Climate and Health Vulnerability & Adaptation Assessment Profile Manaus - Brazil Christovam Barcellos (ICICT/Fiocruz) Diego Xavier Silva (ICICT/Fiocruz) Rita Bacuri (CPqLMD/Fiocruz)
Assessment Objectives To identify the possible links between climate change - more specifically hydrological regime - and water related diseases. To suggest tools for monitoring changes in river regime and water related diseases. To identify social actors and strategies to implement adaptation plans. To contribute as a pilot study for the Brazilian Climate and Health Observatory
Why Manaus? The city of Manaus, Brazil, is situated at the confluence of Negro, Amazon and Purus rivers that determine the region s hydrology, together with the Amazon forest that surrounds it. Since Manaus is an important regional harbor and the main Amazonian metropolis, the city tends to act as a shelter for groups evaded from areas submitted to environmental stress, ethnical struggles or economic crisis.
Why Manaus? The water level of Rio Negro has been a strong regulator of city s economic and social dynamics, since its foundation. The persistence of wooden houses built on stilts (palafitas) is an example of adaptation of the local population to the climatic variability.
Approach to Organization Three steps: Health problem definition/climate factors Gathering and analysis of secondary data Discussion of results with stakeholders
Assessment Methods The first step in our study was to focus on one health problem. This choice may represent a major change in the proposed guide. Because of the city geographical characteristics and the present concern of local authorities and general public, we selected water as a key climate issue to be addressed. Local researchers and authorities have participated of this decision.
Assessment Methods Quantitative approach The second step was to collect and gather routine data for the selected indicators (at Fiocruz, Rio de Janeiro). This activity produced a preliminary report that was distributed among all participants (stakeholders). We have used time series to demonstrate the seasonality and long term variability of precipitation and river water level, and to link them to the incidence of water related diseases. GIS was also used to identify vulnerable population groups.
Assessment Methods Quantitative approach Environmental data: Land use, altimetry, floodable areas, river water level. Weather and climate: Temperature, precipitation, seasonal and long term forecasts; Socioeconomic data: Census information (households, sanitation, migration, education, income); Health data: Health service provision, mortality and morbidity (hospitalization and disease notification.
Health outcomes Malaria incidence and hospitalization Dengue incidence and hospitalization Leptospirosis incidence Hepatitis A incidence and hospitalization Infant mortality by diarrhoea
The final activity was a workshop during which the preliminary report was discussed by the group. The report brought evidences on the relationship between river water regime and the transmission of selected diseases but avoided to pose an explanation about the causal link between water regime and diseases. Assessment Methods Qualitative approach The explanation of the dynamics of disease transmission was suggested by the workshop participants.
Social and environmental processes acting between river water level and disease? Malaria incidence Malaria: water impoundment and flow retention in creeks Hepatitis: Water contamination by faeces Hepatitis A incidence
Leptospirosis in incidence and river water level
Major Findings Changes in the river water level are assimilated by the inhabitants, if these variations occur within a range that does not compromise the operation of transportation systems, sanitation, water and food supply. Major changes, such as prolonged droughts as well as floodings, may cause the collapse of these systems. Both extreme climate events occurred in city during 2009, leading to a perception that climate changes are already affecting the city.
Extreme events in Manaus River water level
Utility of Assessment & Meeting Decision Needs All used data (socioeconomic, epidemiological and climate) are available for public use for free. It can be employed in a CC monitoring system. Stakeholders were especially satisfied with the analysis of health, environment, climate and socioeconomic indicators. They were familiar with the problems presented and felt comfortable to comment and interpret the statistical results. The final report was built on reliable information and it reflects the views of stakeholders on the current health problems and climate scenarios. The study participants declared that the final assessment report will be useful to discuss adaptation strategies and to seek financial sources for its implementation.
Major Challenges It would be useful to include primary data and insights from fieldwork. Due to the limited budget and time it was not possible to incorporate additional data. Stakeholders are concerned with the possibility of materialize plans and benefits to the society. The assessment should point out project opportunities and financial sources. The opinion of stakeholders varies substantially according to their position in the institutional framework (governmental or nongovernmental, sector, political party and so on). The guidance should suggest methodologies of quantitative (graphs, maps, indicators, etc.) and qualitative research (structured or semistructured interviews, focus group etc.). The stakeholder opinion convergence in some aspects was difficultly achieved or even impossible. A methodology for dealing with different points of view would be welcome.
Vulnerability or vulnerabilities? the different origins and vulnerabilities of deprived social groups, such as: Urbanized indigenous people Migrants from the eastern Amazon Migrants from other regions of the country traditional riverside inhabitants (ribeirinhos)
Invasions along the urban fringe - Recent migrants from the eastern Amazon - Poor sanitation and housing conditions - Malaria hotspots
Houses on stilts along the riverside - Traditional Amazonian population - Subject to river changes and water transmitted diseases - More adapted to environmental changes
Adaptation strategies for different vulnerabilities
Adaptation strategies for different vulnerabilities Creek (Igarapés)
Thank you Christovam Barcellos (ICICT/Fiocruz) Diego Xavier Silva (ICICT/Fiocruz) Rita Bacuri (CPqLMD/Fiocruz) Yara, Queen of the Amazonian rivers