- Email: [email protected]
Vulnerability and Health
1.15 Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa K Vincent and T Cull, Kulima Integrated Development Solutions (Pty) Ltd, Pietermaritzburg, South Africa. Ó 2013 Elsevier Inc. All rights reserved.
1.15.1 Introduction 1.15.2 Vulnerability to Climate 1.15.3 Climate and Health 1.15.3.1 Direct Climate Effects on Malaria and Cholera 1.15.3.2 Indirect Climate Effects on HIV/AIDS, Heat Stress, and Respiratory Illness 1.15.4 Health and Vulnerability to Climate 1.15.5 A Case Study from Southern Africa 1.15.6 Conclusion References Relevant Websites
1.15.1
Introduction
Climate and long-term change is increasingly recognized as a critical issue for society, and governments are asking questions about how to allocate scarce resources in order to minimize adverse impacts. A critical component of answering these questions requires an assessment of vulnerability to the changes that are projected to occur. People in Africa are particularly at risk from climate factors, because of exposure combined with low adaptive capacity. In addition, climate coincides with other stressors that affect the livelihoods and well-being of people. On the one hand, long-term changes in weather patterns would bring with it changed health risks, while on the other, the vulnerability of people to climate will be affected by their existing health status.
1.15.2
Vulnerability to Climate
Vulnerability is a contested term that has its origins in the natural hazards and food security literature and is now often applied in climate impacts assessments (Adger 2006). However, an evolution in the understanding of vulnerability has occurred over time. In early impacts assessments, focus was placed solely on the risk of exposure of an ecosystem to a hazard. This meant that impacts assessments at that time would refer to the effects of climate on parameters such as crop production and water availability and could thus be defined as biophysical vulnerability or ‘outcome vulnerability’ (O’Brien et al. 2007). People were only deemed affected because climate would alter the availability of resources on which they depend for their livelihoods. In biophysical or outcome vulnerability assessments, there was little recognition of the fact that people are different, and just because they are exposed to the same hazard does not mean they will respond in the same way. ‘Social vulnerability’ may be defined as the ability to anticipate, resist, cope with, and respond to a hazard (Blaikie et al. 1994). Social vulnerability, in contrast to being seen as an outcome, is viewed more as a potential state of human societies that can affect the way they experience natural hazards (Adger 1999; Adger and Kelly 1999; Blaikie et al. 1994). This potential state is in constant flux, reflecting its
Climate Vulnerability, Volume 1
183 183 184 184 184 185 185 186 186 187
dependence on the dynamic interaction of a range of economic and social processes that influence the capacity of individuals, social groups, sectors, regions, and ecosystems to respond to various socioeconomic and biophysical shocks (Leichenko and O’Brien 2002; Comfort et al. 1999). The most vulnerable are those who are most exposed to any changes, who possess a limited coping capacity, and who are least resilient to recovery (Bohle et al. 1994). As the particular mix of structures and institutions is typically context-specific, this has also been labeled ‘context vulnerability’ (O’Brien et al. 2007). Determining projected climate impacts, therefore, reflects not only likely exposure and biophysical, or outcome, vulnerability (of the ecosystem) but also the social, or context, vulnerability of the people. Given evidence of differential social vulnerability in the face of hazards or broader environmental risk exposure, a number of studies have tried to characterize the determinants that may give rise to vulnerability (e.g., Pelling 2003; Smith 2001; Blaikie et al. 1994). Vulnerability is a function of economic, social, political, environmental, and technological assets. Who is vulnerable to a hazard is therefore determined by the human and physical forces that shape the allocation of these assets in the society (Pelling and Uitto 2001). Defining vulnerability is also dependent on the scale of analysis (Vincent 2007a). On the large scale, macro-processes are the most important in determining the distribution and production of entitlements. In the well-developed food security literature, famines have been explained on the basis of entitlement theory (Sen 1981), where the distribution and reproduction of entitlements is dependent on the structural factors of the political-economic environment that can either reduce or precipitate entitlement failure (Downing 1996; Bohle et al. 1994; Watts and Bohle 1993). In the case of food and famine, e.g., the politicaleconomic environment refers to the dominant political system and the way it mediates trade, labor, and markets. In the face of exposure to climate factors, some populations will be able to draw on their entitlements to adapt to the risk, e.g., through awareness and preparation, insurance for losses, and diversifying livelihoods. For example, Adger (1999) shows how collective vulnerability (at community level or higher) to
http://dx.doi.org/10.1016/B978-0-12-384703-4.00124-6
183
184
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
extremes in coastal Vietnam is determined by institutional and market structures. In contrast, on the local scale, the role of human agency has a greater influence in access to resources and household-level social status. In such cases, entitlements are socially and spatially differentiated according to factors such as gender, ethnicity, religion, class, and age (Denton 2002; Enarson 2000; Wisner 1998; Cutter 1995).
1.15.3
Climate and Health
Weather patterns, and other aspects of climate, affect human health both directly and indirectly, via biological and ecological processes that influence the transmission of several infectious diseases (McMichael et al. 2003). One of the major health impacts of climate relates to disease burden. The effects of climate on vector-borne malaria and waterborne cholera have been well studied, given that they already pose existing risks in Africa (Boko et al. 2007). Fewer studies have looked at the links between other diseases, such as meningitis, Rift Valley fever, and dengue fever, and climate-related variables (Jansen and Beebe 2010; Anyamba et al. 2009; Cuevas et al. 2007). More indirect effects of climate on health relate to the transmission of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), heat stress, and respiratory illness, which are discussed here. Other indirect links of climate and health relate to cancer, mental health and stress-related disorders, zoonotic diseases, and food-borne illness (Portier et al. 2010).
1.15.3.1
Direct Climate Effects on Malaria and Cholera
Malaria is the leading cause of mortality and morbidity in hot and humid African countries (Wandiga et al. 2010). The spread of malaria within Africa is dependent on the susceptibility of the vector (mosquitoes of the Anopheles genus) and parasite (Plasmodium falciparum) to climate. A close association between malaria epidemics and climate has been contested, but a recent paper that analyzes past climate (temperature and precipitation), hydrological and health data (1961–2001), and socioeconomic status of communities from the East African highlands confirms the link between climate and the incidence and severity of malaria epidemics (Wandiga et al. 2010). In the absence of good epidemiological information, the association of malaria with seasonal climate patterns is used to map risk areas (climatic suitability for endemism), as in the MARA (Mapping Malaria Risk in Africa Project) model (GroverKupec et al. 2006; based on baseline endemism maps from Guerra et al. 2008). A global map of P. falciparum malaria endemism shows that of the 1.38 billion people at risk of stable P. falciparum malaria, 0.66 million are found in Africa, Yemen, and Saudi Arabia (a proportion similar to those found in south and central Asia). High endemism was also widespread in the African region, where 0.35 billion people are at this level of risk, with 0.20 billion at intermediate risk, and 0.11 billion at low stable risk (Hay et al 2009; based on the MARA data, which includes over 7000 P. falciparum parasite rate surveys from around the world). Since malaria is endemic in much of Africa, changes in climate factors affecting malaria may induce an increase in transmission on the fringes of stable zones, e.g., at higher
altitude in the highlands (see, e.g., Tonnang et al. 2010). Additional population at risk from malaria is projected in East Africa (Chaves and Koenraadt 2010; van Lieshout and Kovats 2004), while parts of the northern Sahel may have a decreased risk (Caminade et al. 2011). Adverse effects of malaria spread into new regions are typically higher than where the disease is already prevalent, because of the lack of protective genetic modifications that bring immunity. This applies to morbidity and mortality in both children and adults, as shown by the outbreak of epidemics in the East African Highlands (Lindsay and Martens 1998). In Rwanda, the February 1998 malaria epidemic led to a fourfold increase in malaria admissions among pregnant women and a fivefold increase in maternal deaths due to malaria (Hammerich et al. 2002). The risk of cholera has been shown to increase with increased temperature and rainfall (e.g., Trærup et al. 2010) and with increased sea surface temperature (Paz 2009). Analyses of precipitation, temperatures, and hydrological characteristics of selected stations in the Lake Victoria Basin show that cholera epidemics are closely associated with El Nino years, and epidemics are also triggered by sustained temperatures high above normal (Tmax) in two consecutive seasons, followed by a slight cooling in the second season (Olago et al. 2007). A global analysis of cholera data from 1974 to 2005, however, showed that while cholera outbreaks demonstrate seasonal patterns in higher absolute latitudes, closer to the equator cholera outbreaks do not follow a clear seasonal pattern (Emch et al. 2008).
