AdaptCost
Briefing Paper 4: Health Adaptation Costs – Africa Review
Key Messages
1.
Estimates of the economic costs of adaptation require investigation of several lines of evidence. These
range from detailed case studies of projects and plans through to the global scale of integrated
assessments. Each approach brings insight into a complex area, where we have relatively little
experience. This note considers the costs of adaptation for ecosystems.
2.
Health has been identified as one of the key sectors for adaptation in Africa. A range of potential
impacts could occur from climate change, including potentials shift in areas vulnerable to malaria,
diarrhoea, schistosomiasis, the potential for heat related mortality and morbidity, and the increased
incidence of deaths/injuries/disease linked to the coastal and inland flooding. There are also indirect
effects associated with changes in the risk of under-nourishment and malnutrition, and wider effects
between economic and development levels and health. Finally, there are also risks to public health
systems and infrastructure.
3.
There are existing continental studies of the potential impacts of climate change and health, as well as
several national studies. These show increased health risks with climate change, particularly for subSaharan Africa, though the level of impacts are strongly influenced by future development and economic
growth – with assumptions of higher development (and lower baseline incidence), then impacts and
therefore adaptation costs are lower.
4.
At the continental scale, a number of studies have estimated short-term adaptation costs, using
estimates of future health impacts and combining these with prevention costs.
5.
The costs of adaptation associated with malaria and diarrhoeal disease (examples of vector and food
borne disease respectively) have been estimated for Africa at between $2.2 to 3.3 billion per year by
2030 (UNFCCC, 2007), $2 to $9 billion per year by 2030 (Markandya et al, 2009) and most recently,
around $1 billion per year in the period up to 2050 (World Bank, 2009). The range is determined
primarily by assumptions of development baselines and incidence rates. There are some estimates of
the costs of adaptation for malnutrition, but these are much lower, and also overlap with the agriculture
sector, considered in a separate note.
6.
Other studies (Parry et al, 2009) highlight that this focus on only two or three health endpoints implies
that total health adaptation costs will be much higher, and reports that the current estimate above might
therefore reflect only 30 – 50% of total health adaptation costs.
7.
Nonetheless, a general finding is that health adaptation is extremely cost-effective, and that adaptation
can reduce potential impacts very significantly, at relatively low cost. In many cases, measures that are
effective for preventing future climate risks also have more general benefits in relation to the current
adaptation deficit and accelerating development.
8.
There are also a number of national studies that have assessed the costs of adaptation, such as recent
work in Kenya on malaria, a wide coverage of health protection for Ghana, and health protection against
extreme events (droughts) in Tanzania.
9.
The Ghana study estimates the incremental cost of adaptation in the health sector to be $ 350 million by
2020 and a similar amount from 2020 through to 2050 (total, not annual), whilst the Kenya study assess
the annual costs of adaptation at around $23 million/year by the 2050s.
10. These more dis-aggregated studies tend to reinforce the finding that health adaptation costs will be
relatively low compared to some other sectors, and that action is cost-effective. Nonetheless, there is
still a need for further analysis to cover the full range of potential health outcomes from climate change,
to develop the analysis of socio-economic baselines and development, and to further the development
of effective practical adaptation policy and options for health in Africa, including cross sectoral links.
1
factors that will affect health outcomes, including
the movement of people and goods, changes in
land use and economic development influence
their prevalence. In considering the future effects
of climate change on health, it is therefore also
necessary to consider future socio-economic
baselines, including how these might reduce (as
well as increase) future burdens.
Background: Health Impacts of
Climate Change in Africa
Climate change is likely to affect human health,
either directly such as with the effects of heat or
flood injury, or indirectly, for example, through the
changes in the transmission of vector-borne
diseases or through secondary effects following
flood events. There are also a wider set of
indirect impacts from climate change on health,
which are linked to other sectors (e.g. water
quality, food security, etc).
Existing Studies of the Health
Impacts of Climate Change
One of the most widely cited studies on the
potential health impacts of climate change is the
WHO global burden of disease report and the
climate change chapter (McMichael et al, 2004iii).
The report estimated the current and likely future
effects of climate change from exposures to
extreme weather events, such as heat waves and
deaths and injuries associated with floods, the
distribution and incidence of malaria, the
incidence of diarrhoea, and malnutrition (via
effects on yields of agricultural crops).
Previous work (e.g. such as IPCC AR4 i and other
reviewsii) has identified a potentially wide range of
health effects from climate change in Africa.
These conclude that Africa faces the highest
global health burdens of climate change, from:

The shift or increase in incidence of malaria,
diarrhoea, schistosomiasis, as well as other
vector borne diseases such as dengue fever,
yellow
fever,
encephalitis
(tick)
and
Trypanosomiasis (Tsetse fly), noting that
these changes could be positive for some
regions or time periods.

Heat related mortality and morbidity.

Increased incidence of deaths/injuries/disease
linked to the coastal and inland flooding, as
well as secondary events from these floods
associated with water borne diseases, e .g.
cholera, typhoid, dysentery.

