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Global Warming and Climate Change: Why the Health Sector Should be Engaged SEARO Office, New Delhi, March 2008 AJ McMichael National Centre for Epidemiology and Population Health The Australian National University Canberra Should the Health Sector Engage?

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slide1

Global Warming and Climate Change:

Why the Health Sector Should be Engaged

SEARO Office, New Delhi, March 2008

AJ McMichael

National Centre for

Epidemiology and Population Health

The Australian National University

Canberra

should the health sector engage
Should the Health Sector Engage?
  • Health risks are real … and are increasing.
  • Extreme weather events likely to increase: Could overwhelm health sector’s capacity.
  • CC jeopardises other ongoing health gains – esp. in low-income/vulnerable populations
  • (e.g. Millennium Devt Goals; HIV/AIDS pandemic; etc.)
  • 4. Health sector has, generally, been slow to recognise and respond to risk. Consequently:
    • Inadequate capacity-building (research, prevention, policy)
    • Deficient contact/engagement with other sectors
  • 5. Society has been slow to understand that threat to health is the most serious, fundamental, risk.
    • Population health is ultimate marker of ‘sustainability’
climate change health impacts and policy responses
Climate Change: Health Impacts and Policy Responses

Adaptation:Reduce impacts

Natural processes and forcings

  • Global Environmental Changes, affecting:
  • Climate
  • Water
  • Food yields
  • Other materials
  • Physical envtl. safety
  • Microbial patterns
  • Cultural assets
  • Impacts on human society:
  • livelihoods
  • economic productivity
  • social stability
  • health

Human pressure on environment

  • Human society:
  • culture, institutions
  • economic activity
  • demography

Feedback

Mitigation: Reduce pressure on environment

overview of recent cc science
Overview of Recent CC Science
  • Together, the reported GCM model runs for the 6 IPCC emissions scenarios forecast, for 2100, increases in temperature (central estimate per scenario) of 1.4-5.8 oC.
  • Most of the uncertainty reflects unknowable human futures (the scenarios); the rest is due to model uncertainties.
  • A further ~0.7 oC is ‘committed’ (on top of the 0.6oC already realised)
  • IPCC Fourth Assessment Report (2007) already looks conservative. Recent studies indicate accelerating change.
  • Political discourse in high-income countries is now starting to acknowledge need for 80+% reduction in emissions relative 2000.
climate change faster than expected in 1990s

CO2 Concentration

Av Surface Temp

Sea Level Rise (cm)

Climate Change: Faster than expected in 1990s

Solid lines = observed

  • IPCC 4 (2007) was limited to science published by early 2006
  • Subsequent research shows increasing rates of:
    • Global GHG emissions

3.3% p.a. in 2000s, vs 1.3% p.a. in 1990s

    • Temperature rise

especially in polar regions

    • Ice melt (Arctic: 40% loss since 1980, accelerating 2006-07)
    • Sea-level rise

Dashed lines = 1990s projections

Rahmstorf, Church, et al., Science 2007

1975 1985 1995 2005

intergovernmental panel on climate change wkgp2 report 2007 some key findings
Intergovernmental Panel on Climate Change, WkGp2 Report(2007):SomeKey Findings
  • Water:75-250m Africans may face water-shortage by 2020.
  • Crops:
  • Rain-fed agriculture could decline by 50% in
  • some African countries by 2020.
  • Crop yields could:
  • increase by 20% in some parts of Southeast Asia … but
  • decrease by up to 30% in Central/South Asia.
  • Glaciers and snow cover: Expected to decline, reducing supply of melt water to major regions, cities.
  • Species: 20-30% of all plant and animal species face increased risk of extinction if 1.5-2.5 oC rise.*
  • Scientific literature review of >29,000 studies of physical and biological changes in natural world: 89% consistent with accompanying warming.
climate change health

Indirect impacts

Direct health impacts (heat, extreme events, etc.)

