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?

Health Issue Topic: Population vulnerabilities

Summary of discussions

The breakout group discussions, conclusions, and recommendations concerning the problems of vulnerable populations and of population vulnerabilities have been summarized in this report, based on notes and other records made during the sessions.

Participants decided that 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. They stated that a good research methodology must be established before research begins. Priorities and tasks can be reassessed and revised at any time, but will be similar for any of the strategic questions .

A comprehensive approach is needed when trying to identify and to 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 solicitation and dissemination of 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 community research teams, and in related communications initiatives.

How closely a population is tied to the local environment can determine how quickly and how seriously climate change will affect that population. 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.

Like climate, the structure of society may change radically in the next fifty years. Although we are beginning to see effective climate change modeling for the future, our ability to imagine society fifty years from now lags behind.

Unfortunately, no vulnerable population groups were represented at this conference. In the US, indigenous people participated in Climate Change impact assessments as a sector.

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?

Population vulnerabilities

Knowledge and Data Sources
Strengths

• Information Technology (IT) offers increasingly more opportunities for people to access and distribute information, and this facilitates active participation of population groups in research and in decision-making.
• Statistics Canada has information on socio-economic factors and on demographic trends. Health Canada has a National Population Health Survey. A Canadian Community Health Survey being done by the Canadian Institute for Health Information ( CIHI ) includes a national longitudinal survey of children and youths. First Nations and Inuit Regional Health Surveys are also being done.
• Provincial and Territorial health care systems may possess good raw data for assessing health impacts of Climate Change.
• There is good evidence that the environmental impacts of Climate Change might be most severe in Canada's northern regions. Because these regions are also sinks for semi-volatile toxic compounds carried there by air currents from the south by long range transport, one must address the problems resulting from Climate Change also in the context of the effects of population exposure to these toxic chemicals, and of other pre-existing environmental stressors.
• Baseline information is available on chemical and metal contaminants and on their bio-accumulation in wildlife and in humans (through the food chain) from McGill University's CINE (Centre for Indigenous Peoples' Nutrition and Environment). This and other current baseline information on the health status of various population groups will be useful in assessing the health impacts of the coming environmental changes.
• An additional source of information is the International Institute for Sustainable Development (IISD) in Winnipeg (http://iisd1.iisd.ca).
• Expertise is available for assessing population vulnerabilities, and it could be increased if research training were provided to members of the local populations.
• The capture and use of relevant information needs to be facilitated.
• Water quality and use will become a major problem throughout Canada. The information available on water quality and use is of varied quality, but nevertheless useful.
• Much is known about biological or physiological changes in humans during different life stages, so changes related to climate change could be measured during the course of human development. Basic scientific information is available on both children and seniors to use as comparative data.

Limitations

• There is a crisis in knowledge transfer, because many older experts are retiring, and many older people who are sources of traditional knowledge are not being replaced by younger people. More opportunities need to be created for mentoring young people, in order to bridge this growing trans-generational knowledge gap.
• Many isolated and vulnerable communities are not easily reached and not easily connected to a good communications network. Their public health capacity is low.
• There is little understanding of the vulnerabilities of different populations and there is, as yet, no baseline for measuring vulnerabilities due to an absence of health-related data for vulnerable groups. There is much information on climate change, but not much information on health changes due to climate change.
• Data are not standardized. Some data cannot be merged because hospitals use different methods to capture information. Canadian researchers have to extrapolate from other countries, but it is difficult to extrapolate from these sources for Canadian purposes.
• There are not enough data on rural areas.
• Good published reports are available from the US , but there is little access to the data on which they are based.
• Some populations (First Nations, Inuit, people with disabilities, young children, homeless, elderly and the poor) are often not included in the available data.

Methods
Strengths

• Modeling methods and techniques developed elsewhere can be used here.

Limitations

• Climate change modeling needs to focus on identifying vulnerable populations.
• There is a need to ensure that data are collected in a standard format.
• Researchers have limited access to some population groups, due to cultural and language barriers, and this inhibits the collection of information. Also,information is not always collected from a representative sample.
• Health status indicators for past and future effects of Climate Change impacts are not well defined, and there are no established or agreed upon baseline data.
• Health effects reporting systems, including epidemiological registries and databases need to be enlarged to capture the right health end points for assessing Climate Change effects, including minor conditions. End points other than death seem to be inadequately reported.
• Effects of harmful UV radiation, such as skin cancer and cataracts need to be included in Climate Change health impact assessments, because some greenhouse gases destroy the stratospheric ozone layer.
• Researchers need to make better use of the data that do exist, and educational institutions need to bring more emphasis on environmental health research into their teaching and research programs.
• Researchers only get an incomplete picture and understanding of communities and their inhabitants. Local research is often not published.
• Research in remote regions can be prohibitively costly.
• Vulnerable populations have the least influence in setting the research agenda and defining research protocols, and thus research may not meet local needs. Moreover, researchers do not always report their findings back to the communities in which the research was done.

Capacity
Strengths

• Information Technology may allow isolated communities to participate more in population research.

Limitations

• There is very little funding dedicated for studies on the health impacts of Climate Change.
• Resources are needed, including reliable information that is easy to find, searchable and linked to the names of researchers.
• Infrastructure and literacy problems can impede studies of vulnerable populations.
• Often a "top-down" approach is used in community or population health studies instead of a consultative and partnership approach. Efforts are often focused on a single region or population group, thus not addressing all vulnerable populations.
• A greater involvement of social health science experts is needed.
• More researchers are needed, and opportunities for recruiting and mentoring should be exploited. Local people need to be trained to conduct research collaboratively with experts so that eventually they can do it themselves. Most northern researchers work in isolation.
• Research agendas need to be developed with the involvement of vulnerable population groups (First Nations, Inuit, Métis, elderly people, people with disabilities).
• Many isolated and vulnerable communities are not easily reached and may be neglected. Their public health capacity is low.
• There are not enough human or financial resources to do population vulnerability studies. It takes several years to build the infrastructure and capacity for research, and at least three years of research before there are results.
• Health care facilities do not have time to collect research data, and would need specialists for this task.

