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Title: Pr sentation PowerPoint Author: Stephanie Lerner Last modified by: DORA, Carlos Francisco C. Created Date: 9/16/2010 2:50:57 PM Document presentation format – PowerPoint PPT presentation

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Title: Pr

Earth Observations to reduce major diseases
caused by air pollution, water and sanitation and
poor urban infrastructure Dr Carlos
Dora Coordinator Department of Public Health and
Key messages for mini-campaign
This presentation AP
  • Air Pollution causes important risk to health
  • Public health programmes have not focused on AP
  • WHA resolution calls for better data, evidence of
    effective interventions, communications and
    demand for solutions
  • Capacity building for health sector to estimate
    health benefits from policies in polluting
    sectors. Track health gains of policy change
  • SDG 3 and 7 requires AP data
  • EO need for higher resolution geographic
    temporal variation (cities, roads, agriculture
    burning, industry)
  • To provide more precise estimates of AP over
    time, location, and help track impact of policy

Worldwide NCDs are the main cause of death
  • 2 in 3 deaths are from NCDs
  • Cardiovascular disease, mainly heart disease,
  • Cancer
  • Chronic respiratory diseases
  • Diabetes
  • Injuries

Costs Trillions of U dollars
  • Currently public health programmes to reduce NCDs
    consider only other major risk factors
  • Tobacco
  • Physical inactivity
  • Diet (fat, sugar, fiber)
  • Excess use of alcohol

New evidence over the last 10 years AP is a
major risk to NCDs
Substantial new evidence showing that particles
smaller than 2.5mm penetrate deep into the lungs
and effect the body more systematically leading
to diseases like stroke, heart disease, in
addition to the cancers, COPD and
PMlt10mm Coarse PMlt2.5mm Fine PMlt1mm
Medgadget .com
Lungs exposed to tobacco and to Indoor air
Pathology slides - Courtesy Prof. Saldiva, São
Paulo, Brazil
Review of evidence on health aspects of air
pollution - REVIHAAP, WHO 2013 selected
conclusions on PM (A1)
  • Confirm and strengthen results form the 2005 WHO
    Guidelines on Air Quality and Health.
  • New studies on short- and long-term effects
  • Long-term exposures to PM2.5 are a cause of
    cardiovascular mortality and morbidity
  • More insight on physiological effects and
    plausible biological mechanisms linking short-
    and long-term PM2.5 exposure with mortality and
  • Studies linking long-term exposure to PM2.5 to
    several new health outcomes (e.g.
    atherosclerosis, adverse birth outcomes,
    childhood respiratory disease).

Meta-analysis of the association between
long-term exposure to PM2.5 and cardiovascular
Pub. year
Hoek et al, EnvHealth 2013
Mortality and long-term exposure to PM2.5
Results of a cohort study in Rome (1.3 million
adults followed from 2001 to 2010)
PM2.5 3-dimensional Eulerian model (1x1 km)
c increase in risk per 10 µg/m3
Cesaroni et al. EHP 2013
Carotid artery wall thickness (risk of
atherosclerosis) and long-term PM2.5 exposure
change in artery wall thickness
Home outdoor PM2.5 (µg/m3)
Heinz Nixdorf RECALL study, Ruhr region, Germany
Bauer et al, JACC 2010
Long term O3 exposure and risk of death due to
respiratory causes ACS cohort of 448 thousand
adults followed for 18 years
RR per 10 ppb 1.040 (95 CI 1.010 -
1.067) (2-pollutant model with O3 and PM2.5)
Jerrett et al, NEJM 2009
Short-term exposure to ozone, mortality and
hospital admissions European cities in the
APHENA study
Outcome Per cent increase in deaths/admissions (95 CI) per 10 µg/m3 increment in daily maximum 1-hour ozone concentrations Per cent increase in deaths/admissions (95 CI) per 10 µg/m3 increment in daily maximum 1-hour ozone concentrations
Outcome Single pollutant Adjusted for PM10
All-cause mortality a 0.18 (0.070.30) 0.21 (0.100.31)
Cardiovascular mortality 75 years and older a 0.22 (0.000.45) 0.21 (-0.010.43)
Cardiovascular mortality younger than 75 years a 0.35 (0.120.58) 0.36 (0.100.62)
Respiratory mortality b 0.19 (-0.060.45) 0.21 (-0.080.50)
Cardiac admissions older than 65 years a -0.10 (-0.460.27) 0.64 (0.360.91)
Respiratory admissions older than 65 years b 0.19 (-0.280.67) 0.32 (0.050.60)
a lag 0-1 results b lag 1 results
Katsouyanni et al 2009
IARC 2012 finding Diesel a carcinogen
LONDON/GENEVA (Reuters) - The air we breathe is
laced with cancer-causing substances and is being
officially classified as carcinogenic to humans,
the World Health Organization's cancer agency
said on Thursday.
Ischemic and thrombotic effects of diluted diesel
exhaust inhalation in men with coronary heart
Myocardial ischemia during 15-minute
exercise-induced stress and exposure to diesel
exhaust or filtered air in 20 subjects
Mills et al, NEJM 2007
More complete estimates of exposure to air
pollution from Satellite Remote Sensing, air
transport models and ground monitors
Estimating Burden of Disease and Death due to
exposure to air pollution (and other risks to
health) Burden of disease is estimated from
  1. Air pollution concentrations human exposure
  2. Evidence from epidemiology about the health
    impacts of air pollution
  3. Diseases affected
  4. Disease response to levels of AP (dose-response
  5. Baseline disease rates

