Colombia Climate and Health Vulnerability Assessment 2024 i Colombia Climate and Health Vulnerability Assessment 2024 ii © 2024 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy, completeness, or currency of the data included in this work and does not assume responsibility for any errors, omissions, or discrepancies in the information, or liability with respect to the use of or failure to use the information, methods, processes, or conclusions set forth. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: “World Bank. 2024. Colombia Climate and Health Vulnerability Assessment. Washington DC: The World Bank.” This assessment is a complementary analytical product to the “World Bank. 2023. Impact of Climate Change in Health in Colombia and Recommendations for Mitigation and Adaptation. © Washington, DC: World Bank. http://hdl.handle.net/10986/40494 Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Cover photo: © European Union, 2020/D. Membreño (CC BY-ND 2.0 Deed) All photos used with permission, and any reuse requires permission of the copyright holder. Colombia Climate and Health Vulnerability Assessment 2024 iii TABLE OF CONTENTS INTRODUCTION .................................................................................................. 1 SECTION I. Climate ............................................................................................ 3 Observed and Projected Climatology........................................................................ 3 Climate Hazards ....................................................................................................... 7 SECTION II. Climate-Related Health Risks ..................................................... 11 Nutrition and Food Security .................................................................................... 11 Vector-Borne Diseases ........................................................................................... 13 Water-Borne Diseases ............................................................................................ 14 Increasing Temperatures ....................................................................................... 15 Air Quality ............................................................................................................... 16 Zoonotic Diseases .................................................................................................. 16 SECTION III. Adaptive Capacity and Readiness ............................................. 17 Leadership and Governance .................................................................................. 17 Health Financing .................................................................................................... 19 Health Information Systems ................................................................................... 20 Service Delivery ...................................................................................................... 21 SECTION IV. Recommendations .................................................................... 23 ANNEX A. Methodology ................................................................................... 25 Aims of Assessment and Conceptual Framework .................................................. 25 Climatology ............................................................................................................. 26 Adaptive Capacity ................................................................................................... 26 ANNEX B. Estimating the Impacts of Climate Change on Health ................. 27 Methodology ........................................................................................................... 27 Colombia Climate and Health Vulnerability Assessment 2024 iv FIGURES Figure 1. Administrative Boundaries of Colombia’s Departments ............................................ 2 Figure 2. Mean Annual Precipitation for Observed Period 1990 – 2020, and Projected Anomaly to 2020 –2039 and 2040–2059 ................................................................................ 5 Figure 3. Mean Annual Temperature for Observed Period 1990 – 2020, and Projected Anomaly to 2020 –2039 and 2040–2059 ................................................................................ 6 Figure 4. Projected Number of Hot Days with Tmax > 35ºC Anomaly for the Periods 2020 – 2039 and 2040 –2059 ............................................................................................................. 8 Figure 5. Projected Maximum Temperature Anomaly for the Periods 2020 –2039 and 2040– 2059 .............................................................................................................................. 8 Figure 6. Leadership and Governance Capacity Scores .......................................................... 17 Figure 7. Health Financing Capacity Scores ............................................................................ 19 Figure 8. Health Information System Capacity Scores ............................................................ 20 Figure 9. Health Service Delivery Capacity Scores .................................................................. 21 Colombia Climate and Health Vulnerability Assessment 2024 v ACRONYMS AND ABBREVIATIONS AQI Air Quality Index CHVA Climate Health Vulnerability Assessment CMIP Coupled Model Intercomparison Project COI Cost-of-Illness CONASA Consejo Nacional de Salud Ambiental , National Council of Environmental Health COP Colombian Pesos DALY Disability-Adjusted Life Years DHS Demographic Health Survey ERV Emergency Room Visits GHG Greenhouse Gas HCED Health, Climate, Environment, and Disasters HIS Health Information System HNP Health, Nutrition, and Population INS Instituto Nacional de Salud , National Institute of Health IPCC Intergovernmental Panel on Climate Change LAC Latin America and the Caribbean MoH Ministry of Health NAP National Adaptation Plan NDC Nationally Determined Contribution NGO Non-Governmental Organization OECD Organization for Economic Cooperation and Development RCP Representative Concentration Pathway RR Relative Risk SISCLIMA Sistema Nacional de Cambio Climático , National Climate Change System SSP Socioeconomic Pathways Scenario US United States VBD Vector-borne Diseases VSL Value of Statistical Life WASH Water Sanitation and Hygiene WHO World Health Organization Colombia Climate and Health Vulnerability Assessment 2024 vi ACKNOWLEDGMENTS This Climate and Health Vulnerability Assessment (CHVA) for Colombia was produced by the Health, Climate, Environment, and Disasters (HCED) program in the Health, Nutrition, and Population (HNP) Global Practice of the World Bank, which is led by Tamer Rabie, and by the Colombian Health Nutrition and Population office, led by Jeremy Veillard. It was authored by Mikhael Iglesias and Tomas Plaza, with contributions from Christopher Boyer, Alethea Wen Lan Cook, Alice Edmee Marie Renaud, Charles Minicucci, Josiane Alix, Ana Rivera, Arindam Dutta, and Zara Shubber. The authors sincerely appreciate the valuable contributions provided by Diego Moreno and Jose Andres Corredor from the Colombian Environmental Health Department of the Ministry of Health. This work also benefited from the design and production of Danielle Willis. The authors are also highly grateful to HNP management for their strong support of the HCED program and this product and would like to extend their thanks to Juan Pablo Uribe and Monique Vledde. This assessment is a complementary analytical product to the report published in October 2023: Impact of Climate Change in Health in Colombia and Recommendations for Mitigation and Adaptation. Colombia Climate and Health Vulnerability Assessment 2024 1 INTRODUCTION Recognized as a megadiverse country with a wide range of ecosystems and topographies, Colombia is highly vulnerable to the impacts of climate variability and change —not only on the environment but also, critically, on population health. Located in the northwest corner of South America, Colombia faces numerous climate-related hazards influenced by its location in the Intertropical Convergence Zone, where trade winds converge; the complex topography of the Andes; and the presence of the El Niño phenomenon. Colombia has the highest occurrence of extreme events in South America and the vast majority of Colombians (84 percent) are exposed to more than two natural or climate-related hazards.1 Landslides and flooding are major hazards in the mountainous region along the Andes (one of two vulnerability hotspots in Colombia, along with the Caribbean), where the majority of the country’s population is concentrated. The impacts on health are only e xpected to grow, as glacier loss due to increased temperatures affect water availability and increase the occurrence of landslides and floods due to surface run -off from snow melt. Climate change has already had significant impact on Colombia: in the last half century, intense flooding has worsened during La Niña periods, while droughts have increased 2.2 times during El Niño periods. 