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An Approach for Assessing Human Health Vulnerability and Public Health Interventions toAdapt to Climate ChangeAuthor(s): Kristie L. Ebi, R. Sari Kovats and Bettina MenneSource: Environmental Health Perspectives, Vol. 114, No. 12 (Dec., 2006), pp. 1930-1934Published by: Brogan & PartnersStable URL: http://www.jstor.org/stable/4119609 .

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ResearchIMini-MonographAn Approachfor Assessing HumanHealthVulnerabilityand PublicHealthInterventionsto Adaptto ClimateChangeKristieL.Ebi,1R.Sari Kovats,2and BettinaMenne3'ESS, LLC,Alexandria,Virginia,USA;2Departmentof PublicHealthand Policy,London School of Hygieneand TropicalMedicine,London,UnitedKingdom;3WorldHealthOrganizationRegional Officefor Europe,EuropeanCentre or Environmentand Health, Rome, Italy

Assessments f the potentialhumanhealth mpactsof climatechangeare needed o inform hedevelopment f adaptationtrategies, olicies,andmeasureso lessenprojected dversempacts.We developedmethods orcountry-levelssessmentso helppolicymakersmakeevidence-baseddecisions o increaseresilience o currentand futureclimates,and to provide nformationornational ommunicationso theUnitedNationsFrameworkonvention n ClimateChange.Thestepsin an assessmenthould nclude he following:a) determine he scopeof the assessment;b)describe he currentdistributionndburdenof climate-sensitiveealthdeterminantsndout-comes; ) dentify nddescribeurrentstrategies,olicies, ndmeasuresesignedo reduce hebur-den of climate-sensitiveealthdeterminantsndoutcomes; )reviewhehealthmplicationsf thepotential mpacts f climate ariabilityndchangen other ectors; )estimatehe futurepotentialhealthimpactsusingscenarios f futurechanges n climate,socioeconomic, ndotherfactors;fl synthesize he results;andg) identifyadditionaladaptationpoliciesandmeasureso reducepotentialnegative ealthimpacts.Key ssues orensuringhatanassessments informative,imely,anduseful nclude takeholdernvolvement,nadequatemanagementtructure,ndacommunica-tion strategy.Keywords: daptation,limatechange, limatevariability, umanhealthmethods,vulnerability.nvironHealthPerspect14:1930-1934 2006). doi:10.1289/ehp.8430 vailable iahttp://dx.doi.org/Online11July2006]Over the pastdecade, t hasbecomeclear hatthe world'sclimateis changing.In 2001 theIntergovernmental anelon ClimateChangeconcludedthat thereis new and stronger vi-dence that most of the warming observedover the past 50 years is attributable tohuman activities(Albrittonand MeiroFilho2001). The Intergovernmental Panel onClimate Change projected that the globalmeantemperature f theearthwould increaseby the end of the 21st centuryby between1.4and 5.80C. Global precipitationpatternswillalsochange.This projected ateof warming smuchfaster hanthe observedchangesduringthe 20th centuryand is very ikelyto bewith-out precedentduringat least the last 10,000years Albritton ndMeiro Filho2001).The primary international response tocontrolgreenhousegasemissions s the KyotoProtocolnegotiatedunder he UnitedNationsFrameworkConventionon ClimateChange(UNFCCC 2005). The text of the protocolwas adopted at the third session of theConferenceof the Parties o the UNFCCC inKyoto, Japan, on 11 December 1997 andentered into force on 16 February 2005.Because of the long lifetime of some green-housegasesandthe inherent nertia n the cli-mate system, even full compliancewith theKyotoprotocolmeansthat adaptation o cli-mate changewill be required or at leastsev-eral decades (Albritton and Meiro Filho2001). Recent researchand policy attentionhasthereforeocusedon assessmentsf poten-tial vulnerabilities nd identificationof adap-tation strategies,policies,and measures Lim

and Spanger-Siegfried2004; Willows andConnell2003).Three broadcategoriesof health impactsare associated with climatic conditions:impacts that aredirectlyrelatedto weather/climate, mpacts hat result romenvironmen-tal changesthat occur in response o climaticchange, and impacts resulting from conse-quencesof climate-induced conomicdisloca-tion, environmental decline, and conflict(McMichaelet al. 2001). Changes n the fre-quency and intensity of heat events andextreme rainfall events (i.e., floods anddroughts)will directlyaffectpopulationhealth.Indirectimpactswill occurthroughchangesnthe rangeand intensityof infectious diseasesand food- and waterborne diseases, andchanges n the prevalencef diseases ssociatedwithairpollutants ndaeroallergens.Concernsabout climatechangehave ledinternationalagencies,nongovernmental ndregional institutions, and national organiza-tions to undertakevulnerabilityndadaptationassessments.Few national communicationsand other UNFCCC-related assessments nlow-incomecountries nd economies n transi-tion have addressedclimate change-relatedhealthimpacts n anydetailbecauseof limiteddata availability and a lack of guidance onassessmentmethods(Kovats t al. 2003a).Toprovidesuchguidance,and in response o theneed to developa flexibleapproach orcoun-try-drivenhealthassessments,we developedaframeworkusingfamiliarmethodsto evaluatethe impactsof climatevariability ndchange,to identify vulnerable populations, and to