1.15.3.2 Indirect Climate Effects on HIV/AIDS, Heat Stress, and Respiratory Illness In Africa, an important public health issue is the prevalence of HIV/AIDS. There are also interlinkages between climate and HIV/AIDS, although the pathways are less direct than with vector-borne and waterborne diseases. Climate-related factors might increase the risk of HIV/AIDS through its impact on food (in)security and migration. In Malawi, farmers in two districts at high risk of droughts and floodsdNsanje and Salimad observed how the lack of food and limited income to buy food encouraged women to engage in transactional sex as a coping mechanism, thereby increasing their exposure to HIV infection (Action Aid 2006). Migration is also a common coping mechanism in response to local crisis, which may be precipitated by climate extremes and can also increase exposure to HIV infection (Lurie 2004). In addition to altering the nature and type of risk of particular diseases, long-term changes in temperature might also affect heat-related illnesses. If temperatures were to increase over Africa, as projected, diseases may expand their reach and death tolls, with more indirect effects on water and food security (Costello et al. 2009). These indirect effects of climate could bring about not only mortality and morbidity but also adverse impacts on the well-being, health, and productivity of working populations (Bennett and McMichael 2010). Temperature also plays a role in the prevalence of many respiratory diseases, and thus it is not surprising that climate affects these diseases, such as tuberculosis, asthma, and allergies. Although climate has less influence on tuberculosis mortality than some other factors, evidence that warm, damp climates are associated with relatively high tuberculosis
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
mortality dates from the early twentieth century (Morland 1936). The burden of tuberculosis in Africa is high, and there is often coinfection of tuberculosis (Mycobacterium tuberculosis) and HIV (Dye et al. 1999). Allergies affecting the respiratory system and asthma can also be affected by changes in climate, which in turn affect the load of airborne allergenic pollens (Ariano et al. 2010; Shea et al. 2008). Both heat-related and respiratory illnesses will have differential effects on vulnerable subpopulations, such as children (Bunyavanich et al. 2003).
1.15.4
Health and Vulnerability to Climate
The relationship between climate and health status is two-way: climate affects disease burden and the health status of the population affects (social) vulnerability to climate impacts. Social vulnerability is a potential state of human societies that can affect the way they experience climate parameters and hazards (Adger 1999; Adger and Kelly 1999; Blaikie et al. 1994). People living with poor health are likely to have greater social vulnerability when exposed to climate threats. This is exacerbated by any long-term change in the average climate of a region, which, unlike extreme events, means that populations will not necessarily have a chance to recover and reduce their vulnerability levels before the next exposure. Reflecting the chronic nature of the health issue and its widespread prevalence across the continent, in Africa it is HIV/AIDS that has most been studied as the health condition that intersects with vulnerability to climate. It has been shown that the transition to a market economy and the introduction of HIV into the human environment has led to institutional decay in some countries, which, as a result, are more likely to suffer from climate-related health issues (Bloom 2004). Infection by HIV/AIDS makes people more vulnerable to climate threats, as sufferers are less able to cope with reduced food intake and have reduced flexibility in livelihood strategies required to adapt. Furthermore, for people already suffering from HIV/AIDS, exposure to extreme events such as floods can lead to cholera outbreaks, as they are more susceptible. Similarly, any resulting damage to health infrastructure (including home-based care) may impede their access to antiretrovirals. A study of child malnutrition in relation to the HIV epidemic and drought (crop years 2001–02 and 2002–03) in six countries of southern Africa found a strong correlation between HIV and drought and concluded that the combined effects of droughts and HIV/AIDS could have an even more significant adverse impact on child nutrition in the future (Mason et al. 2005).
1.15.5
A Case Study from Southern Africa
This chapter has shown that the impacts of climate are dependent not only on the climate parameters themselves but also on the characteristics of the people who experience those climate parameters and the assets or resources they have with which they can respond to them. It is essential to determine the impacts on society of possible changes in climate parameters. Traditionally, science has concentrated on projections of long-term changes in climate using models based on past analogs of climate variability, and
185
then made some suggestions as to how such changes might have impacts on human populations through changing patterns of weather and extremes (McCarthy et al. 2001). However, a limitation of such top-down approaches is their failure to take into account the differential vulnerabilities of human populations to those environmental risks, either through resisting an event or by coping once it occurs (Jones and Boer 2003; Stonich 2000). Moreover, the top-down approach provides, at best, just a subset of possible future regional and local climatic conditions, and improvements in modeling bring with them additional uncertainties due to the greater complexity of processes being modeled (Pielke and Wilb 2012; Trenberth 2010). Essentially, as once dominated the thinking with regards to natural hazards, changes in climate are seen as a problem for the society, not of the society (Hewitt 1997). Many impacts assessments have thus been impeded by only considering one side of the equationdthe exposure (Cutter 1996). In reality, assessing the impacts of climate is inextricably linked with an assessment of social vulnerability. Assessing social vulnerability is thus an essential component of climate impact assessments. A place-based enquiry was undertaken in one community in Limpopo province, South Africa, chosen for its experience of past climate variability and an example of possible future climate change (Vincent et al. 2011; Vincent 2007b). This area, to the north of the Soutpansberg mountains, is semiarid with a summer rainfall season (November–March). There are high levels of interannual variability, punctuated by regular droughts and occasional floods, most notably in 2000. In terms of human characteristics, the village comprises approximately 700 people in 180 households and has a legacy of natural resource-dependent livelihoods (primarily crop farming), in addition to a small level of formal employment in local towns. The area was formerly part of the Venda homeland. An index of social vulnerability to climate has been developed to compare households at grassroots level in Limpopo province, South Africa, and is explained elsewhere (Vincent et al. 2011; Vincent 2007a,b). Health status is incorporated into the index as a recognized driver of social vulnerability, and this element is elaborated on here (Adger and Vincent 2005). The index is theoretically determined and is an aggregation of five equally weighted component subindices: financial capital, human capital, social capital, physical capital, and natural capital, based on the Sustainable Livelihoods Framework (for more information, see Vincent 2007a,b). While the structure of the index is grounded in the theory of determinants of social vulnerability, the component indicators were chosen as appropriate to the context for which this particular index was first used (a small, dryland village in Limpopo province, South Africa). Human capital refers to the skills, knowledge, ability to provide productive labor, and good health that allow people to pursue their livelihood strategies and thus meet their livelihood objectives. Human capital is a function of the amount and quality of labor available in the household, which is dependent on factors such as education, health status, and knowledge. In this way, human capital is also a prerequisite for the transformation of natural capital (such as soil and water in agriculture) and physical capital (such as the use of building
186
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
materials to construct a house) and for the accumulation of financial capital. Accumulation of human capital is also often seen as an end in itself, as illiteracy and poor health are often regarded as core dimensions of poverty, and overcoming them is a primary goal of development. The human capital subindex, e.g., is a composite of two component indicators: household dependency ratio (ratio of working age adults to youth and elderly) and households with a member suffering from a longterm or recurrent disease (Vincent 2007b). To a certain extent, the progress that South Africa has made in tackling typical rural diseases, such as typhoid and cholera, is offset against the increasing incidence of HIV/AIDS. The disease burden from HIV/AIDS spreads to encompass the entire household, with one study from the Free State province in South Africa finding that people living in a household where at least one person is infected are 3.5 times more likely to have been ill in the last month (Booysen 2002). At the same time, household gross domestic product (GDP) in AIDSinfected households is 19% lower than uninfected households, combined with the increased financial burdens for infected households for medical and funeral expenses (Lewis 2004). Other illnesses would likely have similar effects on household vulnerability, reflecting the same pathways of increased dependence. For that reason, the indicator used to represent this in the demographic structure subindex is a nominal category of whether or not a household has a member who is suffering from a long-term or recurrent illness.