  • Human Health:
  • Injuries/deaths
  • Thermal stress
  • Infectious diseases
  • Malnutrition
  • Mental stresses
  • Conflict, drugs, etc.
Climate Change & Health

Physical systems

(ice, rivers, etc.)

e.g. prime focus of Stern Report (UK, 2006)

Economy: infrastructure, output, growth

Climate Change

Impacts

Food yields

Biological & seasonal cycles

Wealth (and distribution); local environment; etc.

slide9

Cartogram:Emissions of greenhouse gases

Density-equalling cartogram. Countries scaled according to cumulative emissions in billion tonnes carbon equivalent in 2002. Patz, Gibbs, et al, 2007

slide10

Cartogram: (Selected) health impacts of climate change

Malnutrition > diarrhoea > malaria > floods

Density-equalling cartogram: Patz, Gibbs, et al, 2007.

WHO regions scaled according to estimated mortality (per million people) in the year 2000. Based on burden-of-disease attribution to the climate change that occurred from 1970s to 2000 (McMichael et al., 2003).

health impacts examples
Health Impacts: Examples
  • Thermal stress (esp. heat-waves)
  • Diarrhoeal disease
  • Vector-borne infectious disease
  • Dengue fever
  • Food yields: nutrition, child development
  • Disasters: damage, dislocation, displacement
slide13

Heatwave: August 2003

Land surface temperatures, summer of 2003, vs. summers of 2000-04. NASA satellite spectrometry

35,000-50,000 extra deaths over a 2-week period

slide14

Seasonal variation in daily mortality pattern, Delhi, 1991-94

60

40

Daily deaths

20

0

1jan,1991

1jan,1993

1jan,1995

slide15

Heat-related mortality, Delhi, 1991-94: Generalised additive model, with cubic-spline smoothing

Relative mortality (% of daily average)

140

120

100

Uncertainty range: 95% CI

80

0

10

20

30

40

Daily mean temperature (oC)

McMichael et al, ISOTHURM Study

slide16
Diagram of Typical Influence of Seasonal Rainfall, Surface Water, and Crowding on Cholera Occurrence, Madras region

Based on Ruiz-Moreno, Pascual, Bouma, et al, EcoHealth 2007; 4: 52-62.

Study of 26 districts, Madras Presidency, south-east India, 1901-1940.

Ro = ‘reproductive number’

Roprimary (water-borne) transmission

Rosecondary (human-to-human) transmission

human crowding effect

water

dilution effect

1.0

1.0

Flood

Shallow

Water Depth

slide17

Domestic bamboo pole holders

Found in public housing estates

KT Goh, Singapore Ministry of Health

dengue s principal vector aedes aegypti
Dengue’s principal vector: Aedes aegypti

Principal vector is female Aedes aegypti mosquito. Infected mosquito remains infective for life.

Indonesia: reported dengue cases doubled in 2007 vs. 2005.

effects of temperature rise on dengue transmission
Effects of Temperature Rise on Dengue Transmission

Shorten viral incubation period in mosquito

Shorten breeding cycle of mosquito

Increase frequency of mosquito feeding

More efficient transmission of dengue virus from mosquito to human

slide20

Global Dengue Epidemiology

1960s

Thousand-fold increase in reported incidence

1990s

Dengue fever only

DHF/DSS

Dengue007/CMH/260302

slide21

1990

2085

Estimated regional probability of dengue occurrence under medium climate change scenario:2085 vs 1990Using statistical equation derived from observations of recent distribution of disease in relation to meterological variables

Source: Hales et al. Lancet, 2002. http://image.thelancet.com/extras/01art11175web.pdf

Probability

slide22

Schistosomiasis: Northwards extension ofpotential transmission (limited by ‘freezing zone’), in Jiangsu province, due to rise in average January temperature since 1960

Freezing zone 1970-2000

Temperature change from 1960s to 1990s

0.6-1.2 oC

1.2-1.8 oC

Freezing zone 1960-1990

Baima lake

Hongze lake

planned Sth-to-Nth water canal

Yang et al, 2005: Increase in reported incidence of schistosomiasis over past decade. May reflect recent warming?

