WATER, CLIMATE CHANGE AND HEALTH

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WATER, CLIMATE CHANGE AND HEALTH

• R Aertgeerts
• Regional adviser, water and sanitation
• Co-secretary, Protocol on Water and Health

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System adaptation to climate change

• A health system consists of all organizations,
  people and actions whose primary intent is to
  promote, restore or maintain health. This
  includes efforts to influence determinants of
  health, as well as more direct health improving
  activities.
• Health services provide a buffer against the
  climate variability and change.
• Emergency medical services have a role in
  limiting excess mortality.

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Agenda

• Impact of climate change on health systems, and
  adaptation mechanism.
• Impact of climate change on the water and
  sanitation sector, and adaptation mechanisms.
• The Protocol as a tool to promote adaptation
  through TFEW, TFIR, TFWRDS
• Conclusions.

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Health systems
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Health outcomes of climate change

• Water-borne (ingested)
• Infectious diarrhoeal diseases
• Pollutant-related diseases
• Water-washed
• Intestinal helminths,
• Eye and skin infections
• Vector-borne malaria, dengue fever
• Water-based Legionellosis
• Viral diseases ???

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Basis for health sensitivity studies

• Health impacts from extreme events
• Spatial studies
• Temporal studies
• Experimental laboratory and/or field studies

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Assessment of potential health impacts

• Limited local-specific changes
• Multiple, interacting and multicausal outcomes
  make attributing outcome to climate difficult
• Difficult generalising outcomes
• Limited inclusion of different development
  scenarios in health projections
• Difficulty in identifying climate thresholds

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Health system constraints
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Health sector adaptation strategy

• Health action plans
• Emergency medical services
• Improved climate-sensitive disease surveillance
  and control
• Safe water and improved sanitation
• Strengthened health services

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Six building blocks

• Service delivery
• Trained health workforce
• Health information systems
• Access to essential medical products, vaccines
  and technologies
• Adequate and sustainable financing
• Leadership and governance

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Conclusion on health systems

• Health systems are a key player in the detection
  of health threats and in the curative aspect of
  long-term health outcomes, as well as in dealing
  with emergency situation.
• The TFIR, the TFWDS, and the TFEWE are important
  for the implementation of the WHO programme on
  health systems

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Water supply and sanitation, climate change and
extreme events
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Regional impact Asia

• Decrease freshwater availability in C, S, E and
  SE Asia
• Coastal and river flooding in S, E and SE Asia
• Increase in endemic morbidity and mortality due
  to diarrhoeal diseases

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Regional impact Europe

• Magnified regional differences decrease in
  surface flow in S, increase in N
• Reduced water availability in S general decrease
  in summer flow
• Glacier retreat in mountain areas
• Increased water stress in S Europe
• Polar regions hydrogeological changes

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Floods

• Global warming is projected to intensify the
  hydrological cycle and increase the occurrence
  and frequency of flood events
• Health outcome drowning, injuries, contamination
  of resource waters, outbreaks of infectious
  diseases.
• Stagnant pools favour vectors.

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Droughts

• Climate change has likely increased the frequency
  and/or severity of droughts
• Health effects include deaths, malnutrition,
  infectious disease and respiratory disease.
• Extended drought reduces resistance to vulnerable
  disease and population of mosquito predators.

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Groundwater

• Changing quality due to changes in surface water
  quality
• Accelerating hydrological permeability, leading
  to quicker transport of pollutants
• Increased salinity, through seawater intrusion
• Increased evapotranspiration
• Increased soil temperature.

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Aquatic ecology

• Changes in self-purification of rivers due to
  decreased oxygen content.
• More stable vertical stratification in deep lakes
  affecting oxygen, nutrient cycling and plankton
• Eutrophication, change in timing of algal blooms
  and increase of harmful algal blooms
• Alterations to habitats and distribution of
  aquatic organisms incl protozoan invaders

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Relationships

• Linkages between water availability, household
  access to improved water, and health burden due
  to diarrhoeal diseases.
• Role of extreme events (intense rainfall or
  droughts) in facilitating water-borne outbreaks
  of diseases through piped water supplies of
  surface water
• Effects of temperature and runoff on
  microbiological and chemical contamination of
  coastal, recreational and surface waters
• Direct effects of temperature on the incidence of
  diarrhoeal disease

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Conclusion on water and sanitation

• Climate extremes cause both physical and
  managerial stresses on water supply systems,
  although well-managed public water supply systems
  should be able to cope with climate extremes.
• well managed?

