Proposal for a Thesis in the Field of Sustainability and Environmental Management in Partial Fulfillment of Requirements for the Master

of Liberal Arts Degree

Harvard University August 6, 2012

Cesar Marolla

cmarolla@fas.harvard.edu

I. Tentative Title Climate Change Impacts on Health: The Urban Poor in the Worlds Megacities

II. Research Problem The effects of climate change on health will impact most populations in the next decades. The increase in risk factors will put the lives and safety of billions of people in jeopardy and will affect the population unequally. Climate change can change the pattern of diseases, mortality, human settlements, food, water and sanitation. The increased temperatures, rising seas, and frequent incidence of severe storms are known and growing effects of climate change. These effects produce dangerous sanitary consequences and are known as health risks (Jensen, 2007). The state of the climate can be identified by using statistical tests and analyse the variability of climate changes and its properties for an extended period of time. Therefore, climate change is the changes that may be caused by natural processes and external causes or changes in the atmosphere and land use by anthropogenic factors (Climate change information, 2005). There are many factors that contribute to climate change impacts on health. The most deprived populations are exposed to limitations in access to communitys health programs and safety systems to address and prepare for risk. Health impacts will depend on the region, the sensitivity of populations and the capability of societies to adapt and mitigate the impacts. Climate change will be especially significant for cities with the urban poor particularly affected. The location, high density populations, capital assets at risk and the role port cities play in their financial system are crucial to their local and national economies. Urban populations are experiencing an increase in health issues closely related to climate change (e.g. higher temperatures, floods, sea level rising). Urban population refers to people living in urban areas as defined by national statistic offices and it is calculated using World Bank

population estimates and urban ratios from the United Nations World Urbanization Prospects (Urban population, 2012). The urban poor are more vulnerable to health problems caused by extreme weather events and are the least responsible for causing the climate variability they are currently experiencing. There is no consensus on a definition of urban poverty but two wide-ranging complementary approaches are common: economic and anthropological interpretations. Conventional economic definitions use income or consumption complemented by a range of other social indicators (e.g., life expectancy, nutrition, household budget spent on food, literacy and access to health clinics or drinking water) to classify poor groups against a common index of material welfare. Alternative interpretations developed largely by rural anthropologists and social planners consent to local variation in the meaning of poverty, and expand the definition to include perceptions of non-material deprivation and social differentiation (Masika et al., 1997). Climate change could exacerbate the health issues faced by the urban poor to a level of devastating entire communities because the poor have a tendency to live in informal settlements that are more defenseless to drastic weather events. The inequities of these consequences will deepen and the cause will outline the future health of this population, accentuating the risks and the outcome. The increase vulnerability of the urban poors health due to reduced food security, drinking water, and water-rodent borne diseases associated with floods, droughts and the relation between high temperatures and heat stress will be worsened by climate change. Climate change can have an impact on land use and relocation. Migration can have severe consequences for the spread of diseases (e.g. HIV/AIDS) because the environmental

conditions are influenced by the human use of land. Weather extreme events such as flooding and heavy storms can disrupt access to health centers. The extreme temperatures, distress migration from rural areas, interruption of food supply systems, intense flooding, disruption to livelihoods and the health risks associated with those issues are potential hazards of climate change. Although human health has been affected by weather events for centuries, the new challenge posed by climate change will exacerbate those health risks and consequently directly and indirectly affect the urban population harshly. Climate change, as a potential environmental danger, has a distinctive effect to megacities, affecting disproportionally the different demographic groups that compound the urban areas. Hence, climate change effects on the urban poor could become the leading health inequity our societies could face in the 21st. century and beyond. The environmental hazards will affect populations where the current burden of climatesensitive disease is high such as the urban poor. Understanding severe weather events affecting the health of urban populations is an important step to assessing future effects. This leads to the question, How could climate change disproportionately affect the health of the urban poor? The urban poor are exposed to inadequate facilities, poor nutrition, overcrowded living conditions and displacement. The poor populations vulnerability will be caused by greater risk exposure to severe weather effects and lack of capacity to adapt to climate change. As a result, the urban poor dont have the infrastructure and resources to deal with the effects of climate change and they are more susceptible to health risk impacts from extreme weather events. To prove the hypothesis, the research will be conducted using the case method approach (Yin, 2009). The research will seek to enable a cross-case analysis of megacities to collect case knowledge, compare and contrast cases, and then produce new knowledge. Substantiation of the