Northwards extension of “freeze line” (which limits survival of water snails) puts 21 million extra people at risk.

Yangtze River

Shanghai

slide23

Now

2030: + 0.9oC

2050: + 1.6oC

Zhou X-N, Yang G-J, et al. Potential Impact of Climate Change on Schistosomiasis Transmission in China

“Recent data suggest that schisto-somiasis is re-emerging in some settings that had previously reached the [successful disease control] criteria of either transmission control or transmission interruption. …. Along with other reasons, climate change and ecologic transformations have been suggested as the underlying causes.”

slide27

General Relationship of Temperature and Photosynthesis

100%

Photo-synthetic activity

2oC 

2oC 

0%

20o C

30o C

40o C

C Field & D Lobell. Environmental Research Letters, 2007:

A 1oC increase reduces global cereal grain crop yields by 6-10%. So, a rise of 2oC could mean 12-20% fall in global production. [Note: this estimate is higher than most others.]

slide29

Vietnam

Bangladesh

Population

climate change health impacts and policy responses30
Climate Change: Health Impacts and Policy Responses

Adaptation:Reduce impacts

Natural processes and forcings

  • Global Environmental Changes, affecting:
  • Climate
  • Water
  • Food yields
  • Other materials
  • Physical envtl. safety
  • Microbial patterns
  • Cultural assets
  • Impacts on human society:
  • livelihoods
  • economic productivity
  • social stability
  • health

Human pressure on environment

  • Human society:
  • culture, institutions
  • economic activity
  • demography

Feedback

Mitigation: Reduce pressure on environment

cc and health main types of adaptive strategies
CC and Health: Main Types of Adaptive Strategies

Public education and awareness

Early-alert systems: heatwaves, other impending weather extremes, infectious disease outbreaks

Community-based neighbourhood support/watch schemes

Climate-proofed housing design, and ‘cooler’ urban layout

Disaster preparedness, incl. health-system ‘surge’ capacity

Enhanced infectious disease control programs

vaccines, vector control, case detection and treatment

Improved surveillance:

Risk indicators (e.g. mosquito numbers, aeroallergen concentration)

Health outcomes (e.g. inf dis outbreaks, rural suicide rates, seasonal asthma peaks)

Appropriate workforce training and mid-career development

use of climate health time series data to develop a malaria early warning system botswana
Use of climate-health time-series data to develop a Malaria Early Warning System (Botswana)

Observed summer (Dec-Feb) rain

Forecast (advance- modelled) summer rain

  • Thomson M, et al. Summer rain and subsequent malaria annual incidence in Botswana.Nature 2006; 439: 576-9

Highest malaria incidence years

(versus)

Log malaria incidence

Relationship between summer rainfall and subsequent annual malaria incidence …

Lowest malaria incidence years

Summer Precipitation (mm / day)

Precipitation anomaly (mm / day)

climate change and health dual purpose of research
Climate Change and Health Dual Purpose of Research
  • Enhance Health Protection, at two levels:
  • 1. Recognition of health risks will potentiate true primaryprevention – i.e. the reduction of GHG emissions. (Which may also revitalise Health Promotion) Meanwhile ….
  • 2. Health risks already exist and more are unavoidable. So, we must develop and evaluate adaptive (secondary prevention) strategies.
slide34

Conclusion

Plenty to be worried about – but big chance to play a key role in achieving a global solution, revitalised health promotion – and true Sustainability

slide35

Climate Change & Health: ‘Core’ Categories of Research

Empirical data-based studies

Scenario-based future-health risk assessment

2.Detect

impacts

3.Estimate

current burden

4. Predictive estimation (eg, modelling)

1.Learn: CC-health relations

Past

Present

Future

Adaptive strategies

climate change and geopolitical security
Climate Change and Geopolitical Security
  • “Climate change of the order and time frames predicted by climate scientists poses fundamental questions of human security, survival and the stability of nation states which necessitate judgments about political and strategic risks as well as economic cost.”
  • Heating Up the Planet: Climate Change and Security.
  • Dupont A, Pearman G, Lowy Institute Paper 12, 2006
slide37

