- Email: [email protected]
Community level research on water health and global change: where have we been? Where are we going?
Available online at www.sciencedirect.com
Community level research on water health and global change: where have we been? Where are we going? Diana Karanja1, Susan J Elliott2 and Sascha Gabizon3 The changes that are occurring as a result of global environmental change have spurred a great interest within governments and the scientific community, with the realization that it is a threat to large numbers of populations in all regions of the globe. Ensuing research for answers highlights the need to build resiliency, to adapt and mitigate the impacts. At the community level, especially rural communities, the low adaptive capacity resulting from poor health infrastructure and limited resources are challenges in the context of stresses on the availability of safe water, injuries resulting from floods and storms, shortage of drinking water because of droughts, redistribution and/or increase of vector-borne infections and other infectious diseases related to poor sanitation, poor nutrition related to agricultural disruption, and sea-level rise causing saline intrusion into drinking water. These challenges will require research agendas with practical detail and multidisciplinary approaches. Addresses 1 Kenya Medical Research Institute, P.O. Box 1578, Center for Global Health Research, Kisumu, Kenya 2 Faculty of Applied Health Sciences, University of Waterloo, Canada 3 Women in Europe for a Common Future, Utrecht, Netherlands Corresponding author: Karanja, Diana ([email protected]) and
Current Opinion in Environmental Sustainability 2011, 3:467–470 This review comes from a themed issue on Aquatic and marine systems Edited by Lucilla Spini, Zafar Adeel and Mark W Rosenberg Received 15 May 2011; Accepted 5 October 2011 Available online 28th October 2011 1877-3435/$ – see front matter # 2011 Elsevier B.V. All rights reserved. DOI 10.1016/j.cosust.2011.10.002
Introduction There is a momentum to increase resiliency, to adapt and/ or mitigate the impacts of global environmental change following the realization that the threat to the environment’s capacity to sustain life at the global and community level is one of the greatest challenges facing humanity today. Within the limited resources available for tackling the impacts of climate change, there is an increasing interest on whether the focus should be placed on adaptation or mitigation, or give both equal weight for a most costeffective approach [1]. Health impacts brought on by water-related environmental change, whether at the community or global level, are influenced by a complex combination of human activities, spanning social, economic, www.sciencedirect.com
and cultural dimensions. The impacts are forecasted to include injury resulting from floods and storms, shortage of drinking water because of droughts, redistribution and/or increase of vector-borne infections and other infectious diseases related to poor sanitation, and poor nutrition related to agricultural disruption. Although no single community is immune to the impacts of global environmental change, those expected to be especially vulnerable are within developing countries, Small Island developing States, and marginalized rural communities; their vulnerability being particularly driven by their low adaptive capacity [2]. Communities living in coastal regions, megacities, mountains, and Polar Regions, as well as communities with weak health infrastructure and those where the burden of disease is already great will also bear the brunt of adverse impacts of global environmental change. The elderly, children, the poor, and people living with preexisting medical conditions will also influence a community’s resiliency and adaptive capacity. From the initial skepticism and controversies on the reality of environmental change, particularly as influenced by climate change, to the increasing acceptance that changes are occurring [3], the interest in the outcomes of global change on human health has evolved cautiously over the years. The same rigorous scrutiny as the general debate on the reality of global change has clearly endured, with increasing attention from governments. At the outset, the research agenda was to determine the plausibility of the links between global change and human health, and although the debate is far from over, there is a greater shift towards research agendas based on acceptance of the impacts of global change on human health, and a search for strategies for building resilience and adaptive capacity at the community level. This shift is clearly reflected in the WHO’s World Health Assembly (WHA) resolution 61.19 of 2008 requesting for a work plan for protection of human health from climate change [4], and the Climate Change Adaptation in Africa (CCAA) program and International Development Research Center’s (IDRC) Ecohealth programs, which are jointly supporting a research and capacity-building initiative to explore the connections between water health and climate change. At the National Institute of Health (NIH), the establishment of a planning group to assess the research questions in health, medicine, and climate change to link this agenda to parallel activities across other agencies of the United States Government (USG), and to advance a NIH research agenda in this area also supports the increasing interest in the role of climate change in health [5]. Current Opinion in Environmental Sustainability 2011, 3:467–470