assessadaptation oliciesand measuresKovatset al. 2003b). The assessment rocess s stake-holderdrivenand,assuch,is designed o focuson localenvironmentalnd healthpriorities.In this articlewe first definevulnerabilityand adaptation in the context of climatechange.We next describethe steps in a vul-nerabilityand adaptationassessment.Third,we discuss ssuesrelated o the processof con-ducting an assessment.We then expandonusing risk management to address climatechange-relatedhealth risks.A startingpointformanyclimatechangeassessmentshouldbeevaluationof how populationscurrently opewith climatevariability,particularlyweatherextremes such as floods, droughts,and heatevents,to indicatewhere additional nterven-tions are needed. Improvingthe capacitytocopewith current limatevariabilitywill likelyincrease esilienceo climatechange.The remaining articles in this mini-monographdescribecompletedassessmentsnsmall island states(Ebiet al. 2006), Portugal(Casimirot al.2006), Cuba(OrtizBult6et al.2006), and the indigenous populations inCanada(Furgal ndSeguin2006). In addition,Campbell-Lendrumand Woodruff (2006)describe methods that the World HealthOrganization (WHO) use to estimate theattributableurdenof healthdeterminantsndoutcomesdue to climate hange.Vulnerabilityand AdaptationAssessing the potential health impacts ofclimatevariability nd change requiresunder-standingboth thevulnerabilityf apopulationanditscapacityo respond o newconditions.Thisarticlespart f themini-monographClimateChange ndHumanHealth:NationalAssessmentsofImpactsndAdaptation."Addressorrespondenceo K.L.Ebi,ESS,LLC,5249TancretiLane,Alexandria,A 22304USA.Telephone:703)304-6126.Fax: 571)227-7299.E-mail:[email protected] theWorldHealthOrganizationWHO)/Healthanada ork-shopswhoprovidedheirperspectiven humanhealthvulnerabilitieso climatevariability ndchangeand thus contributed o the developmentofthe WHO publication"Methodsof AssessingHumanHealthVulnerabilitynd PublicHealthAdaptation o ClimateChange" Kovatset al.2003b).We also thankHealthCanada or theirfinancial ontribution.The authors declare they have no competingfinancial nterests.

Received17 June 2005; accepted 15 December,2005.

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Assessing vulnerability to climate change

Humanhealth ulnerabilityo climateanbedefined safunctionfa)sensitivity,hichincludesheextent owhichhealth, rthenat-uralor socialsystemson which healthout-comesdepend,aresensitiveto changes nweather ndclimate theexposure-responserelationship)nd hecharacteristicsfthepop-ulation,such as its demographictructure;b)theexposureo theclimate-relatedazard,includinghecharacter,agnitude,ndrate fclimate ariation;ndc)theadaptation ea-sures ndactionsnplaceoreduceheburdenof a specificdverse ealth utcometheadap-tationbaseline),heeffectivenessf whichmayinfluenceheexposure-responseelationship.Adaptationncludeshestrategies,olicies,andmeasureshereaftereferredo asadapta-tion options) undertakennow and in thefutureoreduceheburdenfclimate-sensitivehealth eterminantsndoutcomes. daptationcanbeanticipatoryactionsaken n advanceof climatechange)or responsiveand canencompassothspontaneousesponseso cli-matevariabilityndchangebyaffectedndi-vidualsndplannedesponsesygovernmentsor other nstitutions Smitet al. 2001). Anexample f a publichealthadaptations anearlywarningystemorheat vents.Table1 providesefinitionsndexamplesof coping and adaptivecapacity.Copingcapacityncompasseshe nterventionshatarefeasibleo implementoday ina specific op-ulation),andadaptiveapacity ncompassesthestrategiesndpolicieshathave hepoten-tial to expand uturecopingcapacityYohe