Deaths and DALYs attributable to Climate Change, 2000 & 2030

Selected conditions in developing countries

Deaths

Total Burden

Now (2000)

Future (2030)

Deaths (thousands)

DALYs (millions)

McMichael et al/WHO, 2004

2000

2030

slide38

Impacts, Vulnerability, Adaptations

Characteristics of exposed group

(location, wealth, resources, health status, culture, etc.)

Adaptations

Vulnerability of group

Learning

Actions in response to impact

Health Impact

Exposure

Mitigation: Reduced exposure

slide39

Projected warming, to 2100: for six future global greenhouse gas emissions scenariosIntergovernmental Panel on Climate Change (IPCC), 2007

3 of the 6 emissions scenarios

Uncertainty range: 1 standard deviation

Warming already in ‘pipeline’ from existing GHG levels (~0.6oC)

A1FI

+ 4oC

A2

1.8-4.0 oC

A1B

Warming (oC)

+ 2oC

B1

23 models (tested against recent record)

1980-99 baseline

temperature

A1T

B2

A1FI

16-21 models used for each scenario

Range of estimates for all GCM model runs of B1 scenarios emissions

No. of models

used

1900 2000 2100

6 different GHG emissions scenarios

Year

malaria in tawau sabah
Malaria in Tawau, Sabah

Source: VBDCP, MOH

global rise in dengue cases reported annually to who 1955 2005
Global rise in dengue cases reported annually to WHO, 1955-2005

925,896

1,000,000

One thousand-fold increase

800,000

479,848

600,000

295,554

400,000

122,174

200,000

15,497

908

0

1955-59

1960-69

1970-79

1980-89

1990-99

2000-

2005

Lancet 2006;368:2194

health co benefits from ghg emissions mitigation actions revitalised health promotion
Health Co-Benefits from GHG Emissions Mitigation Actions: Revitalised Health Promotion?
  • Reduce fossil fuel combustion:
    • Reduce cardio-respiratory deaths/hospitalisations from local air pollution (esp. fine particulates).
  • Low-emission urban (public) transport system:
    • Increase physical activity (walking, cycling)  reduce over-weight, improve lipid/endocrine profiles, increase social contact and wellbeing.
    • Road trauma should decline.
  • Reduce red (ruminant) meat consumption(livestock sector is major source of GHG emissions, esp. methane)
    • Reduce risks of some disease: large bowel cancer, ?breast cancer; also heart disease (meat fat content).
  • More energy-efficient housing
    • Reduce family costs, and (especially for lower-income households) reduce thermal stress – and debt-related mental stress.
tasks for policy makers
Tasks for policy-makers
  • Integrate health risk assessment into impact assessments carried out by non-health sectors
  • Understand the intrinsic uncertainties in this topic, including unavoidable uncertainties about projected future risks
  • Identify vulnerable communities and sub-populations
  • Develop and evaluate adaptive strategies/interventions to reduce both present and likely future risks to health from climate change
  • Coordinate development of policy and programs at local, national and international levels
  • Recognise need for governmental regulatory involvement as basis of societal response to this (and other) global environmental problem(s)
achieving sustainability citizens or society or global governance
Achieving Sustainability: Citizens, or Society – or Global Governance?
  • Individual citizen/consumer actions can solve ~5% of problem. (But useful contribution, and good for engagement.)
  • Large-scale (global) environmental changes need large-scale (governmental) policy changes
  • We need a Cultural Transformation (‘Third Industrial Revolution’; Sustainability Transition)
  • Global climate/envtl changes arise from systemic market failures. Government’s role is to remedy these (Adam Smith also recognised that!) ……………..
  • ‘mutually-agreed mutual coercion’