2 Climate-related hazards are only expected to worsen in Colombia as the climate crisis intensifies, with projections pointing to continued rising temperatures, more variable rainfall, rising seas, and more frequent extreme weather events. Population health is under increasing threat from climate change, with extreme events and shifting disease burdens leading to overburdened health systems and challenges for health service delivery. Compounding these challenges, climate change also threatens to increase the health and economic inequalities experienced by Colombia’s most marginalized populations. While Colombia is a middle-income country, it faces high poverty rates and one of the highest rates of inequality in the world (the highest in the Latin America and the Caribbean, or LAC, region). Climate change is likely to exacerbate the country’s present situation: i t is estimated that roughly 2.5 million Colombians will be pushed to extreme poverty due to climate-related impacts on health alone.3 The health and economic impacts of climate change are disproportionately felt by the country’s most vulnerable, as certain groups are at greater risk than others. These include the poor (39.3 percent of the total population), rural populations (23.5 percent), those living in informal urban settlements, women (51.3 percent), young children (18.5 percent), the elderly (13.9 percent), those living with pre- existing conditions and disabilities, and displaced populations, which are a key group for Colombia (around 13 percent of the population has been displaced due to the armed conflict in the country). As the climate crisis accelerates, its devastating health and economic impacts will also accelerate —particularly for these vulnerable groups. In Colombia, additional measures are needed to strengthen the health sector’s ability to adapt to climate change amid these growing challenges, with Colombia Climate and Health Vulnerability Assessment 2024 2 careful consideration of groups that would directly benefit from or may be disadvantaged by adopted measures. The objective of this Climate and Health Vulnerability Assessment (CHVA) is to assist decision-makers in Colombia with planning effective adaptation measures to deal with climate-related health risks. This assessment includes sub-national considerations for health-related climate action (see Annex A for the methodology). Sub-national considerations are given for Colombia’s 32 departments (see Figure 1). It also incorporates data from a Climate and Health Economic Valuation conducted by the World Bank to estimate of the potential economic costs of health impacts arising from projected changes in temperature and precipitation (see Annex B for the methodology). The findings from this CHVA are organized under four sections. Section I characterizes the climatology in Colombia, highlighting observed and projected climate exposures relevant to health. Section II describes key climate- related risks to health, including nutrition and food security, vector-borne diseases (VDBs), water-borne diseases, increasing temperatures, air quality, and zoonotic diseases. Section III analyzes the adaptive capacity and readiness of Colombia’s health system to prevent and manage climate-related health risks. Recommendations are discussed in Section IV. Figure 1. Administrative Boundaries of Colombia’s Departments Source: World Bank’s Cartography Unit Colombia Climate and Health Vulnerability Assessment 2024 3 SECTION I. Climate Colombia is located in the northwest corner of South America and is a topographically diverse country traversed by the Andes Mountains. Considered the 25th largest nation in the world, Colombia covers 1,138,910 square kilometers (km2) of land and features five main topographic regions: the Amazon in the south, the Orinoco in the east, the Caribbean in the north, the Pacific in the west, and the Andes along the country’s central spine. The northwestern edges of the tropical rainforests in the Amazon and Orinoco River basins occupy lowland plains in Colombia’s south and east. The Caribbean region extends from the north of the Andean foothills to the Caribbean Sea, while the Pacific region extends from the western Andean slopes to the Pacific Ocean, encompassing a combined 3,208 km of coastline. The Andes Mountains bisect the country from southwest to northeast and geographically include the oil-rich, lower-elevation Magdalena River Valley, which splits the mountain chain.4 The country’s topographic diversity is categorized by three main climatic zones: the high elevation cold zones ( tierra fria ), located above 2,000 meters (m) in elevation, with mean annual temperatures ranging between 13ºC –17ºC; a temperate zone (tierra templada ), located between 1,000 m – 2,000 m, with mean annual temperatures of approximately 18ºC; and a tropical zone (tierra caliente), which covers all areas below 1,000 m, with mean annual temperatures of 24ºC–27ºC.5 Observed and Projected Climatology Colombia’s climate features a wide range of temperature distributions and one to two rainy and dry seasons annually, depending on the region . The country’s climate is impacted by several strong influencing factors, including the Intertropical Convergence Zone; the Andes’ complex topography , which affects atmospheric circulation patterns; and the El Niño Southern Oscillation.6 Between 1991–2020, Colombia experienced a mean annual temperature of 25.00ºC. On average, the warmest month is March and the coolest month is July. However, there is notable sub- national variability. Its climate is tropical along the coast and the eastern lowlands, but becomes subtropical, temperate, and polar as altitude increases. Since most departments encompass more than one climatic zone within their boundaries, they tend to reflect a blend of different climatic characteristics. Colombia’s five largest population centers occupy all three elevation zones across different topographic areas.7 Mean annual precipitation in from 1991 –2020 was 2,562.17 millimeters (mm), but there are significant regional patterns and seasonal distributions. The Pacific coast and western slopes of the Andes (including Antioquia and Risaralda) received the highest annual rainfall amounts, followed by the Amazon Basin (all greater than 2,600 mm per year), while the drier Northern Caribbean departments Colombia Climate and Health Vulnerability Assessment 2024 4 received approximately 1,000 mm per year. Annual precipitation patterns are varied, with some areas of the country displaying bimodality while others are unimodal (i.e., experiencing two wet seasons or one west season every year, respectively). 8 During El Niño, dry seasons can become more intense and longer, leading to droughts and warmer weather, 9 while La Niña increases the intensity and length of wet seasons, leading to floods and cooler weather particularly between June and August. 10 The box below summarizes observed changes in Colombia’s temperature and precipitation patterns between 1971 and 2020, as well as projected changes in temperature and precipitation. Climatology Temperature Observed Projected Between 1971 and 2020, Colombia’s Under a SSP3–7.0 scenario, mean average mean temperature increased by temperature nationwide will increase from 0.22ºC per decade, with the greatest 24.73ºC (reference period 1995–2014) to changes observed in the Caribbean and 25.44ºC (50th percentile) for the period North Andes regions, especially during the 2020–2039 (+0.71ºC), and to 26.14ºC winter months. 11 (50th percentile) for the period 2040–2059 (+1.41ºC).12 Minimum and maximum temperatures increase homogeneously, but during winter months there are large increases in maximum temperatures across the Caribbean, Central and Northern Andes, and Orinoco regions.13 (See Figure 3 for the observed temperature and projected anomaly at the sub national level for the 2030s and 2050s). Precipitation Observed Projected Over the 50-year period from 1971–2020, Projected precipitation patterns under SSP3 – Colombia experienced significant decreases 7.0 reflect regional shifts in the annual onset, in precipitation per decade across the duration, and intensity by midcentury. Orinoco, Caribbean, and Northern Andes Nationally, there is a projected decrease regions, but precipitation trends varied of -16.35 mm by the 2050s. However, the seasonally both within and across Colombia’s extent of all wet and dry shifts are departments. 14 heterogeneous across the country and display a wide range of uncertainty.16 The Orinoco region observed the largest total decreases in precipitation per decade in The Amazon, Orinoco, Eastern Caribbean, and Casanare (-149.72 mm), Arauca (-141.23 Eastern Andes (Cordillera Oriental) regions are mm), and Meta (-113.93 mm), with the expected to experience an annual decrease in strongest effects seen during the summer precipitation by 2040–2059 under SSP3–7.0, months. A few departments observed while the Western Caribbean, Western Andes significant precipitation increases over the (Cordillera Occidental and Central), and Pacific Colombia Climate and Health Vulnerability Assessment 2024 5 same time period, including several along the regions are expected to experience an annual southwest Pacific coast (Buenaventura, Valle increase in precipitation. Trends in each of del Cauca) and Western Cordillera. 