoring information. If you start with some early indicators about environmental conditions conducive to an outbreak, you have a chance to shift the curve toward a healthier outcome.��A second key element here is outreach, including full engagement of the public health community, this ensures that the climate services are specifically suited to meet the public health need, and that the information is useful to public health and environmental managers.�


Early warning for infectious diseases

• Systems are more complex– Vibrio- multiple water parameters, human behaviors

influence exposure

– Dengue- 4 serotypes, complex breeding behaviors

• Statistical correlative models have been developed– Different parameters significant in different places

– Best within range of observations

• Mechanistic models also developed, but they are not as useful for predictions– Currently used more to explore future scenarios,

mechanisms in more depth


Heat warnings- simple in theory, complex in practice

• Data shows large variation in thresholds among US cities

• Time of year, past year’s experience all influence impact of a given heat wave

• Morbidity is not the same as mortality- lower threholds in some cases

• Nonetheless, early warning and adaptation saving lives in the US and elsewhere


Evidence of effectiveness (Toloo, et al., 2013)

• 7 studies referenced- 6 asserted effectiveness– 2006 heat wave in France with 4400 estimated fewer

deaths

– 1300 fewer deaths in 65+ in Hong Kong after EWS implemented

– 49-73% decline in ambulance calls in Milwaukee

• Unable to analyze which specific measures were most effective

Presenter

Presentation Notes

http://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-12-27

20Oceanic and Atmospheric Research | Climate Program Office

Kicking Off the NIHHIS : 2015 Chicago WorkshopInternational Engagement

NOAA, in conjunction with CDC, WMO, WHO, DeutscherWetterdienst, and GFCS convened a Workshop on the Development of Climate Information Systems for Heat Health Early Warning– incl. India participants.

• Establishing learning network of heat health activities, practitioners, and partners

• Bridge the gap between meteorological and public health(and other) practitioners

• Bridge the gap between weather and climate prediction

• Understanding and informing needs of vulnerable populations

• Understanding and developing communication needs


NIHHIS: US Pilots and International Network

Ahmedabad

Surat

Bhubaneswar

Nagpur

Northeast & NYCWestern Region

Rio Grande/Bravo

Chicago & Midwest

Carolinas RISA

Senegal

Burkina Faso

Mozambique

Tanzania

Bangladesh


Common Characteristics of NIHHIS Pilots• A well defined health problem or question• Institutional buy in and commitment• Capacity Building: climate and health data, human

resources (time), funding, knowledge and training.• A process for selecting and evaluating heat health

parameters depending upon climate & vulnerability.

NIHHIS Pilots Characteristics and Outcomes

OutcomeCommunities that are resilient to heat extremes and health impacts.

Heat Action Plan detailing responsibilities and processes

Improved early warning & monitoring products customized for regional risks

Sectoral decision-making calendars and improved long-term heat outlooks

Communications strategies for and analysis of vulnerable populations

Figure 1. Daily mortality counts in May 2010 heat wave, versus corresponding days in 2009 and 2011.

Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, et al. (2014) Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave. PLoS ONE 9(3): e91831. doi:10.1371/journal.pone.0091831http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0091831

http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0091831

Forecasting in Ahmedabad HAP till 2015

• The Ahmedabad Heat Action Plan (HAP), piloted in April 2013, is the first comprehensive early warning system and preparedness plan for extreme heat events in India and South Asia.

• Till 2013, the Indian Meteorological Department (IMD) used to issue forecasts of extreme heat only one day in advance – not allowed enough window period for preparedness

• Moreover, no interphase between the health and meteorological department- The health authorities did not have any access to meaningful forecasting data

• HAP team generated an innovative hybrid dynamical-statistical temperature forecast system developed by the Georgia Institute of Technology (Georgia Tech, Atlanta, GA, USA) and the Climate Forecast Applications Network which was used for 2013-15