1.15.6
Conclusion
This chapter has provided an overview of the linkages between climate, vulnerability, and health, with a specific focus on southern Africa. Determining the effects of climate parameters on people is dependent on their vulnerability. Initial climate impact assessments assumed that people were passive recipients of global environmental change (i.e., the top-down, outcome vulnerability), only affected insofar as climate affected ecosystems on which they depend. Critiques of this approach posited that people are not all the same, and, in addition to the nature of exposure, their social characteristics (including their health status) mediate how they will experience that exposures and whether it will translate into adverse impacts or not. Moreover, the outcome vulnerability starts with the assumption that changes in regional and local climate statistics can be skillfully predicted, which, as summarized in Preface to this book, is not always the case. A more inclusive assessment of risk can be developed using the bottom-up, contextual vulnerability approach in which the entire spectrum of future possible climates is considered. Climate factors intersect with health in various ways. The range of many diseases is affected by temperature and rainfall patterns. This includes vector-borne malaria and waterborne cholera, as well as meningitis, Rift Valley fever, and dengue fever. However, the impacts on people again depend on their social vulnerability. At the same time, if more people have a compromised health status, they will likely have a higher social vulnerability to climate. In this way, climate,
vulnerability, and health run the risk of negatively reinforcing each other, leading to worse impacts than one alone. The adverse economic and developmental consequences of climate and disease (and broader suboptimal health status) have been recognized (e.g., Stern 2006; Gallup and Sachs 2001). At the same time, there is evidence to show that focusing resources on addressing climate threats and disease (and suboptimal health status) is beneficial for the economy (and often more cost-effective than dealing with the consequences) (Stern 2006). However, it is essential to begin addressing vulnerability reduction to both climate-related factors and disease in tandem. This is because negatively reinforcing interactions between the two can offset progress made to date. Any change in regional and local climate statistics, e.g., may cause additional risk of contracting malaria faster (through additional exposure) than the existing public health responses are able to reduce it. Increased disease burden, in turn, increases the social vulnerability of people to climate. Ultimately, climate-resilient sustainable development that addresses climate and health risks is the most appropriate way to reduce vulnerability to both risks and the intersecting vulnerabilities that result.
References Action Aid, 2006: Climate Change and Smallholder Farmers in Malawi: Understanding Poor People’s Experiences in Climate Change Adaptation, a Report by ActionAid, October 2006, 8 pp. Adger, W. N., 1999: Social vulnerability to climate change and extremes in coastal Vietnam. World Develop., 27, 249–269. Adger, W. N., 2006: Vulnerability. Glob. Environ. Change, 16 (3), 268–281. Adger, W. N., and P. M. Kelly, 1999: Social vulnerability and the architecture of entitlements. Mitig. Adapt. Strateg. Glob. Change, 4, 253–266. Adger, W. N., and K. Vincent, 2005: Uncertainty in adaptive capacity. Compt. Rend. Geosci., 337, 399–411. Anyamba, A., and Coauthors, 2009: Prediction of a Rift Valley fever outbreak. Proc. Natl. Acad. Sci. USA., 106 (3), 955–959. Ariano, R., G. W. Canonica, and G. Passalacqua, 2010: Possible role of climate changes in variations in pollen seasons and allergic sensitizations during 27 years. Ann. Allergy Asthma Immunol., 104 (3), 215–222. Bennett, C., and A. McMichael, 2010: Non-heat related impacts of climate change on working populations. Glob. Health Action, 3, 5640. [Available online at: http://dx.doi. org/10.3402/gha.v3i0.5640, http://www.ncbi.nlm.nih.gov/pubmed/21191440.] Blaikie, P., T. Cannon, I. Davis, and B. Wisner, 1994: At Risk: Natural Hazards, People’s Vulnerability, and Disasters. Routledge, 284 pp. Bloom, G., 2004: Health in a changing world. IDS Bull., 35 (3), 38–41. Bohle, H. G., T. E. Downing, and M. J. Watts, 1994: Climate change and social vulnerability. Glob. Environ. Change, 4 (1), 37–48. Boko, M., and Coauthors, 2007: Africa. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. M. L. Parry, O. F. Canziani, J. P. Palutikof, P. J. van der Linden, and C. E. Hanson, Eds., Cambridge University Press, 433–467. Booysen, F. L. R., 2002: Financial responses of households in the free state to HIV/ AIDS related morbidity and mortality. The South African Journal of Economics, 70 (7), 1193–1215. Bunyavanich, S., C. P. Landrigan, A. J. McMichael, and P. R. Epstein, 2003: The impact of climate change on child health, Ambul. Pediatr., 3 (1), 44–52. Caminade, C., and Coauthors, 2011: Mapping Rift Valley fever and malaria risk over West Africa using climatic indicators. Atmos. Sci. Lett., 12, 96–103. [Available online at http://dx.doi.org/10.1002/asl.296.] Chaves, L. F., and C. J. M. Koenraadt, 2010: Climate change and highland malaria: fresh air for a hot debate. Quarterly Rev. Biol., 85 (1), 27–55. Comfort, L., and Coauthors, 1999: Reframing disaster policy: the global evolution of vulnerable communities. Environ. Hazard., 1, 39–44. Costello, A., and Coauthors, 2009: Managing the health effects of climate change. The Lancet, 373, 1693–1733.
