Technologies for Adaptation to Climate Technologies for Adaptation to Climate Change Impacts on Human HealthChange Impacts on Human Health

F. Agyemang-YeboahF. Agyemang-Yeboah UNFCC SEMINAR ON THE DEVELOPMENT AND TRANSFER ON UNFCC SEMINAR ON THE DEVELOPMENT AND TRANSFER ON

ENVIRONMENTALLYENVIRONMENTALLY SOUND TECHNOLOGIES FOR SOUND TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE, TOBAGO, 14-16 JUNE ADAPTATION TO CLIMATE CHANGE, TOBAGO, 14-16 JUNE 20052005

School of Medical Sciences, Kwame Nkrumah School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, University of Science and Technology, Kumasi,

Ghana.Ghana.

Summary of PresentationSummary of Presentation

1.1. Potential Climate Change Impacts on Potential Climate Change Impacts on Human Health-An illustrative modelHuman Health-An illustrative model

2.2. The Ghanaian Case Study The Ghanaian Case Study

3.3. Identification of technologies from the Identification of technologies from the Ghanaian perspectiveGhanaian perspective

4.4. Other options of Adaptation Other options of Adaptation technologies technologies

5.5. The decision making processThe decision making process

6.6. ConclusionConclusion

INTRODUCTION AND BACKGROUND INTRODUCTION AND BACKGROUND

Potential Impacts of Climate Change on Human Potential Impacts of Climate Change on Human HealthHealth

It is now established that global climate change It is now established that global climate change would affect human health via pathways either would affect human health via pathways either directly or indirectly at different time rate.directly or indirectly at different time rate.

Climate change act via less direct mechanism to Climate change act via less direct mechanism to affect the ecosystem and therefore the affect the ecosystem and therefore the transmission of many diseases. It also affects food transmission of many diseases. It also affects food security.security.

The distribution and abundance of vector The distribution and abundance of vector organisms (carriers) and intermediate hosts are organisms (carriers) and intermediate hosts are affected by both physical (temp. humidity. rainfall affected by both physical (temp. humidity. rainfall etc.) and biological factors (vegetation, host etc.) and biological factors (vegetation, host species, competitors, predators etc.) in the species, competitors, predators etc.) in the ecosystemecosystem

POOR RAINS

Inadequate in volume and distribution

Poor Harvest

People Underfed

(Malnutrition)

Poor grass

Less meat, less milk

Overgrazing where grass is good

Animals underfed

Over-grazing, trees cut down for fuel

Grass /vegetation cover lostAnimal deathPoverty

LAND DEGRADATION

TYPICAL CASES FROM TYPICAL CASES FROM GHANAGHANA

Mean air temperature scenario – seasonal Mean air temperature scenario – seasonal patternpattern

26.5

27.1

28.5

29.6

27.9 27.927.6

27

25.8

24.924.8

25.3

26

26.6

26.1

28.628.6

28.2

27.2

26.3

25.4 25.3

25.8

26.5

27.2

26.7

30.1 30 29.9

29.2

27.7

26.6 26.6

26.9

27.6

28.6

28.1

30.1

30.5

29.4

28.528.228.4

31.4

32.132.132.1

30.6

24

25

26

27

28

29

30

31

32

33

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Mea

n a

ir t

emp

erat

ure

Mean air temperature baseline

Mean air temperature 2020

Mean air temperature2050

Mean air temperature2080

Distribution of the number of malaria cases and Distribution of the number of malaria cases and maximum air temperaturemaximum air temperature

High maximum air temperature values corresponds to low number of malaria cases and vice versa.