andEbi2005).Theprimaryoalof buildingadaptive apacitys to reduce uture ulnera-bility to climate variabilityand change.Increasingheadaptiveapacity f a popula-tionshares oals imilaro those or sustain-abledevelopment-increasingheabilityofcountries, communities,and individualsto effectivelyandefficientlycopewith thechallengesfclimatehange.Anadaptationssessmentescribespecificoptionsthatcanbe implementedo reducecurrent ndfuture ulnerabilityswellastheresources eeded financial,echnologic,ndhuman apital)o implementhem.The nfor-mationgeneratedromanadaptationssess-ment canbe combinedwith a cost-benefitanalysisor other decisionsupporttool toinformpriorityettingbypolicymakerse.g.,Willows ndConnell 003).Steps in a VulnerabilityandAdaptation AssessmentAssessment f vulnerabilityndadaptationusesconcepts imilaro thoseused n healthimpact ssessments.ot allstepsmaybepos-sible or desirablen a particularssessment,and the determinationf whichstepsto beincluded depends on the objectives andresourcesvailable. ssessmentsanhavedif-ferent evels f in-depth nalysis ependingntheobjectives,he nterestfstakeholders,ndthefunding vailable.Determinehescope f theassessment.hefirststep s to specifyhescopeof the assess-ment n relationo thehealthssues fconcern

today and of potentialriskin the future,thegeographic egionto be coveredby the assess-ment, and the time period. The responsiblenationalor regionalhealthauthority an iden-tify the healthoutcomes o be included n col-laboration with, when appropriate, a) theauthoritiesresponsible or the social security,environmentalffairs, ndmeteorologic ffices;b)the researchommunity;and c)other stake-holders such as nongovernmental organiza-tions,business, ndthepublic.Describecurrentassociationsbetweendis-ease outcomesand climate variability andchange.This step involvesdescribing he cur-rentburdenandrecent rends n the incidenceand prevalence of climate-sensitive healthdeterminantsand outcomes of importance nthe population of interest and the reportedassociationsbetween weather/climate nd thehealthoutcomes of concern.The associationsmaybe basedon routine statistics ollectedbynationalagenciesor on publishedliterature.Meteorologists an provide nput into how todefine and describe the important types ofweatherexposure,orexample, heseverity ndfrequencyof extremeweatherevents.Adversehealth outcomes associatedwith interannualclimatevariability,uch as El Nifio events,alsocan be considered Kovats t al. 2003c).Whenpossible, t is useful ordecisionmakers o cal-culatethe proportionof a diseaseburdenthatis attributableo weatherand/orclimate,suchaswhat proportionof all cardiovasculareathsareattributableo high or low temperaturerthe numberof deathscausedbyfloods.If resourcesare availableand data are ofsufficientqualityand quantity,then new epi-demiologicanalysesmaybe undertaken,akinginto accountmodifyingand/orinteractingac-tors. For example, morbidity and mortalityincreaseduringperiodswithboth extremeheatandhigh levelsof airpollutants O'Neillet al.2003).

Identify and describe currentstrategies,policies, and measuresdesigned o reducetheburdenof climate-sensitiveealthdeterminantsand outcomes. he keyquestionso addressora specifichealthoutcome nclude hefollowing:a) What is beingdone now to reduce he bur-den of disease?How effectivearethesepoliciesand measures?b)What can be done now toreduce urrent ulnerability? hat are he mainbarrierso implementatione.g., technologyorpoliticalwill)?c)Whatoptionsshouldbegintobe implementedo increase he rangeof possi-ble future nterventions?For each health outcome, the activitiesand measures hat institutions,communities,and individuals urrentlyundertakeo reducethe burdenof diseasecan be identifiedfroma) review of the literature; b) informationavailable from international and regionalagencies (WHO, the Pan American HealthOrganization,United Nations Environment

Table .Examplesf currentnd uture umanealth ulnerabilityndadaptation.Definition Current FutureVulnerability:hedegreeowhich Populationsivingnareas n he ringe Whetherhesepopulationsighteindividualsnd ystemsre of hecurrentistributionfmalariare vulnerablen he utureepends,susceptibleo orunableocope at riskor pidemicsf herangef he inpart,n he mplementationfwithheadverseffects f Anophelesectorhanges. timelynd ffectivereventionclimatehange. activities.Adaptationaseline:he The xposure-responseelationships Increasingccess oanduseofairadaptationeasuresnd ctions influencedy hecurrentrevention conditioningill educeheper-inplacenaregionr ommunitymeasuresimedtreducingheburden centagefolderdultsho ouldtoreduceheburdenfa ofa disease. orxample,henumber beadverselyffectedy utureparticularealthutcome. ofolder dultsdverselyffectedya heat vents.heat vent ependsn henumbershohave ccesso andwhouseairconditioninguringheat vent.Copingapacity:headaptation Severalities nmiddle-latitudeountries Overime, daptationptionsanoptionshat ould e have he evel fmaterialesources, moverom eing ossibleobeingimplementedow. pecific effectivenstitutions,nd ualityfpublic implementedi.e.,being art f headaptationlansrise rom healthnfrastructureoestablishnd adaptationaseline).orxample,regionr ommunity'soping maintainarly arningystemsorheat universalccess oadequatecapacity. events. ntilmplemented,heseystems quantitiesfsafewatersnot etarewithincity'sopingapacity. possible,lthoughignificantprogressasbeenmade.Adaptiveapacity:hegeneral Adaptiveapacitysthe heoreticalbility Overime,t shopedhat egionsabilityf nstitutions,ystems, ofaregionrcommunityorespondo and ommunitiesillncreaseheirandndividualsoadjusto the hreatsnd pportunitiesresented resilienceowhathe uturelimatepotentialarm,o ake dvantage by limatehange.t ncompassesoth brings.ofopportunities,r ocopewith copingapacityndheoptionshat avetheconsequencesfclimate thepotentialoexpandutureopingvariabilitynd hange. capacity.