Indirect effects associated with changes in the
risk of under-nourishment and malnutrition,
and wider effects between economic and
development levels and health.
Whilst climate change will bring some health
benefits, such as lower cold-related mortality and
greater crop yields in temperate zones, on a
global scale these are likely to be outweighed by
increased rates of other diseases, particularly
infectious diseases and malnutrition. These are a
particular issue for Africa, and the study identifies
much higher relative health burdens for the
continent.
For the analysis, McMichael et al separate the
potential risks between two geographical regions
of Africa, labelled D (primarily North and West
Africa) and E below (primarily East and Southern
Africa).
These health changes will have economic
consequences
through
incurring
medical
treatment and health protection expenditures, and
the potential loss of work productivity. In addition,
there are likely to be associated changes in
welfare from the pain and suffering associated
with adverse health outcomes. These effects can
be expressed in economic terms when captured
by measures of willingness to pay to avoid them.
The study estimates that the total deaths from
current climate change (year 2000) are 55
thousand deaths per year for Africa (with 19 and
36 thousand deaths/year for the two regions
respectively).
The total deaths from current
climate change are equivalent to 67 and 109
deaths/million population for regions D and E
respectively. It also estimates the current total
disease burden from climate change at 1.9 million
DALY per year for Africa (0.6 to 1.3 million
DALY/year for the two regions), primarily from
Assessment of these health effects is uncertain,
due to the multiple climate parameters involved in
many of the impacts. It is also complicated by
changing socio-economic factors and other
2
malnutrition, diarrhoea and malaria.
This is
equivalent to a total disease burden of 2186 and
3840 DALY/million population. These are shown
below.
Adaptation
A wide range of measures have been identified in
the health sector to adapt to climate change
impacts. Most of these build on well-established
public health approaches and are therefore
theoretically easy to implement. They include
general measures such as:
Table 1.
Estimated mortality (000s) and
Disease Burden (000s of DALYs) attributable
to climate change in the year 2000, by cause
and sub-region.
Mortality
(000s)
Region
DALY
(000s)
D
E
D
E
Malnutrition
8
9
293
323
Diarrhoea
5
8
154
260
Malaria
5
18
178
682
Floods
0
0
1
3

Strengthening of effective surveillance and
prevention programmes.

Sharing lessons learned across countries and
sectors.

Introducing new prevention measures or
increasing existing measures.

Development of new policies to address new
threats.
Cardio-vascular
1
1
All Cause
19
36
626
1267
Examples of more specific measures include:
Total deaths/DALY
per mill pop.
67
109
2186
3840

Behavioural
strategies
to
physiological acclimatisation.

Vaccination programmes.

Technical measures, including control of
disease vectors.

Institutional mechanisms, including earlywarning systems and emergency planning /
disaster preparedness schemes, training,
communication, monitoring and surveillance,
and research
Source McMichael et al (2004).
Key for regions:
D. Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape
Verde, Chad, Comoros, Equatorial Guinea, Gabon, Gambia,
Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Mali,
Mauritania, Mauritius, Niger, Nigeria, Sao Tome and Principe,
Senegal, Seychelles, Sierra Leone, Togo.
E. Botswana, Burundi, Central African Republic, Congo, Côte
d’Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia,
Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda,
South Africa, Swaziland, Uganda, United Republic of
Tanzania, Zambia, Zimbabwe.
Examples of associated costs include (Kovats,
2009):
These impacts are projected to increase further in
the future from increasing climate change, as
shown in the table below. By 2030, the relative
risk will have increased between 1 and 1.83.

Costs of improving or modifying health
protection systems to address climate
change, for example, expanding health or
vector surveillance systems. This includes the
costs
associated
with
building
new
infrastructure, training new health care
workers, increasing laboratory and other
capacities, etc.

Costs of introducing novel health interventions
(e.g. heat wave warning systems).

Additional costs for meeting environmental
and health regulatory standards (e.g. air
quality standards, water quality standards).

Costs of improving or modifying health
systems infrastructure, for example, adapting
hospitals to hotter summers.
Table 2. Increase in relative risk by 2030,
relative to the baseline climate, by cause and
sub-region (‘high’ estimates shown)
D
E
Malnutrition
1.02
1.02
Diarrhoea
1.08
1.08
Malaria
1.02
1.14
Floods
1.66
1.66
Cardio-vascular
1.007
1.005
accompany
Source McMichael et al (2004).
Note full study includes a low, medium and high estimate
3

Occupational health costs, for example,
measures to prevent the adverse impacts of
increased heat load on the health and
productivity of workers.

Costs of health research to address to reduce
the impact of climate change, for example,
evaluation studies.

