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Dr. Horacio Riojas Rodríguez MSc. Grea LItai MSc. Magali Hurtado

Research on Climatic Change and Climate Variability on Human Health in Mexico: Present and Future. Dr. Horacio Riojas Rodríguez MSc. Grea LItai MSc. Magali Hurtado Department of Environmental Health, National Institute of Public Health, Mexico. October 1 st , 2008. The Context.

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Dr. Horacio Riojas Rodríguez MSc. Grea LItai MSc. Magali Hurtado

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  1. Research on Climatic Change and Climate Variability on Human Health in Mexico: Present and Future Dr. Horacio Riojas Rodríguez MSc. Grea LItai MSc. Magali Hurtado Department of Environmental Health, National Institute of Public Health, Mexico October 1st, 2008

  2. The Context. • Previous studies. • Diagnostic on the effects of Climate Change on human health in the mexican population • Impact of Climate Variability on the Incidence of Malaria in Chiapas and Dengue in Veracruz. • Scenarios of Health Risk, associated with Climate Change in the Region Olmeca (Veracruz). • Research in Health and Climatic Change. Challenges • Networking

  3. Pathways by which Variability Climate Change and affects health Moderating influences Health effects Regional weather changes Temperature- related illness and death T Variability and Climatic Change Extreme weather- related health effects Contamination pathways Transmission dynamic • heatwaves Air pollution-related health effects • extreme weather • temperature Water -and food borne diseases • precipitation Vector-and-rodent borne diseases Research Needs Adaptation Source: Adaptation from Patz et al. 2000

  4. The Context • Epidemiological Transition • Chronic diseases • Infectious diseases (vector borne diseases) • Demographic Transition • Increase in life expectancy • Increase in urban population • Inequity social and ecological vulnerability • Health Sector: Linkage between Health and Climate is relatively new

  5. MAIN CAUSES OF DEATH IN MEN, 2003 Mortality Deaths Rate (100,000) 1. Ischemic heart disease. 27,978 54.0 2. Diabetes Mellitus 26, 730 51.6 3. Cirrhosis and other chronic liver diseases 20,478 39.5 4. Cerebrovascular diseases 12,604 24.3 5. Obstructive pulmonary disease 10,286 19.8 6. Assault (homicide) 8,660 16.7 7. Acute respiratory infections 7,346 14.2 8. (Motor vehicle accidents (traffic) 7,289 14.1 9. Nephritis and nephrosis 5,535 10.7 MAIN CAUSES OF DEATH IN WOMEN, 2003 EPIMIDEMIOLOGICAL TRANSITION * Source: Institute for Statistics and Information and Director General of Health Information. Secretary of Health, Mexico.

  6. PAST, PRESENT AND FUTURE Estimate the future potential health impacts Vulnerability associated with climate change in Mexico and its local effects on health Effects of Temperature and Ozone on hospital admissions in the Cd. Of Mexico from 1998 to 2007: Vulnerable Population Groups CURRENTLY Retrospective studies States Municipalities States Ecologycal regions Diagnostic study on the effects of climate change on human health in the Mexican population Impact of climate variability on the incidence of Malaria in Chiapas Climate change scenarios to assess their potential impacts on health in Mexico Scenarios of health risk, associated with climate change in the Region Olmeca (Veracruz) 2005 Impact of climate variability on the incidence of dengue in Veracruz 2007 2002 Time

  7. Contribution to the Mexico’s Third National Communication to the United Nations Framework. Convention on Climate Change

  8. Diagnostic on the Effects of Climate Change on Human Health in Mexican Population • Objective: Conducting a national diagnosis of the potential impact of climate change on human health from the selection of causes of illness and death in the scientific literature have been reported related to climate and that are relevant in terms of public health for Mexico. Source: Mexico’sThird National Communication to the United Nations Framework on Climate Change

  9. Health Problems in Mexico • Vector-borne diseases -Dengue -Chagas disease -Malaria • Heat strokes • Scarcity and water quality • Air pollution in large cities • Hydro meteorological Phenomena Source: Mexico’sThird National Communication to the United Nations Framework on Climate Change

  10. Heat Waves in the States with Extreme Temperatures The coefficients of correlation and time series analysis showed in the states of Baja California and Sonora, a positive and statistically significant heat waves with the temperature, the maximum and minimum temperature. Source: Mexico’sThird National Communication to the United Nations Framework on Climate Change

