Climate Adaptation Strategy for Health: Assessment Report on Climate Change Risks to Health at District Hospitals

Samoa is highly vulnerable to the health impacts of climate change. It currently experiences climate variability and extremes (cyclones, floods, droughts) and has a number of climate-sensitive risks that threaten public health. This assessment reviews the current adaptation activities in Samoa as they relate to health. Information was gathered through consultation with stakeholders and review of policy and other documents in order to identify current practices, limitations and needs. Four climate sensitive health risks were previously identified as being of particular concern for Samoa under climate change, and require adaptation activities. These are the health risks associated with extreme events, water and food borne communicable disease, vector borne disease and malnutrition. There was broad agreement among participants in this consultation process that these are important health risks that should be prioritised in health adaptation planning

Climate Adaptation Strategy for Health and Action Plan: Part of the Project “Integrating Climate Change Risks in the Agriculture and Health Sectors in Sāmoa”

Climate change threatens the social, cultural and ecological underpinnings of health and wellbeing. Major health risks related to climate change include loss of life and injury from extreme climate events, communicable and vector borne diseases and malnutrition. Some of these risks can be managed within the health sector, but most require intersectoral collaboration for effective prevention. Broad objectives for climate-health adaptation include the following: strengthen the capacity of health sector to provide protection from climate-related risks; ensure that health concerns are addressed in decisions in other sectors to reduce risks from climate change, and; increase awareness of the health consequences of climate change. We summarize activities that are currently in place in Samoa - within and outside the health sector - that aim to address present-day climate sensitive health risks. These activities do not, in general, consider the potential for climate change to alter or intensify these risks. Deciding on priorities for adaptation to climate change is difficult, due to incomplete information on existing health risks as well as the effectiveness, feasibility, cost and equity implications of potential actions. However, many “no-regrets” or “low-regrets” adaptation policies are available, which would be beneficial regardless of the projected impact of climate change on health. In consultation with stakeholders and using the identified climate sensitive health risks, a matrix was developed to help inform decisions on priority-setting for health adaptation activities. Public health in Samoa is vulnerable to climate change, especially as it relates to flooding and other extreme events, but also to longer term changes to climate averages. Samoa is already subject to a number of climate-sensitive health problems that are not well addressed, and Samoa’s vulnerability to these may be increased with climate change. There was broad agreement on the important climate sensitive health risks that should be considered in climate change adaptation planning. Many of the needs identified for adaptation planning relate to data and information. A lack of data was noted as a significant limitation across sectors. Data is required to establish baseline relationships between, for example, climate variables and health outcomes, in order to estimate future risks, plan appropriate adaptation activities and evaluate the impacts of such activities. Improved laboratory testing and surveillance is a high priority, as are research projects to establish baselines and trends in climate sensitive health risks. A process for sharing information across sectors would improve understanding of responsibilities and relationships between sectors and add value to research. Increasing capacity – technical expertise, for example in research and monitoring – as well as in community resilience was also identified as an important need

Dengue : distribution and transmission dynamics with climate change

Dengue is a mosquito-borne disease (family: Flaviviridae) transmitted by the urban-dwelling mosquito Aedes aegypti and, less efficiently, by the cold-tolerant species Aedes albopictus. Approximately 390 million people living in tropical and subtropical regions are infected each year (Bhatt et al., 2013). It affects mainly people living in urban areas and on the urban fringe because the primary vector, Ae. aegypti, is well adapted to urban environments and feeds preferentially on humans. Dengue manifests with a wide range of severity, from asymptomatic to life threatening. Dengue can only be treated symptomatically; there is no effective antiviral treatment. Current vaccines are only partially effective, and in any case may not be affordable for the majority. Several factors must exist for dengue virus transmission to occur. Climatic conditions that are both appropriate for the biology and ecology of the vector and warm enough for virus replication are necessary – but not sufficient. Within these climatic constraints, biotic and societal factors determine whether or not the transmission of dengue actually occurs, and also its intensity. A viral source in a human is required for transmission to occur: the virus is not thought to ‘overwinter’ in the vector. In non-endemic regions with a suitable vector, the importation of the virus via, for example, infected tourists or returning workers is necessary for transmission. Human migration is not required if the virus is endemic. There also needs to be the presence of competent dengue vectors. Finally, there must be contact between these vectors and a susceptible (non-immune) human population. These factors are driven and shaped by social, economic and environmental circumstances

