title: Health risks of climate change: an assessment of uncertainties and its implications for adaptation policies.
abstract: BACKGROUND
  Projections of health risks of climate change are surrounded with uncertainties in knowledge. Understanding of these uncertainties will help the selection of appropriate adaptation policies.
  
  
  METHODS
  We made an inventory of conceivable health impacts of climate change, explored the type and level of uncertainty for each impact, and discussed its implications for adaptation policy. A questionnaire-based expert elicitation was performed using an ordinal scoring scale. Experts were asked to indicate the level of precision with which health risks can be estimated, given the present state of knowledge. We assessed the individual scores, the expertise-weighted descriptive statistics, and the argumentation given for each score. Suggestions were made for how dealing with uncertainties could be taken into account in climate change adaptation policy strategies.
  
  
  RESULTS
  The results showed that the direction of change could be indicated for most anticipated health effects. For several potential effects, too little knowledge exists to indicate whether any impact will occur, or whether the impact will be positive or negative. For several effects, rough 'order-of-magnitude' estimates were considered possible. Factors limiting health impact quantification include: lack of data, multi-causality, unknown impacts considering a high-quality health system, complex cause-effect relations leading to multi-directional impacts, possible changes of present-day response-relations, and difficulties in predicting local climate impacts. Participants considered heat-related mortality and non-endemic vector-borne diseases particularly relevant for climate change adaptation.
  
  
  CONCLUSIONS
  For possible climate related health impacts characterised by ignorance, adaptation policies that focus on enhancing the health system's and society's capability of dealing with possible future changes, uncertainties and surprises (e.g. through resilience, flexibility, and adaptive capacity) are most appropriate. For climate related health effects for which rough risk estimates are available, 'robust decision-making' is recommended. For health effects with limited societal and policy relevance, we recommend focusing on no-regret measures. For highly relevant health effects, precautionary measures can be considered. This study indicated that analysing and characterising uncertainty by means of a typology can be a very useful approach for selection and prioritization of preferred adaptation policies to reduce future climate related health risks.
authors.affiliation: Department of Innovation, Environmental and Energy Sciences, Copernicus Institute of Sustainable Development, Utrecht University, Budapestlaan 6, 3584 CD, Utrecht, Netherlands. J.A.Wardekker@uu.nl
authors.forename: J Arjan
authors.initials: JA
authors.lastname: Wardekker
authors.forename: Arie
authors.initials: A
authors.lastname: de Jong
authors.forename: Leendert
authors.initials: L
authors.lastname: van Bree
authors.forename: Wim C
authors.initials: WC
authors.lastname: Turkenburg
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: van der Sluijs
mesh_terms: D000397:Air Pollution; D000818:Animals; D057231:Climate Change; D004199:Disease Vectors; D005104:Expert Testimony; D055868:Floods; D005517:Foodborne Diseases; D006801:Humans; D006967:Hypersensitivity; D009426:Netherlands; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013696:Temperature; D014466:Ultraviolet Rays; D035501:Uncertainty