First Annual National Health And Climate Change Science And Policy Research Consensus Conference - How Will Climate Change Affect Priorities For Your Health Science And Policy Research?

Presentations: Intergrated and Coordinated Research Agenda for each Breakout Session

Health Issue Topic: Water-and food-borne contaminants

There is a need for increased knowledge and understanding of which contaminants or pathogenic agents in food and water make people sick, as well as how and where they enter food or water. Knowledge gaps need to be filled with respect to the impacts of climate change on food and water production, and the introduction of contaminants and pathogenic agents. The process from production to consumption must be mapped and research questions should focus on this process and on how climate change might enhance or deter this contamination. For example, climate change may affect the preparation and storage of food in the home by changing the level of contaminants and pathogenic agents it may contain, even though food is usually stored or processed prior to consumption. Subsistence foods may form a special case, since these are generally harvested or collected by the people who will consume them, sometimes raw. The dynamic complexity of food and water systems is such that feedback loops within these systems may result in unexpected effects of contaminants, or unexpected outcomes of mitigation strategies. The assessment and linkage of available data, and the identification of critical gaps is a high priority.

The research must also explore regions and sub-populations, identifying those potentially more susceptible to food- and water-related illness because of climate change, for example, urban, coastal and northern areas, as well as First Nations. As with other environmental stressors, climate change will affect population groups that are most vulnerable. In cases of food or water shortages, the health of those that has already been compromised due to incomplete development (babies) or physiologic deterioration due to aging (elderly), or stressed due to illness or already inadequate nutrition (poors and marginal subsistence groups), will continue to deteriorate. Other examples include threats to the water supply safety in coastal areas due to flooding from sea level rise or extreme weather events; northern and First Nations peoples may encounter changes in their traditional food supply due to wildlife migrations and changes in sea ice; increased temperatures in the North may also increase spoilage of traditional foods.

Scientists and decision-makers in the areas of public health, food and water technology, as well as the public must be made aware of the impacts of climate change on food and water. In particular, communication between government agencies and other researchers is essential to avoid duplication of effort, using technology and mitigation measures that can help research, and keep the public informed. There is also a need to establish networks to foster the sharing of information across disciplines, and enhance the reporting of new findings to decision-makers and the public.

Health Issue Topic: Air pollution-related health effects

A number of climate-related health concerns and research needs are interrelated, starting with the identification of what characterizes health as it relates to climate change and air pollution as well as the determinants of health. Of utmost importance is the need for comprehensive information on the health implications of measures to mitigate greenhouse gas emissions. For instance, sealing up houses to increase their energy efficiency without knowing the effects on indoor air quality may have unanticipated effects on human health. The health effects of recommended mitigation measures should therefore be examined from an overall co-benefits and health perspective.

The consequences of increased temperature on the nature and frequency of smog events and their impact on health requires more study, for example such air contaminants as pollens and spores.

Initiatives for longitudinal population health studies were proposed to determine objectively the impacts of climate change and the value of mitigation strategies assessed. The research should be gap-driven and new techniques may be required to better assess exposure and health risks. The areas of research must be broad and the work must start now. Health effects from air pollution or climate change should be examined not only from a disease aspect, but also from a "quality of life" perspective, and ask the question: "What are the direct and indirect impacts of air pollution on our lives?"

Health Issue Topic: Health and socio-economic impacts

Climate change affects socio-economic status and conditions; in turn, it affects health. A conceptual model presented the direct and indirect three-way linkage between climate change, socio-economic conditions, and human health and well-being. Examples of socio-economic impacts include: changes in income and social status (e.g. farmers suffering crop failures and income losses), productivity and employment shifts from one industry sector to another, increased inequity of access to natural resources (e.g. due to scarcity of water in certain areas), increased migration (regional, provincial, international), decreased quality of life of Aboriginal people and other subsistence populations affected by depletion or disappearance of essential resources due to changes in ecosystems, and consequently exposed to increased stress.

A possibility for climate crises was raised and this could become the cause for large scale social conflicts and wars; major societal shifts anywhere in the world will have impacts in Canada.

Redirecting public thinking towards adaptation was considered important; for this, it is critical to understand the "societal reflex" toward climate change. Human health cannot be addressed in isolation, and the research agenda should be driven in part by an understanding of the broader determinants of health. A key research challenge is that the anecdotal evidence is not adequately supported by scientific data.

