Potential Relationships between exposure situations and disease conditionsHealth condition of

concernExposure situations

PollutedAir

Excreta andhouseholdwastes

Polluted water ordeficiencies in watermanagement

Pollutedfood

Unhealthyhousing

Globalenvironmentalchange

Acute respiratoryinfections

‚ ‚

Diarrhoeal diseases ‚ ‚ ‚

Malaria and othervector-bornediseases

‚ ‚ ‚ ‚

Other infections ‚ ‚ ‚ ‚

Cancer ‚ ‚ ‚

Cardiovasculardiseases

‚ ‚

Mental disorders ‚

Chronic respiratorydiseases

‚ ‚

Injuries andpoisonings

‚ ‚ ‚ ‚ ‚

Source: The World Health Report 1998. Life in the 21st Century – A Vision for All (NB: last column modified )

‚

‚

‚

‚

Source Activities

Emissions

Environmental Concentration

Air Water Food Soil

Exposure

External Exposure

Dose

Early/ Subclinical

Moderate/ Clinical

Advanced/ Permanent

Health Effects

Traditional hazards Modern hazardsHuman activitiesNatural phenomena

Developmentactivities

Drivingforce

Pressure

State

Exposure

Effect

ActIons

Health and environment cause-effect framework

Actions

Pressure GHG emissions

State Climate variability and change

ExposureHeatwaveswindstorms,floods, droughts

Food, water-vector-borne infections

Foodshortage

Airpollution

Effect CVDRespiratory

Mal-nutrition

Infectiousdiseases

InjuriesDrownings

Mentalhealth

Global,national,monitoring

National,internationalagencymitigation,adaptationstrategies

Treatment

Internationalagreements; Nationalpolicies

DPSEEA: Climate and Health

Drivingforces

Population growth

Developmentpolicies

Transport, Energypolicies

Health impacts

Human health impacts and vulnerability to climate change

Agriculture impacts

Forests impacts

Water resources impacts

Impacts on coastal areas

Species and natural areasClimateClimatechangechange

Adaptive

capacity

Regional weatherchanges

•Heatwaves•Extreme weather•Temperature•Precipitation

•Contamination pathways•Transmission dynamics•Food availability•Migration

Temperature relatedillness and death

Extreme weather related health effects

Air pollution relatedhealth effects

Water and food bornediseases

Vector and rodent borneDiseases

Psychological effects

MalnutritionResearch

Moderating influences

Adaptationmeasures

Climate Change

Pathways by whichclimate changeaffects health

Adapted from Patz et al, 2000

Health effects

Causal web: Climate variability and diarrheal disease

Drought

Floods

Unsafe and limitedwater

Hygiene difficult

Nutritional deficiencies

Temperatureincrease

Contamination from pitlatrines, septic tanksand sewage systems

Debris and carcasses inrivers

Failure of watertreatment facilities

Food spoilage

Algal blooms

Climatevariability

Diarrhealdisease

Current and future actions:

•Global, regional burden of disease assessment•Assessing early health impacts of climate change

•National health impact assessment guidelines•National adaptation strategies for health

•Pilot warning system projects (e.g. heatwaves)

•Joint WHO/UNEP/WMO activities:Capacity buildingInformation exchangeResearch promotion

Adaptive actions for the health sector:

primary adaptive measures: actions taken to prevent the onset of disease arising from environmental disturbances, in an otherwise unaffected population (e.g. supply of bed nets to all members of a population at risk of exposure to malaria, early warning systems, integrated environmental management)

secondary adaptive measures: preventive actions taken in response to early evidence of health impacts (e.g. strengthening disease surveillance and responding adequately to disease outbreaks)

tertiary adaptive measures: health-care actions taken to lessen the morbidity or mortality caused by the disease (e.g. improved diagnosis and treatment of malaria)

Impact Primary adaptive measures Secondary adaptive measures

Heat -Heatwave warning systems -Health personnel educated tostress -Urban planning detect and treat heat stress

Extreme -Disaster preparedness and mitigation -Disaster responseweather -Early warning systems events -Disaster protection measures

Infectious -Integrated environmental -Disease surveillance anddiseases management monitoring

-Control of vector-, food- and water- borne diseases

Examples of primary and secondary adaptive measures to reduce health impacts

Impact Primary adaptive measures Secondary adaptive measures

Food -International mechanisms of -Monitoring and surveillancesecurity agriculture, trade and finance -Implementation of nutrition

-Seasonal climate forecasting action plans -Famine early warning systems -National and local agriculture measures

Water -Pollution reduction and control policies -Monitoring and surveillance -Demand management and water -Capacity building allocation policies -Waste water treatment -Economic and regulatory measures to increase irrigation efficiency -Capacity building

Examples of primary and secondary adaptive measures to reduce health impacts

climate Change and Adaptation Strategies for Human health (cCASHh)

V ulnerability A ssessment to E xtreme W eather E vents ,of V ector B orn D iseases , of W ater Food born D iseases

E pidemiologal

EvaluationWHO

LSHTM

NIPH

SU

dWd

E conomic

A ssessment

Feem

P olicy

A nalysis

WHO

Current available datasets, Monitoring resultsResearch results

I ntegrated

A ssessment

ICIS

dWd

Outreach

Framework for adaptation Pik