468 Aquatic and marine systems
Facing challenges of water health and global change It is estimated that the number of people living in waterstressed basins will increase to approximately 3–6 billion by 2050 because of the effects of global environmental change, many of whom will be located in West Asia, North Africa, and sub-Saharan Africa. In Africa, where the majority of people live in rural areas, approximately 75– 250 million people are projected to be exposed to increased water stress [2]. Rural communities lack the resources to cope and/or mitigate the impacts of environmental change and are particularly vulnerable to water stresses. The majority of the population depends on their surrounding natural resources [6], facing multi-pronged climate and non-climate stressors simultaneously [7] including droughts and water scarcity, floods, and poor water quality. The poor health infrastructure creates a special concern for the health of children and elderly members, in the context of stresses on the availability of safe water and the expanding burden of illness from vector-borne diseases [8]. Already, lack of access to safe water supply and sanitation, along with poor hygiene, is the main contributor to the burden of diarrhoeal disease, with an estimated 90% of the burden of diarrhoeal disease being attributable to lack of access to safe water and sanitation [9]. The potential of climate change and variability to exacerbate water-borne and water-related diseases such as malaria, dengue, yellow fever, cholera, and chikungunya thus has and continues to elicit substantial research interest [10]. Because of its sensitivity to climate change, malaria has received a lot of attention from researchers, and findings suggest that climate change has already played an important role in the exacerbation of malaria in the East African region [11]. For climate-sensitive dengue fever, a review of the scientific evidence about the impact of climate change and socio-environmental factors on dengue transmission, particularly in the Asia-Pacific region, shows no clear evidence that such an impact has already occurred; more research is needed. Future research should also consider and adjust for the influence of important socio-environmental factors in the assessment of climate change-related effects on dengue transmission [12]. A biology-driven model developed by Zhou and others projected that climate change would significantly widen the area of China where Schistosoma japonicum transmission occurs within the intermediate host snail Oncomelania hupensi, into non-endemic areas in the north [13]. In Uganda, East Africa, research is showing that the altitudinal threshold for S. mansoni transmission has changed with potential transmission occurring at altitudes higher than 1400 m above sea level, but without clear evidence whether this is as a result of climate change or other factors [14]. A systematic review of literature by Emch and others examines the links between environmental and climatic factors and the temporal variability of Current Opinion in Environmental Sustainability 2011, 3:467–470
cholera, indicating that global environmental change may increase the frequency and duration of cholera outbreaks [15]. Cholera can be especially devastating for rural communities lacking rapid emergency response capabilities. In coastal regions, the potential for climate change induced sea-level rise causing saline intrusion into drinking water forms an integral part of research on extreme weather events and water and health [16]. The dilemma of economic growth from industrialization and the ability to inject substantial resources for the improvement of the environment, health, and quality of life indicators, while at the same time increasing the release of chemical toxins into the environment is a challenge that is well demonstrated in China, which has widespread water pollution, leading to a widespread health hazard [6]. As drought increases in the drylands, water scarcity is an increasingly central theme of many research agendas, and rural communities in drylands are considered particularly vulnerable [17]. In the Southwestern United States, there are predicted declines in natural water sources because of population growth, and together with the continued effects of climate change water shortages will increase in severity, with a potential to lead to water conflict. Such conflicts become significant when the diversion of water infringes on the benefits previously enjoyed by communities [18]. In Asia, research has shown that water conflicts can lead to livelihood insecurity, growing rural poverty, and increasing rates of migration creating a newly vulnerable poor, at higher risk for poor health and malnutrition [19]. Like flooding, water scarcity can also lead to water contamination and cause higher rates of illness from cholera and other forms of diarrhea. The scarcity of water necessitates the use of new water sources, including recycled wastewater for agriculture, but unless properly managed, the use of recycled wastewater can facilitate exposure to microbial contamination. Scarcity of goodquality irrigation water has been reported to be linked to a rise in the use of industrial water and wastewater for irrigation [20], leading to potential further health hazards.
