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Indiana Mid-America Public Health Training Center (IN MAPHTC)
1st Annual National Public Health Week Conference
Sheraton City Center
Indianapolis, Indiana
April 8, 2008
Public Health Impacts of Climate Change:
Stephen J. Jay MD
“Whoever would study medicine aright must learn of the following
subjects. First he must consider the effect of each of the seasons of the
year and the differences between them. Secondly he must study the warm
and the cold winds, both those which are common to every country and
those peculiar to a particular locality…”
Hippocrates, “Airs, Waters, Places” 400 bc
“Fragile Planet”
Video: http://www.gefweb.org/interior.aspx?id=20244:
A project of the Global Environment Facility (GEF), in collaboration
with the United Nations Environment Programme (UNEP), the World
Bank, Global Initiatives, and Artists’ Project Earth. Fuses musician
Sting’s original “Fragile” vocal soundtrack with Latin sounds of
Rhythms del Mundo and images of melting glaciers, forest fires and
other visual reminders of climate change on our “Fragile Planet.”
Frequently Asked Questions: Sources:
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Intergovernmental Panel on Climate Change (2007):
http://www.gcrio.org/ipcc/ar4/wg1/faq/index.htm
National Oceanic and Atmospheric Administration (NOAA)
Global Warming:
http://lwf.ncdc.noaa.gov/oa/climate/globalwarming.html
NASA. Goddard Space Flight Center. Global Change Master
Directory:
http://gcmd.gsfc.nasa.gov/Resources/FAQs/glob_warmfaq.html
U.S. Environmental Protection Agency (EPA). Global Warming
and our Changing Climate:
http://www.epa.gov/climatechange/fq/index.html;
http://www.epa.gov/globalwarming;
http://yosemite.epa.gov/oar/globalwarming.nsf/UniqueKeyLookup
/SHSU5BUN59/$File/gw_faq.pdf
U.S. Climate Change Science Program.
http://www.climatescience.gov/
Hengeveld HG, Bush E, Edwards P: Climate Change Science.
Meteorological Service of Canada. 2002: http://www.mscsmc.ec.gc.ca/saib/
Union of Concerned Scientists. Global Warming:
http://www.ucsusa.org/global_warming/science/global-warmingfaq.html?print=t
National Resources Defense Council (NRDC):
http://www.nrdc.org/globalWarming/f101.asp
Selected Annotated Bibliography.
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Note: This selected bibliography on global warming and public health was based on a
Medline (OVID) search (from 1950-February 2008) on March 8, 2008. The search terms:
“Global Warming/Greenhouse Effect) AND Public Health” produced 175 articles; the
terms “Climate Change AND Public Health produced 145 articles.
Annotation was based on abstracted or paraphrased text from the original sources.
Recurring acronyms: CC (climate change); GHG (greenhouse gases); GW (global
warming); ID (Infectious Diseases); PH (public health); VBD (Vector-borne diseases).
The references were identified and annotated by S.J. between March 5 and April 5, 2008.
The bibliography is grouped under general headings: Peer-reviewed scientific journal
articles/editorials; U.S. Government Agency or Congressional Reports; NGO science
based NGO reports; Newspapers/magazine articles; a separate section has selected papers
by scientists and others who are highly critical of the premises of the majority of
scientists regarding the links between global warming/climate change and degradation of
the environment and human health.
Peer-reviewed Scientific Journals
Agnew B. Planet Earth, getting too hot for health? Bull WHO 2001;79(11):1090-2.
Abstract not available.
American Academy of Pediatrics. Pediatrics, Official Journal. Global Climate Change
and Children’s Health: Committee on Environmental Health. Pediatrics 2007;120;114952. Originally published online: Oct 29, 2007. Available online at:
http://www.pediatrics.org/cgi/content/full/120/5/1149
There is broad consensus that the Earth is warming at an accelerating rate and human activities (primarily the burning
fossil fuels (>90% probability) is the main cause of warming. The impact of these changes will produce numerous
health effects in children, who are a vulnerable group.
Children’s Health effects include: (adapted from McMichael et al and Haines and Patz)
 Extreme Weather: Increased susceptibility to injury/death during floods, hurricanes, tornadoes. Posttraumatic
stress, loss of caregiver, disrupted education, displaced populations
 Increased Temperature; Ecosystem disruption (land and water); Rising sea level, receding coastlines:
Damage to lung function and growth including exacerbations of asthma and allergies from increased air
pollution; Increased waterborne, foodborne illness, diarrhea, dehydration, malnutrition, increased vectorborne
infections; Disruptions of crop yield and fresh water supply, displaced populations, unstable social/political
landscape: malnutrition, vitamin deficiencies and resultant medical complications; threatens survival.
Addressing these challenges will require: 1. decrease in manmade GHG emissions; 2. Mitigation (increase GHG sinks;
(R&D of GHG capture and sequestration technology); 3. Adaptation: Strengthen PH infrastructure, disease
surveillance, and vaccination programs; improve access to health care, disaster preparedness and education.
Anderson K. Global warming health warning. Austr Nursing J 2007;15(3):10
Abstract not available.
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Anderson KV. Readers respond to “global warming may be a graver public health threat
than nuclear war. Part 1—getting your attention”. (Comment). Comment on
MedGenMEd 2006;8(1):71. Medgenmed (Computer file): Medscape Gen Med
2006;8(2):33.
Anonymous. Climate scientists advise White House on global warming. J Environ Health
2001;64(2):46-7.
Abstract not available.
Anonymous. Short-term improvements in public health from global-climate policies on
fossil-fuel combustion: an interim report. Working Group on Public Health and FossilFuel Combustion. (Review-55 ref). Lancet 1997;350(9088):1341-9.
This group focused on potential short- term impacts of global climate change on public health. Models of energy
consumption, carbon emissions, and associated atmospheric particulate-matter (PM) concentration were studied under
two scenarios: business as usual (BAU) and hypothetical climate policy scenario. Findings: By 2020 700,000 avoidable
deaths will occur annually as a result of additional PM exposure under the BAU forecasts compared with the climate
policy scenario. From 2000-2020 the cumulative impact on PH related to the difference in PM exposure could total 8
million deaths globally. In the US alone the avoidable deaths annually from PM in 2020 would equal in magnitude
deaths associated with HIV or all liver diseases in 1995. Conclusion: The short-term PH impacts of reduced PM
exposures associated with GHG reductions are likely to be substantial even under the most conservative set of
assumptions.
Anonymous. Malaria, in second place, sees fewer victims, but greater difficulty of
control. With climate, including global warming, as complications. UN Chronicle
1999;36(1):19.
Article discusses malaria risks and prevention. Risks include: changes in land use related to road building; mining,
logging, and agricultural and irrigation projects; global climatic change, disintegration of health services, armed
conflicts and mass movements of refugees.
Atapattu S. The public health impact of global environmental problems and the role of
international law. Am J Law & Med 2004;30:283-304.
Health experts are becoming more and more concerned about potential impact on public health if no precautionary
measures are taken to deal with these global environmental problems. This paper focuses on the role that international
law can play in relation to the public health impact of global environmental problems. Reviews the UN Charter that
first addressed importance of finding solutions to health problems. The Constitution of the WHO in 1946 referred to
health as a fundamental right. The Universal Declaration of Human Rights in 1948 said: “Everyone has the right to a
standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing
and medical care and necessary social services…” (WHO Const. pmbl.) The UN again endorsed the right to health in
the International Covenant on Economic, Social and Cultural Rights in 1967. This is the first time an international
human rights instrument recognized health as a stand alone right.
Environmental instruments and public health: While human rights instruments were slow to link health and the
environment, international environmental instruments have been more forthcoming. Principle 1 of Stockholm
Declaration (1972) said: “man has the fundamental right to freedom, equality and adequate conditions of life, in an
environment of a quality that permits a life of dignity and well-being…” Principle 1 of the Rio Declaration (1992) is
more explicit: “Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy
and productive life in harmony with nature.” Agenda 21, adopted at the Rio conference devotes a chapter to human
health. The Plan of Implementation adopted at the World Summit on Sustainable Development in 2002 emphasizes the
importance of public health.
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Today, the single most challenging environmental issue facing the international community is global warming. In 1885
the Vienna Convention for the Protection of the Ozone Layer was adopted based on the Precautionary Principle,
followed by the Montreal Protocol on Substances that Deplete the Ozone Layer two years later. This is the first time in
an international convention the Precautionary Principle was adopted in a treaty governing an environmental problem.
The Role of International Law: An important function of international law instruments is to protect human health and
the environment. The UN FCCC (Rio conference 1992) referred to earth’s climate as a common concern of humankind.
The objective was to stabilize GHG concentrations in the atmosphere at levels to prevent dangerous anthropocentric
interference with the climate system. Adverse effects including changes in the physical environment and human health.
Principles used: protect climate system for future generations; responsibility principle; the precautionary principle;
sustainable development and the principle of cooperation.
Framework Convention lays down general principles but Kyoto Protocol adopted in 1997 specific obligations.
Implementation became difficult when President Bush announced the US would not ratify the Protocol.
Other environmental treaties with a public health focus include: Convention on Environmental Impact Assessment in a
Transboundary Context of 1991; Convention on Long-range Transboundary Air Pollution of 1979; Convention for the
Prevention of Pollution from Ships; Basel Convention on the Control of Transboundary Movement of Hazardous
Wastes and their Disposal; Rotterdam Convention on Prior Informed Consent Procedure for Certain Hazardous
Chemicals and Pesticides in International Trade; The Cartegena Protocol on Biosafety; Protocol on Water and Health
(1999).
