Protecting our Health from
Climate Change:
a Training Course for Public Health
Professionals
Chapter 3:Population’s Health
and Climate Change in SouthEast Asia
Outline
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South East Asia is disaster prone
The most vulnerable
Climate-sensitive health outcomes
Exacerbating current burden of disease
South East Asia Region
80°0'0"E
90°0'0"E
100°0'0"E
110°0'0"E
120°0'0"E
130°0'0"E
140°0'0"E
40°0'0"N
70°0'0"E
INDIA
BHUTAN
BANGLADESH
20°0'0"N
NEPAL
30°0'0"N
DPR KOREA
MYANMAR
10°0'0"N
THAILAND
0°0'0"
SRI LANKA
10°0'0"S
INDONESIA
MALDIVES
TIMOR-LESTE
70°0'0"E
80°0'0"E
90°0'0"E
100°0'0"E
110°0'0"E
120°0'0"E
130°0'0"E
140°0'0"E
The Region is Vulnerable to Climate
Sensitive Health Stressors
 44% of all disasters, globally
 1996-2005: 57% of people killed
globally in natural disasters were
from SEAR countries
 Indonesia, 2007: 3 flood events;
4 landslides; 2 tornadoes
 Maldives, May 2007: high tide floods
 Bangladesh November 2007: Super
cyclone SIDR: 4,000 dead, millions
affected
 Myanmar, May 2008: Cyclone Nargis,
135,000 perish
Photo: http://cache.daylife.com/imageserve/02fAd1d1tWeAW/340x.jpg
Population Estimates for 2025 in
Southeast Asia
Country
Bangladesh
2025
(thousands)
% of world
population
206,024
2,6
819
0,01
25,228
0,3
1,447,499
18,5
271,227
3,4
Maldives
411
0,005
Myanmar
55,374
0,7
Nepal
38,855
0,5
Sri Lanka
20,328
0,3
Thailand
68,803
0,9
2,011
0,03
2,136,579
27,1
Bhutan
Democratic People's Republic of Korea
India
Indonesia
Timor-Leste
SEA total
UN Department of Economic and Social Affairs, 2009
“Adverse health impacts will be greatest in low-income countries. Those at
greater risk include, in all countries, the urban poor, the elderly and children,
traditional societies, subsistence farmers, and coastal populations (high
confidence).” (IPCC AR4, 2007)
Global Warming Impacts on
Climate and Risk Factors
 More extreme weather events: storms, cyclones
 Heat waves: more frequent, more intense, and
longer
 Air pollution: increase in levels of ground ozone,
more allergens
 Rapid glacier melting: landslides, flash floods, and
reduced water availability
 Disturbed rainfall patterns: more droughts, more
extreme precipitation events, floods, and disrupted
water supply
 Warmer temperatures: warmer minima
 Sea-level rise: inundation, saltwater intrusion, loss
of land
Climate Change Impacts on Health:
Increase in Climate Sensitive
Health Outcomes
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Injuries, disability, drowning
Heat stress
Water and food-borne diseases
Malnutrition
Vector-borne diseases
Psychological stress
Photo: http://southasia.oneworld.net/ImageCatalog/climate-picture.jpg
More Injuries, Disabilities, and Drowning
from Extreme Weather Events
Photo: ©Abir Abdullah/Still Pictures
Photo: ©Abir Abdullah/Still Pictures
9
Adding to the Existing Burden
Myanmar: Nargis 2008
India: “Super-cyclone” 1999 shattered lives
and livelihoods of 12 million people in Orissa
http://media.economist.com/images/20080906/3608AS2.jpg
Bangladesh: Cyclone SIDR, 2007
Photo: xanthis.wordpress.com
Drowning: A Leading Cause of Child
Death in Many Asian Countries
 More than 175,000
children and teenagers
die from drowning each
year
 Children under the age of
5 years are most at risk
 Most child drowning
events happen in and
around the home
World Health Organization, 2008c
More Heat Waves and Heat
Strokes
Photo: © T. Balabaadkan UNEP / Still Pictures
Refugee Study Centre (RSC), http://www.rsc.ox.ac.uk
 2003 Andhra
Pradesh, India
heat wave,
with
temperatures
of up to 54oC,
took a toll of at
least 3,000
lives
 The number of
heat strokes
was not
recorded
More Respiratory Infections
 Air pollution: Meeting
increasing energy
demands by greater
use of fossil fuels will
increase in ground
ozone levels and
allergens
Photo: © Deb Kushal -UNEP / Still Pictures
Rapid Glacier Melting = Less
Freshwater
http://msnbcmedia3.msn.com
Himalayan Major River Basins
The Water Tower of Asia
River
Area sq
km
Mean discharge
(m3/s)
% of Glacier melt
in river flow
Population
x1,000
Population
density
Water per
person
m3/year
Indus
1,081,718
5,533
44.8
178,483
165
830
Ganges
1,016,124
18,691
9.1
407,466
401
~2500
Brahma
651,335
19,824
12.3
118,543
182
~2500
Irrawaddy
413,710
13,565
unknown
33,097
80
18,614
Salween
271,914
1,494
8.8
5,982
22
23,796
Mekong
805,604
11,048
6.6
57,198
71
8,934
Yangtze
1,722,193
34,000
18.5
368,549
214
2,265
Yellow
944,970
1,365
1.3
147,415
156
361
Tarim
1,152,448
40.2
8,067
7
754
Total
ICIMOD, 2008
1,324,800
Glacier Mass Balance
 Himalayan glaciers
are shrinking
more rapidly than
anywhere else on
the globe
Dyurgerov and Meier, 2005
Glacial Retreat Example