Table 3. Projected excess incident cases (in
thousands) in 2030 relative to 1990 level in
Africa
for
two
scenarios
of
GHG
concentrations.
Incident cases 000s in 2030
750 ppmv
Costs of preventing the additional cases of
disease due to climate change as estimated
by scenario-driven impact modelsiv.
Estimates of the aggregate costs associated with
adaptation to climate change-induced health risks
in Africa are presented in the following sections.
550 ppmv
Disease
Africa
Global
Africa
Global
Diarrhoeal
50,343
131,980
41,952
113,073
Malnutrition
437
4,673
328
3,097
Malaria
17,703
21,787
14,170
17,369
Source UNFCCC 2007
It is possible to use these estimates to scale the
global adaptation costs to Africa, (i.e. assuming
equal incremental cost per case). The results are
shown in Table 4 below.
Aggregate Costs of Adaptation
for Africa
A number of recent studies have estimated the
costs of adaptation for Africa. These are
summarised below.
Table 4. Estimation of additional financial
flows (US$ Million / year) needed in Africa, in
2030 relative to 1990.
1) UNFCCC (2007)
750 ppmv
550 ppmv
% Africa of global cases
38%
37%
Global finance $Mill/yr
2,235
1,923
853
713
9%
11%
92-122
61-81
9-11
6-9
81%
82%
Global finance $Mill/yr
2,173-3,033
1,773-2,418
The UNFCCC study on Investment and Financial
Flows to address Climate Change (2007v) and the
related journal paper (Ebi, 2008, see below)
estimated the total global adaptation costs to
climate change impacts (all sectors) at $50 to
$170 billion/year by 2030, of which $28 to $67
billion/year was anticipated in developing
countries (Non-Annex1 parties).
Diarrhoeal disease
The study estimated global health adaptation
costs (the increase in global financial flows) at
between $3.8 and $5.4 billion, depending on the
emission scenario, but did not produce values by
region.
Africa $Mill/yr
Africa $Mill/yr
1766 - 2464
1446-1752
The study was based on the projected increases
in estimated cases of diarrhoeal disease,
malnutrition and malaria globally shown in Table
3, which includes a split for Africa.
Total for Africa
Mill $US/yr
2627 - 3328
2166-2474
Africa $Mill/yr
Malnutrition
% Africa of global cases
Global finance $Mill/yr
Malaria
% Africa of global cases
This implies costs of adaptation of $2.2 to $3.3
billion per year by 2030 for Africa, primarily for
malaria and diarrhoeal disease. The numbers
exclude public health infrastructure investment
associated with health, and so was considered an
underestimate.
This shows that a very large proportion of the
global impacts of climate change on health
(particularly for malaria and diarrhoeal disease)
will arise in Africa.
4
Table 5. Additional Annual Costs of Health
Adaptation in Alternative Climate Change
Scenarios per Geographical World Region
2000-2030 (Million US$, 2000).
The adaptation costs above are estimated based
on the costs of prevention for additional cases of
disease. The estimates were based on underlying
costs of prevention, based on Disease Control
Priorities in Developing Countries (World Bank,
2006vi), e.g.



Africa
For
diarrhoeal
disease,
it
includes
breastfeeding promotion, rotavirus and
cholera immunisation and improvement in
water supply and sanitation.
For malaria, it includes insecticide-treated
bed-nets plus case management with
artemesin-based combination therapy, as well
as indoor residual insecticide spraying.
Climate scenario
S550
S750
UE
Diarrhea
633-1,334
756-1,646
954-2,026
Malaria
1,283-3,718
1,567-4,595
2,508-7,222
Total
1,916-5,052
2,323-6,241
3,462-9,248
Source: Markandya and Chiabai (2009)
The estimated annual costs of adaptation for
these two disease burdens in Africa are $1.9 to
5.0 billion (S550), $2.3 to 6.2 billion (S750) and
3.4 to 9.2 billion (unlimited), emission scenario),
with malaria accounting for approximately twothirds of the total and diarrhoea comprising the
remainder. Malnutrition results (not shown) were
found to be only 1% of the totals. In the full study,
the majority of global malaria costs were
estimated for Africa.
For malnutrition, it includes breastfeeding
promotion, child survival programmes,
nutritional programmes, growth monitoring.
These are based on the most cost-effective
measures (cost per DALY averted) and includes
measures that would have wider benefits. For
example, for diarrhoeal disease, the World Bank
study found that more general water and
sanitation facilities (e.g. hand pumps, basic
sanitation) were often very cost-effective and
were essentially no regret actions as they
increased development and had health benefits
(even without climate change).
The estimated figures do not include the full range
of costs including infrastructure, equipment and
health care personnel costs, training costs and
maintenance costs. For diarrhoea, the costs
included in the analysis are those related to
immunization programs and improvement in water
supply and sanitation. For malaria, the estimated
measures include provision of impregnated bed
nets, indoor spraying, and preventive treatment in
pregnancy, besides the specific required
therapies.
2) Ebi (2008) / Markandya and Chiabai
(2009)
Ebi (2008vii) extends the UNFCCC work above,
and her results are utilised in a synthesis review
by Markandya and Chiabai (2009viii) on health
adaptation costs that disaggregates the estimates
on a sub-regional basis, and thus includes
specific values for Africa. The analysis follows the
three scenarios in the UNFCCC and Ebi study:
Markandya and Chiabai also cite another study
from Van Rensburg and Blignautix who estimated
the additional health care costs in year 2025 due
to an increase in the incidence of malaria as a
result of climate change in Southern Africa.
1) Unlimited Emissions;
2) CO2 Stabilisation at 550 ppm by 2170
This study focuses on prevention and treatment
costs of malaria for different levels of risk, and
future projections of population, and estimates
total annual costs (upper bound) for prevention
and treatment of malaria in South Africa at around
US$ 3,800 million in 2025 (2000 US$),
representing 3% of GDP per capita. This is based
on an intervention program from 2000 to 2025.
They also report estimates for Botswana and
3) CO2 Stabilisation 750 ppm by 2210.
The additional annual costs of adaptation for
malaria and diarrhoea for Africa are reported
inTable 5. Under each emission scenario, the
range of estimates is determined by the range of
relative risk factors for each disease, as identified
in McMichael et al (2004).
5
Namibia, where the figures are lower due to
smaller populations (US$ 125 million in Botswana;
US$ 177 million in Namibia), with percentage of
GDP/capita estimated at around 4.5% for the
latter.
3) Parry et al (2009) (IIED/Grantham):
Assessing the Costs of Adaptation to
Climate Change
One of the most recent reports is the
IIED/Grantham Institute study on assessing the
costs of adaptation (Parry et al, 2009x). This is
primarily a review of the numbers cited in the
earlier UNFCCC (2007) study (see above). It
highlights that the UNFCCC study, and other
similar ones, have a number of deficiencies. It
also undertakes a re-assessment of the UNFCCC
study, and on the basis of this, suggests these
previous numbers are substantial underestimates.
The cost of the interventions remains constant
from 2000 to 2030. Intervention costs may
reduce, or new ones (vaccinations) may
emerge, but burdens may change from
resistance to malarial treatment.