15 their anomalies differ seasonally, but wetter seasons typically become wetter while drier seasons become drier17 (see Figure 2 for the observed precipitation and projected anomaly at the sub-national level for the 2030s and 2050s). Figure 2. Mean Annual Precipitation for Observed Period 1990 –2020, and Projected Anomaly to 2020–2039 and 2040–205918 Observed period 1990 –2020 Projected anomaly 2020–2039 Projected anomaly 2040–2059 Colombia Climate and Health Vulnerability Assessment 2024 6 Figure 3. Mean Annual Temperature for Observed Period 1990–2020, and Projected Anomaly to 2020–2039 and 2040–205919 Observed period 1990 –2020 Projected anomaly 2020–2039 Projected anomaly 2040–2059 Colombia Climate and Health Vulnerability Assessment 2024 7 Climate Hazards Climate-related disasters comprise nearly 90 percent of emergencies reported in Colombia between 1998– 2011 and cause significant economic losses.20 With its diverse landscape, Colombia is highly vulnerable to extreme events. Highland areas, where the majority of the country’s population is concentrated, are subject to landslides and significant flooding due to increased surface run-off from snow melt and extreme rainfall on degraded high-elevation forest ecosystems, which increases sediment loads. As temperatures continue to rise in the future, critical glaciers are likely to disappear, further contributing to water shortages in the highlands. This will pose a significant challenge for water resource management and likely affect all sectors of society.21 Along Colombia’s coastal areas, rising seas, coupled with increased storm surges, can lead to localized flooding. As the climate changes further, climate-related disasters are expected to continue in Colombia and risk exacerbating existing vulnerabilities across the country, such as infrastructure built on unstable mountains, which could add to the damage and loss from disasters such as landslides and avalanches. The boxes below capture observed and projected changes for climate-related hazards impacting Colombia, many of which are growing in frequency and intensity. Key climate-related hazards for Colombia include extreme temperatures, extreme precipitation and floods, landslides, and sea level rise and sea surface temperature. Extreme Temperatures For the 2040–2059 period, many departments are expected to experience a dramatic increase in the number of days surpassing the Heat Index (above 35ºC). This is due to high atmospheric moisture content during the summer and fall months nationwide, and yearlong in the Pacific, Amazon, and Western Caribbean. The regions with the greatest expected increases are the Amazon, Orinoco, and Caribbean, with Atlántico department in the Western Caribbean projected to increase 169.55 days (50th percentile) (69.74 days and 215.44 days for the 10th and 90th percentiles, respectively) by midcentury. 22 The number of tropical nights with a minimum temperature above 20ºC is projected to increase not only in the Caribbean and eastern lowlands, but also in parts of the high-elevation Andes. 23 Under the SSP3–7.0 scenario, most departments are expected to experience an increase of more than 150 days on the Warm Spell Duration Index by midcentury, with an increase of more than 200 days expected annually in San Andrés y Providencia and Chocó. 24 Colombia Climate and Health Vulnerability Assessment 2024 8 Figure 4. Projected Number of Hot Days with Tmax > 35ºC Anomaly for the Periods 2020 – 2039 and 2040–205925 Figure 5. Projected Maximum Temperature Anomaly for the Periods 2020 –2039 and 2040–205926 Colombia Climate and Health Vulnerability Assessment 2024 9 Extreme Precipitation and Floods Riverine floods, already a hazard across the country, are likely to become more pronounced as snow melts faster from the country’s glaciers due to rising temperatures . For the period of 2035–2064, the largest 1-day precipitation amounts associated with 50-year and 100-year historical return periods are projected to be nearly two times more likely to occur in the Western Caribbean, the Central and Northern Andes, and parts of the Pacific coast. The greatest changes are projected in Antioquia, Santander, and Córdoba. However, the rate of change is lower for 10-year and 25-year events. The Andes region is expected to experience the greatest increases in average largest 1-day precipitation by midcentury, with the largest monthly increases occurring at the end of the year. 27,28 Landslides Landslides and various types of mass movement can be influenced by an array of factors, including seismic activity, geology, water saturation, and erosion —all of which can be exacerbated by human activities. According to the national government, the departments with the greatest percentage of land area exposed to high-hazard landslides are located in northern parts of the Cordillera Oriental (Norte de Santander, Santander, Boyacá, and Cundinamarca) and Cordillera Occidental (Chocó, Antioquia, Caldas, Risaralda, and Cauca). Between 1970 and 2011, landslides resulted in over 5,200 fatalities. In 2017, a mudslide caused by heavy rain and erosion associated with deforestation in Mocoa, Putumayo (Amazon) resulted in 273 deaths, underscoring the importance of precipitation and land management as key factors in assessing for landslide hazard risk. 29,30 Colombia Climate and Health Vulnerability Assessment 2024 10 Droughts Droughts are common in Colombia, particularly during drier seasons occurring between January and March and between July and September and can lead to water supply shortages for human and agricultural needs. Abnormal climatic conditions associated with the El Niño phenomenon can produce high temperatures and severe droughts in Colombia, damaging agricultural output and threatening operations at hydroelectric power projects which generate most domestic energy supplies. 31 Notably, La Guajira has been heavily impacted by the El Niño phenomenon; between 2012 and 2015, La Guajira experienced a severe multi-year drought that resulted in substantial losses in agriculture and severely affected livelihoods.32 Nationally, drought-related conditions have increased in frequency by roughly 2.2 times compared to previous years. As temperatures rise, these will likely (i) exacerbate existing tensions for water between agricultural and livestock needs and human population needs, especially during dry seasons; (ii) alter water quality from available surface sources; and (iii) increase pressures on urban zones as urbanization rates rise. Sea Level Rise and Sea Surface Temperature Sea level rise and coastal inundation will increasingly threaten Colombia’s coastal zones. In terms of observed sea level changes along Colombia’s coastline , the average annual anomaly steadily increased from 30.01 mm in January 1993 to 107.71 mm in January 2015. Under a Representative Concentration Pathway 8.5 scenario (CMIP5), sea level rise is projected to increase by 0.29 m (0.26 m, 0.34 m) by 2050 and 0.76 m (50th percentile) (0.67 m, 0.86 m for the 10th and 90th percentiles, respectively) by 2099. Rising sea levels are projected to flood 4,900 km 2 of lowland coasts and 5,100 km 2 inland, affecting an estimated 1.4 to 1.7 million people, 80 percent of which are living on the Caribbean coast and the other 20 percent on the Pacific coast. Furthermore, more than 45 percent of Colombia’s areas of coastal mangroves, grasslands, scrublands, and lagoons are vulnerable. 33 Colombia Climate and Health Vulnerability Assessment 2024 11 SECTION II. Climate-Related Health Risks Colombia’s burden of disease is caused primarily by non -communicable diseases, which accounted for 70 percent of total disability-adjusted life years (DALYs) in 2019, followed by injuries (18 percent) and communicable diseases (12 percent). Colombia has gone through an epidemiological transition and successfully reduced the burden caused by communicable diseases, including maternal and child conditions. However, infectious disease outbreaks —notably the COVID-19 pandemic —continue to pose a significant risk to population health. 34 Life expectancy in Colombia increased from 57 years to 77 years between 1960 and 2019, but fell to 75 years in 2020, driven by the COVID-19 pandemic. 35 The country’s burden of disease is also influenced by the socioeconomic determinants of health, such as income, environmental factors, access to basic services, and urbanization. Some of these determinants were negatively impacted by the COVID-19 pandemic; for instance, the pandemic contributed to an increase in the proportion of people living below the national poverty threshold, which rose from 35.7 percent in 2019 to 42.5 percent in 2020. 36 Colombia’s CHVA focusses on six climate-related health risk categories: (a) nutrition and food security, (b) VDBs, (c) water-borne diseases, (d) impacts of increasing temperatures on non-communicable diseases, (e) air quality, and (f) zoonotic diseases. Each category is assessed in terms of current and future risk, with considerations for national and sub-national variation, where possible. It is important to note that these risk categories represent only a sample of the most pressing health risks to the population of Colombia, as expressed in key policy documents and during meetings held with key stakeholders. Other climate-related health risks have not been included in this assessment; these include, but are not limited to, direct injuries and mortality associated with natural hazard events and air quality morbidity and mortality. Nutrition and Food Security Weather and climate are foundational drivers of healthy and sustainable diets. The mechanisms through which climate change affects nutrition via the food system are profound and include both acute and chronic effects on agricultural production, storage, processing, distribution, and consumption. Nutritionally secure and stable diets depend not only on agricultural production, but also on the complex interactions of demand, economics, legislation, conflict, food waste, nutrient losses, food safety, and access. Climate variability is already contributing to increases in global hunger and malnutrition. While a comprehensive analysis of climate change’s impact on the food system is beyond the scope of this assessment, this CHVA examines climate and nutrition linkages through a food security lens in Colombia as it relates to weather and Colombia Climate and Health Vulnerability Assessment 2024 12 climate impacts on agricultural and fishing productivity. Agricultural productivity is a key determinant of food availability and economic productivity in Colombia and is affected by weather and climate patterns. 