8.6 Adaptation: practices, options and constraints
Adaptation is needed now in order to reduce current vulnerability to the climate change that has already occurred and additional adaptation is needed in order to address the health risks projected to occur over the coming decades. Current levels of vulnerability are partly a function of the programmes and measures in place to reduce burdens of climate-sensitive health determinants and outcomes, and partly a result of the success of traditional public-health activities, including providing access to safe water and improved sanitation to reduce diarrhoeal diseases, and implementing surveillance programmes to identify and respond to outbreaks of malaria and other infectious diseases. Weak public-health systems and limited access to primary health care contribute to high levels of vulnerability and low adaptive capacity for hundreds of millions of people.
Current national and international programmes and measures that aim to reduce the burdens of climate-sensitive health determinants and outcomes may need to be revised, reoriented and, in some regions, expanded to address the additional pressures of climate change. The degree to which programmes will need to be augmented will depend on factors such as the current burden of climate-sensitive health outcomes, the effectiveness of current interventions, projections of where, when and how the burden could change with changes in climate and climate variability, access to the human and financial resources needed to implement activities, stressors that could increase or decrease resilience to impacts, and the social, economic and political context within which interventions are implemented (Yohe and Ebi, 2005; Ebi et al., 2006a). Some recent programmes and measures implemented to address climate variability and change are highlighted in the examples that follow.
The planning horizon of public-health decision-makers is short relative to the projected impacts of climate change, which will require modification of current risk-management approaches that focus only on short-term risks (Ebi et al., 2006b). A two-tiered approach may be needed, with modifications to incorporate current climate change concerns into ongoing programmes and measures, along with regular evaluations to determine a programme’s likely effectiveness to cope with projected climate risks. For example, epidemic malaria is a public-health problem in most areas in Africa, with programmes in place to reduce the morbidity and mortality associated with these epidemics. Some projections suggest that climate change may facilitate the spread of malaria further up some highland areas (see Section 8.4.1.2). Therefore, programmes should not only continue their current focus, but should also consider where and when to implement additional surveillance to identify and prevent epidemics if the Anopheles vector changes its range.
How public health and other infrastructure will develop is a key uncertainty (see Section 8.3) that is not determined by GDP per capita alone. Public awareness, effective use of local resources, appropriate governance arrangements and community participation are necessary to mobilise and prepare for climate change (McMichael, 2004). These present particular challenges in low-income countries. Furthermore, the status of and trends in other sectors affect public health, particularly water quantity, quality and sanitation (see Chapter 3), food quality and quantity (see Chapter 5), the urban environment (see Chapter 7), and ecosystems (see Chapter 4). These sectors will also be affected by climate change, creating feedback loops that can increase or decrease population vulnerability, particularly in low-income countries (Figure 8.1).