The underlying interventions are not 100%
effective, and there will be residual impacts.

The estimates of future health impacts are
dependent upon development pathways,
which make the presentation of costs difficult
as they have to be contextualised within
specific sets of scenarios and assumptions.

Estimates for malnutrition incorporate the
assumptions for technological adaptation in
the agricultural sector, and the estimates for
diarrhoeal diseases assume that the disease
is reduced as countries get richer.
Parry et al also highlight the current ‘level of
health service provision’ and the existing
adaptation deficit in regions such as Africa.
Finally, it reports that National Adaptation
Programmes of Action typically address current
disease control issues, usually for malaria.
Financial requests for specific projects range from
$22,000 to $600,000 for disease-control, earlywarning information systems to $7 million for a
major project in Bangladesh. It also notes that
other sectoral adaptations projects such as
rainwater harvesting and improving food security
will have health benefits.
The Parry et al study highlights that the health
sector was only partially covered. In health, just
three impacts were included - the effect of climate
change on diarrhoeal diseases, malaria and
malnutrition in low and middle-income countries
only. Other disease burdens were not considered
due to insufficient estimates: thus, the estimated
health adaptation costs are likely to be
significantly underestimated. The authors also
emphasise that investment alone is unlikely to be
sufficient to improve health in developing
countries, as many other barriers remain, such as
poor governance, inequality and low adaptive
capacity.
4) World Bank EACC
The Economics of Adaptation to Climate Change
(EACC) Study (World Bank, 2009xi) estimates the
costs of adaptation – in $Billion/year over future
decades in developing countries through to 2050.
It has some similarities to the previous global
studies, but also marks a significant advance
forward because it works with a more explicit
economic framework. The study also uses country
specific data sets as well as climate model output,
using a range of climate projections reflecting the
range of model projections for temperature and
precipitation, and also accounts for future socioeconomic development.
The Parry et al review considers that the health
adaptation costs reported in UNFCCC (2007) to
be significant underestimates, as they only
includes 30-50% of extra disease burden from
climate change in developing countries.
A number of further methodological issues were
highlighted in the study:


The UNFCCC estimates assume constant
number of annual cases over time, despite
population increasing through to 2030
(thereby implying that incidence decreases).
This is plausible with increasing development,
but is not explicit.
The study assesses adaptation costs as the costs
of initiatives needed to restore welfare to levels
prevailing before climate change along the
6
projected development baseline (note that this
assumption has been the subject of considerable
comment1).
diarrhoea and updates the dose-response
functions used to compute the relative risk for
malaria.
The study focuses on planned (public sector)
adaptation costs. It primarily considers “hard”
options involving engineering solutions in all
sectors (except extreme events, where the costs
of adaptation where based on education). It also
considers
different
aggregation
rules
in
accounting for the positive as well as negative
effects of climate change and adaptation costs 2.
These changes significantly reduce the adaptation
costs compared to Ebi (2008), reported above.
The total cost of preventing or treating the
additional cases is the product of the additional
cases and the average cost of preventing or
treating additional cases.
The average cost of averting additional cases of
each disease is based on updated treatment
costs from the Disease Control Priorities in
Developing Countries Project (DCCP2) for the
cost-effective methods of treatment.
Two climate scenarios are adopted in the study.
Under the drier scenario, the global costs of
adaptation for developing countries for all sectors
over the period 2010 – 2050 are estimated at
US$78 billion per year.
Under the wetter
scenario, the costs are higher at US$90 billion.
As with the UNFCCC study, the World Bank
assessment considers conventional public health
adaptation activities, with a focus on malaria and
diarrhoea. Adaptation costs were estimated for
these two diseases in each country for each of 16
demographic groups. The costs are determined
by the baseline incidence of disease without
climate change, plus the additional risk that
climate change results in.
Costs were derived from the unit cost of
preventing and treating additional cases of the
disease. Note that unlike Ebi (2008) above, who
fixed the baseline incidence of disease, the EACC
study incorporates a future baseline global burden
of disease based on WHO GBD projections to
2030 plus extensions through 2050. This implies
a reduction in the incidence, and in incidence
rates, in the future. The analysis also incorporates
updates and revisions to the unit cost of
prevention and treatment for malaria and

For diarrhoeal diseases, they are based on
breastfeeding promotion; vaccination against
rotavirus, cholera, and measles; and
improvements in water supply and sanitation.