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Economic vulnerability
Countries with annual GDP per capita of less than
6,000 USD are assumed to be at additional risk of
diarrhoea.
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Europes rural population in 2004

• EUR-A 24
• 86 million
• EUR-B 44
• 97 million
• EUR-C 30
• 72 million

In rural areas, water scarcity is associated with
multiple adverse health outcomes, incl parasites,
vector borne diseases associated with faulty
water-storage systems, and malnutrition.
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(Lack of) access to improved water supply

• EUR-A
• Universal house connection
• EUR-B
• 84 have house connection, 95 of urban and 66
  of rural areas
• EUR-C
• 83 have house connection, 92 of urban and 56
  of rural areas

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(Lack of) access toimproved sanitation

• EUR-A
• 62 have house connection, 61 of urban and 44
  of rural areas
• EUR-B
• 71 have house connection, 88 of urban and 27
  of rural areas
• EUR-C
• 67 have house connection, 85 in urban and 24
  in rural areas

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Guidelines for drinking-water quality

• 1984 1987 First edition
• 1993 1997 Second edition
• 2004 Third edition
• Thereafter rolling revision

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Need for more holistic approach
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Risk scoring matrix
?
?
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Description of water supply system
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WSP and floods

• Floods
• Infrastructure adaptation
• Functionality assessment
• Protection of sewerage systems
• Protection of production units
• Contingency plans for rehabilitation

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WSP and droughts

• Demand management to safeguard drinking water
  supply
• Resource allocation on consensual river basin
  management plan, but mandatory allocation
  possible
• Increase reuse of treated wastewater for
  irrigation and for aquifer recharge

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WSP and sea level rise

• Develop legal framework
• Address saltwater intrusion in aquifers for
  drinking-water production
• Address food quality issues if conditions lead to
  algae growth

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General adaptation issues for the water sector

• Differentiate adaptation strategy by sub-region
• Improve understanding of climate change impact at
  the basin level
• Ensure that current legislation develops to
  include climate adaptation measures at the local,
  national and supranational level.

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Water sector adaptation strategies

• Address the existing situation
• Ensure the fulfilment of the basic human right to
  water for those who do not yet have sustainable
  house connections to drinking water and/or
  sanitation
• Plan for increasing demand as lifestyles change (
  baths, washing machines)
• Protect the most vulnerable first

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Water adaptation strategies

• 2. Demand and supply management
• Inter-sectoral cooperation (agriculture) for
  water resource conservation IWRM
• OM optimization
• Safe storage
• Re-use of treated wastewater
• New techniques (desalination)
• Realistic pricing with social programmes

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Protocol on water and health
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Safeguard water supply and sanitation

• Joint and coordinated action
• Notification of threats of disease outbreak
• Cooperation on transboundary water management
• Joint and coordinated water management plans
• International support for national action
• Project facilitation mechanism

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Safeguard water supply and sanitation

• TF on Indicators and Reporting
• Management, protection from pollution and use of
  water resources for dw production
• Access to water supply and sanitation
• Performance of service provider (loss reduction)
• Quality of drinking water supplied
• Safe reuse/disposal of treated wastewater/sludge

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Strengthen health systems

• Task Force on water-related disease surveillance
• Assess current surveillance systems
• Provide guidance on reduction of water-related
  diseases
• Assist in the development of contingency plans
• Assist in strengthening response capacity

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Manage extreme events

• Task Force on indicators and reporting
• Discharges of untreated storm water
• Task Force on water supply and extreme events
• Exchange information on management of water and
  sanitation utilities under extreme drought/
  flooding
• Codify good practice guidance documents in this
  area

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Conclusion

• Climate change will pose considerable challenges
  for the realisation of the basic human right to
  safe drinking-water, both in quantity and in
  quality.
• WHO through the Protocol on Water and Health is
  in the forefront of supporting adaptation efforts
  by its Member States.

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THANK YOU
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WHO Country Offices