Aug-0427.7

Aug-0328.4

Aug-02 28.0Aug-01

27.6

Aug-00 28.2

Sep-99 28.7

Jan-04

33.90C

Mar-03

34.90C

Feb-02

35.70CFeb-01

35.50C

Feb-99

33.40C

Mar-00

34.90C

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Jan-99

Apr-99

Jul-99

Oct-99

Jan-00

Apr-00

Jul-00

Oct-00

Jan-01

Apr-01

Jul-01

Oct-01

Jan-02

Apr-02

Jul-02

Oct-02

Jan-03

Apr-03

Jul-03

Oct-03

Jan-04

Apr-04

Jul-04

Oct-04

Time (1999 - 2004)

Nu

mb

er o

f O

utp

atie

nt

Mal

aria

Cas

es

26.0

28.0

30.0

32.0

34.0

36.0

38.0

Max

imu

m T

emp

erat

ure

(C

)

Number of malaria cases Maximum Temperature

DISTRIBUTION OF MALARIA CASES AND MEAN RELATIVE HUMIDITY

Aug-0146039

Sep-9937898 Feb-02

41979Jul-01 40505

Apr-9930730

Jun-99 48000

Feb-00 18717

Jun-0056000

Aug-0280300

Feb-0339700

Oct-0368043

Dec-0034866 (72%)

Jul-0184.5

Dec-0072.5%

Jun-0084.5%

Jun-9982%

Mar-03, 67.5

Feb-0263.5%

Sep-9984.9%

55% Feb.00

Aug-0186%

84.5%Aug. 02 Jun-03

82.5%

Apr-9979%

5000

15000

25000

35000

45000

55000

65000

75000

85000

YEAR (1999 - 2003)

OU

TPA

TIE

NT

MO

RB

IDIT

Y M

ALA

RIA

CA

SE

S

50

55

60

65

70

75

80

85

90

ME

AN

RE

LATI

VE

HU

MID

ITY

(%)

MALARIA CASES MEAN RELATIVE HUMIDITY

•Generally, increasing mean relative humidity corresponds to increasing incidence of malaria, whilst decreasing mean relative humidity corresponds to decreasing incidence of malaria.

Distribution of the number of malaria cases and Distribution of the number of malaria cases and rainfall amountrainfall amount

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Jan-99

Apr-99

Jul-99

Oct-99

Jan-00

Apr-00

Jul-00

Oct-00

Jan-01

Apr-01

Jul-01

Oct-01

Jan-02

Apr-02

Jul-02

Oct-02

Jan-03

Apr-03

Jul-03

Oct-03

Jan-04

Apr-04

Jul-04

Oct-04

Time (1999 - 2004)

Nu

mb

er o

f O

utp

atie

nt

Mal

aria

Cas

es

0

50

100

150

200

250

300

350

400

Rai

nfa

ll am

ou

nt

(mm

)

Number of malaria cases Rainfall Amount

CommentsComments

Baseline study shows that under the present Baseline study shows that under the present climatic conditions malaria is perennial. climatic conditions malaria is perennial.

Mean air temperature ranges from mean air Mean air temperature ranges from mean air temperatures 24.8temperatures 24.8ººC to 27.9C to 27.9ººC for Ashanti RegionC for Ashanti Region

The maximum number of malaria cases occurs in The maximum number of malaria cases occurs in June at mean air temperature of 25.8June at mean air temperature of 25.8ººC. C.

Low number of malaria cases occurs in February , Low number of malaria cases occurs in February , March and April where mean air temperature March and April where mean air temperature ranges from 27.6ranges from 27.6ººC in April , 27.9C in April , 27.9ºCºC in both in both February and March respectively.February and March respectively.

DistributionDistribution of Meningitis cases and maximum air of Meningitis cases and maximum air temperaturetemperature

Periods of high meningitis cases coincide with periods of high maximum air temperature

Jan-04 7

Jan-03

390C

Feb-02 7

Feb-01 15

Mar-0018Mar-99

17

Mar-99

33.30C

Mar-00

34.90CJan-04

33.90CJan-0333.1

Feb-02

35.70CFeb-01

35.50C

0

5

10

15

20

25

30

35

40

45

Jan-99

Apr-99

Jul-99

Oct-99

Jan-00

Apr-00

Jul-00

Oct-00

Jan-01

Apr-01

Jul-01

Oct-01

Jan-02

Apr-02

Jul-02

Oct-02

Jan-03

Apr-03

Jul-03

Oct-03

Jan-04

Apr-04

Jul-04

Oct-04

Time (1999 - 2004)

Nu

mb

er o

f m

enin

git

is c

ases

22

24

26

28

30

32

34

36

38

Max

imu

m A

ir t

emp

erat

ure

Meningitis Cases Maximum air temperature

Distribution of diarrhoea cases and rainfall Distribution of diarrhoea cases and rainfall amountamount

