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TFEW April 21 - 22, 2008 1

WATER, CLIMATE CHANGE AND HEALTH

R AertgeertsRegional adviser, water and sanitation

Co-secretary, Protocol on Water and Health

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TFEW April 21 - 22, 2008 2

System adaptation to climate change

• A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health, as well as more direct health improving activities.

• Health services provide a buffer against the climate variability and change.

• Emergency medical services have a role in limiting excess mortality.

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TFEW April 21 - 22, 2008 3

Agenda

• Impact of climate change on health systems, and adaptation mechanism.

• Impact of climate change on the water and sanitation sector, and adaptation mechanisms.

• The Protocol as a tool to promote adaptation through TFEW, TFIR, TFWRDS

• Conclusions.

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TFEW April 21 - 22, 2008 4

Health systems

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TFEW April 21 - 22, 2008 5

Health outcomes of climate change

• Water-borne (ingested):– Infectious diarrhoeal diseases– Pollutant-related diseases

• Water-washed: – Intestinal helminths, – Eye and skin infections

• Vector-borne: malaria, dengue fever • Water-based: Legionellosis

• Viral diseases ???

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TFEW April 21 - 22, 2008 6

Basis for health sensitivity studies

• Health impacts from extreme events

• Spatial studies

• Temporal studies

• Experimental laboratory and/or field studies

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TFEW April 21 - 22, 2008 7

Assessment of potential health impacts

• Limited local-specific changes• Multiple, interacting and multicausal

outcomes make attributing outcome to climate difficult

• Difficult generalising outcomes• Limited inclusion of different development

scenarios in health projections• Difficulty in identifying climate thresholds

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TFEW April 21 - 22, 2008 8

Health system constraints

Constraint Disease-specific response

Health system response

Financial access Payment exemption Pooled pre-paid funds

Physical access Outreach programs Location planning

Competence low Continued education Licensing, curricula

Management Skill training Control and accountability

Intersectoral action National commitments Local cross-sectoral action

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TFEW April 21 - 22, 2008 9

Health sector adaptation strategy

• Health action plans• Emergency medical services• Improved climate-sensitive disease

surveillance and control• Safe water and improved sanitation• Strengthened health services

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Six building blocks

• Service delivery• Trained health workforce

• Health information systems• Access to essential medical products,

vaccines and technologies• Adequate and sustainable financing

• Leadership and governance

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Conclusion on health systems

• Health systems are a key player in the detection of health threats and in the curative aspect of long-term health outcomes, as well as in dealing with emergency situation.

• The TFIR, the TFWDS, and the TFEWE are important for the implementation of the WHO programme on health systems

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Water supply and sanitation, climate change and extreme events

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Regional impact Asia

• Decrease freshwater availability in C, S, E and SE Asia

• Coastal and river flooding in S, E and SE Asia

• Increase in endemic morbidity and mortality due to diarrhoeal diseases

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Regional impact Europe

• Magnified regional differences: decrease in surface flow in S, increase in N

• Reduced water availability in S: general decrease in summer flow

• Glacier retreat in mountain areas• Increased water stress in S Europe• Polar regions: hydrogeological changes

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Floods

• Global warming is projected to intensify the hydrological cycle and increase the occurrence and frequency of flood events

• Health outcome: drowning, injuries, contamination of resource waters, outbreaks of infectious diseases.

• Stagnant pools favour vectors.

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Droughts

• Climate change has likely increased the frequency and/or severity of droughts

• Health effects include deaths, malnutrition, infectious disease and respiratory disease.

• Extended drought reduces resistance to vulnerable disease and population of mosquito predators.

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Groundwater

• Changing quality due to changes in surface water quality

• Accelerating hydrological permeability, leading to quicker transport of pollutants

• Increased salinity, through seawater intrusion

• Increased evapotranspiration• Increased soil temperature.

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Aquatic ecology

• Changes in self-purification of rivers due to decreased oxygen content.

• More stable vertical stratification in deep lakes affecting oxygen, nutrient cycling and plankton

• Eutrophication, change in timing of algal blooms and increase of harmful algal blooms

• Alterations to habitats and distribution of aquatic organisms incl protozoan invaders

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Conclusion on water and sanitation

• Climate extremes cause both physical and managerial stresses on water supply systems, although well-managed public water supply systems should be able to cope with climate extremes.

• … well managed?

