CLIMATE CHANGE AND PUBLIC HEALTH ADAPTATION IN INDONESIA

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• CLIMATE CHANGE AND PUBLIC HEALTH ADAPTATION IN
  INDONESIA
• Budi Haryanto
• Department of Environmental Health
• Faculty of Public Health University of
  Indonesia
• The Nautilus Institute Workshop on Mapping Causal
  Complexity
• in Climate Change Impacts and Adaptation,
• Melbourne, 21-22 November 2008

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INTRODUCTION

• Climatic changes have already affected numerous
  damaging impacts on human health.
• Spreading infectious disease, longer and hotter
  heat waves, and extreme weather claim thousands
  of additional lives nationwide each year.
• Warming climate is creating the ideal conditions
  for spread of infectious disease, putting
  millions of people at risk.
• Climate change has lead to increase the outbreaks
  and spread of Dengue Hemorrhagic Fever (DHF),
  malaria, cholera, encephalitis, hantavirus, and
  other diseases all over the world.
• Ironically, the countries which have less
  contributed to the global warming are highly
  susceptible and more outbreaks of diseases and
  deaths due to global warming impact

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OUTLINE PRESENTATION

1. Introduction
2. Climate change and health impacts
3. Research in Indonesia
4. Public health adaptation
5. Strategic idea for public health adaptation in
   Indonesia

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EXTREME EVENTS HEALTH IMPACTS (DoH, WA)
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Potential health impacts of gradual climatic
changes
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Potential health impacts of gradual climatic
changes
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Potential health impacts of gradual climatic
changes
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Potential health impacts of gradual climatic
changes
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Trend of Temperature and DHF Cases in Indonesia
1968-Sept 2007
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Dengues principal vector Aedes aegypti
Principal vector is female Aedes aegypti
mosquito. Infected mosquito remains infective for
life. Indonesia reported dengue cases doubled in
2007 vs. 2005.
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Malaria Cases
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Malaria Endemic Areas
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Effects of Temperature Rise on Dengue
Transmission

• Shorten viral incubation period in mosquito
• Shorten breeding cycle of mosquito
• Increase frequency of mosquito feeding
• More efficient transmission of dengue virus from
  mosquito to human

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IMPACTS CLIMATE CHANGE ON HUMAN HEALTH IN
INDONESIA

• Direct effects
• Increasing of injuries associated with extreme
  weather events
• Indirect effects
• Increasing of vector borne diseases (malaria,
  dengue, filariasis) associated with increasing of
  temperature, rainfall, humidity, and vector
  density.
• Increasing of water borne diseases (diarrhea,
  cholera, typhoid, leptospirosis) associated with
  decreasing of water quality and water supply as
  well as floods and droughts.

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• Indirect effects
• Increasing of malnutrition cases is related to
  food production and land use shifts
• Increasing of cardio cerebral vascular diseases,
  hypertension, and mental disorders are associated
  with urban stress, life style, displacements and
  conflicts.
• Increasing of influenza (ARI) and respiratory
  diseases (asthma, pneumonia) are associated with
  increasing of air pollution outdoor as well as
  indoor
• Increasing of food borne diseases is associated
  with contamination, food handling, and poverty.

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MAIN CONCERN SPREADING OF DISEASES

• Unique transmission pathways
• Specific for every single disease outcome
• Once the impact occurred, the disease will spread
  from infected person to others and from the new
  infected people to broader population as snow
  ball phenomenon
• The spread of disease may not be controlled
  directly even by manipulating or modifying the
  environment
• Analysis of each of these steps allows a logical
  determination of vulnerability and subsequent
  development of adaptive measures that aim to
  decrease vulnerability
• It will need specific discipline of technology,
  method, and expert such as public
  health/environmental health, medical, and
  pharmacy to deal with the impacts.

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CURRENT RESEARCH REVIEWS

• Rainfall and rain date in Jakarta associated with
  Incidence Rate and Case Fatality Rate of Dengue
  Infection in 2002-2006 by Nainggolan L et al., UI
  07.
• Aedes aegypti density in Jakarta associated with
  climate change by Sungkar S et al., UI 07.
• The influence of climate change to the spreading
  of dengue virus serotypes and the increasing of
  cases in Jakarta by Adriansjah et al., UI 07.
• Pulmonary tuberculosis and climate change in
  Indonesia by Burhan E et al., UI 07.
• The incidence of leptospirosis and its risk
  factors in Jakarta by Nainggolan L et al., UI
  07.
• Mental health of adolescents associated with
  climate change by Ismail RI et al., UI 07.
• Increasing morbidity and mortality caused by air
  pollution associated with climate change in City
  of Bandung 2002-2006 by Soemirat J Dirgawati
  M, ITB 07.
• Occupational dermatosis incident associated with
  climate change in Surabaya by Martiana T et al.,
  Unair 07.
• Lung disorders associated with climate change in
  Jakarta by Andarini S et al., UI 07.

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Research

• Lung cancer associated with climate change in
  Jakarta by Syahruddin E et al., UI 07.
• Predicting the increasing of malaria cases in
  endemic area caused by climate change 2002-2003
  by Yudhastuti R et al., Unair 07.
• Approach and method of studies on health and
  infectious diseases-related to climate change by
  Haryanto B, UI 07.
• Early warning system for malaria outbreak by
  Subirosa BS et al., UI 07.
• The pattern of malaria distribution as impact of
  climate change in Pacitan regency 1998-2002 by
  Chatarina UW et al., Unair 07.
• Global warming ad public health impact in
  Indonesia by Sutomo S, UI 07.
• Climate change and DHF in Tanah Laut District of
  South Kalimantan Province 2001-2006 by Basuki H
  et al, Unair 07.
• Climate change and voice of public health
  association in Indonesia by Indonesian Public
  Health Association 2007.

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Health impact assessment

• to evaluate the impact of climate variability and
  change in a range of areas and populations
• to evaluate possible threshold effects
• to evaluate the effects of multiple stresses,
  including changes in socioeconomic systems
• to evaluate uncertainty and its implications for
  risk management
• to evaluate the effects of reducing emissions,
  such as by comparing impact under scenarios with
  business-as-usual and stabilization of emissions
  and
• to measure coping capacity, especially under
  different socioeconomic futures and in the
  context of sustainable development.

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PUBLIC HEALTH RESPONSE AND ADAPTATION IN INDONESIA

• Infectious disease surveillance
• Health action in emergencies
• Safe drinking water
• Integrated vector management
• Environmental health capacity building
• Healthy public policy (healthy housing, school,
  forest, industry, city)

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WHO Adaptation Focus

• Health security
• Strengthening health systems
• Health development
• Evidence and information
• Delivery
• Partnership

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PUBLIC HEALTH ADAPTATION IDEAS IN INDONESIA

• Empowering ecological-diseases surveillance
  system and developing public health early warning
  system
• Development response to disaster effects of
  climate change
• Enhancing capacity building for government,
  private sector, and civil society on managing
  prevention and control climate change on human
  health
• Increasing political awareness on climate change
  human health
• Empowering public health services system for
  disease prevention and control
• Generating research and method on epidemiology
  and medicine to find out the approach in breaking
  the disease transmission chains
• Preventing and eradicating climate change
  vector-related diseases

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Impacts, Vulnerability, Adaptations
Characteristics of exposed group (location,
wealth, resources, health status, culture, etc.)
Adaptations
Vulnerability of group
Learning
Actions in response to impact
Health Impact
Exposure
Mitigation Reduced exposure
BREAKING TRANSMISSION CHAINS
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THANK YOU