This document summarizes a presentation on building resilient health systems for climate change. It discusses the need for frameworks to increase health system resilience. It provides background on key concepts like health, health systems, and environmental determinants of health. It then highlights research examples on how climate change impacts health through water and sanitation systems and vector-borne diseases. The presentation introduces a WHO framework with 10 components for resilient health systems and provides details on the health research and environmental health management components. It also discusses national climate change adaptation research plans, including Australia's plan for the health sector.

1. Climate Change and Health: need of frameworks
for building resilient health systems
Sharm El Sheikh, April 5, 2018, 09:00 – 09:30
Plenary: Risk Management Frameworks
Guéladio Cissé1,2,3
1 Swiss Tropical and Public Health Institute, Basel, Switzerland
2 University of Basel, Basel, Switzerland
3 James Cook University, Townsville, Australia

2. Swiss TPH/University of Basel

3. Swiss Centre
for
International
Health
Medicine
Education and Training
Epidemiology
and Public
Health
Medical
Parasitology
and Infection
Biology
<
Swiss Tropical and
Public Health Institute
Staff members
770from
60+nations
138working abroad,
632in Basel
Swiss TPH/University of Basel
5 Departments

4. • To recall a few major terms and concepts about
“health”
• To highlight with a few examples the importance
of research on relevant health components for
NAP
• To highlight the need for increasing the
resilience of health systems to face climate
change risks
• To present an operational framework for
increasing the resilience of health systems
• To emphasise the importance of health research
adaptation plans
Objectives of the talk

5. 1. Background: health, health sector, health systems
2. Climate and health research: a few illustration of
health systems challenges in face of climate
change
3. Operational framework for resilient health systems
4. Adaptation Research Plans
5. Questions and Outlook
Outline

6. 1. Background

7. Background
Health: a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity
Determinants of health
- Individual determinants of health
- Social determinants of health
- Environmental determinants of health
“Health” requires more than treating diseases and injuries
Taking care of these is key and at the roots
WHO

8. Background
Health care sector
Includes facilities that provide direct health treatment
procedures for patients.
(Health care vs Public health?)
Public health
All organized measures (whether public or private) to
prevent disease, promote health, and prolong life among
the population as a whole. Not only by heath care sector
(but an entire “health system”?)

9. Background
Health system: All organizations, people and actions
whose primary intent is to promote, restore or maintain
health
WHO: “health systems and health determining
sectors (e.g. water and sanitation, food and agriculture,
energy, urban planning)”
(Source : WHO 2015)
Human Health, Animal Health, Environmental Health
Ecosystem Health, …

10. Background
Ecohealth
• How changes in the earth’s
ecosystems affect human health
• Changes in the biological, physical,
social and economic environments
and how these changes relate to
human health
• Together physicians, veterinarians,
ecologists, economists, social
scientists, planners and others.
• Components: Human –
Ecosystems – Social
Environment

11. Background
One Health
• Designing and implementing
programs, policies, legislation and
research, particularly for the control
of zoonoses (diseases that can
spread between animals and
humans, such as flu, rabies and
Rift Valley Fever).
• Components: Human – Animal -
Environment
Example of Zoonotic diseases

12. Climate change and health
Source: www.cdc.org

13. 2. Climate change and
Health Research
• Vulnerabilities of water and sanitation systems
• Water-borne diseases
• Vector-borne diseases

14. Municipal Solid Waste
Currently global
# 1.3 billion tonnes per year
Expected by 2025
# 2.2 billion tonnes per year
Increase faster than population
growth
Change in consumption patterns
… Solid Waste on rise
(Source: WB 2012; Photo: turbosquid.com )

15. Wastewater on rise
Wastewater
1,500 km3 per day worldwide
>80-90% urban wastewater
improperly discharged,
insufficiently treated, and
directly or indirectly reused
Wastewater from industries is
on rise!
Source: UN World Water Development Report 2003; Corcoran et al 2010

16. Urban water - withdrawal and
pollution discharge
16
• Agriculture
• Domestic
• Industry

17. 2.1 Vulnerabilities of Water and
Sanitation Systems
Côte d’Ivoire

18. • What are the climate trends in the area?
• Where are the areas and communities most physically
vulnerable to floods within the city?
• What are the main water supply systems and
sanitation facilities in the city different zones?
• To what extent may floods impact health, through
water and sanitation systems in the most vulnerable
areas?
Research questions