Building resiliency, adaptation, and mitigation for water health and global change Communities that are under threat of water stresses need to have a good grasp of the problem and a strong knowledge base as a bottom rung to step up from their vulnerability milieu, to a level of resiliency and adaptation practices. When water stresses are concomitant with economic stresses, then resource limitation can hinder this next logical step. A program evaluation in Bangladesh found that practices tended to follow on from knowledge, except where financial expenditure was required [21]. A community-based approach requires not only a knowledge base but also advocacy to engage stakeholders such as governments and local health workers [22,23]. www.sciencedirect.com
Community level research Karanja, Elliott and Gabizon 469
Engaging stakeholders is a meaningful way to build social capital. There has been a fairly good amount of research focus on determination of what knowledge already exists on water health and global change at the community level. Following information with educational interventions directed both at identified individuals and the community can strengthen a community’s resiliency through self-management of water resources [24]. An interesting area of research for mitigating water scarcity, and which is high on the agenda of the International Water Management Institute, is that of curbing water losses and wastage in the food chain, from production to consumption. A Stockholm International Water Institute (SIWI) policy brief on curbing water losses and wastage in the Food chain indicated that such losses may be in the tune of 50%, but there is still room for research on the types, magnitude and implications of such losses [25]. By virtue of the fact that global environmental change is a dynamic phenomenon, so will be the populations and communities at risk. The need to forecast and determine vulnerable regions and populations, to develop emergency preparedness, and to prepare for any emerging new infections is attracting a lot of interest in predictive modeling studies. Such studies have been used to predict the impacts of global change on the transmission risk of many vector-borne infectious diseases in different parts of the world, such as malaria [26] and the potential impact of rising sea levels on the prevalence of mosquito species possessing salinity-tolerant larvae and pupae, and capable of transmitting arboviruses [27]. Risk assessment and monitoring will be a key factor in building adaptive capacity and should therefore be a continuous process. Who is most vulnerable to changing environments is a continuously changing concept. Predictive models however need to be adapted to community level from the current regional and global systems. Conditions that contribute to a community’s vulnerability are varied and change over time, and successful adaptation initiatives require the understanding of the social, economic, and institutional challenges facing individuals and communities [28]. A research agenda that explores the knowledge and technologies already in existence can make a real contribution toward identifying priorities for better health at the community level and contribute toward establishing strategies to build adaptive capacity for water-related global change. There is therefore the potential for sustainable management of water resources by applying a proactive approach to the development and application of traditional water management technologies [29]. Rural communities are more likely to be dependent on indigenous knowledge for climate change adaptation. This is knowledge developed by local people on their environment and local practices employed to manage the forces that frequently impact them [30]. Innovative traditional technologies can benefit from research and make a contribution toward alternatives for sustainability [16]. www.sciencedirect.com
Future research for effective planning Research on global change and environment generally reveals many gaps and is lacking in practical detail. A greater focus on integrated approaches to water health and global change, with the integration of meteorological, environmental, socio-economic, geospatial, and health data, can provide a better assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identification of health co-benefits of mitigation strategies, and evaluation of cost-effective public health adaptation options [9,31]. This requires scientists from different disciplines to work together for a multidisciplinary approach to focus research outcomes toward more practical solutions to a community’s adaptive capacity. The final report of a year-long Commission held jointly between The Lancet and University College London (UCL) Institute for Global Health calls for ‘an unprecedented era of cooperation between widely divergent, but utterly connected, spheres-disease, food, water and sanitation, shelter and settlements, extreme events, and population and migration’ in order to fill in the gap in information and knowledge strategies for responding to the negative health effects of climate change [32]. Research on water health and global impact needs to be strengthened in the vulnerable regions of West Asia, North Africa, and sub-Saharan Africa, especially around the great lakes and in areas of potential water scarcity stress. The need for strong policies and governance to strengthen health sectors in the face of global change challenges requires research that stimulates action by governments to integrate health needs into the laws of other related disciplines such as health laws and water laws, environmental laws, and to incorporate gender issues. Gender roles in building community water resiliency and adaptive capacity are completely downplayed. Water policies both domestically and internationally are lacking, and Fuller and Harhay [18] have tried to draw attention to and stimulate discussion around scarce policy discussion domestically by documenting existing and emerging consequences of water scarcity in the Southwestern United States. Water and health, being extremely sensitive to environmental change, will continue to be intricately intertwined in the rapidly and continually changing scenarios of global change, and research agendas need to be flexible and innovative. Researchers acknowledge that adaptation is best established at the community level, and that management and policy will necessarily play a crucial role, arguing that prevention and mitigation of emergencies can greatly reduce susceptibility to disaster. There is thus an interest in determining the role of local public health agencies in building human resilience to climate-related disasters [33]. Current Opinion in Environmental Sustainability 2011, 3:467–470
470 Aquatic and marine systems
References and recommended reading Papers of particular interest, published within the period of review, have been highlighted as: of special interest of outstanding interest 1.
Schmidt Charles W: Beyond mitigation: planning for climate change adaptation. Environ Health Perspect 2009, 117:A306A309.
2.
IPCC: Climate Change 2007. Impacts, Adaptation and Vulnerabilty. Working Group II Contribution to the Fourth Assessment. Report of the Intergovernmental Panel on Climate Change. Summary for Policymakers and Technical Summary (WMO/UNEP); 2007.
3.
William R, Anderegg L, Prall JW, Harold J, Schneider SH: Expert credibility in climate change. Proc Natl Acad Sci U S A 2010 doi: 10.1073/pnas.1003187107.
