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 Topics: Temperature-related morbidity and mortality and Health effects from extreme weather events

Summary of Discussion

The group identified and reviewed the strategic questions, clarifying the issues for the larger group in the plenary session. It was noted that the discussion surrounding the health effects of climate change can go in a variety of directions. The group focused on both cold- and heat-related mortality and morbidity, including cardiopulmonary and cardiovascular stresses. Other key issues raised involved the effects that climate change or extreme weather can have on mental health, immune systems, population displacements, and the added strain on already strained health institutions.

Issues related to health effects can be characterized by both long- and short-term outcomes and by variability. There are variations in scale and in patterns of intensity, as well as unknown effects on ecosystem health and life support systems. The group called for new research approaches to create more detailed and inclusive analyses of heat waves, cold waves, indirect effects and unknown interactions. Among the priorities would be 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 policymakers, 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.

The various knowledge limitations identified by the group served as the basis for defining four strategic questions grouped into two categories: explanation and identification; and action and adaptation. The strategic questions dealing with temperature and extreme events are given below as formulated by the group. They have also been summarized somewhat differently in the Tables located at the end of the report. The relative importance of the strategic questions and research tasks in the Tables have been given a tentative priority rating. A critical path analysis is still to be done.

Temperature-related morbidity and mortality and Health effects from extreme weather events

Knowledge
Strengths

• Good infrastructure to cope with and respond to issues.
• Capacity to develop strong GIS skills.

Limitations

• Limited awareness of the full gamut of ecological controls.
• Inadequate understanding of full impacts of climate change on health.
• Insufficient modeling ability.
• Shortage of fully trained professionals.
• Significant uncertainties in current measurement methods.
• Insufficient sharing of information and knowledge on the health effects of climate change among primary health care providers.
• Need for more comprehensive environmental health indicators.
• Failure to consider traditional and Indigenous health care and methods for preventing and dealing with disease.
• Insufficient number of modelling studies.
• Potential publication biases in favour of sensational research findings.
• Absence of a vested interest in climate change as demonstrated by a tendency to focus on short-term approaches.
• Failure to recognize varying levels of population vulnerability.
• Failure of economic models to weigh the costs associated with the medium and long-term effects of climate change (a need for macro-economic modelling).

Data Sources

Strengths

• Sufficient research literature.
•  Availability of free or inexpensive data sources on the Internet
•  Established confidentiality guidelines for sharing and gaining access to data.
•  Existence of standards for data collection, which contributes to data accuracy.

Limitations

• Limited access to and linkages between certain types of data.
• Limited awareness of existing data.
• Various data gaps, including data collection that is not comprehensive or which focuses on irrelevant issues.
• Under-reporting from remote or under-serviced communities.

Methods
Strengths

• Well-developed epidemiological methods.
• Global Public Health Intelligence Network (GPHIN) housed at Health Canada.
• Good examples of effective public education (e.g. Lyme disease, skin cancer).

Limitations

• The existence of political boundaries instead of regional or climate-based denominators.
• Reliance on reductionist rather than systemic approaches.
• Insufficient attention to multi-disciplinary or transdisciplinary approaches.
• Failure to factor in social and ecological determinants.

Capacity
Strengths

• The Prairie Adaptation Research Cooperative (PARC).
• The Canadian Climate Impacts and Adaptation Research Network, C-CIARN.

Limitations

• Uncertainty over the use of the precautionary principle.
• Limited federal funding for surveillance, resulting in insufficient surveillance capacity.
• Inadequate collaboration among professionals.
• Insufficiently advanced computer systems for detailed regional climate change analyses.
• Inadequate explanations of the science of climate change.
• Absence of scenario-based risk assessment and integrated assessment frameworks.
• Existence of both positive and negative aspects of the relationship between climate change and human health.
• Inadequate rapid response systems.
• Inadequate scenarios for managing possible extreme weather disasters (e.g. flooding) resulting from climate change.