materials presented will depend upon interviews, scientific data, research studies and archived records. Evidence will primarily be derived from a search of existing literature. Interviews will be conducted as needed and they will provide perceptive information to the research (Stewart & Cash, 2005). The data collected will be analyzed using the research design methods (Yin, 2009). This research will have practical and conceptual implications for academic researchers. The research will extend the discussion further by using the case study method to examine how climate change can disproportionally affect the urban poors health (Yin, 2009). An established multi-case study framework to evaluate particular cases will be used to analyze specific health risk issues affecting the urban poor and will examine the practical problems of the implementation and study the results of different approaches. The research will provide a case to develop policies to leverage human capacity, investment, and technology to capture mitigation opportunities, while simultaneously involved individuals with an example of how these theories can be utilized at a local level for future policy development. This research will also present a new method for evaluating and comparing actual cities against one another in terms of their climate change mitigation program and results. This maturity comparison will allow other researchers to compare other cities in other regions in a similar manner. The implications of the latter notion will lead to more research efforts to help guide major cities to combat climate change health impacts and improve their implementation and development plans. A detailed discussion on how climate change disproportionally affects the health of the urban poor will be presented in the Background section, following the Definition of Terms.

III. Definition of Terms Anthropogenic: of, relating to, or resulting from the influence of human beings on nature.

Degraded productivity: Reduced far below ordinary standards labor efficiency. Which it can be measured by quantity of output per time spent or numbers employed.

Epidemiological studies: The study of the distribution and patterns of health-events and its characteristics as well as their causes or influences of well-defined populations.

Megacities: Spanish sociologist Manuel Castells' term for large cities in which some people are connected up to global information flows whilst others are disconnected and 'information poor'. It is also defined as a metropolitan area with a total population in excess of 10 million people.

Risk: risk is the chance that something will happen that will have an impact on the planned outcomes of an organization (Pojasek, 2008).

Risk management: attempts to reduce risks to an acceptable level, which is defined by an organizations legal responsibilities and sustainability policy. Risks can be viewed both as positive (the opportunities) and negative (the threats and losses). The process of managing risks considers both of these (Pojasek, 2008).

Urban heat island: The condition in which a city is relatively warmer than the surrounding areas due to the heat generated by the good conductors such as concrete, cars, and city buildings and the lack of vegetation.

IV. Background Climate has impacted our health for thousands of years. The increasing acknowledgment of climate change and its consequences creates a growing interest in how climate affect health. The range of health effect factors are varied such as social and economic developments, adaptation to those climate events, implementation and mitigation. Some other factors that will impact the populations health are population growth, urbanization, land use reduction, and fresh water resources. All these elements have connotations for the populations health and maximize the impacts of climate change events (Haines, 2006). Climate change has an effect on economics, infrastructure, natural life-support systems and the essential requirements for health such as safe drinking water, food supply, safe shelter and clean air. These impacts have an adverse effect on the populations health (Human health impacts, 2012). The direct effects of those events come from heat waves, floods, socially mediated risks (e.g., infrastructure deterioration), dislocation of populations and ecological risks (e.g., vector-borne diseases), food and water (Protecting human health, 2010). Heat Waves in Europe Some of these climate change impacts on human health have been experienced by many different countries and regions around world. France has lost many lives attributed to a heat wave across Western Europe in the summer of 2003. More than 14,000 people perished in that event (Wang, 2005). Heat waves are just one source of the harms climate change causes to human health. The range of disease carrying insects will expand affecting populations that have never been exposed to those factors. Crop productivity will be affected as well creating a parallel increase effect in malnutrition (Heinzerling, 2007).