37 In 2022, 18 percent of the country’s population lived in rural areas, 38 and in 2021, 16 percent of employment was in the agriculture sector, 39 signaling that a significant number of livelihoods are vulnerable to the impacts of climate change. Short-term shocks (e.g., natural disasters) pose a significant threat, as they can drastically reduce yields or redefine spatiotemporal patterns of crop suitability. Current and projected risks related to nutrition and food security are discussed below. Nutrition and Food Security Current Projected Approximately 12.7 percent of children in Globally, it has been estimated that the risk of Colombia experience stunting and 1.6 percent hunger and malnutrition will increase by experience wasting —figures that are above the 20 percent by 2050.42 In Colombia, climate LAC average. Within Colombia, La Guajira, change is likely to impact crop suitability and Chocó, and Arauca departments have the the food system overall. By 2050, it is projected highest percentage of stunted children, with that roughly 3.5 million Colombians will be 30 percent, 23 percent and 17 percent, affected, due to the impact on agro-industries, respectively.40 supply chains, and food and nutritional security. According to projections, the present lack of 15.5 million people in Colombia are food adaptation measures in the food system will put insecure, and approximately half of the total 80 percent of the country’s crops at risk, and population is marginally food secure. This more than 60 percent of land currently used for means that they are vulnerable to becoming agriculture will experience an overall decline in food insecure if there is no improvement in crop yield.43 conjunctural factors in the short term or if shocks occur, including those linked to In Bogotá, Colombia’s capital, crops such as climate. The departments with the highest mango, papaya, corn, and plantain —food prevalence of food insecurity are concentrated staples in the country —will see a decrease of on the Atlantic Coast, and include Cordoba 19 percent to 47 percent suitability. Sugarcane (70 percent), Sucre (63 percent), and Cesar and coffee, which are particularly sensitive to (55 percent).41 heat, will likely be the most affected.44 It is projected that changes in precipitation and temperature will affect fishing and food production in coastal communities, where marine products are an important source of protein. More than 1.5 million people work in Colombia’s fishing sector and associated industries. 45 It is estimated that climate change alone could contribute an additional 80,000 cases of stunting in the year 2030 and 127,000 cases in the year 2050 in Colombia, and an additional 150 deaths in 2030 and 2050 each. The economic cost of the impacts of climate change on stunting are projected to reach over US$250 million per year between 2030 and 2050. 46 Colombia Climate and Health Vulnerability Assessment 2024 13 Vector-Borne Diseases Weather and climate are critical drivers of spatiotemporal VBD distribution and transmission dynamics. Climate variability causes vector and host ranges to expand or contract, shifting disease distribution, seasonality, and/or facilitating the emergence or re-emergence of VBDs. Considering that the main dengue vector in Colombia is Aedes Aegyptis, the optimal vector temperature for reproduction and survival is between 22 –32ºC.47 The species will cease all biting at 15ºC and will die at temperatures above 40ºC.48 Given that temperature projections for the 2050s are between 20.06ºC (min) and 29.45ºC (max), with a mean temperature of 25.51ºC, this would create an optimal range for vector reproduction in Colombia. The box below discusses current and projected risks related to VDBs. Vector-Borne Diseases Current Projected Vector-borne diseases are a critical challenge for Considering the increasing temperatures, the health system and livelihoods of Colombians. vectors such as Aedes Aegypti and Anopheles Dengue represents 0.14 percent of total deaths will have more suitable areas for reproduction, in the country. There is a higher rate of deaths especially in the Andean region, as nationally (0.73 deaths per 100,000) when temperatures will allow the mosquito to survive compared to the regional average (0.23 per at higher altitudes. The relative vectorial 100,000), and the death rate has seen an capacity for dengue is projected to increase annual increase of 8.61 percent. Notably, from 0.66 to 0.76 by 2070 under a high dengue disproportionately impacts children emissions scenario. 52 under five years of age (2.24 deaths per It is estimated that in the year 2050, Colombia will 100,000), and females (2.45 deaths vs. 2.04 experience an additional 178,000 cases of deaths for males).49 dengue and 111,000 cases of malaria as a result Malaria has decreased in Colombia, falling from of climate change alone. These two diseases are 20.98 per 100,000 DALYs to 8.03 per 100,000 projected to result in approximately 2,000 DALYs between 2009 and 2019. However, it still additional deaths in the year 2050. In this same yields 0.12 deaths per 100,000.50 Moreover, the year alone, the economic cost of climate change prevalence of malaria has increased in higher on dengue and malaria is projected to reach over elevation areas in the northwest region of the US$4 billion.53 country.51 Colombia Climate and Health Vulnerability Assessment 2024 14 Water-Borne Diseases Water quality, which is in part affected by climate-related hazards such as floods and landslides, has been associated with an increased incidence of water -borne diseases. Colombia faces a significant burden of water-borne diseases such as diarrhea, dysentery, cholera, food poisoning, and parasitic infections, which disproportionately impact children under five years of age. Current drivers of water- borne diseases throughout the country are attributable to many factors, including water sources, quality and quantity of drinking water, sanitation facilities, and hygiene practices, each of which can be negatively affected by climate -related factors. Current and projected risks related to water-borne diseases are summarized in the box below. Waterborne Disease Risks Current Projected In the 2010 Demographic and Health Survey Although data are scarce and there are many (DHS), Colombia reported that 16.4 percent of confounding factors, projections for the children experienced diarrhea in the three years relative risk of diarrhea in South America preceding the survey. Sub-nationally, most cases of suggest that for each 1º C of warming, the diarrhea were reported in Amazonas (30.4 percent risk of diarrhea will increase from 1.09 of children experiencing diarrhea), Vichada relative risk (RR) for the period 2010–2039 (25.6 percent), Putumayo (23.6 percent), Chocó to 1.17 RR for period 2040 –2069, and to (22.5), Caquetá (22.2), and Magdalena (22.2).54 1.25 RR in period 2070–2099.56 Households using unimproved water sources are In Colombia, it is estimated that climate at increased risk for water-borne diseases. change will contribute an additional 89,000 Nationally, 7.6 percent of households use cases of diarrhea in the year 2030 and unimproved water sources. Notably, Putumayo 271,000 cases in the year 2050. The and Guajira departments have the fewest economic cost due to diarrhea because of households with access to improved water climate change is projected to reach US$15 sources, at 26.9 percent 22 percent, million in the year 2050.57 respectively. Nationally, around 10 percent of households have limited sanitation services. Departments such as Casanare, Guaviare, and Putumayo have more households that lack access to adequate sanitation services, at 22.1 percent, 20.7 percent, and 17.9 percent respectively. 55 Colombia Climate and Health Vulnerability Assessment 2024 15 Increasing Temperatures With rising temperatures and an increasing frequency of extreme temperatures projected in Colombia, the country’s population faces increased risk of heat -related illness. Notably, extreme weather events can worsen chronic non-communicable conditions, such as cardiovascular and respiratory diseases, contributing to increased emergency room visits (ERVs) and higher burden on the health system. The current and projected risks related to increasing temperatures are summarized below. Increasing Temperatures Current Projected Between 1998 and 2013, 267,730 deaths in Projections under business-as-usual models Colombia were attributed to heatwaves. 