Context

This Summary for Policymakers presents key findings from the Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX). The SREX approaches the topic by assessing the scientific literature on issues that range from the relationship between climate change and extreme weather and climate events (‘climate extremes’) to the implications of these events for society and sustainable development. The assessment concerns the interaction of climatic, environmental, and human factors that can lead to impacts and disasters, options for managing the risks posed by impacts and disasters, and the important role that non-climatic factors play in determining impacts. Box SPM.1 defines concepts central to the SREX.

The character and severity of impacts from climate extremes depend not only on the extremes themselves but also on exposure and vulnerability. In this report, adverse impacts are considered disasters when they produce widespread damage and cause severe alterations in the normal functioning of communities or societies. Climate extremes, exposure, and vulnerability are influenced by a wide range of factors, including anthropogenic climate change, natural climate variability, and socioeconomic development (Figure SPM.1). Disaster risk management and adaptation to climate change focus on reducing exposure and vulnerability and increasing resilience to the potential adverse impacts of climate extremes, even though risks cannot fully be eliminated (Figure SPM.2). Although mitigation of climate change is not the focus of this report, adaptation and mitigation can complement each other and together can significantly reduce the risks of climate change. [SYR AR4, 5.3]

Introduction

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults in the Western world, accounting for nearly 25% of all leukemias with an estimated annual age-adjusted incidence of 3 per 100,000 persons in the United States. The median age at diagnosis is approximately 70 years, with 81% of the patients diagnosed when aged ≥ 60 years. Under the World Health Organization (WHO) classification, CLL is a B-cell neoplasm and the entity T-cell CLL has been reclassified as T-cell prolymphocytic leukemia (PLL). Recent data from the Surveillance, Epidemiology, and End Results (SEER) cancer statistics indicate that 5-year survival of patients with CLL is 73%.

Significant changes in the understanding and management of CLL have occurred in the last two decades. With the advent of newer treatment modalities, such as purine analogs and monoclonal antibodies, substantial improvements have been made in achieving complete responses (CR), with a proportion achieving molecular remissions and durable responses. Despite the advances in the treatment of patients with CLL, the majority of patients will relapse after primary therapy.

Diagnosis

The current diagnosis of CLL is based on minor modifications of the criteria originally proposed by the National Cancer Institute (NCI) (Table 5.1). A bone marrow evaluation is no longer required for diagnosis but is useful to determine the extent and pattern of involvement and to clarify the etiology of cytopenias.

The morphology and immunophenotype are adequate for diagnosis and to distinguish CLL from other disorders (Table 5.2).

Almost every day new scientific evidence suggests that the climate is changing due to human action and will continue to change over our lifetimes and those of the next generations. It would be inconceivable that humans, as the most adaptable of species, would not adapt to this challenge. But the state of science about how and whether we adapt and the cost and consequences of such adaptations is nowhere near that of science of atmospheric change. Of course, societies adapt all the time to diverse risks and challenges. So, drawing on theoretical and empirical research, we should be able to discern how adaptation to a changing climate will proceed. Herein lies the impetus for this book.

Until recently, adaptation has been somewhat sidelined, or some would say, actually tabooed, in the climate change discourse. Many argue that investing in adapting to the impacts distracts from the major task of mitigating the causes of anthropogenic climate change by reducing greenhouse gas emissions. Others are convinced that adaptation will automatically happen, once environmental changes become visible. But the time for adaptation action has arrived and the demand for information and rigorous science in this area is increasing exponentially. The funding for adaptation research is growing, and so are the questions that need to be addressed. Many of these questions are directly related to the process of adaptation, and to one overarching question: can we live with climate change?

Introduction

Look out the window and assess the weather. If it is hot, change into a lighter shirt. If it is raining, take an umbrella. This is adaptation to changing weather.

Adaptation to changing climate is a different matter. The climate may change either slowly or rapidly, and the changes may be irreversible and impossible to predict with any accuracy. The simple principles of adapting to changing weather begin to break down when the climate changes. In the context of climate change the options for adaptation may involve relocating homes, moving cities, changing the foods we grow and consume, seeking compensation for economic damages, and mourning the loss of our favourite place or iconic species. The difference between adapting to changing weather and adapting to a changing climate lies both in the time-frame and in the significance of the changes required. Moreover, the consequences of not adapting to climate change may be far more serious than not adapting to changing weather.

There are two aspects of climate change that have profound significance for adaptation. First is the growing recognition that the weather is no longer ‘natural’. While the weather varies and changes seasonally as part of the natural rhythm of our lives, climate change, as it is presently observed, is now beyond all reasonable doubt driven by human activities. This induces a feeling, for some, that the world is sullied, and nature itself is at an end (McKibben, 1999).

Introduction

Climate change adaptation is increasingly seen as both a necessary and urgent response to a changing climate, and much research is being undertaken to identify barriers and constraints to successful adaptation. Most discussions focus on limited adaptive capacity as a constraint to adaptation to climate change, and emphasise technological, financial and institutional barriers (Grothmann and Patt, 2005; Yohe and Tol, 2002). It is presumed that once these external barriers are removed or overcome, society will be able to successfully adapt to a changing climate. It has, however, also been suggested that adaptation to climate change may be limited by the irreversible loss of places and identities that people value (Adger et al., 2009a, 2009b). Adger et al. (2009b) argue that social and individual characteristics may likewise act as deep-seated barriers to adaptation. Such perspectives raise important questions about the role that individual and societal values play in adapting to climate change: is adaptation a successful strategy for maintaining what is valued? How do adaptation measures taken by some affect the values of others? In the case of value conflicts, whose values count?

Values are, in effect, an interior and subjective dimension of adaptation. In contrast to systems and behaviours that can be objectively measured and observed, values subjectively influence the adaptations that are considered desirable and thus prioritised.