Climate Change Inequalities Climate change impacts on human health are particularly inequitable. Climate change is rising as a threat to global public health since the poorest populations are exposed to greater risks (Campbell-Lendrum et al., 2008). Poor populations living in major cities with a rapid economic development will be susceptible to climate change effects. Moreover, they will be one of the causes of the problem as diseases, malnutrition; displacement is going to be stressed with population density (Campbell-Lendrum et al., 2008). The health susceptibility factors of the urban poor, particularly in developing countries are location, the effects of the urban heat island, air pollution, growing population and lack of proper sanitation (Campbell-Lendrum et al., 2008). Megacities Global climate change will have enormous impacts on urban areas in the developing world but those effects will be maximized in the worlds megacities. The known and growing effects of increased temperatures, rising sea levels, and enhanced frequency of intense storms are important for major cities to consider because of the geographic locations, crowded populations living near the coast, the risks related to capital assets, and the crucial economic impact of the aforementioned climate factors (Schmidhuber, 2012). The global scale of the climate change health effects create a distinctive involuntary exposure to the cities affected by those issues. The majority affected population is the urban poor and minority groups that represent the largest health inequity we have experienced in many decades. The World Health Organization has produced a comprehensive report stating that the most increase in diseases caused by high temperatures in the past 30 years paradoxically hold

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populations least responsible for causing GHG emissions and the consequences of its effects (Patz et al., 2007). The urban poor will be the most affected for the cost of staple foods as climate change creates droughts, heavy rains and affect agricultural production to an extent of diminishing the supply and consequently increased prices. The socio-economic groups affected by climate change will likely see an increase in poverty rates that are parallel to extreme weather events impacting impoverished people in each city (Gardner et al., 2009). These conclusions were acquired from the 20th century data study and projections for the late 21st century to generate a context that analyze climate change events, grain production distressed and the impact on the deprived populations (Gardner et al., 2009). Rural Population and Urban Population Poverty Rates The rural population has a tendency to migrate to urban areas seeking employment and other opportunities to improve their life quality standards (Barrios, 2006). The migration of populations has experienced a gradual increase in the last few decades and that reflects the accelerated poverty rate in the urban population. The gap between rural and urban poverty rates is increasing as urban areas have grown in numbers due to many factors as economic opportunities, housing and climate change (Gardner et al., 2009). The following figure represents population in poverty from rural to urban inhabitants. The urban poor population has been gradually increasing for the last two decades from rural migration. Several factors are in placed such as job security, drastic environmental condition, droughts, severe storms and quality of living (Gardner et al., 2009). The following figure represents the aforementioned poverty gap between urban and rural population:

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Figure 1: Rural and Urban Population Living in Poverty

Climate Change and Public Health The effects of climate change in the environment have an impact on public health and include water supplies, change in air quality, food security, and direct effects on vectors (Portier et al, 2010).

Change in water supply The change in rainfall will increase the severity and occurrence of droughts in some regions and floods in others. These events will impact the vector population and water scarcity will affect crops and pasture yields. Change in precipitation patterns could change the population density of vectors, infecting inhabitants in greater numbers (A human health, 2012). The roads, schools, power supplies, houses are affected by flooding, destroying essential infrastructure to support communities and cities (A human health, 2012). Moreover, storm water discharges are damaged by heavy rains, putting waste into water supply. High concentration of salt and chemicals is a result of water scarcity and subsequently contaminates the water sources.
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Furthermore, any city near the cost will be affected by rising sea levels and consequently will result in salination of freshwater supplies, loss of land productivity and breeding coastal dwelling mosquitoes breeding habitats changed by climate change events (Haines et al., 2005).

Change in air quality Air pollutants are changed by higher temperatures. Their formation and dispersal are modified by heat and these ozone, a major urban air pollutant, forms quickly under these conditions. The higher temperatures also affect the range and concentration of pollen, affecting a larger range of the population (Portier et al., 2010).

Change in food security Food yields will be affected by climate change. It will affect populations around the world but primarily will make a greater impact in regions where warmer temperatures and reduced rainfall will likely occur. Coastal cities will be affected by a restrain in food supply caused by rising sea levels, heavy storms and floods. These negative factors are increased by acidification, warmer waters, and reduced river flows (Killmann, 2008).

Effect on infectious organisms and vectors Infections agents like mosquitoes have a fertile ground for reproduction in warmer temperatures. These vectors carry malaria plasmodium and dengue virus and because of the warmer conditions they mature more rapidly. Climate change affects the frequency of diseases from animal species as warmer temperatures increase the reproduction of the species.