AdaptedromKovatst al. 2003b).

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Programme,and others)and nationalhealthand social welfareauthorities (ministriesofhealth);and c) consultationswith otheragen-cies and experts hat dealwith the impactsofthe healthoutcomeof concern(e.g.,the agen-cies that dealwith the weatherdisasters).Forexample,is an earlywarningsystemfor heateventsin place? f so, whatactivitiesareinsti-tutedduringa heateventto reducemorbidityandmortality?Ideally, heeffectivenessf adaptationmea-sures should be evaluated. An evaluationshould considerapproaches o monitor howthe performancef a measuremaychangeovertimecomparedwith the baseline.Forexample,if an earlywarning ystem orheatevents s inplace,evaluation an determinewhethermor-talityduringan eventis lowerwith the system(Ebiet al.2004).Informationgeneratedromthisassessmentof the adaptationbaselinecan identifypoliciesandmeasures hatcouldbe implementednowto reduce vulnerability and increase futureadaptivecapacity.Considerationneedsto begivento whowill implementnewmeasuresndthepossiblebarriershatmaybeencountered.Review the health implications of thepotential impactsof climate variabilityandchangeon othersectors.Assessmentshould beintegratedacrossrelevantsectors, especiallywaterresources, griculture,loodhazardman-agement, and the built environment. Theresultsof otherassessmentshouldbe includedto betterunderstandssues such as the healthimplicationsof the direct impactsof climatechangeon the food supplyand the risk of dis-asters(e.g., coastalor riverflooding).In addi-tion the impactsof implementedadaptationoptions in response o actualor projectedcli-mate changeneed to be evaluated n termsofpotentialadversehealtheffects.Forexample,recommendingdomestic waterstoragemayhave implications orvectorbreedingand thetransmissionof dengue.Becauseof the manypossible interactions and types of feedbackamongsectors,development nd otherprojectsshould be subject o environmentalnd healthimpactassessments.Estimate the future potential healthimpacts. Assessing future health impactsrequiresusingclimateandsocioeconomic ce-narios.The scenariosused can be assumptionsabout a certainamount of increase n globalmeansurfaceemperaturei.e.,1 or2?C)orcanbe detailedquantitativecenarios. f available,nationalor regionaldownscaled limate cenar-ios should be used (Arnellet al. 2004; Hulmeet al. 2002; Willows and Connell 2003).Similarly,the appropriatenational-or local-level projections of population growth andaging should be used. Addressingpotentialimpacts both in the near term (the next20 years)and the long term (up to 2050 or2080) is advisablebecause a near-term ocus

providesrelevantnformationwithinthe usualplanning horizon of health agencies,and anestimate f impactsn thelonger erm sneededto developacomprehensivedaptationtrategy.Estimation of the potentialfuture healthimpacts of climate variability and changeimpliesusingan approachn which modelsofclimatechange(andotherchanges)drivecli-mate-healthassociations(Campbell-Lendrumet al. 2006). Health models maybe complexspatialmodels or basedon a simple relation-ship betweenexposureand response.The useof climate scenariodata has been addressedin detail elsewhere (Hulme et al. 2002;Nakicenovic and Swart 2000). Projectionsmay be incorporated rom models developedfor othersectors, uch as flood risk,food sup-ply, andland-usechanges.Policy makersmust understandhe multi-ple sources of uncertainty in estimationsof potential future impacts, from climateprojections to the climate/health models.Uncertaintiesbegin with the climatemodelsthemselves, ue to suchfactors s thecomplex-ityof climatesystems, hepossibility f nonlin-ear responses to changing greenhouse gasconcentrations, variations in assumptions/model input, and lack of resolution at theregionaland national evels.In additiontherearemultiplesourcesof uncertaintyn climate/healthmodels, ncludinga lack of understand-ing of the key determinants f the geographicrangeand intensityof climate-sensitiveealthdeterminantsand outcomes (e.g., the role ofland-usechangein the spreadof vectorbornediseases),incompletedataon these relation-ships,a lack of understandingf how to math-ematically model the relationshipsto makeprojections of future burdens of disease,and how societies and burdens of diseasewill change over the next 25-100 years(McMichael t al. 2001). Explicitly stimatinguncertaintycan furtherunderstandingof thelevelof confidence n what is known and canprovideinput into future researchdirectionsand policy making (Moss and Schneider2000). Policymakers houldbe realistic boutthe likelihood that the uncertainty can beresolved n a meaningfulimeframe.Synthesizeheresults.The quantitativendqualitativenformationcollected n the previ-ous stepsis synthesized o identifychanges nrisk patterns and to identify links amongsectors, vulnerablegroups, and stakeholderresponses.It is importantthat the synthesisfocusboth on long-termprojectionso identifyemerging trends and on the shorter timeframesused in decisionmaking.Examplesofassessmentsthat synthesized qualitativeandquantitativedata are presentedin Casimiroet al. (2006) and Furgaland Sequin (2006).The key issuesthatneed to be communicatedto decision makersand stakeholders ncludethe specific projected health impacts, the

