This is Chapter 15 of the Arctic Climate Impact Assessment.

Lead Authors: Jim Berner, Christopher Furgal; Contributing Authors: Peter Bjerregaard, Mike Bradley, Tine Curtis, Edward De Fabo, Juhani Hassi, William Keatinge, Siv Kvernmo, Simo Nayha, Hannu Rintamaki, John Warren.

Health impacts related to climate change in the Arctic are likely to vary across communities and regions, with some changes being positive and others adversely affecting the health of individuals. In response to these impacts, communities need to develop strategies to take advantage of opportunities and to minimize risks. In some cases, communities have already started to adapt to climate related changes with potential impact on aspects of health. For example, in Inuit communities of the western Canadian Arctic, individuals report now taking bottled water on trips due to the lack of fresh water sources while on the land and hunters have adapted their hunting and fishing times to compensate for the changes in species availability and access to continue to procure fresh traditional foods^[1]. A key component in this ability to adapt and respond is the development of a better understanding of the relationship between climate and the health of northern peoples and access to locally relevant information on the changes taking place. The identification, selection, and monitoring of some basic indicators for climate and health is one tool communities can use to help in the development of their response to these changes. This information can support the community’s capacity to know what changes are occurring, what changes are likely to take place in the future, and what impacts these changes may have. Linking these indicators to the projected scenarios of change reported in other chapters of this assessment allow communities to monitor, and where required develop strategies to minimize negative impacts in the future. This section proposes some candidate indicators for this purpose based on the scientific review of direct and indirect climate–human health interactions presented in this chapter.

Goals of community indicators (15.6.1)

The identification, selection, and monitoring of indicators is one way in which communities can gather the information to support their diagnostic needs and to support the development of potential response strategies. Within this context, indicators for climate change impacts on human health are measurements or observations of a parameter (e.g., snow, ice, water, temperature, UV-B radiation, permafrost, a component of human health) that link climate, the environment, and an aspect of community or individual health. The indicators selected by the community need to be issue-specific and must be presented in a way that makes the information they generate easy to understand and useful in making decisions about climate change and health impacts at the community level. Indicators can potentially serve many purposes. For example:

• To confirm changes or trends in a condition over time (e.g., date of freeze-up of the local bay).
• To assess the current condition of the environment to judge its adequacy with reference to a standard (e.g., safety of ice for travel).
• To anticipate hazardous conditions before negative impacts occur (e.g., to know when a severe storm event is coming or to predict a shortage of a fresh source of a specific traditional food in the community related to difficulties with access and availability).
• To identify causes of effects and to identify appropriate action (e.g., windchill factor to warn people about cold injury).

The type(s) of indicators chosen by a community or region for a monitoring program must be determined by the specific goals of the community. For example, whether it is the intent to be able to warn individuals of future dangerous conditions, whether it is to determine if an increase in accidents experienced by residents while on the land or water is associated with changes in local climate conditions, or whether it is to determine if changes in local food security (access and availability of traditional food species) are associated with changes in climate and whether this situation will become sufficiently bad in the future that they must be prepared to take early action. In many cases, regional and community public health and other authorities (e.g., Meteorological Service/Weather Bureau, Wildlife Dept.) can be helpful in selecting and gathering such indicator-based data. A good definition of goals for the monitoring activity will provide direction as to what indicators are best suited to their needs and are most appropriate to the community or region. The scale at which the indicators are gathered is also critical as some changes can be detected and are best managed at a regional scale (e.g. changes in access to market foods to supplement local diets at critical times of the year) while others require a more local-scale approach (e.g., monitoring permafrost stability at the airstrip of a community). In all cases, for indicators to be appropriate, meaningful, and useful to local communities, community individuals must be directly involved in their identification and selection as well as in the design and implementation of the data gathering monitoring programs^[2].