Estimates of outdoor air pollution exposures used
by WHO for BOD estimates
  • Brings together existing data from
  • Satellite remote sensing (sparsely covereed
  • Urban ground monitoring stations pollutant
  • 3. Estimates of air pollution levels based on
    emissions from sectors (e.g. transport, industry,
    power production, etc.)
  • Mathematical models - combining information from
    monitoring, from satellite remote sensing,
    chemical transport models to fill gaps and
    improve estimates

Deaths attributed to HAP Outdoor Air Pollution
7 million deaths globally in 2012 AP a main RF
for around 1/5 of NCDs
3.7 million deaths were attributed to ambient air
pollution exposure in 2012

Breakdown of by disease
21 of all deaths from ischaemic heart disease
(IHD) 23 of all deaths due to stroke 13 of
all deaths to chronic obstructive pulmonary
disease (COPD)
First World Health Assembly Resolution on Air
Pollution and Health
7 million deaths a year due to household and
ambient air pollution
The resolution
  • key role health authorities in raising awareness
    about the potential to save lives and reduce
    health costs, if air pollution is addressed
  • Need for strong cooperation between different
    sectors and integration of health concerns into
    all national, regional and local air
    pollution-related policies.
  • It urges Member States to develop air quality
    monitoring systems and health registries to
    improve surveillance for all illnesses related to
    air pollution
  • It urges Member States to strengthen
    international transfer of expertise, technologies
    and scientific data in the field of air

collaborate, as appropriate, with relevant
international, regional and national
stakeholders, to compile and analyse data on air
quality, with particular emphasis on
health related aspects of air quality
  • to create, enhance and update, in cooperation
    with relevant United Nations agencies and
    programs a public information tool of WHO
    analysis, including policy and cost-efficiency
    aspects, of specific and available clean air
    technologies to address the prevention and
    control of air pollution, and its impacts on

raise awareness of the public health risks of air
pollution and the multiple benefits of Improved
air quality, in particular in the context of the
discussions on the post- 2015 development agenda
Asks the WHO
advise and support tools to assist the health and
other sectors at all levels of government,
especially the local level and in urban areas,
taking into account different sources of
pollution in tackling air pollution and their
health effects
SDG 11 cities
Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable.
Target 11.7 By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality, municipal and other waste management.
Target indicator
11.7 Annual mean levels of fine particulate matter (i.e. PM2.5) air pollution in cities (population weighted)
SDG 7 Energy
Goal 7 Ensure access to affordable, reliable, sustainable, and modern energy for all
Target 7.1 By 2030, ensure universal access to affordable, reliable and modern energy services
Target Indicator
7.1 7.1.1 Percentage of population with electricity access
7.1 7.1.2 Percentage of population with primary reliance on clean fuels and technologies at the household level
  • Recommendation 4
  • Household combustion of kerosene is discouraged
  •  Rationale
  • High levels of emissions of PM and other
    health-damaging emissions.
  • Epidemiologic studies suggest links to
    tuberculosis, cancer, respiratory disease,
    adverse birth outcomes, etc., but are not of
    adequate consistency/quality.
  • Kerosene use carries substantial risks of burns
    and poisoning.