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Furthermore, mosquitoes not only reproduce more efficiently but also need to feed more frequently and their survival rate increases. Nevertheless, the distribution of vectors expands as climate changes, posing a threat to public health populations (Troge et al., 2007). Impacts of Climate Change on Cities Climate change impacts on cities can affects the social systems and urban sectors within cities. The economic activity in major cities will be affected. Temperature change will shift energy demands, requirements and costs. Urban infrastructure and built environment will be impacted by pavement damages and the cities will experience an intensified urban heat island effect (Rodriguez, 2009). Human and health safety will be affected by air quality and respiratory illnesses. Health risks for heat sensitive populations will be increased. The vulnerabilities of the urban poor will be exacerbated by heat fatalities due to poor air circulation in congested slums and lack of access to air conditioning. The displacement of urban communities due to climate change will rise and will experience habitat lose (Rodriguez, 2009). New York City and Rio de Janeiro Megacities are often located in vulnerable coast lines and they provide home to millions of residents. The improving of climate change forecast is accelerating the awareness of mitigation the impacts of drastic weather events in major cities. The population exposure to diseases, loss of lives, migration is increases in urban areas. New York City is a well developed urban system and represents a good example of how a metropolitan city experience changes in climate that affects the infrastructure and the population (Rosenzweig, 2010). Rio de Janeiro has a climate change factor that is a concern for cities near the coast line. The sea level rise related to climate change will result in a variety of impacts (e.g., flooding, sanitation issues, quality and quantity of water resources). The coast line climate change effect is
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closely related to the ocean land interface as the city of New York. Therefore, there is a relation between major coastal cities and the effect of drastic weather changes (Rosenzweig, 2010). New York City and Rio de Janeiro offer a good case for city governments to be the drivers for addressing climate change health risks. The vital role that local governments play to prepare for and mitigate the effects of climate change to the urban poors health is imperative. The local government involvement in developing a risk management plan is critical to improving the resilience of the urban poor (Rosenzweig, 2010). This research could provide additional insight as to how major cities can prepare, develop and implement a risk management framework to deal with climate change issues. Risk Management The cases examined will identify the effect of risk management and will explore the value of integrating a risk management framework such as ISO 31000. Climate events represent risks to people, organizations, infrastructure, and network systems. These risks arise from normal day-to-day, seasonal, and year-to-year variability in climate as well as regional climate differences (Climate change impacts, 2006). ISO 3100 provides a structure for managing the increased risk to cities and its residents due to climate change impacts. The Risk Management framework aims to help businesses and organizations to enumerate risks related to climate change impacts; prioritize risks that require further attention; and establish a process for ensuring that these higher priority risks are managed effectively (Climate change impacts, 2006). ISO 31000 for managing risk follows a typical plan-do-check-act cycle. The elements of the framework are described in the following figure:

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Figure 2: ISO 31000 Framework for Managing Risk (Pojasek, 2011).

Governance of Risk Management The organizations board of directors represents the center of its risk management governance structure. The board presents the mandate and commitment to risk management (Pojasek, 2011).

Design of the Risk Management Program The process of designing or planning the companys risk management program includes the following components: Understanding the organization and its context Establishing risk management policy Creating accountability associated with the Management of risk Integrating risk management into organizational processes Providing adequate resources for risk management
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Establishing internal and external communication Reporting mechanisms. (Pojasek, 2011).

Implementation of the Risk Management Program The company implements its risk management program by carrying out the elements specified during the programs design phase. This is accompanied by implementing a risk management process (Pojasek, 2011).

Monitoring and Review Management at all levels in the company should be involved in monitoring and reviewing the parts of the risk management framework that they control (Pojasek, 2011).

Continual Improvement All those involved in governance at all levels of the organization should be responsible for continually improving the risk management framework. This improvement can be driven by judicious use of the risk management process (Pojasek, 2011).

Risk Management Process ISO 31001 articulates a clear process for managing risk. Establishing context: It is important to view every risk in the context of the organization and the interests of the stakeholders.

