Strengthen the Implementation of the Climate and Health Strategic Action Plan
Clarify and articulate institutional roles, and incorporate the necessary budget items to carry out the defined activities in national climate change instruments.
The Dominican Republic is a developing country, considered middle income, which occupies two-thirds of the island of Hispaniola, between the Caribbean Sea and the Atlantic Ocean. The territory of the Dominican Republic consists of steep mountains and highlands, interspersed with fertile valleys. The climate, typically tropical, presents great diversity due to the orographic characteristics of the territory, spacing from the perhumid of the areas exposed to the trade winds, to the arid– pre-desert of the leeward areas to the main mountain chains. Seasonal variations in rainfall are observed, with severe storms experienced from June to October. The majority of the population lives along the coast (1). The Dominican Republic is one of the most exposed countries in the world to disasters caused by natural phenomena and, as such, is particularly vulnerable to climate change. Natural disasters have had a huge financial impact in the Dominican Republic, since individual hurricanes have cost up to 14% of gross domestic product (GDP) in damages (2).
Climate change is anticipated to increase the risk of extreme weather events, variations in precipitation, sea level rise, destruction of marine habitats, and rising temperatures. For human health, these changes could have significant direct and indirect detrimental effects, among which are: impacts in terms of food and water insecurity, in the generation and supply of electricity, population displacement, death, injuries and mental health due to extreme weather events, loss of livelihoods and the spread of vector-borne and waterborne diseases.
The Government of the Dominican Republic recognizes the country’s vulnerability to climate change and is actively working to increase its resilience. In 2015, the government submitted its Nationally Determined Contribution (NDC) to the UNFCCC. Adaptation to climate change is identified as a constitutional priority in its NDC. Health is identified as a key sector to address the greatest vulnerabilities to climate change and it is also recognized that public health is severely affected by extreme weather events, with future climate changes that represent major threats to the population’s health (3).
Country-specific projections are outlined up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions (see Figures 1–5). The climate model projections given below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 (RCP8.5 – in orange) and a low emissions scenario (RCP2.6 – in green). 1 1Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed.
The text describes the projected changes averaged across about 20 global climate models (thick line). The figures 2 2Analysis by the Climatic Research Unit, University of East Anglia, 2018. also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and the annual and smoothed observed record (in blue).3 3Observed historical record of mean temperature is from CRU-TSv3.26 and total precipitation is from GPCC. Observed historical records of extremes are from JRA55 for temperature and from GPCC-FDD for precipitation. In the following text the present-day baseline refers to the 30-year average for 1981–2010 and the end-of-century refers to the 30-year average for 2071–2100.
Modelling uncertainties associated with the relatively coarse spatial scale of the models compared with that of small island States are not explicitly represented. There are also issues associated with the availability and representativeness of observed data for such locations.
Under a high emissions scenario, the mean annual temperature is projected to rise by about 3.2°C on average by the end-of-century (i.e. 2071–2100 compared with 1981–2010). If emissions decrease rapidly, the temperature rise is limited to about 1.0°C.
Total annual precipitation is projected to decrease by about 16% on average under a high emissions scenario, although the uncertainty range is large (-43% to +4%). If emissions decrease rapidly, there is little projected change on average, with an uncertainty range of -8% to +9%.
The percentage of hot days4 4A ‘hot day’ (‘hot night’) is a day when maximum (minimum) temperature exceeds the 90th percentile threshold for that time of the year. is projected to increase substantially from about 10% of all observed days on average in 1981–2010. Under a high emissions scenario, about 95% of days on average are defined as ‘hot’ by the end-ofcentury. If emissions decrease rapidly, about 75% of days on average are ‘hot’. Note that the models overestimate the observed increase in hot days (about 25% of days on average in 1981–2010 rather than 10%). Similar increases are seen in hot nights (not shown).
The proportion of total annual rainfall from very wet days5 5The proportion (%) of annual rainfall totals that falls during very wet days, defined as days that are at least as wet as the historically 5% wettest of all days (about 30% for 1981–2010) shows little change on average by the end-of-century although the uncertainty range is somewhat larger (about 10% to almost 50% under a high emissions scenario). Total annual rainfall is projected to decrease under a high emissions scenario (see Figure 2).
The Standardized Precipitation Index (SPI) is a widely used drought index which expresses rainfall deficits/excesses over timescales ranging from 1 to 36 months (here 12 months, i.e. SPI12).6 6SPI is unitless but can be used to categorize different severities of drought (wet): above +2.0 extremely wet; +2.0 to +1.5 severely wet; +1.5 to +1.0 moderately wet; +1.0 to +0.5 slightly wet; +0.5 to -0.5 near normal conditions; -0.5 to -1.0 slight drought; -1.0 to -1.5 moderate drought; -1.5 to -2.0 severe drought; below -2.0 extreme drought. It shows how at the same time extremely dry and extremely wet conditions, relative to the average local conditions, change in frequency and/or intensity.