58 highlight that heat-related mortality will increase by more than 2000 percent by the Health effects caused by heat include the 2080s, considering a high population growth acute exacerbation of pre-existing conditions, scenario. Notably, the impact of humidity, including respiratory and cardiovascular which can be high in certain regions of diseases, heat rash, cramps, exhaustion, and Colombia, can exacerbate the impacts of heat dehydration. Approximately, 85,154 ERVs on health and wellbeing. 60 (1.5 percent of all ERVs) were attributed to increasing mean temperatures in the period Under a SSP3–7.0 scenario, Colombia is 2010–2019.59 projected to experience 380,565 ERV for the period 2020–2039—a projected increase of around 440 percent. 61 Considering the projections for the number of ERV attributable to temperature, it is estimated that the economic burden will increase to 50,000 million Colombian Pesos (COP) by 2039 (point estimate); however, it could reach up to 250,000 million COP considering the prediction interval. Colombia Climate and Health Vulnerability Assessment 2024 16 Air Quality Both ambient (outdoor) and indoor air pollution pose a major threat to health, whether from fine particular matter (PM2.5) or inefficient indoor stoves. Colombia has a prevalence of respiratory illnesses, making air pollution a significant concern for the country. Current and projected risks related to air quality are discussed below. Air Quality Risks Current Projected Air and water quality are the main environmental There are no projections of indoor air risk factors for Colombia, jointly causing around pollution exposure due to climate change. 17,549 deaths per year and representing However, given the high prevalence of 8 percent of total annual mortality.62 respiratory illnesses in Colombia, it is essential to better understand the exposure The Air Quality Index (AQI) 2023 shows a pathway and the influence of climate change. moderate concentration of PM2.5 in Colombia In 2019, chronic respiratory diseases (AQI=14.6 μg/m³), which exceeds the World accounted for 37.2 deaths per 100,000 in Health Organization recommended guidelines of Colombia, while respiratory infections and 10 μg/m³. Ambient air quality can be impacted tuberculosis accounted for 18.48 deaths per by smoke from wildfires. Droughts and 100,000.64 increased temperatures can increase the frequency, intensity, geographic proximity, and length of the wildfire season in Colombia, worsening wildfire-induced air pollution. Indoor air pollution is a major concern in Colombia. According to the latest available DHS from 2015, 11.7 percent of households used solid fuel for cooking (solid fuel is made up of coal/lignite, charcoal, straw/branches/grass, or agricultural residues). This percentage is higher in rural areas (47.9 percent) due to the lack of access to gas pipes.63 Zoonotic Diseases Colombia is the second most biodiverse country in the world, with more species of birds, amphibians, butterflies, and frogs than any other country. In addition, the Colombian agricultural sector has expanded in recent years, driven by the growth of poultry and pig farming. Expansions in land used for agriculture or construction can result in changes in wildlife habitats, increasing exposure pathways for zoonotic diseases.65 In Colombia, both the rich biodiversity and trends in the agricultural sector have increased the country’s vulnerability to zoonotic diseases.66 Zoonotic diseases can impact society in numerous ways, including by affecting agricultural productivity and livelihoods, trade, and human and animal health. Changes in precipitation and temperature patterns can also affect the capacity of ecosystems and species to adapt to evolving burdens of zoonotic diseases. Colombia Climate and Health Vulnerability Assessment 2024 17 SECTION III. Adaptive Capacity and Readiness The extent to which Colombia’s health system is prepared for and has the capacity to manage changes in climate-related hazards and exposures will determine the country’s resilience in coming decades. This section analyzes the adaptive capacity and readiness of the health system to prevent and manage climate-related health risks across four key building blocks, while assessing equity as a cross-cutting component. The building blocks include: 1. Leadership and Governance 2. Health Financing 3. Health Information Systems 4. Service Delivery Leadership and Governance Figure 6. Leadership and Governance Capacity Scores Source: Elaborated by authors from Adaptive Capacity and Readiness scores Colombia Climate and Health Vulnerability Assessment 2024 18 While Colombia has been timely in developing key policy documents such as the National Determined Contributions (NDCs), Long-term Strategy Colombia 2050, National Adaptation Plan (NAP),67 and Climate Change policy and law, the country has not yet developed a comprehensive climate and health strategy or plan. While the Environmental Health Department within the Ministry of Health (MoH) has been active in leading the country’s efforts on climate change and health, the lack of a comprehensive climate and health strategy, and limited financing and technical capacities suggests points to potential limitations. Currently, the work on climate and health is guided by the NAP and the NDCs, which outline priorities and strategies. Relevant sectors such as emergency preparedness and response ; water, sanitation, and hygiene; and agriculture have their own sector-specific plans and there is a lack of integration and alignment of efforts and resources. The National Department of Planning acts as a catalyzer of these cross-sectoral coordination efforts and provides technical support for developing plans in the face of climate change. However, technical support is limited due to a lack of human and financial resources. Moreover, at the sub-national level, governance, capacity, and resources are more varied, and in most territories, there is a lack of leadership and advocacy for the integration of climate change into health strategies and activities. The territorial units under the SISCLIMA (National Climate Change System) and the CONASA (National Council on Environmental Health) do not adequately articulate efforts for ensuring effective implementation and allocation of resources for departments and for the populations most vulnerable to climate change and climate-related health risks. Decision making and prioritization of climate and health interventions and strategies is mainly conducted by the MoH ’s Environmental Health Department, with limited involvement by non-governmental stakeholders, such as private health service providers, non-governmental organizations (NGOs), or community-based organizations in decision-making process related to climate change and health risks and adaptation. Notably, there are no direct channels for feedback from or accountability between communities and the MoH. Nevertheless, regarding emergency responses, there is a framework for bridging different stakeholders that includes community leaders under the Unified Leadership Post, or Puesto de Mando Unificado . Furthermore, climate change and health strategies and activities do not incorporate information or target specific vulnerable populations for the development of activities or the allocation of resources. Colombia Climate and Health Vulnerability Assessment 2024 19 Health Financing Figure 7. Health Financing Capacity Scores Source: Elaborated by authors from Adaptive Capacity and Readiness scores Colombia does not have an exclusive budget line for climate and health activities, and there has been minimal change in the budget allocated for the Environmental Health Department within the MoH, highlighting a low financing capacity for climate change and health strategies. Climate and health activities and strategies depend mostly on donors and international organizations, such as the World Bank, Inter - American Development Bank, Center for Disease Control and Prevention, German Agency for International Cooperation, United States Agency for International Development, and Health Care Without Harm. This hinders continuity of strategies and plans for strengthening the health system in the face of climate change, fragmenting and projectizing different efforts. Contingency funds in the country for climate-related emergencies are mostly used for infrastructure outside the health sector, and investments for health are minimal. Moreover, these emergency resources are allocated mostly to response activities, leaving preparedness and risk mitigation with scarce resources and limited planning. There are some formal provisions available to reallocate funds during an emergency to meet changing needs, including a fund managed by the National Institute of Health or Instituto Nacional de Salud (INS), but there are delays and differences in deployment and implementation at the sub-national level (Law 1523 enables the reallocation of resources in the face of emergencies and called for the formation of the Disaster Risk Management Unit). Strategic purchasing and procurement of essential medicines have limited articulation with the private sector and with development partners, especially for emergency preparedness. Essential medicines stocks and procurement plans exist, but