Approaching Adaptation: Parallels and Contrasts between the Climate and Health Communities

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Approaching AdaptationParallels and Contrasts
between the Climate and Health Communities

• Center for Integrated Study of the Human
  Dimensions of Global Change,
• Carnegie Mellon University
• National Science Foundation, ExxonMobil, API and
  CMU

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Context and Introduction

• Public health prevention and climate change
  adaptation share the goal of increasing the
  ability of nations, communities and individuals
  to cope effectively and efficiently with
  challenges and changes.
• Public health researcher approach from the
  perspective of protecting and enhancing the
  health and well-being of individuals and
  communities
• Climate researchers approach adaptation from a
  perspective that can trace its roots to the
  natural hazards community.

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Public Health

• Public health is the combination of sciences,
  skills, and beliefs that is directed to the
  maintenance and improvement of the health of all
  people through collective or social actions. The
  programs, services, and institutions involved
  emphasize the prevention of disease and the
  health needs of the population as a whole.
  Public health activities change with changing
  technology and social values, but the goals
  remain the same to reduce the amount of
  disease, premature deaths, and disease-produced
  discomfort and disability in the population (Last
  2001).

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Three Stages of Prevention

• Public health aims to achieve its goals through
  prevention (adaptation).
• Measures to reduce disease and save lives are
  categorized into primary, secondary and tertiary
  prevention (Last 2001).

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Three Stages of Prevention

• Primary prevention is the protection of health
  by personal and community wide efforts.
• Secondary prevention includes measures available
  to individuals and populations for the early
  detection and prompt and effective intervention
  to correct departures from good health.
• Tertiary prevention consists of the measures
  available to reduce or eliminate long-term
  impairments and disabilities, minimize suffering
  caused by existing departures from good health,
  and to promote the patients adjustment to
  irremediable conditions.

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Climate Community and Adaptation

• Human and natural systems adapt autonomously to
• gradual change, if it can be detected, and
• variability (or change in variability).
• Human systems can plan to adapt and implement
  their plans

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Public Health and Vulnerability

• Public health uses the concept of vulnerability
  in two different senses.
• One acknowledges that advances in public health
  are not permanent and that deterioration of the
  public health infrastructure could permit the
  return of adverse health outcomes that are
  currently controlled. As a result, vulnerability
  depends on maintaining and improving health
  systems.

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Public Health and Vulnerability

• The second sense relates to specific health
  outcomes.
• The classic approach to evaluating environmental
  health risks is a four-step assessment paradigm
  hazard identification, dose (exposure) cum
  response assessment, exposure assessment, and
  risk characterization.
• The evaluation of information on the hazards of
  environmental agents and exposure of sensitive
  receptors (e.g., humans, animals, and ecosystems)
  produces quantitative or qualitative statements
  about the probability and degree of harm.

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Comparison

• To a climate researcher, vulnerability is a
  function of exposure and sensitivity and
  exposure and sensitivity are themselves functions
  of adaptive capacity. In general, it is a
  statement about future conditions after
  adaptations have been implemented.
• In the health community, vulnerability is a
  function of exposure to an agent and the
  exposure-response relationship between that
  exposure and a particular health outcome. In
  general, it is a statement about current
  conditions. It is preferable to have the
  exposure-response relationship determined before
  preventative measures (i.e. adaptations), are
  implemented.

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Determinants of Adaptive Capacity

• The range of available technological options for
  adaptation
• The availability of resources and their
  distribution
• The structure of critical institutions and the
  derivative allocation of decision-making
  authority
• The stock of human capital (e.g. education and
  personal security
• The stock of social capital
• The systems access to risk spreading processes
• The ability of decision-makers to manage
  information and
• The publics perceived attribution of the source
  of stress and the significance of exposure to its
  local manifestations.

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Prerequisites for Prevention

• An awareness that a problem exists
• A sense that the problem matters
• Understanding of what causes the problem
• Capability to deal with the problem and
• Political will to control the problem.

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Table 1 Determinants of Adaptive Capacity and
the Prerequisites for Prevention

• Determinants of Adaptive Cap Prerequisites for
  Prevention
• Availability of Options Capability to control
• Resources Capability to control
• Governance Political will
• Human and social capital Understanding of
  causes political will
• Access to risk spreading mechanism Capability to
  control
• Managing information Understanding of causes
  problem matters
• Public perception Awareness problem
  matters

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Table 2 Trends in Selected Health Indicators and
Their Determinants in Costa Rica and the former
USSR, 1960-1990

• Costa Rica Former USSR
• Health Indicator 1960 1990 to Tech
  1960 1990 to Tech
• Under 5 Mortality 124 14 55
  39 27 40
• Female Adult Mortality 203 73 48
  
• Male Adult Mortality 246 122 59
• Female Life Expectancy 65 79 59 72
  74 43
• Male Life Expectancy 62 74 60 65
  63 46
• Total Fertility Rate 7 3.3 38
  2.7 2.2 25
• Determinants
• Income Per Capita 2001 3381 2397 7453
• Female Education (yrs) 4.0 5.6 7.6
  10.3
• Male Education 4.1 5.5 8.5 10.8

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Table 3 Socioeconomic and Health Services and
Finance Indicators for Costa Rica and the Russian
Federation, 1960-1990

• Socioeconomic Indicator Costa Rica
  Russian Federation
• Malnutrition (children under 5)
• Males 6 12
• Females 7 13
• Health Services/Finance Indicator
• Children Immunized for Measles 99
  92
• Health Expenditure
• Total ( of GDP) 8.5 4.8
• Public Sector ( of GDP) 6.3 4.1
• Public Sector ( of total) 74 87

