Addressing Health Adaptation Gaps: Synergies between ...Vector-borne diseases Estimated or reported annual cases of selected vector-borne diseases (WHO, 2017c): • Malaria: 212 million.

Addressing Health Adaptation Gaps: Synergies between Sustainable Development Goals

Keynote, BSF 2019, Basel, Switzerland

Guéladio Cissé 1, 2

Head, Ecosystem Health Sciences Unit Department of Epidemiology and Public Health 1 Swiss Tropical and Public Health Institute (Swiss TPH) 2 University of Basel, Switzerland

Overview •  Insights from the UNEP

Adaptation Gap Reports •  UNEP Gap Report 2018: focus on

health (Infectious diseases, Heat, Nutrition)

•  How to address health adaptation gaps

•  Highlights of synergies needed from SDGs

3

Framework for Adaptation Gaps

Source: UNEP GAR 2014

Inappropriate, Ineffective Practice

Appropriate, Effective Practice

Adaptation Gap Knowledge Gap

Implementation Gap

Residual Impacts Gap

AdaptationGapTypology

Source: Peter Berry 2018

Appropriate, Effective Practice

Inappropriate, Ineffective Practice

Implementation Gap

Knowledge Gap Residual Impacts Gap

Adaptation Gap Over Time

Time 2050 2030

Impa

cts

Source: Peter Berry 2018

6

Estimatingtheadaptationgap:morechallengingthancalculatingtheemissionsgap-  Nogloballyagreedgoalormetricsforadaptation-  Adaptationisaresponsetospecificclimaterisksandimpactsoftenlocalinnatureandvariableovertime-Needfindingwaysofmeasuringtheadaptationgapsothatprogresstowardsreducingitcanbemonitored

Defining Adaptation Gap: a challenge

Funding Technology Knowledge

Source: UNEP GAR 2014

7

Adaptation Funding Gap

Source: UNEP GAR 2014

8

Adaptation Technology Gap

Source: UNEP GAR 2014

9

Adaptation Knowledge Gap

Source: UNEP GAR 2014

Adaptation gap in health

Thedifferencebetweentheclimate-relatedhealthoutcomesunderactualadaptationeffortsandtheclimate-relatedhealthoutcomesthatwouldoccurunderdesirablelevelsofhealthadaptationefforts,consistentwithasocietallysetgoalforadaptation.

Source: UNEP GAR 2018

Adaptation GAR 2018: Focus on Health

Chap 6- Heat & EEs Chap 7- Inf. Disease Chap 8- Nutrition

•  Baseline situation: a significant, largely preventable, current burden of climate-related illness and mortality

•  Projections

•  Addressing gaps

Heat and Extreme Events

CurrentimpactsalreadythreatenhealthofvulnerablepopulationsinmanyregionsProjectedincreasesinheatandextremeweathereventsandchangingsocio-demographictrendswillfurtherincreaseexposureandrisks

Disasters,manyofwhichareexacerbatedbyclimatechangeandwhichareincreasinginfrequencyandintensity,significantlyimpedeprogresstowards

sustainabledevelopment.

SendaiFrameworkforDisasterRiskReduction2015-2030

HeatandExtremeEvents

Heat and Extreme Events Vulnerable Groups

•  Theelderlyfromdysfunctionalthermoregulatorymechanisms,chronicdehydration,medicationandpre-existingdiseases

•  Pregnantwomenandfoetuses;extremeheatisariskfactorforadversebirthoutcomessuchaslowbirthweightandprematurebirth

•  Patientswithchronicdiseases;forexample,peoplewithdiabetes,whoareobeseandthosewithcognitiveimpairments

•  Outdoorseasonalworkers

•  TravellersSociallydisadvantagedorisolatedgroups

•  Migrants,refugeesandinternallydisplacedpeople

Infectious diseases

Cissé et al. 2018; UNEP AGR, 2018

Infectious diseases : #20 percent of the global burden of disease (Murray et al., 2012). Three important categories of infectious diseases sensitive to climate change: (i)   water-borne diseases (WBDs); (ii)   food-borne diseases (FBDs); and (iii)  vector-borne diseases (VBDs) Adaptation gap associated with infectious diseases, focus on WFDs and VBDs.

Infectious diseases CurrentbudenandprojectionsforWFBDsandVBDs

Exposure/outcome Currentimpacts ProjectedimpactsW a t e r -a n df o o d -b o r n edisease

•  In2016,diarrheacausedaround1.7milliondeaths,includingalmost450,000inchildrenyoungerthanfiveyears(Troegeretal.,2017).

•  600millionfood-borneillnessesand420,000associateddeathsin2010(WHO,2015b).

•  InEurope,themostprevalentwater-andfood-bornediseaseiscampylobacteriosis,whichishighlysensitivetoclimate(ECDC,2012).

