Africa Case Study

1. Africa Case Study Dele Ogunseitan School of Social Ecology University of California, Irvine May 20th 2004 Advanced Institute of Vulnerability to Global Environmental Change International Institute for Applied Systems Analysis, Austria

2. Outline (1) Institutional Issues: Framing and prioritizing vulnerability assessments in Africa. (2) Thinking outside the dominant framework: Global environmental change and the African burden of disease. (3) Proposed solutions to global environmental change will have impacts too: No-cost adaptation and the clean development mechanism in Africa. (4) Break (5) Group discussion/summary

3. Panarchy and Vulnerability “Panarchy focuses on ecological and social systems that change abruptly. It is the process by which ecosystems and societies grow, adapt, transform, and, in the end, collapse.” - C.S. “Buzz” Holling (2004) Vulnerability is inevitable? • Holling, C. S. 2004. From complex regions to complex worlds. Ecology and Society 9(1): 11. [online] URL: http://www.ecologyandsociety.org/vol9/iss1/art11 • Gunderson, L. H., and C. S. Holling. 2002. Panarchy: understanding transformations in human and natural systems. Island Press, Washington D.C., USA. Epidemics Extinctions Forest fires Earthquakes War

4. Several external factors contribute simultaneously to vulnerability e.g. “abrupt” climate change; emerging pathogens; global trade; how do we prioritize assessments? Vt = ∑(Vi)*∑ (Ve) Internal vulnerability

5. Perpetual Panarchy in Africa Normative Issues When resources are limited, choices are typically made to focus on pre-existing stressors rather than on emerging threats, but innovative frameworks address both challenges through “no-cost” adaptation strategies. In many African countries, the reconciliation of national development plans with international priority to mitigate global environmental change (e.g. climate change, ozone depletion, biodiversity loss) remains an intractable policy controversy. Its resolution requires conviction of vulnerability to new conditions that will exacerbate preexisting environmental stresses on society and public welfare.

6. Emergence of Regional Frames of Vulnerability The Perspective of Developing Countries: The New Delhi Conference in 1989 (The equity argument). African Perspectives: Nairobi Conference in 2-4 May 1990; Sponsored by the Woods Hole Research Center at the UNEP headquarters. The Cost of Gaining International Financial Support: Framing, funding, and the question of intellectual hegemony. Prioritizing GHG Inventories, Mitigation, and Vulnerability (Sensitivity + Capacity for Adaptation). The benefits of national GHG inventories and mitigation are shared globally. Whereas the burden of adaptation to the impacts are expected to be borne nationally.

7. Policy Recommendations from the 1990 Gathering of “African Perspectives” Focus on deforestation, carbon sinks, and food security Futuristic scenarios Enhancing research and training Strengthening the technological base Promoting public awareness and participation Reforming the institutional environment Vigilance of industrialized country actions Promotion of private sector initiatives Adjusting UN agency framework

8. Framing environmental issues across different scales International Conventions; Country representatives Negotiation of Alternative International Frameworks At the same scale e.g. CoP to UNFCCC; Ramsar National Environmental And Health Policy e.g. Country Study Programs; IPCC Local knowledge systems e.g. Burden of disease estimates

9. International Support for Vulnerability Assessments in Africa

10. U.S.-sponsored Country Study Programson climate change inventories, mitigation, and vulnerability assessments

11. African Participation in the USCSP: Assessments of Vulnerability and Adaptation by Sector

12. Agenda setting: Institutional structure, state of the science, and advocacy Q: When USCSP started supporting national assessments in 1992-94, health was not included in the first round of vulnerability assessments -until much later in 1996-98 with the second round of assessments and national action plans. What caused the delay? A: “We were limited mainly by the development of the science. We did not have good information or training to provide, but after we got into the program, some countries began to agitate for the inclusion of health. At about the same time, some influential scientists were beginning to produce empirical work on health impacts of climate change, and as a result of the combination of the request from participating countries and the availability of scientific expertise, we decided to include health.” I would say that, except in the health area, which really did in fact come up from a number of different countries, nothing else came completely out of the blue, because we had a big net for the issues. - Jack Fitzgerald, Acting Director, USCSP (2000).

