Ravi K MishraMPH, 3rd Batch

Department of Community Medicine, NMC, Birgunj

Recent Advanced on

Climate Change and Human Health

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Outline of Recent Advanced

• Introduction• Observed Climate Change• Climate change in Nepal Context • Impacts of Climate Change • Health Impacts of Climate Change• Recent Activities on climate change and Public Health• Vulnerability• References

Total No of Slide:66Estimated Time Period : 50 Minutes

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Climate Change

Climate change refers to the variation in the Earth's global

climate or in regional climates over time.

It describes changes in the variability or average state of the

atmosphere over time scales ranging from decades to

millions of years.

These changes can be caused by processes internal to the

earth, external forces or, more recently, human activities.

Source (IPCC 2007)

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The impact of climate change is not experienced equally through out the world.

Developing Countries are considered to be particularly susceptible to climate change due to their limited capacity to cope with hazards associated with changes in climate change.

Nepal is no exception in being a country vulnerable to the impact of climate change due to its fragile mountain ecosystem, weak geological condition and diverse nature of climate.

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Observed Climate Change Global average surface air temperature has increased, especially since

about 1950.

The average temperature of the world has increased by 0.74 degreeCelsius over the last 100 years (1906-2005).

2005 and 1998 were the warmest two years in the instrumental globalsurface air temperature record since 1850. Eleven of the last 12 years(1995 to 2006)-1996 exception-rank among the 12 warmest years onrecord since 1850.

Climate models calculate that the global mean surface temperature couldrise by about 1 to 4.5 centigrade by 2100.

Average global precipitation has also increased by 0.5-1% annually. It is decreasing in equatorial region and increasing in higher latitude.Precipitation has increased over land at high latitudes of the Northern Hemisphere, especially during the cold season. Decrease in precipitation occurred in steps after the 1960s over the subtropics and the tropics from Africa to Indonesia.

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Observed Climate Change

Temperature

Days and nights are both becoming warmer.

Warm spell duration (Long hot days) is increasing

Cool nights and cool days are becoming less frequent.

Extreme weather ahead

RainfallTotal rainfall and heavy rainfall events are

increasing

Maximum 24 hour rainfall is also increasing 6

Climate change may result from:

Natural factors, such as changes in the Sun’s energy or slow

changes in the Earth’s orbit around the Sun; changes in ocean

circulation.

Anthropogenic factors that change the atmosphere’s make-

up (e.g., burning fossil fuels) and the land surface (e.g.,

cutting down forests, building developments in cities and

suburbs, etc.).

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Global warming

Global Warming is an average increase in temperatures near

the Earth’s surface and in the lowest layer of the atmosphere.

Increases in temperatures in our Earth’s atmosphere can

contribute to changes in global climate patterns.

It can be considered part of climate change along with

changes in precipitation, sea level, etc.

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Greenhouse Effect

The greenhouse effect is a natural process in which the Earth's atmosphere

insulate the Earth.

Incoming solar radiation (short-wave radiation) is absorbed at the Earth's

surface. Energy is then radiated back from the Earth's surface into the

atmosphere as long-wave radiation.

Over time there is an approximate balance in this incoming and outgoing

radiation.

Changes to this balance, such as changes in the amount of radiation received or

lost by the system(due to GHGs), or changes to the distribution cycles within

the system, can affect climate.

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IPCC 2007a

Greenhouse gases’ effect

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IPCC (2007):- Most of the observed increase in global

averaged temperature ... is very likely due to ... increase in

GHG concentrations.

Source :- Intergovernmental Panel on Climate Change(IPCC)11

IPCC (2007)

Warming in

the

climate system

is unequivocal.

Source :- Intergovernmental Panel on Climate Change(IPCC)12

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Environmental health risks in different scale

Regional air pollution

Acid rain,

Asian brown cloud

Global change

Direct, toxic, hazard

Extremes of exposures; disruption of life/health-support systems

Environmental tobacco smoke

Indoor air

Local air pollution

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Land Areas Warm More than the Oceans with the Greatest Warming at High Latitudes

Annual mean temperature change, 2071 to 2100 relative to 1990.

Global average in 2085 = 3.1°C.

IPCC 2007b 17

Nepal Context

Nepal is the fourth most vulnerable country in terms ofclimate risks and 30th in terms of water-induced disaster.Climate change is posing additional threat to Nepal.

Nepal's average annual mean temperature has increased by0.060C between 1977 and 2000 and these increases are morepronounced at higher altitudes and in winter.

