16 Human Health - rioccadapt

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16 Human Health - rioccadapt
16
Human Health
Ana Rosa Moreno Sánchez (Mexico), Marilyn Aparicio Effen (Bolivia),
Julio Díaz (Spain), Edgar González-Gaudiano (Mexico),
José María Ordóñez Iriarte (Spain), and M. Cristina Tirado von der
Pahlen (USA/Spain).

This chapter should be cited as:

Moreno A.R., M. Aparicio Effen, J. Díaz, E. González-Gaudiano, J.M. Ordóñez Iriar-
te, and M.C. Tirado von der Pahlen, 2020: Human Health. In: Adaptation to Climate
Change Risks in Ibero-American Countries — RIOCCADAPT Report [Moreno, J.M.,
C. Laguna-Defior, V. Barros, E. Calvo Buendía, J.A. Marengo, and U. Oswald Spring
(eds.)], McGraw Hill, Madrid, Spain (pp. 615-658, ISBN: 9788448621667).
16 Human Health - rioccadapt
Chapter 16 - Human Health

         CO N T E NTS

         Executive summary..........................................................................................................................................................................................................................              618
           16.1. Introduction...........................................................................................................................................................................................................................          618
                      16.1.1. Conceptual framework......................................................................................................................................................................................                          618
                      16.1.2. Key sector/system figures..............................................................................................................................................................................                             619
                      16.1.3. Relationship of the sector with climate and climate change......................................................................................................... 620
                      16.1.4. Review of past reports .....................................................................................................................................................................................                        621
           16.2. Risk components in relation to health................................................................................................................................................................... 622
                      16.2.1. Hazards..................................................................................................................................................................................................................... 622
                      16.2.2. Exposure................................................................................................................................................................................................................... 623
                      16.2.3. Vulnerability............................................................................................................................................................................................................ 624
           16.3. Characterization of risks and their impacts........................................................................................................................................................ 626
                      16.3.1. Vector-borne diseases...................................................................................................................................................................................... 626
                      16.3.2. Extreme weather or climatic events.......................................................................................................................................................... 628
                      16.3.3. Air pollution............................................................................................................................................................................................................. 629
                      16.3.4. Water.......................................................................................................................................................................................................................... 630
                      16.3.5. Food ............................................................................................................................................................................................................................   631
           16.4. Adaptation measures.......................................................................................................................................................................................................                       631
                      16.4.1. Adaptation options.............................................................................................................................................................................................                     631
                      16.4.2. Planned adaptation actions............................................................................................................................................................................ 632
                                    16.4.2.1. At the supranational scale............................................................................................................................................................. 632
                                    16.4.2.2. At the national and subnational scale...................................................................................................................................... 633
                                    16.4.2.3. At the local or municipal scale..................................................................................................................................................... 635
                      16.4.3. Autonomous adaptation actions..................................................................................................................................................................                                     637
           16.5. Barriers, opportunities and interactions............................................................................................................................................................... 637
           16.6. Measures or indicators of adaptation effectiveness..................................................................................................................................... 638
           16.7. Case studies.......................................................................................................................................................................................................................... 638
                      16.7.1. Vector-borne diseases – Adaptation challenges and options in Bolivia, with an emphasis on the Chaco region 638
                                    16.7.1.1. Case summary..................................................................................................................................................................................... 638
                                    16.7.1.2. Introduction to the case problem.............................................................................................................................................. 640
                                    16.7.1.3. Case description................................................................................................................................................................................. 640
                                    16.7.1.4. Limitations and interactions ....................................................................................................................................................... 642
                                    16.7.1.5. Lessons learned.................................................................................................................................................................................. 643
                      16.7.2. Plan for Preventive Actions against the Health Effects of Excess Temperatures of the Ministry of Health
                              (Spain)........................................................................................................................................................................................................................ 643
                                    16.7.2.1. Case Summary..................................................................................................................................................................................... 643
                                    16.7.2.2. Introduction to the case problem.............................................................................................................................................. 643
                                    16.7.2.3. Case description................................................................................................................................................................................. 644
                                    16.7.2.4. Limitations and interactions........................................................................................................................................................ 644
                                    16.7.2.5. Lessons learned.................................................................................................................................................................................. 644
                      16.7.3. Adaptation and resilience of communities vulnerable to flooding in Veracruz (Mexico)................................................ 644
                                    16.7.3.1. Case summary..................................................................................................................................................................................... 644

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                            16.7.3.2. Introduction to the case problem.............................................................................................................................................. 644
                            16.7.3.3. Case description................................................................................................................................................................................. 645
                            16.7.3.4. Limitations and interactions........................................................................................................................................................ 645
                            16.7.3.5. Lessons learned.................................................................................................................................................................................. 645
              16.7.4. Aeroallergen warning system in Spain through Red Palinocam................................................................................................... 646
                            16.7.4.1. Case Summary .................................................................................................................................................................................... 646
                            16.7.4.2. Introduction to the case problem.............................................................................................................................................. 646
                            16.7.4.3. Case description................................................................................................................................................................................. 646
                            16.7.4.4. Limitations and interactions........................................................................................................................................................ 647
                            16.7.4.5. Lessons learned.................................................................................................................................................................................. 647
              16.7.5. Adaptation for food security and nutrition in the Dry Corridor in Central America (Guatemala, Honduras,
                      El Salvador)............................................................................................................................................................................................................. 647
                            16.7.5.1. Case summary..................................................................................................................................................................................... 647
                            16.7.5.2. Introduction to the case problem.............................................................................................................................................. 648
                            16.7.5.3. Case description ................................................................................................................................................................................ 648
                            16.7.5.4. Limitations and interactions........................................................................................................................................................ 649
                            16.7.5.5. Lessons learned.................................................................................................................................................................................. 649
  16.8. Main knowledge gaps and priority lines of action........................................................................................................................................... 649
  16.9. Conclusions............................................................................................................................................................................................................................ 650
Frequently Asked Questions...................................................................................................................................................................................................... 650
Acknowledgements..........................................................................................................................................................................................................................              651
Bibliography.........................................................................................................................................................................................................................................   651