4.
http://www.who.int/phe/news/wha/en/index.html.
5.
Rosenthal JP, Jessup CM: Global climate change and health: developing a research agenda for the NIH. Trans Am Clin Climatol Assoc 2009, 120:129-141.
6.
Zhang J, Mauzerall DL, Zhu T, Liang S, Ezzati M, Remais JV: Environmental health in China: progress towards clean air and safe water. Lancet 2010, 375:1110-1119.
7.
Ramin BM, McMichael AJ: Climate change and health in subSaharan Africa. A case-based perspective. EcoHealth 2009, 6:52-57 doi: 10.1007/s10393-009-0222-4.
8.
Bernstein AS, Myers SS: Climate change and children’s health. Curr Opin Pediatr 2011, 23:221-226.
9.
UNEP/GRID-ARENDAL; 2008 (http://www.unep.org/dewa/ vitalwater/article1.html).
10. Bush KF, Luber G, Kotha SR, Dhaliwal RS, Kapil V, Pascual M, Brown DG, Frumkin H, Dhiman RC, Hess J et al.: Impacts of climate change on public health in India: future research directions. Environ Health Perspect 2011. (Epub ahead of print). 11. Alonso D, Bouma MJ, Pascual M: Epidemic malaria and warmer temperatures in recent decades in an East African highland. Proc Biol Sci 2011, 278:1661-1669 (Epub 2010 November 10). 12. Banu S, Hu W, Hurst C, Tong S: Dengue transmission in the Asia-Pacific region: impact of climate change and socioenvironmental factors. Trop Med Int Health 2011 May, 16:598607 doi: 10.1111/j.1365-3156.2011.02734.x (Epub 2011 February 14). 13. Zhou XN, Yang GJ, Yang K, Wang XH, Hong QB, Sun LP, Malone JB, Kristensen TK, Bergquist NR, Utzinger J: Potential impact of climate change on schistosomiasis transmission in China. Am J Trop Med Hyg 2008, 78:188-194. 14. John R, Ezekiel M, Philbert C, Andrew A: Schistosomiasis transmission at high altitude crater lakes in western Uganda. BMC Infect Dis 2008, 8:110. 15. Khan AE, Ireson A, Kovats S, Mojumder SK, Khusru A, Rahman A, Vineis P: Drinking water salinity and maternal health in coastal Bangladesh: implications of climate change. Environ Health Perspect 2011. (Epub ahead of print).
18. Fuller AC, Harhay MO: Population growth, climate change and water scarcity in the Southwestern United States. Am J Environ Sci 2010, 6:249-252. A discussion of the need for water policies is very apt for future directions in dealing with water and health issues at local, national and global context in the face of global environmental change. 19. Janes CR: Failed development and vulnerability to climate change in central Asia: implications for food security and health. Asia Pac J Publ Health 2010, 22(Suppl):236S-245S. 20. Ghosh AK, Bhatt MA, Agrawal HP: Effect of long-term application of treated sewage water on heavy metal accumulation in vegetables grown in Northern India. Environ Monit Assess 2011. (Epub ahead of print). 21. Fisher S, Kabir B, Lahiff E, Maclachlan M: Knowledge, attitudes, practices and implications of safe water management and good hygiene in rural Bangladesh: assessing the impact and scope of the BRAC WASH programme. Water Health 2011, 9:80-93. 22. Ebi KL, Semenza JC: Community-based adaptation to the health impacts of climate change. Am J Prev Med 2008, 35:501-507. 23. Kebede S, Duales S, Yokouide A, Alemu W: Trends of major disease outbreaks in the African region, 2003–2007. East Afr J Publ Health 2010, 7:20-29. 24. Hunter PR, Ramı´rez Toro GI, Minnigh HA: Impact on diarrhoeal illness of a community educational intervention to improve drinking water quality in rural communities in Puerto Rico. BMC Publ Health 2010, 10:219. 25. Luundqvist J, de Fraiture C, Molden D: Saving water: from field to fork – curbing losses and wastage in the food chain. SIWI Policy Brief. SIWI; 2008. COMMENT: In terms of where we are going, the idea of acknowledging and taking action against water losses along the food production chain makes a great contribution towards mitigation for global change, and health protection. 26. Ermert V, Fink AH, Jones AE, Morse AP: Development of a new version of the Liverpool Malaria Model. II. Calibration and validation for West Africa. Malar J 2011, 10:62. 27. Ramasamy R, Surendran SN: Possible impact of rising sea levels on vector-borne infectious diseases. MC Infect Dis 2011, 11:18. 28. Westerhoff L, Smit B: The rains are disappointing us: dynamic vulnerability and adaptation to multiple stressors in the Afram Plains. Ghana Mitigation and Adaptation Strategies for Global Change. 2009, 14:317–337 doi:10.1007/s11027-008-9166-1. This paper shows the dynamic nature of vulnerability, even at the community level, and the importance of approaching adaptation from a multidisciplinary and integrated approach. 29. Adeel Z, Safriel U, Niemeijer D, White R, de Kalbermatten G, Glantz M, Salem B, Scholes B, Niamir-Fuller M, Ehui S, YapiGnaore V: Ecosystems and Human Well-being: Desertification Synthesis, a Report of the Millennium Ecosystem Assessment. Washington, DC, USA: World Resources Institute; 2005. 30. Anthony MD: Climate change in the lake Victoria basin: can local communities adapt? Lake Victoria Basin Digest. A Newsletter of the Lake Victoria Basin Commission. 2010:. USAID.