For malaria, they are based on use of
insecticide-treated
bednets;
case
management
with
artemisinin-based
combination therapy plus insecticide-treated
nets and with insecticide-treated nets plus
indoor
residual
spraying;
and
case
management
with
artemisinin-based
combination therapy plus insecticide-treated
nets plus indoor residual spraying plus
intermittent
presumptive
treatment
in
pregnancy.
The health adaptation costs are found to be a
very low proportion of total adaptation costs, at
only $1.5 to 2 billion/year globally. However, most
of these were in Africa, with estimated costs of
$0.6 to 1.0 billion/year. The values for Africa,
disaggregated by time-period, are shown in Table
6 below.
The study reports a decline in global adaptation
costs over time, even though the risks increase. In
Sub-Saharan Africa, the share of malaria cases
increases from the current 7–12 percent to 12–19
percent by 2050, depending on the climate
scenario and dose-response functions. Similarly,
the share of diarrhea cases increases from the
current 2–4 percent to 7–8 percent by 2050,
depending on the climate scenario.
1
There are two issues here. First, it is questionable whether
this degree of adaptation is actually physically possible. Other
literature (e.g. Parry et al. 2009) above indicates that
adaptation might only be able to reduce economic costs by
around 50% in developing countries, thus leaving considerable
residual impacts. Second, it assumes that such a level of
adaptation is (economically) rational - which may be
questioned, and leads to a potential overestimation of costs.
2
For some sectors, in some regions, climate change leads to
a potential economic benefits – the study applied different
rules when netting these against adaptation costs, by country
or region. The main results are presented as X-sums, where
positive and negative items are netted within countries but not
across countries.
7
Table 6. Average annual adaptation cost for
human
health—preventing
and
treating
malaria and diarrhoea, by region and decade,
2010–50 ($ billions a year at $2005 prices, no
discounting)
Time
period
Middle East
and North
Africa
SubSaharan
Africa
Total
Africa
5) Grantham Institute (2009)
The Grantham Institute for Climate Change
produced a fact-base on climate change in Africa,
including impacts, required actions and adaptation
costs, presented at the CAHOSCCxii.
The study derives estimates of health adaptation
costs in Africa from the UNFCCC (2007) study,
and thus estimates a value of $3 billion per year in
incremental costs by 2030. It also highlights
health concerns in relation to access to water, and
the effects of extreme events (flood and
droughts).
NCAR
2010-19
0.1
0.9
1.0
2020-29
0.1
0.7
0.8
2030-39
0.1
0.7
0.8
2040-49
0.0
0.8
0.8
CSIRO
2010-19
0.1
0.6
0.7
2020-29
0.1
0.6
0.7
2030-39
0.0
0.6
0.6
2040-49
0.0
0.6
0.6
It highlights opportunities for health adaptation
include improving forecasting and diagnostic
capabilities, broadening access to health services
to address diseases, and applying greater
resources and co-ordination in dealing with
humanitarian disasters.
Source: World Bank, 2009.X-sums.
It stresses that broader access to primary and
secondary healthcare is a development priority
that forms the basis for adaptation action in the
sector. Further that health is closely linked to
development and adaptation efforts in other
sectors. Finally, that further research is required
on the health impacts of climate change in Africa,
including for other disease burdens, transparency
of adaptation costs, and evidence on the
effectiveness of adaptation.
This reduction occurs because of rapid declines in
the baseline incidence of these diseases and
deaths due to development – indeed, these
assumptions have a very large effect on the
results. H
owever, the rates of decline are lower (in relative
terms) in Africa than other regions. As a result, by
2050 more than 80 percent of the health sector
adaptation costs are borne by Sub-Saharan
Africa.
It also highlights the need for integrating climate
change information in health planning and
decision-making to increase resilience to climate
change.
The report also highlights that other health
adaptations are included in other sectoral
estimates and not included in health, to avoid
double counting. These include the additional cost
of climate-proofing health sector infrastructure;
the cost of reducing additional cases of
malnutrition (agriculture); and the adaptation cost
related to extreme weather (floods and droughts).
Country Studies of the Costs of
Adaptation for Health
In contrast to the high-level, top-down global and
regional studies reported above that primarily
serve to scope out the scale of potential
aggregate costs, a number of recent and on-going
studies adopt the national level of analysis. These
studies benefit from a greater degree of
contextualisation and are designed to inform the
design of adaptation strategies for national and
sub-national authorities. A sample of these
studies is outlined below.
Nonetheless, the study judges that the adaptation
costs it reports to be under-estimates because
they do not include many other infectious
diseases such as dengue, heat stress, population
displacement, and increased pollution and
aeroallergen levels.
8
1) Kenya – Economics of Climate
Change and Adaptation to Malaria
The additional economic burden of endemic
malaria disease in the 2050s was estimated to be
over $ 86 million annually (for population levels of
2009, with arrange of $48 to 99 million annually
across the temperature projections) based on the
clinical and economic malaria burden. These
welfare cost estimates increased to a range of
$144 to 185 million annually when disutility costs
(e.g. discomfort pain and inconvenience
