Conclusions (cont.)Most actions focus on awareness building,
capacity development, and research and policy development; few
focus on supporting community resilienceHealth sector does not yet
fully participate in national, regional, or global debates on
climate changeThe actions plans developed with support from WHO
need to be integrated into national plans and institutionalized to
ensure their implementationA positive step forward is this
course!
The South-East Asia (SEA) Region consists of eleven countries:
Bangladesh, Bhutan, Democratic Peoples Republic of Korea, India,
Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor
Leste.
While only occupying 5% of the Earths surface, the SEA Regions
population was estimated in 2005 to be 1,696,550,000, 26% of the
worlds population (WHO, 2008).
The challenges posed by climate change to human health concern
the potential increase in respiratory illnesses, heat strokes, and
injuries. But also widespread malnutrition due to food crisis and
more cases of malaria and dengue. Land loss from sea level rise may
trigger massive migration that would lead to social conflicts and
psycho-social stress.
In low-income countries and areas where malnutrition is
widespread, the level of education is poor and the infrastructure
is weak. These areas will have the most difficulty adapting to
climate change and related health hazards. The populations
considered to be at greatest risk are those living in small
islands, low-lying and coastal areas, mountainous regions,
water-stressed areas, in mega-cities particularly the large urban
and periurban agglomerations in delta regions in the SEA Region. We
are talking about communities depending directly from ecosystem
service and resource delivery such as fishermen and farmers living
in remote areas, mountain people, and ethnic minorities.
Most people in SEA countries are already burdened with a high
incidence of environmental disasters. The cumulated effects of
climate change on the Regions socioeconomic development will in
turn seriously undermine the health and the well-being of
communities in those countries.
In Bangladesh, the production of rice and wheat might drop by 8%
and 32%, respectively, by the year 2050. Recent studies suggest a
2% to 5% decrease in yield potential of wheat and maize for a
temperature rise of 0.5 C to 1.5C in India (IPCC, 2007a). The net
cereal production in South Asian countries is projected to decline
between 4 and 10% by the end of this century under the most
conservative climate change scenario. Some studies agree that
higher temperatures and longer growing seasons could result in
increased pest populations in temperate regions of Asia (UN Office
for the Coordination of Humanitarian Affairs, 2007b).
Global warming will also affect sea temperatures. Increased
frequency of El Nio events and future changes in ocean currents,
sea level, sea-water temperature, salinity, wind speed and
direction, strength of upwelling, the mixing layer thickness, and
predator response to climate change have the potential to
substantially alter fish breeding habitats and food supply for fish
and ultimately the abundance of fish populations in Asian waters
(IPCC, 2001).
According to the IPCC, 18 heat waves were reported in India
between 1980 and 1998. A heat wave in 1988 caused 1,300 deaths,
while another one in 2003 caused more than 3,000 deaths. Heat waves
in South East Asia cause high mortality in rural populations, and
among the elderly and outdoor workers. Examples are the reported
cases of heatstroke in metal workers and in rickshaw pullers in
Bangladesh (UN Office for the Coordination of Humanitarian Affairs,
2007a).In 2006, Bhutan reported an increased loss of life from
frequent flash floods, glacier lake outburst floods, and
landslides. Rises in flood-related diarrhoeal disease have been
reported in India and Bangladesh (Faisal and Parveen, 2004). In
2007, four monsoon depressions double the normal number caused
severe floods in Bangladesh, India, and Nepal; and also the
Democratic Peoples Republic of Korea, which resulted in death, loss
of livelihood, and displacement of millions (Aggarwal, 2003).
In November 2008, tropical cyclone SIDR made landfall in
Bangladesh, generating winds of up to 250 km/hour and torrential
rains. More than 8.5 million people were affected and over 3,300
died. Nearly 4.7 million people saw their houses damaged or
destroyed, most of them belonging to the poorest of the poor (UN
Office for the Coordination of Humanitarian Affairs, 2007a).