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
Cuevas, L. E., I. Jeanne, A. Molesworth, M. Bell, E. C. Savory, S. J. Connor, and Thomson, 2007: Risk mapping and early warning systems for the control of meningitis in Africa. Vaccine, 25, A12–A17. Cutter, S. L., 1995: The forgotten casualties: women, children and environmental change. Glob. Environ. Change, 5 (1), 181–194. Cutter, S. L., 1996: Societal responses to environmental hazards. Int. Social Sci. J., 48, 525–536. Denton, F., 2002: Climate change vulnerability, impacts and adaptation: why does gender matter? Gender Develop., 10 (2), 10–21. Downing, T.E., Ed., 1996: Climate Change and World Food Security. Springer, 662 pp. Dye, C., S. Scheele, P. Dolin, V. Pathania, and M. C. Raviglione, 1999: Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. J. Am. Med. Assoc., 282 (7), 677–686. Emch, M., C. Feldacker, M. S. Islam, and M. Ali, 2008: Seasonality of cholera from 1974 to 2005: a review of global patterns. Int. J. Health Geogr., 7, 31, 103–110. Enarson, F., 2000: Gender issues in natural disasters: talking points and research needs. ILO InFocus Programme on Crisis Response and Reconstruction Workshop, Geneva, 3–5 May 2000. Gallup, J. L., and J. D. Sachs, 2001: The economic burden of malaria. Am. J. Trop. Med. Hyg., 64 (Suppl. 1), 85–96. [Available online at http://www.ajtmh.org/cgi/ content/abstract/64/1_suppl/85.] Grover-Kopec, E. K., M. B. Blumenthal, P. Ceccato, T. Dinku, J. A. Omumbo, and S. J. Connor, 2006: Web-based climate information resources for malaria control in Africa. Malaria J., 5, 38. [Available online at http://www.ncbi.nlm.nih.gov/ pubmed/16689992.] Guerra, C. A., P. W. Gikandi, A. J. Tatem, A. M. Noor, D. L. Smith, S. L. Hay, and R. W. Snow, 2008: The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLOS Med., 5 (2), E38. [Available online at http://www.plosmedicine.org/article/info:doi/10.1371/ journal.pmed.0050038.] Hammerich, A., O. M. Campbell, and D. Chandramohan, 2002: Unstable malaria transmission and maternal mortality – experiences from Rwanda. Trop. Med. Int. Health, 7 (7), 573–576. [Available online at http://www.ncbi.nlm.nih.gov/pubmed/ 12100439.] Hay, S. I., and Coauthors, 2009: A world malaria map: Plasmodium falciparum endemicity in 2007. PLOS Med., 6 (3), e1000048. Hewitt, K., 1997: Regions of Risk: A Geographical Introduction to Disasters. Longman, 389 pp. Jansen, C. C., and N. W. Beebe, 2010: The dengue vector Aedes aegypti: what comes next. Microb. Infect., 12, 272–279. Jones, R. N., and R. Boer, 2005: Assessing Current Climate Risks, Adaptation Policy Frameworks for Climate Change: Developing Strategies, Policies and Measures. Lim, B., E. Spanger-Siegfried, I. Burton, E. Malone, and S. Huq, Eds., Cambridge University Press, 91–118. Leichenko, R., and K. O’Brien, 2002: The dynamics of rural vulnerability to global change: the case of Southern Africa. Mitig. Adapt. Strateg. Glob. Change, 7, 1–18. Lewis, J. D., 2004: Assessing the demographic and economic impact of HIV/AIDS. AIDS and South Africa: The Social Expression of a Pandemic. K. D. Kauffman, and D. L. Lindauer, Eds., Palgrave Macmillan, 97–119. Lindsay, S. W., and W. J. Martens, 1998: Malaria in the African highlands: past, present and future. Bull. World Health Organ., 76 (1), 33–45. [Available online at http://www.ncbi.nlm.nih.gov/pubmed/9615495.] Lurie, M. N., 2004: Migration, Sexuality and the Spread of HIV/AIDS in Rural South Africa. Southern African Migration Project. J. Crush, Ed., IDASA, 39 pp. Mason, J. B., and Coauthors, 2005: AIDS, drought, and child malnutrition in southern Africa. Pub. Health Nutr., 8, 551–563. McCarthy, J. J., O. F. Canziani, N. A. Leary, D. J. Dokken, and K. S. White. Eds., 2001: Climate Change 2001: Impacts, Adaptation and Vulnerability. (Contribution of Working Group II to the Third Assessment Report of the Intergovernmental Panel on Climate Change), Cambridge University Press 1032 pp. McMichael, A. J., D. H. Campbell-Lendrum, C. F. Corvalán, K. L. Ebi, A. K. Githeko, J. D. Scheraga, and A. Woodward, 2003: Climate Change and Human Health: Risks and Responses. WHO, 322 pp. Morland, A., 1936: Climate and tuberculosis. Br. J. Tuberc., 30 (3), 142–152. O’Brien, K., S. Eriksen, L. P. Nygaard, and A. Schjolden, 2007: Why different interpretations of vulnerability matter in climate change discourses. Clim. Policy, 7, 73–88. Olago, D., and Coauthors, 2007: Climatic, socio-economic and health factors affecting human vulnerability to cholera in the Lake Victoria Basin, East Africa. Ambio,
187
36 (4), 350–358. [Available online at http://www.bioone.org/doi/full/10.1579/ 0044-7447%282007%2936%5B350%3ACSAHFA%5D2.0.CO%3B2.] Paz, S., 2009: Impact of temperature variability on cholera incidence in southeastern Africa, 1971–2006. EcoHealth, 6, 340–345. Pelling, M., Ed., 2003: Natural Disasters and Development in a Globalising World. Routledge, 272 pp. Pelling, M., and J. Uitto, 2001: Small island developing states: natural disaster vulnerability and global change. Environ. Hazard., 3, 49–62. Pielke, R. A., Sr., and R. L. Wilby, 2012: Regional climate downscaling – what’s the point? Eos Forum, 93 (5), 52–53. Portier, C. J., and Coauthors, 2010: A Human Health Perspective on Climate Change: a Report Outlining the Research Needs on the Human Health Effects of Climate Change. Environmental Health Perspectives/National Institute of Environmental Health Sciences, Research Triangle Park, 80 pp. [Available online at http://dx.doi.org/10. 1289/ehp.1002272, . www.niehs.nih.gov/climatereport.] Sen, A., 1981: Poverty and Famines: An Essay on Entitlement and Deprivation. Clarendon Press, 257 pp. Shea, K. M., R. T. Truckner, R. W. Weber, and D. B. Peden, 2008: Climate change and allergic disease. J. Allergy Clin. Immunol., 122 (3), 443–453. Smith, K., 2001: Environmental Hazards: Assessing Risk and Reducing Disaster. 3rd ed. Routledge, 392 pp. Stern, N., 2006: Stern Review on the Economics of Climate Change. HM Treasury. Pre-publication edition., Executive Summary, 27 pp. Stonich, S., 2000: The Human Dimensions of Climate Change: The Political Ecology of Vulnerability. Department of Anthropology and Environmental Studies, University of California. Tonnang, H. E., R. Y. Kangalawe, and P. Z. Yanda, 2010: Predicting and mapping malaria under climate change scenarios: the potential redistribution of malaria vectors in Africa. Malaria J., 23 (9), 111. [Available online at http://www.ncbi.nlm. nih.gov/pubmed/20416059.] Trærup, S. L. M., R. A. Ortiz, and A. Markandya, 2010: The Health Impacts of Climate Change: a Study of Cholera in Tanzania. BC3 Working Paper Series 2010–01. Basque Centre for Climate Change (BC3), 27 pp. [Available online at http://www. bc3research.org/working_papers/view.html.] Trenberth, K. E., 2010: More knowledge, less certainty. Nat. Clim. Change, 4, 20–21. van Lieshout, M., R. S. Kovats, M. T. J. Livermore, and P. Martens, 2004: Climate change and malaria: analysis of the SRES climate and socio-economic scenarios. Glob. Environ. Change, 14 (1), 87–99. Vincent, K., 2007a: Uncertainty in adaptive capacity and the importance of scale. Glob. Environ. Change, 17, 12–24. Vincent, K., 2007b: Gendered vulnerability to climate change in Limpopo Province, South Africa. Ph.D. Dissertation, University of East Anglia, 271 pp. Vincent, K., T. Cull, and E. Archer, 2011: Gendered Vulnerability to Climate Change in Limpopo Province, South Africa. Gender and Climate Change: An Introduction. I. Dankelman, Ed., Earthscan, pp. 160–167. Wandiga, S. O., and Coauthors, 2010: Vulnerability to epidemic malaria in the highlands of the Lake Victoria Basin: the role of climate change/variability, hydrology and socio-economic factors. Clim. Change, 99, 473–497. [Available online at http://www.springerlink.com/content/9v7580722h610350/.] Watts, M. J., and H. G. Bohle, 1993: The space of vulnerability: the causal structure of hunger and famine. Progr. Hum. Geogr., 17, 43–67. Wisner, B., 1998: World Views, Belief Systems, and Disasters: Implications for Preparedness, Mitigation and Recovery. Paper Prepared for a Panel on World Views and Belief Systems at the 23rd Annual Natural Hazards Research and Applications Workshop, Boulder, Colorado, 12–15 July 1998.
Relevant Websites The South African Risk and Vulnerability Atlas. http://www.sarva.org.za/. World Bank Climate Change Knowledge Portal. http://sdwebx.worldbank.org/ climateportal/index.cfm. WHO Global Burden of Disease. http://www.who.int/healthinfo/global_burden_disease/ en/index.html. MARA Mapping Malaria Risk in Africa Project. www.mara.org.za. Malaria Atlas Project. http://www.map.ox.ac.uk/. IRI/LDEO Climate Data Library. http://iridl.ldeo.columbia.edu/.