There is a general increase in temperature extremes withwarmer days and nights becoming more frequent and coolerdays and nights less frequent.

A study conducted by Nepal Country Vulnerability Study Teamin 2009 has projected that Nepal’s mean annual temperaturemay rise by 1.4 degree Celsius by 2030, 2.8 degree Celsius by2060 and by 4.7 degree Celsius by 2090.

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Annual Mean Temperature Increase by Ecological

Region in Nepal (1977-2000)

Ecological Regions Temperature (°C)

Mountain 0.08

Hill0.06

Terai 0.04

Nepal0.06

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21(DHM, Nepal)

Climate Change: Temperature Distribution Shift to

More Heat

IPCC, 2007b22

Impacts of Climate Change

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Impacts on Water Resources

Water is the most impacted sector by climate change.Water impacts are key for all sectors.

IPCC predicts that by 2050, freshwater availability incentral, south, east and south east Asia, particularly inlarge river basins, is projected to decrease.

Effects of climate change on water resources could yieldmanifold implications either due to too much and/or toolittle water (NAPA 2010).

Due to rise in temperature, Himalayan region is noticeablyimpacted by climate change. The reported impact is rapidreduction in glaciers.

Climate change will increase the frequency and intensity ofwater induced disasters.

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Cont… Nepal’s high altitude glaciers are thinning (30 cm-1 m) and

retreating at an alarming rate (10-20m annually), fasterthan the world average, resulting in an increase in thenumber and size of glacial lakes and the threat ofcatastrophic Glacial Lake Outburst Floods (GLOFs). LakeImja Tsho is an example of a glacier lake which was non-existent in 1960 and now covers nearly one squarekilometre. The Imja glacier that feeds the lake hasretreated 75 m between 2001 and 2006.

The new inventory identified 3,808 glaciers with a totalarea of 4212 sq.km and 1,466 glacial lakes in Nepal(ICIMOD 2011). The rapid reduction in glaciers hasprofound future implication for downstream waterresources.

There are about 21 potentially dangerous glacial lakesidentified by ICIMOD, among which 6 are most critical

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Impacts on Agriculture Nepal’s agriculture is facing risks due to

changes in the reliability of stream flow,

a more intense and potentially erratic

monsoon rainfall and flooding. About

64% of cultivated areas are fully

dependent on monsoon rainfall.

Decline in rainfall from November to

April adversely affects the winter and

spring crops.

Rice yields are sensitive to climatic

conditions and may fall in western region

and it may threaten overall food security.

A study carried out by B.R.Regmi and A.

Adhikary in 2007 reveals that climate

change is posing threat to food security

due to loss of some local land races and

crops.26

Cont… Initial National Communication,2004 states that with the increase of

temperature beyond 4 degree Celsius, the yield of Terai rice is

projected to decrease. The effect of temperature on rice crops in the

hills is little more severe than in the Terai. But in mountain region it is

better, but rice is grown negligibly there.

The yield of wheat is projected to fall down with the rise in temperature

in Terai. The effect of temperature on wheat yield in the hills is less

than in Terai. There is insignificant decline of wheat yield in mountain

environment with rise in temperature.

The rise in temperature will affect yield of maize crops in Terai more

than wheat and rice crops. It affects less in the hills than in Terai but

increases production of maize in mountain areas.

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Impact on Livestock Livestock production is highly sensitive to climate

change.

Rising temperature increases lignifications of plant

tissues and reduces the digestibility (Minson, 1990),

reducing meat and milk production in range-based

livestock production system.

Increased heat stress is another pathway affecting the

livestock production. The increased heat alters heat

exchange between animal and environment affecting the

feed intake and metabolism (SCA, 1990; Mader and

Davis, 2004). Such stresses will affect growth and

productivity of the animals. But, effects vary from species

to species.

Water buffaloes need frequent bath for heat exchange.

Drying of ponds due to drought can deprive the buffaloes

for taking baths affecting adversely the productivity of the

buffaloes.

Similarly, the increased energy deficits may decrease

cow fertility, fitness, and longevity (King et al., 2006).

Increased temperature and humidity will increase the

risks of mortality and morbidity among the livestock and

poultry.28

Impacts on Forests and Biodiversity

IPCC predicts that approximately 20 to 30% of

plant and animal species assessed so far are

likely to be at increased risk of extinction if

increases in global average temperature exceed

1.5 to 2.5 degree Celsius.

Increased temperature and rainfall variability

have resulted into shifts in agro-ecological zones,

prolonged dry spells, and higher incidences of

pests and diseases.

New alien and invasive species are emerging

and their habitat is spreading at a fast rate.