Source: Laboratory of Cryosphere Variation, Nagoya University http://snowman.hyarc.nagoya-u.ac.jp
The Temperature Increases
Faster on High Altitude
Liu and Chen, 2000
Rapid Melting of Imja Glacier,
Nepal
1956
(Photo: Fritz Muller;
courtesy of Jack Ives)
www.unforum.org
2006
(Photo: Giovanni
Kappenberger courtesy
of Alton C Byers)
Glacial Lake Outburst Flood
 Excess melt water
leads to Glacial Lake
Outburst Flood (GLOF)
or “mountain tsunami”
 In 2007, two hundred
glacial lakes in the
Himalayas were at risk
of bursting
Photo: Nare glacier GLOF
hits Pangboche village,
Nepal, 1977
21
More Water Borne Diseases
 In 2005,
diarrhoeal
diseases
accounted for
20.1% of deaths in
children less than
five years
Photo credit: © Shehzad Noorani/Still Pictures
Weaker Monsoons
Science Daily, 2009
Scarcity of Food = Malnutrition
Photo credit: © Shehzad Noorani / Still Pictures
Malnutrition: First Cause of
Children Mortality
Proportional mortality among children under five years
of age  World 2002
Underweight and Stunting among
Children in Bangladesh, 1990 to 2005
Prevalence of underweight and stunting (height-for-age <-2 Z-scores)
among children under five years of age in rural Bangladesh, 1990 to 2005
Spread of Vector Borne Diseases
Aedes aegypti
 Warmer temperatures
and disturbed rain
patterns could alter the
distribution of important
disease vectors
 Combined with altered
rainfall patterns, hotter
conditions may increase
the spread of disease,
such as malaria, dengue,
and chikungunya, to new
areas
Dengue
 In 2005, the estimated
number of population
at risk from dengue in
the South East Asia
Region was 1.3 billion
 This is 52% of the
global estimated
2.5 billion at risk.
Photo credit: © Shehzad Noorani /Majority World / Still Picture
Sea Level Rise Risks in
South East Asia
 IPCC, 2007:
“Coastal areas,
especially the
heavily-populated
mega deltas regions
in South, East and
South East Asia, will
be at greatest risk
due to increased
flooding from the
sea and, in some
mega deltas,
flooding from the
rivers”
Robert A. Rohde / Global Warming Art
Sea Level Rise Enhances Cholera
Outbreaks
Space.com, 2000
Sea Level Rise: Bangladesh
Psychosocial Stress Will Affect the
Health of Communities and Individuals
Photo credit: © Gil Moti / Still Pictures
Selected Health Impacts of
Climate Change
Mortality attributed to climate change impacts
on malnutrition, diarrhoea, malaria, and floods
Patz et al., 2008
Mountain People at Risk
Impact on Biodiversity
Altitudinal Distribution
(Land-use and Vegetation) and ecological zones
Climate zones are shifting
Species extinction
Land use patterns and
livelihood may shift
Alpine-meadow
Tree-line
Agro-pastoral
Agriculture
and
Settlement
Riverine
ICIMOD, 2007
Land Use Change in Northern
Himalaya
Dingri County, Tibet. 4300 m
Dried-up wetland
Nomad
Shift
ICIMOD, 2008
Sedentary
Feminisation of Rural Mountain
Areas
ICIMOD, 2008
Urgent Action is Needed
Adaptation for health sector: strengthen
prevention, surveillance and early warning
systems pertaining to climate sensitive diseases
Natural
processes and
forcings
Human pressure
on environment
Human society:
• Culture, institutions
• Economic activity
• Demography
Global Environmental
Changes, affecting:
• Climate
• Water
• Food yields
• Other materials
• Physical envtl. safety
• Microbial patterns
• Cultural assets
Adaptation:
Reduce impacts
Impacts on human
society:
• Livelihoods
• Economic productivity
• Social stability
• Health
Mitigation: Reduce
pressure on environment
Mitigation for health sector: to promote and support initiatives that
protect health by reducing greenhouse gas emissions
World Health Assembly adopts
Global Action Plan, May 2009
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Aim: to scale up WHO's technical assistance to countries
to assess and address the implications of climate change
for health and health systems. It has four objectives:
advocacy and awareness raising;
engagement in partnerships with other UN organizations
and sectors other than the health sector at national,
regional and international levels;
promoting and supporting the generation of scientific
evidence; and
strengthening health systems to cope with the health
threat posed by climate change, including emergencies
related to extreme weather events and sea-level rise.
Conclusions
 The SEA region has a large population that is
currently vulnerable to a number of climate
sensitive health stressors
 These stressors are already having a significant
adverse health impacts in the Region
 Climate change is likely to increase the risks linked
to these stressors, and introduce new sources of
risk going forward
 Without adaptation and mitigation climate change
could result in a dramatically increased health
burden in the Region