Discussion of the C-CIARN Health Node

Participants discussed the pros and cons of locating the Climate Change Impact and Adaptation Research [C-CIARN] health node within the Climate Change and Health Office [CCHO] of Health Canada.. Apart from the possibility that Health Canada might be the only available location for the node, the 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. 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 C-CIARN, and in distinguishing between the Department's overall mandate and its role in the C-CIARN partnership.

The group made the following conclusions and recommendations regarding the C-CIARN Health Node:

• The health node should be located at Health Canada and 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.
• Ongoing communications will be extremely important for maintaining the visibility of the node. A quarterly electronic newsletter would be one way of keeping stakeholders informed.
• 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 summary 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.

Strategic Questions

Explanation/Identification
(Knowledge Gaps)

• What are the short- and long-term health effects of climate (including extreme weather events)?

Further research must address the magnitude of the effects, including short- and long-term consequences for health. These research initiatives should consider issues such as the freeze and thaw effect. Geographical differences must also be identified, since there are extensive rural and urban variations. Future research should consider interference, incidents of acceleration, and spacial variation.

• What are the risks to health from extreme weather events, now and in the future?

There is a need to achieve a better understanding of changing events, and to quantify and classify uncertainties. These risks and uncertainties must be communicated to policy-makers in order to inform policy and planning.

• What are the differential health impacts from climate variability and extreme weather events?

The group decided to view population health in terms of the elements of health proposed by Health Canada in examining the different effects of climate variability and extreme weather events on health (e.g. do the effects vary by age, gender or genetic makeup?). Another issue that must be considered is whether the differential impacts vary according to scale ( geographically, temporally, and in terms of individuals and communities).

Action/Adaptation

• How do we minimize/reduce health effects from extreme weather events?

There is a need for more exploration and implementation of modes and methods of testing. In order to make changes effectively, the approach must consider community risks and input. It must involve modified planning paradigms as well as ecological literacy and awareness through education.

A group in Quebec is currently working on the education and outreach aspect of climate change and health. Maps on climate change for seven regions in Canada have been developed. They contain a wealth of information, including some health impacts, and are ideal for raising awareness in such places as educational institutions.

Strategic Questions

The research agenda should address the following specific strategic questions:

Research results that will support efforts to mobilize resources

• The short- and long-term health impacts of extreme weather events;
• The overall health impacts of extreme weather events, and the local preparations or adaptations that will minimize those impacts;
• Canada's emergency preparedness, including the capacity to manage more than one or two disasters at a time;
• Steps that can be taken to prepare in advance for weather emergencies, cope with them when they occur, and manage consequences in the aftermath;
• Placing extreme weather in the context of the wider range of "median" events that could result from climate change, as a means of mobilizing the resources to address the problem;
• The profile and location of vulnerable populations in Canada, possibly in contrast to the recent emphasis on inner city/urban dynamics in the US, and the extent to which local conditions affect vulnerability;
• The most effective and cost-effective methods of reducing vulnerability to heat-related mortality and morbidity;
• Vulnerable populations' own perception of the potential impact of temperature variability and extreme weather events;
• Linkages to the root causes of climate change, such as demographics and consumer lifestyles, aimed at attracting research resources to the study of health and climate change.

Research results to help minimize the impact of extreme weather events

• Quantification of the current and future health risks of extreme and less extreme weather events across Canada;
• The relative importance of climate change - and of related concerns like air quality, heat stress and impaired immune response - compared to other health problems in Canada;
• The different impacts of weather variability and extreme weather events as individuals and communities move through the age continuum;
• The relative importance of climate to good health, compared to accepted determinants like income, social status, education, general environmental quality, coping skills, genetic makeup, and access to health services.

Discussion also touched on the following research questions:

• A comparison of temperature-related mortality and morbidity in summer and winter, both in the current climate and after accounting for the impacts of climate change;
• The synergistic and differential relationship between heat and air quality, and the relative impacts on mortality;
• The extent to which climate change will lead to an increase in the duration and frequency of heat waves and smog episodes;
• The capacity of the population to adapt to temperature variations;
• The impact on mental health when the climate changes, including implications for workplace depression;
• Management of the consequences of landscape and habitat loss resulting from extreme weather events, from anxiety among children to lost income when a wood lot is destroyed;
• Use of multi-disciplinary research to explain why health equals wealth.