Migration of the forest towards the higher altitude,

change in their composition, and extinction of

species.

Extreme climatic conditions have led to

increased incidence of fire in recent years

affecting more than 50,000 people and loss of

large areas of productive forest land. These

changes lead to species and habitat loss. 29

Cont…

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Cont…

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Health Impacts of Climate Change

McMichael et al. 2003a 32

Pathways: climate change human health

Source: adapted from Patz et al., 2000

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Change in disease pattern

Food and nutrition

Water source depletion

Natural disaster

Health Climate change

Health impact of climate change

Change in agent

Change in carrier

Change in host

Disease

Climate change

Causal pathway

Health impact of climate change: the causal pathway

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1) Extreme weather related: cold waves and heat waves in the Tarai,

2) Water and food borne: diarrhoea, dysentery, typhoid, giardiasis,

amoebiasis, gastritis, jaundice and infectious hepatitis

3) Climate induced disaster: prolonged droughts and flash floods

4) Air pollution-related: respiratory diseases like acute respiratory

infection (ARI), bronchitis & asthma

5) Vector borne diseases: Japanese encephalitis, Malaria, Dengue and

Kala-azar (Visceral leishmaniasis)

6) Nutritional, Mental and Other: Malnutrition, Mental diseases and

non-communicable diseases including injuries and accidents

Climate Sensitive Diseases Identified by NAPA (2010)

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Celsius Notes

27–32 °CCaution — fatigue is possible with prolonged exposure and

activity. Continuing activity could result in heat cramps

32–41 °CExtreme caution — heat cramps, and heat exhaustion are

possible. Continuing activity could result in heat stroke

41–54 °CDanger — heat cramps, and heat exhaustion are likely; heat

stroke is probable with continued activity

≥54 °C Extreme danger — heat stroke is imminent

Classification of heat index

Source: Steadman (1979);

http://www.bom.gov.au/info/thermal_stress

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Recent activities in climate change and public health

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Adaptation Initiatives The government of Nepal prepared the NAPA in 2010 to address its urgent

and immediate adaptation needs through a consultative and country-driven

process.

NAPA is a strategic tool to access climatic vulnerability, and symmetrically

respond to climate change adaptation issues by developing appropriate

adaptation measures.

Out of about 250 adaptation options proposed by the Thematic Working

Groups (TWG), nine integrated projects have been identified as the urgent

and immediate national adaptation priority.

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Cont… The government of Nepal has approved the National Framework on

Local Adaptation Plans for Action (LAPA Framework) in 2011 that helps to

integrate climate adaptation and resilience aspects in local and national

plans.

Agriculture, forestry, health, water and sanitation, watersheds and micro-

finance have been identified as the main entry points. But it states that

education, local infrastructure, disasters and other environment-related

areas may also be taken as entry points.

Since 2013, the government is implementing 70 Local Adaptation Plan

for Actions in 69 village development committees and one municipality of 14

districts in the Mid and Far Western regions of Nepal with support from

Nepal Climate Support Programme: Building Climate Resilience in Nepal

Project funded by UNDP/DFID/EU

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LAPA ProcessThe LAPA Framework consists of the following 7

steps for formulation and implementation. They

are:

Climate change sensitization

Climate vulnerability and adaptation

assessment

Prioritization of adaptation options

LAPA formulation

LAPA integration in planning process

LAPA implementation

LAPA progress assessment

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STEP 2: VULNERABILITY & ADAPTATION ASSESSMENT

STEP 3: PRIORITISATION OF ADAPTATION

OPTIONS

STEP 4: ADAPTATION PLAN

DEVELOPMENT

STEP 5: INTEGRATING THE

ADAPTATION PLAN

STEP 6: IMPLEMENTING

ADAPTATION PLAN

STEP 7: ASSESSING PROGRESS

{Carried out in all steps}

LAPA StepsSTEP 1:

SENSITISATION{Carried out in

all steps}

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The Doha Declaration on Climate, Health and Wellbeing

• The international health and medical community have developed a jointstatement on climate health and wellbeing in Doha, Qatar on 2012.

• It calls for health to be central to climate action, and highlights theopportunities to improve health through emissions reductions – pointingout that reducing fossil fuel consumption and moving to low carbonenergy systems can deliver many benefits to health worldwide particularlychildren, women and poorer people and those in developing nations.

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Tackling climate change in cities: the role of best practices

• Increasingly the burden of developing climate change policy with ‘real’efficacy has shifted to cities.