measured by survey-based willingness to pay
estimates) were taken into account.
The Regional Economics of Climate Change
Studies (RECCS) – commonly known as ‘miniSterns’ have assessed the economic costs of
climate change and mitigation, as well as the
economics of adaptation.
The study for Kenya (SEI, 2009xiii) included
analysis of the potential impacts and costs of
adaptation for malaria3. The current burden of
climate-sensitive disease – particularly malaria - is
high in Kenya. It accounts for an estimated 30%
of all out-patient consultations and 19% of all
hospital admissions. Of the total population,
around 23 million (70%) are reported to live in
areas at risk of malaria, including 3.5 million
children under 5: consequently the disease is a
major contributor to under 5 child mortality.
The estimation of the malaria’s economic burden
resulting from climate change is sensitive to adult
mortality resulting from epidemics. The economic
value of life years lost resulting from epidemics is
estimated at 89 million annually (population 2009,
and minimum wage 870$ per year), when
predicted mortality is annualized until 2055.
Contrary to the declining “epidemic costs” when
malaria shifts to less densely populated areas, the
“endemic costs” are long lasting, and continue to
rise. A gradually increasing endemic burden of
malaria will result in a higher health budget
required for malaria control.
The study applied a malaria risk model based on
altitude, to assess at the national scale the impact
of future climate change. The model projected
that by 2055, as a result of the central average
climate warming (2.3ºC) across the projections,
the population annually affected by malaria in
rural areas over 1000 metres (which comprises
63.5% of the population of Kenya) would increase
by up to 74% (in absence of adaptation).
Malaria and poverty are intimately linked and in
Kenya the lower socio-economic classes
(household income < $ 50 per month) bear the
brunt of the disease. Thus, an effective way to
avoid the consequences of climate change is to
improve living standards, thereby enhancing
entitlement and affordability of adequate
healthcare and prevention. However, the
increasing economic and psychological burden
resulting from aggravated malaria is likely to
undermine the population’s capacity to cope with
the disease.
The report also presents results for increases in
average temperature of 1.2 and 3°C – the range
across the model projections (from ten models) –
leading to increases from 36% to 89%.
Based on current population levels and incidence
rates (2009), an extra 5.8 million people were
estimated to be affected in the 2050s (with 2.8 to
7.0 million people across the range of
temperature projections), with excess mortality of
15,700 people per year, of which 11,400 are
below the age of 15.
Nevertheless, this study assessed only direct
malaria control initiatives and costs based on:
1) Quick and effective treatment
2) The provision of prevention and treatment of
pregnant women
The economic burden resulting from projected
climate change on endemic malaria in terms of
direct and indirect costs was estimated. Where
morbidity is concerned, treatment and costs can
be viewed as remedial adaptation activities.
3) The use of insecticide treated nets (ITNs) in
high risk communities.
In areas of existing malaria there would be no
change required in policy, though it is recognized
that additional infrastructure and staff would be
3
London School of Hygiene and Tropical Medicine: Menno
Bouma and Sari Kovats, and Alistair Hunt, Metroeconomica.
9
required to address the increased health care
demands. In contrast, in areas which become
endemic with the malaria lapse rate shifting to
higher altitudes, new facilities will have to be
established and new staff trained and employed.
However, the cost of additional health care
facilities and staff is not assessed in this report.
in reduced cost-benefits, particularly in view of
the much more expensive ACTs which now
have replaced cheaper chloroquine. As every
episode requires confirmation or exclusion of
malaria, rapid diagnostic tests are important.
The study estimated the cost for
 IRS coverage in low endemic and potential
epidemic areas (shifting to higher altitudes
due to climate change).
 Distribution of bednets for the additional
population at risk.
 Additional
medical tests for the new
population at risk.
 Preventive treatment of pregnant women.
 Treatment (direct) costs for additional malaria
cases.
There is more extensive scope to prevent the
economic and societal impact of epidemic
malaria. With increasing ambient temperatures
large numbers of people, not previously exposed,
can be protected from the worst consequences of
epidemic malaria. In recent years Kenya has
started to use Indoor Residual Spraying (IRS) in
highland areas to control malaria in low endemic
areas and to prevent epidemics. It should be
borne in mind that this initiative for IRS followed
the rise in malaria since the 1980 and associated
epidemics. It should be seen as an adaptation
when temperature as a driver is accepted. As the
economic costs associated with epidemics are
highest in the next 2 decades due to the altitudinal
distribution of the population, and will decrease
over time, adaptive initiatives to protect the
population from epidemics appears a high priority.
The total annual costs were estimated at around
$23 million/year (central value, with a range
across the projections). The main costs for
diagnosis and prevention ($ 15 million) is
associated with IRS. Annual cost for treatment of
additional cases is estimated at$ 8 million.
2) Ghana – NEEDS project
Kenya’s malaria control initiatives also include the
Improvement of epidemic preparedness and
response in epidemic-prone areas.