Right to a healthy environment: Given the close relationship between health and the environment (and, in turn, human
rights and the environment), it is not surprising that a right to a healthy environment seems to be emerging under
international law. Many environmentalists view the emerging “health” right with alarm since an anthropocentric
approach could undermine the rights of other species. For the purposes of protecting public health at least, it is
submitted that the recognition of a right to a healthy environment would be invaluable.
Bailis R, Ezzati M, Kammen DM. Greenhouse gas implications of household energy
technology in Kenya. Environ Sci & Technol 2003;37(10):2051-9.
Authors studied GHG emissions under conditions of actual use in 19 Kenyan households. Findings: Charcoal stoves
have larger emissions than woodstoves. Policy implications and options for environment and public health are
discussed.
Ballester F, Michelozzi P, Iniguez C. Weather, climate, and public health. (Editorial) J
Epidemiol Community Health. 2003;57:759-60.
The knowledge regarding the relationship between environmental temperature and health has ancient roots. A “U” or
“V” shape graphic describes mortality rates with lower rates on days with temperature between 15-25C rising
progressively as average temperatures become hotter or colder. Cardiovascular and respiratory deaths are strongly
linked to changes in temperature, especially in the elderly. Several public health actions have been proposed to prevent
negative health effects of temperature: education programs; social measures; sanitary measures. The definition of
public health programes to prevent heat and cold related mortality needs further research to clarify: 1. population at
risk; 2. lag time of effect; 3. effect on CV and Respiratory morbidity; 4. role of respiratory infections; 5. significance of
other meteorological variables (humidity, wind, precipitation). More epidemiological research is needed.
Bartra J, et al. Air pollution and allergens. (Review-57 ref) J Invest Allergol & Clin
Immun 2007;17 Suppl 2:3-8.
Air pollution is a growing public health problem. Air pollutants such as diesel exhaust particles (DEPs) have a direct
and indirect effect on the individual and exert important actions on aeroallergens. Physical contact of pollutants such as
DEPs changes the structure/function of allergens and facilitates their penetration into human airways. CC may cause
plants to vary pollination calendar; advance and prolong pollination period; and increased CO2 concentrations and
temperatures may cause species extinction. Allergic sensitization among exposed population to non-native species may
occur. There is sufficient scientific evidence on the effect of air pollution upon allergens indicating that exposure to
allergens may increase and allergenic activity may increase as air pollutants and aeroallergens interact.
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Bates DV. Climate change and health (comment) Comment on: CMAJ 2005;172(4):5012. CMAJ 2005;173(4):339; author reply 340, 2005, Aug 16.
Beggs PJ, Bambrick HJ. Is the global rise of asthma an early impact of anthropogenic
climate change? Environ Health Perspectives 2005;113(8):915-919.
Although the etiology of asthma is complex, the recent global rise in asthma could be an early health effect of
anthropogenic climate change.
Beniston M. Climatic change: possible impacts on human health. Swiss Med Weekly
2002;132(25-26:332-7.
Direct effects of climate change: hygrothermal stress; atmospheric pollution; water quality and availability; while
indirect effects include potential for spread of vector-borne diseases outside their current ranges. Possible response
strategies to decrease adverse effects of CC on human health are presented. (A review with 23 ref.)
Bernard SM, Ebi KL. Comments on the process and product of the health impacts
assessment component of the national assessment of the potential consequences of
climate variability and change for the United States. Environ Health Perspectives
2001;109 (suppl 2): 177-84. Available online at:
http://ehpnet1.niehs.nih.gov/docs/2001/suppl-2/177-184bernard/abstract.html
Important paper from Johns Hopkins: Environmental Health Sciences. In 1990 Congress charged the U.S. Global
Change Research Program to conduct periodic national assessment of the potential impacts of climate variability and
change on all regions and select economic/resource sectors of the U.S. In 2000 a team of experts collaborated on a
health impacts assessment that became the first National Assessment’s analysis of the potential impacts of climate on
human health. Outcomes included: identification of vulnerable populations, adaptation strategies, research needs and
data gaps. This report is published in 5 articles in this issue. The article by Bernard and Ebi is organized into the
following headings: The U.S. National Assessment; Methods for assessment of environmental risks to human health;
the human health impacts assessment, and Conclusions.
In each of the 5 articles in this issue authors tried to elucidate scientific uncertainties, describe some adaptation
measures currently in place of available, and identify future research needs and data gaps. The authors recognize that
“historically, two important variables drive public health strategies: the level of scientific and technical knowledge and
the content of public values and popular opinion.” An important role for scientists will be to explain the role of
uncertainty in scientific process and the role of uncertainty in policy development.
Berns DS, Rager B. Emerging infectious diseases: a cause for concern (see comment)
(Review-22 ref). Comment in: Isr Med Assoc J 2000;2(12):916-8. Israel Med Assoc J:
Imaj. 2(12):919-23.
The 20th century began with hope of elimination of ID but closed with reemergence of many deadly ID. Alarming is
emergence of ID: HIV; hantavirus; Lyme disease; hemolytic uremic syndrome (E. coli); Rift Valley fever, Dengue
hemorrhagic fever, malaria, cryptosporidiosis, and schistosomiasis. Some reasons: permissive use of antibiotics;
industrial use of antibiotics, demographic changes; societal behavior patterns, changes in ecology, global warming,
inability to deliver minimal health care and the neglect of well-established public health priorities.
Bettcher D, Lee K. Glossary: Globalisation and public health. J Epidemiol Community
Health 2002;56:8-17.
Author from WHO. Focuses on broad idea of the relationship between globalization and public health. Provides an
excellent Glossary of key terms used in the published literature in an effort to clarify confusing language, definitions
and terms.
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Author provides a brief section in the Glossary: “Global climate change and health”. In the latter 20 th century
humankind became aware of the need for a more collective approach to tackle urgent environmental problems.
Interconnectedness of human societies has been intensified by globalization. The 1989 Intergovernmental Panel on
Climate Change studied effects of increased emissions of anthropogenic emissions of GHG such as CO2, methane and
nitrous oxides on global warming. Worldwide political concern led to negotiation and entry into force in 1992 of the
FCCC and subsequent negotiation in 1997 of the Kyoto Protocol. The links between climate change and public health
were detailed in a joint report by the WHO, World Meteorological Organization and UN Environment Programme
which concluded that global warming and CC due to increased GHGs will probably lead to shifts in disease patterns
and vector distribution, deaths from heat waves, increased trauma due to floods and storms, and exacerbation of food
shortages and malnutrition in many regions of the world. Global environmental issues raise bioethical concerns in that
one of the principal tenets of “principle based ethics” is the concept of “non-maleficence” to do not harm.
Betts K. How charcoal fires heat the world. Environ Sci & Technol 2003;37(9):160A161A.
Abstract not available.
Blashki G, Butler CD, Brown S. Climate change and human health—what can GPs do?
Australian Fam Phy 2006;35(11):909-11.
Recently most respected peer-reviewed medical journals in Australia, US, and Britain have called for urgent action to
reduce climate change. The chief scientist of the UK has described CC as “the most sever problem that we are facing
today—more serious even than the threat of terrorism.” What does this have to do with general practice?
Blashki G, McMichael T, Karoly DJ. Climate change and primary health care. Aust Fam
Phys 2007;36(12):986-9.
Review with 21 ref. CC and rising average global temperatures threaten to disrupt the physical, biological, and
ecological life support systems on which human health depends. The author reviews CC related injuries, diseases and
other health effects: heat stress; extreme weather; fires; ID outbreaks due to changing patterns of mosquito borne and
water borne disease; poor nutrition from reduced food availability and affordability; psychosocial impact of drought;
the displacement of communities. Primary care givers have an important role in preparing for and responding to CC
related threats to human health.
Blendon R. Hurricane preparedness: One-third on high risk coast will refuse evacuation
order. Harvard School of Public Health (2007, July 26). Available online at ScienceDaily
(Jul. 26, 2007) http://www.sciencedaily.com/releases/2007/07/070724113927.htm
Complete survey and charts with figures available at:
https://apps.sph.harvard.edu/publisher/upload/news/pressreleases/files/Hurricane_2007_Survey_landing_page_overall_results.doc
Survey of people in high risk hurricane areas found: 31% of residents said if government officials said they had to
evacuate due to a major hurricane this season, they would not leave. This is an increase from 2006 when 23% said they
would not evacuate.
Blumer C. Climate change and public health: our priorities (comment). Comment on:
Aust J Public Health 1995 19(6):543-5. Aust & New Zealand J Pub Health
1996;20(1):103-4.
Abstract not available.
Boeuf pG. Ocean and bio-medical research (French). J de la Soc de Biol 2007;201(1):512.
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Oceans are threatened in part by GW. We have to manage and protect these to maintain ecosystems, stocks and
biodiversity; otherwise we could lose one million ocean species by 2050.
Bransford KJ, Lai JA. Global climate change and air pollution: common origins with
common solutions. JAMA 2002;287(17):2285.
Fossil fuel combustion causes climate change and air pollution; In U.S. fossil fuel combustion accounts for 98% of
anthropogenic emissions of CO2, the predominate Greenhouse gas. A common solution to CC and air pollution is
reduction in use of fossil fuels as an energy source.
Global climate change with GW will increase ground level ozone which causes human disease: decreased pulmonary
function in healthy adults depending on exposure concentration and duration. Long-term exposure with summer ozone
levels of 80ppb or more for at least 1 hr daily may cause adult-onset asthma in otherwise healthy, nonsmoking persons.
Ozone exposure may cause: asthma attacks, ER visits, hospitalizations; increased use of asthma medications; greater
morbidity and mortality in persons with pre-existing pulmonary or CV diseases. Children are at higher risk. Other
pollutants are known to cause human disease: fine particles; NOx; Sox.
Brown VJ. Of two minds: groups square off on carbon mitigation. Environ Health
Perspect 2007;115(11):A546-9.
Abstract not available.