Health Issue Topic: Population vulnerabilities in cities and communities

The problem of vulnerable populations could be approached by considering two important tasks: formulating strategic research questions to fill critical knowledge gaps, and defining essential tasks related to health policy development, health risk management, and other non-research aspects. A good research methodology must be established before research begins.

A comprehensive approach is needed when trying to identify and address climate change impacts and adaptation problems facing vulnerable populations. This means integrating a wide range of disciplines into research programs and projects through extensive consultation and partnership development, and soliciting and disseminating information to and from researchers, different levels of government, communities and other stakeholders, policy makers, health risk managers, and health professionals.

Data collection must be standardized before a baseline can be established, and the relationship between weather and health must be better understood in order to determine who is vulnerable. The kind and availability of health effects data are influenced by where people go when they are sick; this has an impact on how information on climate- or weather-related health effects is gathered. Valuable information will be missed if it is not captured from all potential sources. Experience in the Canadian North suggests that information reporting improves when local people are included in com munity research teams, and in related communications initiatives.

How closely a population is tied to the local environment can determine how quickly and how seriously it will be affected by climate change. In Canada, First Nations, Inuit and Métis people are among the most dependent on their local environment, and they and other subsistence populations are therefore probably among the most vulnerable groups in terms of health.

Inadequate or fragile infrastructures, and areas likely to be subjected to climate extremes, including droughts, fires, or floods, are other important risk factors, and thus should also be identified. People living in large cities may be especially vulnerable to climate change because of their very high reliance on a complex infrastructure and fragile electricity supplies to maintain their lifestyle, and because of the urban heat island effect. Urban economic, socio-cultural and language barriers may become important factors in vulnerability. The experience gained during the 1995 heat wave in Chicago may be very useful in coping with similar future emergencies in Canadian cities.

Priority questions are: What will vulnerable communities look like in twenty to thirty years? Who will make up the vulnerable populations in a changing world? How will future environmental changes affect the social and economic disparities that exist today? What health indicators do we need to explore the relationships between climate change and health and well being? Who is best qualified to assess the impacts of environmental change on population health and well being? Who is most capable of finding and using the best adaptation strategies?

Health Issue Topic: Temperature-related morbidity and mortality / Health effects of extreme weather events

The discussion focused on both cold- and heat-related mortality and morbidity, including cardiopulmonary and cardiovascular stresses. Other key issues involve the effects of climate change or extreme weather on mental health, immune systems, population displacements, and the added strain on already strained health institutions.

There are both long- and short-term outcomes and variability issues related to effects on human health. There are also variations in scale and in patterns of intensity, as well as unknown effects on ecosystem health and life support systems. New research approaches need be developed to create more detailed and inclusive analyses of heat waves, cold waves, indirect effects and unknown interactions. Priorities would include to fill major knowledge gaps, and to define and reduce uncertainties. The use of Geographic Information Systems (GIS) should be considered for mapping the spatial distribution of interacting risk factors and other critical data, and for communicating research results effectively to policy-makers, stakeholders and the public.

The temperature-related health effects of extreme weather events are mainly the result of excessively variable temperatures (extremes) and excessive or lacking precipitation. However these two factors are characterized by many unknowns and uncertainties, due to insufficient knowledge and research in this area.

Various knowledge limitations served as the basis for defining four strategic questions grouped into two categories:

1. explanation and identification:
   
   
   1. What are the short-and long-term health effects of climate (including extreme weather events)?;
   2. What are the risks to health from extreme weather events, now and in the future?;
   3. What are the differential health impacts from climate variability and extreme weather events?; and
      
      
2. action and adaptation: How do we minimize/reduce health effects from extreme weather events?

Health Issue Topic: Vector-borne infectious diseases

There is a need for a baseline of data and other information to track disease trends. Research and methods must also be improved to address issues related to the identification and control of vector-borne diseases and to understand the interactions between vectors and their environment.

Key needs were identified for enhancing current research areas and creating new ones. The focus would be on baseline data since valuable information may be lost if surveillance and reporting are not accurate, immediate and complete. The prerequisite for effecting change involves collecting data from areas where the incidents are actually occurring, using an integrated approach. This would include biological and other approaches to studying vector-borne diseases in the context of climate change. Thus is best done by using a multi-disciplinary approach with international collaboration.