19. Zone 1
Zone 3
Zone 2
City zones Korhogo

20. Photo: Kouakou E.

21. Peri-urban agriculture
Photos: Kouakou E.
Activities around the dam

22. Photos: Kouakou E.
Environmental health challenges

23. Stagnant Wastewater in the city
Rainy seasonDry season
Photo: Kouakou E.

24. Major waste dumps in the city
Dry season Rainy season

25. Photos: Kouakou E.
Water wells

26. Vulnerability map for water wells
Vulnerability maps

27. Urban contexts
Vulnerabilities
Water, sanitation and hygiene systems
Communication and bridge with policy actors

28. 2.2 Vulnerabilities of Water and
Sanitation facilities
South Africa
Informal settlements, Diarrhea

29. Research Program of a Joint Swiss-South Africa
Chair on Global Environmental Health
Areas/Projects
• Project 1: Pesticides
• Project 2: Air pollution
• Project 3: Water pollution
• Project 4: Climate change
• University of Cape Town
• Swiss Tropical and Public Health Institute / University of Basel
Source: Röösli et al. 2016
Illustration : Cape Town

30. 30
• Africa is urbanizing quickly
• At # 3.9%/year, urban
population growth rates in
Africa = highest in the world
• Urban growth highly
correlated to growth in slums
• Poor continuity of water
service and inadequate
water quality
• Cape Town: more than 20% of
the city households are located
in informal settlements
Urban Informal Settlements
Population Living in Slums in Africa
Source: World Bank

31. • Cape Flats rivers (Big and
Little Lotus rivers) in the
Southern Management Area of
the City of Cape Town
• Due to urbanisation and
encroachment: poor water
quality in these ‘rivers’
• Many of greater Cape Town’s
urban rivers water : unfit for
domestic or recreational use
River Water Quality in South Africa
Source: River Health Programme

32. The Lotus River catchment area
d service areas. Communities in the catchment range
lements, to low-and middle income communities
!
own (left) and different land use types in the Lotussocio-
to high
aquifer
Figure 5 Land use
• Cape Flats Aquifer
• 90,000 of 380,000 inhabitants
in informal settlements
• Great and Little Lotus River
• Variety of land use types
• Poor informal settlers : low
and middle income

33. Field toilet WeltvredenSolid waste- b/n Phola & Lotus park
Waste water discharged into L.R.
-Lotus Park
Pictures along the Lotus River
Canal near Ottery - commercial +
Industrial site
Photos: N. Redi

34. Kids playing around L. River Animals in L. Park area
A man cleaning his paint brush Weltvreden area after rain
Pictures along the Lotus River

35. Environmental health and diarrhea

36. 2.3 Climate and Diarrhea
Senegal
Thiam et al. 2017

42. 2.4 Climate and Malaria
Cote d’Ivoire
Impact of climate variability on the
transmission risk of malaria in northern Côte
d’Ivoire
Richard K. M’Bra1,2,3,4*, Brama Kone2,5, Dramane P. Soro1,2, Raymond T. A. S. N’krumah2,6, Nagnin Soro1
, Jacques A. Ndione7, Ibrahima Sy7
, Pietro
Ceccato8 , Kristie L. Ebi9 , Jürg Utzinger3,4, Christian Schindler3,4, Guéladio Cissé3,4
Mbra et al. 2018, submitted Malaria Journal

43. Climate change and malaria

44. 2.4 Climate, Diarrhea and Malaria
Mozambique
Horn et al. 2018, accepted IJERPH Journal
Fernanda Zermoglio, Anna Steynor,
Chris Jack, Izidine Pinto, Kris Ebi,
Lindsay Horn, Colin Quinn, James
Colborn

45. 3. Operational Framework for
Increasing the resilience of health
systems
Source: WHO 2015

46. 46Source: WHO 2015
A sound climate
adaptation plan will
therefore include many, if
not all, of the 10
components
10 Components of WHO Framework

47. 1. Leadership and governance
2. Health workforce
3. Vulnerability, capacity and adaptation assessment
4. Integrated risk monitoring and early warning
5. Health and climate research
6. Climate resilient and sustainable technologies and infrastructure
7. Management of environmental determinants of health
8. Climate-informed health programmes
9. Emergency preparedness and management
10. Climate and health financing
For each component:
A) Objectives of the implementation and
B) Examples of measurable outputs
Components of WHO Framework

48. A) Objectives for the implementation of this component
• Research agenda: multidisciplinary national research agenda
on climate change and health defined and endorsed by
stakeholders
• Support for research: research capacity on climate change and
health built by supporting relevant multidisciplinary networks,
making available financial resources and creating training
opportunities.
• Connect to policy: research findings on climate change and
health disseminated to and used by policy makers
#5 Health and climate research (WHO framework)