High number of diarrhoea cases corresponds to periods of high rainfall amount and vice versa

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Jan-99

Jun-99

Nov-99

Apr-00

Sep-00

Feb-01

Jul-01 Dec-01

May-02

Oct-02

Mar-03

Aug-03

Jan-04

Jun-04

Nov-04

Time(1999 - 2004)

Num

ber

of D

iarr

heal

Cas

es

0

50

100

150

200

250

300

350

400

Rai

nfal

l am

ount

(mm

)

Diarrhoea Cases Rainfall amount

MalariaMalaria

Cost of malaria treatment – 2003 Cost of malaria treatment – 2003 figuresfigures

Total cost = Direct Cost + Indirect CostTotal cost = Direct Cost + Indirect Cost Direct Cost = Costs of Drugs + OPD fees Direct Cost = Costs of Drugs + OPD fees

+ Laboratory fees etc.+ Laboratory fees etc. Indirect Cost = Opportunity Cost of Indirect Cost = Opportunity Cost of

Labour for affected person and caring Labour for affected person and caring parentparent

0006205294500,21680,210 CostDirect 0006205294500,21680,210 CostDirect

Total Cost for ChildrenTotal Cost for Children

Total Cost for Children = Direct Cost + Indirect Total Cost for Children = Direct Cost + Indirect CostCost

Direct Cost = 210, 680 Direct Cost = 210, 680 × ¢21500 = ¢4, 529, 620, × ¢21500 = ¢4, 529, 620, 000.00000.00

Indirect Cost = 210680 × ¢9600× 7 = ¢ 14, 157, 696, Indirect Cost = 210680 × ¢9600× 7 = ¢ 14, 157, 696, 000.00000.00

Total for Children Total for Children = ¢ 18, 687, 316, = ¢ 18, 687, 316, 000.00000.00

Total Cost of AdultsTotal Cost of Adults

Total Cost for Adults (Direct + Indirect)Total Cost for Adults (Direct + Indirect)Direct Costs = 353608 Direct Costs = 353608 × ¢23,000 = ¢ 8132984000.00× ¢23,000 = ¢ 8132984000.00

Indirect Cost = 353608 ×¢9,600×7 = ¢ 23762457600 Indirect Cost = 353608 ×¢9,600×7 = ¢ 23762457600

Total Cost for Adults Total Cost for Adults = ¢ 31, 895, 441, 600.00 = ¢ 31, 895, 441, 600.00

Total Cost BurdenTotal Cost Burden

Total Cost Burden for Adults and Children in the Total Cost Burden for Adults and Children in the year 2003year 2003

Total for Children + Total for AdultsTotal for Children + Total for Adults

= = ¢¢18, 687, 316, 000.00 + 18, 687, 316, 000.00 + ¢¢31, 895, 441, 600.0031, 895, 441, 600.00

= = ¢¢50, 582, 757, 600.00 (1US$50, 582, 757, 600.00 (1US$~~¢¢8,000 at 2003 8,000 at 2003 which is approximately US$6,000,000/year)which is approximately US$6,000,000/year)

NB. Only two regions of Ghana.NB. Only two regions of Ghana.

Summary of socioeconomic impactsSummary of socioeconomic impacts

Reduced income of affected individuals due to Reduced income of affected individuals due to loss of productivityloss of productivity

Increased expenditure of affected familiesIncreased expenditure of affected families Increased insecurity of employment (low skilled Increased insecurity of employment (low skilled

workers and casuals)workers and casuals) Diminished quality of lifeDiminished quality of life Social disruptionSocial disruption Reduction in Gross Domestic ProductReduction in Gross Domestic Product Increased cost of Health Delivery at the National Increased cost of Health Delivery at the National

LevelLevel

Population Vulnerability and Adaptive Population Vulnerability and Adaptive ResponseResponse

It should however be mentioned that human It should however be mentioned that human populations as with individuals, vary in their populations as with individuals, vary in their vulnerability to certain health outcomes. This vulnerability to certain health outcomes. This will thus affect not only the type but the will thus affect not only the type but the choice of adaptive strategies to offset those choice of adaptive strategies to offset those effects.effects.