                                                                                                                                                                                                             RIOCCADAPT REPORT 617
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Chapter 16 - Human Health

      Executive summary                                                   to its allergenic capacity. Risk communication could be the
                                                                          tool to protect the health of vulnerable populations, such as
                                                                          people with chronic respiratory problems and those suffering
      In the context of the fight against climate change, human           from allergies.
      health should be considered a priority. There are still uncer-
      tainties regarding the impacts of climate change on health.         Early warning systems are an essential part of climate
      Nevertheless, there is sufficient evidence to justify strength-     change adaptation for populations exposed to extreme
      ening the resilience of health systems to ensure that adap-         hydrometeorological events. Consequently, to protect vul-
      tation and mitigation actions effectively protect and promote       nerable populations, efforts must be strengthened in terms
      health. Consequently, health is best reflected as a priority        of managing integrated information systems and communi-
      area in climate change negotiations.                                cating risk to provide timely warnings and promote action;
                                                                          the availability of trained and well-equipped personnel; and
      Populations with fewer resources are the most vulnerable
                                                                          posessing the necessary infrastructure to manage evacuees
      to climate change. Approximately 197 million people in Latin
                                                                          and provide medium- and long-term needs care to displaced
      America were living in poverty in 2017. This condition—along
                                                                          persons.
      with poor infrastructure and health services—increases the
      region’s vulnerability to climate change.                           An adequate health care response must be guaranteed at
                                                                          both the remedial and preventive stages, which requires
      The hazards and risks to health associated with climate
                                                                          good planning and well-trained professionals from all fields.
      change need to be determined and assessed by identify-
                                                                          Although there is considerable information on the possible
      ing vulnerable populations and their exposure to climate
                                                                          impacts of climate change on vulnerable populations, there
      change hazards. Based on this information, geographic infor-
                                                                          is a lack of policy frameworks and evidence of its impacts
      mation systems can be developed to identify, propose, and
                                                                          at the regional level that would allow decision makers to
      implement adaptation measures and co-benefits to reduce
                                                                          promote the development of health services based on re-
      the adverse effects of hazards on these populations.
                                                                          gional medium- and long-term needs. Health services should
      Temperature increases due to heat waves will increase the           improve access to safe drinking water, sanitation, and pre-
      risk of illness and death in vulnerable populations, such as        vention programs such as vaccination, and strengthen sur-
      the elderly and individuals with pre-existing diseases. Fur-        veillance systems, including for climate-related diseases.
      ther warming of urban areas can amplify the impacts of heat         Effective planning and training for health professionals from
      waves. Adaptation measures should aim to protect vulnerable         various disciplines will enable them to provide high-quality,
      individuals through early warning systems that inform the           climate-adapted health services, ensuring that the popula-
      population and raise awareness of protective measures for           tion receives the necessary care to cope with the long-term
      individuals and families, and of the health services that are       challenges of climate change.
      prepared to identify and assist people in need of emergency
      services.                                                           Climate change adaptation is both necessary and urgent to
                                                                          reduce climate change impacts on health. Health benefits
      High temperatures can promote the transmission of vec-              from adaptation include reducing the burden of climate-sen-
      tor-borne diseases, particularly dengue fever and malaria.          sitive diseases, decreasing the effects of climate change on
      These diseases could expand their geographical reach and            human health, and improving knowledge of the connection
      their seasonality could be extended, increasing the number          between climate, health, and regions within a country.
      of people at risk. Adaptation measures include risk reporting
      to prevent the presence of mosquitoes in households and to
      protect against their bites. In addition, entomological surveil-
      lance to detect vector dynamics should be ongoing. Pesticide        16.1. Introduction
      spraying will be required in the event of epidemic outbreaks.
      Rising temperatures will worsen the living conditions of            16.1.1. Conceptual framework
      vulnerable populations such as farmers, fishers, and people
                                                                          There is strong evidence that the planet’s climate is chang-
      living in food insecurity. This will particularly affect children
                                                                          ing, mainly due to human activities (IPCC, 2013). Tempera-
      under the age of five and those living in poverty, severely
                                                                          ture increases and sea level rise, changes in rainfall distribu-
      threatening their health. Improved agricultural management
                                                                          tion, and extreme events pose a range of hazards to health,
      practices could be adopted to address this problem. Agri-
                                                                          increasing the diversity of risk scenarios. These hazards vary
      cultural biodiversity as a production strategy could support
                                                                          from the direct effects of heat waves, floods, storms, and
      adaptation to environmental pressures such as salinization,
                                                                          droughts, to conditions associated with ecosystem damage
      droughts, and floods, as could implementing programs and
                                                                          that lead to the transmission of infectious diseases, adverse
      policies to promote sustainable agriculture and fisheries.
                                                                          changes in air pollution, food insecurity and malnutrition, and
      Since ozone is temperature-dependent, increased tempera-            impacts on socioeconomic sectors (Watts et al., 2018; Ebi et
      tures can raise the levels of this pollutant and affect the         al., 2011). Figure 16.1 illustrates the connections between
      health of urban populations, as can pollen production due           climate change and human health, summarizing the various