  11. Acute Diarrheal Disease in Areas with High Poverty Source: Mexico’sThird National Communication to the United Nations Framework on Climate Change

  12. Classic Dengue Morbidity in Endemic States Most states are considered endemic, show an increase in dengue cases. Classic dengue morbidity Mexico 1998-2004 Rate by 100,000 hab. In the states of Colima, Guerrero and Veracruz this increase is related (significantly) with the temperatures.. Source: Mexico’sThird National Communication to the United Nations Framework on Climate Change

  13. Impact of Climate Variability on the Incidence of Dengue and Malaria in Veracruz and Chiapas • Objective: Assess the influence of temperature, precipitation and El Nino-Southern Oscillation (ENSO) on the transmission of dengue and malaria in Mexican municipalities, representing different climates.

  14. Design of the study • A retrospective ecological study was conducted, using time-series in which we compiled the weekly reported cases of dengue and malaria, the weather and climatic parameters: temperature, rainfall and sea-surface temperature (SST) of the 2 municipalities of the State of Veracruz and State of Chiapas.

  15. GULF OF MEXICO Veracruz San Andres Tuxtla Pantelho and Chenalho Pacific Ocean Dengue Study Area: Veracruz San Andrés Tuxtla and Veracruz Study Period: 1995 - 2003 Dependent Variable: Weekly reported cases of dengue Climate variables: Temperature (including min. and max) Precipitation Sea-surface Temperature (SST) Malaria Study Area: Chiapas Pantelho and Chenalho Study Period: 1990 - 2000 Dependent Variable: Weekly reported cases of malaria Climate Variables: Temperature (observed, min. and max ) Precipitation Sea-surface Temperature (SST)

  16. Statistical Analysis • Trends and seasonal variations. • Cross-correlation coeficients between autoregressesd dengue series, with different lag times. • Autoregressive Integrated Moving Averages (ARIMA) • Normality and heteroskedasticity • White noise tests • Seasonality • Logaritmical transformation

  17. RESULTSDengue in San Andres Tuxtla and Veracruz

  18. SST Date Weekly dengue cases Weekly dengue cases SST Hurtado et al. TMIH 2007 SST and weekly dengue cases of San Andres Tuxtla Weekly dengue cases

  19. SST and weekly dengue cases of Veracruz Weekly dengue cases SST Date Weekly dengue cases Weekly dengue cases SST Hurtado et al. TMIH 2007

  20. Adjusted coefficients between the natural logarithm of weekly cases of dengue in San Andres Tuxtla and climate variables The weekly cases of dengue are increased by 46% when the SST rises by 1° C with a delay of 16 weeks, the minimum temperature 1°C at the same week and rainfall 1cm 3, three weeks earlier. *Precipitation: Lag of 3 weeks **SST: Lag of 16 weeks Hurtado et al. TMIH 2007

  21. Adjusted coefficients between the natural logarithm of weekly cases of dengue in Veracruz and climate variables The weekly cases of dengue are increased by 42% when the SST rises by 1° C with a delay of 20 weeks, the minimum temperature at the same week rises 1°C and rainfall 2 weeks earlier, rises 1cm 3. *Precipitation: Lag of 2 weeks **SST: Lag of 20 weeks Hurtado et al. TMIH 2007

  22. 2003 Weekly dengue cases Prediction Prediction Weekly dengue cases Prediction Weekly dengue cases San Andres Tuxtla DenguePredictions Date

  23. 2003 Weekly dengue cases Prediction Veracruz- DenguePredictions Prediction Weekly dengue cases Weekly dengue cases Prediction

  24. RESULTSMalaria in Chiapas

  25. 30 20 15 28 Weekly malaria cases 10 Casos de malaria SST 26 5 24 0 1990w1 1992w1 1994w1 1996w1 1998w1 2000w1 2002w1 2004w1 SST Weekly malaria cases Casos de malaria TSM SST and weekly Malaria Cases in Pantelho and Chenalho

  26. Adjusted coefficients between the natural logarithm of weekly cases of Malaria in Pantelho and Chenalho and climate variables Observed temperature: Lag of 7 weeks Precipitation: Lag of 3 weeks Sea Surface Temperature: Lag of 10 weeks

  27. Scenarios of health risk, associated with climate change in the Region Olmeca (Veracruz) • Objective: Conducting a regional pilot study to develop and evaluate risk scenarios on human health caused by climate change in the state of Chiapas and Veracruz, including the components of health, environment and vulnerability.