Human Health Review and Research Synthesis: Prepared for the Office of Environment and Heritage for the Sydney Adaptation Strategy New South Wales, Australia

This Report reviews current and emerging research in health adaptation planning for climate change for the Sydney Adaptation Strategy. Increases in temperature and altered rainfall patterns have been observed for Sydney over recent decades, and further changes are projected for future decades. Temperatures will continue to increase, as will the annual number of ‘hot days’, while weather extremes such as droughts and severe storms are expected to become more frequent and more intense. A number of adverse health outcomes are expected as a consequence of climate change, including increases in heat-­‐related illness and mortality, vector-­‐borne disease, and certain infections. Without adequate adaptation planning, climate change may place a considerable burden on the health of Sydney’s population. Based on the nine research themes identified in the Human Health National Adaptation Research Plan, this Report reviews recent and emerging research, and identifies priorities and needs to further research to inform health adaptation planning. Information for this report was gathered from the literature (peer-­‐reviewed and published reports) and through interviews with expert researchers, policy makers and practitioners. The nine themes are: Heat; Extreme weather events; Vector-­‐borne disease; Food safety and quality; Air quality; Water quality; Mental health; Community and Indigenous health; and Health services and infrastructure

Climate change and health vulnerability in informal urban settlements in the Ethiopian Rift Valley

Climate change in Ethiopia is occurring against a backdrop of rapid population growth and urbanization, entrenched poverty and a heavy burden of disease, and there is little information on specific health risks with which to approach adaptation planning and strengthen adaptive capacity. Using detailed household surveys (400 households, 1660 individuals, 100% participation) and focus groups in two informal urban communities in the Southern city of Shashemene, we identified locally relevant hazards and found that climate change is likely to intensify existing problems associated with poverty. We also showed that despite their proximity (situated only 1 km apart) the two communities differ in key characteristics that may affect climate change vulnerability and require nuanced approaches to adaptation. Detailed, community-level research is therefore necessary, especially where other sources of data are lacking, to ensure that adaptation activities in the world's poorest communities address relevant risks

Deaths in a sunburnt country: differential mortality responses to temperatures in a 'hot' country and implications for climate change adaptations

We present an analysis of the association between daily temperatures and mortality that we conducted for the Australian government’s Climate Change Review (the Garnaut Review), which explores for the first time the differential effects of temperature on mortality in Australia according to region and uses these baselines to model likely climate change impacts. Compared with much of Europe and North America, with whom Australia shares a substantial proportion of its genetic and cultural heritage, Australia is a relatively hot count

Garnaut Climate Change Review: The Impacts of Climate Change on Three Health Outcomes: Temperature-Related Mortality and Hospitalisations, Salmonellosis and Other Bacterial Gastroenteritis, and Population at Risk From Dengue

Climate change will affect the health of Australians over this century in many ways. Some impacts will become evident before others. Some will occur via quite direct pathways (e.g. heatwaves and death); others will occur via indirect pathways entailing disturbances of natural ecological systems (e.g. mosquito population range and activity) or disruption to livelihoods and communities (e.g. mental health consequences of prolonged droughts and regional drying trends). Most health impacts will occur at different levels among regions and population sub-groups, reflecting the influence of environment, socioeconomic circumstances, infrastructural and institutional resources, and local preventive (adaptive) strategies on the patterns of disease. The likely health impacts are many and varied. The main health risks in Australia from climate change include: health impacts of weather disasters (floods, storms, cyclones, bushfires, etc.); health impacts of temperature extremes, including heatwaves; mosquito-borne infectious diseases (e.g. dengue fever, Ross River virus disease); food-borne infectious diseases (including those due to Salmonella, Campylobacter and many other microbes); water-borne infectious diseases, and other health risks from poor water quality; diminished food availability: yields, costs/affordability, nutritional consequences; increases in urban air pollution (e.g. ozone), and the interaction of this environmental health hazard with meteorological conditions; changes in aeroallergens (spores, pollens), potentially exacerbating asthma and other allergic respiratory diseases; mental health consequences of social, economic and demographic dislocations (e.g. in parts of rural Australia, and via disruptions to traditional ways of living in remote Indigenous communities) At this stage of research and understanding, and in context of available time and resources, it is only possible to include a minority of those anticipated health impacts in this quantitative modelling exercise