current ndprojectedburdenof thoseimpacts,the effectiveness of currentinterventions tocontrol the health impact, the rateat whichnegative impactscould be detected, and thedegreeof certaintyassociatedwith the projec-tions.Qualitativeesults an be summarized s,for example, a particular health outcomeincreasingroma low to medium evel of con-cern over the next few decades with a highdegreeof certainty,dependingon the effective-nessof interventionsmplemented o reducedthe diseaseburden.Conveningan interdiscipli-narypanelof expertswith relevant xpertisesone approacho developinga consensusassess-ment. Once synthesized, the informationshouldbepeerreviewed ndpublished.Assumptionsthat underlieany quantita-tive estimates should be clearly described.Quantitativestimates hould be clearlydenti-fiedwith its climate cenario.The degreeof cer-taintyof qualitativendquantitativetatementsshould be provided,and the most vulnerablepopulation roups houldbeidentified.Value judgments have to be made insummarizing the assessment. In particular,decisions should be made about how to bal-ance near-termand long-termeffects;weighthe potential effects in different populationgroups;balance he morecertain,quantifiablepotentialeffectswith those thatare esscertainand not quantifiable;nd balance he interestsof the variousstakeholdergroups(LehtoandRitsatakis, npublished ata).Identifyadditionaladaptation oliciesandmeasures,ncludingproceduresor evaluationafterimplementation. his stepidentifiespos-sibleadaptationmeasureshat couldbe under-taken over the short term to increase thecapacity of individuals, communities, andcountriesto effectivelycope with the weatheror climate exposureof concern. A reviewofadaptation measuresimplemented in otherregionswith similar health concernsmay beone sourceof newadaptations. hesemeasuresshould be possible to implement within thepopulation's ccess o material esources,ech-nology, and human and social capital. Forexample, f heat-relatedmorbidityandmortal-ity are health ssues n an urbanareaandif anearlywarningsystem for heat waves has notbeen implemented, hen would implementingsuch a system ikelybenefitpopulationhealth?Strengths nd weaknesses s well as opportuni-ties and threats o implementation hould beevaluated ndprioritieset.In addition, countries need to adapt tolong-termclimatechange.The secondaim ofthis step is to identifypossiblemeasures hatcan be taken today and in the future toincrease he abilityof individuals,communi-ties, and institutions to effectivelycope withfuture weather, including extreme weatherevents. Consideration should be given tothe lessons learned from past public health

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policies,includingthe effectiveness f variousmeasures, such as vector control and earlywarning ystems.Manyof thepossiblemeasures oradaptingto climate change lie primarilyoutside thedirect control of the health sector.They arerooted in areassuch as sanitationand watersupply,education,agriculture,rade, tourism,transport,development,and housing. Inter-sectoralandcross-sectoraladaptationtrategiesare needed to reduce the potential healthimpactsof climatechange.A policy analysiswill determine he feasibilityof and prioritiesamongtheseoptions. Generally,manyof thepoliciesand measuresdentifiedalso promotesustainabledevelopment.Criteriashould be established n advancefor evaluatingpossibleadaptationmeasures.Evaluation hould be an ongoingprocessbothto identify opportunities for improvingtheeffectiveness f the measuresbut also to iden-tify maladaptation and unintended conse-quencesas quicklyas possible(Yoheand Ebi2005). The traditionalpublichealthmethodsforevaluatingheefficacy ndeffectivenessf aparticularnterventionhouldbe applied,withappropriateonsideration f the localcircum-stances.Forexample, he effectiveness f heatevent earlywarningsystemscan be evaluatedby determiningwhethermortalityduringheateventsdecreases ftersystemimplementation.This, of course,requireshatevaluation riteriabe builtintothesystemwhenit isdeveloped.Frameworkor the AssessmentFor an assessment o be informative,timely,and useful, key issuesneed to be addressed,particularly stakeholder involvement, anadequate management structure, and acommunicationstrategy.Experiencesromcountries hat haveper-formed assessments have shown the impor-tance of includingstakeholdersn assessmentplanning, implementation, and evaluation.Stakeholders nclude people within govern-ments, nongovernmental organizations,researchnstitutions,and privateentitiesthatfocus on publichealth.The issues and ques-tions of greatestconcernto the stakeholdersmust be elicitedto ensurethat the assessmentprovides useful information. This does notimplythatrelevantssues,otherwisenot identi-fied or known as importantto stakeholders,would be left out of the assessment.Assessorsstrive to answerstakeholderquestionsto theextent possiblegiven uncertainscience;theyalso characterizehe uncertaintyand explorethe implicationforvariouspolicy or resourcemanagementdecisions.Once an assessment scompletedand the stakeholders reinformedof the results,assessorshould elicit from thestakeholdersany new interestsand concernsthe assessment aises.Opennessand inclusive-nessenableparticipantso bringa diversityof