Participants briefly considered the use of GIS mapping to measure and document the consequences of extreme weather events.

Later in Wednesday's discussion, participants agreed that the research agenda should focus on demonstrating the long-term need for research on the health effects of climate change, and on its significance and usefulness. A key objective, they said, should be to show how climate events link with social phenomena.

Research Tasks

• Establish geographical information systems (GIS) to complete various tasks, including collecting data and mapping macro-, meso- and micro-environmental spatial locations;
• Establish adequate early-warning surveillance and monitoring based on indicators sensitive to disease, the environment and climate change impacts;
• Establish climate and environmental controls that will feed into all other research questions;
• Research potential publication biases by reviewing studies that have no explicitly positive or negative outcomes;
• Evaluate the effectiveness of prevention, control and treatment strategies including public health measures, conventional medical practice and traditional/holistic practices and approaches;
• Develop an integrated and effective framework for data access, sharing and research collaboration and partnerships;
• Establish transparent processes and open information exchange;
• Establish a role for ethics and values in policy development;
• Establish a baseline for subsequent research;
• Integrate GIS spatial tools into the decision-making process so as to optimize GIS consideration in policy development;
• Research various methodologies to determine which are best suited for initiatives;
• Define and agree on the indicators that should be used to elucidate the relationship between the environment and health.

Outputs/Deliverables

• State of knowledge report on health impacts and adaptation, including an inventory of successful adaptations or maladaptions to current climate conditions, and a list of climate-related health indicators that would contribute to the measurement and valuation of health effects;
• An ongoing communication function to maintain the visibility of research on the health effects of climate change;
• Development of maps or posters that overlay temperature extremes with vulnerable groups, communities and regions;
• Establishment of a health and climate surveillance network.

Research Sub-Topics

• Identification: What are the short- and long-term health effects of climate change, including extreme weather events?
• Identification: What are the risks to health of extreme weather events, now and in the future?
• Identification: What are the differential health effects from climate variability and extreme weather events?
• Action: How can the health effects of extreme weather events be minimized

Health Issue Topic: Temperature Related Health Effects from Extreme Weather Events

Research Sub-Topic	Impacts
Strategic Question	What are the past and future short- and longterm health effects of climate change and variability, and of extreme events in different regions, localities, population groups or communities in Canada?
Tasks	Assess health effects of climate change and variability (magnitude of short- and long term regional, local, rural, urban health effects in susceptible population groups). Assess influence of human (age, gender, genetic ) and environmental factors (cold, heat, changing freeze / thaw cycles), and interactions with other factors.
Products	State of Knowledge Report on Climate Change health impacts and adaptation, with an inventory of successful or unsuccessful adaptation attempts, indicators for climate related health effects; visual aids, e.g. maps, posters to reflect expected risks and their trends. Baseline data for trend measurements.
Uses / Linkages	Identification of knowledge gaps and of vulnerable population groups. Risk communication. Development of adaptation polices and strategies. Emergency preparedness planning. Improved health risk assessment and management.
Order On Critical Path	High

 

Research Sub-Topic	Impacts
Strategic Question	What are the key determinants of health and well-being in populations subjected to extreme weather events?
Tasks	Identify major factors influencing morbidity, mortality, and mental and social well-being during past extreme events; identify successful protective features or measures. Develop comprehensive predictive health effect models. Develop improved health effects monitoring and reporting systems.
Products	Matrix and models of interactions of environmental and social factors influencing health and well-being during and after extreme events.
Uses / Linkages	Improved health impact monitoring and surveillance programs for extreme events. Better emergency preparedness.
Order On Critical Path	High

 

Research Sub-Topic	Impacts
Strategic Question	How do social and non-climatic environmental factors influence the shortand long-term key determinants of health in population groups subjected to climate variability and extreme weather events ?
Tasks	Assess the importance of social status, education, income, coping skills, stress, access to health services, and of environmental factors other than climate (e.g. geography, rural vs. urban), including synergistic effects.
Products	Identification of interactions of social and non-climatic environmental factors in population groups exposed to climate variability and extremes.
Uses / Linkages	Improved adaptation strategies. Better emergency preparedness and response planning. Improved access of most vulnerable groups to key health and social services in weather disasters.
Order On Critical Path	High