•  Global projections (WHO, 2014); 48,000additional deaths per year in childrenagedunder15yearsareprojectedduetodiarrheal disease for the year 2030 and33,000deathsfor2050.

•  InEuropeinthe2080s,climatechangecouldinduceanadditional40,000casesofsalmonellaannually(Watkissetal.,2009).

Vector-bornediseases

Estimatedorreportedannualcasesofselectedvector-bornediseases(WHO,2017c):

•  Malaria:212million.•  Schistosomiasis:207million.

•  Dengue:96million.

•  Lymphaticfilariasis:38.5million.

•  Onchocerciasis:15.5million.

•  Globalprojections (WHO,2014):60,000additionaldeaths peryearfrommalariafortheyear2030and33,000deaths for2050.

•  Climatechangewillcontinuetoincreasetheriskoftick-bornediseases(Stoneetal.,2017).

Infectious diseases Projectionsforfoodandwater-bornediseases(2)

WHO, 2014

Infectious diseases Current burden of vector-borne diseases (2)

WHO, 2014

InfectiousdiseasesProjectionsforvector-bornediseasesMostmodelsprojectanincreasedriskforVBDtransmissionathighlatitudesduringthenextcentury(Tjadenetal.,2017).

WHO, 2014

Infectious diseases

Addressbothimplementationgapsandknowledgegaps-  IncreaseaccesstoWASH-  InvestmoreinhealthresearchinareasthataremostaffectedbyWBDandFBD

-  Moreeffortsforreducingthepopulationofparasites,microbesandvectors

-  Improveintegratedvectormanagement-  Reducehumanexposure-  Reducetheburdenofdiseases

-  MakeprogresstowardsSDGs.

Unequalexposuresandimpacts•  Majorityoftheworld’shungrypeopleliveindevelopingcountries,

where12.9percentofthepopulationisundernourished.

•  Poornutritioncausesnearlyhalf(45percent)ofdeathsinchildrenunderfive–3.1millionchildreneachyear.

•  AsiaandAfricarepresentnearlyallofthecurrentstuntingburden.

•  SouthAsiarepresentsmorethanhalfofthosewasted.•  Missedtarget:reducethenumberofstuntedchildrenby40%as

comparedwith2012by2025.

FoodandNutritionalSecurity

Climatechangewillmakesitworse…•  Mortality

•  95’176additionalundernourishmentrelateddeathsinchildrenunderfiveby2030and84’697by2050.

•  Undernourished•  530-550millionundernourishedby2050@1.5°C•  540-590millionundernourishedby2050@2°C

•  Stunting•  570’000(underprosperity/lowclimatechangescenario)•  >1million(underthepoverty/highclimatechangescenario)•  7.5millionmoderatelyandseverelystunted(2030)and10.1

m(2050)underbase-casesocio-economicscenario.

FoodandNutritionalSecurity

Multi-level governance: resources, sectors, and actors

FoodandNutritionalSecurity

Need Climate Resilient Health Systems

•  The overall presence of health-sector activities in international climate adaptation finance stands at less than one percent.

•  Additional resources are needed to build the capacities of health professionals to deal with climate-related impacts

•  Accelerated action on basic climate-sensitive determinants of health within SDGs (WASH, evidence-based interventions to avoid malnutrition, etc.)

•  Early warning, monitoring and DRR (including building evidence base and improving data coverage)

NEEDOFABROADERDEVELOPMENTPERSPECTIVE

HEALTH in the SDG ERA

WHO

Increase Synergies from SDGs

•  Twopolicy-relatedclustersarehighlighted:WaterSupplyandSanitationandHealthandHealthcareofIndigenousPeoples.

•  Water Supply and Sanitation: a central concern linking Environment and Health

•  NEEDFORSUSTAINEDACTION

Nakamura et al. 2019 Web of Sc. Group

Increase Synergies from SDGs

•  Africa,theArabStates,andLatinAmericaare,bycontrast,smallparticipantsdespitethefactthatSDGsarekeyconcernsintheseregions.

•  EuropeannationsdominateSDGsresearch,withNorthAmericaandtheAsia&Pacificregioncontributingless,butroughlysimilar

Nakamura et al. 2019 Web of Sc. Group

EEA Report No 1/2018 National climate change vulnerability and risk assessments in Europe, 2018

Source: EEA Report 2018

Timelines of CCIV information and adaptation policy developments for Switzerland

Source: EEA Report 2018

Countries to do more for NAPs & SDGs

The Lancet 2018 391, 581-630DOI: (10.1016/S0140-6736(17)32464-9) Weneed:•  Moreofthem•  Betterones,insomecases•  Fortheexistingonestobeimplemented

Thank you very much for your attention

gueladio.cisse@swisstph.ch