SDG 3 Health
Goal 3 Ensure healthy lives and promote well-being for all at all ages
Target 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution from contamination.
Target Proposed Indicator
3.9 3.9.1. Mean levels of exposure to air pollution (population weighted) OR deaths and diseases due to air pollution
Urban Air Quality Data (WHO) 1600 cities, but
sparse coverage for Africa, Latin America, Middle
East no coverage in rural areas
Satellite Remote Sensing
(No Transcript)
Found discrepancy in satellite estimates for
urban areas in developing countries
Modelled data
Ground monitors
(No Transcript)
(No Transcript)
Created Global Platform on Air Quality and Health
  • To ensure best estimates of human exposure to air
    pollution will continue to be regularly available
    for Burden of Disease estimates, as well as to
    ensure accountability, transparency and wide
    access of these results worldwide.
  • Established in January 2014,
  • A wide collaboration with international agencies
    including UNECE, WMO, UNEP, JRC, IIASA, World
    Bank, space research agencies (e.g. NASA, JAXA),
    as well as national agencies and research
  • Yearly meetings to update on progress and
  • Task forces to provide improvements in methods
    and outputs from one year to the next.
  • First year
  • improvements in data integration and statistical
    fusion, (using data from monitors, atmospheric
    transport models and satellite remote sensing).
  • First database of source apportionment studies

Second year
  • Data fusion Global air quality data as a result
    of fusion from various data sources, report on
    progress and work ahead,
  • Emission sources information, including from
    emission inventories and source apportionment
  • Exposure-risk relationship Integrated
    dose-response functions that relate levels of air
    pollution indoors and outdoors to a range of
    diseases, report on progress and work ahead.
  • Surface monitoring key air pollution indicators
    to be monitored, minimum data sets for health
    purposes systematic data collection and display
  • Automated Data acquisition, portable monitors
    etc. quality of outputs form different sources,
  • Household air pollution exposure assessment,
    progress in IAP data, availability of exposure
    data from Europe
  • New task forces proposed
  • Data fusion and synthesis further improvements
  • Models for integrating Household and Ambient Air
    Polluton exposure estimates
  • Guidance on the collection of ground measurement
  • Guidance on source apportionment studies.

Recommendations for Satellite remote sensing
  • To strengthen satellite-derived PM2.5 estimates
    used by the Global Platform, the following steps
    are recommended
  • Proceed towards higher spatial resolution of
    estimates (e.g. using satellites MODIS with 1-3
    km resolution, MISR with 4 km, and eventually
    VIIRS with 750m resolution)
  • Use more accurate and precise retrievals (e.g.
    through MODIS Collection 6)
  • More fully incorporate active measurements (e.g.
    through CALIOP space-borne lidar)
  • Use measurements with higher temporal resolution
    to estimate annual mean more accurately (e.g.
    from geostationary satellites)
  • Endorse and foster the collocation of AOD and
    surface PM2.5 measurements (e.g. through SPARTAN
    project and other networks)
  • Develop related information on NO2 and other
    pollution species (e.g. using the TROPOMI
    instrument onboard the Sentinel-5 precursor
    satellite with 7km resolution after expected
    launch in 2015)
  • Build on expertise from space agencies to
    increase data continuity
  • Consider modifications of the estimating
    procedures to account for urban increment
  • Consider using ground-based and airborne
    measurements which offer valuable resources to
    calibrate and validate satellite data
  • Consider exploring information on road networks
    to inform proximity to road.
  • Make formal statements to space agencies to
    encourage relevant measurements
  • Nurture groups and communities that will inform
    the exposure dataset.

Establishment of a web-based resource providing
access/ web linkage to
  • Results from the platform methods, tools,
  • Tools for estimating health impacts from air
    pollution at local level
  • Exposure-response functions
  • Access to air quality databases
  • WHO ambient air quality in cities,
  • WHO household air pollution database,
  • Joint ambient/ household air pollution (future)
  • Analysis of trends.
  • Burden of disease estimates.
  • Awareness raising and communication tools.
  • Collection of cost-effective interventions/ best
    practices to address air pollution and health.