Browner C. Foreword: environmental policy: principles for the next generation of
protection. Am J Law & Med 2004;30(2-3):115-7.
Abstract not available.
Burns WCG. Climate change and human health: the critical policy agenda. JAMA
2002;287(17):2287.
Primary international response to global climate change is the 1992 UN Framework Convention on Climate Change
(UNFCCC), ratified by 186 nations. UNFCCC goal: “stabilize greenhouse gas concentrations in the atmosphere at a
level that would prevent dangerous anthropogenic interference with the climate system…” Because of resistance of
U.S. and others to binding targets, UNFCCC asked parties to “aim” to return their emissions to 1990 levels –at an
unspecified time in the future. When data indicated that parties were failing to voluntarily reduce their emissions and
projects were the possible increase by 40% form 1990 levels by 2010, the 3 rd conference of UNFCCC parties drafted
the Kyoto Protocol in 1997 calling for reduction of emissions by at least 5% below 1990 levels (2008-2012) for
industrialized countries. The Bush administration rejected this, instead announcing other initiatives: additional funding
for research and largely voluntary efforts to reduce the ratio of GHG emissions to economic output. The World
Resources Institute predicted that US emissions under the Bush plan would grow by an additional 14% or more over
the next decade. Even if Kyoto Protocol is fully implemented it is a small down payment on the job of mitigating
climate change: GHG emissions must be reduced by 60-70% below 1990 levels to stabilize GHG emissions at twice
preindustrial levels (a critical threshold according to many researchers). Strategies to adapt to GW were recognized by
the 7th conference of UNFCCC and the EU and others agreed to collectively contribute $410 million annually by 2005
to a preliminary fund for adaptation initiatives. Effective mitigation of CC will require the participation of the U.S.
Camp SL. Population pressure, poverty and the environment. Integration 1992;32:24-7.
Authors conclude the population growth (took 9800 years to reach 1 billion; will take 11 years to reach the 6 th billion.)
is outstripping Earth’s carrying capacity. Each year 40-50 million acres of forest are cut down and soil erosion and
desertification threaten 1/3 of the total land surface which is home to 1/5 of the population. The cost of universal family
planning is only US$9 billion.
Campbell-Lendrum D, Corvalan C. Climate change and developing-country cities:
implications for environmental health and equity. J Urban Health 2007;84(3 Suppl):110917.
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CC is an emerging threat to global public health. It is inequitable: risks high to poor who have contributed least to the
GHG emissions. There are clear opportunities for improving PH and cutting GHG emissions through policies related to
transport; urban planning; building regulations and household energy supply. These influence global health burdens:
800,000 annual deaths from urban air pollution; 1.2 million deaths from road accidents; 1.9 million deaths from
physical inactivity; 1.5 million deaths from indoor air pollution. More input from the health sectors is needed to
contribute to a preventive approach to local and global environmental sustainability, urban population health, and
health equity.
Cifuentes L, Borja-Aburto VH, Gouvela N. et al. Assessing the health benefits of urban
air pollution reductions associated with climate change mitigation (2000-2020): Santiago,
Sao Paulo, Mexico City, and New York City. Environ Health Perspectives 2001;109
(Supple 3): 419-425. Available online at: http://ehpnet1.niehs.nih.gov/docs/2001/suppl3/419-425cifuentes/abstract.html.
Similar conclusions to Cifuentes et al 2001 in AAAS Science’s Compass. Adopting GHG mitigation policies is
estimated to have significant improvement in air pollution morbidity and economic loss.
Cifuentes L, Borja-Aburto VH, Gouvela N. et al. Hidden health benefits of greenhouse
gas mitigation. Science’s Compass: Policy Forum: Climate Change. AAAS. Science
2001;293(5533):1257-59.
Actions taken to reduce the long-term build up of GHG-reductions in burning fossil fuels—can yield powerful,
immediate benefits to PH by reducing adverse effects of local air pollution. Deaths from air pollution are ranked as one
of the top ten causes of disability by WHO. In 1997 WHO and World Resources Institute (WRI) estimated that about
700,000 deaths are related to air pollution and that about 8 million avoidable deaths will occur worldwide by 2020.
This study evaluated the reductions in adverse health effects that might be achievable over two decades in Mexico City,
NY City, Santiago, Chile, and Sao Paulo, Brazil which have combined population of 45 million. Adoption of GHG
mitigation technologies would reduce particulate matter and ozone concentrations by about 10%, avoiding 64,000
premature deaths; 65,000 cases of chronic bronchitis; and 37,000,000 person-days of restricted activity or work loss in
these 4 cities by 2020. Implication: For every day that policies to reduce fossil-fuel combustion emissions are
postponed, deaths and illness related to air pollution will increase.
Coombs A. Climate change concerns prompt improved disease forecasting. Nature
Medicine 2008;14(3). Available March 21, 2008 online:
http://www.nature.com/nm/journal/v14/n1/full/nm0108-3.html
A growing body of evidence suggests CC may influence the distribution of devastating illnesses such as malaria and
heat stroke (Nature 2005;438, 310-17). GW could cause an increase of 45-70% in the number of people exposed to
dengue fever worldwide (Lancet 2002;360:830-34) and a 1C increase in temperature could lead to an 8% increase in
incidence of diarrhea (Lancet 2000;355:442-450. West Nile fever, malaria, and other ID will be affected by CC induced
changes in ecosystems which affect distribution of vectors such as mosquitoes, rodents, ticks, etc.
In the U.S., the National Oceanic and Atmospheric Association and NASA are the primary funders of projects that
explore how human health and global warming might relate. Experts believe the US. NIH needs to dedicate funds to
research on the impacts of climate on health-and to solutions. There has been controversy over reports on October 2007
that the Bush administration had censored Dr. Gerberding, director of the US CDC, on the topic of possible new
funding for the use of remote sensing to assist in quantifying the links between CC and human health. Gerberding’s
testimony was apparently cut from 12 to 6 pages by the White House. Gerberding’s deleted testimony described how
some areas of the Midwest and Northeast might experience more heat-related illnesses and heat waves. The censored
text also mentioned that areas in the northern part of the US will probably bear the brunt of increases in ground-level
ozone and airborne pollutants.
Currie BJ, Brewster DR. Childhood infections in the tropical north of Australia. (Review53 ref) J Paediatrics & Child Health 2001;37(4):326-30.
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With global warming infectious disease among Aboriginal children living in remote communities may increase.
Curry J. Judith Curry. Interview by Paul D Thacker. Environ Sci & Tech 2006;40(1):8-9.
Davis DL and Working Group on Public Health and Fossil-Fuel Combustion. Short-term
improvements in public health from global-climate policies on fossil-fuel combustion: an
interim report. The Lancet. 1997;(9088);350:1341-49. Available online:
http://www.sciencedirect.com/science
Most public health assessments of climate-control policies focus on long-term impacts of global change; this working
group combined models of energy consumption, carbon emissions, and associated atmospheric particulate-matter
(PM_) concentration under different forecasts. The authors predicted that by 2020, 700,000 avoidable deaths will occur
annually as a result of additional PM exposure. From 2000-2020 the cumulative impact on public health related to the
difference in PM exposure could total 8 million deaths globally (90% CI 4.4-11.9 Million). In the U.S. the avoidable
deaths from PM in 2020 (without change in climate change policies would equal deaths associated with human
immunodeficiency diseases or all liver diseases in 1995.
De Man JC. Worldwide changes in the environment and public health. (Comment)
(Dutch). Comment on Ned Tijdschr Geneeskd 2006;150(32):1788-93. Nederlands
Tijdschrift voor Geneeskunde 2006;150(46):2575.
Dessai S. Heat stress and mortality in Lisbon Part II. An assessment of the potential
impacts of climate change. Int J Biometeorology 2003;48(1):37-44.
Global CC will have an adverse effect on public health. In Lisbon an empirical-statistical model was developed to
quantify the climatic risks of heat-related mortality (1980-98) and project to 2020-50/ Annual heat-related death rates
are estimated to increase from between 5.4 and 6/100,000 for 1980-1998 to between 5.8 and 15.1 for the 2020s. By the
2050s the potential increase ranges from 7.3 to 35.6.
Desapriya EB. Climate change and health (comment) CMAJ. See Young K, 2005.
Diaz JH. The public health impact of global climate change. Fam Community Health
2004;27(3):218-229.
Reviews GHGs (CO2; methane; nitrous oxide; chlorofluorocarbons (CFCs) and perfluorocarbons (PFCs); sulfur
hexafluoride); GW; Precipitation effects; polar meltdown; rising sea levels; ocean temperature oscillations; Ozone
depletion (by CFCs); increasing tectonic and volcanic activity.
Climate change may cause public health consequences: heat waves, wildfires, air pollution, water wars, crop failures,
emerging infectious diseases, environmental refugees, coral reef destruction, and commercial fishery disruption.
 Heat waves: heat and heart related morbidity/mortality; 1995 >500 deaths Chicago; 2003 Western
Europe: >3000 died, mostly cardiac-relate4d among infants, disabled and elderly.
 Drier weather: increased fires, displaced residents, smoke inhalation; injuries and deaths; Wildfires
burned >5million acres in AZ, CA, CO, ID, NM: 10 deaths; $2billion cost
 GHG trapping: deterioration of air quality, visibility with more seasonal asthma
 Droughts: crop failure with malnutrition/famine in developing nations
 Warm/wet conditions: more fungal and arthropod-borne disease
 Flooding: more waterborne and zoonotic disease epidemics
 Rainer weather from El Nino in CA: increased hospitalization in females with viral pneumonia;
also waterborne outbreaks, giardiasis and cryptosporidiosis.