16. Michael E, FeldackeCaryl R, Sirajul Islam M, Mohammad Ali: Seasonality of cholera from 1974 to 2005: a review of global patterns. Int J Health Geogr 2008, 7:31 doi: 10.1186/1476-072X7-31 (published online 2008 June 20).
31. Huang C, Vaneckova P, Wang X, Fitzgerald G, Guo Y, Tong S: Constraints and barriers to public health adaptation to climate change: a review of the literature. Am J Prev Med 2011, 40:183-190.
17. Zafar A: Promoting traditional water management in drylands: adapting traditional knowledge to meet today’s challenges. In What Makes Traditional Technologies Tick? A Review of Traditional Approaches for Water Management in Drylands. Edited by Zafar A, Schuster B, Bigas H. The United Nations University; 2008.
32. A commission on climate change. Lancet 2009, 373:1659.
Current Opinion in Environmental Sustainability 2011, 3:467–470
33. Keim ME: Building human resilience: the role of public health preparedness and response as an adaptation to climate change. Am J Prev Med 2008, 35:508-516.
www.sciencedirect.com
Community level research on water health and global change: where have we been? Where are we going? Diana Karanja1, Susan J Elliott2 and Sascha Gabizon3 The changes that are occurring as a result of global environmental change have spurred a great interest within governments and the scientific community, with the realization that it is a threat to large numbers of populations in all regions of the globe. Ensuing research for answers highlights the need to build resiliency, to adapt and mitigate the impacts. At the community level, especially rural communities, the low adaptive capacity resulting from poor health infrastructure and limited resources are challenges in the context of stresses on the availability of safe water, injuries resulting from floods and storms, shortage of drinking water because of droughts, redistribution and/or increase of vector-borne infections and other infectious diseases related to poor sanitation, poor nutrition related to agricultural disruption, and sea-level rise causing saline intrusion into drinking water. These challenges will require research agendas with practical detail and multidisciplinary approaches. Addresses 1 Kenya Medical Research Institute, P.O. Box 1578, Center for Global Health Research, Kisumu, Kenya 2 Faculty of Applied Health Sciences, University of Waterloo, Canada 3 Women in Europe for a Common Future, Utrecht, Netherlands Corresponding author: Karanja, Diana ([email protected]) and
Current Opinion in Environmental Sustainability 2011, 3:467–470 This review comes from a themed issue on Aquatic and marine systems Edited by Lucilla Spini, Zafar Adeel and Mark W Rosenberg Received 15 May 2011; Accepted 5 October 2011 Available online 28th October 2011 1877-3435/$ – see front matter # 2011 Elsevier B.V. All rights reserved. DOI 10.1016/j.cosust.2011.10.002
Introduction There is a momentum to increase resiliency, to adapt and/ or mitigate the impacts of global environmental change following the realization that the threat to the environment’s capacity to sustain life at the global and community level is one of the greatest challenges facing humanity today. Within the limited resources available for tackling the impacts of climate change, there is an increasing interest on whether the focus should be placed on adaptation or mitigation, or give both equal weight for a most costeffective approach [1]. Health impacts brought on by water-related environmental change, whether at the community or global level, are influenced by a complex combination of human activities, spanning social, economic, www.sciencedirect.com
and cultural dimensions. The impacts are forecasted to include injury resulting from floods and storms, shortage of drinking water because of droughts, redistribution and/or increase of vector-borne infections and other infectious diseases related to poor sanitation, and poor nutrition related to agricultural disruption. Although no single community is immune to the impacts of global environmental change, those expected to be especially vulnerable are within developing countries, Small Island developing States, and marginalized rural communities; their vulnerability being particularly driven by their low adaptive capacity [2]. Communities living in coastal regions, megacities, mountains, and Polar Regions, as well as communities with weak health infrastructure and those where the burden of disease is already great will also bear the brunt of adverse impacts of global environmental change. The elderly, children, the poor, and people living with preexisting medical conditions will also influence a community’s resiliency and adaptive capacity. From the initial skepticism and controversies on the reality of environmental change, particularly as influenced by climate change, to the increasing acceptance that changes are occurring [3], the interest in the outcomes of global change on human health has evolved cautiously over the years. The same rigorous scrutiny as the general debate on the reality of global change has clearly endured, with increasing attention from governments. At the outset, the research agenda was to determine the plausibility of the links between global change and human health, and although the debate is far from over, there is a greater shift towards research agendas based on acceptance of the impacts of global change on human health, and a search for strategies for building resilience and adaptive capacity at the community level. This shift is clearly reflected in the WHO’s World Health Assembly (WHA) resolution 61.19 of 2008 requesting for a work plan for protection of human health from climate change [4], and the Climate Change Adaptation in Africa (CCAA) program and International Development Research Center’s (IDRC) Ecohealth programs, which are jointly supporting a research and capacity-building initiative to explore the connections between water health and climate change. At the National Institute of Health (NIH), the establishment of a planning group to assess the research questions in health, medicine, and climate change to link this agenda to parallel activities across other agencies of the United States Government (USG), and to advance a NIH research agenda in this area also supports the increasing interest in the role of climate change in health [5]. Current Opinion in Environmental Sustainability 2011, 3:467–470