views and informationthat may benefit theassessmentprocessand make the processmoretransparentndcredible.An adequatecommunication strategyisneeded before, during, and afterthe assess-ment. Effectiveriskcommunicationss atwo-way process including exchanges amonginterestedparties(individuals,social groups,industry, and governments) (NationalResearchCouncil 1989). Risk communica-tion is, by definition, proactive and mayinvolvemanystakeholders ndaudiences,var-ious levelsof communication,and phasesorstagesof communication o accommodate heneeds inherent n eachstepof the assessment.The potential for achieving successful riskcommunicationincreaseswith knowledgeofthe audience-what their concernsare, howthey perceive risk, and whom they trust.Identifyingthis informationearlyand incor-porating it into the initial stages can bringbenefits ater n the process.Many of the aspects of the assessmentprocess, such as engaging stakeholders,syn-thesizingresults,and developingpolicy, willhaveimplicationsafter he assessments com-pleted. Researchgapsand informationneedsidentifiedduringthe assessmentwill establishdirections for futuredevelopment. Selectingand implementing policy options feed intofurthermonitoring and surveillancework tocreateaniterative ycleof assessment ndpol-icy development (Scheragaet al. 2003). Forexample, research gaps that are identifiedshouldguidethe priority ettingof researchofill thesegaps,and new researchfindingscanadvance utureassessments.RiskManagementApplyingappropriateiskmanagementprinci-ples, tools, and measurescan reducecurrentand futurehumanhealthvulnerabilityo cli-mate variabilityand change. Numerous riskmanagementrameworks avebeendevelopedthat can be modified to address national,regional, and local assessment needs (e.g.,Willows and Connell2003). The firststep intheseframeworkstypically nvolvesevaluationof whether a specific exposure is a risk tohumanhealth andwell-being.Once a typeofexposures determinedo bea risk(e.g.,heavyrain causing rivers to overflow), the conse-quencesof exposurefor the affectedpopula-tion areassessed,ncluding he magnitudeandfrequencyof the risk,the likelihoodof expo-sure, who is or will be at increased risk ofadversehealtheffectsby levelof exposure,andwhat is or will be at riskthat could adverselyaffect health, such as damage to built infra-structureand/or interferencewith health andsocialservices.

Risk dentifications followedby an assess-ment of the strengthsand weaknessesof thehuman and material resources available to

reduce (or manage) the risks. This mightinclude assessing he ability of public healthunits,firedepartments, mergencyervices, ndevenmilitaryunits to provide emergency er-vices duringweather-relateddisasters.Therealso should be an assessmentof the abilitytocopewith risks hat increase radually,uchasprogressive roughtsshrinkingwatersuppliesandincreasing ropfailures.Policymakersandthepublicneed to know whetherpublichealthservicesand other health and social nfrastruc-ture might be weakened by a deterioratingeconomyandby shrinking overnmentncomeand resources.

Next, informations neededon the aware-nessand tolerance f riskat the local,regional,and national levels. Information should begathered n the risks hat stakeholderserceiveto be the most importantandwhy. Prioritiesneed to be established orhow, bywhom,howquickly, o whatextent,and in which order herisks houldand could bereduced.The adaptation ssessmentwill have denti-fied a rangeof possibleoptions that could beimplementedto address he risks of concern.These interventions havevaryingdegreesofeffectiveness,aseof implementation, xpecteddisadvantages,nd costs. Decision makersandpolicy makerscombine this informationwithfactors such as currentpolicy priorities andsocialvalues o determinea strategicdirection.Stakeholders should be made aware of thehuman and financial resource trade-offsrequired for the recommended adaptationoptions,and the uncertainties ssociatedwithboth the climatechange-relatedealthimpactsandthe effectivenessf theproposed pproachesto mitigate hoseimpacts.Finally, mechanismsfor monitoring andevaluationneed to be establishedo determinewhetherthe measures mplementedhave thedesiredeffectandwhether midcoursecorrec-tions are needed. Corrections may arisebecauseof changes n social, economic, envi-ronmental,and technologic conditions overtime.Significant hangesmayrequirenitiatinga new cycle of assessment and risk manage-ment to take hesechangesnto account.DiscussionAddressing climate change-related healthimpacts has become more urgent with therealization hat impactsarealreadyoccurring(Patzet al. 2005). Considerablymore infor-mation is needed on the pathwaysby whichweather can affect health, on the subgroupsmost vulnerable to climate-sensitive healthdeterminants ndoutcomes,andon theimpli-cations of climate change for public healthpolicy and practice. Continuing currentapproacheso risksposed by weatherand cli-mate runs the risk that potentially effectiveadaptation options may be unidentified,unimplemented, or implemented too late,