Potential microbial agents from CC induced infectious disease outbreaks: Waterborne: Cryptosporidium, Cyclospora,
Isopora; viruses; Giardia, Vibrios, Campylocbactor, Salmonella and Shigella. St. Louis Encephalitis; West Nile virus,
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dengue, yellow fever, malaria, plague; leptospirosis. From 1975-2002 CC associated infectious disease epidemics
killed about: 5,000 in US, Latin America; Western India and East Africa.
Planning responses to CC and its PH consequences: Deficiency in PH infrastructure must be corrected. Active steps to
CC and PH effects:
1. Acknowledgement of CC and commitment to reduction in GHG
2. conservation of energy and development of renewable energy resources
3. Prepare for costal storm surges, flooding
4. Improved drinking water filtration
5. Improved surveillance of global weather and geologic (tectonic and volcanic) activity
6. Improved sentinel animal surveillance for environmental changes and vector-borne zoonotic ID
7. Better arthropod and rodent vector control
8. Environmental tort litigation
Reviews private citizen energy consuming strategies; involvement of some industries in reducing GHG, PH measures
to mitigate impacts; Environmental and regulatory measures; community advocacy.
Diaz JH. Global climate changes, natural disasters, and travel health risks (Review-23
ref). J Trav Med 2006;13(6):361-72.
Accurate predictions of the true public health outcomes of global climate change are confounded by several effect
modifiers including human acclimatization and adaptation, contributions of natural climatic changes, and conflicting
atmospheric models of CC. Temporal relationships between environmental factors and human health outcomes have
been identified and may be used as criteria to judge causality of associations between human health outcomes of CC.
Travel physicians are obligated to educate their patients about known PH outcomes of CC.
Diaz JH. Should we be concerned about global warming? (Review-28 ref). J Louisiana
State Med Soc 2006;158(6):278-7.
There is uniform consensus in the international scientific community that earth is warming from a variety of climatic
effects, including cyclical re-warming and the cascading effects of GHG emissions to support human activities.
D’Souza RM, Becker NG, Hall G, et al. Does ambient temperature affect foodborne
disease? Epidemiology. 2004;15(1):86-92.
This study examined associations between temperature and salmonellosis notifications, and compared these
associations for 5 Australian cities. Log-linear models describing monthly salmonellosis notifications in terms of
calendar time and monthly average temperatures were fitted over the period 1991 to 2001 for each city. The long-term
trend showed an increase in salmonellosis notifications in each of the 5 cities and a plausible biologic pathway suggests
that higher ambient temperatures are a cause of higher salmonellosis notifications. Findings have implications for GW.
Dwight RH, Semenza JC, Baker DB, et al. Association of urban runoff with coastal water
quality in Orange County, CA. Water Environ Res 2002;74(10):82-90.
The results indicate that urban river discharge is a primary source of Southern California’s coastal water pollution and,
as a result, swimming at beaches near rivers may pose a significant public health risk. The strong association found
between precipitation and water pollution may be relevant to studies of potential health effects associated with climate
change.
Eaton L. A hot issue. Nursing Times 2001;97(15):28-9.
Abstract not available.
Ebi KL, Paulson JA. Climate change and children. (Review-57 ref) Ped Clin North Amer
2007;54(2):213-26.
12
CC is increasing the burden of climate-sensitive health determinants and outcomes worldwide. Children are particularly
vulnerable to these health outcomes because of their potentially greater exposures, greater sensitivity to certain
exposures, and their dependence on caregivers.
Ebstein B. Readers respond to “global warming may be a graver public health threat than
nuclear war. Part 1—getting your attention.” (Comment) Comment on: MedGenMed
2006;8(1):71. Medgenmed(computer file): Medscape Gen Med 8(2):33, 2006
Edwards P. Climate change, air pollution and your health. Can J Pub Health
2001;92(3):supppl 1-24 following 200.
Abstract not available.
El’piner LI. The assessment of a risk to public health within the framework of global
climate warming. (Russian) Gigiena I Sanitariia 2002;7:42-5.
Abstract not available.
Environmental Health Update. Environ Health. September 2001:46-47.
A committee of 11 top U.S. Climate scientists, including 7 members of NAS one of whom is a Nobel-Prize winner
provided a report to President Bush: Climate Cjhange Science: An Analysis of Some Key Questions”. The Report
reviews global warming over past 100 yrs, warming attributable to human activity, predictions for the 21 st century.
Report calls for more research to reduce uncertainties in climate change science. “We don’t know precisely how much
of this rise to date is from human activities…” Average global temperature will rise between 2.5 and 10.4 F (1.4-5.8C)
by end of century. The committee agreed with the conclusions of the Intergovernmental Panel of Climate Change
(IPCC) report that GW over the past 50yrs is likely the result of increases in GHG, particularly CO2. This report for the
President was completed in one month to facilitate U.S. discussions internationally regarding climate change.
Epstein PR. West Nile virus and the climate. J Urban Health 2001;78(2):367-71.
It is unknown how WN virus was introduced to the U.S. But climatic conditions that amplify disease that cycle among
urban mosquitoes, birds, and humans are warm winters and spring droughts. The extreme weather conditions
accompanying long-term climate change may also be contributing to the spread of WN virus in the U.S. and Europe.
Feachem RG, Medlin CA. Health is wealth. Nature 2002;417(6890):695.
Abstract not available.
Fields S. Underground fires surface. Environ Health Perspect 2002;110(5):A234.
Abstract not available.
Fields S. Great lakes: resource at risk (see comment) Comment in: Environ Health
Perspect 2005;113(3):A148-9. Environ Health Perspect 2005;113(3):A164-73/
Foster WP, Connolly J, Bazzaz F, Epstein P. Production of allergenic pollen by ragweed
(Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. (See comment:
Ann Allergy Asthma Immunol. 2002 Mar; 88(3):251-2. Ann Allergy Asthma Immunol.
2002; 88(3):279-82.
A doubling of the atmospheric CO2 concentration stimulated ragweed-pollen production by 61% (p=0.005) There may
be significant increases in exposure to allergenic pollen under the present scenarios of global warming.
13
Frumkin H. Urban sprawl and public health. Pub Health Rep. 2002;117(3):201-17.
Abstract not available.
Frumkin H, Hess J, Luber G, et al. Climate Change: The public health response. Am J
Public Health 2008;98:435-445.
Excellent review from US CDC, National Center for Environmental Health (170 ref) There are known, effective public
health responses for many of the impacts of climate change on human health, but the scope, timeline, and complexity of
CC are unprecedented. The authors propose a PH approach to CC based on the essential public health services and
extending to clinical and population health services and emphasizing the coordination of government agencies (federal,
state, and local), academia, the private sector, and NGOs.
Potential health effects of CC: 1. injuries/fatalities related to severe weather/heat waves; 2. ID related to changes in
vector biology, water, and food contamination; 3. allergic symptoms from increased allergen production; 4. respiratory
and CV disease from worsening air pollution. The WHO estimates that by 2000 CC produced 150,000 excess deaths
per yr.
Key principles in PH relate to CC: Prevention (primary, secondary, tertiary). Primary prevention corresponds to
“mitigation” e.g. slow CC by reducing GHG emissions. Secondary and tertiary prevention corresponds to “adaptation”
e.g. prepare for effects of CC to reduce disease burden. These activities are called Public Health Preparedness which
often occurs in the face of scientific uncertainty (Precautionary Principle: 1998 Wingspread Conference). Risk
Management, hazard analysis, health impact assessment are key tools for scientists and decision-makers. Cobenefits:
reducing GHG emissions for controlling CC also improves air quality and reduces disease and death. A broad PH
approach that accounts for health benefits provide support for evidence-based CC strategies. Economics: maximizing
health at the lowest cost and investing in public health strategies as a means of avoiding downstream costs are
important principles. No action on CC may produce enormous costs. Ethical issues: autonomy, beneficence,
nonmaleficence and justice are relevant in guiding PH response to CC. PH ethics includes 3 traditions: utilitarianism,
liberalism, and communitarianism—all provide rationale for addressing CC.
Ten Essential Services of PH (developed in 1994) provide a framework for addressing CC: 1. monitor; 2. diagnose; 3.
inform; 4. mobilize partnerships; 5. develop policies/plans to support communities; 6. enforcer laws/regs
7. link people to personal health services; 8 ensure competent public and personal health care workforce; 9. Evaluate
effectiveness, accessibility, quality; 10. Research.
Complexity is a cardinal feature of CC and systems thinking are critical and tools such as dynamic modeling
technology must be used. An effective PH response to CC is critical; science-based decision making, informed by PH
ethics will help manage uncertainty and optimize health, environmental, and economic outcomes. The Essential
Services of PH are a useful framework for planning and implementing a PH response.
Gajadhar AA, Allen JR. Factors contributing to the public health and economic
importance of waterborne zoonotic parasites. (Review 37 ref) Vet Parasitology
2004;126(1-2):3-14.
Authors discuss trends in global warming and CC and potential for concurrent rise in waterborne disease outbreaks due
to parasites. Impacts of technology and globalization on transmission of zoonotic waterborne zoonotic parasites are
discussed, including effects of large-scale agricultural practices, rapid transportation of goods and widespread
movement of individuals and animals.
Geddes A. Infection in the twenty-first century: predictions and postulates. J Antimicr
Chemo 2000;46(6):873-7.
Lecture in honor of the late Paul Garrod. Discusses emergence and prevalence of ID, the necessity for discovering
therapies to treat them and major influences on their course in the 21 st century: global warming; biological
warfare/terrorism; dissemination of infections, including those caused by resistant pathogens, by travelers and certain
untreatable zoonotic diseases.
14
Gewin V. Disease control: virtual plagues get real. Nature 2004;427(6977):774-5.
Abstract not available.