618   RIOCCADAPT REPORT
Chapter 16 - Human Health

changes in climate due to GHG emissions that have resulted                              followed by Argentina and El Salvador. Millions of inhabi-
in health and security hazards.                                                         tants are therefore highly vulnerable to climate change, which
                                                                                        poses a major challenge for these countries. In terms of
Climate change will increase the difficulty of preventing and
                                                                                        the percentage of GDP allocated to health, in Uruguay this
responding to a wide range of health effects derived from
                                                                                        percentage is high, as it is in Spain and Portugal, followed by
population exposure to climate change hazards. While pop-
                                                                                        Brazil and Ecuador. Regarding this parameter, although the
ulations with fewer resources and greater vulnerability may
be the first to be affected, the fact that climate systems,                             poverty index for some of these countries is not available,
ecosystems, and global society are interconnected implies                               one could expect that they enjoy better health conditions and
that virtually no-one will be spared the consequences.                                  have greater possibilities for investment in prevention and
                                                                                        medical care in the face of climate change impacts.
                                                                                        In terms of international health policy, the universal health
16.1.2. Key sector/system figures                                                       strategy constitutes the reference framework to improve the
                                                                                        well-being and health of all people, strengthen health sys-
Table 16.1 presents several figures on current health ex-                               tems, and increase their resilience and ability to respond to
penditure and the national poverty threshold (UNDP, 2018).
                                                                                        challenges such as climate change (PAHO, 2017a).
This information enables visualizing the status of the sector
in terms of economic resources. A heterogeneous distribu-                               Healthcare benefits in the region are costly, which prevents
tion of poverty can be observed in these countries, with the                            many people with fewer economic resources from exercis-
highest values found in Honduras, Guatemala, and Mexico,                                ing their right to health. An estimated one-third of the pop-

                                                                     GREENHOUSE GAS EMISSIONS

                                                                            CLIMATE CHANGE

                                                 Temperature increase
                                                                                                                             Other atmospheric
                                                                                                                                 pollutants
                                        Altered rainfall patterns        Extreme weather     Sea level rise

                                                                   Extreme events

                                                                                                                                                    Social
            Reduced
                                                                                                                                                 determinants
         productivity of
                                                                                                                                                   of health
          fisheries and
           aquaculture

                                                  Loss of bio-
                Reduced                                                                                                      Injuries,
                                                 diversity, eco-
              agricultural                                                          Increase of air pollutants                disease
                                                system collapse
              productivity                                                                                                   and death
                                                   and pests

                             Gastrointestinal
                                diseases

                               Impacts on               Cardiovascular              Respiratory               Vector-borne
       Malnutrition
                              mental health                diseases                  diseases                   diseases

  Figure 16.1. Pathways of climate change incidence on human health. Source: compiled by the authors based on Watts et al., 2018, P. 2482.

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       Table 16.1. Various indices and indicators of human development,   logical events, the reliability and capacity to maintain these
       RIOCC countries. Source: UNDP, 2018.                               types of services is particularly important from the health
                                                                          perspective. With regard to water sources, practically all ur-
                                                       National poverty   ban areas in the region receive this service. Overall, most of
                        Actual expenditure in
          Country                                         threshold,      the Latin American region has sanitation services, with the
                       health, 2015 (% of GDP)
                                                       2006–2017 (%)
                                                                          exception of the Andean Area. However, the figures for san-
       Argentina                6.8                       39.5            itation coverage are lower, both at the country and regional
       Brazil                   8.9                        8.7            level and in urban areas. Compared to water, the Andean
                                                                          Area, Central America, and rural areas of Brazil have the
       Bolivia                  6.4                       28.0
                                                                          poorest sanitation coverage, with unquestionably low figures.
       Chile                    8.1                              *        Limitations in both of these services result in conditions of
       Colombia                 6.2                       28.0            vulnerability, with rural areas being noticeably less privileged.
       Costa Rica               8.1                              *        Currently, only 3% of health resources are committed to pre-
       Ecuador                  8.5                       21.5            vention, and only 0.5% of multilateral climate funding has
                                                                          been specifically allocated to health projects (WHO, 2018a).
       El Salvador              6.9                       38.2
       Spain                    9.2                              *
       Guatemala                5.7                       59.3            16.1.3. Relationship of the sector with
       Honduras                 7.6                       60.9                    climate and climate change
       Mexico                   5.9                       43.6
                                                                          According to the WHO (WHO, 2019b), the current situation
       Nicaragua                7.8                       24.9            and its upcoming challenges call for a transformation in
       Panama                   7.0                              *        environmental management as it relates to health. Current
       Paraguay                 7.8                       28.9            approaches have provided a foundation but have been insuf-
                                                                          ficient to sustainably and adequately reduce environmental
       Peru                     5.3                       20.7
                                                                          health risks and create favorable conditions for health and
       Portugal                 9.0                              *        security. Therefore, the answer is to build a new strategy for
       Uruguay                  9.2                              *        health, the environment, and climate change.
       Venezuela                3.2                              *        Climate change undermines the social and environmental
                                                                          determinants of health, including people’s access to clean
                                                                          air, clean water, sufficient food, and safe shelter. This affects
                                                                          health and increases its associated inequality, especially
      ulation in the Americas still faces restrictions in accessing       in the poorest and most vulnerable communities and least
      health services. In addition, a number of obstacles, such
      as relocation to rural or hard-to-reach areas and the lack of
      well-equipped health centers, limits the provision of services
      to people with fewer economic resources (Etienne, 2018).             Table 16.2. Number of doctors, nurses, and dentists per
      People living in rural or remote areas are also less likely to       thousands of inhabitants in Latin American regions, Mexico, and
      have access to sanitation, drinking water, and safe housing.         Brazil. Note: Data for 2011, except where indicated with (*) 2014;
                                                                           (**) 2016; (***) 2015. Sources: PAHO, 2014; World Bank, 2019;
      Table 16.2 shows the number of doctors, nurses, and den-
                                                                           Indexmundi, 2019; WHO, 2019a.
      tists in Latin American regions and countries, in addition to
      Brazil and Mexico, in 2011. The availability of medical per-                                                                Hospital
                                                                                           Medical staff/10,000 inhabitants
      sonnel is variable. Mexico has a larger supply of doctors and           Region/                                           beds/1,000
      nurses than Brazil—especially nurses, whose role in public              Country                                          inhab. (2010–
                                                                                           Doctors     Nurses      Dentists        2013)
      health is considered paramount in rural areas. At the regional
      level, Central America and the Andean Area present similar           Latin America    17.2        13.8         4.3             2
      figures that stand out from those of the Southern Cone, with         Mexico           21.2        25.1         1.0            1.5
      a high number of doctors and dentists and a percentage of
      nurses that surpasses that of Latin America. In terms of             Central          12.6         9.7         3.5            0.9
                                                                           America
      hospital beds, the Southern Cone region is prominent, while
      as a country, Brazil surpasses Mexico. Spain and Portugal            Andean Area      13.4         8.8         4.8            1.4
      have equal hospital bed coverage and a higher number of              Brazil           15.1         7.1         5.5            2.3
      doctors and nurses compared to Latin America.
                                                                           Southern Cone    21.2        15.2         8.2            3.7
      Table 16.3 outlines the percentage of services from improved         Spain             40*       55.3**      4.5***            3
      water sources and sanitation facilities in Brazil, Mexico, and
      Latin American regions in 2012. As regards hydrometeoro-             Portugal*         40*       63.7**      5.6***            3