HEALTH ADAPTION STRATEGIES HEALTH ADAPTION STRATEGIES

FROM THE GHANAIAN PESPECTIVE FROM THE GHANAIAN PESPECTIVE Two main strategies can be identifiedTwo main strategies can be identified1.1. PREVENTIVE STRATEGY( Primary, PREVENTIVE STRATEGY( Primary,

Secondary and Tertiary)Secondary and Tertiary)2.2. CURATIVE STRATEGIES (Diagnosis, CURATIVE STRATEGIES (Diagnosis,

Management and Monitoring)Management and Monitoring)All technologies for adaptation (Ghana’s All technologies for adaptation (Ghana’s

perspective) to combat the effect of perspective) to combat the effect of climate change/variability on health climate change/variability on health will be discussed along this line. will be discussed along this line.

ADAPTATION OPTIONSADAPTATION OPTIONS

NB. NB. 1-3….PREVENTIVE ADAPTATIONS1-3….PREVENTIVE ADAPTATIONS 4……CURATIVE ADATATIONS4……CURATIVE ADATATIONS

1.1. PRIMARY PREVENTION: Any intervention implemented before there PRIMARY PREVENTION: Any intervention implemented before there is evidence of disease or injury (e.g. avoiding hazardous exposure to is evidence of disease or injury (e.g. avoiding hazardous exposure to asbestos, pollen, using insecticide-impregnated mosquito nets etc.)asbestos, pollen, using insecticide-impregnated mosquito nets etc.)

2.2. SECONDARY PREVENTION: Any intervention implemented after SECONDARY PREVENTION: Any intervention implemented after disease has begun but before symptoms show (e.g. early detection or disease has begun but before symptoms show (e.g. early detection or screening for say cholera) and subsequent treatment to avert full screening for say cholera) and subsequent treatment to avert full progression to disease. Enhancing monitoring and surveillance, progression to disease. Enhancing monitoring and surveillance, improving disaster response and recovery and strengthening the public improving disaster response and recovery and strengthening the public health system.health system.

3.3. TERTIARY PREVENTION: Any intervention to minimize the adverse TERTIARY PREVENTION: Any intervention to minimize the adverse effects of an existing disease and injury (e.g. better treatment of heat effects of an existing disease and injury (e.g. better treatment of heat stroke, improved diagnosis of vector-borne disease.stroke, improved diagnosis of vector-borne disease.

4.4. MANAGEMENT – Any intervention taken to treat or manage existing MANAGEMENT – Any intervention taken to treat or manage existing diseases or injury (drug prescription and compliance)diseases or injury (drug prescription and compliance)

HEALTH ADAPTATION STRATEGIES EXAMPLES HEALTH ADAPTATION STRATEGIES EXAMPLES FROM THE GHANAIAN PESPECTIVEFROM THE GHANAIAN PESPECTIVE

DISEASEDISEASE ADAPTATION ADAPTATION TECHNOLOGYTECHNOLOGY

TYPE OF ADAPTATIONTYPE OF ADAPTATION LIMITATION/LIMITATION/

COMMENTCOMMENT

MALARIAMALARIA DEVELOPMENT OF DEVELOPMENT OF VACCINES, HERBAL VACCINES, HERBAL PREPARATIONSPREPARATIONS

Introduction of Predators Introduction of Predators to reduce vector to reduce vector populationpopulation

PREVENTIVEPREVENTIVE

CURATIVECURATIVE

LACK OF RESOURCESLACK OF RESOURCES

INADQUATE FACILITIESINADQUATE FACILITIES

SKILLED PERSONNELSKILLED PERSONNEL

ETHICAL ISSUESETHICAL ISSUES

MALARIAMALARIA INSECTICIDE-INSECTICIDE-MPREGNETED NETSMPREGNETED NETS

POCT, COMBINED POCT, COMBINED THERAPYTHERAPY

PREVENTIVEPREVENTIVE

CURATIVECURATIVE

COST, INEFFICIENT COST, INEFFICIENT HEALTH CARE HEALTH CARE DELIVERY SYSTEMDELIVERY SYSTEM

CSMCSM NEW ARCHITECTURAL NEW ARCHITECTURAL HOUSE DESIGNS, EARLY HOUSE DESIGNS, EARLY VACCINATION, MOBILE VACCINATION, MOBILE CLINICS, Health EducationCLINICS, Health Education