Gill E, Guest C. The flood, the Hague and the mosquito. Aust & New Zeal J Pub Health
2001;25(1):98-9. (Letter)
Greenough G. McGeehin M, Bernard SM et al. The potential impacts of climate
variability and change on health impacts of extreme weather events in the U.S. Environ
Health Perspect 2001;109 (suppl2):191-198. Available online:
http://ehpnet1.niehs.nih.gov/docs/2001/suppl-2/191-198greenough/abstract.html.
Climate change may alter the frequency, timing, intensity, and duration of extreme weather related deaths and injuries,
directly or indirectly. Secondary effects from changes in ecologic systems and public health infrastructure occur.
Impacts depend on vulnerabilities and recovery capacities of the natural environment and local population. Variables
include: building codes; warning systems, disaster policies, evacuation plans, and relief efforts. Future research should
focus on improving climate models to project trends and improve public health preparedness and mitigation.
Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of
the full health impacts and will assist in planning and resource allocation.
Griffiths J. Shaping a sustainable future. J Roy soc of Health 2007;127(5):209-10.
No abstract available.
Groves MG. Public Health education of veterinarians and veterinary students for the
future. (Review-0 ref). J Am Vet Med Assoc 2000;217(12):1831-3.
Abstract not available.
Gubler DJ, Reiter P, Ebi KL, et al. Climate variability and change in the U.S.: Potential
impacts on vector-and rodent-borne diseases. Environ Health Perspectives
2001;109(supplement 2):223-233.
Climate change is likely to affect the transmission patterns of VBD pathogens but more research is needed to clarify the
interactions of weather variables and the diseases they affect. Major epidemics in the U.S. will be unlikely if the public
health infrastructure is maintained and improved.
Guidotti TL. Atmospheric change: health/ecological linkages. (See comment). Comment
in: Environ Int 2003;29(2-3):351. Environ Int 2003;29(2-3):359-64.
Ecosystem health studies describe the mechanism and assess the potential to threaten or enhance human health.
Haigh N. The environment for the next generation. J Roy Soc Health 1995;115(1):44-7.
Abstract not available.
Haines A. Sustainable energy, economic growth and public health. (Review-20 ref). Med,
Conflict & Survival 2001;17(1):56-62.
Dramatic economic growth over the past 50 yrs has been accompanied by widening inequalities worldwide in wealth and energy consumption, diminished life-expectancy in some countries, and deteriorating
indices of environmental sustainability, including loss of bio-diversity. The experience of some developing
countries shows that favourable indicators of health and development can accompany a low output of
15
greenhouse gases. It is unclear whether contemporary political and social systems can deliver improved
human development without increased use of fossil fuels and other resources.
Hales S, Woodward A, Guest C. Climate change in the South Pacific region: priorities for
public health research (see comment) Comment in: Aust N Z J Public Health
1996;20(1):103-4. Australian J Public Health 1995;19(6):543-5.
Abstract not available.
Hales S, de Wet N, Maindonald J, Woodward A. Potential effect of population and
climate changes on global distribution of dengue fever: an empirical model. Lancet
2002;360:830-34.
In 1990, almost 30% of the world population, 1.5 billion people, lived in regions where the estimated risk of dengue
transmission was greater than 50%. With population and climate change projections for 2085, we estimate that about 56 billion people (50-60% of the projected global population) would be at risk of dengue transmission, compared with
3.5 billion people, or 35% of the population, if climate change did not happen. Conclusion: Climate change is likely to
increase the area of land with a climate suitable for dengue fever transmission, and that if no other contributing factors
were to change, a large proportion of the human population would then be put at risk.
Hancock T. Future directions in population health. Can J Pub Health 1999;90 Suppl
1:S68-70.
The long-term health of the population will be influenced by major forces in the next century, including environmental
and economic issues. Environmental changes: climate change; resource depletion; ecotoxicity and reduced biodiversity;
and toxic environmental chemicals. But the most profound threat is economic growth to the extent that it undermines
environmental and social sustainability. We need a new form of capitalism, one that simultaneously increases
environmental, social, economic and human capital, if population health is to be maintained in the 21 st century.
Hay SI, Cox J, Rogers DJ, et al. Climate change and the resurgence of malaria in the East
African highlands. (See comment- Nature 2002;420(6916):627-8.)Nature
2002;415(6874):905-9.
There is debate whether anthropogenic climate change is exacerbating the malaria problem, especially in areas of high
altitude where P. falciparum transmission is limited by low temperature. The IPCC has concluded there is likely to be a
net extension in the distribution of malaria and increase in incidence within this range. The authors raise doubt and
suggest that claimed associations between local malaria resurgences and regional changes in climate are overly
simplistic.
Holton WC. Trusting in a better future: the global environment facility. Environ Health
Perspect 2000;108(7):A316-9
The Global Environmental Facilty (GEF) was created in 1991 as a mechanism for international cooperation in funding
grants to address concerns in four areas of the global environment: biological diversity; climate change; international
waters, and ozone layer depletion. To date >500 projects have been funded with over $2 billion of GEF funds and
another $5 billion leveraged from public and private sources, including $2 billion in matching funds from developing
countries.
Hunt G. Climate change and health (editorial comment) Nursing Ethics 2006;13(6):5712.
Author decries the relative lack of acknowledgement among national government health policy makers; health care
delivery organizations, health care professional bodies, and the nursing profession of the human predicament of CC.
Recommends: 1. Research into long-term impact of CC on need for nursing care; 2. Urge governments and
16
international agencies to act now to mitigate and prepare for the enormous impact of GW on health; 3. Urge all bodies
involved in nurse education to put “climate change and health” on the curriculum.
Israil A, Balotescu C. Effects of changes in global climate on human activity and
implications for public health. (Review—Romanian). Bacteriologia, Virsulogia,
Parazitologia, Epidemiologia 2004;49(1-2):13-22.
Abstract not available.
James WP. Food quality and human nutrition. (Review-21 ref). Ciba Foundation
Symposium 1993;175:80-82.
New nutritional analyses suggest current trends in production of food are inappropriate for the health of most of the
world’s populations. 4 deficiency problems: iodine, Vit A and Iron deficiency and protein energy malnutrition affect 2
billion children and adults. Most major non-infective public health issues throughout the world are nutritionally related.
Global warming will exacerbate these problems, but effective dietary change with less animal production could release
land which could be used more efficiently.
Jollands N, Bernier RM, Golubiewski N. The climate’s long-term impact on New
Zealand infrastructure (CLINZI) project-a case study of Hamilton City, New Zealand. J
Environ Man 2007;83(4):460-77.
Infrastructure systems and services are vulnerable to changes in climate. Historical climate data and 4 scenarios were
modeled for impact of CC on water supply and quality, transport, energy demand, public health, and air quality.
Hamilton’s infrastructure systems demonstrated greater responsiveness to population changes than to gradual CC.
Jones J. Mother Nature’s disasters and their health effects: A literature review. (Review28 ref) Nursing Forum 2006;41(2):7887.
Author provides a nurse’s perspective on health impacts of disasters including: Volcano eruptions; Hurricanes;
Earthquakes and Floods. Specific injuries and illnesses are summarized.
Jutro PR. Biological diversity, ecology, and global climate change. (Review-22 ref).
Environ health Perspect 1991;96:167-70.
Worldwide climate change and loss of biodiversity are issues of global scope and importance that have recently
become subjects of considerable public concern. The perceived threat lies in the potential to disrupt ecological
functioning and stability rather than from any direct threat that may pose to human health. Over the past 5 years the
international scientific community and public have become aware of the implications of atmospheric warming. Human
activities are currently responsible for a species loss rate that is the most extreme in millions of years. In the case of
global warming and reduction of biological diversity, man is affecting nature in an unprecedented fashion, on a global
scale and with unpredictable and frequently irreversible results.
Kalkstein LS. Lessons from a very hot summer. The Lancet; 1995;346 (8979):857-59.
In summer 1995 in Chicago more than 500 people perished from heat-related causes; Philadelphia had 75 deaths. A
NOAA disaster team was dispatched to American cities to investigate heat-related morbidity and review options for
prevention.
The impact of global warming is difficult since it is difficult to assess a population’s ability to adapt to gradual climate
change. But death rates increase sharply during hot weather and the frequency and intensity of heat waves will increase,
according to most climate models-so the risk of additional heat-related deaths and illnesses is likely to increase
substantially. Large cities such as Shanghai and New York will experience several thousand extra health-related deaths
annually by the middle of the 21st century. Impacts greatest in mid-latitude cities and among the poor. A pressing
17
requirement is and adequate public health surveillance system to alert the public and city agencies that dangerous
weather is coming.
Kanestrom I. Climatic changes in Scandinavia-consequences for public health
(Norwegian). Tidsskrift for Den Norske Laegeforening 1999;119(3):388-90.
Describes the implications of increased GHG for human health.
Kennedy D. Going it alone. (Editorial) Science 2001;293:1221.
“The agreement on carbon emissions targets miraculously reached in Bonn on 23 July 2001 left the U.S. right where
President Bush apparently thinks it should be: all alone on climate change.” Kennedy urges Congress to create pressure
by creating new authorities where necessary for promoting reductions in greenhouse gases, promoting science and
improved energy policy. “We are now undertaking a vast experiment with Earth’s climate. We’re not doing it to test a
hypothesis or achieve a result, and it doesn’t have a design. We’re doing it because we can’t help it. But since we are
doing it, we can at least start behaving like good experimenters: Collect the data carefully, examine the background
factors that have taken us to where we are, and prepare ourselves for mid-course modifications in the protocol if the
need for that becomes clear.” Firmer U.S. commitments would help persuade the rest of the world that the U.S.,
despite its isolation from the treaty nations, at least believes there is a problem.
Khasnis AA, Nettleman MD. Global warming and infectious disease (Review-59 ref).
Arch Med Research 2005;36(6):689-96.