1.15.1 Introduction 1.15.2 Vulnerability to Climate 1.15.3 Climate and Health 1.15.3.1 Direct Climate Effects on Malaria and Cholera 1.15.3.2 Indirect Climate Effects on HIV/AIDS, Heat Stress, and Respiratory Illness 1.15.4 Health and Vulnerability to Climate 1.15.5 A Case Study from Southern Africa 1.15.6 Conclusion References Relevant Websites
1.15.1
Introduction
Climate and long-term change is increasingly recognized as a critical issue for society, and governments are asking questions about how to allocate scarce resources in order to minimize adverse impacts. A critical component of answering these questions requires an assessment of vulnerability to the changes that are projected to occur. People in Africa are particularly at risk from climate factors, because of exposure combined with low adaptive capacity. In addition, climate coincides with other stressors that affect the livelihoods and well-being of people. On the one hand, long-term changes in weather patterns would bring with it changed health risks, while on the other, the vulnerability of people to climate will be affected by their existing health status.
1.15.2
Vulnerability to Climate
Vulnerability is a contested term that has its origins in the natural hazards and food security literature and is now often applied in climate impacts assessments (Adger 2006). However, an evolution in the understanding of vulnerability has occurred over time. In early impacts assessments, focus was placed solely on the risk of exposure of an ecosystem to a hazard. This meant that impacts assessments at that time would refer to the effects of climate on parameters such as crop production and water availability and could thus be defined as biophysical vulnerability or ‘outcome vulnerability’ (O’Brien et al. 2007). People were only deemed affected because climate would alter the availability of resources on which they depend for their livelihoods. In biophysical or outcome vulnerability assessments, there was little recognition of the fact that people are different, and just because they are exposed to the same hazard does not mean they will respond in the same way. ‘Social vulnerability’ may be defined as the ability to anticipate, resist, cope with, and respond to a hazard (Blaikie et al. 1994). Social vulnerability, in contrast to being seen as an outcome, is viewed more as a potential state of human societies that can affect the way they experience natural hazards (Adger 1999; Adger and Kelly 1999; Blaikie et al. 1994). This potential state is in constant flux, reflecting its
Climate Vulnerability, Volume 1
183 183 184 184 184 185 185 186 186 187
dependence on the dynamic interaction of a range of economic and social processes that influence the capacity of individuals, social groups, sectors, regions, and ecosystems to respond to various socioeconomic and biophysical shocks (Leichenko and O’Brien 2002; Comfort et al. 1999). The most vulnerable are those who are most exposed to any changes, who possess a limited coping capacity, and who are least resilient to recovery (Bohle et al. 1994). As the particular mix of structures and institutions is typically context-specific, this has also been labeled ‘context vulnerability’ (O’Brien et al. 2007). Determining projected climate impacts, therefore, reflects not only likely exposure and biophysical, or outcome, vulnerability (of the ecosystem) but also the social, or context, vulnerability of the people. Given evidence of differential social vulnerability in the face of hazards or broader environmental risk exposure, a number of studies have tried to characterize the determinants that may give rise to vulnerability (e.g., Pelling 2003; Smith 2001; Blaikie et al. 1994). Vulnerability is a function of economic, social, political, environmental, and technological assets. Who is vulnerable to a hazard is therefore determined by the human and physical forces that shape the allocation of these assets in the society (Pelling and Uitto 2001). Defining vulnerability is also dependent on the scale of analysis (Vincent 2007a). On the large scale, macro-processes are the most important in determining the distribution and production of entitlements. In the well-developed food security literature, famines have been explained on the basis of entitlement theory (Sen 1981), where the distribution and reproduction of entitlements is dependent on the structural factors of the political-economic environment that can either reduce or precipitate entitlement failure (Downing 1996; Bohle et al. 1994; Watts and Bohle 1993). In the case of food and famine, e.g., the politicaleconomic environment refers to the dominant political system and the way it mediates trade, labor, and markets. In the face of exposure to climate factors, some populations will be able to draw on their entitlements to adapt to the risk, e.g., through awareness and preparation, insurance for losses, and diversifying livelihoods. For example, Adger (1999) shows how collective vulnerability (at community level or higher) to
http://dx.doi.org/10.1016/B978-0-12-384703-4.00124-6
183
184
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
extremes in coastal Vietnam is determined by institutional and market structures. In contrast, on the local scale, the role of human agency has a greater influence in access to resources and household-level social status. In such cases, entitlements are socially and spatially differentiated according to factors such as gender, ethnicity, religion, class, and age (Denton 2002; Enarson 2000; Wisner 1998; Cutter 1995).
1.15.3
Climate and Health
Weather patterns, and other aspects of climate, affect human health both directly and indirectly, via biological and ecological processes that influence the transmission of several infectious diseases (McMichael et al. 2003). One of the major health impacts of climate relates to disease burden. The effects of climate on vector-borne malaria and waterborne cholera have been well studied, given that they already pose existing risks in Africa (Boko et al. 2007). Fewer studies have looked at the links between other diseases, such as meningitis, Rift Valley fever, and dengue fever, and climate-related variables (Jansen and Beebe 2010; Anyamba et al. 2009; Cuevas et al. 2007). More indirect effects of climate on health relate to the transmission of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), heat stress, and respiratory illness, which are discussed here. Other indirect links of climate and health relate to cancer, mental health and stress-related disorders, zoonotic diseases, and food-borne illness (Portier et al. 2010).
1.15.3.1
Direct Climate Effects on Malaria and Cholera
Malaria is the leading cause of mortality and morbidity in hot and humid African countries (Wandiga et al. 2010). The spread of malaria within Africa is dependent on the susceptibility of the vector (mosquitoes of the Anopheles genus) and parasite (Plasmodium falciparum) to climate. A close association between malaria epidemics and climate has been contested, but a recent paper that analyzes past climate (temperature and precipitation), hydrological and health data (1961–2001), and socioeconomic status of communities from the East African highlands confirms the link between climate and the incidence and severity of malaria epidemics (Wandiga et al. 2010). In the absence of good epidemiological information, the association of malaria with seasonal climate patterns is used to map risk areas (climatic suitability for endemism), as in the MARA (Mapping Malaria Risk in Africa Project) model (GroverKupec et al. 2006; based on baseline endemism maps from Guerra et al. 2008). A global map of P. falciparum malaria endemism shows that of the 1.38 billion people at risk of stable P. falciparum malaria, 0.66 million are found in Africa, Yemen, and Saudi Arabia (a proportion similar to those found in south and central Asia). High endemism was also widespread in the African region, where 0.35 billion people are at this level of risk, with 0.20 billion at intermediate risk, and 0.11 billion at low stable risk (Hay et al 2009; based on the MARA data, which includes over 7000 P. falciparum parasite rate surveys from around the world). Since malaria is endemic in much of Africa, changes in climate factors affecting malaria may induce an increase in transmission on the fringes of stable zones, e.g., at higher
altitude in the highlands (see, e.g., Tonnang et al. 2010). Additional population at risk from malaria is projected in East Africa (Chaves and Koenraadt 2010; van Lieshout and Kovats 2004), while parts of the northern Sahel may have a decreased risk (Caminade et al. 2011). Adverse effects of malaria spread into new regions are typically higher than where the disease is already prevalent, because of the lack of protective genetic modifications that bring immunity. This applies to morbidity and mortality in both children and adults, as shown by the outbreak of epidemics in the East African Highlands (Lindsay and Martens 1998). In Rwanda, the February 1998 malaria epidemic led to a fourfold increase in malaria admissions among pregnant women and a fivefold increase in maternal deaths due to malaria (Hammerich et al. 2002). The risk of cholera has been shown to increase with increased temperature and rainfall (e.g., Trærup et al. 2010) and with increased sea surface temperature (Paz 2009). Analyses of precipitation, temperatures, and hydrological characteristics of selected stations in the Lake Victoria Basin show that cholera epidemics are closely associated with El Nino years, and epidemics are also triggered by sustained temperatures high above normal (Tmax) in two consecutive seasons, followed by a slight cooling in the second season (Olago et al. 2007). A global analysis of cholera data from 1974 to 2005, however, showed that while cholera outbreaks demonstrate seasonal patterns in higher absolute latitudes, closer to the equator cholera outbreaks do not follow a clear seasonal pattern (Emch et al. 2008).