The nature and significance of the challenges posed by climate
change to human health are still being clearly identified and
addressed in most countries of the Region. A major obstacle is the
fact that the understanding of public health authorities on the
linkages between climate change and health is still poor. Most SEA
countries have set up national expert committees, often under the
direct supervision of prime ministers, to formulate national plans
for mitigation and adaptation to climate change. The active
participation of the health sector in these initiatives is still
negligible and needs to be improved.
Discussions on international health security and climate change
and health by the health ministers of the Region in 2007, resulted
in the Thimphu Declaration wherein the Ministers committed to
addressing the health impacts of global warming and climate change
(WHO-SEARO, 2007). They concluded that climate change is a major
threat to health security in South-East Asia countries of the
Region, and these countries should carry out systematic
vulnerability assessments to develop and implement national plans
of action incorporating a practical approach to mitigating and
adapting to climate change.
As a follow-up to the Ministers meeting, national workshops in
Bangladesh, Indonesia, India, and Nepal on human health and climate
change, and a regional workshop were held in 2007, with WHO
support.
While the outputs of the national workshop are being used as
inputs to the national climate change action plans in the concerned
countries, they also incorporated in the drafting of the regional
framework for action to protect human health from the effects of
climate change, worked out in Bali in December 2007 by
representatives of all SEA Region Member countries.
The goal of the regional action plan is to build capacity and
strengthen health systems.
The regional plan has three broad objectives:
To increase awareness of the health consequences of climate
changeTo strengthen health system capacity to provide protection
from climate-related risks and to substantially reduce health
systems greenhouse gas emissionsTo ensure that health concerns are
addressed in all decisions on reducing risks from climate change
taken by other key sectors.
In December 2007, SEA countries, with the support of WHO,
prepared a regional action plan to protect human health from the
effects of climate change.
SEA region countries plan to increase the awareness of health
consequences of climate change by:
Undertaking studies on the health implications of climate change
and sharing information to understand how to promote changes in
individual and corporate behaviours that mitigate climate-related
health risks, while protecting and promoting health.
Facilitating national working groups, nongovernmental
organizations, and civil society to develop coordinated mitigation
and adaptation plans, including relevant sectors, regions, and
disciplines. Developing awareness-raising programmes and learning
materials to educate and engage a broad range of stakeholders,
including local communities, health and other professionals, and
the media on the potential health impacts of climate change and on
appropriate measures to reduce climate-sensitive risk factors and
adverse health outcomes.To strengthen health systems capacity to
provide protection from climate-related risks, and to substantially
reduce health systems GHG emissions, SEA countries will:
Develop and implement national action plans for health that are
integrated with existing national plans on adaptation and
mitigation to climate change.
Develop integrated strategies to incorporate current and
projected climate change risks into existing health policies,
plans, and programmes to control climate-sensitive health outcomes,
including integrated vector management and disaster risk
management.
Strengthen existing infrastructure and interventions, including
human resource capacity, particularly surveillance, monitoring, and
response systems and risk communication, to reduce the burden of
climate-sensitive health outcomes. Key concerns vary by country.
Common concerns include vector-borne diseases, air quality, and
food and water security.
Strengthen public health systems and disaster/emergency
preparedness and response activities, including psychosocial
support, through increased collaboration and cooperation across
sectors. This should include documentation, sharing, and evaluation
of the effectiveness of local knowledge and practices.Provide early
warning systems to support prompt and effective responses to
current and projected health burdens. To achieve this end, national
and regional climate forecasting information, including climate
change projections, should be fully utilized.
Implement adaptations over the short-, medium-, or long-term; be
specific about local health determinants and outcomes of concern;
and facilitate the development of community-based resource
management. The costs and benefits of different interventions
should be determined.
Establish climate change focal points or mechanisms within the
national health institutions to ensure the implementation,
monitoring, and evaluation of health mitigation and adaptation
actions, and ensure that health issues are adequately addressed in
these actions.
Establish programmes to substantially reduce GHG emissions by
the health sector, which could also serve as a best practice model
for other sectors.