13. Health as a focal point for assessments of vulnerability • Health is a common concern for African countries, and the ultimate impact of climate on crop production and water resources is population health. • Development of “Early warning systems” for local environmental changes that currently accounts for most impact on human health and social welfare. • Possibility of circumventing health-damaging pathways to industrial development. • *Pre-epidemiologic transition. Therefore, burden of disease is attributable to environmental factors that are sensitive to climate change. • *WMO-day 1999: Weather, Climate, and Health

14. 1963 1973 Lake Chad 25,000 km2 95% reduction 1,250 km2 1987 1997

15. The Lake Chad Basin Commission has mandate over 967,000 km2 watershed. Five member states own it and contribute it's budgets. The mandates of regional organizations enable them to undertake active multipurpose infrastructural projects that could generate funds to finance of regional basin organizations.

16. Population migration, resource conflict, and vulnerability to AIDS in Lake Chad Basin Countries Estimates of the number of persons living with the HIV, June 2000* *Source : UNAIDS

17. High expectations for new cross-scale institutional arrangement The Ramsar Convention on Wetlands Memorandum of Cooperation between Ramsar and the Lake Chad Basin Commission (established in 1964) The signing ceremony, Valencia, Spain, 23 November 2002: Delmar Blasco and Muhammad Sani Adamu

18. Naivasha Lake BasinToday at 1880 m above sea level (1886 m in 1926), it is the highest of the Rift Valley freshwater lakes, and second largest at 100 km2, but only 5 m deep; and no outlet! >400 species of birds 1980 Human population 20,000 Fish harvest 68 tonnes 2000 Human population 250,000 Fish harvest 14 tonnes Sewage, pesticides, and Fertilizer loading. Ramsar Convention Designation in 1996

19. Optimization of institutional collaborations • Negotiation of constraints on agenda setting and funding mechanisms to re-establish ownership of assessments and responsibility for intervention schemes). • Technical capacity development, including qualitative and quantitative analyses. • Re-configuration of science-policy interfaces within countries.

20. Published On-line http://www.globalforumhealth.org/forum_6/sessions/ Every year more than US $70 billion is spent on health research and development by the public and private sectors. An estimated 10% of this is used for research into 90% of the world's health problems. This is what is called "the 10/90 gap".

21. Research Approach • It is generally assumed that potentially controllable environmental risk factors, as opposed to life style preferences, contribute most to the burden of disease in developing countries. • Quantitative assessments of the health impacts of environmental remediation are not commonly performed because of methodological difficulties and the paucity of data that could usefully correlate investment in infrastructures for environmental protection to prevent adverse health outcomes. • These limitations have incapacitated attempts to prioritize risk factors in the interface between the environment and human health sectors.

22. Objectives • The main objective of this research was to use composite indicators of disease burden as tools for prioritizing solvable environmental problems that influence sub-regional burden of disease. • To test the sensitivity of the composite indicators to various scenarios of global environmental change as a way to monitor population vulnerability.

23. Global Burden of Disease Assessment Seven RegionsWHO/WB/HSPH

24. Estimating local burden of diseases • A composite measure of the combined impact of death and disability in a population is used to estimate disease burden. The Disability-Adjusted Life Years (DALY) model: • DALYi[0,0] = YLLi + YLDi • Where DALYi[0,0] = Undiscounted, unweighted for disease i • YLLi = Years of Life Lost due to disease i • YLDi = Years of Life lived with Disability due to disease i

26. Communicable diseases Non-communicable diseases Injury-related

28. Future projections of disease burden ln M = C + b1lnY + b2lnHC + b3T Where: M = projected mortality level C = constant term Y = GDP per capita HC = Human capital (including population growth) T = Time

29. Estimating risks attributable to environmental factors Attributable Risk is assessed according to the following equation, using published data on relative risks for each cause of death and disability related to the exposure, levels of exposure (prevalence), and burden of disease due to each cause of death and disability in the population: AB = ∑AFj Bj=∑Pj(RRj – 1) ÷ ∑Pj(RRj – 1) + 1 • Where • AB = Attributable Burden for a risk factor • AFj = Fraction of Burden from cause j • Bj = population level burden of cause j • P = Prevalence of exposure • RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed group. • n = Maximum exposure level

30. Combining future projections with attributable risk can give an estimate of avoidable disease burden WHO, 2002

31. Models and Scenarios • In the first scenario, decadal evaluation of selected climate-driven epidemics were evaluated against projected scenarios of climate change predicted by the Intergovernmental Panel on Climate Change. • In the second scenario, co-benefits of climate change mitigation were explored using the burden of disease approach and the abatement of lead (Pb) exposure as the dependent variable.