1.15.3.2 Indirect Climate Effects on HIV/AIDS, Heat Stress, and Respiratory Illness In Africa, an important public health issue is the prevalence of HIV/AIDS. There are also interlinkages between climate and HIV/AIDS, although the pathways are less direct than with vector-borne and waterborne diseases. Climate-related factors might increase the risk of HIV/AIDS through its impact on food (in)security and migration. In Malawi, farmers in two districts at high risk of droughts and floodsdNsanje and Salimad observed how the lack of food and limited income to buy food encouraged women to engage in transactional sex as a coping mechanism, thereby increasing their exposure to HIV infection (Action Aid 2006). Migration is also a common coping mechanism in response to local crisis, which may be precipitated by climate extremes and can also increase exposure to HIV infection (Lurie 2004). In addition to altering the nature and type of risk of particular diseases, long-term changes in temperature might also affect heat-related illnesses. If temperatures were to increase over Africa, as projected, diseases may expand their reach and death tolls, with more indirect effects on water and food security (Costello et al. 2009). These indirect effects of climate could bring about not only mortality and morbidity but also adverse impacts on the well-being, health, and productivity of working populations (Bennett and McMichael 2010). Temperature also plays a role in the prevalence of many respiratory diseases, and thus it is not surprising that climate affects these diseases, such as tuberculosis, asthma, and allergies. Although climate has less influence on tuberculosis mortality than some other factors, evidence that warm, damp climates are associated with relatively high tuberculosis
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
mortality dates from the early twentieth century (Morland 1936). The burden of tuberculosis in Africa is high, and there is often coinfection of tuberculosis (Mycobacterium tuberculosis) and HIV (Dye et al. 1999). Allergies affecting the respiratory system and asthma can also be affected by changes in climate, which in turn affect the load of airborne allergenic pollens (Ariano et al. 2010; Shea et al. 2008). Both heat-related and respiratory illnesses will have differential effects on vulnerable subpopulations, such as children (Bunyavanich et al. 2003).
1.15.4
Health and Vulnerability to Climate
The relationship between climate and health status is two-way: climate affects disease burden and the health status of the population affects (social) vulnerability to climate impacts. Social vulnerability is a potential state of human societies that can affect the way they experience climate parameters and hazards (Adger 1999; Adger and Kelly 1999; Blaikie et al. 1994). People living with poor health are likely to have greater social vulnerability when exposed to climate threats. This is exacerbated by any long-term change in the average climate of a region, which, unlike extreme events, means that populations will not necessarily have a chance to recover and reduce their vulnerability levels before the next exposure. Reflecting the chronic nature of the health issue and its widespread prevalence across the continent, in Africa it is HIV/AIDS that has most been studied as the health condition that intersects with vulnerability to climate. It has been shown that the transition to a market economy and the introduction of HIV into the human environment has led to institutional decay in some countries, which, as a result, are more likely to suffer from climate-related health issues (Bloom 2004). Infection by HIV/AIDS makes people more vulnerable to climate threats, as sufferers are less able to cope with reduced food intake and have reduced flexibility in livelihood strategies required to adapt. Furthermore, for people already suffering from HIV/AIDS, exposure to extreme events such as floods can lead to cholera outbreaks, as they are more susceptible. Similarly, any resulting damage to health infrastructure (including home-based care) may impede their access to antiretrovirals. A study of child malnutrition in relation to the HIV epidemic and drought (crop years 2001–02 and 2002–03) in six countries of southern Africa found a strong correlation between HIV and drought and concluded that the combined effects of droughts and HIV/AIDS could have an even more significant adverse impact on child nutrition in the future (Mason et al. 2005).
1.15.5
A Case Study from Southern Africa
This chapter has shown that the impacts of climate are dependent not only on the climate parameters themselves but also on the characteristics of the people who experience those climate parameters and the assets or resources they have with which they can respond to them. It is essential to determine the impacts on society of possible changes in climate parameters. Traditionally, science has concentrated on projections of long-term changes in climate using models based on past analogs of climate variability, and
185
then made some suggestions as to how such changes might have impacts on human populations through changing patterns of weather and extremes (McCarthy et al. 2001). However, a limitation of such top-down approaches is their failure to take into account the differential vulnerabilities of human populations to those environmental risks, either through resisting an event or by coping once it occurs (Jones and Boer 2003; Stonich 2000). Moreover, the top-down approach provides, at best, just a subset of possible future regional and local climatic conditions, and improvements in modeling bring with them additional uncertainties due to the greater complexity of processes being modeled (Pielke and Wilb 2012; Trenberth 2010). Essentially, as once dominated the thinking with regards to natural hazards, changes in climate are seen as a problem for the society, not of the society (Hewitt 1997). Many impacts assessments have thus been impeded by only considering one side of the equationdthe exposure (Cutter 1996). In reality, assessing the impacts of climate is inextricably linked with an assessment of social vulnerability. Assessing social vulnerability is thus an essential component of climate impact assessments. A place-based enquiry was undertaken in one community in Limpopo province, South Africa, chosen for its experience of past climate variability and an example of possible future climate change (Vincent et al. 2011; Vincent 2007b). This area, to the north of the Soutpansberg mountains, is semiarid with a summer rainfall season (November–March). There are high levels of interannual variability, punctuated by regular droughts and occasional floods, most notably in 2000. In terms of human characteristics, the village comprises approximately 700 people in 180 households and has a legacy of natural resource-dependent livelihoods (primarily crop farming), in addition to a small level of formal employment in local towns. The area was formerly part of the Venda homeland. An index of social vulnerability to climate has been developed to compare households at grassroots level in Limpopo province, South Africa, and is explained elsewhere (Vincent et al. 2011; Vincent 2007a,b). Health status is incorporated into the index as a recognized driver of social vulnerability, and this element is elaborated on here (Adger and Vincent 2005). The index is theoretically determined and is an aggregation of five equally weighted component subindices: financial capital, human capital, social capital, physical capital, and natural capital, based on the Sustainable Livelihoods Framework (for more information, see Vincent 2007a,b). While the structure of the index is grounded in the theory of determinants of social vulnerability, the component indicators were chosen as appropriate to the context for which this particular index was first used (a small, dryland village in Limpopo province, South Africa). Human capital refers to the skills, knowledge, ability to provide productive labor, and good health that allow people to pursue their livelihood strategies and thus meet their livelihood objectives. Human capital is a function of the amount and quality of labor available in the household, which is dependent on factors such as education, health status, and knowledge. In this way, human capital is also a prerequisite for the transformation of natural capital (such as soil and water in agriculture) and physical capital (such as the use of building
186
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
materials to construct a house) and for the accumulation of financial capital. Accumulation of human capital is also often seen as an end in itself, as illiteracy and poor health are often regarded as core dimensions of poverty, and overcoming them is a primary goal of development. The human capital subindex, e.g., is a composite of two component indicators: household dependency ratio (ratio of working age adults to youth and elderly) and households with a member suffering from a longterm or recurrent disease (Vincent 2007b). To a certain extent, the progress that South Africa has made in tackling typical rural diseases, such as typhoid and cholera, is offset against the increasing incidence of HIV/AIDS. The disease burden from HIV/AIDS spreads to encompass the entire household, with one study from the Free State province in South Africa finding that people living in a household where at least one person is infected are 3.5 times more likely to have been ill in the last month (Booysen 2002). At the same time, household gross domestic product (GDP) in AIDSinfected households is 19% lower than uninfected households, combined with the increased financial burdens for infected households for medical and funeral expenses (Lewis 2004). Other illnesses would likely have similar effects on household vulnerability, reflecting the same pathways of increased dependence. For that reason, the indicator used to represent this in the demographic structure subindex is a nominal category of whether or not a household has a member who is suffering from a long-term or recurrent illness.