Global warming has serious implications for all aspects of human life, including ID. GW will cause changes in the
epidemiology of ID. The ability of mankind to react or adapt is dependent upon the magnitude and speed of the change.
Kizer KW. Lessons learned in public health emergency management: personal
reflections. Prehospital & Disaster med 2000;15(4):209-14.
Ten forces promoting increase in natural and technological disasters: 1. global warming; 2. population growth; 3.
decreased biodiversity with ecological fragility; 4. deforestation and loss of natural habitat for animal species, with
greater overlap in human and animal habitats, human exposure to animal pathogens; 5. increased technological
development (especially in developing countries, with immature safety programs; 6. globalization and increased
population mobility; 7. sub-national religious and ethnic conflicts with potential for large scale displacement of
populations; 8. collapse of several major countries with unraveling of social order; 9. rise of terrorism; 10. dramatic
advances in science and technology of computing, communications, biotechnology and genomics.
Ten lessons learned relative to public health aspects of emergency management: 1. planning pays; 2. a bad situation can
be made worse by inappropriate responses; 3. most life saving interventions will occur before the disaster happens and
immediately afterwards by local action; 4. PH emergency management is not a democratic process; 5. psychological
impacts are usually greater than anticipated; 6. communications are vital but are often the weak link; 7. Collaboration
essential; 8. Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9. Never assume
anything; 10. Post-event evaluation is important and must be coordinated.
Knowlton K, Rosenthal JE, Hogrefe C, et al. Assessing ozone-related health impacts
under a changing climate (see comment) Comment in: Environ Health Perspect
2005;113(2):A86-7; author reply A87. Environ Health Perspect 2004;112(15):1557-63.
Only recently have models become available that can assess impact of CC on O3 concentrations and health effects at
regional and local scales that are relevant to adaptive planning. We assessed changes in O3-related impacts on summer
mortality resulting from CC alone and with climate change superimposed on changes in O3 precursor emissions and
population growth. Considering CC alone (31 county New York metropolitan area) there was a median 4.5% increase
in O3 related acute mortality. Adding O3 increases with CC yielded similar results. When population growth was
included in projections, absolute impacts increased substantially. This modeling framework provides a potentially
useful new tool for assessing the health risks of CC.
18
Kole LA. As the planet heats, is watchful waiting the best we can do? JAAPA
2001;14(8):7-8.
Abstract not available.
Kovats S, Patz JA, Dobbins D. Global climate change and environmental health:
proceedings of the 1997 annual conference of the Society for Occupational and
Environmental Health (Review-7 ref). Intern J Occ & Environ Health 1998;4(1):41-52.
Abstract not available.
Kolodynski J., Malinowska A. Impacts of climate change on infectious disease.
Wiadomosci Parazytologiczne. 2002;48(1):29-37. (Review: 48ref Pol.)
Authors discuss consequences of climate change in the distribution and seasonality of vector-borne diseases and effects
of transmission of imported tropical diseases in Europe.
Kovats RS, Campbell-Lendrum D, Matthies F. Climate change and human health:
estimating avoidable deaths and disease. Risk Analysis 2005;25(6):1409-18.
Human population health has always been central in the justification for sustainable development but nearly invisible in
the UN FCCC negotiations. Current science indicates that CC will contribute to global disease burden through
increases in: diarrhoeal disease, VBD, malnutrition, health impacts of extreme weather and climate events. The use of a
standardized and established methodology has been developed to quantify the impact of CC in relation to different
GHG emission scenarios. All health risk assessments are necessarily biased toward conservative best-estimates of
health effects that are easily measured. Global, regional, and national risk assessments can take no account of
irreversibility, or plausible low-probability events with potentially very high burdens on human health. There is no
“safe limit” of CC with respect to health impacts as health systems in some regions do not adequately cope with current
climate variability. Current scientific methods cannot identify global threshold health effects in order for policymakers
to regulate a “tolerable” amount of CC. More research to reduce the potential impacts of CC on health, including
development of improved methods for quantitative risk assessment is needed.
The large uncertainty about the future effects of CC on human health should be a reason to reduce GHG emissions, and
not a reason for inaction.
Kovats RS, Hanes A, Stanwell-Smith R. et al. Climate change and human health in
Europe. BMJ 1999;318(7199):1682-1685.
Europe has warmed in recent decades and changes in climate warming and rainfall patterns may have significant and
wide ranging impacts on health: thermal stress; and distribution and seasonality of vectorborne diseases, and food and
water related diseases. Societies will need to adapt to minimize adverse effects on health and society. Monitoring health
indicators: surveillance of diseases sensitive to climate should be developed to detect and respond to impacts of climate
change on human health.
The potential impact of a global climate change on human health has been identified as a priority for research and
action in the next century. Climate change will not affect human health in isolation but will do so simultaneously with
other ecological and demographic changes. A heat wave (summer of 1976) occurs every 310 yrs under current climate
but may occur every 5-6 yrs by 2050. Heat wave in 1995 caused 16% increase in mortality: London (137 excess deaths
compared with seasonal average). In 1987 a heat wave in Athens caused 2,000 extra deaths. Coastal flooding in central
Europe recently left 200,000 people homeless and killed 100. Long term mental health effects, including suicide, after
flooding have been reported. Increased risk of problems with water purification and sewage disposal, toxic waste, and
communicable diseases (leptospirosis) occur after flooding.
Limiting emissions of greenhouse gases agreed in Kyoto under the United Nations convention on climate change are
likely to have little effect on the projected rises in temperature within the next 50 yrs. Adapting will have to include:
19
strengthening public health programmes, including surveillance; vaccination programmes for diseases such as tick
borne encephalitis.
The WHO-European Centre for Environment and health working group on climate change for human health has 4
priorities for surveillance during climate change in Europe: Camplyobacter spp; Cryptosporidium parvum; Malaria;
Tick borne encephalitis.
Potential difficulties in forecasting impacts on public health should not be an excuse to delay precautionary action to
reduce greenhouse gas emissions in view of inadequate progress made in international negotiations on climate change.
Kovats RS, Haines A. Global climate change and health: recent findings and future steps.
(See comment) Canadian Med Assoc J. 2005;172(4):501-02. (See comments in several
issues of 2005 CMAJ)
The author is at London School of Hygiene and Tropical Medicine and a member of Working Group II of the
Intergovernmental Panel on Climate Change.
Kovats and Haines mention that 7 years after the Kyoto Protocol was adopted at a UN conference on climate change,
this international and legally binding agreement to reduce GHG emissions world-wide comes into force on February
16, 2005. It is not sufficient to have a major effect on CC but is a basis for future actions. There remains uncertainty
regarding the scope and magnitude of CC impacts on health: floods, droughts, heat waves; infectious diseases. More
research is needed but uncertainty should not prevent developed countries from leadership in reducing dependence on
fossil fuels, even though developing countries stand to suffer the largest adverse health impacts from CC.
LaDou J, Teitelbaum DT, Egilman DS, et al. American College of Occupational and
Environmental Medicine (ACOEM): a professional association in service to industry.
(See comment). (Review—205 ref). Int J Occ & Environ Health 2007;13(4):404-26.
ACOEM represents interests of its company-employed physician members. Recently company doctors in ACOEM
blocked attempts to have ACOEM from taking a position on particulate air matter and also on global warming.
ACOEM company doctors were employed by the petrochemical industry. The controlling influence of industry over
the SCOEM physicians should cease. The ACOEM has a responsibility to join the public health movement. This paper
chronicles the history of Occupational Medicine and industry physicians as influenced and even controlled by corporate
leaders.
Last J. Logan H. Monitoring, surveillance and research needs. Public health planning
priorities and policy concerns. (Review-26 ref). Can J Pub Health. 1999;90(6):SU 1-16.
Abstract not available.
Lawson C. (See Epstein B 2006).
Leder K, Sinclair MI, McNeil JJ. Water and the environment: a natural resource or a
limited luxury? (See comment) Comment in: Med J Aust 2004;181(6):344. Med J Aust
2002;177(11-12):609-13.
Environmental issues such as increasing salinity and global warming are likely to affect the sustainability of our current
drinking water supplies and increase the threat of waterborne disease outbreaks.
Ledrans M, Pirard P, Tillaut H, et al. The heat wave of August 2003: what happened?
(French) Rev du Practicien 2004;54(12):1289-97.
Heat wave in France (Aug 2003) caused 14,800 excess deaths, equivalent to a total mortality increase of 60% between
Aug 1 and 20th, 2004. Deaths were highest among seniors, disabled or mentally ill. Needed: standardized methods of
20
data collection in Europe; collaborative studies regarding risk factors. A provisional Heat Watch Warning System
(HWWS) will be implemented 2004.
Liang SY, Linthicum KJ, Gaydos JC. Climate change and the monitoring of vector-borne
disease. JAMA 2002;287(17):2286.
GW is likely reshaping the ecology of many medically important arthropod vectors: mosquito; tick. Remote sensing
(RS) and geographic information systems (GIS) are powerful tools to study vector populations that transmit diseases
such as Rift Valley fever, malaria, and Lyme disease. Environmental data gathered by RS and analyzed using GIS may
provide a cost-efficient way to identify regions at high risk for exposure to vector-borne diseases.
Lofstedt RE, Ideda S, Thompson KM. Risk management across the globe: insights from a
comparative look at Sweden, Japan, and the U.S. Risk Analysis 2000;20(2):157-61)
In light of global warming and other issues such as hormones in beef, a brief perspective of risk management in three
nations is presented: Japan, Sweden, and U.S.
Longstreth J. Anticipated public health consequences of global climate change. Battelle
Washington Operations, Washington, DC. Environ Health Perspectives 1991;96:139-44.
Human activities are placing enormous pressures on the biosphere. Because atmospheric effects of global warming are
less understood, public health problems that could be intensified by climate change are assessed qualitatively. The
interactive effects of global warming and public health are discussed.