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Economic vulnerability

Above, 36

Below, 20

0

1,000

2,000

3,000

4,000

5,000

6,000

ROM KAZ BUL MTG ALB AZE ARM KOS MDV KYR

GDP per capita (US$)

Countries with annual GDP per capita of less than 6,000 USD are assumed to be at additional risk of diarrhoea.

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Europe’s rural population in 2004

• EUR-A 24% – 86 million

• EUR-B 44% – 97 million

• EUR-C 30% – 72 million

In rural areas, water scarcity is associated with multiple adverse health outcomes, incl parasites,

vector borne diseases associated with faulty water-storage systems, and malnutrition.

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(Lack of) access to improved water supply

• EUR-A: – Universal house

connection• EUR-B:

– 84% have house connection, 95% of urban and 66% of rural areas

• EUR-C: – 83% have house

connection, 92% of urban and 56% of rural areas

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(Lack of) access toimproved sanitation

• EUR-A – 62 % have house

connection, 61% of urban and 44% of rural areas

• EUR-B – 71% have house

connection, 88% of urban and 27% of rural areas

• EUR-C – 67% have house

connection, 85% in urban and 24% in rural areas

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Guidelines for drinking-water quality

• 1984 – 1987 First edition• 1993 – 1997 Second

edition• 2004 Third edition• Thereafter ‘rolling revision’

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Need for more holistic approach

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Risk scoring matrix

Likeli-hood

Severity of consequencesIn-significant

Minor Moderate Major Catastrophe

Certain

Likely

Moderate

Unlikely

Rare

?

?

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D O C U M E N T A T I O N O F W S P

Su

pp

orti

ng

pro

gram

sV

alidation

Description of water supply system

Controlling hazards

Implement and maintain control measures

Establish operational monitoring

Define corrective actions

Verification and auditing

System assessmentIdentify hazards

Determine existing control measures

Assess and prioritize risks

Identify additional or improved control measures

C O

N T

I N U

O U

S R

E V

I E W

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WSP and floods

• Floods

• Infrastructure adaptation

• Functionality assessment

• Protection of sewerage systems

• Protection of production units

• Contingency plans for rehabilitation

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WSP and droughts

• Demand management to safeguard drinking water supply

• Resource allocation on consensual river basin management plan, but mandatory allocation possible

• Increase reuse of treated wastewater for irrigation and for aquifer recharge

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General adaptation issues for the water sector

• Differentiate adaptation strategy by sub-region

• Improve understanding of climate change impact at the basin level

• Ensure that current legislation develops to include climate adaptation measures at the local, national and supranational level.

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Water sector adaptation strategies

1. Address the existing situation • Ensure the fulfilment of the basic human

right to water for those who do not yet have sustainable house connections to drinking water and/or sanitation

• Plan for increasing demand as lifestyles change ( baths, washing machines…)

• Protect the most vulnerable first

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Water adaptation strategies

2. Demand and supply management– Inter-sectoral cooperation (agriculture) for

water resource conservation IWRM– O&M optimization– Safe storage– Re-use of treated wastewater– New techniques (desalination)– Realistic pricing with social programmes

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Protocol on water and health

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Safeguard water supply and sanitation

• Joint and coordinated action– Notification of threats of disease outbreak

• Cooperation on transboundary water management– Joint and coordinated water management plans

• International support for national action– Project facilitation mechanism

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Safeguard water supply and sanitation

• TF on Indicators and Reporting– Management, protection from pollution and

use of water resources for dw production– Access to water supply and sanitation– Performance of service provider (loss

reduction)– Quality of drinking water supplied– Safe reuse/disposal of treated

wastewater/sludge

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Strengthen health systems

• Task Force on water-related disease surveillance– Assess current surveillance systems– Provide guidance on reduction of water-

related diseases– Assist in the development of contingency

plans– Assist in strengthening response capacity

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Manage extreme events

• Task Force on indicators and reporting– Discharges of untreated storm water

• Task Force on water supply and extreme events– Exchange information on management of water

and sanitation utilities under extreme drought/ flooding

– Codify good practice guidance documents in this area

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Conclusion

• Climate change will pose considerable challenges for the realisation of the basic human right to safe drinking-water, both in quantity and in quality.

• WHO through the Protocol on Water and Health is in the forefront of supporting adaptation efforts by its Member States.

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THANK YOU