Causes of air and climate pollutants urban
A New Urban Health Project
  • Inform /support demand/ adoption of policy
    choices/behaviours that
  • mitigate Air Pollution
  • mitigate Climate Pollutants (SLCPs, CO2)
  • maximize health benefits.
  • How? Equip/engage city actors in health,
    planning, development, government, with
  • Health knowledge interventions with greatest
    health benefits.
  • Tools for health assessment and for
  • Strengthened institutional and technical
  • Framework of collaboration, monitoring and
  • Communication/awareness raising

  • Part of the implementation of the WHA resolution
  • International efforts on sustainable Energy,
    Transport, Energy, Waste Management, Land Use
  • Cities already organized to address air
    pollution, climate change, health (ICLEI, C40,
    Clean Air Asia, Healthy Cities)
  • 5 to 7 pilot cities for in-depth work - model for
    other cities

Policies that fulfill multiple social
objectives Focus main sources of air and climate
  • Transport
  • Waste burning
  • Home energy
  • Buildings
  • Land use plans
  • Industry
  • Health benefits from improving
  • Air pollution
  • Injuries,
  • Physical activity,
  • Noise,
  • Diets
  • Air andClimate pollutant reductions

Health benefits from AP reduction
  • Transport, energy, land use policies / Combustion

Local/ short term health impacts
Injuries, physical activity, noise, diet,
Air pollution (PM)
Climate change (SLCPs)
Global/long term health impacts
Climate change (CO2)
A significant fraction of NCDs is attributable to
exposure to traffic-related air pollution
'Healthy' urban transport can reduce chronic
disease, injuries and improve health equity
Better fuels and engines help, but private
vehicle transport increases congestion, injuries,
pollution, and physical inactivity. Rapid
transit/NMT improves access to schools, jobs
services for poor, children, women, elderly
disabled, improving equity. It can reduce injury,
cardiovascular disease support healthy physical
activity. Cycling to work reduced premature
mortality by 30 among commuter groups in
Shanghai Copenhagen.

Effectiveness of interventions - BCA WHO tool
for estimating health economic gains from cycling
HEAT for cycling and user guide from
Housing that is good for health
 Improved insulation saved 0.26 months of life
per person  (UK Warm Front Programme)
Reduction of respiratory illness by 9 to 20 and
increase of individual productivity between 0.48
and 11 with natural ventilation startegies
Photo 1 (graphic, table, map, etc) zone
 Reduced wheezing, days-off school, doctors'
visits were reported by occupants of insulated
homes   (NZ Insulation study)
Health co-benefits in housing
Energy-efficient heating, cooling and natural
ventilation can reduce strokes and respiratory
illness as well as TB and vector-borne diseases
A focus on slums /sub-standard housing - where
needs are greatest/benefits could be multiplied
Solar hot water heating - India
Slum in Mexico City
Indoor emissions
  • Outdoor ?? indoor
  • Evidence base stronger than for other approaches
  • Implementation practicality via design,
    production, standards, etc
  • Some options (clean fuels), are relatively
    independent of user behaviour.


Recap AP
  • Air Pollution causes important risk to health
  • Public health programmes have not focused on AP
  • WHA resolution calls for better data, evidence of
    effective interventions, communications and
    demand for solutions
  • Capacity building for health sector to estimate
    health benefits from policies in polluting
    sectors. Track health gains of policy change
  • SDG 3 and 11 requires AP data
  • EO need for higher resolution geographic
    temporal variation (cities, roads, agriculture
    burning, industry)
  • To provide more precise estimates of AP over
    time, location, and help track impact of policy

Water and santitation
Purposes of Global Monitoring
Global advocacy monitoring for action Measuring
progress for the global community Informing
global investments Informing investments at
country Supporting regional and country
benchmarking and reporting Focus on national
governments and citizens

Transition in the development sector
  • MDGs
  • (born out of Millennium Declaration buy in of
    189 Member States)
  • Focused on human development
  • 8 goals, 21 targets, 60 indicators
  • Countries did primary evaluations and submitted
    results to an overview committee
  • Post2015 development agenda
  • (post Rio20 SDGs, SDSN, WHO-World Bank UHC, HFA2
  • growing consensus on sustainable development
    ensuring economic, social and environmental
    sustainability, and good governance)
  • Goes beyond human development
  • OWG 17 goals, 169 targets, more than 1000