 

Research Sub-Topic	Adaptation
Strategic Question	How can we effectively and economically reduce the negative effects of ext reme weather events, and our vulnerability to them?
Tasks	Assess the effectiveness, costs, and benefits of national, regional, and local emergency preparedness plans and capacities. Identify and correct weaknesses, gaps, or costbenefit ratios. Assess environmental and population vulnerabilities and develop protective measures. Consider improved damage insurance schemes.
Products	Cost-benefit evaluations of integrated emergency preparedness plans and capacities. Evaluations of the effectiveness of measures to protect the environment and population groups at risk of extreme events. Evaluations of the availability, and cost effectiveness of governmental and non-governmental insurance or compensation schemes.
Uses / Linkages	Improved emergency preparedness policies and plans. Improved protection of the health and social and economic wellbeing of vulnerable environments and population groups.
Order On Critical Path	High

 

Research Sub-Topic	Methods	Impacts
Strategic Question	How can the uncertainties of health risks from future extreme weather events be defined and best communicated to policy makers and the public?	What are the risks to health and well-being from extreme weather events, now and in the future?
Tasks	Assess the nature, causes, and magnitude of uncertainties in risk assessments of extreme events. Produce simple but correct explanations for effective communication.	Using global and regional climate change modeling results, and data on impacts of past extreme events, assess the likelihood of extreme weather events in different regions, and their likely health impacts.
Products	Better understanding and communication of uncertainties in planning for extreme events, similar to indicating uncertainties in weather forecasts.	Regional assessments of the likelihood of extreme events and of their health impacts.
Uses / Linkages	Preparation of effective communications to policy makers. Improved policy making.	Emergency preparedness planning. Adaptation strategies.
Order On Critical Path	High	High

 

Research Sub-Topic	Methods	Impacts
Strategic Question	How can the uncertainties of health risks from future extreme weather events be defined and best communicated to policy makers and the public?	How will future summer and winter temperatures affect present morbidity and mortality patterns?
Tasks	Assess the nature, causes, and magnitude of uncertainties in risk assessments of extreme events. Produce simple but correct explanations for effective communication.	Assess current temperaturerelated health effects. Construct and apply integrated temperaturehealth effect models to assess possible future trends under various climatic conditions on national and regional or local scales.
Products	Better understanding and communication of uncertainties in planning for extreme events, similar to indicating uncertainties in weather forecasts.	Temperaturemorbidity and mortality data bases and models. Assessments of population vulnerabilities to temperature extremes.
Uses / Linkages	Preparation of effective communications to policy makers. Improved policy making.	Adaptation strategies Emergency preparedness planning.
Order On Critical Path	High	High

 

Research Sub-Topic	Methods
Strategic Question	What are the synergistic and differential relationships between high temperatures and air quality, and what are their effects on morbidity and mortality?
Tasks	Assess relationships between temperature and indoor and outdoor air chemistry (including pollutants). Use existing data and integrated modeling to assess the separate and combined effects of temperature and air quality (e.g. of "offensive air masses") on morbidity and mortality of populations "at risk".
Products	Data bases on health effects of temperature and indoor and outdoor air quality. Mathematical models and modeling results. Identification of critical factors (indicators) for health effects of temperature and of air quality (pollutants).
Uses / Linkages	Adaptive strategies. Forecasts of the buildup or arrival of hot and/or polluted air masses. Improved protective measures and emergency preparedness for populations at risk. Mitigation and control strategies for air pollutants.
Order On Critical Path	High

 

Research Sub-Topic	Adaptation
Strategic Question	To what extent can Canadian population groups in different regions acclimatize to extreme temperatures?
Tasks	Assess regional acclimatization capacities of "at risk" groups.
Products	Assessments of adaptation capacities of "at risk" groups. Identification of most vulnerable groups, communities, or regions.
Uses / Linkages	Improved adaptive and protective measures for groups at risk of adverse health effects of extreme temperatures.
Order On Critical Path	High