Under a high emissions scenario, SPI12 values are projected to decrease to about -0.6 on average by the end of the century (2071–2100), with a number of models indicating substantially larger decreases and hence more frequent and/or intense drought. Year-to-year variability remains large with wet episodes continuing to occur into the future.
Future climate scenarios based on historical climate data for the Dominican Republic provided by the National Meteorological Office (ONAMET) and analysed by experts from the Water Center for the Humid Tropics of Latin America and the Caribbean (CATHALAC), concluded :
The period of relative droughts between the months of July–August could be more intense.
It is anticipated that the total number of tropical cyclones may decrease towards the end of the century. However, it is likely that human-induced warming will make cyclones more intense (an increase in wind speed of 2–11% for a mid-range scenario (i.e. RCP4.5 which lies between RCP2.6 and RCP8.5 – shown on pages 4–5) or about 5% for 2˚C global warming). Projections suggest that the most intense events (category 4 and 5) will become more frequent (although these projections are particularly sensitive to the spatial resolution of the models). It is also likely that average precipitation rates within 100 km of the storm centre will increase – by a maximum of about 10% per degree of warming. Such increases in rainfall rate would be exacerbated if tropical cyclone translation speeds continue to slow (5–12).
Sea level rise is one of the most significant threats to low-lying areas on small islands and atolls. Research indicates that rates of global mean sea level rise are almost certainly accelerating as a result of climate change. The relatively long response times to global warming mean that sea level will continue to rise for a considerable time after any reduction in emissions.
The average change in Caribbean sea level over the period 1993–2010 (13) is projected at 1.7 mm/year (± 1.3), with substantial spatial variability across the region. A further 0.5–0.6m rise is expected in the Caribbean by the end of the century (14) with variation amongst models and emissions scenarios.
The relatively long response times to global warming mean that sea level will continue to rise for a considerable time after any reduction in emissions.
Potential impacts of sea level rise include:
The report “Impact of Climate Change on Human Health in the Dominican Republic: Case Study”, a contribution prepared in the framework of technical cooperation with the United Nations Economic Commission for Latin America and the Caribbean (ECLAC) and the Support of the Technical Support Group/ECLAC of the Project Socio-Economic Impact of Climate Change and Policy Options in Central America and the Dominican Republic, InterAmerican Development Bank (IDB)/Nordic Development Fund (NDF), within the framework of the Third National Communication on Climate Change (TCNCC), produced the following results on the national situation of vector-borne diseases (16).
In the Dominican Republic, dengue is endemic and occurs with greater intensity between the months of June and October, in the rainy season. All dengue virus serotypes have been isolated (17).
Malaria is endemic in the country and the causative agent in all cases is Plasmodium faciparum, sensitive to chloroquine treatment. The annual increase in the number of cases have been related to climatic phenomena. The number of cases decreased from 3525 in 2006 to 1838 in 2008.
In 2010, 1643 cases were detected, and 200 670 sheets were examined, resulting in a positive sheet index of 0.58%; 65% of the cases corresponded to the male sex and the most affected age group was 10–49 years (74%). Outbreaks were associated with movements of migrant groups of temporary workers linked to agriculture and construction. The national malaria control programme reports an upward trend since 2009 in the imported cases of malaria from people from Haiti.
Dengue is currently the main viral disease transmitted by arthropods in terms of morbidity and mortality. Dengue viruses are transmitted mainly by Aedes aegypti mosquitoes and to a lesser extent by Aedes albopictus. Symptomatic infections can be mild, moderate and severe, which can lead to death. The geographical distribution of dengue largely reflects the distribution of the vector. The geographical expansion and magnitude of the disease in recent decades has paralleled rapid population growth, unplanned urbanization and the unprecedented increase in population mobility.
Climate is an important determinant of the temporal–spatial distribution of dengue. It is known that elevated temperatures increase the speed of development of the larvae and consequently of the adult mosquito, which can lead to an increase in the rate of bite and the rate of replication of the virus in the mosquito, which leads to vectors. They become infective sooner and itch more frequently. Variability in rainfall influences the availability of vector breeding sites and consequently the abundance of the vector. Humidity influences the half-life of the vector and potentially the transmission. The existence of four dengue serotypes, the duration of cross-protection between serotypes, the phenomenon of ADE (antibody-dependent amplification) also influence the dynamics of transmission and the severity of the disease.
The authorities of the Ministry of Public Health reported that in the first quarter of 2016 at least 10 cases of Zika had already been confirmed through the Center for Disease Control in Atlanta, United States of America (MISPAS, 2016) (18). The Zika virus – also transmitted by the Aedes aegypti mosquito – is the same that transmits dengue and chikungunya
The majority of SIDS face a triple-burden of malnutrition whereby undernutrition, micronutrient deficiencies and overweight and obesity exist simultaneously within a population, alongside increasing rates of diet-related NCDs.