Slide courtesy Dr. Partha Ganguly

Transition in heat forecasting by IMD• The HAP team worked in close collaboration with IMD

local and National teams during these years (2013-15)• This collaboration inspired IMD to work on longer (5-7)

day heat forecasting• Since 2014, IMD has developed the 5-day forecast,

which is also available IMD’s website http://www.imd.gov.in/pages/city_weather.php

• Over last two years (2014 & 2015) the HAP team analysed the variability between CFAN and IMD temperature forecast and found it within acceptable limit


http://www.imd.gov.in/pages/city_weather.php

Comparison of CFAN and IMD

Forecasting - CFANIMD forecast for Ahmedabad city


Forecasting in India-2016• In 2016, the HAP team in Ahmedabad is going to use the

IMD forecast

• Working out closely with IMD to ensure a smooth and effective transition

• As the HAP is scaled up to other cities in 2016, moving to IMD forecast is necessary because IMD forecast is only source in other cities across India

• Working out pathways to improve access of nodal implementing authorities to this forecasting

• A system is being devised through which the IMD local offices in each state will communicate 5 day temperature forecast with probability, to all implementing agencies every day


National Institutes of HealthU.S. Department of Health and Human ServicesReiner et al., PNAS, 2012

http://www.pnas.org/content/109/6/2033.full.pdf?with-ds=yes


Understanding Climate and Health Associations in India Community of Practice

Vision of the UCHAI Community of Practice

• India’s health sector has capacity to adapt to climate change and its health impacts.

Goals of the UCHAI Community of Practice• Training

– Train-the-trainer workshops, curriculum, training modules, Web portal• Research

– Extreme heat and weather events, climate-related diseases, vulnerable populations, capacity of the health systems etc.

• Development of Tools – Including Heat Action Plans, Predictive Models

• Community Engagement – Stakeholder/public participation to increase efficacy and

impact of adaptation strategies.


UCHAI Activities to Date

• Workshop in New Delhi

• Initiative kickoff

• September 22-24, 2015

• Webinar series in partnership with TERI

– Sustainable Development Goals – Hopes and Challenges was held on Dec 8, 2015

– Building the bridge between climate and public health: The use of meteorological forecasts for public health early warning systems

• March 1, 2016


UCHAI Scientific Committee• India

– Dr. Sanjeev Kumar, Director, National Health Systems Resource Center

– Prof. Sanjay Zodpey, Director, Public Health Education, Public Health Foundation of India

– Anjali Singh, Indian Institute of Public Health, Delhi

– Dr. Ramesh Dhiman, National Institute of Malaria Research

– Prof. Anand Krishnan, Center for Community Medicine, All India Medical School

– Dr. Pawan Kumar Taneja, Indian Institute of Public Administration

– Ms. Suruchi Bhadwal, The Energy Resources Institute

– Dr. Shyamala Mani, National Institute of Urban Affairs

– Manu Prakash, TARU

– Dr. Nitish Dogra, TARU

• USA

– Dr. John Balbus, NIEHS

– Dr. Banalata Sen, NIEHS


Climate Services User Forum: April 26-28, 2016

• In conjunction with South Asia Seasonal Climate Outlook Forum in Colombo, Sri Lanka

• First such meeting to focus on health sector

• Goals– raise awareness of health impacts;

– clarify types of climate services needed for health;

– knowledge transfer and community building to develop early warning systems and other public health interventions


Summary

• Extremes of weather and climate variability have multiple serious health consequences

• Research is starting to provide capability to use forecasts health-relevant meteorologic parameters for interventions

• Growing momentum for large scale collaborations to enhance health resilience in setting of climate change

• This is a good time to develop collaborative group between public health and hydrometeorology


THANK YOU!John M. Balbus, M.D., M.P.H.

[email protected]

http://www.niehs.nih.gov/gehhttp://toolkit.climate.gov/

http://www.niehs.nih.gov/geh

http://www.niehs.nih.gov/geh

http://toolkit.climate.gov/

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Out from Under the Weather: Using Meteorological Data to ... · Out from Under the Weather: Using Meteorological Data to Protect Public Health. John Balbus, MD, MPH. Senior Advisor