• Cities now must interpret scientific findings into economic, and politicalterms then devise physical and social policy; they must also localize globalideas on climate change mitigation strategies.

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(International centre for climate governance, 2014)

Contd…

• Analysis of municipal plans from 51 cities across the globe, has highlightedcommonalities in the efforts of cities to mitigate the adverse effects ofclimate change on human health.

• Under the umbrella of transportation, cities are focused on improvingaccess to transportation, public transportation routes and services, varietyof transportation options such as trains, and buses; and promotion ofalternatives, namely cycling and walking (active travel), thereby improvinghealth outcomes.

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Contd…

• Cities have focused on the built environment.

• Through the employment of green building guidelines such as LEED andBREEAM, that are focused on increasing energy efficiency, usingsustainable building materials and a rating system to encouragedevelopers and cities to favor the construction of environmentally friendlybuildings .

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Contd…• Cities have increasingly been focused on Green Infrastructure (GI).

• GI includes blue infrastructure, namely protecting water resourcessuch as rivers, lakes, and wetlands.

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Contd…

• Portland (US), Vancouver (Canada) and New York (US), are three cities thattend to dominate in the realm of being green, with the City of Vancouversetting out to be the Greenest City by 2020.

• New York, has a wide range of programs and initiatives aimed at mitigatingthe impacts of climate change. Most notable of these is the city’sEnvironmental Public Health Tracking program.

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Contd…

• In Paris, after the 2003 heat wave, recognized the importance ofpreventing heat related deaths.

• As part of their heat plan, they developed CHALEX (Chaleur Extreme) aregistry of vulnerable individuals and their addresses that would enablemunicipal worker to visit or call these individuals during extreme heatevents to ensure that their health is not compromised.

• Nationally Singapore has NEWater practice, involves the purification ofwaste water to potable quality through reverse osmosis.

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Activities by the German Federal Environment Agency on adaptation to climate

change (2010)

• In Germany, the Federal Environment Agency has invested a high level ofresources in developing measures to address the issue of climate changeand public health, in particular through establishing the nationalCompetence Centre on Climate Impacts and Adaptation, which created acatalogue of climate change and health data that is and will be used by alldecision-making bodies.

• A climate change adaptation plan has been developed, including measuressuch as awareness-raising at both national and local levels.

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Contd..

• The plan involved 15 sectors, including health, and included adatabase for sharing the information between stakeholders, rapidalert system and climate change guide for small and mediumsizedbusinesses, which provides advice on issues such as pest control, thehealth impacts of pollen, and adaptation measures.

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Contd…

• An analysis of the heat health warning system and UV index was carriedout for three key sectors of the population: nursing homes, kindergartensand elderly people living in single households.

• The heat-health warning system was well-received by some nursinghomes, and were interpreted as a principally appropriate instrument forhealth-related adaptation.

• Although, for example 55% of nursing homes felt that the alerts wereunnecessary as they would have taken the precautionary measuresanyway, because of the prediction of the weather forecasts from themedia.

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has been developed as a unique mechanism for increasing financial flows to developing countries for promoting clean technologies that not only reduce greenhouse gas emissions but also contribute towards the sustainable development of the country.

Nepal has recently deposited the instrument for accession to the Kyoto Protocol and has thus fulfilled the first requirement for participation in the Clean Development Mechanism.

Nepal in the process of CDM

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A transfer of finances and contribution to sustainable

development in the Host Country

Developing Country (Nepal)

Flow of Finances

Flow of Carbon Credits

Developed Country

CDM Concept: An Opportunity to Reduce the Climate Change Impacts

Clean energy

projects

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Climate Change: Impacts and Urgent

Adaptation Actions in Dang District of Nepal (2011)

• After intensive field based study in Dang district, different issues are founddue to climate change and variation in precipitation.

• Terai VDCs of Dang have climate induced disasters such as flooding andlandslide problems in slope land areas.

• Drought is another problem faced by farmers which reduced theproductivity of land.

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Contd…• Study recommended following intervening programmes to develop

climate change resilience capacity in communities:

Development of physical infrastructures like access roads, electricity andlocal market infrastructures fulfill demands of fertilizers to farmers on timewhich help to increase high production of rice.

Develop physical infrastructure like embankment and check dams tocontrol flooding.

Forest management program and control mechanism of degradation offorest resources.

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Public Health Impacts of Climate Change in Nepal.

56Joshi HD, Dhimal B, Dhimal M, Bhusal CL. J Nepal Health Res Counc 2011 April;9(18):71-5.