32. Rank order of population at risk for vector-borne diseases Millions

33. Nigeria’s Demographic Characteristics* *Source: United Nations Development Program 1999.

34. Socioeconomic indicators and health care status in Nigeria *Values are for 1995 unless otherwise stated. Source: UNDP, 1999.

35. Cases of Notifiable Diseases in Nigeria 1990-1999.National Database Source: Federal Epidemiology Division, Federal Ministry of Health, Abuja, Nigeria 1Cerebrospinal meningitis 2Guinea worm *January - August only

36. Deaths from Notifiable Diseases in Nigeria 1990-1999National Database Source: Federal Epidemiology Division, Federal Ministry of Health, Abuja, Nigeria 1Cerebrospinal meningitis 2Guinea worm *January - August only

37. Regional Mortality by Gender in Study Population (1990 - 1999).

38. Hospital Admissions by Gender in the Study Population (1990 - 1999).

39. Disease Incidence per 1000

41. DALY (HeaLY) model scenarios

42. The local burden of disease: Top categories for Years of Health Lives Lost (1990-1999)

43. Sensitivity of disease burden to environmental change

44. Epidemic potential for climate-sensitive Vector-borne diseases EP = reciprocal of host density threshold Critical density for vector-borne disease transmission Mc1 = c1 (- ln (p) ÷ (b)(c)(a2)(pn)) Where p = survival probability of mosquito a = frequency of blood feeding n = incubation period of the parasite vector b = efficiency of infection c1 = constant based on recovery rate and host susceptibility factors Reproductive rate of disease = R0 = (m)(a2)(b)(c)(pn) ÷ r (-ln (p)) When R0 > 1, disease will spread. n = Dm ÷ T – Tmin, m Dm = degree-days required for parasite development T = average ambient temperature Tmin = minimum temperature required for parasite development

45. MIASMA Modeling framework for the health Impact ASsessment of Man-induced Atmospheric changes • MIASMA is an acronym devised to refer to several models dealing with health impacts of global atmospheric changes: the vector-borne diseases model.

47. From Shakespeare to Defoe: malaria in England in the Little Ice Age.Paul ReiterCenters for Disease Control and Prevention, USA. ipr1@cdc.gov • Present global temperatures are in a warming phase that began 200 to 300 years ago. Some climate models suggest that human activities may have exacerbated this phase by raising the atmospheric concentration of carbon dioxide and other greenhouse gases. Discussions of the potential effects of the weather include predictions that malaria will emerge from the tropics and become established in Europe and North America. The complex ecology and transmission dynamics of the disease, as well as accounts of its early history, refute such predictions.

48. Emerging scientific controversy over the linkage between climate and vector-borne diseases (e.g. Malaria) Vol. 6, No. 4, Jul–Aug 2000 To the Editor: I read with great interest the article "From Shakespeare to Defoe: Malaria in England in the Little Ice Age" (1). Unfortunately, the article is not as balanced as a presentation last year by Paul Reiter, which clearly illustrated that, although climate is important in the transmission of malaria, the influence of other factors (e.g., access to medical care and improved housing) is likely to be of more importance in Europe…. While Reiter's paper offers an interesting perspective on the history of malaria in Europe, it provides no illuminating information on the influence of climate change on human health. - Pim Martens (Maastricht University, Maastricht, The Netherlands) To the Editor: The two reports from the International Panel on Climate Change (IPCC) (1,2) cited in the letter by Pim Martens (3) are widely regarded as "the standard scientific reference for all concerned with climate change and its consequences," yet the contents of these reports are often misleading…….. Repeated claims that global warming may have already led to increases in these diseases in the tropics are equally indefensible….. - Paul Reiter (Centers for Disease Control and Prevention, USA)

49. Climate change and malaria vulnerability in Nigeria