To ensure that health concerns are addressed in decisions to
reduce risks from climate change in other key sectors, the
following activities will be carried out: Develop integrated
strategies to incorporate current and projected climate change
risks into existing policies, legislation, strategies, and measures
of key development sectors to control climate-sensitive health
outcomes. Examples include the promotion of public and
non-motorized transportation, clean energy, and disaster risk
management.
Facilitate the health sector to actively participate in national
communications to the UNFCCC, and include health issues as the core
elements in the negotiation process.
Ensure active health participation in the national climate
change team.SEA countries are in the process of increasing health
relate climate action. The following slides show some examples at
the national level.While no national health impact assessments to
evaluate the current and potential impacts of global warming
climate change have yet been conducted, some countries have started
to take action.
Bangladesh prepared a National Adaptation Programme of Action
(NAPA) in 2002 (see:
http://unfccc.int/resource/docs/napa/ban01.pdf), under the
leadership of the Ministry of Environment and Forests. Although the
health sector contribution during its preparation was limited, some
NAPA activities have health benefits. The phase out of two-stroke
three wheelers, the mandatory use of catalytic diesel particulate
filters in cities, and the installation of 30,000 Solar Home
Systems in rural households, are lowering the health burden from
both indoor and outdoor air pollution. Several other health related
projects such as one aiming at securing drinking water from
enhanced salinity due to sea level rise are being developed. The
country aims to mainstream climate change adaptation into policies
and programmes across the different sectors, including health.
In 2007, a national workshop supported by WHO, focused on how to
reduce the disease burden from current and projected risks due to
climate change. National health authorities agreed:
To increase knowledge and awareness of the health consequences
from climate change within and outside the health sectorTo prepare
mitigation and adaptation plans based on a vulnerability assessment
of the national health systemsTo ensure coordination with, and
advocate for decisions on, climate change in other key sectors that
enhance public health.Bhutans National Adaptation Programme of
Action is available at:
http://unfccc.int/resource/docs/napa/btn01.pdf.
Bhutan aims at strengthening existing health programmes that are
already addressing climate-sensitive health outcomes. These include
community-based clean water supply schemes, health hygiene
campaigns, integrated vector management, and capacity building for
emergency medical services.
To this purpose, a GEF/UNDP/WHO project has been enabled to
strengthen the national capacity to identify and prevent adverse
climate change and climate variability-related health outcomes in
Bhutan.
Project outcomesOutcome 1: Overall awareness on climate change
and climate variability and its adverse impacts on human health is
increased and concerned professional staff are trained
Outcome 2: Emergency preparedness plans to reduce life loss and
injury from flash floods and glacier lake outburst floods (GLOF)
are developed
Outcome 3: The burden from disease vectors is reduced through
the implementation of community-based, integrated vector
management
Outcome 4: Rural water quality and sanitation are improved and
maintained by the concerned communitiesIndonesia, the fourth most
populous country in the world with more than 17,000 islands
scattered over a large area, is vulnerable to climate change.
The UN International Conference on Climate Change, held in Bali
in December 2007, helped generate impetus to address health
concerns.
The National Climate Change Inter-sectoral Committee is led by
the Ministry of Environment, with the Ministries of Forestry,
Energy, Industry, Agriculture, Health, Planning Board, Public Work,
and Universities as co-members. The Committee is currently
incorporating health concerns and actions related to health
implications from climate change into the new Five-Year National
Development Plan. At provincial and district levels, these concerns
are being streamlined into the Healthy Cities Programme.