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 Table 16.3. Percentages of services from improved water sources and improved sanitation facilities in Latin American regions, Mexico, and
 Brazil, 2012. Notes: (*) Population with access to basic drinking water supply systems, 2017; (**) National sanitation estimates, at least
 basic, in 2015; (***) 2016. Source: PAHO, 2014; Statista, 2019; WHO and UNICEF, 2017; Portuguese Water Partnership, 2019.
                                       Population using improved water sources              Population using improved sanitation facilities
          Region/Country
                             Region/ Country        Urban areas         Rural areas    Region/ Country       Urban areas          Rural areas
 Latin America                    94                   77                 82                82                  87                  62
 Mexico                           95                   96                 91                85                  87                  79
 Central America                  92                   98                 84                76                  83                  67
 Andean Area                      89                   94                 73                75                  82                  57
 Brazil                           98                  100                 85                81                  87                  49
 Southern Cone                    98                   99                 90                96                  98                  82
 Spain                           100                  100                100               100**              100**                100**
 Portugal*                        96***                     ND                 ND           85***                    ND                  ND

developed countries. In addition, the adverse effects of cli-              into political will, resources, and programs to improve health
mate change are extremely broad, as they impact all human                  care and protection and aid climate-resilient development
organs and affect health institutions in terms of disease                  remains a challenge. For example, due to the close rela-
care and prevention, in addition to damaging public health                 tionship between air pollution and climate change, failure to
infrastructure.                                                            jointly address air pollution and climate change mitigation is
                                                                           a missed opportunity to achieve multiple health, economic,
While all people are exposed to climate impacts, exposure                  and environmental benefits.
differs from place to place. Climate change happening place
more quickly in certain places than in others, and the risks               Current governance mechanisms, including at the local level,
are not the same everywhere. The local context should there-               have failed to effectively address the cross-cutting nature of
fore be considered in order to understand the challenges                   environmental problems that impact health, including climate
faced, the opportunities available, the inherent capacities of             change. To the extent that policies continue to be imple-
these locations, and the actions to be taken to ensure the                 mented without identifying their possible impacts on health
resilience of the population and prevent adverse effects as                and healthcare systems, their overall benefit will be limited
climate continues to change.                                               (WHO, 2018a).

For more than two decades, scientists have been investi-
gating the implications of observed and projected climate
change, along with the magnitude and pattern of adverse
                                                                           16.1.4. Review of past reports
health outcomes resulting from these changes. However, in                  The Fifth Assessment Report of the IPCC (Smith et al., 2014)
part due to financial constraints, in low-income countries the             notes that, until the mid-century, climate change will continue
evidence base remains fragmented and particularly limited.                 to increase and even aggravate existing health problems.
The main health hazards from climate change include expo-                  Based on such assumptions, health issues arising from cli-
sure to extreme weather events that cause injury, mental                   mate change will imply higher risks of injury, disease, and
health problems, and death; heat waves, with their asso-                   death due to heat waves and wildfires; increased likelihood
ciated health problems and loss of life; poor water quality                of malnutrition resulting from diminished food production in
and distribution, which is associated with gastrointestinal                low-income regions and among people with fewer economic
diseases, algae growth, and leptospirosis; food insecurity                 resources; loss of working capacity and reduced labor pro-
leading to malnutrition, intoxication, and exposure to myco-               ductivity in vulnerable populations; and increased risks from
toxins; alterations in vector ecology and distribution, with               vector-borne diseases (VBDs) and food- and water-borne dis-
examples of vector-borne diseases (VBDs) such as dengue,                   eases. The expected beneficial impacts would be a moderate
chikungunya, zika, malaria, hantavirus, and encephalitis,                  decrease in morbidity, mortality, and, in some cases, VBDs
among others; and social factors that promote impacts on                   associated with low-temperature conditions, although at the
physical and mental health due to violent conflicts and forced             global scale these impacts will be surpassed by the severity
migration (Haines and Ebi, 2019).                                          and magnitude of the adverse effects (Smith et al., 2014).
                                                                           This report emphasizes the need to strengthen public health
While promising progress has been made in integrating cli-                 programs, particularly the supply of potable water and san-
mate change and health, translating clear scientific evidence              itation services, primary health care, child health services,