Lonsdale J. Only you can save the Earth! J Roy Soc of Health 2007;127(5):204-5.
Abstract not available.
Luber G, Hess J. Climate change and human health in the United States. J Environ Health
2007;70:43-46.
Report from the CDC Environmental Health Services Branch. Worldwide the effects of CC have significance for
human health: 1. temperature increase and variability cause increased probability of Category 4 & 5 hurricanes and
higher sea levels; 2. increased forest fire frequency and severity. Negative health effects are likely to accelerate as CO2
emissions continue to rise. Although the processes of CC are incompletely understood, the significant health-related
problems are relatively well understood. In the U.S. CC will have less health impacts than in developing countries but
health impacts in US may be significant: a. increased catastrophic weather; b. aging population increasing vulnerable;
c. injury from extreme weather; d. severity of many chronic diseases may worsen; e. outbreaks of VBD; f. mental
health stresses. Neighbors to the south may experience similar ecologic and health impacts: desertification; increased
freshwater runoff and floods; food and water shortages with mass migration with environmental refugees, regional
tensions, possibly armed conflicts.
In U.S. CC may cause: 1.heat stress, direct thermal injury and exacerbations of associated diseases; 2. respiratory
diseases: asthma, COPD, allergic disease; 3. injuries and other morbidity from extreme weather and forest fires; 4.
waterborne diseases and effects of algal blooms; 5. vectorborne ID; 6. hunger/malnutrition from disruption of food
supply; 7. mental health effects; 8. secondary health effects from conflict over scarce resources, mass migration,
population displacement from disasters, economic disruption.
Health effects of CC present a novel PH problem with unprecedented scope, timeline and complexity and will act as a
general stressor on the PH infrastructure. To address these issues in Jan 2007 CDC convened a workshop of experts in
CC. From meetings the CDC has identified 11 priority health actions for CC (see
http://www.cdc.gov/nceh/climatechange/) PH must take a leadership role in preparing for the consequences of CC.
Lunberg GD. Global warming may be a graver public health threat than nuclear war. Part
1—getting your attention. (See comment). Comments in MedGenMed 2006;8(2):33 and
others.
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See other comments: Epstein B, Lawson C.
Mackenbach JP. Global environmental change and human health: a public health research
agenda. J Epi & Comm Health 2007;61:92-94.
Excellent summary of key areas for research into global environmental change and human health. The author
summarizes current knowledge regarding this relationship: 1. GW is already having adverse impacts on population
health and the burden is shouldered by developing countries, not by countries that are contributing most to GHG
emissions. 2. One quarter of earth’s terrestrial surface is used for human purposes and degradation of land facilitates
spread of microorganisms, erosion, desertification and salinisation of fertile soils which threaten food production and
promotes malnutrition; 3. Human fresh water use exceeds supplies and safe water is threatened by chemical pollution;
4. Destruction of habitats is causing massive extinction of plants and animal species and loss of biodiversity threatens
human health by impairing “ecosystem services” such as regulation of infectious diseases, pollination, waste removal
and serving as a reservoir for new crops and medicines.
The health care industry itself is contributing to global environmental degradation: hospitals consume large amounts of
energy, water, materials and hospital waste contributes to air, water and soil pollution. The “ecological footprint” of
one Canadian hospital is estimated to be >700 times its physical footprint. But population health which has greatly
improved human health from mid 20th century has contributed to rise in human population with the attendant
environmental pressures.
Measuring global health effects from environmental change is difficult; but local estimates are clear: In the Netherlands
between 2% and 5% of the total burden of disease (measured as loss of disability-adjusted life years) is attributable to
environmental problems: air pollution (fine dust and ozone); in house exposures (dampness, radon); noise (road traffic,
air traffic; and food contamination (micro-organisms). This estimate does not consider The Netherlands negative
impacts outside the boundaries of the country. For example Netherlands is a net exporter of environmental problems
which cause health problems in other populations.
Research areas and examples of topics include: 1. Better understanding of the health effects of global environmental
change; 2. Adaptation to reduce the health effects of global environmental change; 3. Better understanding of the
contribution of healthcare to global environmental change; 4. Mitigation of the contribution of healthcare to global
environmental change. A few public health research centers around the world have dedicated groups working on these
problems: Harvard medical school: Harvard Center for health and the Global Environment
(http://chge.med.harvard.edu/) Johns Hopkins Bloomberg School of Public Health: Program on Health Effects of
Global Environmental Change (http://www.jhsph.edu/researchcenters/) ; London School of Hygiene and Tropical
Medicine: (http://www.Ishtm.ac.uk/cgch/)
Marris E. Car emissions are EPA’s problem. Nature 2007;446(7136):589.
Abstract not available.
Maynard NG, Conway GA. A view from above: use of satellite imagery to enhance our
understanding of potential impacts of climate change on human health in the Arctic.
Alaska Med 2007;49(3):78-85.
Space-based systems in place can contribute valuable information through monitoring the processes of long-range
transport of pollutants to the Arctic. Remote sensing; GIS; GPS; enable monitoring, risk mapping, information sharing,
communications, and surveillance of environmental parameters. These technologies allow study of thermal stress,
extreme weather; contaminant transport and deposition into oceans, atmosphere, and ice; air and water quality; built
environment impacts; ultraviolet radiation; and ID and VBDs.
Mckinley G, Zuk M, Hojer M, et al. Quantification of local and global benefits from air
pollution control in Mexico City. Environ Sci & Technol 2005;39(7):1954-61.
20 million residents of Mexico City suffer some of the worst air pollution in the world. This study illustrates that
improved quantitative analysis can change implementation prioritization for air pollution and greenhouse gas control
measures in Mexico City.
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McKone TE, Daniels JI, Goldman M. Uncertainties in the link between global climate
change and predicted health risks from pollution: hexachlorobenzene (HCB) case study
using a fugacity model. Risk Analysis 1996;16(3):377-93.
Paper examines the extent to which uncertainty about global climate change could impact the precision of predictions
of secondary outcomes such as health impacts of pollution. Modeled climate change with predictions of chemical
exposure (Hexacholrobenzene (HCB) and human health risk in the Western region of the U.S. The authors found little
impact on public health consequences for HCB releases.
McKenzie RL, Bjorn LO, Bais A, et al. Changes in biologically active UV radiation
reaching the Earth’s surface. Photochemical & Photobiol Sci 2003;2(1):5-15. (Review-94
ref)
Since publication of the 1998 UNEP Assessment, there has been continued rapid expansion of literature on UV-B
radiation. Global climatologies of UV radiation are now available on the Internet. Anthropogenic aerosols play a more
important role in attenuating UV irradiances than has been assumed previously, and this will have implications for the
accuracy of UV retrievals from satellite data. While halogen concentrations remain high, the ozone layer remains
vulnerable to further depletion from events such as volcanic eruptions. Interactions between global warming and ozone
depletion could delay ozone recovery by several years and this topic remains an area of intense research interest. Future
changes in greenhouse gases will affect the future evolution of ozone through chemical, radiative, and dynamic
processes.
McMichael AJ. Issues in environmental epidemiological research: the example of
environmental lead and health. Asia-Pacific J of Pub Health 1989;3(2):150-5.
Environmental epidemiology is increasingly exploring supranational problems such as ozone depletion and global
warming. Improved quantitative estimates of environmental risks to health are needed. This study examines the
relationship between postnatal exposure to lead and mental development. Exposure to lead was associated with adverse
effect on mental development at age two and four.
McMichael AJ. Climate change and health: information to counter the White House
Effect. Intern J Epi. 2001;30:655-657.
President George Bush, within 2 months of assuming office, openly reneged on his electoral commitments to reduce
the nation’s industrial carbon dioxide emissions and withdrew the US from the Kyoto Protocol, forged in 1997. His
rationale was to protect the nation’s economy. Silver lining to his decision is to force the science community and public
to understand the uncertainty of modeling, to clarify the role of the Precautionary Principle as a basis for prompt
decision-making where unavoidable uncertainty exists and where failure to act may have potentially serious risks. At
the UN conference on Environment and Development (Rio de Janerio) (1992) the PP was adopted: “Where there are
threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing
cost-effective measures to prevent environmental degradation.”
The UN International Panel on Climate Change (IPCC) issued its 3 rd report—the result of 5 years of intense peerreviewed work (2001) concluded: 1. Majority of surface warming over the past quarter century due to GHG emissions
by human populations 2. Estimated range of global average temperature increase in coming century is higher than
previously estimated (range 2-5 C). 3. Many simple physical/biological processes have already been affected by
climate change: glacier retreat; permafrost thawing, sea-ice reduction, earlier bird-nesting, earlier insect hatching,
polewards shifts in various animal and plant species, and earlier bud burst. 4. There has been an increase in adverse
impacts on human wellbeing, physical infrastructure, physical safety and health caused by the increase in frequency
and intensity of extreme weather events over the past several decades, at least in part attributable to climate change.
We lack hard scientific data regarding the health impacts. The WHO European has embarked on a co-ordinated plan of
studying the early impacts of climate change: trends in health related deaths; health impacts of weather disasters;
summer food-poisoning, pollen-related allergies and vector-borne diseases. New university centers are being
established; new textbooks are appearing.
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McMichael AJ et al. In Comparative Quantification of Health Risks: Global and Regional
Burden of Disease due to Selected Major Risk Factors (eds Ezzati, M, Lopez, AD,
Rodgers A & Murray CJL) Ch 20, 1543-1649 (World Health Organization, Geneva,
2004)
McMichael AJ. Will considerations of environmental sustainability revitalize the policy
links between the urban environment and health? New South Wales Pub Health Bull
2007;18(3-4):41-5.
Paper explores population health and urban planning. Cities must be planned and managed for sustainability. Cities
today are contributing to climate change with resultant risks to population health.