Lessons from MDG monitoring
High focus on development silent on
sustainability etc. Piggy backing on household
surveys Cost effective Limits indicators and
timely reporting Admin data quality improved in
the last decade? Earth observations Data
available for cost effective monitoring Billions
in EO developed countries contribution to

Task Team Contributors
  • International WHO, GEO, WMO, UNU-FLORES, WCRP
    (GEWEX), WMO-CHY, CIESIN, World Bank, UN Global
  • Countries Australia (CSIRO), Bangladesh, China,
    Colombia, Japan (MEXT), Germany, Pakistan, USA
  • Space Agencies ESA, JAXA, NASA, NOAA
  • Academia and institutes Chouaib Doukkali
    University (Morocco), U of Tokyo, Chinese Academy
    of Sciences, U of Bonn, Vrije Universiteit
    Amsterdam, University of Twente, CUNY, U of
    Texas, GMU, Delatres, Fraunhofer Institute of
    Optronics, WRI
  • Two members from SG IEAG on data revolution for SD

UN proposal to OWG
  • Achieve universal access to safe drinking water,
    sanitation and hygiene
  • Improve by (x) the sustainable use and
    development of water resources in all countries
  • All countries strengthen equitable, participatory
    and accountable water governance
  • Reduce untreated wastewater by X, nutrient
    pollution by Y and increase wastewater reuse by
  • Reduce mortality by (x) and economic loss by
    (y) from natural and human-induced water-related

OWG draft to UN General Assembly
  • 6.1 by 2030, achieve universal and equitable
    access to safe and affordable drinking water for
  • 6.2 by 2030, achieve access to adequate and
    equitable sanitation and hygiene for all, and end
    open defecation, paying special attention to the
    needs of women and girls and those in vulnerable
  • 6.3 by 2030, improve water quality by reducing
    pollution, eliminating dumping and minimizing
    release of hazardous chemicals and materials,
    halving the proportion of untreated wastewater,
    and increasing recycling and safe reuse by x
  • 6.4 by 2030, substantially increase water-use
    efficiency across all sectors and ensure
    sustainable withdrawals and supply of freshwater
    to address water scarcity, and substantially
    reduce the number of people suffering from water
  • 6.5 by 2030 implement integrated water resources
    management at all levels, including through
    transboundary cooperation as appropriate
  • 6.6 by 2020 protect and restore water-related
    ecosystems, including mountains, forests,
    wetlands, rivers, aquifers and lakes
  • 6.a by 2030, expand international cooperation and
    capacity-building support to developing countries
    in water and sanitation related activities and
    programmes, including water harvesting,
    desalination, water efficiency, wastewater
    treatment, recycling and reuse technologies
  • 6.b support and strengthen the participation of
    local communities for improving water and
    sanitation management

EO in next generation development monitoring
Earth Observations for knowledge and action
  • Earth observations include
  • Satellite data (global, periodic)
  • In-situ measurements (local,
  • frequent)
  • Observations on the cusp
  • Data Assimilation System outputs
  • Model outputs
  • Citizen observations (Big data)

Courtesy NASA
In-situ point measurements may not always be
representative of an area
Courtesy Environment Canada
EODI works to date
The EOTT reviewed all of the WWQM and WRM
indicators and assessed how EO could be used to
assess the UN Water recommended indicators. The
results are documented in the EOTT indicators
report. Following the availability of TT reports
a few members of EODI TT reviewed the additional
suggested indicators and makes the following
assessment and proposed further contributions of
EO need to integrate with socio-economic data
Potential EO Data applications dom ww treated indus ww treated municipal ww reused indus ww reused WQ (N, Ph)
EO Population Density X X X X
Infrastructure data-maps X
Precipitation X X
Water Cycle Data X X
Distributed Hydrologic model X X
Water Use X X X
On sustainability to reconsider maximum use of
available data, rather than trying to force fit
EO into the current paradigm
EO and WRM
Indicator/data type Withdraw/availability basins with alloc frmwk Storage capacity/avaulable Change in ecosystem Red list, living planet index Water stress Domestic use per capita
EO Population Density X X X X X X
Infrastructure data-maps X X X X X X
Precipitation X X X X X
Water cycle data X X
Water storage X X X X X X X
Ground water X X X
Distributed Hydrologic model X X X X X X X
Water Use X X X X X
Assessment of TT reports
  • Lack of cross fertilization between the TTs
  • EO largely not considered, like WQ, IWRM etc.
  • Doesn't consider the capacity of national
    statistical systems, lack links with UN
    Statistical Division
  • Lack of innovation and transformative thinking
  • Too many suggestions for questionnaire approach
  • AQUASTAT, GEMSSTAT, are they 'fit for purpose'?
  • General rule of indicators from data, from use
    of toolsstats paper!

