Social VulnerabilitySandy A. Johnson, Ph.D.

2006 Summer Colloquium on Climate & Health

Boulder, CO

Definitions

• Risk – probability that a negative outcome will occur

• Risk factor – increases probability of a negative outcome

• Vulnerability – Ability to mitigate risk

“In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.”

- Eric Hoffer

Vulnerability

Physical Environment Socioeconomic

Sociocultural Political Environment

Agency

Vulnerability

• Climate Pattern• Relationship of climate pattern to well-

being• Identification of vulnerable populations• Building sustainable adaptation

Effects of climatic events on malaria incidenceAve. rainfall Event

Low Epidemic – El Nino high temp. and rainfall in cool dry, high altitude areas Pakistan (37)

Epidemic – high rainfall, arid/semiarid areas Kenya (6), Gujarat (3), Punjab (41)

Epidemic – high temp. and rainfall, tropical highlands w/little moisture deficit Africa (234, 184)

Epidemic – high rainfall with La Nina 1988, extend area of endemicity NE Venezuela (23)

Lapse in transmission – flooding; hot-wet areas, flooding washes away breeding sites in southern African (190) (24)

High Epidemic – drought, humid areas w/ponding of rivers in Sri Lanka (41), Colombia (39, 256), drought in Venezuela (36)

Source: Sutherst 2004

Health

Resources

Lost work

Lost income

Lost resources

Health care expenses

Death rites

Increased poverty

DecreasedProductivity

Increased Poverty

Higher reproduction

Social welfareHealthcare

Vulnerability

Resources

Risk

Exposure

Mitigating health impacts

• Scale• Accurate identification of the vulnerable• (Mis)match of priorities• Communication• Sustainable, culturally competent strategy• Time perspective• Change in vulnerability over time• Ethical considerations

Scale

• Population• Neighborhood• Household• Individual

Identify the vulnerable

• National Vulnerabilities– Low income,

especially rural– Women– Haitians

• Vulnerabilities in La Altagracia– Sugarcane workers, but

less so than construction workers

– Construction workers– Permanent residents

near construction/tourist facilities

Priority Mismatch

Communication

• Know the audience• Frame the issue

– Cultural competency• Semantic networks• Priority match

• Appropriate messenger• Build trust• Positive communication

Source: Moser 2006, Rogers 1962

Sustainable, Culturally

Competent Strategy

Time Horizons

To a man, a butterfly has but a short life. To a tree, a man’s life is but the blink of an eye.

Taoist adage

Vulnerability in Flux

Time

Incidence

Sources: Aral 2002, Suthrest 2004

Vulnerability in Flux

Construction Projects and Malaria Cases in the Dominican Republic

1985 to 1999

0

500

1000

1500

2000

2500

3000

3500

4000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Year

Case

s

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Area

Und

er C

onst

ruct

ion

(m2)

No. of CasesArea (square meters)

Ethical Dimensions

• Who are the winners and who are the losers?

• Will desired outcomes be achieved? What are foreseeable consequences?

• Are we harming anyone?• Are we reducing suffering?• Who is driving the agenda?• Is the solution equitable and just?

Louisiana’s Katrina Mortality, July 20, 2006Race Mortality based on 835 Total mortality is 1,577

African American - 451 (53%)

Caucasian 334 (39%)

Other 33 (4%)

Unknown 35 (5%)

GenderMale 432 (53%)

Female 421 (47%)

Age 0 - 15 7 (< 1%)

16 - 20 5 (< 1%)

21 - 30 13 (2%)

31 – 40 26 (3%)

41 - 50 75 (9%)

51 - 60 119 (14%)

61 - 75 196 (23%)

0ver 75 388 (45%)

Unknown 24 (3%)Source: State of Louisiana Dept. of Health and Hospitals

Female Male AfricanAmerican

Caucasian

Proportion state

51% 45% 33% 66%

Proportion city

53% 46% 68% 28%

Female 47%Male 53%

African American 53%Caucasian 39%

Rate per 100,000 (Orleans Parish)

86 89 93 69Age over 50

145 per 100,000

Source: Times Picayune, Oct. 2006

Tools

• Mixed methodologies

• Translational research

• Community-based Participatory Research / Participatory Action Research