Environmental Health Implications and Adaptation to Climate Change in Africa Dele Ogunseitan Program in Public Health University of California, Irvine Chicago 2009 Outline Framing Climate Change Impacts and Health Stalking the Environmental Burden of Disease Translating Vulnerability Assessment Data into Resources for No-cost Adaptation “Framing” A frame represents the schema of interpretation that we depend on to understand and respond to events – both local and global scales. Framing is used to contain elements of rhetoric that encourage certain interpretations while discouraging others. Frame Analysis: An Essay on the Organization of Experience. London, Harper & Row. (1974) By Ervin Goffman, 1922 – 1982. Framing vulnerability and climate assessments: In many countries, attempts to reconcile national development priorities with international plans to mitigate climate change represents an intractable policy controversy. The resolution requires conviction of vulnerability to new conditions that will exacerbate preexisting environmental stresses on society. Ogunseitan, O.A. 2003. Framing environmental change in Africa: Cross-scale institutional constraints on progressing from rhetoric to action against vulnerability. Global Environmental Change 13:101-111. Emergence of Regional Frames of Vulnerability to Climate Change The Perspective of Developing Countries: The New Delhi Conference in 1989 (The equity argument). African Perspectives: Nairobi Conference in 2-4 May 1990; Sponsored by the Woods Hole Research Center at the UNEP headquarters. Arrogation of International Support: Framing, funding, and the question of intellectual hegemony. Prioritizing GHG Inventories, Mitigation, and Vulnerability (Sensitivity + Capacity for Adaptation). The benefits of national GHG inventories and mitigation are shared globally. Whereas the burden of adaptation to the impacts are expected to be borne nationally. Policy Recommendations from the 1990 Gathering of “African Perspectives” Focus on deforestation, carbon sinks, and food security Futuristic scenarios Enhancing research and training Strengthening the technological base Promoting public awareness and participation Reforming the institutional environment Vigilance of industrialized country actions Promotion of private sector initiatives Adjusting UN agency framework UNEP, 2002 The Emergence of Public Health as a Dominant Frame of Climate Change Impacts Argumentum in terrorem (Fear Appeal) Health is a common concern for many developing, and the ultimate impact of climate on crop production and water resources is population health. Development of “Early Warning Systems” for local environmental changes that currently accounts for most impact on human health and social welfare. *Pre-epidemiologic transition. Therefore, burden of disease is attributable to environmental factors that are sensitive to climate change. *WMO-day 1999: Weather, Climate, and Health The U.S. Country Studies Program provides financial and technical assistance to developing and transition countries for climate change studies. The program was announced by the President prior to the United Nations Conference on Environment and Development (UNCED) in Brazil in 1992. The first round of two-year studies began in October 1993, and a second round followed in October 1994. Fifty-six countries on five continents currently participate in the program. Regional and sectoral oversight for this program is provided by the U.S. Country Studies Management Team (CSMT). Each participating country has both a U.S. Project Officer and its own Country Study Coordinator. Objectives of the Country Studies Program Country Study National Action Plans The objectives of the program are to assist countries as they: Establish a process for developing and implementing national policies and measures, including formulation of National Communications Develop information to further national and international discussions Support principles and objectives of the U.N. Framework Convention on Climate Change The objectives of the SNAP phase are: To assist countries in preparing climate change action plans that may form the basis for their national communications To promote diffusion of mitigation and adaptation technologies by assisting countries with assessments of needs and opportunities for technology exchange and diffusion To enhance support for the objectives and principles of the