MEWS. Malaria Early Warning Systems,
monitoring environmental risk parameters and
early detection.

Pregnant Women. The existing policy for
pregnant women in endemic areas is
treatment (SP) 2 times (ITPt) during
pregnancy to reduce the adverse effects of
malaria. There is increasing support for all
pregnant women in low endemic and
epidemic areas to be targeted and the study
considered this policy over the “endemic
intercept”, covering the area of potential
periodic epidemics, parallel to the proposed
area of ITNs (see figure). However, during
perceived high risk years (e.g. during warmer
El Niño years), this policy can be adapted to
take interannual variability into account.

The National Economic, Environment and
Development Study (NEEDS) for Climate Change
Project4 was launched by the UNFCCC
secretariat launched early in 2009. It is providing
technical assistance from the secretariat to
conduct financial needs assessments.
A number of countries have joined the project,
including Egypt, Ghana, Mali and Nigeria.
Some results for the health sector are available
from Ghana, which assessed how to reduce the
burden of climate-sensitive health determinants
and outcomes and how to reduce the risk of heat
stress. Adaptation options considered include
improved monitoring systems to detect the arrival
or presence of infectious diseases, and warning
systems to warn the population about heatwaves.
Diagnostic Tests (RDT). In high endemic
areas, most treatment is on presumptive
basis. In low endemic and epidemic areas
false positive clinical malaria diagnosis results
4
http://unfccc.int/2807.php. The project was launched
in response to SBI 28 mandate for the secretariat, to
provide, upon request, information to non-Annex I
Parties on the assessment of financing needs to
implement mitigation and adaptation measures
10
The study estimates the incremental cost of
adaptation in the health sector to be USD 350
million by 2020 and USD 352 million by 2050.
the future (albeit simply, without assumptions of
changes in development, baseline rates, etc),
linked to assumed changes in drought frequency
and severity (again, without any socio-economic
changes).
In addition, the study in Ghana assessed public
and private expenditures for malaria treatment,
which forms about 50 per cent of outpatient care
in public hospitals5. Whilst public expenditure is
used to run health facilities that treat malaria,
private expenditure covers the cost of treatment.
The study estimated that by 2030, under the
moderate climate change scenario, a 10 percent
decrease in average rainfall was projected to
cause a 60 percent increase in the proportion of
the population under food stress, and significant
increases in the number of cases of cholera and
dysentery. Trachoma cases were estimated to
potentially double in number. The high climate
change scenario would worsen this impact.
The additional investment in controlling malaria
that will be required is estimated to be USD 7.6
million in 2020 and USD 7.54 million in 2050.
These estimates do not include the costs of
setting up new infrastructure (such as new
hospitals).
The study analyzed measures to protect against
drought-related health risks cases. Measures
were classified as prevention (such as cholera
vaccinations) or treatment (such as oral
rehydration therapy for cholera patients). The
costs of each measure were estimated, including
the costs of various components of the
programme and the likely efficacy of the
intervention.
3) Tanzania - ECA
The Economics of Climate Adaptation Working
Group (ECA, 2009xiv) undertook case studies on
the costs of climate change risks and costs (and
benefits) of adaptation. The level of application is
small scale and single sector at the sub-national
level and the have a useful focus on the shortterm adaptation costs and benefits.
Costs of medication included purchase, shipping,
storage and distribution of storage, as well as the
overhead costs such as training and salaries.
A case study based in Tanzania focused on two
specific drought impacts that are of particular
concern for the central region of Tanzania, one of
which was human health, which is threatened by
the spread of cholera and other infectious
diseases caused by shortages of fresh water.
The other case study was on power generation.
The estimated disease burden that would be
prevented with each measure was estimated,
discounted by the penetration rate - the proportion
of the population that could be reached - and the
efficacy rate (%). Applying this information, the
study ranked a number of potential strategies on
the basis of cost per effective case, considering:
The study identified drought-related health
impacts as: malnutrition, trachoma (an infectious
eye disease that causes blindness), dysentery,
cholera, and diarrhoea.
While recognizing that many factors drive disease
prevalence and occurrence, the study focused on
isolating a single driver. It correlated historical
rainfall data with historical numbers of cases of
key diseases and with crop supply and demand
imbalances (as a proxy for malnutrition). This
analysis allowed a prediction of the additional
number of people affected by those diseases in
5
Health expenditure on malaria in Ghana comes from
both the public and private sectors:
11

Educational programmes to encourage good
hygiene and sanitation

Educational program to encourage
breastfeeding

Administration of Oral Rehydration Therapy

Targeted administration of antimicrobials

To build basic covered wells with pipes

Rainwater harvesting (1,000L and 2,500L and
larger schemes 20,000-45,000L for schools
and other buildings)

To build ventilated pit latrines

Administering of zinc supplements

Building of 100 MM boreholes + pump +

engine + 40,000L holding tank +

distribution pipes

Mechanical filtration of water

Chemical filtration of water

Cholera vaccination
NEEDS project, and from the UNDP Investment
and Financial Flow Studies in Africa.
Conclusions and Research
Priorities
The study found the educational programmes and
water quality improvements (rainwater harvesting)
were highly cost effective measures, as shown in
the figure below.
This paper provides an overview of the literature
currently available on the estimation of adaptation
costs associated with climate change-induced
health risks in Africa.
Cost-effectiveness ranking of alternative
measures to reduce climate change-related
health impacts in Tanzania.
Initial estimates have been reviewed at the scale
of the African continent as a whole and are
designed to inform international negotiations on
mitigation and adaptation policy, and in particular,
the possible scale of financial transfers to the
continent.
Because of the scale of the aggregation, these
estimates are necessarily crude. Because of the
scope of their coverage, they are also partial.
These continent-scale studies have subsequently
begun to be complemented by a growing series of
national scale studies that better reflect local
resource costs and specific national health
priorities.
However, even with these studies, the
uncertainties surrounding the climate scenarios
and impact estimation, as well as the effects of
socio-economic change, ensure that the resulting
adaptation cost estimates remain open to debate.
Consequently, the following research priorities are
identified:
Source ECA, 2000.
4) Other studies
Additional information will emerge later in 2010
from the World Bank country studies on the
economics of adaptation, from the UNFCCC
12

