"Climate change: a driver for (faster) change also for

health services"

Dr. Jean-Jacques BERNATAS (jbernatas@adb.org) Asian Development Bank Bogor, Indonesia - 28 October 2015. "Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms."

Climate Change and Health: Why it is becoming a concern?

• Human beings are selfish …

CC comes on top of the development

agenda because it represents theoretically a direct threat to human lives.

• Human beings are naïve …

Relation between CC and Health

might be confusing.

CC and public health • Current impact of CC is not obvious at global level, except (?) spectacular

consequences of extreme weather events (typhoon, tsunami);

• “Climate-related hazards exacerbate other stressors, often with negative outcomes for livelihoods, especially for people living in poverty” (IPCC, 5th Assessment report, 2014)

• Clues at local level: Lyme disease, DF and CHIKV extension, heat waves (France and Europe, 2003; China …..), but could be observation biases:

• Extreme complexity and uncertainty: interactions with other determinants of health;

• There might be positive impact of CC on health (↓ morbidity/lethality by cold; geographical shifts in food production, and reduced capacity of vectors to transmit some diseases …), but negative impacts of CC should overweigh the positive.

• CC is likely to exacerbate the impact of social determinants of health and to widen the gap of health inequities, at least until mid-21st century (IPCC, 5th Assessment Report, 2014).

Other Determinants of Health and CC

Schematic diagram of pathways by which climate change affects health, and concurrent direct-acting and modifying (conditioning) influences of environmental, social and health-system factors. In: Human health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Confalonieri, U., et Al.

Impact of CC on Health (1)

Climate change and health: on the latest IPCC report - Alistair Woodward et Al.

Main impacts of CC: • Undernutrition • VB Diseases • Occupational

Health • Mental

health/violence • Extreme weather

events • Air quality

(household air pollution=3rd RF of GBD in 2010)

• Food/water borne infections

• Heat waves

Impact of CC on Health (2)

Health Services (HS): basic ingredients

• “Making” health (preventive/curative) requires: – Health Care Workers: ratio to target

population, adequate training, migration, repartition (rural vs. urban)

– Facilities: adequate repartition according to level of care;

– Equipment: adequacy to the need, maintenance

– Procedures: efficiency, evidence-based, quality of care, people-centred and integrated health services

– Availability of treatment/Drugs: adequate prescription/delivery; continuing supply; quality;

Health Services delivery

• Adequate and sustainable financing: out-of pocket share vs. Universal Health Coverage; private vs. public;

• Public Health policy: based on a vision of Health as a universal public good Vs. good following market law/ supply&demand; planning, implementation, monitoring, enforcement, supervision, control;

• Accessibility (geographical, financial, social, cultural) to health services is crucial.

• Sustainable development in health services delivery is key.

Impact of CC on HCS • Disruption of HCS service delivery:

– Facilities affected (destruction, supply of energy); – Procurement: disruption of supply chain (imported items); deficit of

maintenance; – Lack of HR4H due to migration of HCW; – Budget becoming insufficient for necessary equipment; – Surge in medical care: immediate and collateral impacts on HCS.

• Inadequacy of HCS in regards with changing needs: – Training – Diagnosis tools – Geographical distribution of providers

• Inaccessibility of HCS: – Geographical: mobility of population and HCW on different scales of

time and place. Costal populations/long term; displaced population due to extreme weather events/short term (and repeatedly).

– Financial /Social/cultural CC increase vulnerability of the poor by lowering incomes, and limiting access to HCF (f.e.: displaced population to different social or religious environment)

Contribution of Health Services to CC management (1): leading by

example • Mitigating its own carbon footprint, GHG emission,

production of water and air pollutants: – Access to clean, high-efficiency and renewable source of energy; – Sustainable management: sustainable and eco-responsible

supply chain management; – Eco-construction; healthier and climate-resilient buildings; – Sustainable management of effluents.

• Increasing resilience of Health system to CC-induced constrains: – Unforeseeable (?) natural disaster: preparedness. – Progressive change in disease burden and patterns: knowledge

management, continuing education, adequacy of means

• Advocating for UHC, poverty reduction, multisectoral approach.

Contribution of Health Services to CC management (2): Health

promotion • Promoting health while mitigating CC= co-benefits to Health

and Climate – “health gains from strategies that are directed primarily at

climate change and mitigation of climate change from well-chosen policies for health advancement”.

– reducing local emissions of health-damaging and climate-altering air pollutants in shifting to cleaner energy sources;

– Transport changes favoring public transport, walking, and cycling;

– Short-term strategy, at community level; – Multiple direct impacts on health: respiratory diseases, traffic

accidents, cardiovascular diseases.

• Requires cross-sectoral approach (urbanism, transport, agriculture, education, …) at local/national/global level.

Contribution of Health Services to CC management (3): Health

education

• Supporting communities to adapt to climate change impacts = resilience strengthening: – Health education to emerging risks (ComDis, heat

waves, exposure to pollution);

– (Re-)Education to basic hygiene: hands hygiene, access and use of safe water, waste management at individual and community level;

– Diseases prevention: improve vaccination coverage, prevention of NCD in promoting healthy nutrition and physical activity;

Contribution of Health Services to CC management (4): data management

• “Recording/reporting/analysis/utilization” of data and “monitoring/evaluation” in the era of internet and in a connected world: – Geolocalization, data collection and transfer

capabilities at community level and in health care facilities;

– Mobile technology (mobile health/e-Health) is opening a new era in Health management;

– Generation of big data: by whom and what for?