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Figure 1aHistorical Context Adaptation Baseline
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Figure 1bAmplifying the Historical Trend -
Baseline Revisited
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Figure 1c
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Figure 2Building a Levy in the Fifth Period
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Figure 3Smoothing Variation with an Upstream Dam
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Figure 4Reducing Flood Threat by Dredging
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Figure 5a Initial Conditions
Variable 2

• A0

• B0

Variable 1
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Figure 5b Conditions in 50 Years
Variable 2

• A50

• B 50

Variable 1
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Figure 5c Trajectories of Sustainability Indices
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Figure 6Sustainability Indices for the
Hypothetical River Example
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Public Health Perspective

• Public health seeks to identify and reduce both
  the background level of disease and any epidemics
  or outbreaks.
• Public health does not use the terminology or the
  concept of a coping range. Use of the term
  suggests a range within which significant
  consequences are not observed.
• Adaptation policies and measures are needed now
  to address current conditions.
• Public health has recognized thresholds for
  centuries.

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Public Health and Thresholds

• It is difficult to generalize approaches to
  thresholds because each is specific to a
  particular exposure-response relationship.
• Exposures that exhibit J- or U-shaped
  relationships with health outcomes, where either
  too little or too much is detrimental to health
  (i.e., ambient temperature and oxygen).
• Exposures that have threshold relationships with
  health outcomes, where low doses are not
  associated with increased morbidity and mortality
  (i.e., arsenic and dose required to develop a
  case of cholera).
• Exposures that have linear relationships with
  health outcomes (e.g., tobacco smoking and
  asbestos).

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Example with A Zero ThresholdEradication of
Smallpox

• Smallpox is a highly infectious viral disease
• Repeated epidemics have decimated populations
• Spread is person-to-person
• Case fatality rate up to 25
• No effective treatment
• No carrier state and no animal reservoir
• Potent and stable vaccine available
• 1967 eradication campaign launched
• 1980 smallpox eradicated
• Budget 81 million (WHO) 232 million
  (country-level and bilateral assistance)

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Example with a Positive ThresholdArsenic

• Arsenic is a metalloid that is abundant in the
  earths crust
• Environmental exposures are primarily through
  food water
• Average daily intake 20-300 ug
• Adverse health effects begin once an individuals
  threshold body burden is exceeded
• Groundwater standards
• WHO 10 ug/L
• Bangladesh 50 ug/L
• In Bangladesh, 28-57 million people consuming
  water above the standard
• 1/100-300 people who consume water containing gt50
  ug/L may suffer an arsenic-related cancer (lung,
  bladder, liver)

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Issues of Scale

• Determinants of Adaptive Capacity operate on
  different scales from site to site.
• Some are truly macro in scale - provide handles
  for national and even international intervention
• This can be true even if their relevant
  manifestations are micro in scale
• Prerequisites for Prevention do the same

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Relationship Between Vulnerability to Natural
Disasters and Income
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Relationship Between Vulnerability to Natural
Disasters and Income
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Relationship Between Vulnerability to Natural
Disasters and Income
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A Caveat - Incorporating the Second Best into
the Adaptation Baselines

• Local scale implications are most critical.
• Determinants and prerequisites can work to
  support or impede specific adaptations.
• Relating adaptations to their efficacy in
  reducing exposure or sensitivity can be
  accomplished.
• Looking for patterns here can uncover the macro
  scale implications.
• BUT adaptation baselines must reflect existing
  distortions analysis can investigate the
  implications of reducing their power.
• Public Health can be a natural laboratory for
  examining how to do this.

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A Template for Adaptation Analysis in Either
Context

• Proper vulnerability cum adaptation analyses must
  confront these issues directly by comparing
  results from a series of runs into the future.
• One might, for example, look at the future with a
  given adaptation baseline (with existing
  distortions and impediments) and no extra stress.
  
• A second set of runs into the future might then
  persist with the no extra stress assumption but
  include adjustments in adaptation that could be
  anticipated to reduce exposure or sensitivity to
  present vulnerability.

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A Template for Adaptation Analysis in Either
Context

• A third set of runs could then impose the extra
  stress on the adaptation baseline (the first set)
  to see how they might work.
• A fourth collection could repeat the analysis
  with anticipated adjustments (the adjusted
  baseline for the second set of runs).

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A Template for Adaptation Analysis in Either
Context

• In every case, however, it is critical that the
  analysis presumes neither dumb actors who will
  not respond to any changes in environment nor
  clairvoyant actors who know everything from the
  very beginning.
• The future will be fraught with uncertainty, just
  like the present and any considerations of
  adaptation must recognize this fact.
• A complete vulnerability cum adaptation analysis
  of a particular region or sector would
  contemplate a range of not-implausible.

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Applying the Template - Coastal Storms and Sea
Level Rise

• S1 - Storm scenarios with current practices
• S2 - Storm scenarios with enlarged set-backs
• S3 - Rerun S1 with climate induced sea level rise
  and changes in storm patterns - frequency and/or
  intensity
• S4 - Rerun S2 with climate change
• S3 vs S1 - Cost of climate change along current
  baseline
• S2 vs S4 - Cost of climate change with modified
  baseline
• S1 vs S2 - Value of modification absent climate
  change
• S3 vs S4 - Value of modification with climate
  change

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Synthesis and Conclusions

• Vulnerability means different things in the two
  communities.
• Approaches can still be comparable.
• Determinants hypotheses supported by health
  understanding of the prerequisites for
  prevention.
• Any thoughts?