Effective prevention must focus on two aspects: 1) public health measures involving the identification of vector-borne diseases and effective measures for vector and disease surveillance and control; and 2) conventional health care and holistic health care which involve comprehensive care of the health and well-being of infected and at-risk populations groups or individuals, including traditional and multicultural health care methods, and social supporting mechanisms.

Discussion of the C-CIARN Health Node

Participants discussed the positive and negative aspects of locating the Climate Change Impact and Adaptation Research (C-CIARN) Health Node within the Climate Change and Health Office (CCHO) of Health Canada.

Against locating the Health Node within Health Canada, some groups believed that the greatest benefit would be achieved if it was situated outside of government, as a watchdog, although there are also benefits that come from being located at Health Canada who should continue to play an organizational role in relation to C-CIARN. It was also believed that, although Health Canada may be the appropriate central organization to manage the CCIARN health node, the effectiveness of that node may be compromised if it is situated within the Department and that a CCIARN health node or hub would function more effectively as a clearinghouse if there were a distance established between it and Health Canada, although the latter could be a sponsoring agency. Another group added that Health Canada's current organizational role is a positive one but that C-CIARN should be kept at arm's length from government agencies and put forward the possibility of having universities involved.

On the positive side, apart from the possibility that Health Canada might be the only available location for the node, one group balanced the benefit of CCHO as a champion for the issue against the possible perceptual problem of a government agency taking the lead. A non-government organization (NGO) might present a more impartial profile, but very few NGOs are involved in climate change and health research, as opposed to education, outreach and advocacy. Therefore, Health Canada is well placed for central support, and the CCHO may be the most appropriate location for the CCIARN Health Node, as the Department already coordinates and integrates regional health information.

Some group members noted that CCHO's goal is to act as an "orchestra leader" for research on climate change and health, not to control the agenda. A participant stressed the need to ensure that the health node is led by good listeners, so that other stakeholders' views are taken into account. Another delegate suggested that the existing checks and balances are sufficient to ensure an inclusive approach. CCHO staff affirmed that their role is to support existing networks and facilitate the work that needs to be done, adding that ultimate control of the health node would rest with an outside policy committee, not with the staff member assigned to coordinate the node. Participants appreciated CCHO's assurance that its role is to facilitate research, not control it. They asked for clarity on Health Canada's role in relation to CCIARN, and in distinguishing between the Department's overall mandate and its role in the CCIARN partnership.

Recommendations regarding the functioning of the CCIARN Health Node follow:

• The credibility of the Health Node will depend in large part on early successes. One possibility for the first year would be to assemble a state of knowledge report on health impacts and adaptation, with a plain language su mm ary and a clear communication strategy. The node could also study the effectiveness of specific actions and adaptations, as a first step in developing a resource and data inventory on climate variability and how people adapt.
• Early effort will be required to engage key target audiences, including primary caregivers, public health officers, and municipal planners.
• An initial concern is the governance of and representation / input from different groups. The health node should be directed by an advisory committee with representation from all levels of government, NGOs, academic institutions and health associations. Eric Taylor of Natural Resources Canada was suggested as coordinator.
• The CCIARN Health Node needs to be actively engaged in communicating with researchers and stakeholders to ensure that the right priority issues are addressed, to avoid duplication of effort, and to make the best use of limited resources. Ongoing communications will also be extremely important for maintaining the visibility of the node. To keep participants informed and engaged from this point on, the Climate Change and Health office should, provided it has adequate resource allocations:
  produce regular newsletters to establish and increase the lines of communication;
• establish a clearinghouse;
• coordinate with researchers;
• build a research library;
• identify knowledge gaps and hold annual workshops for knowledge exchange;
• organize electronic discussion groups, disseminate information on its own mandate and on C-CIARN as a whole;
• provide advice on where to apply for research funding;
• disseminate information on activities related to the health impacts of climate change under such formats as fact sheets, reports, videos, Internet sites, and conferences, a list server to distribute information updates and offer people a choice between quarterly or more frequent e-mail updates;
• establish a website with links to related sites;
• set up an information database easy to find, searchable linked to the names of researchers and stakeholders.