Following are some of the priority activities outlined to be
initiated:Identify local evidences of health impacts from climate
change, and use them as illustrations for increasing public
awareness. Develop and disseminate IEC materials and encourage
communities and schools to minimize GHG emissions in daily
activities.Expand research and development on global warming,
climate change, and health effects. Capacity building within the
health sector. Update national health policy to increase resilience
to climate change issues.Focus on potential risks of water and food
scarcity, and research adaptations to reduce disease burden from
diarrhoeal diseases and under nutrition.Coordinate and network with
relevant sectors, government institutions, and private players
concerned with climate change with particular focus to health.The
national Climate Change Action Planconsiders eight missions, but no
specific one focuses on health concerns. A Task Force has been set
up to prioritize health action: Vector borne diseases: Studies on
vulnerability assessment and impact of climate change on Malaria
being undertaken. Studies on dengue, chikungunya, and Japanese
encephalitis (JE) need to provide evidence for taking proactive
measures.Eye diseases: Multi-centric Collaborative Study on the
impact of global warming and ultra violet radiation (UVR) exposure
on ocular health. Adaptation measures would be suggested
accordingly. Mental health: Use the lessons learned from management
of disasters. Need for research (short- and long-term) and develop
infrastructure at Primary Health centre level to handle the
psychiatry cases due to loss of property and life. Respiratory
diseases: Multicentric studies are required to assess respiratory
diseases sensitive to climate change. This can be done through
collection of data from OPD attendance, patterns of indoor
admissions, mortality variation from different respiratory
diseases, pulmonary function changes in different climatic
conditions, and monitoring of temperature and pollutants in
different areas of the country. Malnutrition: The Indian
Agricultural Research Institute is carrying out an impact
assessment of climate change on major crops and integrated
vulnerability assessment to map the kind of adaptive capacity that
farmers can implement to adapt. National authorities plan to supply
food grains at affordable prices during droughts, improve storage
systems, and work through the Drought Relief Cells established by
State governments and NGOs. Diarrhoeal diseases: Multicentric
studies are required to assess links between water quality and
diarrhoeal disease. The Bay of Bengal, which forms the site of the
Ganges - Brahmaputra river basin, is a priority area as it is also
influenced by the effect of climate change on the Himalayan
glaciers. To address the issue of climate change and health in
comprehensive perspective, institutes/persons have been identified
for undertaking studies on vulnerability assessment and adaptation
needs. Some are the National Vector Borne Disease Control Programme
and the National Rural Health Mission in the Ministry of Health and
Family Welfare. The World Bank sponsored project on vector borne
disease control was implemented in 139 districts of 11 states for
malaria and kala-azar. The national workshop on health and climate
change that was held in December 2007 established priority actions
(see text in slide). To achieve them, a series of immediate and
short-term actions were proposed:
Establish a focal point/coordination unit for environmental
health/climate change and health in the health sectorOrganize
consultative meetings every six monthsTrain health professionals to
understand the threats posed by climate change and contribute to
build the capacity of national and local institutions, including
negotiation skillsConduct research to fill out the knowledge gaps
and reduce uncertainties Develop and implement programmes for
mitigation and adaptation to reduce vulnerabilityInvolve
communities in monitoring climate change impacts and help them to
employ appropriate measuresEstablish or strengthen surveillance,
reporting, and response systems for infectious diseasesPromote
cooperation and coordination of different sectors on climate change
research and strengthening alliances for sustainable
development
Thailand is taking action to reduce of GHG emissions in absolute
terms by incorporating state-of-the-art technologies and a careful
adoption of energy efficiency measures. The specific policy
instruments to reduce GHG emissions include: (1) regulations; (2)
fiscal incentives; (3) information; and (4) research, development
and demonstration, and will contribute to health gains in terms of
air quality, physical activity, and reduction of road injuries.
Thailand is taking action to reduce greenhouse gas emissions in
absolute terms by incorporation of state-of-the-art technologies
and careful adoption of energy-efficiency measures. The Ministry of
Natural Resources and Environment has developed a Strategic Plan on
Climate Change for 20082012 with six elements:
Build capacity to adapt and reduce vulnerabilities to climate
changePromote greenhouse gas mitigation activities based on
sustainable developmentSupport research and development to better
understand climate change, its impacts, and adaptation and
mitigation optionsRaise awareness and promote public
participationBuild capacity of relevant personnel and institutions,
and establish a framework of coordination and integrationSupport
international cooperation to achieve the common goal of climate
change mitigation and sustainable development.