                                                                                                                     RIOCCADAPT REPORT 621
Chapter 16 - Human Health

      vector control and, most importantly, early warning systems         This diversity of present and future climate effects exposes
      (EWS) and disaster response systems, as well as the fight           more people in more places to health hazards. A hazard is
      against poverty (Smith et al., 2014).                               the possible occurrence of a physical event, a trend, or a
                                                                          physical impact that may result in loss of life, injury, or
      The special repor t on 1.5°C published by the IPCC
                                                                          other health-related outcomes. The significance of a hazard
      (Hoegh-Guldberg et al., 2018) has revealed, among other
                                                                          will depend on its location, and identifying hazards requires
      findings, that the impact of the scenarios studied will be
                                                                          an awareness of all changes in the physical environment
      lower if temperature is stabilized at 1.5°C, compared to
                                                                          (UNEP, 2019).
      the 2°C threshold. However, this does not guarantee an
      absence of adverse effects, and the report reiterates that          Populations can be exposed to a number of hazards, includ-
      in order to achieve this goal it is essential that the actions      ing changes in air or sea temperature and precipitation,
      to stop warming increase and become more ambitious. The             droughts, wildfires, storms, hurricanes, and sea level rise
      document holds that, in the field of health, the main areas         (UNEP, 2019). Some of these health hazards may be present
      of risk are VBDs, food- and water-borne infections, extreme         for longer periods or at unprecedented times of the year,
      events, food insecurity, and air pollution. Health impacts          and some people will be exposed to hazards that are new in
      are expected to intensify, with socioeconomic factors influ-        the place they live (Balbus et al., 2016), which can lead to
      encing the magnitude and pattern of risks. In terms of food         severe consequences when authorities and citizens alike are
      security and health systems, adaptation may be more of a            uncertain of how to act.
      challenge at a temperature increase of 2°C than of 1.5°C.
                                                                          Extreme weather events have tripled since the 1960s. They
      The role of these systems remains essential to meet the
                                                                          are estimated to cause more than 60,000 deaths per year,
      challenges of rising temperatures. Empowering the health
                                                                          par ticularly in developing countries. These increasingly
      sector through intersectoral work is essential to coping with
                                                                          intense events, coupled with sea level rise, can destroy
      the impacts of climate change, as is supporting research
                                                                          homes, medical services, urban services, and agricultural
      into adaptation and mitigation with health co-benefits and
                                                                          and livestock areas. Many people may be forced to migrate.
      ensuring the availability of economic, technological, and hu-       In addition, the increase in floods may create areas for vec-
      man resources. A fundamental aspect is investing in various         tor growth. Moreover, changes in temperature may prolong
      areas in addition to health, such as education, public social       transmission times and change their geographical distribu-
      security systems, policies to fight poverty, and insurance          tion (WHO, 2019a).
      to manage risk, since significant synergies can be achieved
      by these means (Ebi et al., 2018; Hoegh-Guldberg et al.,            Extreme events are responsible for deaths caused by car-
      2018).                                                              diovascular and respiratory diseases, mental disorders,
                                                                          communicable diseases, dermatological diseases, drown-
                                                                          ing, physical injuries, and malnutrition. Floods and extreme
      16.2. Risk components in relation                                   precipitation also lead to serious health consequences. An
                                                                          estimated 15% of all disaster-related deaths from extreme
            to health                                                     events are due to floods (Raes, 2013). South America ac-
                                                                          counted for 22% of the global occurrence of disasters be-
                                                                          tween 2000 and 2015; of these, floods accounted for 50%
      16.2.1. Hazards                                                     of the events, followed by storms (9%), landslides (8%), and
                                                                          extreme temperatures (8%) (McBreen, 2016). Globally, 77%
      Rising concentrations of greenhouse gases (GHGs) result             of countries experienced an increase in the population’s daily
      in changes in climate that manifest through increased tem-          exposure to wildfires between 2001 and 2014 and 2015–
      perature, changes in precipitation, increased frequency and         2018 (Watts et al., 2019). Nagy et al. (2018) have reported
      intensity of some extreme weather events, and sea level             that Bolivia, Brazil, Costa Rica, Honduras, Nicaragua, and
      rise. These climate change impacts endanger health by af-           Peru were the countries with the highest percentage of pop-
      fecting food and water sources, the air we breathe, and the         ulation affected by disasters and, to a lower extent, Mexico,
      weather we endure, as well as our interactions with natural         Paraguay, Uruguay, and Venezuela.
      environments.
                                                                          According to Nagy et al. (2018), in Latin America the impacts
      The social determinants of health are the socioeconomic cir-        of extreme meteorological events are mainly related to so-
      cumstances in which people are born, grow up, live, work and        cioeconomic and human development, geographical deter-
      age, including the health system. Conversely, environmen-           minants of health vulnerability to climate, and variables that
      tal determinants are specific environmental health problems         describe health disparities. Countries that experience the
      arising from, inter alia, energy use, water resources, the pres-    fewest direct impacts on human well-being are those with
      ence or absence of basic sanitation, crops and agricultural         the best human, socioeconomic, and vulnerability indices,
      systems, labor conditions, the presence of hazardous waste,         and the highest per capita expenditures on public health.
      and air, water, and soil pollution (Galvão et al., 2010), as well   Specifically, the countries with the highest public expendi-
      as any environmental conditions that impact on health, such         tures are Chile, Uruguay, Costa Rica, Panama, Argentina,
      as climate change.                                                  Paraguay, Brazil, and Mexico.