there are no considerations or specific contingencies that account for climate-related hazards. Notably, the deployment and implementation of contingencies varies considerably at the sub-national level. Colombia Climate and Health Vulnerability Assessment 2024 20 Health Information Systems Figure 8. Health Information System Capacity Scores Source: Elaborated by authors from Adaptive Capacity and Readiness scores Colombia has functioning health information and surveillance systems that have the capacity to aggregate data for health and climate, but there are opportunities for improvement regarding digitalization and integration across sub-systems. Regional disparities in the deployment of the HIS also exist. Concerning climate change and health diagnostics, Colombia does not conduct risk assessments beyond some municipal-level data analysis. Capacity to test and analyze climate-sensitive diseases is limited in terms of geographical standardization and coverage. Although the INS has adequate capacity, capacity beyond the Institute is limited. There is currently no integration of data for climate change and health. Although Colombia generally collects good quality data across these areas, data sources are heavily fragmented and there have not been prioritized efforts to create an integrated health and climate database. There are existing and largely adequate HISs related infrastructure (such as power, information and communications technology, and hardware), but there are significant gaps, particularly at the sub-national level. Key challenges are the reliance on paper records and the lack of trained and skilled personnel to ensure timely data collection and sharing. The mandate for data management and analytics falls on the INS, which has limited capacity and resources. There is a lack of sufficient staff capable of producing analytics for evidence-based planning and decision making. Currently, there are no real-time dashboards to track climate change and health risks and adaptation interventions, and there is no functional early warning and response system for health risks beyond some regional initiatives. Colombia Climate and Health Vulnerability Assessment 2024 21 Service Delivery Figure 9. Health Service Delivery Capacity Scores Source: Elaborated by authors from Adaptive Capacity and Readiness scores National health workforce density is below LAC and Organization for Economic Cooperation and Development (OECD) averages and is particularly low in rural areas of the country. The law governing health workforce planning dates to 2007 and does not adequately include considerations related to climate change and health. There has not been a national effort to assess the knowledge or awareness level of climate and health among staff. Training and capacity building protocols are being updated as part of the Health NAP currently under preparation, but the comprehensive implementation of training programs in Colombia is challenging due to high informality and high turnover of staff. There is no national surge capacity plan in place, which constrains Colombia’s emergency response capacity. The current normative framework limits flexibility for procurement, receipt of donations, and partnerships with the private sector. There are also no national-level mechanisms for monitoring the delivery of health services during periods of disruption, which leads to the unavailability of necessary data to inform the deployment of human and capital resource reserves. Partnerships with private facilities occur during emergencies and disruptive events in an ad-hoc manner, but there are no formal mechanisms or processes to facilitate these partnerships. Colombia has a vast regulatory framework to respond to emergency situations, such as the COVID-19 pandemic, with a strong focus on primary health care, but there is a high degree of variability in existing governance capacity at regional and local levels in practice due to unclear roles and responsibilities and lack of meaningful citizen Colombia Climate and Health Vulnerability Assessment 2024 22 and social participation. There are some programs to organize the provision of services for certain vulnerable groups, such as migrants or populations in malnutrition-prone regions. However, there are no articulated programs targeting specific climate-vulnerable populations. Outside of a limited number of initiatives at the regional and municipal level s, there have not been nationwide investments to retrofit health care facilities considering climate change impacts. Updated building codes under preparation include sustainability features that will contribute towards incorporating climate considerations in new and existing constructions. Nevertheless, the forthcoming new building codes will apply only to new infrastructure, having limited monitoring and enforcement of codes to existing infrastructure. Colombia Climate and Health Vulnerability Assessment 2024 23 SECTION IV. Recommendations This section outlines recommendations for Colombia, based on assessments of the magnitude of current and projected climate-related health risks and of existing gaps in the adaptive capacity and readiness of Colombia’s health system to manage and/or prevent these risks. 1. Mobilize and allocate resources to the MoH’s Environmental Health Department for the forthcoming Integrated Climate Change Management for the Health Sector Plan. While the upcoming World Bank Program-for-Results project in Colombia will finance the development of a Climate Change Plan for the health sector, it is critical to allocate resources for implementation. 2. Expand the technical personnel within the Environmental Health Department to increase capacity for engaging in cross-sectoral coordination and for strengthening the monitoring of climate and health strategies’ implementation in the territories. The Environmental Health Department needs increased capacity to ramp up efforts in support of the climate change and health agenda, and for ensuring implementation at the sub-national level. 3. Engage globally and regionally on initiatives for climate change and health to leverage funding opportunities that would enable necessary resources for implementation. Funding opportunities include tapping into global funds, such as the Green Climate Fund, Climate Investments Fund, or the Green Environmental Facility. 4. Redesign procedures and regulations for emergency procurement and resource utilization to minimize disruption of health services by ensuring availability of resources for health service provision amid extreme weather events. Current emergency funds are mostly directed towards infrastructure outside of the health sector, and resources must be directed across the health system. Colombia Climate and Health Vulnerability Assessment 2024 24 5. Prioritize the roll out of the Integrated Environmental Health Information System, or SUISA, ensuring deployment at the sub-national level. 6. Scale up the national-level monitoring system for health service delivery to produce timely information during periods of disruption to guide effective decision making. Availability of timely information amid climate-related or natural hazards is critical to inform the deployment of human and capital resources. 7. Establish standard practices for coordinating with private facilities during emergencies to ensure efficiency and reduce service disruption for patients. 8. Ensure enforcement of upcoming new building codes on existing infrastructure. This can be accomplished through three strategies: a. Conduct a needs assessment for existing infrastructure. b. Establish a financing mechanism to fund retrofitting work. c. Establish a committee for monitoring of the adoption of the new building codes in existing infrastructure. Colombia Climate and Health Vulnerability Assessment 2024 25 ANNEX A. Methodology Aims of Assessment and Conceptual Framework The objective of this CHVA is to assist decision-makers with planning effective adaptation measures to address climate-related health risks. Where available, these measures are provided at a sub-national level to assist regional health planners. The recommendations of this CHVA are aimed at the health sector and related sectors that influence health risks from climate change, such as disaster risk management. Adaptation priorities need to run alongside fundamental and urgent action to mitigate climate change. It is important to stress how complex the climate challenge is and how hard it is to precisely predict the magnitude of how severe climate exposures facing populations will become. Many factors could slightly slow or significantly speed up rates of change, including positive feedback effects and, most worrying of all, cascading climatological tipping points. For this reason, mitigating existing GHG emissions and developing and implementing measures to protect human development from the changing climate are, in addition to adaptation measures, of paramount importance. Investment in adaptation strategies to proactively address the effects of climate change on health outcomes is critical. This assessment is concerned with climate risks to health and health systems, the adaptive capacities in place to deal with these risks, and recommendations to meet identified gaps. The primary focus of this assessment is, therefore, on climate adaptation and resilience