Box 86 Crosscutting case study indigenous populations and adaptation

A series of workshops organised by the national Inuit organisation in Canada, Inuit Tapiriit Kantami, documented climate-related changes and impacts, and identified and developed potential adaptation measures for local response (Furgal et al., 2002a, b; Nickels et al., 2003). The strong engagement of Inuit community residents will facilitate the successful adoption of the adaptation measures identified, such as using netting and screens on windows and house entrances to prevent bites from mosquitoes and other insects that have become more prevalent.

Another example is a study of the links between malaria and agriculture that included participation and input from a farming community in Mwea division, Kenya (Mutero et al., 2004). The approach facilitated identification of opportunities for long-term malaria control in irrigated rice-growing areas through the integration of agro-ecosystem practices aimed at sustaining livestock systems within a broader strategy for rural development.

Two or more countries can develop international responses jointly when adverse health outcomes and their drivers cross borders. For example, flood prevention guidelines were developed through the United Nations Economic Commission for Europe for countries along the Elbe, Danube, Rhine and other transboundary rivers where floods have intensified due to human alteration of the environment (UN, 2000). The guidelines recognise that co-operation is needed both within and between riparian countries in order to reduce current impacts and increase future resilience.

8.6.13 Individual-level responses

The effectiveness of warning systems for extreme events depends on individuals taking appropriate actions, such as responding to heat alerts and flood warnings. Individuals can reduce their personal exposure by adjusting clothing and activity levels in response to high ambient temperatures and by modifying built environments, such as by the use of fans, to reduce the heat load (Davis et al., 2004; Kovats and Koppe, 2005). Weather can partially determine cultural practices that may affect exposure. Adaptation in health systems

Health systems need to plan for and respond to climate change (Menne and Bertollini, 2005). There are effective interventions for many of the most common causes of ill-health, but frequently these interventions do not reach those who could benefit most. One way of promoting adaptation and reducing vulnerability to climate change is to promote the uptake of effective clinical and public-health interventions in high-need cities and regions of the world. For example, health in Africa must be treated as a high priority investment in the international development portfolio (Sachs, 2001). Funding health programmes is a necessary step towards reducing vulnerability but will not be enough on its own (Brewer and Heymann, 2004; Regidor, 2004a, b; de Vogli et al., 2005; Macintyre et al., 2005). Progress depends also on strengthening public institutions; building health systems that work well, treating people fairly and providing universal primary health care; providing adequate education, generating demand for better and more accessible services; and ensuring that there are enough staff to do the required work (Haines and Cassels, 2004). Health-service infrastructure needs to be resilient to extreme events (EEA, 2005). Efforts are needed to train health professionals to understand the threats posed by climate change.

8.6.2 Integration of responses across scales

Adaptation responses to specific health risks will often cut across scales. For example, an integrated response to heatwaves could include, in addition to measures already discussed, consideration of climate change projections in the design and construction of new buildings and in the planning of new urban areas (Kovats and Koppe, 2005). In addition, national energy efficiency programmes and transport policies could include approaches for reducing both urban heat islands and emissions of ozone and other air pollutants.

Interventions designed to increase the adaptive capacity of a community or region could also facilitate the achievement of greenhouse gas mitigation targets. For example, measures to reduce the urban heat-island effect, such as planting trees, roof gardens, growth planned to reduce urban heat islands, and other measures, increase the resilience of communities to heatwaves while reducing energy requirements. Increasing the proportion of energy derived from solar, wind and other renewable resources would reduce emissions of greenhouse gases and other air pollutants from the burning of fossil fuels.

8.6.3 Limits to adaptation

Constraints to adaptation arise when one or more of the prerequisites for public-health prevention have not been met: an awareness that a problem exists; a sense that the problem matters; an understanding of what causes the problem; the capability to influence; and the political will to influence the problem (Last, 1998). Decision-makers will choose which adaptations to implement where, when and how, based on assessments of the balance between competing priorities (Scheraga et al., 2003). For example, different regions may make different assessments of the public-health and environmental-welfare implications of the ecological consequences of draining wetlands to reduce vector-breeding sites. Local laws and social customs may constrain adaptation options. For example, although the application of pesticides for vector control may be an effective adaptation measure, residents may object to spraying, even in communities with regulations to assure appropriate use. Increasing awareness of climate-change-related health impacts and knowledge diffusion of adaptation options are of fundamental importance to better decision-making.

Although specific limits will vary by health outcome and region, fundamental constraints exist in low-income countries where adaptation will partially depend on development pathways in the public-health, water, agriculture, transport, energy and housing sectors. Poverty is the most serious obstacle to effective adaptation. Despite economic growth, low-income countries are likely to remain poor and vulnerable over the medium term, with fewer options than high-income countries for adapting to climate change. Therefore, adaptation strategies should be designed in the context of development, environment, and health policies. Many of the options that can be used to reduce future vulnerability are of value in adapting to current climate and can be used to achieve other environmental and social objectives. However, because resources used for adaptation will be shared across other problems of concern to society, there is the potential for conflicts among stakeholders with differing priorities. Questions also will arise about equity (i.e., a decision that leads to differential health impacts among different demographic groups), efficiency (i.e., targeting those programmes that will yield the greatest improvements in public health), and political feasibility (McMichael et al., 2003a).

8.6.4 Health implications of adaptation strategies, policies and measures

Because adaptation strategies, policies and measures can have inadvertent short- and long-term negative health consequences, potential risks should be evaluated before implementation. For example, a microdam and irrigation programme in Ethiopia developed to increase resilience to famine increased local malaria mortality by 7.3-fold (Ghebreyesus et al., 1999). Increased ambient temperatures due to climate change could further exacerbate the problem. In another example, air-conditioning of private and public spaces is a primary measure used in the USA to reduce heat-related morbidity and mortality (Davis et al., 2003); however, depending on the energy source used to generate electricity, an increased use of air conditioning can increase greenhouse gas emissions, air pollution and the urban heat island.

Measures to combat water scarcity, such as the re-use of wastewater for irrigation, have implications for human health (see Chapter 3). Irrigation is currently an important determinant of the spread of infectious diseases such as malaria and schistosomiasis (Sutherst, 2004). Strict water-quality guidelines for wastewater irrigation are designed to prevent health risks from pathogenic organisms and to guarantee crop quality (Steenvoorden and Endreny, 2004). However, in rural and periurban areas of most low-income countries, the use of sewage and wastewater for irrigation, a common practice, is a source of faecal-oral disease transmission. The use of wastewater for irrigation is likely to increase with climate change, and the treatment of wastewater remains unaffordable for low-income populations (Buechler and Scott, 2000)

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