Broadening the coverage of disease types
considered, both in top-down or national scale
studies;

Developing the sophistication of the use of
socio-economic baselines, mapping these
against countries’ individual development
strategies;

Broadening the range of adaptation options
considered to include more behaviouralbased measures (e.g. domestic and
international migration) and measures that are
cross-sectoral in nature but which have
significant influence on health.
The AdaptCost Project
The AdaptCost Africa project, funded by United
Nations Environment Programme (UNEP) under
the Climate Change – Norway Partnership, is
producing a range of estimates of the financial
needs for climate adaptation in Africa using
different evidence lines. The study aims:
 To help African policymakers and the
international climate change community to
establish a collective target for financing
adaptation in Africa.
 To investigate estimates to adapt to climate
change and improve understanding of
adaptation processes. This will provide useful
information
for
planning
adaptation
programmes and support decision-making by
national governments and multi- and bilateral
donors by allowing them to better compare
projects and policies on their economic
grounds. In the process, countries will also
gain a better understanding of their adaptation
investment requirements, and build a stronger
basis for articulating their financing priorities
and attracting capital.
This briefing note was prepared by Paul Watkiss
and Alistair Hunt.
13
Footnotes and References
http://www.uneca.org/apf/documents.asp
xiii
SEI (2009). The Economics of Climate Change in East
Africa. Downing, T., et al. Report for DFID and DANIDA.
Available at http://kenya.cceconomics.org/. (Accessed January
2010).
xiv
ECA (2009). Shaping Climate-resilient Development a
framework for decision-making. A report of the economics of
climate Adaptation working group. Economics of Climate
Adaptation. Available at:
http://www.swissre.com/resources/387fd3804f928069929e92b
3151d9332ECA_Shaping_Climate_Resilent_Development.pdf (Accessed
January 2010).
i
Boko, M., I. Niang, A. Nyong, C. Vogel, A. Githeko, M.
Medany, B. Osman-Elasha, R. Tabo and P. Yanda, 2007:
Africa. Climate Change 2007: Impacts, Adaptation and
Vulnerability. Contribution of Working Group II to the Fourth
Assessment Report of the Intergovernmental Panel on Climate
Change, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der
Linden and C.E. Hanson, Eds., Cambridge University Press,
Cambridge UK, 433-467.
ii
J. C. Nkomo, Ph.D. University of Cape Town, South Africa, A.
O. Nyong, Ph.D. University of Jos, Nigeria, K. Kulindwa, Ph.D.
University of Dar es Salaam, Final Draft Submitted to The
Stern Review on the Economics of Climate Change July, 2006.
iii
McMichael, A.J., et al. (2004). Climate change. In: Ezzzati,
M., Lopez, A.D., Rodgers, A., and Murray, C.J., (eds)
Comparative quantification of health risks: global and regional
burden of disease due to selected major risk factors, Vol 2.
World Health Organisation, Geneva, 1543–1649.
iv
This can also be considered as ‘damage’ or impact costs,
rather than adaptation costs.
v
UNFCCC (2007). Investment and financial flows relevant to
the development of an effective and appropriate international
response to Climate Change (2007). United Nations
Framework Convention on Climate Change
vi
World Bank, 2006: Disease Control Priorities in Developing
Countries. The World Bank.
vii
Ebi, K.L. (2008) ‘Adaptation costs for climate change-related
cases of diarrhoeal disease, malnutrition, and malaria in 2030’,
Globalization and Health, vol. 4, no. 9.
viii
Markandya, A. and A. Chiabai, Valuing Climate Change
Impacts on Human Health: Empirical Evidence from the
Literature. Int. J. Environ. Res. Public Health, 2009. 6(2): p.
759-786.
ix
Van Rensburg, J.J.J.; Blignaut, J.N. The Economic Impact of
an Increasing Health Risk due to Global Warming. In
Proceedings of the Forum for Economics and Environment
Conference, Cape Town, South Africa, 2002.
x
Martin Parry, Nigel Arnell, Pam Berry, David Dodman,
Samuel Fankhauser, Chris Hope, Sari Kovats, Robert Nicholls,
David Satterthwaite, Richard Tiffin, Tim Wheeler (2009)
Assessing the Costs of Adaptation to Climate Change: A
Review of the UNFCCC and Other Recent Estimates,
International Institute for Environment and Development and
Grantham Institute for Climate Change, London.
xi
World Bank (2009). The Costs to Developing Countries of
Adapting to Climate Change: New Methods and Estimates.
The Global Report of the Economics of Adaptation to Climate
Change Study. Consultation Draft. September 2009. Available
at:
http://siteresources.worldbank.org/INTCC/Resources/EACCRe
port0928Final.pdf (Accessed January 2010)
xii
African Partnership Forum and Conference of African Heads
of State and Government on Climate Change (CAHOSCC), at
the special session on climate change. September 3rd 2009,
Addis Ababa.
http://www.uneca.org/apf/index.asp
Grantham Institute (2009). Possibilities for Africa in global
action on climate change.
Executive Summary. July 2009
Documents available at:
14