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 Risk identification, analysis, and evaluation: The organization assesses key business risks using risk identification, analysis, and evaluation methods. Risk treatment: The company treats unacceptable risks in an effort to lower their risk threshold. Communication and consultation: The organization communicates all these activities to stakeholders in order to provide a proper level of engagement and consultation with company management. Monitoring and review: The organization carries out extensive monitoring and review to determine how its risk profile is changing over time. Further risk assessment: The organization needs to carry out additional contextual analysis and further risk assessment and treatment when appropriate (Pojasek, 2011). ISO 31000 can be used to establish a risk management policy, ensure that risk is managed properly and manage and control risk. Furthermore, it can explain how risk should be managed and controlled and provide a framework to develop risk management procedures and guides. Therefore, the risk management framework can reduce uncertainty in how to deal with climate change in the megacities by improving knowledge and understanding of risk. The selected research method and the proposed cases are further discussed in the Method section.

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V. Methods The case study method will be used in this research to examine how climate change can disproportionally affect the urban poors health (Yin, 2009). The selected research method will be used to support the hypothesis that the urban poors health risks are disproportionally affected in comparison with the rest of the population, and will follow an established multi-case study framework where two particular cases will evaluate specific types of health risks situations to this deprived urban population (Yin, 2009). Case Study Design The result from analyzing the cases involved will be applied to case study research to bring an understanding of a complex issue such as human health and climate change and can encompass experience or add strength to what is already known through previous research. It will emphasize detailed contextual analysis of a limited number of events and conditions and their relationships. The findings will follow a trend or inclination that can be verified and consequently be applied to other situations. Interviews may be used as an additional research method to further explain the evidence pertaining to the research hypothesis (Stewart & Cash, 2005). The research in this study will try to provide evidence to support the stated hypothesis. Toward this end, a logical connection will have to be found between the data and the research question that will allow conclusions to be drawn (Yin, 2009). The case study design is presented in Table 1. The first and second components of the design, the research question and hypothesis, are already defined. Table 1: Case Study Design
Case Study Design Components Application to the Research

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Research Question

How can climate change disproportionally affect the urban poor? The urban poor dont have the infrastructure and resources to deal with the effects of climate change and they are more susceptible to health risk impacts from extreme weather events. Climate change health impacts of the urban poor in New York City and Rio de Janeiro, Brazil Explanation Building in multiple case studies, cross-case synthesis, and complex time series (Yin, 2009) Construct validity, internal validity, external validity, and reliability (Yin, 2009) Articles, Climate change, urban poor and health issues lists of websites, online research documents.

Research Hypothesis

Unit of Analysis

Data Interpretation Techniques

Criteria for Interpreting Data

Physical artifacts

The case study of unit of analysis is climate change health impacts of the urban poor in the cities of New York and Rio de Janeiro, Brazil. The case study method requires the researcher to collect different types of evidence or data from multiple sources to support the research hypothesis to ensure construct validity. Evidence will be collected from a variety of sources to come to a conclusion and test the hypothesis. A literature review that includes articles, published materials by scholars, researchers, and federal and local leaders will be conducted to learn about the impacts of climate change on health. Archival records may include historical performance metrics from different

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organizations such as NGOs, Federal Governments, the World Bank and the World Health Organization. Interviews of leaders and organizations will serve to assist in gathering data (Stewart & Cash, 2009). The researcher will apply for an exemption from the committee of Human Subject on the Use of Human Subjects at Harvard University before any formal interviews are conducted. This research is unlikely to use either artifacts direct or participant observations in the process of collecting evidence. The expected sources of evidence are presented in Table 2. Sources of Evidence Table 2: Sources of Evidence

Source
Documentation

Evidence
Scientific reports, Data reports, Articles, Documentation regarding health public reports, Urban Populations, Major cities

Archival Records

Records of different cases of health issues caused by climate change among the urban poor

Interviews

Interviews with key researchers and leaders in climate change and public urban health will supplement documentation and support archival documentation

Direct Observations

None.

Participant-Observation

None.

This research will investigate the health risks associated with climate change and to determine the factors that significantly affect the urban poor.