468 Aquatic and marine systems
Facing challenges of water health and global change It is estimated that the number of people living in waterstressed basins will increase to approximately 3–6 billion by 2050 because of the effects of global environmental change, many of whom will be located in West Asia, North Africa, and sub-Saharan Africa. In Africa, where the majority of people live in rural areas, approximately 75– 250 million people are projected to be exposed to increased water stress [2]. Rural communities lack the resources to cope and/or mitigate the impacts of environmental change and are particularly vulnerable to water stresses. The majority of the population depends on their surrounding natural resources [6], facing multi-pronged climate and non-climate stressors simultaneously [7] including droughts and water scarcity, floods, and poor water quality. The poor health infrastructure creates a special concern for the health of children and elderly members, in the context of stresses on the availability of safe water and the expanding burden of illness from vector-borne diseases [8]. Already, lack of access to safe water supply and sanitation, along with poor hygiene, is the main contributor to the burden of diarrhoeal disease, with an estimated 90% of the burden of diarrhoeal disease being attributable to lack of access to safe water and sanitation [9]. The potential of climate change and variability to exacerbate water-borne and water-related diseases such as malaria, dengue, yellow fever, cholera, and chikungunya thus has and continues to elicit substantial research interest [10]. Because of its sensitivity to climate change, malaria has received a lot of attention from researchers, and findings suggest that climate change has already played an important role in the exacerbation of malaria in the East African region [11]. For climate-sensitive dengue fever, a review of the scientific evidence about the impact of climate change and socio-environmental factors on dengue transmission, particularly in the Asia-Pacific region, shows no clear evidence that such an impact has already occurred; more research is needed. Future research should also consider and adjust for the influence of important socio-environmental factors in the assessment of climate change-related effects on dengue transmission [12]. A biology-driven model developed by Zhou and others projected that climate change would significantly widen the area of China where Schistosoma japonicum transmission occurs within the intermediate host snail Oncomelania hupensi, into non-endemic areas in the north [13]. In Uganda, East Africa, research is showing that the altitudinal threshold for S. mansoni transmission has changed with potential transmission occurring at altitudes higher than 1400 m above sea level, but without clear evidence whether this is as a result of climate change or other factors [14]. A systematic review of literature by Emch and others examines the links between environmental and climatic factors and the temporal variability of Current Opinion in Environmental Sustainability 2011, 3:467–470
cholera, indicating that global environmental change may increase the frequency and duration of cholera outbreaks [15]. Cholera can be especially devastating for rural communities lacking rapid emergency response capabilities. In coastal regions, the potential for climate change induced sea-level rise causing saline intrusion into drinking water forms an integral part of research on extreme weather events and water and health [16]. The dilemma of economic growth from industrialization and the ability to inject substantial resources for the improvement of the environment, health, and quality of life indicators, while at the same time increasing the release of chemical toxins into the environment is a challenge that is well demonstrated in China, which has widespread water pollution, leading to a widespread health hazard [6]. As drought increases in the drylands, water scarcity is an increasingly central theme of many research agendas, and rural communities in drylands are considered particularly vulnerable [17]. In the Southwestern United States, there are predicted declines in natural water sources because of population growth, and together with the continued effects of climate change water shortages will increase in severity, with a potential to lead to water conflict. Such conflicts become significant when the diversion of water infringes on the benefits previously enjoyed by communities [18]. In Asia, research has shown that water conflicts can lead to livelihood insecurity, growing rural poverty, and increasing rates of migration creating a newly vulnerable poor, at higher risk for poor health and malnutrition [19]. Like flooding, water scarcity can also lead to water contamination and cause higher rates of illness from cholera and other forms of diarrhea. The scarcity of water necessitates the use of new water sources, including recycled wastewater for agriculture, but unless properly managed, the use of recycled wastewater can facilitate exposure to microbial contamination. Scarcity of goodquality irrigation water has been reported to be linked to a rise in the use of industrial water and wastewater for irrigation [20], leading to potential further health hazards.