Framework Convention on Climate Change Framing Malaria and Climate MIASMA – Modeling framework for the health Impact ASsessment of Man-induced Atmospheric changes Danny Dorling of the University of Sheffield: Worldmapper Project – PLOS-Medicine 2007 ~ 500 million cases per year; 2 – 3 million deaths, most under 5 years old children in Africa http://www.rollbackmalaria.org/ Mapping Malaria Risk in Africa (MARA/ARMA) Highland Malaria 1995 2005 “From Shakespeare to Defoe: Malaria in England in the Little Ice Age.” - Paul Reiter Centers for Disease Control and Prevention, USA. ipr1@cdc.gov “Present global temperatures are in a warming phase that began 200 to 300 years ago. Some climate models suggest that human activities may have exacerbated this phase by raising the atmospheric concentration of carbon dioxide and other greenhouse gases. Discussions of the potential effects of the weather include predictions that malaria will emerge from the tropics and become established in Europe and North America. The complex ecology and transmission dynamics of the disease, as well as accounts of its early history, refute such predictions.” Scientific Controversy: Climate and vector-borne diseases (Malaria) Vol. 6, No. 4, Jul–Aug 2000 Pro- Con- To the Editor: I read with great interest the article "From Shakespeare to Defoe: Malaria in England in the Little Ice Age“ . Unfortunately, the article is not as balanced as a presentation last year by Paul Reiter, which clearly illustrated that, although climate is important in the transmission of malaria, the influence of other factors (e.g., access to medical care and improved housing) is likely to be of more importance in Europe…. While Reiter's paper offers an interesting perspective on the history of malaria in Europe, it provides no illuminating information on the influence of climate change on human health. - Pim Martens (Maastricht University, Maastricht, The Netherlands) To the Editor: The two reports from the International Panel on Climate Change (IPCC) cited in the letter by Pim Martens are widely regarded as "the standard scientific reference for all concerned with climate change and its consequences," yet the contents of these reports are often misleading…….. Repeated claims that global warming may have already led to increases in these diseases in the tropics are equally indefensible….. - Paul Reiter (Centers for Disease Control and Prevention, USA) Malaria Continues to Dominate Health Impacts of Climate Vulnerability Assessments Source: Vattenfal (2007); IPCC WG II (2007) Malaria Eradication? Genetically-Engineered Mosquitoes Pesticides/DDT WHO – Studies on the Environmental Burden of Disease In 1990, the Commission on Health Research for Development estimated that only about 5% of the world's resources for health research (which totaled ~US$ 30 billion) were being applied to the health problems of developing countries, where 93% of the world's burden of ‘preventable mortality’ occurred. The term '10/90 gap' was coined to capture this major imbalance between the magnitude of the problem and the resources devoted to addressing it. 2008 Update: The Bamako Call to Action on Research for Health Global expenditure on health research has more than quadrupled to over US$ 125 billion; There are many more actors engaged in funding or conducting health research relevant to the needs of developing countries; But the epidemiology of diseases has shifted substantially, so that many developing countries are now experiencing high burdens of non-communicable diseases such as cancer, diabetes, heart disease and stroke, as well as continuing high burdens of infectious diseases and injuries: The End of Epidemiologic Transition. Observations and Recommendations: [6] “There is often misalignment between funders, government, and other organizations in relation to research for health.” [16] “To better align and harmonize their funding and programs to country research and innovation for health plans and strategies, in line with the Paris Declaration of Aid Effectiveness.” http://www.oecd.org/document/18/0,2340,en_2649_3236398_35401554_1_1_1_1,00.html How Useful are Composite Measures of Disease Burden for Agenda Setting at the Local Level? A composite measure of the combined impact of death and disability in a population is used to estimate disease burden. The Disease-Adjusted Life Years (DALY) model: DALYi[0,0] = YLLi + YLDi Where