Characteristics of useful indicators (15.6.2)

Criteria can be used to guide indicator identification and selection to ensure that appropriate indicators are chosen to help meet community objectives. It is essential that each community or region develops its own criteria, although many may be general and useful to all regions. Two general types of criteria that are often used are scientific and use-based criteria.

Scientific criteria are intrinsic to the issue of scientific quality (sensitivity, reliability, and statistical validity) and are often addressed by using indicators from existing and recognized lists. Indicators based on traditional or indigenous knowledge are very useful and should include a description, where possible, of the understanding of the link between the indicator and the specific health impact. It is also important to consider other “use-based” criteria, such as:

• Feasibility (are they already available and if not, what is the feasibility of collecting new information, taking account of cost, ease and time for collection, capacity to gather data, etc.).
• Perceived importance of the indicator to those affected (community representatives).
• Number of indicators (a manageable number is needed to attain specified goals, but this number must not be too cumbersome for community monitoring system managers).
• Balance (a rough balance among the various aspects of the issue).
• Catalyst for action (those that act as a catalyst to drive action are also useful, e.g., ice thickness on travel routes).
• Understandability by the media, local decisionmakers, and policy-makers.
• Minimal environmental impact to collect.
• Relevance to all members of the population.

The candidate indicators listed in the following section are proposed on the basis of the review presented in this chapter and all meet the following basic criteria:

• The indicator relates climate changes, directly or indirectly, to potential human health impacts.
• The data are already being gathered by regional or national governments or are readily available from other sources.
• Where the indicator data are not already gathered, they could be easily collected by communities using standard methods.
• Time trend data for the indicator exist or can be easily gathered.

Proposed candidate indicators (15.6.3)

This section lists indicators proposed as potential candidates for community selection. They are not an exhaustive or complete list but are proposed as tools to assist communities in discussing and identifying their own indicators. They are derived from the review of direct and indirect climate–human health interactions presented in this chapter and assume the collection of general environmental data related to climate changes at the local and regional scale (e.g., temperature, precipitation, ice cover).

Direct impact mechanism indicators (15.6.3.1)

The collection of some basic indicator data can help communities monitor the direct impacts of climate on health in northern communities. Table 15.2 identifies indicators of health impacts related to direct interactions with climate variables such as accidents while on the land or ice (unintentional trauma) related to bad weather conditions, deaths or injuries related to extreme weather events, and the health impacts of increased UV-B exposure.

Indirect impact mechanism indicators (15.6.3.2)

Similarly, the monitoring of basic indicators, such as those presented in Table 15.3 can be used to help communities identify, understand, and track the indirect impacts climate variables may be having on community and individual health in the circumpolar North. Impacts related to exposure to zoonotic diseases, indirect injuries related to environmental conditions, changes in the stability and safety of community infrastructure, and the combined impacts of climate-related changes on social and mental health and well-being can be monitored via the collection of such data.

Chapter 15: Human Health
15.1. Introduction
15.2. Socio-cultural conditions, health status, and demography
15.3. Potential impacts of direct mechanisms of climate change on human health
15.4. Potential impacts of indirect mechanisms of climate change on human health
15.5. Environmental change and social, cultural, and mental health
15.6. Developing a community response to climate change and health
15.7. Conclusions and recommendations

References

1. ^ Nickels, S., C. Furgal, J. Castelden, P. Moss-Davies, M. Buell, B. Armstrong, D. Dillon and R. Fongerm, 2002. Putting the human face on climate change through community workshops. In: I. Krupnik and D. Jolly (eds.).The Earth is Faster Now: Indigenous
   Observations of Arctic Environmental Change, pp. 300–344. Arctic Research Consortium of the United States, Fairbanks, Alaska.
2. ^Eyles, J. and C. Furgal, 2002. Indicators in environmental health: identifying and selecting common sets. Canadian Journal of Public Health, 93(1): 62–67.
3. ^[4]AMAP, 2003. AMAP Assessment 2002: Human Health in the Arctic. Arctic Monitoring and Assessment Programme, Oslo.