Climate change is likely to exacerbate the tripleburden of malnutrition and the metabolic and lifestyle risk factors for diet-related NCDs. It is expected to reduce short- and long-term food and nutrition security both directly, through its effects on agriculture and fisheries, and indirectly, by contributing to underlying risk factors such as water insecurity, dependency on imported foods, urbanization and migration, and health service disruption. These impacts represent a significant health risk for SIDS, with their particular susceptibility to climate change impacts and already over-burdened health systems, and this risk is distributed unevenly, with some population groups experiencing greater vulnerability.
On food security, the TCNCC project carried out an analysis of the impact of future climate scenarios. Changing precipitation patterns, extreme rainfall events and intensively exploited water resources are likely to increase challenges in future water supplies for rain-fed agriculture. Furthermore, the livelihoods of rural populations are often dependent upon fragile environments, making these groups particularly vulnerable to the impacts of climate change on natural resources (15).
The following section measures progress in the health sector in responding to climate threats based on country reported data collected in the 2021 WHO Health and Climate Change Country Survey (32).
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has a national health and climate change strategy or plan been developed ? | NO | ||
| Are the health co-benefits of climate change mitigation action considered in the strategy/plan? | NO | ||
| Level of implementation of the strategy/plan? | NO | ||
| Portion of estimated costs to implement the strategy/plan covered in the health budget | N/A | ||
| Are health adaptation priorities identified in the strategy/plan? | NO |
Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy?
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Transportation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Electricity generation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Household energy | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Agriculture | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Social services | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Water, Sanitation & Waste-water management | NO |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has an assessment of health vulnerability and impacts of climate change been conducted at a national level? | NO | ||
| → Level of influence of the assessment findings on policy prioritization to address the health risks of climate change | Unknown | ||
| → Level of influence of the assessment findings on human and financial resource allocation to address the health risks of climate change | Unknown |
| Climate-sensitive diseases and health outcomes | qid | Health surveillance system is in place (a) | Health surveillance system includes meteorological information (b) |
|---|---|---|---|
| Thermal stress (e.g. heat waves) | 22111 | NO | NO |
| Vector-borne diseases | 22121 | YES | NO |
| Foodborne diseases | 22131 | YES | NO |
| Waterborne diseases | 22141 | YES | NO |
| Nutrition (e.g. malnutrition associated with extreme-climatic events) | 22151 | NO | |
| Injuries (e.g. physical injuries or drowning in extreme weather events) | 22161 | NO | NO |
| Mental health and well-being | 22171 | NO | NO |
| Airborne and respiratory diseases | 22181 | YES |
| Climate hazard | qid | Health early warning system (HEWS) in place? | Health sector response plan in place? | Health sector response plan includes meteorological information? |
|---|---|---|---|---|
| Heat waves | 23111 | YES | YES | YES |
| Storms (e.g. hurricanes, monsoons, typhoons) | 23131 | YES | YES | YES |
| Flooding | 23141 | YES | YES | YES |
| Drought | 23161 | NO | NO | NO |
| Air quality (e.g. particulate matter, ozone levels) | 23171 |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there a national curriculum developed to train health personnel on the health impacts of climate change? | NO | ||
| Does your human resource capacity as measured through the International Health Regulations Monitoring Framework (IHR) adequately consider the human resource requirements to respond to climate-related events? | COMPLETELY |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has there been a national assessment of the climate resilience of health infrastructure and technology? | |||
| Have measures been taken to increase the climate resilience of health infrastructure and technology? | |||
| Is there a national initiative/programme in place to promote the use of low-carbon, energy-efficient, sustainable technologies in the health sector? |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is your government currently accessing international funds to support climate change and health work? | NO |
Greatest challenges faced in accessing international climate funds
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Greatest challenges faced in accessing international climate funds | Lack of information on the opportunities | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of country eligibility | ||
| Greatest challenges faced in accessing international climate funds | Lack of connection by health actors to climate change processes | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of capacity to prepare country proposals | ||
| Greatest challenges faced in accessing international climate funds | Lack of success in submitted applications | ||
| Greatest challenges faced in accessing international climate funds | None (no challenges/challenges were minimal) | ||
| Greatest challenges faced in accessing international climate funds | Not applicable | ||
| Greatest challenges faced in accessing international climate funds | Other (please specify) |
Clarify and articulate institutional roles, and incorporate the necessary budget items to carry out the defined activities in national climate change instruments.
Establish integrated risk monitoring that includes a preventive approach to climate variability, which should contribute to the strengthening of the platform for dialogue and decision-making.
Improve access to the sources of additional financing to help promote policy implementation and expand risk monitoring and early warning systems.
Identify the co-benefits of existing mitigation measures in the well-being of mental and physical health of Dominicans.
Prevent the devastating impacts of climate change on access and provision of health services, including a commitment to sustainable low emission practices to promote a recovery environment and mitigate the impacts of climate change.
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WHO/HEP/ECH/CCH/21.01.02
© World Health Organization and the United Nations Framework Convention on Climate Change, 2020
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Most estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. Published official national statistics, if presented, are cited and included in the reference list.
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