PREVENTIVEPREVENTIVE

CURATIVECURATIVE

COSTCOST

CHOLERACHOLERA BOLE-HOLE DRILLS, BOLE-HOLE DRILLS, ACTIVATED CHARCOAL ACTIVATED CHARCOAL DOMESTIC FILTERATION DOMESTIC FILTERATION SYSTEMS. POINT OF SYSTEMS. POINT OF CARE TESTING (POCT)CARE TESTING (POCT)

PREVENTIVEPREVENTIVE COSTCOST

ALL DISEASEALL DISEASE

ALL DISEASESALL DISEASES

COMPUTER INFO. SYS.COMPUTER INFO. SYS.

TelemedicineTelemedicine

PREVENTIVEPREVENTIVE

CURATIVECURATIVE

COST, LACK OF COST, LACK OF SKILLED PERSONNELSKILLED PERSONNEL

OTHER SPECIFIC ADAPTION OTHER SPECIFIC ADAPTION TECHNOLOGY OPTIONSTECHNOLOGY OPTIONS

Heat-related illness-Heat-related illness- Design buildings to be more heat resistant (insulation, air flow, air-conditioning)Design buildings to be more heat resistant (insulation, air flow, air-conditioning) Planting trees to reduce urban heat effectPlanting trees to reduce urban heat effect Creating public education campaigns to offset risk of heat waveCreating public education campaigns to offset risk of heat wave Establishing new weather watch/warning systems that focus on health related Establishing new weather watch/warning systems that focus on health related

adverse conditionsadverse conditions

Agricultural Stresses-Agricultural Stresses- Production of climate- resistant seeds, plants, high yielding varieties eg. Production of climate- resistant seeds, plants, high yielding varieties eg.

“Obaatanpa” maize- Genetically modified grains? (ethical issues) “Obaatanpa” maize- Genetically modified grains? (ethical issues) Promoting land reform and management systems that favour environmentally Promoting land reform and management systems that favour environmentally

sound land usagesound land usage Reducing the proportion of monocultural farming practices to increase yield and Reducing the proportion of monocultural farming practices to increase yield and

also for better resistance to pests.also for better resistance to pests.

OTHERS- OTHERS- ELISA(Diagnostics), enzymes for biodegrading waste, ELISA(Diagnostics), enzymes for biodegrading waste, Affrostestation, Bushes fires, bio-fuel to reduce air pollutionAffrostestation, Bushes fires, bio-fuel to reduce air pollution

APPLICATIONAPPLICATION TECHNIQUE/TECHNIQUE/

TECHNOLOGYTECHNOLOGY

INDICATORINDICATOR LIMITATION/LIMITATION/

RECOMMENTATIONRECOMMENTATION

Disease Disease SurveillanceSurveillance

Simple Mapping StudiesSimple Mapping Studies

GIS and Remote SensingGIS and Remote Sensing

Mobile Clinics, POCTMobile Clinics, POCT

Disease Incidence, Disease Incidence, PrevalencePrevalence

May not provide May not provide quantitative estimate quantitative estimate may lack compatibilitymay lack compatibility

Disease MonitoringDisease Monitoring GIS and Remote SensingGIS and Remote Sensing

Telemedicine (satellite Telemedicine (satellite remote sensing)remote sensing)

Disease Incidence, Disease Incidence, Prevalence Prevalence

May not provide May not provide quantitative estimate quantitative estimate may lack may lack compatibility/Costcompatibility/Cost

Demographic Data/ Demographic Data/ Climate PredictionClimate Prediction

Simple Mapping StudiesSimple Mapping Studies

GIS and Remote SensingGIS and Remote Sensing

Computer Information Computer Information and Reporting Systemsand Reporting Systems