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The collected data will be analyzed according to the research procedures outlined in Table 1: Explanation building in multiple case studies, cross-case synthesis, and complex time series (Yin, 2009). Data Analysis After collection, careful analysis of the data will follow the case study protocol. The analytical strategy will be supporting the theoretical propositions inferred in the stated hypothesis (Yin, 2009). Using the explanation building technique and comparison of the data gathered the hypothesis will hopefully strengthen its validity. After a cross-case synthesis of results an explanation will be built to add additional support (Yin, 2009). As the data is collected it will be analyzed according to the research protocols: pattern matching and explanation building (Yin, 2009). Pattern matching is a comparative analysis that looks for coinciding patterns from each case to identify evidence that will support the hypothesis. Explanation building is a special type of patterning matching and its goal is to analyze the data by building an explanation about the case, in that way supporting the hypothesis. It is mainly relevant to explanatory case studies. This form of analysis deals with creating causal links among the various forms of evidence and by that explaining what happened and why. The cross-case synthesis only applies to multiple-case studies and it pertains in this particular case as the research compares two major cities. Within this approach each case is examined as a separate study. The cases are then matched applying methods that unify the collected data in such a way that they are comparable. Complex time series is when multiple variables are present. These methods will ensure internal validity of the evidence collected (Yin, 2009).

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This research seeks to prove the vulnerability of the urban poor to health risks due to climate change. The research also seeks the viability of the implementation of a risk management framework as a valid method to mitigate the effects caused by climate change in major cities. The research will show that there are identifiable performance indicators and the conclusions will look toward a framework for measuring the impact of climate change. The research protocol that will be followed to achieve these results is shown in Figure 1. Figure 1: Research Protocol Define Design Collection of Data & Cases Resources Analyze Cross Analysis & Conclude

Initial Literature Review

Identify Cases Define Unite of Analysis Identify Interviews, Candidates & Develop Interviews

Documents & Texts Conduct Interviews

Analyze and Discuss Cases

Cross Analyze Cases Alter Hypothesis

Collect Data Construct Findings & Conclusions

Research Question & Hypothesis

Collect Evidence

Evaluate

Check Logical Consistency for Construct Validity

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Risk Management Another method that will be used to create a concise plan to major cities for preparing and mitigating the climate change effects on the urban population is the Risk Management method ISO 31000. It establishes a framework for managing risk within an enterprise system. This framework follows a typical plan-do-check-act cycle. ISO 31000 provides a set of tools for risk management, including a wide-range of root cause analysis tools. It makes clear, effective risk management offering numerous opportunities for improvement (Pojasek, 2011). The benefit of reducing risks in the worlds megacities must be greater than the cost of managing them. The research protocol is designed to ensure that the evidence is collected consistently and logically and the analysis will result in compelling and balanced conclusions. There will be specific limitations that will have to be recognized and addressed. These limitations are discussed in the following section.

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VI. Limitations of Method There are several anticipated limitations to the proposed research project. The availability of data is a major limitation for this research. Although there have been several research studies conducted by well known organizations such as the United Nation and the World Health Organization, there is not a comprehensive research on specific cities impacted by climate change health issues on the urban poor. The World Bank, for example, has done some research mostly in South-east Asia. Other limitations are bias and time and resource constraints. The researcher will have only six to nine months at his disposal to design the research framework, perform the research, analyze the data, and write the thesis. Completing the background research, the case studies, a case history, and a careful evaluation of the cities examined is an ambitious work plan for the amount of time the thesis needs to be completed. Limitations in traveling to the cities examined are also present. The researcher lives in Los Angeles, California and the time, distance, and resources to travel to the location to gather information on the topic are limited due to work constraints, money available to travel, and family obligations. Another limitation is the availability of data. The researcher has at his disposal a limited availability of resources to gather information related to the thesis topic. While information on major cities is commonly available, it may be difficult to collect sufficient data on specific health issues impacting the urban poor. Climate change is a wide topic for research and the available information in health issues affecting the urban poor may not be sufficient to collect reliable data. In addition to the above limitations the research methods present their own limitations.

