Outlook on climate change adaptation in the Hindu Kush Himalaya

disease), communities can suffer severe economic losses from the loss of livestock to the disease. As is the case for other sectors, exposure to climate change and the ability of people and systems to respond to this will greatly determine its impact on human health. In economic terms, health can be seen as an input to human capital (the attributes of a human population that contribute to economic productivity). Thus, reduced health leads to reduced human capital, impacting economic productivity and development. In the HKH region, climate change will mostly affect the poor, those from low social classes, women, children and the elderly, since these groups are most vulnerable and are less able to cope (Sharma, 2012). Mountain communities in most HKH countries already suffer from food insecurity and malnutrition more than communities in the plains (with the exception of India), and higher malnutrition and micronutrient deficiency rates are especially common among poorer mountain communities (Rasul et al., 2017). In addition, poorer people in HKH mountainous areas are far more likely to experience more health shocks than non-poor counterparts and are much less likely to be able to afford professional health services (Mohanty et al., 2017). These factors undermine their resilience to climate shocks and their ability to adapt. In general, there is not much knowledge available on the specific impacts of climate change on human health in the HKH region, possibly due to the difficulty in differentiating climate change impacts fromnon-climatic factors, including economic, social and public health issues. However, some studies are available which examine both observed impacts and/ or projections of future impacts on HKH populations (Ebi et al., 2007; Singh et al., 2011; Sharma, 2012; Gautam et al., 2013).

seriously affect mountain tourism to the region (Wang and Cao, 2014). However, stakeholders in Annapurna also see some positive outcomes of climate change, as warmer temperatures have made the trekking season slightly longer and more comfortable for a wider group of people (Rayamajhi, 2012). Tourism that depends on certain weather, such as nature-based tourism (e.g. trekking, mountaineering, safari) will likely be impacted by changing monsoon patterns, since these will determine when and where tourists travel. In Nepal, the tourism season peaks in the dry autumn and spring months when temperatures are pleasant and there is little precipitation. Changing monsoon patterns could therefore impact when tourists arrive (Nyaupane and Chhetri, 2009; Rayamajhi, 2012). Access to and availability of water will likely impact tourism in the HKH region, whether it is climate-linked or not. Tourists can increase the demand for water substantially, which may become unsustainable in water scarce areas. In Ladakh, India, tourists are asked to bring water from lower sources to cope with acute water scarcity (Karki, 2014). Sacred springs have also been affected and reportedly dried up in some locations, such as in Sikkim and above the Tiger’s Nest monastery in Bhutan, which can cause water-driven prayer wheels to stop spinning (Higgins-Zogib et al., 2011). Changes in the ecological characteristics of wetlands, lakes and rivers can change their significance as cultural and religious tourism sites (Tsering et al., 2010). For example, the Modi and Kali Gandaki river corridor in Nepal has 22 traditional sites, known as ghats, which are used for religious bathing and cremation. Changes in the water flow can increase the risk of using these ghats and inconvenience the people who use them (Shrestha and Aryal, 2011). Reduced water flow in rivers can have a negative impact on activities such as rafting and canoeing (Nyaupane and Chhetri, 2009).

Human health Climate change can directly and indirectly affect human health in various ways. Among direct impacts of climate change on health is extreme weather, which can lead to sickness from heatwaves or cold episodes, drowning or hypothermia due to floods, or exposure to infectious diseases, such as cholera. Indirect impacts include those resulting from changes in ecosystems, such as temperature, precipitation and humidity, which can facilitate the spread of infectious diseases, such as malaria, dengue fever, and food and waterborne diseases, or affect the air quality and spread of allergic diseases. Climate change is also a contributing factor for other health issues, including undernutrition and occupational health hazards, such as heat exhaustion and heat stroke from working outside for extended periods (Smith et al., 2014). Additional indirect impacts on human health include climate-driven changes to the health of livestock, since humans can become exposed to and catch climate-sensitive zoonotic diseases, such as bird flu and swine flu. Even when diseases are not transmissible from animals to humans (for example, foot and mouth During August 2017, Bangladesh, India, Nepal and Pakistan were hit by heavy monsoons that caused devastating floods across the countries. An estimated 1,288 people died and around 40 million people were affected by the devastation, including 16 million children (UNICEF, 2017). Although floods occur yearly between July and September in the monsoon season, the South Asian floods of 2017 were the worst in many years (the Guardian, 2017). South Asian floods of 2017

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