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Some examples of the impact of extreme events during just          placement events were organized by the authorities as part
one week in October 2019 include: 101,600 people affected          of the risk management system (GRID, 2019). Digestive and
by floods and landslides in Guatemala, 400 houses at risk          water-borne diseases are associated with heavy precipitation
of collapsing after heavy rains and floods in El Salvador, 530     and floods.
families affected by rain and floods in 14 municipalities in
                                                                   There are other relevant variables that, when associated with
Nicaragua, and 9,000 families affected by wildfires in Bolivia
                                                                   hazards, can strongly influence the impacts on a population.
(OCHA, 2019).
                                                                   These variables include changes in poverty or socioeconomic
One-sixth of worldwide diseases and disabilities are due to        status, and demographics such as age structure and ethnic
VBDs, with more than half of the world’s population at risk.       composition (Oppenheimer et al., 2014).
More than one billion people are infected and more than one
                                                                   If emissions are substantially reduced, projections indicate
million people die from malaria, dengue fever, schistosomia-
                                                                   that by 2100 the world’s population could be simultaneously
sis, leishmaniasis, and Chagas disease every year. The per
                                                                   exposed to the greatest magnitude of any of these hazards—
capita mortality rate is almost 300 times higher in develop-
                                                                   or to all three, if emissions are not reduced, with some trop-
ing countries than in developed regions (Campbell-Lendrum
                                                                   ical coastal areas being exposed to up to six simultaneous
et al., 2015).
                                                                   hazards (Mora et al., 2018).
Regardless of how climate-displaced migrants are counted,
many factors contribute to health risks associated with mi-
gration. Wesselbaum and Aburn’s (2017) findings regarding          16.2.2. Exposure
migration indicate that climate change generates consider-
able adverse effects in migrants’ countries of origin, while it    Both the frequency and the intensity of hazards may change
has been observed that the effect of temperature is stronger       continuously. Health effects occur when individuals or pop-
than the combined effect of income and political freedom           ulations who may be particularly vulnerable are exposed to
there. Moreover, the number of climate-related disasters in        climate-related hazards. More intense storms are likely to
migrants’ home countries increases migration (Wesselbaum           affect more people; likewise, an increase in their frequency
and Aburn, 2017). The resulting health impacts depend on           may increase peoples’ exposure to their effects, while recur-
both pre-existing conditions (e.g. mental health and nutrition-    ring events may have cumulative effects.
al status, desire to migrate, and existing health systems) and     Exposure to hazards resulting from changes in climate can
interventions (e.g. access to health care, provision of food       be acute, e.g. when populations experience a heat wave, or
and shelter, and changes in healthcare resources) (Watts et        their effects can be observed in the medium term, such as
al., 2019).                                                        in drought conditions, where the impacts experienced will
Air quality can be affected by meteorological variables such       depend on the duration and intensity of the hazard.
as wind and temperature. The World Health Organization             The pathways of exposure to hazards will differ over time
(WHO, 2018b) has estimated that some seven million people          and for different areas. Similarly, climate change-related
die annually from air pollution-related diseases, identified as    exposure may affect different people and communities to
the main environmental health risk in the Americas (PAHO,          various degrees. Exposure to multiple climate change-related
2018c). An estimated 93,000 deaths per year in low- and            hazards may occur simultaneously, resulting in combined
middle-income countries and 44,000 in high-income coun-            or cascading effects, which can also accumulate over time,
tries are attributable to pollution in the region (PAHO, 2018c).   leading to long-term changes in resilience and health (Balbus
In Spain, pollution accounts for more than 10,000 deaths per       et al., 2016)
year (Díaz, 2018), and in Portugal the number of deaths in
2015 was estimated at 15,000 (Marques, 2019).                      The heat island effect in cities is known to increase heat
                                                                   stress from heat waves in their inhabitants (Zhao et al.,
Precipitation variability affects the availability of water, and   2018). These events cause excess mortality, increased in-
extreme events can also impact water quality, undermining          cidence of heat exhaustion and heat stroke, exacerbation of
hygiene and increasing the likelihood of diarrheal infections      circulatory, cardiovascular, respiratory, and renal diseases
that can lead to death, particularly in vulnerable populations     in elderly populations, children (PAHO, 2017b), and persons
such as children under five years of age living in poverty and     with pre-existing diseases (Linares et al., 2016) who live or
marginalization. In Guatemala, for example, cholera cases          work in environments with no air conditioning. Due to hor-
increased almost tenfold after Hurricane Mitch in 1998. In         monal changes, older women experience a direct impact
addition, of all deaths of children under five in 2015, diar-      on their thermoregulatory capacity, leaving them especially
rhea accounted for 8% in Nicaragua, 7% in Guatemala, and           vulnerable to the effects of high temperatures. This hazard
6% in Bolivia (PAHO, 2017b). Severe droughts can lead to           is exacerbated in women who live alone (Díaz et al., 2018).
famine and migration. In 2018, some 67,000 new cases of
internal displacement associated with upstream flooding and        Since 1990, hazards from extreme heat have increased
torrential rains were recorded in Colombia. In Mexico, 13,000      steadily in all regions, with 157 million more people exposed
new instances of internal displacement were reported as a          to heat wave events in 2017 than in 2000 and 18 million
result of Hurricane Willa, which struck six states. These dis-     additional exposure events compared to 2016. An estimated

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Chapter 16 - Human Health

      153 billion working hours were lost due to exposure to high                16.2.3. Vulnerability
      temperatures in 2017. In 2018, populations experienced 220
      million heat wave exposure events worldwide, breaking the                  The extent and severity of climate change impacts on health
      previous record of 209 million set in 2015. This increase                  depend on the interaction between exposure to alterations
      in heat wave exposure poses a direct risk to the health of                 in the affected meteorological variables and the vulnerability
      affected populations; moreover, there are additional indirect              of the human and natural systems exposed to them, coun-
      effects (e.g. food insecurity as a result of livestock exposure            terbalanced by the responsiveness or adaptive capacity of
      to heat waves). Due to rising temperatures and heat waves,                 these systems, which includes financial and technological
      133.6 billion potential working hours were lost globally in                resources and organizational and planning capacity (Ebi et
      2018, 45 billion more than the 2000 baseline (Watts et                     al., 2011; Gutiérrez and Espinosa, 2010). For example, early
      al., 2018).                                                                warning systems focused on vulnerable populations, such
      Between 2010 and 2016, air pollutant concentrations wors-                  as the elderly, to alert them of heat waves, as well as pre-
      ened in nearly 70% of cities worldwide, especially in low- and             ventive health services prepared to assist them in case of
      middle-income countries. Exposure to air pollution is estimat-             emergency, are adaptation meaures that could reduce the
      ed to have contributed to 130,000 deaths in the Americas in                risk of aggravating health conditions or death.
      2015 (Watts et al., 2018).                                                 As regards vulnerability in a given area, a series of relevant
      According to the WHO (WHO, 2017), VBDs account for more                    factors may be its unique climate, including the intensity
      than 17% of all infectious diseases and cause more than                    and frequency of weather phenomena, and its geograph-
      700,000 deaths per year. More than 3.9 billion people in                   ical location, such as the coast, mountains, islands, etc.
      over 128 countries are at risk of dengue fever, with an esti-              Population-specific factors that affect vulnerability include
      mated 96 million cases per year. Malaria causes more than                  demographic structure, the prevalence of pre-existing health
      400,000 deaths each year worldwide, most of them among                     disorders, genetic factors, and acquired factors such as im-
      children under five. An estimated 500,000 people are ex-                   munization. Another element is the coverage and effective-
      posed to the severe dengue vector and require hospitalization              ness of the public health system, as evidenced by the qual-
      each year; a large percentage of whom are children (Camp-                  ity of monitoring and control programs and primary health
      bell-Lendrum et al., 2015).                                                care (Balbus and Malina, 2019). Relevant demographic and
                                                                                 socioeconomic factors are population density, resource dis-
      Latin America, Spain, and Portugal are exposed to various                  tribution, and social capital, which play a decisive role in
      hazards, incuding hydrometeorological events, VBDs, air                    vulnerability; these factors often interact with those of a
      pollution, heat waves, and poor water availability and qual-               biological nature.
      ity. Each event has its own particularities, such as area of
      impact, duration and timing of the event, intensity, and ex-
      posure pathway.