Disease Incidence, Disease Incidence, PrevalencePrevalence

Lack of trained and Lack of trained and skilled personnelskilled personnel

Weather extremes Weather extremes and Sea-level riseand Sea-level rise

Engineering Engineering measures- sea wallsmeasures- sea walls

Flash Flood , Flash Flood , residential placementresidential placement

Maintenance of Maintenance of disasters, reduced disasters, reduced erosionerosion

Inability to provide Inability to provide sufficient resources sufficient resources for engineering for engineering optionsoptions

Vector-borne diseaseVector-borne disease

Water-borne diseaseWater-borne disease

Installation of window Installation of window screens,screens,

Vaccination, public Vaccination, public education, promotion of education, promotion of pyrethroid impregnated pyrethroid impregnated nets, water filterationnets, water filteration

Disease Incidence, Disease Incidence, Prevalence Prevalence

Inability to develop Inability to develop pesticide and or drug pesticide and or drug resistance productsresistance products

Disease Disease Control/PreventionControl/Prevention

Public Health Public Health Education, Releae of Education, Releae of sterilized male insects sterilized male insects to reduce to reduce reproductive capacity reproductive capacity of vector populationof vector population

Disease Incidence, Disease Incidence, Prevalence Prevalence

Insufficient resourcesInsufficient resources

THE DECISION MAKING FRAMEWORK FOR THE DECISION MAKING FRAMEWORK FOR ADOPTING A TECHNOLOGY-Key QuestionsADOPTING A TECHNOLOGY-Key Questions

(Monitoring and Evaluation)(Monitoring and Evaluation)

1.1. What are the main drivers behind the decision? Is it mainly about What are the main drivers behind the decision? Is it mainly about adapting to future climate? If not, could climate change be important? adapting to future climate? If not, could climate change be important? Is it most appropriate to meet local needs?Is it most appropriate to meet local needs?

2.2. What are the criteria for recognizing a successful outcome? What are What are the criteria for recognizing a successful outcome? What are the legislative requirements or constraints? What are the rules for the legislative requirements or constraints? What are the rules for making the decision? -risk averse or focused on maximizing benefit or making the decision? -risk averse or focused on maximizing benefit or minimizing costminimizing cost

3.3. What is the lifetime of your decision? What climate variables could be What is the lifetime of your decision? What climate variables could be most important? How could climate change affect your ability to meet most important? How could climate change affect your ability to meet your objectives?your objectives?

4.4. What range of technology options should be considered? High Tech, What range of technology options should be considered? High Tech, Medium Tech or Low Tech?Medium Tech or Low Tech?

5.5. How do these options rate against your criteria? Could particular How do these options rate against your criteria? Could particular options make it difficult for others to manage climate change?options make it difficult for others to manage climate change?

6.6. Is there a clear preferred option?Is there a clear preferred option?7.7. Did the decision deliver the expected benefit or not?Did the decision deliver the expected benefit or not?

5

11

2

3

4

6

7

8

Identify problem and objectives

Establish decision making criteria

Assess risk

Identify optionsAppraise options

YES Criteria met?Problems defined correctly?

NoYes

Monitor

Implement decision

ConclusionConclusion Effective technological adaptation and transfer will require Effective technological adaptation and transfer will require individuals skilled at recognizing, reporting and responding individuals skilled at recognizing, reporting and responding to health threats associated with climate change. to health threats associated with climate change.

Building capacity is therefore an essential step in preparing Building capacity is therefore an essential step in preparing adaptation strategies. Education, awareness creation and adaptation strategies. Education, awareness creation and the creation of legal frameworks, institution and an the creation of legal frameworks, institution and an environment that enables people to take well-informed, environment that enables people to take well-informed, long-term sustainable decision are all needed.long-term sustainable decision are all needed.

Building adaptive capacity in public health will also require Building adaptive capacity in public health will also require strong and determined vision of appropriate healthcare strong and determined vision of appropriate healthcare delivery systems.delivery systems.

It must be stressed adapting to climate change will require It must be stressed adapting to climate change will require more than financial and technology, human resource and more than financial and technology, human resource and knowledge are essential as well as institutions that are knowledge are essential as well as institutions that are committed to face the health challenges associated with committed to face the health challenges associated with climate change.climate change.

ENDEND

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