The Canadian Climate Impacts and Adaptation Research Network, C-CIARN: Support from Health Canada's Climate Change and Health Office, CCHO

Health Canada is well-placed for central support, and the CCHO may be the most appropriate location for the C-CIARN Health Node, as the Department already coordinates and integrates regional health information. However, an initial concern is the governance of and representation / input from different groups. How will different concerns and issues be dealt with? There should be a multi-stakeholder advisory group to ensure that stakeholders' views are taken into account. Partners involved in collecting data might want to be involved in its analysis.

The C-CIARN Health Node needs to be actively engaged in communications to 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. The Health Node should therefore 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, establish a website with links to related sites, arrange a list server to distribute information updates and offer people a choice between quarterly or more frequent e-mail updates. The information data base should be easy to find, searchable, and should link to the names of researchers and stakeholders. Participants considered various forms of information dissemination, including fact sheets, reports, videos, Internet sites, and conferences. This will require adequate resource allocations.

Strategic Questions

The research agenda should address the following strategic questions:

• What are the sensitive populations?
• What is the baseline?
• What health indicators are needed to support an exploration of the relationship between climate change and health?
• Who are the stakeholders?
• What are the vulnerable infrastructures and ecosystems as they relate to vulnerable populations?
• How does research on the vulnerability of specific populations to the health effects of climate change translate into policy?
• How can the climate change and health community develop an effective communication strategy that targets the general population, the health professions and specific stakeholders? What are the tools required for such a strategy?

Research Tasks

• Determine where to go for information;
• Prepare a position paper that outlines populations that may be vulnerable or sensitive to the health effects of climate change;
• Undertake consultations with a broader range of groups that may provide a more comprehensive view of vulnerable and sensitive populations;
• Define direct and indirect health indicators by population group;
• Develop and maintain a feedback mechanism to reassess and modify research priorities;
• Identify appropriate research methodologies;
• Outline a framework for identifying the factors that must be addressed in exploring the relationship between climate change and health.

Outputs/Deliverables

• Position papers;
• Results of consultations with broader groups;
• A document that identifies specific climate change issues and the vulnerable populations t he y affect;
• A literature review;
• Results of interviews and data analysis.

Uses

• Raise awareness among scientists, policy-makers, health care professionals, the general population and vulnerable population groups;
• Develop strategies for reacting and adapting to the impact of climate change, and for mitigating impact;
• Allocate federal, provincial/territorial, municipal, NGO, community and private sector resources to mitigate the impacts of climate change on vulnerable populations.

Disciplines

• Public health;
• Environmental science;
• Epidemiology;
• Medical anthropology;
• Human geography;
• Toxicology/ecotoxicology;
• Health promotion and education;
• Social, environmental and economic justice;
• Biology;
• Climatology;
• Culture and ethnicity;
• Medical professions;
• Ecology;
• Statistics;
• Immigration and border control.

Prerequisites

Prerequisites for research on strategic questions

• Vulnerable populations must be identified and baselines must be established before health indicators can be put in place.
• Appropriate experts must be identified and engaged.

Prerequisites for research tasks

• More funding, based on "buy-in" at various levels;
• Sufficient human resources;
• Adequate data;
• Contact with community stakeholders;
• Ethical review, consent forms, and research licensing;
• Education and training of researchers;
• A workable definition of "infrastructure" as it relates to climate change;
• Identification of vulnerable parts of the ecosystem that have implications for health.

Prerequisites for outputs/deliverables

• High-quality, standardized data to support reliable baselines;
• A feedback loop to support the assessment and, if necessary, modification of priorities, tasks and hypotheses;
• Dissemination of results using a variety of appropriate media;
• Identification and acknowledgment of limitations and gaps, in order to strengthen data collection;
• Creation of a framework to identify the health indicators that will help clarify the relationship between climate and health.

NB: For all strategic research questions, the research tasks, outputs or deliverables, and uses of the research work will remain similar to those shown in the Table below.

Health Issue Topic Population Vulnerabilities

Research Sub-Topic	Impacts
Strategic Question	Which are the vulnerable populations ?
Tasks	Find best information sources, summarize key data, identify data gaps.	Produce a health indicator and research framework; report on how to identify sensitive or vulnerable population groups.	External peer review and consultations to validate the proposed methodology and work plans.
Products	Summary of data sources and key baseline data; definitions of research tasks.	A position paper explaining the research framework, health indicators, research tasks and work plans.	Suggestions for improvements. Modified or validated research framework.
Uses / Linkages	Basic information for establishing a research framework.	Hypothesis and research method generation.	Assessment of validity and feasibility of proposed methodology and work plans.
Order On Critical Path	1	2	3

Research Sub-Topic
Strategic Question
Tasks	Disseminate the results. Apply new knowledge, implement recommendations. Carry out followup studies to validate information transfer and usefulness of recommendations resulting from the study.
Products	Multimedia, multichannel communications. Policy development or modification. Adaptation strategies and measures. Community actions.
Uses / Linkages	Validation of new approaches to Climate Change health risk assessment and management. Better resource allocation. Improved mitigation and adaptation strategies. Improved communications strategies. Increased awareness among scientists, health care providers, policy makers, general population and vulnerable population groups.
Order On Critical Path	5