The noncommunicable diseases: effects of climate change mitigation and adaptation strategies (S. Friel et al, 2011)

Sector Strategy Climate change implication

Pathways for climate change to NCDs

NCD risk

Energy Reduce household use of solid(biomass) fuels

Mitigation: reduceGHG emissions

Reduced indoor airpollution

• Reduced CVD• Reduced respiratory diseases• Reduced COPD

Urban planning

Improve walking and cycling infrastructure

Mitigation: reduceGHG emissions

Increased activetransport, physicalactivity

• Reduced CVD• Reduced obesity• Reduced respiratory diseases

Food and agriculture

Support rural development: newfood production techniques,rural livelihoods

Adaptation: Improveresilience toclimate change

Improved and expandedsupply of nutritionalfood sources

•Decreased undernutritionand improved resilience toNCDs

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Vulnerability

• “The degree to which a system is susceptible to,

and unable to cope with, adverse effects of climate

change”

Intergovernmental Panel on Climate Change,

Fourth Assessment Report 2007

(IPCC AR4, 2007)

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Vulnerability = f (Exposure, Sensitivity, Adaptive capacity)

Background (contd.)

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Definition of Vulnerability (cont.)

Vulnerability = susceptibility to adverse effects + inability to adapt

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Vulnerable Groups of Climate Change Impact:

- By location: rivers banks, steep slopes, slums and

squatter settlements & remote areas

- By social groups: poor, women and children,

disabled, and refugees

- By occupation groups: those working in hazard

activities such as garment, carpet, brick kilns,

stone crushing

Determinants of Vulnerability

• Character, magnitude, and rate of climate change

• Sensitivity to climate change

• Coping capacity (adaptation)

Adaptation and Mitigation

Global Environmental Changes, affecting:

• Climate• Water

• Food yields

• Other materials

• Physical envtl. safety

• Microbial patterns

• Cultural assets

Naturalprocesses and forcings

Impacts on human society:

• Livelihoods

• Economic productivity

• Social stability

• HealthHuman society:• Culture, institutions

• Economic activity

• Demography

Adaptation:

Reduce impacts

Human pressure

on environment

Mitigation: Reduce pressure on environment

Mitigation for health sector: to promote and support initiatives that protect health by reducing greenhouse gas emissions

Adaptation for health sector: strengthen prevention, surveillance

and early warning systems pertaining to climate sensitive diseases

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References• Dhimal M, Bhusal CL. Impacts of Climate Change on Human Health and

Adaptation Strategies for Nepal. J Nepal Health Research Council 2009Oct;7(15):140-141.

• Badu M. Assessing the impact of climate change on human health: statusand trends of malaria and diarrhea with respect to temperature andrainfall variability in nepal. Kathmandu University Journal of Science,Engineering and Technology VOL. 9, No. I, July, 2013, pp 96-105.

• Climate change and public health in UTAH. The Great Seal of the State ofUTAH.

• Report of national workshop on Climate change and human health:Potential impact, Vulnerability and Adaptation in Nepal. NHRC.

• WHO. Climate Change, extreme weather events and public health-meeting report. 2010 november 29-30; Bonn Germany.

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References (II)• Climate change and human health: Impacts, vulnerability and public

health. Journal of the Royal Institute of Public Health (2006); 120, 585–596.

• Thapa K.B. Climate Change: Impacts and Urgent Adaptation Actions in

Dang district of Nepal. 2011 November 8.

• S. Friel et al. Climate Change, Noncommunicable Diseases andDevelopment: The Relationships and Common Policy Opportunities.Annual Review Public Health Journal. 2011.32:133-47.

• Huss J.J, McDowells J. Z., Luber G. Integrating Climate Change Adaptationinto Public Health Practice: Using Adaptive Management to IncreaseAdaptive Capacity and Build Resilience. Environ Health Perspect 120:171–179 (2012).

• Joshi HD, Dhimal B, Dhimal M, Bhusal CL. Public Health Impacts of Climate Change in Nepal. J Nepal Health Res Counc 2011 April;9(18):71-5.

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References (III)

• Mills J.N., Gage K.L., Khan S.A. Potential Influence of Climate Change onVector-Borne and Zoonotic Diseases: A Review and Proposed ResearchPlan. Environmental health perspectives. 118:1507–1514;2010.

• D. Sabrina (ICCG). Tackling climate change in cities: The role of bestpractices. ICCG Reflection No. 23/May 2014.

• Madhav Karki, Pradip Mool and Arun Shrestha: Climate Change and its Increasing Impacts in Nepal, ICIMOD, Kathmandu, Nepal,

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Thank U

Discussion ???

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