Building resiliency, adaptation, and mitigation for water health and global change Communities that are under threat of water stresses need to have a good grasp of the problem and a strong knowledge base as a bottom rung to step up from their vulnerability milieu, to a level of resiliency and adaptation practices. When water stresses are concomitant with economic stresses, then resource limitation can hinder this next logical step. A program evaluation in Bangladesh found that practices tended to follow on from knowledge, except where financial expenditure was required [21]. A community-based approach requires not only a knowledge base but also advocacy to engage stakeholders such as governments and local health workers [22,23]. www.sciencedirect.com
Community level research Karanja, Elliott and Gabizon 469
Engaging stakeholders is a meaningful way to build social capital. There has been a fairly good amount of research focus on determination of what knowledge already exists on water health and global change at the community level. Following information with educational interventions directed both at identified individuals and the community can strengthen a community’s resiliency through self-management of water resources [24]. An interesting area of research for mitigating water scarcity, and which is high on the agenda of the International Water Management Institute, is that of curbing water losses and wastage in the food chain, from production to consumption. A Stockholm International Water Institute (SIWI) policy brief on curbing water losses and wastage in the Food chain indicated that such losses may be in the tune of 50%, but there is still room for research on the types, magnitude and implications of such losses [25]. By virtue of the fact that global environmental change is a dynamic phenomenon, so will be the populations and communities at risk. The need to forecast and determine vulnerable regions and populations, to develop emergency preparedness, and to prepare for any emerging new infections is attracting a lot of interest in predictive modeling studies. Such studies have been used to predict the impacts of global change on the transmission risk of many vector-borne infectious diseases in different parts of the world, such as malaria [26] and the potential impact of rising sea levels on the prevalence of mosquito species possessing salinity-tolerant larvae and pupae, and capable of transmitting arboviruses [27]. Risk assessment and monitoring will be a key factor in building adaptive capacity and should therefore be a continuous process. Who is most vulnerable to changing environments is a continuously changing concept. Predictive models however need to be adapted to community level from the current regional and global systems. Conditions that contribute to a community’s vulnerability are varied and change over time, and successful adaptation initiatives require the understanding of the social, economic, and institutional challenges facing individuals and communities [28]. A research agenda that explores the knowledge and technologies already in existence can make a real contribution toward identifying priorities for better health at the community level and contribute toward establishing strategies to build adaptive capacity for water-related global change. There is therefore the potential for sustainable management of water resources by applying a proactive approach to the development and application of traditional water management technologies [29]. Rural communities are more likely to be dependent on indigenous knowledge for climate change adaptation. This is knowledge developed by local people on their environment and local practices employed to manage the forces that frequently impact them [30]. Innovative traditional technologies can benefit from research and make a contribution toward alternatives for sustainability [16]. www.sciencedirect.com
Future research for effective planning Research on global change and environment generally reveals many gaps and is lacking in practical detail. A greater focus on integrated approaches to water health and global change, with the integration of meteorological, environmental, socio-economic, geospatial, and health data, can provide a better assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identification of health co-benefits of mitigation strategies, and evaluation of cost-effective public health adaptation options [9,31]. This requires scientists from different disciplines to work together for a multidisciplinary approach to focus research outcomes toward more practical solutions to a community’s adaptive capacity. The final report of a year-long Commission held jointly between The Lancet and University College London (UCL) Institute for Global Health calls for ‘an unprecedented era of cooperation between widely divergent, but utterly connected, spheres-disease, food, water and sanitation, shelter and settlements, extreme events, and population and migration’ in order to fill in the gap in information and knowledge strategies for responding to the negative health effects of climate change [32]. Research on water health and global impact needs to be strengthened in the vulnerable regions of West Asia, North Africa, and sub-Saharan Africa, especially around the great lakes and in areas of potential water scarcity stress. The need for strong policies and governance to strengthen health sectors in the face of global change challenges requires research that stimulates action by governments to integrate health needs into the laws of other related disciplines such as health laws and water laws, environmental laws, and to incorporate gender issues. Gender roles in building community water resiliency and adaptive capacity are completely downplayed. Water policies both domestically and internationally are lacking, and Fuller and Harhay [18] have tried to draw attention to and stimulate discussion around scarce policy discussion domestically by documenting existing and emerging consequences of water scarcity in the Southwestern United States. Water and health, being extremely sensitive to environmental change, will continue to be intricately intertwined in the rapidly and continually changing scenarios of global change, and research agendas need to be flexible and innovative. Researchers acknowledge that adaptation is best established at the community level, and that management and policy will necessarily play a crucial role, arguing that prevention and mitigation of emergencies can greatly reduce susceptibility to disaster. There is thus an interest in determining the role of local public health agencies in building human resilience to climate-related disasters [33]. Current Opinion in Environmental Sustainability 2011, 3:467–470
470 Aquatic and marine systems
References and recommended reading Papers of particular interest, published within the period of review, have been highlighted as: of special interest of outstanding interest 1.
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18. Fuller AC, Harhay MO: Population growth, climate change and water scarcity in the Southwestern United States. Am J Environ Sci 2010, 6:249-252. A discussion of the need for water policies is very apt for future directions in dealing with water and health issues at local, national and global context in the face of global environmental change. 19. Janes CR: Failed development and vulnerability to climate change in central Asia: implications for food security and health. Asia Pac J Publ Health 2010, 22(Suppl):236S-245S. 20. Ghosh AK, Bhatt MA, Agrawal HP: Effect of long-term application of treated sewage water on heavy metal accumulation in vegetables grown in Northern India. Environ Monit Assess 2011. (Epub ahead of print). 21. Fisher S, Kabir B, Lahiff E, Maclachlan M: Knowledge, attitudes, practices and implications of safe water management and good hygiene in rural Bangladesh: assessing the impact and scope of the BRAC WASH programme. Water Health 2011, 9:80-93. 22. Ebi KL, Semenza JC: Community-based adaptation to the health impacts of climate change. Am J Prev Med 2008, 35:501-507. 23. Kebede S, Duales S, Yokouide A, Alemu W: Trends of major disease outbreaks in the African region, 2003–2007. East Afr J Publ Health 2010, 7:20-29. 24. Hunter PR, Ramı´rez Toro GI, Minnigh HA: Impact on diarrhoeal illness of a community educational intervention to improve drinking water quality in rural communities in Puerto Rico. BMC Publ Health 2010, 10:219. 25. Luundqvist J, de Fraiture C, Molden D: Saving water: from field to fork – curbing losses and wastage in the food chain. SIWI Policy Brief. SIWI; 2008. COMMENT: In terms of where we are going, the idea of acknowledging and taking action against water losses along the food production chain makes a great contribution towards mitigation for global change, and health protection. 26. Ermert V, Fink AH, Jones AE, Morse AP: Development of a new version of the Liverpool Malaria Model. II. Calibration and validation for West Africa. Malar J 2011, 10:62. 27. Ramasamy R, Surendran SN: Possible impact of rising sea levels on vector-borne infectious diseases. MC Infect Dis 2011, 11:18. 28. Westerhoff L, Smit B: The rains are disappointing us: dynamic vulnerability and adaptation to multiple stressors in the Afram Plains. Ghana Mitigation and Adaptation Strategies for Global Change. 2009, 14:317–337 doi:10.1007/s11027-008-9166-1. This paper shows the dynamic nature of vulnerability, even at the community level, and the importance of approaching adaptation from a multidisciplinary and integrated approach. 29. Adeel Z, Safriel U, Niemeijer D, White R, de Kalbermatten G, Glantz M, Salem B, Scholes B, Niamir-Fuller M, Ehui S, YapiGnaore V: Ecosystems and Human Well-being: Desertification Synthesis, a Report of the Millennium Ecosystem Assessment. Washington, DC, USA: World Resources Institute; 2005. 30. Anthony MD: Climate change in the lake Victoria basin: can local communities adapt? Lake Victoria Basin Digest. A Newsletter of the Lake Victoria Basin Commission. 2010:. USAID.
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Current Opinion in Environmental Sustainability 2011, 3:467–470
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