WEATHER, HEALTH AND DISASTERS

Many of us in the UN are not overly bothered by weather. Usually bad weather means a change in what we wear or planning for extra time to drive to work. But for millions of people around the world, the weather and climate make the difference between life and death, good health and disease, prosperity and poverty. Experts say that as much as 90% of all disasters over the last fifty years have been related to weather, climate, water and extreme events. With predictions of increased frequency and intensity of extreme weather events due to climate change, more and more people are looking closely at the link between weather, disasters and health.
The two UN agencies responsible for weather and health, the World Meteorological Organization (WMO) and the World Health Organization (WHO) have collaborated for sometime on the issues of climate, health and disasters. Last year, WHO dedicated its World Health Day to health and Climate Change. This year the focus is on Making Hospitals Safe in emergencies.
Michel Jarraud, Secretary-General of the World Meteorological Organization spoke to WHO on how he sees the link between weather, health and disasters and about the issues that we should be considering for the World Health Day theme.

How do weather and climate impact health?
Climate variability and climate change have a huge impact on many health factors. In particular extreme weather events can be an aggravating factor for many health issues. It is very important to address this issue at all stages. We need to undertake risk evaluation. Then we need to have preparedness measures and continues to the issuance of early warnings. After the disaster very often it is important to have weather information for rescue operations. Climate and health are linked in inextricable ways. With climate change we anticipate the number of these extreme events will increase and also the intensity, and when it comes to health there will probably be an increase in the occurrence of vector-borne diseases including malaria, dengue fever and many others. The quality of water maybe affected after floods, and that will have an impact on cholera and other water-borne diseases. so you will have the vector-borne diseases, the water-borne diseases, climate warming will probably also mean a proliferation of toxic algae in the oceans. In many countries the food production will be affected by the changes to the climate. It will have an impact on the food security, and in turn it will weaken populations in the least developed countries, and as we know a weaker population is more vulnerable to diseases. So if you keep in mind that about 90% of all natural disasters are related to weather, water, climate, this proportion is likely to increase further with climate change. These will have a dramatic impact on health. So it is really important that the two communities work together and that we properly integrate this information in decisionmaking. Good decision-making requires good information, and this is particularly true in the least developed countries which are the most vulnerable but also the least able to cope with that, so it has to be a multidisciplinary approach.

France
Europe’s 2003 heatwave hit France and its health sector hard. A 60% increase in deaths – close to 15,000 people – was recorded during the 16-day heatwave. The French government found that heatwave monitoring before and during the summer was insufficient.
So a heatwave warning system was developed to respond quickly with life-saving actions involving both hospitals and public health workers. The system aims to give public authorities three days warning that a heatwave may occur so measures can be implemented under the “national heatwave plan.” In parallel, a volunteer “syndromic” surveillance system now operates in at least 120 health facilities to monitor the number of patients presenting to emergency departments with heat-related illnesses. The system shows that hospital emergency departments can provide real-time information on heatwave illness to allow authorities to take early action to save lives.

What is the effect on hospitals and health services?
Extreme events can put an extraordinary load on the health infrastructure. When extreme events strike like a storm surge, like a tropical cyclone hits, it has an impact on not only the infrastructure, but also sometimes on the health workers themselves, who may not be able to come to work. It is very important to address this issue at all stages.

What can be done to make hospitals safe in emergencies related to weather?
First, good risk mapping has to be done to evaluate the risk for risk preparation and rescue phase. It is very important to be able to locate hospitals in places which are not vulnerable to these extreme events. Proper building codes should be available and they should be enforced so that hospitals and clinics will not be destroyed by earthquakes. Although earthquakes are not meteorological factors, weather, like during the earthquake in Pakistan, was an aggravating factor because the buildings including the hospitals were destroyed before the winter came with the snow, with the very cold weather. So it is very important to factor all of these elements in at the planning phase.
Early warning is key to prevention and preparedness. Good early warning systems properly integrated in disaster preparedness management are absolutely essential for saving lives and for a cost-effective response. We see a cost:benefit ratio of the order of 1:7 and it will save a huge amount of lives. Over the last fifty years thanks to proper early warning systems we reduced by factor 10 the number of people who lost their lives because of extreme weather events. In Botswana, proper use of seasonal forecasts several months in advance of the rainy season allows the government to plan for the next malaria epidemic. This is a very cost effective weapon to improve people’s health. In Europe there was a big heat wave in 2003. In France there was a heat health index which was developed in very close cooperation between the meteorological health service and the health community, and that will certainly help to save many more lives during similar heat waves. But when it comes to the post-disaster events, it is also very important to have proper information to coordinate our actions, and this is not something that which has to be improvised after the events. It has to be prepared in advance.

Haiti
The 2008 hurricane season in Haiti was highly intense, with three major tropical storms (Ike, Gustav and Hannah) hitting the country within two months. More than 800 people were killed and critical infrastructure was severely damaged. The city of Gonaives was one of the hardest hit areas, with its 175-bed Providence Hospital completely lost. The hospital served a population of more than 1.8 million people in and around Gonaives. In response, the Ministry of Health, with WHO support, is tackling ways to prevent such tragedies in the future. Sites on higher ground are being located to build the new hospital so that it can be protected from future floods. The new hospital, if built as planned, will comply with all the standards to make it a “Safe Hospital”.

Is preparing hospitals and communities for emergencies expensive?
I think all the actions I mentioned (above) very cost effective. It is estimated that if we invest something like $1, 1 € or one of any currency in disaster prevention activities, the benefit to society is about seven to ten times as big, and that includes the health sector. But it is important to focus on the developing and least developed countries, because they are the ones who are the most vulnerable but also the least able to deal and to cope with these disasters. What is noticeable is that there has been a significant increase in the number of such disasters. Today we see about fifty times more disasters than fifty years ago. But at the same time, we are losing about ten times fewer lives than we were fifty years ago.

So we have more disasters today but fewer people are dying. Why?
This is mainly because of better early warning systems and better use of these early warning systems by all socioeconomic sectors. The health sector is making very effective use of this early warning system. But at the same time the disasters are all different. An earthquake is not the same as a tropical cyclone, which is not the same as a flood. So what is important is to put in place a multi-hazard early warning system, so that irrespective of the disaster, we can use the same approach, taking into account the special effects of each hazard. But at the same time it is very effective for disasters which happen very infrequently, like the Tsunami that may “only” happen once every hundred years in Indonesia, it is very important to have in place a multi-hazard warning system that can be tested and used for all kinds of disasters. And this must involve communities, the health sector, the meteorological sectors, the civil protection, all the other actors who work together through national disaster management structure so that they work together for the best results.