Effects of acculturation on lifestyle and health status among older Vietnam-born Australians

Abstract Vietnamese immigrants represent a substantial culturally and linguistically diverse population of Australia, but little is known about the health-related effects of acculturation in this population. This study investigated the relationship between measures of acculturation and lifestyle behaviors and health status among 797 older Vietnam-born Australians who participated in the 45 and Up Study (www.45andup.org.au). The findings suggested that higher degrees of acculturation were associated with increased consumption of red meat, white meat, and seafood; higher levels of physical activities; and lower prevalence of overweight and obesity, type 2 diabetes, and smoking (in men). Targeted health messages could emphasize eating more vegetables, avoiding smoking and alcohol drinking, and increasing levels of physical activity

Physical activity and psychological distress in older men : findings from the New South Wales 45 and Up Study

Physical activity is an important factor in healthy aging and has been shown to reduce depressive symptoms. This association, however, is relatively understudied in older men. This study was a cross-sectional analysis of the association between physical activity (Active Australia Survey) and psychological distress (Kessler-10). Participants were a sample of 17,689 men age ≥65 yr drawn from a large-scale Australian cohort study of people age 45 years and over (The 45 and Up Study). The likelihood of reporting high or very high levels of psychological distress decreased with increasing weekly sessions of physical activity. Compared with participants reporting no sessions of physical activity, the fully adjusted odds ratio for high or very high psychological distress was .66 (95% CI .51-.85) for men who undertook 1-6 sessions of physical activity per week and decreased to .57 (95% CI, .43-.79) for men who reported 16 or more weekly sessions. The cross-sectional findings show that older men who are more active are less likely to report psychological distress, regardless of their level of functional limitation. Further research, informed by these findings, is required to investigate causal pathways and the temporal sequence of events

Prospective cohort study of body mass index and the risk of hospitalisation : findings from 246 361 participants in the 45 and Up Study

Objective: To quantify the risk of hospital admission in relation to fine increments in body mass index (BMI). Design, setting and participants: Population-based prospective cohort study of 246 361 individuals aged ≥45 years, from New South Wales, Australia, recruited from 2006-2009. Self-reported data on BMI and potential confounding/mediating factors were linked to hospital admission and death data. Main outcomes: Cox-models were used to estimate the relative risk (RR) of incident all-cause and diagnosis-specific hospital admission (excluding same day) in relation to BMI. Results: There were 61 583 incident hospitalisations over 479 769 person-years (py) of observation. In men, hospitalisation rates were lowest for BMI 20-<25 kgm-2 (age-standardised rate:120/1000 py) and in women for BMI 18.5-<25 kgm -2 (102/1000 py); above these levels, rates increased steadily with increasing BMI; rates were 203 and 183/1000 py, for men and women with BMI 35-50 kgm-2, respectively. This pattern was observed regardless of baseline health status, smoking status and physical activity levels. After adjustment, the RRs (95% confidence interval) per 1 kgm-2 increase in BMI from ≥20 kgm-2 were 1.04(1.03-1.04) for men and 1.04(1.04-1.05) for women aged 45-64; corresponding RRs for ages 65-79 were 1.03(1.02-1.03) and 1.03(1.03-1.04); and for ages≥80 years, 1.01(1.00-1.01) and 1.01(1.01-1.02). Hospitalisation risks were elevated for a large range of diagnoses, including a number of circulatory, digestive, musculoskeletal and respiratory diseases, while being protective for just two-fracture and hernia. Conclusions: Above normal BMI, the RR of hospitalisation increases with even small increases in BMI, less so in the elderly. Even a small downward shift in BMI, among those who are overweight not just those who are obese, could result in a substantial reduction in the risk of hospitalisation