        Box 16.1. Poverty and climate change

         Climate change will have devastating consequences for people liv-       vulnerable to diseases, loss of crops, food price increases, and
         ing in poverty, as the greatest burden will fall on them. Even in the   death or disability caused by extreme events.
         best-case scenario, hundreds of millions will face food insecurity,
                                                                                 Climate change threatens to undo the progress of the past 50 years
         forced migration, disease, and death.
                                                                                 in terms of development and counteract efforts to reduce global
         Health crises and ill health contribute to poverty through loss of      health and poverty. It could even affect middle-class families and
         income, health expenditures, and caregiving, so the impacts of cli-     contribute to their impoverishment (Hallegatte et al., 2016).
         mate change on health will act as an additional obstacle to poverty
         reduction and increase inequality.                                      Climate change will exacerbate existing poverty and inequality. Its
                                                                                 most severe impacts will be felt in low-income countries and regions
         People living in poverty are likely to reside in areas more suscep-     and in locations where people with incomes below the poverty line
         tible to climate change and in less resilient housing. Their pos-       live and work (UN Human Rights Council, 2019).
         sessions may be affected by extreme events; they have fewer
         resources, less government support, and weaker financial systems        The World Bank estimates that without immediate action, climate
         to cope with their losses, all of which may leave them too fragile to   change could drive an additional 120 million people into poverty
         recover from the impact. In addition, their livelihoods and assets      by 2030, a figure that is likely underestimated and could increase
         are more exposed (Hallegatte et al., 2016) and they are more            in subsequent years (Hallegatte et al., 2016).

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 Table 16.4. Variables that affect vulnerability, their specific associated conditions, and examples. Source: Ebi et al., 2011.
      Variables that affect vulnerability                     Specific conditions                                     Examples
 Reference climate                            Projected magnitude and frequency of                Being located in urban areas or flood zones
                                              meteorological phenomena; geographical              subject to various health and safety risk factors
                                              circumstances
 Effectiveness and coverage of the public     Quality of monitoring and control programs          Mortality and morbidity
 health system and related institutions
 Characteristics of the population            Demographic structure; prevalence of pre-existing   Vulnerable groups, such as women, children, the
                                              medical conditions such as immunity and genetic     elderly
                                              factors
 Demographic and socioeconomic factors        Population density; social capital; resource        Differences in ability to adapt or respond to
                                              distribution                                        exposure

Groups that are vulnerable to the impacts of climate change                  capacity to climate change. Rapid population growth increas-
consist of persons living in conditions of social inequality,                es vulnerability and exposes more people to various risk fac-
children, older adults, women, people with disabilities, and                 tors, which will affect the population’s morbidity and mortality
people with pre-existing or chronic diseases who work out-                   rates (Soares da Silva et al., 2016).
doors (e.g. police officers, street vendors, construction work-
                                                                             Many cities in developing countries lack adequate infrastruc-
ers) due to their exposure to heat waves (Beggs, 2010).
                                                                             ture and urban planning, increasing their degree of exposure
In terms of age, infants are often the most affected by the                  and vulnerability to extreme events. For example, houses
potentially permanent effects of malnutrition due to hazards                 located on hills, in dry riverbeds, or near streams are vulner-
affecting food production and food security. Children are                    able to landslides.
among the most susceptible to diarrheal disease and expe-
                                                                             In Latin America, the indigenous population—estimated at
rience the most severe effects of dengue fever. During ado-
                                                                             42 million—is a highly vulnerable group (World Bank, 2017).
lescence and beyond, air pollution, driven mainly by fossil fu-
                                                                             Much of their vulnerability is due to their dependence on
els and exacerbated by climate change, damages the heart,
                                                                             land and natural resources, which are affected in various
lungs, and all other vital organs. Throughout life, families and
                                                                             ways by climate change. Due to poverty and marginaliza-
livelihoods bear the risks of the increasing frequency and
                                                                             tion, indigenous peoples often have very limited access to
severity of extreme weather conditions, with women being
                                                                             mainstream health and prevention services and health pro-
among the most vulnerable in a variety of social and cultural
                                                                             motion programs. For example, the Rarámuris, an indigenous
contexts. Another group identified as vulnerable comprises
                                                                             people living in the northern Mexican highlands (sierras), ex-
workers, as rising temperatures and heat waves increasingly
                                                                             perienced a drought that severely impacted the maize and
limit various populations’ ability to work. Other conditions
                                                                             bean harvests, which are highly valuable crops in their food
that are difficult to quantify include migration, exacerbation
                                                                             system (PAHO, 2017a).
of poverty, violent conflict, and mental illness, which can
affect people of all ages and regions regardless of where                    Gender is another condition for vulnerability. Women may
they live (Watts et al., 2019).                                              be more vulnerable to psychosocial health impacts during
                                                                             extreme events, as they are more likely to bear the burden of
Moreover, people’s vulnerability can be affected by the deg-
                                                                             recovering from the event and continuing their lives to satisfy
radation of air quality, industrial pollutants, poor housing,
                                                                             multiple demands both within and outside the home (Oswald
lack of air conditioning, and changes in the built environment
                                                                             et al., 2014) and to lack access to health services during the
(PAHO, 2017b), while the occurrence of extreme events can
                                                                             event (Kovats et al., 2003; Cannon, 2008).
exacerbate the vulnerability of a population (Sorensen et al.,
2017). Table 16.4 presents variables that affect vulnerabil-                 Indicators of climate change and its effects on human health;
ity, the specific conditions they are associated with, and a                 the adaptation measures planned to benefit the vulnerable;
few examples. With this information, it is possible to identify              the monitoring and evaluation of the actions proposed, im-
elements that should be considered when designing adapta-                    plemented, and executed; and the resources invested can be
tion measures to protect people’s health.                                    used to identify, analyze, and address vulnerability (Kovats
                                                                             et al., 2003). This will enable adaptation measures to reduce
In recent decades, Latin America has experienced a signifi-
                                                                             vulnerability in the medium and long terms, in addition to
cant growth in population and urbanization, and these trends
                                                                             reducing the burden of disease.
are likely to continue. In Spain and Portugal, growth has been
quite low and, in some cases, slightly negative (National In-                Ebi et al. (2011) have argued for the need to assess current
stitute of Statistics, 2017; IndexMundi, 2017). These trends                 and future vulnerability to health risks from climate change,
carry significant implications for vulnerability and adaptive                as well as to evaluate policies that could focus on improving