1.15.6
Conclusion
This chapter has provided an overview of the linkages between climate, vulnerability, and health, with a specific focus on southern Africa. Determining the effects of climate parameters on people is dependent on their vulnerability. Initial climate impact assessments assumed that people were passive recipients of global environmental change (i.e., the top-down, outcome vulnerability), only affected insofar as climate affected ecosystems on which they depend. Critiques of this approach posited that people are not all the same, and, in addition to the nature of exposure, their social characteristics (including their health status) mediate how they will experience that exposures and whether it will translate into adverse impacts or not. Moreover, the outcome vulnerability starts with the assumption that changes in regional and local climate statistics can be skillfully predicted, which, as summarized in Preface to this book, is not always the case. A more inclusive assessment of risk can be developed using the bottom-up, contextual vulnerability approach in which the entire spectrum of future possible climates is considered. Climate factors intersect with health in various ways. The range of many diseases is affected by temperature and rainfall patterns. This includes vector-borne malaria and waterborne cholera, as well as meningitis, Rift Valley fever, and dengue fever. However, the impacts on people again depend on their social vulnerability. At the same time, if more people have a compromised health status, they will likely have a higher social vulnerability to climate. In this way, climate,
vulnerability, and health run the risk of negatively reinforcing each other, leading to worse impacts than one alone. The adverse economic and developmental consequences of climate and disease (and broader suboptimal health status) have been recognized (e.g., Stern 2006; Gallup and Sachs 2001). At the same time, there is evidence to show that focusing resources on addressing climate threats and disease (and suboptimal health status) is beneficial for the economy (and often more cost-effective than dealing with the consequences) (Stern 2006). However, it is essential to begin addressing vulnerability reduction to both climate-related factors and disease in tandem. This is because negatively reinforcing interactions between the two can offset progress made to date. Any change in regional and local climate statistics, e.g., may cause additional risk of contracting malaria faster (through additional exposure) than the existing public health responses are able to reduce it. Increased disease burden, in turn, increases the social vulnerability of people to climate. Ultimately, climate-resilient sustainable development that addresses climate and health risks is the most appropriate way to reduce vulnerability to both risks and the intersecting vulnerabilities that result.
References Action Aid, 2006: Climate Change and Smallholder Farmers in Malawi: Understanding Poor People’s Experiences in Climate Change Adaptation, a Report by ActionAid, October 2006, 8 pp. Adger, W. N., 1999: Social vulnerability to climate change and extremes in coastal Vietnam. World Develop., 27, 249–269. Adger, W. N., 2006: Vulnerability. Glob. Environ. Change, 16 (3), 268–281. Adger, W. N., and P. M. Kelly, 1999: Social vulnerability and the architecture of entitlements. Mitig. Adapt. Strateg. Glob. Change, 4, 253–266. Adger, W. N., and K. Vincent, 2005: Uncertainty in adaptive capacity. Compt. Rend. Geosci., 337, 399–411. Anyamba, A., and Coauthors, 2009: Prediction of a Rift Valley fever outbreak. Proc. Natl. Acad. Sci. USA., 106 (3), 955–959. Ariano, R., G. W. Canonica, and G. Passalacqua, 2010: Possible role of climate changes in variations in pollen seasons and allergic sensitizations during 27 years. Ann. Allergy Asthma Immunol., 104 (3), 215–222. Bennett, C., and A. McMichael, 2010: Non-heat related impacts of climate change on working populations. Glob. Health Action, 3, 5640. [Available online at: http://dx.doi. org/10.3402/gha.v3i0.5640, http://www.ncbi.nlm.nih.gov/pubmed/21191440.] Blaikie, P., T. Cannon, I. Davis, and B. Wisner, 1994: At Risk: Natural Hazards, People’s Vulnerability, and Disasters. Routledge, 284 pp. Bloom, G., 2004: Health in a changing world. IDS Bull., 35 (3), 38–41. Bohle, H. G., T. E. Downing, and M. J. Watts, 1994: Climate change and social vulnerability. Glob. Environ. Change, 4 (1), 37–48. Boko, M., and Coauthors, 2007: Africa. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. M. L. Parry, O. F. Canziani, J. P. Palutikof, P. J. van der Linden, and C. E. Hanson, Eds., Cambridge University Press, 433–467. Booysen, F. L. R., 2002: Financial responses of households in the free state to HIV/ AIDS related morbidity and mortality. The South African Journal of Economics, 70 (7), 1193–1215. Bunyavanich, S., C. P. Landrigan, A. J. McMichael, and P. R. Epstein, 2003: The impact of climate change on child health, Ambul. Pediatr., 3 (1), 44–52. Caminade, C., and Coauthors, 2011: Mapping Rift Valley fever and malaria risk over West Africa using climatic indicators. Atmos. Sci. Lett., 12, 96–103. [Available online at http://dx.doi.org/10.1002/asl.296.] Chaves, L. F., and C. J. M. Koenraadt, 2010: Climate change and highland malaria: fresh air for a hot debate. Quarterly Rev. Biol., 85 (1), 27–55. Comfort, L., and Coauthors, 1999: Reframing disaster policy: the global evolution of vulnerable communities. Environ. Hazard., 1, 39–44. Costello, A., and Coauthors, 2009: Managing the health effects of climate change. The Lancet, 373, 1693–1733.