Target 6.3 waste water indicators
EOTT recommended indicator A consolidated
indicator of waste water production, treatment
and reuse/recycling Rationale AQUASTAT and
natural Environment agencies have reliable
statistics for some countries but are limited.
Global Estimates validated by AQUASTAT greatest
promise EO support for the indicator
Population densities derived from Landsat data
can be combined with census data to estimate
waste water generation potential, Releases and
their impacts.
High resolution satellite images could document
the location of treatment facilities.
Target 6.3 water quality indicators
EOTT recommended indicator The UN Water
indicator related to Nitrogen and Phosphorus
pollution in large lakes, water bodies and
coastal zones. Rationale The WQ TT report
indicators seemed complex and focused on point
data. While improving GEMSTAT data is desirable,
an indicator that provides information for every
country is most desirable. EO support for the
. http//
Hydrologic models can estimate the movement and
changes of concentrations of pollutants (incl. N
and Ph) in rivers
LANDSAT and MODIS data provide global data on
phytoplankton blooms and sedimentation
Target 6.4 water-use efficiency and scarcity
EOTT recommended indicator indicator suggested
by TT Water Use Efficiency Index and its
variation in time and by sector. Rationale Water
Use Efficiency is the critical indicator for the
target because it is foundational to the other
objectives. EO support EO can provide
comprehensive information on water availability
including precipitation can be used to estimate
consumption of water through irrigation others
Operational satellite based average precipitation
product from NOAA
Irrigation estimated from ET in Arizona
Target 6.5 IWRM indicators
EODI recommended indicator Number of tools and
data sets available to support IWRM. Rationale
Implementation of IWRM is very difficult and
needs to be enabled by the support of agencies
and countries with this vision. EO support for
the indicator
  • The availability and sharing of satellite
  • information is not restricted by national
  • boundaries or national data policies.
  • Other basin-scale EO data relate to
  • Changes in water availability
  • Water stress
  • Storage capacity or CC impacts

Basins Countries Lack of
data sharing across borders
Target 6.6 ecosystems indicators
EOTT recommended indicator Natural Water Capital
Index Rationale More relevant to water issues
than some others in this TT report. It also ties
to some of the overall issues of Natural Capital
and ecosystem services that the UN may
consider. EO support for the Indicator
EO can provide water storage in groundwater and
surface stores (lakes) and measures of wetland
and ecosystem extent
Groundwater variability
From NASA variability in lake levels
Evaluation of EO applicability
Indicator/Parameter Type Selected by EO applicability EO EO-Based Data Assimilation Model Relevance Other Socio-Economic, and Census/Statistical Data Relevance Direct Measurability Analytical Soundness Limitations  
6.2 Waste Water         Computed as a residual product using EO
6.3 Water Quality         For Nitrates, Phosphates and Algae, Phytoplankton Blooms and Sediment
6.4 Water Efficiency         Accurate Quantification of Water Use and Type Required
6.5 Water Resource Management       Associated management inputs combined with EO on Water availability/change variables
6.6 Natural Water Capital Index         Resolution and accuracy is dependent on type of parameter, data availability and application
Application of remote-sensed technologies to main
health risks from climate change
Risk maps of suitability for vector-borne disease

City-level risk maps of urban heat island effect
Satellite based weather warnings connected to
operational health services
Qualitative assessment of the health impacts of
climate change in the late 21st century (IPCC,
Use of remote-sensed technologies to enhance key
functions of health resilience to climate risks
Remote-sensed risk maps to inform VA
Remote-sensing highlighted as an emerging
technology to enhance health resilience
Remote-sensing as an input to health early
earning systems
WHO Operational framework on health resilience to
climate change. Inner circle is the standard
"building blocks" of health systems. Outer
sections represent the key functions that should
be strengthened to enhance health resilience to
climate change.