DALYi[0,0] = Undiscounted, unweighted for disease i YLLi = Years of Life Lost due to disease i YLDi = Years of Life lived with Disability due to disease i Estimating risks attributable to environmental factors Attributable Risk is assessed according to the following equation, using published data on relative risks for each cause of death and disability related to the exposure, levels of exposure (prevalence), and burden of disease due to each cause of death and disability in the population: AB = ∑ AFj Bj = ∑ {Pj (RRj – 1) ÷ Pj (RRj – 1) + 1} Where AB = Attributable Burden for a risk factor AFj = Fraction of Burden from cause j Bj = population level burden of cause j P = Prevalence of exposure RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed group. n = Maximum exposure level Relative Contribution of Modifiable Environmental Risk Factors to the Global Burden of Disease UNSAFE WATER, SANITATION AND HYGIENE 50% 45% 40% 35% 30% 25% 20% CLIMATE CHANGE 15% INDOOR SMOKE FROM SOLID FUELS 10% 5% 0% URBAN AIR POLLUTION LEAD EXPOSURE Studies on the Environmental Burden of Disease Deaths DALYs Public Health and Environment Department (WHO). 2007. Country Profiles of Environmental Burden of Disease http://www.who.int/quantifying_ehimpacts/countryprofilesafro.pdf Environmental Burden of Disease Summaries United States Botswana Angola Infant mortality = 260/1000 Nigeria Africa’s Share of the Global Burden of Diseases 1990 D A L Y s aDisability 2000 D A L Y s 2010 D A L Y s 2020 D A L Y s % of T o ta l A fric a n B u rd e n A fr ic a ’s S h are of G lo b a l B u rd en W ith in C a te g o r y (% ) % of T o ta l A fric a n B u rd e n A fr ic a ’s S h are of G lo b a l B u rd en W ith in C a te g o r y (% ) % of T o ta l A fric a n B u rd e n A fr ic a ’s S h are of G lo b a l B u rd en W ith in C a te g o r y (% ) % of T o ta l A fric a n B u rd e n A fr ic a ’s S h are of G lo b a l B u rd en W ith in C a te g o r y (% ) 9 85 32 3 52 18 13 19 75 8 9 < 0 .1 1 3 3 1 6 91 41 5 58 24 13 19 51 6 7 < 0 .1 1 2 4 1 6 93 46 6 64 28 14 19 42 4 5 < 0 .1 0 .5 2 5 1 4 94 49 6 73 30 15 20 33 Disease Malaria Diarrhea Dengue Tropical C. Malnutrition Respiratory Eyes HIV a 11 < 0 .1 2 3 3 1 3 Adjusted Life Years Lost (Murray & Lopez, 1996). Data were extracted from Murray & Lopez 1996 (baseline scenarios) vector-borne tropical-cluster diseases includes Trypanosomiasis, Schistosomiasis, Leishmaniasis, Lymphatic Filariasis, and Onchocerciasis. cNutritional deficiencies include: Protein energy malnutrition, Iodine deficiency, Vitamin A deficiency, and Iron deficiency anemia. dChronic Obstructive Pulmonary Disease (COPD) and Asthma eCataracts and Glaucoma fHIV is included primarily for comparison, but the impact of climate change-induced population destabilization on the HIV epidemic should be taken seriously. In addition, the impact of ultraviolet light exposure on the immune system is a concern for the prognosis of AIDS. bInsect Energy Resources and Respiratory Health Hugo Ahlenius, UNEP/GRID-Arendal Climate, Water Stress and Diseases The 10/90 Gap on the Ground Water quality Disease vectors Solid fuel Broadening the Frame Forest fires / meningitis belt Annual Fires: 2002 Cases of Cerebrospinal Meningitis 120000 100000 80000 60000 40000 20000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 YEAR Neisseria meningitidis (Nm) serogroup A *1.2 Million Cases/year; *135,000 Fatalities *8-12 year cycles in hyper-endemic regions *Shorter and more irregular intervals since 1980s 1999 2000 1963 1973 25,000 km2 95% reduction Population Migration and HIV 1,250 km2 1997 1987 Goal 5 Conference @ Harvey Mudd 30 Climate Change and Lead Poisoning Blackwell Institute. 2006. The Worlds Worst Polluted Sites – The Top Ten. http://www.blacksmithinstitute.org/ten.php Kabwe, Zambia Lead, cadmium Source of Pollution: Lead mining and processing Conclusions/Acknowledgments Public health impacts of climate change is one of the most compelling strategies for frame alignment. Exacerbation of existing conditions rather than new/emerging conditions is key to arrogating resources for mitigation. Co-benefits of climate change mitigation need to be better quantified to support expenditure of meager resources at the local level for global issues. Thanks to: Global Forum for Health Research Centers for Disease Control and Prevention National Science Foundation Dr. Timothy Smith Mr. Aaron Hipp Several Undergraduate Students