Social VulnerabilitySandy A. Johnson, Ph.D.
2006 Summer Colloquium on Climate & Health
Boulder, CO
Definitions
• Risk – probability that a negative outcome will occur
• Risk factor – increases probability of a negative outcome
• Vulnerability – Ability to mitigate risk
“In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.”
- Eric Hoffer
Vulnerability
Physical Environment Socioeconomic
Sociocultural Political Environment
Agency
Vulnerability
• Climate Pattern• Relationship of climate pattern to well-
being• Identification of vulnerable populations• Building sustainable adaptation
Effects of climatic events on malaria incidenceAve. rainfall Event
Low Epidemic – El Nino high temp. and rainfall in cool dry, high altitude areas Pakistan (37)
Epidemic – high rainfall, arid/semiarid areas Kenya (6), Gujarat (3), Punjab (41)
Epidemic – high temp. and rainfall, tropical highlands w/little moisture deficit Africa (234, 184)
Epidemic – high rainfall with La Nina 1988, extend area of endemicity NE Venezuela (23)
Lapse in transmission – flooding; hot-wet areas, flooding washes away breeding sites in southern African (190) (24)
High Epidemic – drought, humid areas w/ponding of rivers in Sri Lanka (41), Colombia (39, 256), drought in Venezuela (36)
Source: Sutherst 2004
Health
Resources
Lost work
Lost income
Lost resources
Health care expenses
Death rites
Increased poverty
DecreasedProductivity
Increased Poverty
Higher reproduction
Social welfareHealthcare
Vulnerability
Resources
Risk
Exposure
Mitigating health impacts
• Scale• Accurate identification of the vulnerable• (Mis)match of priorities• Communication• Sustainable, culturally competent strategy• Time perspective• Change in vulnerability over time• Ethical considerations
Scale
• Population• Neighborhood• Household• Individual
Identify the vulnerable
• National Vulnerabilities– Low income,
especially rural– Women– Haitians
• Vulnerabilities in La Altagracia– Sugarcane workers, but
less so than construction workers
– Construction workers– Permanent residents
near construction/tourist facilities
Priority Mismatch
Communication
• Know the audience• Frame the issue
– Cultural competency• Semantic networks• Priority match
• Appropriate messenger• Build trust• Positive communication
Source: Moser 2006, Rogers 1962
Sustainable, Culturally
Competent Strategy
Time Horizons
To a man, a butterfly has but a short life. To a tree, a man’s life is but the blink of an eye.
Taoist adage
Vulnerability in Flux
Time
Incidence
Sources: Aral 2002, Suthrest 2004
Vulnerability in Flux
Construction Projects and Malaria Cases in the Dominican Republic
1985 to 1999
0
500
1000
1500
2000
2500
3000
3500
4000
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Year
Case
s
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Area
Und
er C
onst
ruct
ion
(m2)
No. of CasesArea (square meters)
Ethical Dimensions
• Who are the winners and who are the losers?
• Will desired outcomes be achieved? What are foreseeable consequences?
• Are we harming anyone?• Are we reducing suffering?• Who is driving the agenda?• Is the solution equitable and just?
Louisiana’s Katrina Mortality, July 20, 2006Race Mortality based on 835 Total mortality is 1,577
African American - 451 (53%)
Caucasian 334 (39%)
Other 33 (4%)
Unknown 35 (5%)
GenderMale 432 (53%)
Female 421 (47%)
Age 0 - 15 7 (< 1%)
16 - 20 5 (< 1%)
21 - 30 13 (2%)
31 – 40 26 (3%)
41 - 50 75 (9%)
51 - 60 119 (14%)
61 - 75 196 (23%)
0ver 75 388 (45%)
Unknown 24 (3%)Source: State of Louisiana Dept. of Health and Hospitals
Female Male AfricanAmerican
Caucasian
Proportion state
51% 45% 33% 66%
Proportion city
53% 46% 68% 28%
Female 47%Male 53%
African American 53%Caucasian 39%
Rate per 100,000 (Orleans Parish)
86 89 93 69Age over 50
145 per 100,000
Source: Times Picayune, Oct. 2006
Tools
• Mixed methodologies
• Translational research
• Community-based Participatory Research / Participatory Action Research