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      resilience to health risks. This assessment could focus on                of increasing temperature and changing climate threaten to
      a region or locality, and its findings would provide valuable             undermine recent global progress against some VBDs.
      information to policymakers on the type and magnitude of
                                                                                Vector-borne diseases are a major cause of death; they signifi-
      the health risks associated with climate change, both now
                                                                                cantly contribute to the global burden of disease and health
      and in the future, and on the policies to avoid its existing
                                                                                inequality, cause epidemics that disrupt health security, and
      effects and prevent and reduce future ones. Likewise, it
                                                                                place a strain on development and health services. About one-
      would provide elements to define progress towards building
                                                                                sixth of the illnesses and disabilities experienced worldwide are
      climate-resilient communities and protecting the health of
                                                                                caused by these diseases (Campbell-Lendrum et al., 2015).
      the population.
                                                                                The greatest risk of disease is usually faced by people with
                                                                                fewer economic resources, due to their more limited environ-
      16.3. Characterization of risks                                           mental and social conditions (e.g. lower-quality housing near
                                                                                vector breeding sites) and lack of access to preventive and
            and their impacts                                                   remedial medical interventions and services (Ottesen et al.,
                                                                                1997). Urbanization is another cause for concern, since in
                                                                                developing countries it is uncontrolled and water and sewer-
      Latin America and the Iberian Peninsula are vulnerable to
                                                                                age services are not provided, thus creating conditions for
      some of the most harmful aspects of climate change. Various
                                                                                the proliferation of vectors (Hay et al., 2006).
      hazards are responsible for changes in ecosystems, which in
      turn give rise to various health risks. Figure 16.2 describes             The WMO (2018) has noted that the emergence of the zika
      the eight main risks to health, their climate determinant,                virus epidemic, mainly transmitted in Latin America by the
      magnitude, urgency, and affected regions. Central America                 Aedes aegypti mosquito and caused by drought and unusu-
      stands out as the most vulnerable region.                                 ally high temperatures, has developed at least since 2013
                                                                                due to environmental changes caused by lack of humidity
                                                                                and temperature increases. Changes in temperature, rain-
      16.3.1. Vector-borne diseases                                             fall, and humidity can have strong effects on leishmaniasis,
                                                                                which in addition to drought, floods, and famine can lead
      Diverse disease vectors exist, including mosquitoes, phlebot-             to human migration to transmission areas. In the case of
      omines, triatomine bugs, simulids, ticks, mites, snails, and              dengue fever, geographical distribution can be significantly
      lice. Mosquitoes are especially sensitive to changes in tem-              affected by changes in temperature, rainfall, and humidity
      perature and humidity (Smith et al., 2014). Current trends                (Prüss-Ustün et al., 2016).

        Box 16.2. Human rights and climate change

         Climate change threatens the enjoyment of all internationally guar-     1. To mitigate climate change and to prevent its negative human
         anteed human rights, including the rights to health, water, food,          rights impacts
         housing, self-determination, and life itself. Many people will be
         living in poverty, but they will be far from the only victims (UN       2. To ensure that all persons have the necessary capacity to
         Human Rights, 2019a).                                                      adapt to climate change

         Any climate-related hazard can challenge the full and effective         3. To ensure accountability and effective remedy for human rights
         enjoyment of various human rights worldwide, including the right           harms caused by climate change
         to life, to water and sanitation, to food, to health, to housing, to
                                                                                 4. To mobilize maximum available resources for sustainable,
         self-determination, to culture, and to development (UN Human
                                                                                    human rights-based development
         Rights, 2019a).
                                                                                 5. International cooperation
         The adverse impacts of climate change are disproportionately suf-
         fered by individuals and communities who are already at a disad-        6. To ensure equity in climate action
         vantage due to geography, poverty, gender, age, disability, and
         cultural or ethnic background.                                          7. To guarantee that everyone enjoys the benefits of science and
                                                                                    its applications
         In order to promote policy coherence and help ensure that climate
         change mitigation and adaptation efforts are adequate, sufficiently     8. To protect human rights from business harms
         ambitious, non-discriminatory, and compliant with human rights
                                                                                 9. To guarantee equality and non-discrimination
         obligations, the following considerations should be a part of all
         climate actions (UN Human Rights, 2019b):                              10. To ensure meaningful and informed participation

626   RIOCCADAPT REPORT
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