Vulnerability and Health: Exploring the Linkages in a Case Study from Southern Africa
Cuevas, L. E., I. Jeanne, A. Molesworth, M. Bell, E. C. Savory, S. J. Connor, and Thomson, 2007: Risk mapping and early warning systems for the control of meningitis in Africa. Vaccine, 25, A12–A17. Cutter, S. L., 1995: The forgotten casualties: women, children and environmental change. Glob. Environ. Change, 5 (1), 181–194. Cutter, S. L., 1996: Societal responses to environmental hazards. Int. Social Sci. J., 48, 525–536. Denton, F., 2002: Climate change vulnerability, impacts and adaptation: why does gender matter? Gender Develop., 10 (2), 10–21. Downing, T.E., Ed., 1996: Climate Change and World Food Security. Springer, 662 pp. Dye, C., S. Scheele, P. Dolin, V. Pathania, and M. C. Raviglione, 1999: Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. J. Am. Med. Assoc., 282 (7), 677–686. Emch, M., C. Feldacker, M. S. Islam, and M. Ali, 2008: Seasonality of cholera from 1974 to 2005: a review of global patterns. Int. J. Health Geogr., 7, 31, 103–110. Enarson, F., 2000: Gender issues in natural disasters: talking points and research needs. ILO InFocus Programme on Crisis Response and Reconstruction Workshop, Geneva, 3–5 May 2000. Gallup, J. L., and J. D. Sachs, 2001: The economic burden of malaria. Am. J. Trop. Med. Hyg., 64 (Suppl. 1), 85–96. [Available online at http://www.ajtmh.org/cgi/ content/abstract/64/1_suppl/85.] Grover-Kopec, E. K., M. B. Blumenthal, P. Ceccato, T. Dinku, J. A. Omumbo, and S. J. Connor, 2006: Web-based climate information resources for malaria control in Africa. Malaria J., 5, 38. [Available online at http://www.ncbi.nlm.nih.gov/ pubmed/16689992.] Guerra, C. A., P. W. Gikandi, A. J. Tatem, A. M. Noor, D. L. Smith, S. L. Hay, and R. W. Snow, 2008: The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLOS Med., 5 (2), E38. [Available online at http://www.plosmedicine.org/article/info:doi/10.1371/ journal.pmed.0050038.] Hammerich, A., O. M. Campbell, and D. Chandramohan, 2002: Unstable malaria transmission and maternal mortality – experiences from Rwanda. Trop. Med. Int. Health, 7 (7), 573–576. [Available online at http://www.ncbi.nlm.nih.gov/pubmed/ 12100439.] Hay, S. I., and Coauthors, 2009: A world malaria map: Plasmodium falciparum endemicity in 2007. PLOS Med., 6 (3), e1000048. Hewitt, K., 1997: Regions of Risk: A Geographical Introduction to Disasters. Longman, 389 pp. Jansen, C. C., and N. W. Beebe, 2010: The dengue vector Aedes aegypti: what comes next. Microb. Infect., 12, 272–279. Jones, R. N., and R. Boer, 2005: Assessing Current Climate Risks, Adaptation Policy Frameworks for Climate Change: Developing Strategies, Policies and Measures. Lim, B., E. Spanger-Siegfried, I. Burton, E. Malone, and S. Huq, Eds., Cambridge University Press, 91–118. Leichenko, R., and K. O’Brien, 2002: The dynamics of rural vulnerability to global change: the case of Southern Africa. Mitig. Adapt. Strateg. Glob. Change, 7, 1–18. Lewis, J. D., 2004: Assessing the demographic and economic impact of HIV/AIDS. AIDS and South Africa: The Social Expression of a Pandemic. K. D. Kauffman, and D. L. Lindauer, Eds., Palgrave Macmillan, 97–119. Lindsay, S. W., and W. J. Martens, 1998: Malaria in the African highlands: past, present and future. Bull. World Health Organ., 76 (1), 33–45. [Available online at http://www.ncbi.nlm.nih.gov/pubmed/9615495.] Lurie, M. N., 2004: Migration, Sexuality and the Spread of HIV/AIDS in Rural South Africa. Southern African Migration Project. J. Crush, Ed., IDASA, 39 pp. Mason, J. B., and Coauthors, 2005: AIDS, drought, and child malnutrition in southern Africa. Pub. Health Nutr., 8, 551–563. McCarthy, J. J., O. F. Canziani, N. A. Leary, D. J. Dokken, and K. S. White. Eds., 2001: Climate Change 2001: Impacts, Adaptation and Vulnerability. (Contribution of Working Group II to the Third Assessment Report of the Intergovernmental Panel on Climate Change), Cambridge University Press 1032 pp. McMichael, A. J., D. H. Campbell-Lendrum, C. F. Corvalán, K. L. Ebi, A. K. Githeko, J. D. Scheraga, and A. Woodward, 2003: Climate Change and Human Health: Risks and Responses. WHO, 322 pp. Morland, A., 1936: Climate and tuberculosis. Br. J. Tuberc., 30 (3), 142–152. O’Brien, K., S. Eriksen, L. P. Nygaard, and A. Schjolden, 2007: Why different interpretations of vulnerability matter in climate change discourses. Clim. Policy, 7, 73–88. Olago, D., and Coauthors, 2007: Climatic, socio-economic and health factors affecting human vulnerability to cholera in the Lake Victoria Basin, East Africa. Ambio,
187
36 (4), 350–358. [Available online at http://www.bioone.org/doi/full/10.1579/ 0044-7447%282007%2936%5B350%3ACSAHFA%5D2.0.CO%3B2.] Paz, S., 2009: Impact of temperature variability on cholera incidence in southeastern Africa, 1971–2006. EcoHealth, 6, 340–345. Pelling, M., Ed., 2003: Natural Disasters and Development in a Globalising World. Routledge, 272 pp. Pelling, M., and J. Uitto, 2001: Small island developing states: natural disaster vulnerability and global change. Environ. Hazard., 3, 49–62. Pielke, R. A., Sr., and R. L. Wilby, 2012: Regional climate downscaling – what’s the point? Eos Forum, 93 (5), 52–53. Portier, C. J., and Coauthors, 2010: A Human Health Perspective on Climate Change: a Report Outlining the Research Needs on the Human Health Effects of Climate Change. Environmental Health Perspectives/National Institute of Environmental Health Sciences, Research Triangle Park, 80 pp. [Available online at http://dx.doi.org/10. 1289/ehp.1002272, . www.niehs.nih.gov/climatereport.] Sen, A., 1981: Poverty and Famines: An Essay on Entitlement and Deprivation. Clarendon Press, 257 pp. Shea, K. M., R. T. Truckner, R. W. Weber, and D. B. Peden, 2008: Climate change and allergic disease. J. Allergy Clin. Immunol., 122 (3), 443–453. Smith, K., 2001: Environmental Hazards: Assessing Risk and Reducing Disaster. 3rd ed. Routledge, 392 pp. Stern, N., 2006: Stern Review on the Economics of Climate Change. HM Treasury. Pre-publication edition., Executive Summary, 27 pp. Stonich, S., 2000: The Human Dimensions of Climate Change: The Political Ecology of Vulnerability. Department of Anthropology and Environmental Studies, University of California. Tonnang, H. E., R. Y. Kangalawe, and P. Z. Yanda, 2010: Predicting and mapping malaria under climate change scenarios: the potential redistribution of malaria vectors in Africa. Malaria J., 23 (9), 111. [Available online at http://www.ncbi.nlm. nih.gov/pubmed/20416059.] Trærup, S. L. M., R. A. Ortiz, and A. Markandya, 2010: The Health Impacts of Climate Change: a Study of Cholera in Tanzania. BC3 Working Paper Series 2010–01. Basque Centre for Climate Change (BC3), 27 pp. [Available online at http://www. bc3research.org/working_papers/view.html.] Trenberth, K. E., 2010: More knowledge, less certainty. Nat. Clim. Change, 4, 20–21. van Lieshout, M., R. S. Kovats, M. T. J. Livermore, and P. Martens, 2004: Climate change and malaria: analysis of the SRES climate and socio-economic scenarios. Glob. Environ. Change, 14 (1), 87–99. Vincent, K., 2007a: Uncertainty in adaptive capacity and the importance of scale. Glob. Environ. Change, 17, 12–24. Vincent, K., 2007b: Gendered vulnerability to climate change in Limpopo Province, South Africa. Ph.D. Dissertation, University of East Anglia, 271 pp. Vincent, K., T. Cull, and E. Archer, 2011: Gendered Vulnerability to Climate Change in Limpopo Province, South Africa. Gender and Climate Change: An Introduction. I. Dankelman, Ed., Earthscan, pp. 160–167. Wandiga, S. O., and Coauthors, 2010: Vulnerability to epidemic malaria in the highlands of the Lake Victoria Basin: the role of climate change/variability, hydrology and socio-economic factors. Clim. Change, 99, 473–497. [Available online at http://www.springerlink.com/content/9v7580722h610350/.] Watts, M. J., and H. G. Bohle, 1993: The space of vulnerability: the causal structure of hunger and famine. Progr. Hum. Geogr., 17, 43–67. Wisner, B., 1998: World Views, Belief Systems, and Disasters: Implications for Preparedness, Mitigation and Recovery. Paper Prepared for a Panel on World Views and Belief Systems at the 23rd Annual Natural Hazards Research and Applications Workshop, Boulder, Colorado, 12–15 July 1998.
Relevant Websites The South African Risk and Vulnerability Atlas. http://www.sarva.org.za/. World Bank Climate Change Knowledge Portal. http://sdwebx.worldbank.org/ climateportal/index.cfm. WHO Global Burden of Disease. http://www.who.int/healthinfo/global_burden_disease/ en/index.html. MARA Mapping Malaria Risk in Africa Project. www.mara.org.za. Malaria Atlas Project. http://www.map.ox.ac.uk/. IRI/LDEO Climate Data Library. http://iridl.ldeo.columbia.edu/.