measures. However, as the Intergovernmental Panel on Climate Change (IPCC’s) Sixth Assessment Report68 makes clear, “Global surface temperature will continue to increase until at least the mid-century under all emissions scenarios considered.” Mitigation is no longer a sufficient strategy, regardless of the pace with which governments and communities around the world act. Adaptation is now a critical part of climate action as mitigation. This report, therefore, focuses on adaptation measures but, where possible, also includes recommendations that reduce GHGs or facilitate the decoupling of emissions for progress toward human development goals. This assessment follows a stepwise linear approach. The first step characterizes the climatology in Colombia, highlighting the observed and future climate exposures relevant to health. The second step examines climate-related health risks, including identifying vulnerable populations most at risk. The final step assesses the adaptive capacity of the health system, identifying gaps to manage current and future climate- related health risks. The assessment was conducted using desk-based available sources such as scientific published literature, national statistics, and meetings with key government stakeholders. Colombia Climate and Health Vulnerability Assessment 2024 26 Climatology This section describes observed climatic changes and projected climate trends, highlighting the priority climate-related hazards in relation to human health risks in Colombia. Climate information is acquired from the World Bank Group’s Climate Change Knowledge Portal. Observed climate data are presented at a 50km x 50km spatial resolution for 1901 –2020. Model-based climate projection data are derived from the Coupled Model Intercomparison Project Phase 6 (CMIP6), and projections are shown through five Shared Socioeconomic Pathways (SSPs). This assessment explores projected climate change under SSP3 –7.0 for the short- (2030s; 2020 – 2039) and medium- (2050s; 2040–2059) terms. The SSP3 –7.0 is a high GHG emission scenario in which countries are increasingly competitive and emissions continue to climb, doubling from current levels by 2100. Adaptive Capacity The extent to which the health system in Colombia is prepared for and has the capacity to manage changes in hazards, exposure, and susceptibility will determine its resilience in coming decades. In this assessment, Colombia’s adaptive capacity 69 to prevent and manage climate-related health risks is examined using the Adaptive Capacity Assessment Tool which focuses on four main building blocks while considering Equity as a cross cutting component: (1) Leadership and Governance, (2) Health Information Systems, (3) Service Delivery, and (4) Health Financing. It should be noted that several factors outside the scope of the health sector can also drive reductions in adaptive capacity to manage the health risks of climate change in Colombia’s institutions and people. These include the country’s economic challenges, changing demographic patterns, and slowly improving soc ial conditions. Promotion of equity as a cross-cutting theme for enhancing adaptive capacity and resilience to the health risks of climate change is also critical. Adaptive capacity is likely to be greater when access to resources within a community, nation, or the world is equitably distributed. Colombia Climate and Health Vulnerability Assessment 2024 27 ANNEX B. Estimating the Impacts of Climate Change on Health The World Bank has supported the development of the Climate and Health Economic Valuation Tool (CHEVT) to provide an estimate of the potential economic costs of the health impacts arising from the projected changes in temperature and precipitation. A brief outline of the CHEVT methodology is provided below. Methodology Climate Data and Scenario Climate data (temperature and precipitation projections) were obtained from the latest projections made available by the Coupled Model Intercomparison Project (CMIP6). Results from the climate models participating in CMIP6 form the foundation of the climate change projections presented in the Sixth Assessment Report of the IPCC. Five priority scenarios are used by IPCC: SSP1 –1.9, SSP1–2.6, SSP2–4.5, SSP3– 7.0, and SSP5 –8.5. This assessment retained the SSP3 –7.0 scenario, as it was considered to be the most relevant and realistic pathway for modeling purposes. Estimating the economic cost of the health impacts of climate change employs a two-step approach. The first step consists of estimating the impacts of projected climate change on the number of cases of both mortality and morbidity. This estimation is performed for the year 2030 and 2050, using 2020 as a baseline. Estimating the Number of Deaths and Cases The future incidence or probability of death associated with the above diseases is estimated based on the methodology presented by the World Health Organization (WHO) (2014).70 Except for stunting, these future incidences are estimated using the dose-response functions presented below. Colombia Climate and Health Vulnerability Assessment 2024 28 Dengue The dose-response function is: PDengue Ln [ ] = Constant + F(Temperature,Precipitation) + 0.059Ln(GDPpc ) (1 − PDengue where: P Dengue Probability of dengue transmission F Spline function71 Temperature Annual average temperature Precipitation Annual total precipitation GDP pc Gross domestic product per capita in purchasing power parity (PPP) terms Malaria The dose-response function is: 1/2 Logit(Malaria) = β0 + β1 Tmin + β2 PR max + β3 GDPPC where: Logit(Malaria) Probability of malaria Tmin Mean temperature of the coldest month PRmax Mean precipitation of the wettest month Diarrhea The dose-response function is: exp(β∆Tc,t ) − 1 nc,t = Nc,t exp (β∆Tc,t ) where: nc,t Number of diarrhea deaths attributable to climate change among children aged under 15 years in country c in year t Nc,t Number of diarrhea deaths in children aged under 15 years in a future without climate change in country c in year t ∆Tc,t Temperature anomaly in country c in year t β = log(1+ α) Mid-estimate of the log-linear increase in diarrheal deaths per degree of temperature increase, with α being the linear increase in diarrheal deaths per degree of temperature increase Colombia Climate and Health Vulnerability Assessment 2024 29 Stunting The study used regional stunting data for cases and deaths due to climate change from the WHO (2014) study to derive country-level data. WHO (2014) established the links between climate change and undernutrition by using a range of models. The results of the analysis are reported as the percentage of children aged under five in 2030 and 2050 who are moderately or severely stunted, as well as the number of deaths of children due to stunting for both scenarios—with and without climate change. Estimated future incidence levels (obtained from the dose-response functions) are applied to the national country populations projected under SSP3 to estimate the numbers of both morbidity and mortality cases for each of the diseases stated above. The methodological approach is used to estimate the number of both mortality and morbidity cases for the year 2020 (serving as a base year), and for the year 2030 and 2050. These estimates inform policy makers of the future burden that may confront healthcare systems. The methodological approach is also used to estimate the number of both mortality and morbidity cases for the year 2030 and for the year 2050 in a scenario with climate change and in a scenario without climate change. These estimates provide a measure of the health impacts directly attributable to climate change and may in turn provide policymakers with a climate rationale for justifying access to climate financing. Data for 2020 pertaining to total number of deaths and cases for malaria, dengue, and diarrhea were extracted from the Global Burden of Disease website. For stunting, the WHO 2014 percentage estimates of stunting cases and deaths per region were used to derive the country estimates. Economic Valuation of Deaths and Cases The second step transforms these estimated numbers of cases and deaths into economic costs. The cost-of-illness (COI) approach and the value of statistical life (VSL) are used to estimate the economic costs of morbidity and mortality, respectively.72 WHO (2014) does not provide an assessment of the economic costs arising from their quantitative assessment. The COI and VSL values are specific to each of the countries, while the national VSL values are based on an estimated VSL of USD6 million73 in the United States (US) in 2020 and then adjusted for each country based on the adjustment factor being the ratio of US and national GDP per capita. For both stunting and extreme heat, the estimated economic costs include only the economic cost of mortality, not the economic cost of morbidity. There is very limited information from the literature to derive COI for developing countries on stunting and extreme heat. For the purpose of estimating the morbidity cost arising from diarrhea, it is estimated that only 0.5 percent of all cases of diarrhea require treatment.74 Colombia Climate and Health Vulnerability Assessment 2024 30 REFERENCES 1World Bank Climate Change Knowledge Portal. 2021. “Colombia - Risk - Historical Hazards.” https://climateknowledgeportal.worldbank.org/country/colombia/vulnerability 2Gobierno de Colombia . 