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The case study method is that it provides little basis for scientific generalization (Yin, 2009). This is reduced by the multiple case study approach taken by this research. Both the case study method and the interview method allow for researcher bias to be introduced (Yin, 2009). To ensure the validity of data acquired by interviews, the researcher will use an establish interview method (Stewart & Cash, 2005) and will comply with the Harvard University Human Subjects guidelines. This early stage examination will serve as an attempt to minimize the impact of those limitations to this research. The validity of the research must be attained under certain condition where the researcher has little control and influence over the relevant variables of the research. Another limitation is the danger of the excessive researcher influence in the research process that can cause partiality in the research. This research highly depends on an environment of openness and trust. These factors must be part of the process among the participants. The research process will be undermined if any of these factors are not present. The research protocol is intended to anticipate research limitations. Furthermore, continuous efforts will be made throughout the research process to limit the impact of these limiting factors. The research protocol will help to focus the researcher on the cases and limit diversions. A preliminary timeline is presented in the following section.

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VII. Tentative Schedule Initial submission of proposal...August 6, 2012 Proposal returned for revisions........August 20, 2012 Submission of second draft of proposal......August 26, 2012 Proposal accepted by research advisorAugust 28, 2012 Thesis director agrees to serve.......October 30, 2012 Revised draft completed...February 11, 2013 Thesis director returns revised draft.......March 1, 2013 Final text approved.....April 15, 2013 Bound copy delivered to Harvard University Extension School.May 15, 2013

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VIII. Bibliography Barrios, S. (2006). Climatic change and ruralurban migration. European Commission, Joint Research CentreInstitute for Prospective Technological Studies, 60(3), 357371.

Campbell-Lendrum, et al. (2007). Global climate change: implications for international public health policy. Department of Public Health and Environment, World Health Organization, 85(3),

Climate change information: Working group I. (2005). IPCC Fourth Assessment Report: Climate Change 2007 Cambridge, United Kingdom and New York, NY. USA: Cambridge University Press.

Gardner E., et al. (2009). Study of 16 developing countries shows climate change could deepen poverty. Purdue University, 32(4), 1-3.

Haines A. (2006). Climate Change and Human Health: Impacts, vulnerability and public health. The Royal Institute of Public Health. 22(1), 34-36.

Heinzerling, L. (2007). Climate change, human health, and the post-cautionary principle. Georgetown University Law Center, (4), 3.

Human health impacts. (2010). Centre for Occupational and environmental Health Research, 53, 4-6.

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Intergovernmental Panel on Climate Change. (2007). Climate change 2007: Mitigation of climate change. Cambridge, United Kingdom: Cambridge University Press.

Jensen, M. E. (2007). Evidence and implications of recent climate change (72 ed., Vol. 3, pp. 251-298). Netherlands: Springer.

Masika R., et al. (1997). Urbanization and urban poverty: A gender analysis. Institute of Development Studies, University of Sussex, 54, 5-6.

Patz J.A., et al. (2007). Climate Change and Global Health: Quantifying a growing ethical crisis. Center for Sustainability and the Global Environment, 2-5.

Pojasek, R. B. (2008). Creating a Complete Business Management System. Environmental Quality Management (online publication). Wiley InterScience.

Pojasek, R. B. (2011). Linking sustainability to risk management. Environ. Qual. Manage., 21: 8596.

Portier C., et al. (2010). A human health perspective on climate change. In The Interagency Working Group on Climate Change and Health (4 ed., pp. 10-12). Research Triangle Park, NC: Environmental Health Perspectives and the National Institute of Environmental Health Sciences.

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Protecting human health. (2010). Lancet and University College London Institute for Global Health Commission, 373(19), 2.

Rodriguez, A., et al. (2009). Impact of climate change on health and disease in Latin America. Faculty of Medicine, Universidad Central de Venezuela, 12-15.

Rosenzweig, C. (2010). Climate change and a global city learning from new york. Environment: Science and Policy for Sustainable Development, 43(3),

Schmidhuber, J. (2012). Global food security under climate change. National Academy of Sciences, 104, 50.

Stewart, C. J. & Cash, W. B. (2007). Interviewing: Principles and Practices. New York, NY: McGraw Hill.

Urban population. (2012). Economic Commission for Latin American and, (5), 18-23.

Wang, J. (2005). Global warmings increasingly visible impacts. Environmental Defense, 12 (4).

Yin, R. K. (2009). Case study research: design and methods (4th ed.). Thousand Oaks, CA: SAGE Publications.

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