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Ebiet al.

resultingin preventable llnessesand deathsand increased osts.Adaptation options to address climatechange-relatedhealthimpactswill aim to becost-effective n termsof lives savedand illnessavoided. The focus should be on win-win

strategies o improve publichealthregardlessof the changes n weatherandclimate.Addingadaptationmeasuresinto existing programsmay not be costly. For example, integratedvector management programs could adjustsome monitoringsitesto determine f a vectoror the diseaseit carries s expandingor con-tracting ts range.In addition thereareoppor-tunities to adapt to multiple factors. Forexample,the existenceof federal lood insur-ance in the United Statesprovidesan incen-tive for developmentn high-riskcoastalareas(asstronglyevidencedin the 2005 hurricaneseason),whichincreaseshe riskof injuryanddeath to coastalpopulations(Scheragaet al.2003). Eliminationof federal lood insurancetoday would reduce the size of the coastalcommunitiescurrentlyat risk (at a financialcost to individualsliving in coastalcommuni-ties)andat futureriskdue to risingsealevels.The decisionof whether o adaptnow or latershould be based on a comparisonof the pre-sent value of expectednet benefitsassociatedwith acting sooner or later (Scheragaet al.2003).Initialnationalassessmentsndcommuni-cationsmade clear that a majorconstraint oconducting a vulnerability and adaptationassessments the lackof high-qualityong-termdata sets, particularlyin most low-incomecountries ndmanyeconomiesn transition,ounderstand current relationships betweenweather and climateand healthdeterminantsandoutcomes.However,ministriesof health,nongovernmental rganizations, therorgani-zations, and researchersan qualitatively sti-mate currenthealth burdens and how theseburdens ouldchangeunderdifferent cenariosof changing temperatureand precipitation.Another onstraintn conducting ssessmentssthe lackof experiencewith doing so, which iswhy the secretariatfor the UNFCCC, theUnited NationsDevelopmentProgramme, ndotherorganizations reprovidingtrainingonmethodsandtools to buildnational apacityor

evaluatingvulnerability o climatevariabilityand changeand for mainstreamingdaptationdecisions into ongoing processes, such assustainabledevelopment lans.Assessmentsf thepotentialhealthimpactsof climatevariabilityndchangeare neededtoinformthe developmentof adaptation ptionsin health and other sectors and to provideinformation n the impactsand the adaptationrequirementso internationalpolicy processes.The assessmentmust make the problemandthe potential mpactsexplicitand clear o pol-icymakersand shouldhelpdecisionmakersnchoosingamong adaptationoptions designedto reducenegative mpacts.

REFERENCESAlbrittonLMeiro ilho G.001.Technicalummary.n:ClimateChange 001:TheScientificBasis.ContributionfWorkingGroupto theThird ssessmentReport fthe Intergovern-mentalPanel on ClimateChange Houghton T,DingY,

GriggsDJ,NoguerM,van der Linden J,DaiX,et al., eds).NewYork:Cambridgeniversityress,21-85.ArnellNW,Livermore JL,Kovats , LevyPE,NichollsR,ParryML,t al.2004. ocio-economiccenariosorclimatehangeimpactassessments:characterisinghe SRES torylines.Global nvironhange 4:3-20.Campbell-Lendrum,WoodruffR.2006.Comparative iskassessmentofthe burden f diseasefrom limate hange.Environ ealth erspect114:1935-1941.CasimiroE,Calheiros , SantosFD,KovatsS. 2006.NationalAssessmentof human ealth ffectsof climate hange nPortugal:approach and key findings. EnvironHealthPerspect114:1950-1956.EbiKL,LewisND,CorvalanC. 2006. Climate ariability ndchange andtheirpotentialhealtheffects insmall slandstates: informationor adaptation lanningn the healthsector.Environ ealth erspect114:1957-1963.EbiKLTeisbergTJ,Kalkstein S,Robinson ,WeiherRF. 004.Heatwatch/warning ystemssave lives: estimated ostsandbenefits orPhiladelphia995-1998. ullAmMeteorolSoc 85(8):1067-1073.FurgalC,SeguinJ. 2006.Climatehange,health,andvulnera-bilityin Canadian NorthernAboriginalcommunities.Environ ealthPerspect114:1964-1970.HulmeM,JenkinsGJ,LuX,TumpennyR,MitchellTD,JonesRG, t al.2002.ClimateChangeScenarios or the UnitedKingdom: heUKCIP02cientificReport.Norwich,UK:TyndallCentre or ClimateChangeResearch,SchoolofEnvironmentalciences,Universityf EastAnglia.KovatsRS,EbiK,MenneB.2003b.Methods fAssessingHumanHealthVulnerabilityndPublicHealthAdaptationo ClimateChange. Health and Global EnvironmentalChangeSeries, No. 1. Copenhagen:World ealthOrganization,HealthCanada,UnitedNationsEnvironmentrogramme,WorldMeteorological rganization.Kovats S,MenneB,AhemMJ,Patz A.2003a.Nationalssess-mentsof health mpactsof climatechange:a review.In:ClimateChange nd HumanHealth:RisksandResponses(McMichael J,Campbell-Lendrum,Corvalan F,EbiKL,