2016. Plan Nacional de Adaptacion al Cambio Climatico . https://www.minambiente.gov.co/wp- content/uploads/2022/01/1._Plan_Nacional_de_Adaptacion_al_Cambio_Climatico.pdf 3World Bank. 2022. Consolidating the Recovery: Seizing Green Growth Opportunities . Washington, DC: World Bank. https://openknowledge.worldbank.org/server/api/core/bitstreams/5bc5b212-640e-50d7- ac04-a822defbb85f/content 4World Bank. 2023. Climate Risk Country Profile: Colombia . Washington, DC: World Bank. https://climateknowledgeportal.worldbank.org/sites/default/files/country-profiles/16698- WB_Colombia%20Country%20Profile-WEB.pdf 5 Ibid. 6 Ibid. 7 The capital Bogotá is located in the Central Andes, Medellin is located in the Northern Andes, Cali is located in Southern Andes and Pacific, Barranquilla is located in the Western Caribbean, and Cartagena is located in Western Caribbean. 8 World Bank. 2023. Climate Risk Country Profile: Colombia . Washington, DC: World Bank. https://climateknowledgeportal.worldbank.org/sites/default/files/country-profiles/16698- WB_Colombia%20Country%20Profile-WEB.pdf 9 Urrea, Viviana, Andres Ochoa, & Oscar Mesa. 2019. “Seasonality of Rainfall in Colombia. ” Water Resources Research 55(5), 4149-4162. 10 Gobierno de Colombia . 2016. Plan Nacional de Adaptacion al Cambio Climatico. https://www.minambiente.gov.co/wp- content/uploads/2022/01/1._Plan_Nacional_de_Adaptacion_al_Cambio_Climatico.pdf World Bank. 2023. Climate Risk Country Profile: Colombia . Washington, DC: World Bank. 11 https://climateknowledgeportal.worldbank.org/sites/default/files/country-profiles/16698- WB_Colombia%20Country%20Profile-WEB.pdf 12 Ibid. 13 Ibid. 14 Ibid. 15 Ibid. 16 Ibid. 17 Ibid. 18 Map elaborated by the World Bank, using data from the Climate Change Knowledge Portal Colombia Climate and Health Vulnerability Assessment 2024 31 19 Map elaborated by the World Bank, using data from the Climate Change Knowledge Portal 20World Bank. 2023. Climate Risk Country Profile: Colombia . Washington, DC: World Bank. https://climateknowledgeportal.worldbank.org/sites/default/files/country-profiles/16698- WB_Colombia%20Country%20Profile-WEB.pdf 21World Bank. 2011. Analysis of Disaster Risk Management in Colombia: A Contribution to the Creation of Public Policies . 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Navarro-Racines. 2012. “ A Way Forward On Adaptation to Climate Change in Colombian Agriculture: Perspectives Towards 2050. ” Climatic Change 115(3-4):611-628. https://cgspace.cgiar.org/handle/10568/42053 44Eitzinger, Anton, Peter Läderach, Christian Bunn, Audberto Quiroga, Andreas Benedikter, Antonio Pantoja, Jason Gordon et al. 2014. “Implications of a Changing Climate On Food Security and Smallholders’ Livelihoods in Bogotá, Colombia.” Mitigation and Adaptation Strategies for Global Change 19, 161-176. https://doi.org/10.1007/s11027-012-9432-0 45OECD. 2018. “Climate Change and Fisheries.” https://www.oecd.org/greengrowth/fisheries/climatechangeandfisheries.htm 46World Bank. An Economic Assessment of the Health Impacts of Climate Change in Developing Countries . (Forthcoming) 47Estefanía Muñoz, Germán Poveda, M. Patricia Arbeláez, & Iván Vélez. 2020. “Spatiotemporal Dynamics of Dengue in Colombia in Relation to the Combined Effects of Local Climate and ENSO.” Acta Tropica 224: 106136. https://doi.org/10.1016/j.actatropica.2021.106136 48Christophers, S. Rickard. Aedes Aegypti (L.). The Yellow Fever Mosquito: Its Life History, Bionomics and Structure. London: Cambridge University Press, 1960. 49GBD Compare (database). Institute for Health Metrics and Evaluation https://vizhub.healthdata.org/gbd-compare/. Accessed July 05, 2023. 50 Ibid. Colombia Climate and Health Vulnerability Assessment 2024 33 51United States Agency for International Development. 2017. Climate Risk Profile: Colombia . https://www.climatelinks.org/sites/default/files/asset/document/2017_USAID%20CCIS_Cli mate%20Risk%20Profile_Colombia.pdf 52 Portilla Cabrera, Cristiam Victoriano and John Josephraf Salvaraj. 2020. Geographic Shifts in the Bioclimatic Suitability for Aedes Aegypti Under Climate Change Scenarios in Colombia . Heliyon , 6(1), e03101. https://doi.org/10.1016/j.heliyon.2019.e03101 53World Bank. An Economic Assessment of the Health Impacts of Climate Change in Developing Countries . (Forthcoming) 54 Ministerio de Salud y Protección Social. 2010. Colombia Encuesta Nacional de Demográfia y Salud 2015. Bogotá: Ministerio de Salud y Protección Social. https://dhsprogram.com/pubs/pdf/fr334/fr334.2.pdf 55 Ibid. 56Kolstad, Erik W. & Kjell Arne Johansson. 2010. “Uncertainties Associated with Quantifying Climate Change Impacts on Human Health: A Case Study for Diarrhea.” Environmental Health Perspectives 119(3), 299-305. https://doi.org/10.1289/ehp.1002060 57World Bank. An Economic Assessment of the Health Impacts of Climate Change in Developing Countries. (Forthcoming) 58Guo, Yuming, Antonio Gasparrini, Shanshan Li, Francesco Sera, Ana Maria Vicedo -Cabrera, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva et al. 2018. “Quantifying Excess Deaths Related to Heatwaves Under Climate Change Scenarios: A Multicountry Time Series Modelling Study. ” PLoS Medicine 15(7): e1002629. https://doi.org/10.1371/journal.pmed.1002629 59 Models elaborated by the World Bank 60Guo, Yuming, Antonio Gasparrini, Shanshan Li, Francesco Sera, Ana Maria Vicedo -Cabrera, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva et al. 2018. “Quantifying Excess Deaths Related to Heatwaves Under Climate Change Scenarios: A Multicountry Time Series Modelling Study. ” PLoS Medicine 15(7): e1002629. https://doi.org/10.1371/journal.pmed.1002629 61 Models elaborated by the World Bank 62Instituto Nacional de Salud. 2018. Carga de Enfermedad Ambiental en Colombia . Observatorio Técnico Especial 10. https://www.ins.gov.co/Direcciones/ONS/Informes/10%20Carga%20de%20enfermedad%2 0ambiental%20en%20Colombia.pdf 63Ministerio de Salud y Protección Social. 2017. Colombia Encuesta Nacional de Demografía y Salud 2015. Bogotá: Ministerio de Salud y Protección Social. https://dhsprogram.com/pubs/pdf/fr334/fr334.2.pdf 64GBD Compare (database). Institute for Health Metrics and Evaluation https://vizhub.healthdata.org/gbd-compare/. Accessed July 05, 2023. Colombia Climate and Health Vulnerability Assessment 2024 34 65World Bank. 2023. Impacts of Climate Change in Health in Colombia and Recommendations for Mitigation and Adaptation. Washington, DC: World Bank. https://openknowledge.worldbank.org/entities/publication/1bbf309c -5b31-4b3b-8ba3- a35f5d333579 66Centers for Disease Control and Prevention. 2023. Workshop Summary: Prioritizing Zoonotic Diseases for Multisectoral One Health Collaboration in Colombia. https://www.cdc.gov/onehealth/pdfs/colombia-508.pdf 67Gobierno de Colombia. 2016. Plan Nacional de Adaptacion al Cambio Climatico . https://www.minambiente.gov.co/wp- content/uploads/2022/01/1._Plan_Nacional_de_Adaptacion_al_Cambio_Climatico.pdf 68 Intergovernmental Panel on Climate Change. 2023. AR6 Synthesis Report: Climate Change 2023 . https://www.ipcc.ch/assessment-report/ar6/ 69 Adaptive capacity is defined by the IPCC as, “the ability of a system to adjust to climate change, moderate potential damages, take advantage of opportunities, and cope with the consequences” (IPCC Fifth Assessment Report). The related term, resilience, is the ability to prepare and plan for, absorb, recover from, and more successfully adapt to adverse events. People and communities with strong adaptive capacity have greater resilience. This assessment makes use of the term adaptation and adaptive capacity to encompass both terms. 70World Health Organization. 2014. Quantitative Risk Assessment of the Effects of Climate Change on Selected Causes of Death, 2030s and 2050s. Geneva: WHO. https://iris.who.int/bitstream/handle/10665/134014/9789241507691_eng.pdf?sequence=1 71A spline function is used to draw a risk function curve, which allows for a flexible relationship and interaction between climate factors (temperature and precipitation) and the probability of dengue transmission areas. 72Cost-of-illness (COI) is an approach used in economics to estimate the cost of morbidity. It includes the direct cost of treating illness as well as the indirect cost (lost productivity). Being a cost-based approach, COI provides an under-estimate of the true economic (social) cost of morbidity. The value of statistical life (VSL) represents aggregate demand for reductions in mortality risk, i.e., how much individuals (in aggregate) are willing to pay for a very small reduction in the probability of death. Since individuals’ willingness to pay is positively correlated to their income, VSL increases with income per capita. VSL certainly does not measure the value of life. 73Viscusi (2020) uses a VSL of USD11 million. The use of USD6 million would lead to under - estimating the economic cost of mortality in this assessment. Source: Viscusi, W Kip. 2020. “Pricing the Global Health Risks of the COVID -19 Pandemic.” Journal of Risk and Uncertainty 61(2): 101-128. https://doi.org/10.1007/s11166-020-09337-2 74Lamberti, Laura M., Christa L. Fischer Walker, and Robert E. Black. 2012. “ Systematic Review of Diarrhea Duration and Severity in Children and Adults in Low - and Middle-income Countries.” BMC Public Health 12: 276. https://doi.org/10.1186/1471-2458-12-276