49. B) Examples of measurable outputs
Research agenda
National research agenda on climate change and health defined through the
organization of a stakeholder forum involving representatives from health
and other government ministries, research institutions, nongovernmental
organizations, the private sector and vulnerable populations
Support research
• Access to and linkage of data on meteorological information, health
determinants and outcomes enabled.
• Multidisciplinary research partnerships, knowledge management networks
and rosters of local experts established
#5 Health and climate research (WHO framework)

50. B) Examples of measurable outputs (cont.)
Support research (cont.)
• Financial backing mechanisms to support research programmes and
postgraduate training programmes established
Connect to policy
• Mechanism established for researchers to inform planning, policy and
stakeholder groups
• Policy makers included in the definition and review of research agendas
#5 Health and climate research (WHO framework)

51. #7 Management of environmental determinants
of health

52. A) Objectives for the implementation of this component
• Monitoring: joint monitoring of climate-sensitive environmental
risks against evidence based standards
• Regulation: regulatory policies protecting populations against
climate-sensitive environmental risks defined, revised and
enforced
• Coordinated management: environmental determinants of
health jointly managed, with clear roles and responsibilities
defined across sectors
Health and climate research (WHO framework)#7 Management of environmental determinants
of health

53. B) Examples of measurable outputs
Monitoring
• Integrated monitoring systems allowing collection and analysis of
data on environmental hazards, socioeconomic factors and
health outcomes established
• Evidence-based quality standards for climate-sensitive
environmental conditions defined
Regulation
• Regulations on key environmental determinants of health (air
quality, water quality, food quality, housing safety, waste
management) revised and enforced to reflect broader ranges of
expected climatic conditions
• Building regulations and waste management infrastructure,
environmentally sustainable and resistant to likely local extreme
events promoted
#7 Management of environmental determinants
of health

54. B) Examples of measurable outputs (cont.)
Coordinated management
• Health impact assessments for policy and programmes in sectors
such as transport, agriculture and energy, implemented
• Joint multisectoral risk management approaches to health risks
related to disasters, water, waste, food and air pollution (e.g.
food safety, diarrhoeal disease control, integrated vector
management, joined-up risk communication) undertaken
#7 Management of environmental determinants
of health

55. 4. Adaptation Research Plans

56. National Climate Change Adaptation
Research Plan
Australia
The Australian Government established the National
Climate Change Adaptation Research Facility
(NCCARF) in 2008
NCCARF developed National Climate Change
Adaptation Research Plans (NARPs) for eight
themes:
1. Emergency management
2. Human health
3. Marine biodiversity and resources
4. Settlements and infrastructure
5. Terrestrial biodiversity
6. Primary industries
7. Social, economic and institutional dimensions of
climate change; and
8. Freshwater biodiversity

57. National Climate Change Adaptation
Research Plan
Australia
The Australian Government established the National
Climate Change Adaptation Research Facility
(NCCARF) in 2008
NCCARF developed National Climate Change
Adaptation Research Plans (NARPs) for eight
themes:
1. Emergency management
2. Human health
3. Marine biodiversity and resources
4. Settlements and infrastructure
5. Terrestrial biodiversity
6. Primary industries
7. Social, economic and institutional dimensions of
climate change; and
8. Freshwater biodiversity

58. National Climate Change Adaptation
Research Plan
Human Health
Heat
• Which people are most vulnerable to short-term extremes of heat?
- Do levels of understanding of the nature of the risks, and
personal/household-level ways to ameliorate them, vary between these
population sub-groups?
- Are changes needed to mainstream public health policy?
• Do early warning systems for heat waves and other extreme weather
events reduce adverse health impacts?
- Which types of early warning systems are most effective?
Extreme weather events
Vector-borne diseases
Food, air and water quality

59. National Climate Change Adaptation
Research Plan
Implementation Plan
Evaluation of NCCARF , report 2017

60. 5. Outlook

61. • How many countries have a National Climate Change Adaptation
Research Plan?
• How many countries have developed specific Health National Climate
Change Adaptation Plan?
• How many countries have developed a National Climate Change
Adaptation Research Plan for Health?
• How many countries have already used the WHO framework for
climate resilient health systems?
• How many countries have implemented the component 7 of the
framework?
• What difficulties to anticipate for research on environmental health
challenges?
Questions

62. • Collaboration between countries on Health Adaptation Plans
• Regional collaboration on Health Adaptation Plans
• Collaboration on Health Research Adaptation Plans
Outlook

63. Thank you very much
Contact:
gueladio.cisse@unibas.ch
gueladio.cisse@swisstph.ch