GithekoA, Scheraga JD,WoodwardA, eds). Geneva:WHO/World eteorologicalOrganization/nitedNationsEnvironmentrogramme,81-203.KovatsRS,BoumaMJ,Hajat ,WorrellE,HainesA. 2003c.ElNiiio ndhealth.Lancet 61:1481-1489.LimB,Spanger-Siegfried,eds.2004.AdaptationolicyFrame-works or ClimateChange: eveloping trategies,PoliciesandMeasures.NewYork:Cambridgeniversityress.McMichaelA, GithekoA, AkhtarR,CarcavalloR, GublerF,HainesA, et al. 2001.Human ealth. In:ClimateChange2001. mpacts, daptation,ndVulnerability.ontributionfWorkingGroup I o the ThirdAssessmentReport f theIntergovernmentalanelon Climate hangeMcCarthyJ,CanzianiOF,LearyNA, Dokken DJ, White KS,eds).Cambridge,K:Cambridgeniversityress,451-485.MossRH,SchneiderSH.2000.Uncertaintiesn the IPCC AR:recommendationso authors or moreconsistentassess-ment and reporting. n:GuidancePaperson the CrossCuttingssuesof the Third ssessmentReport f the IPCC(PachauriR,TaniguchiT, TanakaK,eds). Tokyo:GlobalIndustrial nd SocialProgressResearchInstitute, 3-51.Available: ttp://www.ipcc.ch/pub/xcutting.pdfaccessed30 October 003].NakicenovicN, SwartR,eds. 2000. EmissionsScenarios.A

Special Reportof WorkingGroup ll of the Intergovern-mentalPanelon Climate hange.Cambridge,K:CambridgeUniversityress.NationalResearchCouncil.1989.Improving iskCommuni-cation.Washington, C:Nationalcademy ress.O'NeillM,Zanobetti ,Schwartz . 2003.Modifiers f thetem-perature ndmortality ssociation.AmJ Epidemiol57:1074-1082.Ortiz ult6 LO, drezRodriguez,Rivero alencia ,Le6nVegaN,DiazGonzalezM,P6rezCarrera . 2006.Assessmentofhuman ealth ulnerabilityo climate ariabilityndchangeinCuba. nviron ealth erspect 14:1942-1949.PatzJA, Campbell-Lendrum, HollowayT,FoleyJA. 2005.Impact fregional limate hangeon human ealth.Nature438:310-317.

Scheraga D,EbiKL, urlow, MorenoAR. 003.Fromcienceto policy:developingresponses to climatechange. In:ClimateChange nd HumanHealth:RisksandResponses(McMichael J,Campbell-Lendrum,Corvalan F,EbiKL,GithekoA, ScheragaJD,et al., eds). Copenhagen:WorldHealthOrganization/WorldeteorologicalOrganization/UnitedNationsEnvironmentrogramme,37-266.SmitB,Pilifosova , Burton ,Challenger , HuqS, KleinRJT,et al.2001.Adaptationo climate hange n the contextofsustainabledevelopment ndequity. n:ClimateChange2001: mpacts,Adaptation ndVulnerability.ontributionofWorkingGroupI o the ThirdAssessmentReport ftheIntergovernmentalanel on ClimateChange McCarthyJJ, CanzianiOF,LearyNA,DokkenDJ,White KS,eds).Cambridge, K:Cambridgeniversityress,877-912.UNFCCC.005.UnitedNations rameworkonventionnClimateChangeHomePage. Available:http://www.unfccc.int[accessed21 November005].WillowsRI,ConnellRK, ds. 2003.ClimateAdaptation:RiskUncertaintyand Decision-Making.Oxford,UK:UnitedKingdom limatempactsProgramme.YoheG,EbiKL. 005.Approaching daptation: arallelsandcontrastsbetween he climate ndhealth ommunities.n:Integration f PublicHealthwithAdaptationo ClimateChange:Lessons Learned nd New Directions EbiKL,Smith , Burton,eds).London:TaylorFrancis, 8-43.

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