  28. Design of the study Ecological study with a retrospective analysis of time series of monthly records of dengue fever, acute diarrheal diseases and acute respiratory infections in the municipalities of the “Region Olmeca” of the state of Veracruz in relation to temperature and rainfall and considering the component of vulnerability

  29. Study Area • Study area: Región Olmeca, Veracruz • Study Period : 1995 -2005 • Health outcome: monyhtly cases of • Dengue • Acute diarrheal diseases • Acute Respiratory Infection • Climate variables: • Temperature (max. and min) • Precipitation

  30. Factors of vulnerability • Region affected by the events in health. • Susceptible population: children under five years and people older than 65. • Limits or thresholds of temperature events in health. • Identification: -geographical factors -physical factors -demographic factors -population factors that determine the vulnerability of a region. September 25, 2008

  31. Statistical analysis • Trend and seasonal variations in the graphs of time series • Using sine and cosine functions to adjust for seasonality • Negative Binomial Regression Analysis: -Model with sine-cosine, population and time variable with appropriate lags -Autocorrelation test on the residual model -Lags of the residual model -Repeat residuals generation of the model, till to eliminate its autocorrelation

  32. RESULTSDengue, ARI and ADD in Region Olmeca

  33. History trend of temperature (San Juan Evangelista)

  34. Relative Risk (RR) of weekly dengue in Municipalities of the Region Olmeca 1995 – 2005

  35. RR of weekly dengue cases of Acute Diarrheal Diseases in children (<5yrs), associated with changes in maximum temperature and precipitation, Municipalities of the Región Olmeca 1998– 2005

  36. RR of weekly cases of ARI in children ( <5 yrs) associated with change in minimum temperature and precipitation. Municipialities of the Region Olmeca 1998 – 2005

  37. Research in Health and Climatic Change. Challenges HEALTH SECTOR • Identify health risk associated with climate change by region including vulnerability using climate change scenarios. • Vector borne diseases • Climate and pollution in large cities. Interation between temperature and ozone • Disasters and new conditions for diseases • Strength the link between research and policy • Build Early Warning Systems and link them with the Epidemiological Surveillance System • Include health aspectDisss into the Local Adaptation Plans • Impact on the health system

  38. Research in Health and Climatic Change. Challenges LINK WITH OTHER SECTORS AND DISCIPLINES • Multidisciplinary and interdisciplinary projects • Continuos assessment from climatologists • Driven forces of health risk generation (deforestation, food scarcity, water) • Cost estimation on health • Permanent assessment from the Climatic Researhers • Environmental and Social Vulnerability. • Ecosystemic approach • Social inequity

  39. 2050 2100 Time 2020s 2050s 2080s Level Age group (years) 0-4 5-14 15-29 30-44 45-59 60-69 70+ 1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 3 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 3 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 3 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 3 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 3 1.7 1.7 1.7 1.7 1.7 1.7 1.7 Scenarios of Climate Change and Health Scenarios of greenhouse gas emissions Global climate models: Generate series of maps of climate prediction at a future Model impact on health: To estimate the changes in relative risks of specific diseases 2020s 2050s 2080s CONACYT Conversion into public health measures: Early Warning Systems Adapted from: McMichael et al. 2004

  40. Networking • Meeting on climate variability and change, risk associated with the weather. IAI • Regional Consultation to assess capabilities, gaps and priorities for Research on Climate Change and Poverty Reduction in Latin America and the Caribbean. IDRC • INE/SEMARNAT (Advice on technical analysis of studies for the Third National Communication in Mexico to the United Nations Framework Convention on Climate Change) • International Ecohealth Forum. IDRC, FIOCRUZ, IAEH. • CRN (Collaborative Research Network). Interamerican Institute for Climate Change Research • Cuba, Bolivia, Panama, Venezuela (“The effect of global change on human health and food vulnerability”) • Science Center of the Atmosphere/UNAM • Mexico City and Veracruz Government.

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