– Useful real-time disease modelling at the right scale of observation, where the right action is to be taken urgently. Ex.: early warning system for health surveillance extended to climate data collection.

Example of available climate warning: ENSO

El Niño Southern Oscillation, drought/precipitations -> health consequences (VBD, water supply and WBD).

Clinician

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Laboratory

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Epidemiologic

Control Quarantine

Response Information Coordination

& Control Risk

Communication

Information Coordination

& Control Risk Communication

Surveillance

Outbreak

Investigation

Courtesy of Pr. Rodney Hoff

Wheel of Health Resilience

Prevent Mitigate Respond Recover Transform

Adapted from Pr. Rodney Hoff

The global strategy: back to Alma-Ata

• Primary Health Care – Alma Ata, September 1978: “Primary health care: … includes at least:

– Health education on methods of preventing and controlling diseases;

– promotion of food supply and proper nutrition; – adequate supply of safe water and basic sanitation; – maternal and child health care, including family planning; – immunization against the major infectious diseases; – prevention and control of locally endemic diseases; – appropriate treatment of common diseases and injuries;

and provision of essential drugs.”

• All provision of services aiming at strengthening resilience at community level.

Health services response to CC in practice

• Health Care Workers: – Aware, committed, resilient. – Continuously informed and trained

• Facilities: – resilient to CC-related catastrophic events; – environmentally sustainable construction (material, power supply, GHG

emission control, …)

• Equipment: accessibility and adequacy to the need. Short chain supply. Low environmental impact technologies. E-Health.

• Procedures: Revision and improvement to respond to the risks posed by climate change. Assessment of negative secondary impact on health;

• Availability of treatment/Drugs: adequate prescription/delivery; adaptation to CC. Ex. Drug supply management in extreme heat.

• Adequate and sustainable financing: out-of pocket share vs. Universal Health Coverage; private vs. public; PPP.

• From Public Health to Global Health policy:

ADB, Climate Change, and Health

• ADB: a major player in fight against CC in Asia-Pacific region.

• Assessment of the ADB on CC in Asia-Pacific region.

• ADB, Nordic Development Fund Help GMS Counter Climate Change Health Threat

• ADB Operational Plan for Health 2015-2020.

Conclusions

• CC is not everything for health, but is everywhere in the future.

• The overall risks of climate change impacts can be reduced by limiting the rate and magnitude of climate change: – CC pushes Health Services to change/adapt at a faster pace – Health Services: take the lead and “walk the talk” – Health Services Health sector Other sectors

• Impact of the remaining unavoidable risk: – resilience strengthening = vulnerability and poverty reduction narrow the health inequity gap.

– primary care service delivery improvement, quality and accessibility.

• Particularly relevant in Asia-Pacific region; • Hippocrates mentioned the relevancy of an environmental

approach of health in “On Airs, Waters and Places”, basis of CC impact on health as a chapter of Global health.

“On Airs, Waters and Places”, Part 1

“Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces for they are not at all alike, but differ much from themselves in regard to their changes. Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality. We must also consider the qualities of the waters, (…) whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking …

and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live …”

Hippocrates, 460 B.C.-370 B.C. (?)

References • IPCC, 2014: Summary for policymakers. In: Climate Change 2014: Impacts, Adaptation, and

Vulnerability.Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Field, C.B., V.R. Barros, D.J. Dokken, K.J. Mach, M.D. Mastrandrea, T.E. Bilir, M. Chatterjee, K.L. Ebi, Y.O. Estrada, R.C. Genova, B. Girma, E.S. Kissel, A.N. Levy, S. MacCracken, P.R. Mastrandrea, and L.L. White (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, pp. 1-32.

• Climate change and health: on the latest IPCC report - Alistair Woodward, Kirk R Smith, Diarmid Campbell-Lendrum, Dave D Chadee, Yasushi Honda, Qiyong Liu, Jane Olwoch, Boris Revich, Rainer Sauerborn, Zoë Chafe, Ulisses Confalonieri, Andy Haines - The Lancet Volume 383, Issue 9924, pages 1185-1189 (April 2014) DOI: 10.1016/S0140-6736(14)60576-6

• A comparative risk assessment of burden of disease and injury attributable to 67 risk factors

and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 Lim, Stephen S et al. The Lancet , Volume 380 , Issue 9859 , 2224 - 2260

• Human health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Confalonieri, U., B. Menne, R. Akhtar, K.L. Ebi, M. Hauengue, R.S. Kovats, B. Revich and A. Woodward, 2007: M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, Eds., Cambridge University Press, Cambridge, UK, 391-431.

• Conference on Health and Climate Change 27 – 29 August 2014, Geneva, Switzerland. Conference Report

• Spatial analysis of the effect of the 2010 heat wave on stroke mortality in Nanjing, China. Chen, Kai et Al. Nature. Scientific Reports. 2015/06/02/online. 5;10816. Macmillan Publishers Limited. http://dx.doi.org/10.1038/srep10816 (accessed at http://www.nature.com/articles/srep10816#supplementary-information on 10 October 2015)