Medina_Ramon M, Zanobetti A, Cavanagh DP, et al. Extreme temperatures and
mortality: assessing effect modification by personal characteristics and specific cause of
death in a multi-city case-only analysis. Environ Health Dispar 2006;114(9):1331-1336.
Available online at: http://dx.doi.org/ (6 July 2006)
Several subpopulations and mortality causes susceptible to temperature extremes were identified in this analysis of >7
million deaths (1989-2000). These data may contribute to establishing health programs that would better protect the
vulnerable.
Menne B, Bertollini R. Health and climate change: a call for action. (Editorial) BMJ
2005;331:1282-4.
CC-subject of this week’s UN summit in Montreal—is already affecting human health in Europe and countries are not
prepared. In Europe WHO regional Office is coordinating a project to assess the health impacts of CC and the required
measures and policies that it demands. The heat wave in Europe august 2003 caused 35,000 excess deaths. Cases of
salmonellosis rise 5-10% for each 1C in weekly temperature. Floods, VBD, and increased growing season of plants
with allergenic pollen causing allergic sensitivity are problems.
Communities need to get proactive to minimize risks: collaboration between PH and climatologists and planners;
collecting information systematically on potential impacts of global changes and on cost-effective strategies to reduce
them; political will and public support for PH approaches are important; reducing causal factors (mitigation) and
helping populations cope and deal with risks posed by CC (adaption) will be important strategies of PH.
Michaels D. Manufactured uncertainty: protecting public health in the age of contested
science and product defense. Ann New York Acad Sci 2006;1076:149-62.
The strategy of “manufacturing uncertainty” has been used with great success by polluters and manufacturers of
dangerous products to oppose public health and environmental regulation. This approach has been used by tobacco
industry but also by manufacturers of asbestos, benzene, beryllium, chromium, diesel exhaust, lead, plastics, etc to
avoid health regulation. It is also central to the debate on global warming. “Manufacturing” uncertainty has become a
business in itself: consulting firms providing services: “product defense” or “litigation support”. The objectives of these
activities is not to generate new knowledge to protect public health but to protect corporations whose products are
alleged to have toxic properties. Evidence of a “funding effect”—the close relationship between results of a study
desired by a study’s funder and the reported results of that study—suggests that the financial interest of a study’s
sponsors should be taken into account when considering the study’s findings. Manufacturing uncertainty is antithetical
to the public health principle that decisions be made with the best evidence available.
Mishra UC. Environmental impact of coal industry and thermal power plants in India.
(Review -6 ref) J Environ Radioactivity 2004;72(1-2):35-40.
Coal is the only natural resource and fossil fuel available in India. India has about 90,000 MW installed capacity for
electricity generation of which more than 70% is produced by coal-based thermal power plants. Installed electricity
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generating capacity has to increase rapidly (at present 8-10%) per annum since India has on of the lowest per capita
electricity consumptions. The extent of GW in this century will be determined by how developing countries like India
manage their energy generation plans.
Molyneux DH. Common themes in changing vector-borne disease scenarios. (Review-43
ref) Trans Roy Soc Trop Med & Hygiene 2003;97(2):129-32.
The impact of CC on disease patterns is controversial. The conditions which drive the changing epidemiology of ID are
linked by common themes: interactions of generalist vectors and reservoir hosts at interfaces with humans; reduced
biodiversity associated with anthropogenic environmental changes, increases in Plasmodium falciparum: P. vivax ratios
and land use changes: hydrological, urbanization, agricultural, mining and forest-associated impacts (extractive
activities, road building, deforestation and migration) which are seen on a global scale.
Mooney H, Cropper A, Reid W. Confronting the human dilemma: How can ecosystems
provide sustainable services to benefit society? Nature 2005;434:561-62.
The authors review the Millennium Ecosystem Assessment released in March 2005, a “gigantic” endeavour that
explores the link between human well-being, the status of ecosystems and their sustainable use. They call for a
continuation of this project. The MEA used new methodology of evaluating Earth’s human support systems by placing
audits of numbers of organisms into the context of how ecosystem changes have affected human well-being and how
they may change in the future. Despite significant gains (increased personal wealth, longer lifespan and access to
plentiful and inexpensive food) for many people, these gains have not been equally distributed: 1.0 billion people
survive on less than a dollar a day; 1.1 billion lack access to water; 2.6 billion lack access to basic sanitation; >850
million are undernourished; millions face lack of stable protein sources as fisheries dwindle. There are pressures on
ecosystems that threaten goals of sustainability: fertilizer pollution of groundwater; river dams for irrigation that divert
water from ecosystems upon which humans depend. The MEA concluded that 60% of ecosystem services evaluated
were either being degraded or being used unsustainably. These included: regulating services responsible for climate,
erosion, air and water quality control, regulation of pests and natural hazards, resulting from massive land-surface
conversion, atmosphere alteration, eutrophication, overharvesting and the impact of invasive species. For example
cultivated systems (areas where about 30% of land is in cropland, confined livestock production or freshwater
aquaculture) now cover 25% of Earth’s surface, partly by conversion of temperate grasslands. Forests have disappeared
from 25 countries with 9.4 million hectares being lost annually from the Earth’s surface. Similar degradation is found
in fisheries and coral reefs. These changes have a serious impact on delivery of ecosystem-regulating services with
impacts such as greater prevalence of infectious diseases, adverse effects on local climates by ecosystem modification
and loss of flood protection.
What can be done? The MEA suggests current drivers of change in ecosystems will continue in direction and intensity.
Major changes in the way global society operates will be needed at all levels top to bottom. Systems thinking will be
critical because of the interrelatedness of resource issues. New economic arrangements must be created that recognize
and value ecosystem regulating services—Costa Rica has initiated such. Subsidies that promote excessive use of
ecosystem services will be needed. Education of the public regarding the link between sustainability and human lives is
critical. The MEA has provided stimulus for scientists to quantify the extent to which operation of ecosystems is
directly linked to human well-being.
Monzon A, Guerrero MJ. Valuation of social and health effects of transport-related air
pollution in Madrid (Spain). Sci of the Total Environ 2004;334-335:427-34.
This paper concludes: the health and social costs of transport related air pollution in Madrid is 357 M Euro. In these
circumstances, the recent public health tax applied in Madrid is clearly correct and sensible with a fair pricing policy on
car use.
Newsted JL, Makanishi J, Cousins I, et al. Predicted distribution and ecological risk
assessment of a “segregated” hydrofluorrother in the Japanese environment. (Erratum in
Environ Sci Technol 2003 Mar 15;37(6):1228.) Environ Sci & Technol
2002;36(22):4761-9.
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The hydrofluoroethers belong to a class of fluorochemicals currently being proposed as replacements for traditional
CFCs and PFCs used in the semiconductor and other industries. These compounds have ozone-depleting or GHG
characteristics. Risk assessments for hydrofluoroethers were carried out and findings: no significant risk to either
aquatic or terrestrial wildlife species or humans living in the Japanese environment. Replacement of CFCs and PFCs
with these compounds would result in a net improvement of environmental health and safety.
O’Neill MS, McMichael AJ, Schwartz F, et al. Poverty, environment, and health: the role
of environmental epidemiology and environmental epidemiologists. Epidemiology
2007;18(6):664-8.
GW disproportionately affects the poor and developing countries. The authors call for environmental epidemiologists
(EP) to be more active in further the global agenda for sustainability, environmental health and equity. The discipline of
EP and funding agencies need to broaden their focus to include rigorous research on the upstream larger-scale societal
factors that contribute to inequitable patterns of exposure and health outcomes. We need evidence on how poverty and
the environment together affect health to improve efforts to promote social justice and reduce health inequities.
Olsen J. Shipwrecks and sudden deaths. European J Pub Health 2006;16(6):581-2.
Abstract not available.
Omi S. Tuberculosis control strategy in Asia for the 21st century—tuberculosis control in
the Western Pacific Region of World Health Organization (Japanese). Kekkaku
2003;78(1):37-44.
Rapid changes at the global level pose a big challenge to public health and tuberculosis control in the Western Pacific
where 1000 persons die daily from tuberculosis. Global challenges include: 1. population growth and aging; 2.
epidemiological issues; 3. social and environmental issues such as rapid urbanization and global warming.
Opar A. Profile: Paul Epstein. Nature Med 2006;12(9):988.
Abstract not available.
Ortun V. Public health: politics help those who help themselves (in health services)
(Review 21 ref) (Spanish). Gaceta Sanitaria 2007;21(6):485-9.
Income growth in poor countries is not sufficient for ensuring public health: institutional capacity and political will are
required. Increasing inequalities among countries and global warming may require a change of our institutions given
that both market mechanisms and traditional policy intervention by nation states may prove insufficient.
Pabon JD, Nicholls RS. Climate changes and human health (Spanish). Biomedica
2005;25(1):5-8.
Abstract not available.
Pascual M, Ahumada JA, Chaves LF, et al. Malaria resurgence in the East African
highlands: Temperature trends revisited. PNAS 2006;103(15):5829-5834.
Malaria incidence in East Africa highlands has increased since the 1970s. The role of climate change has been
controversial. The authors confirmed a significant warming trend at all sites. They used dynamical modeling to assess
the statistical significance of climate trends but also their biological implications.
Patz JA, McGeehin MA, Bernard SM, et al The potential health impacts of climate
variability and change for the U.S.: Executive Summary of the Report of the Health
26
Sector of the U.S. National Assessment. Environ Health Perspectives 2000;108(4):36776.
Summary of Congressionally mandated study of climate change in the U.S. (first 18 mo. of work). Five categories
identified re health outcomes that are most likely to be affected by climate change because they are associated with
weather &/or climate variables: 1. temperature-related morbidity and mortality; 2. health effects of extreme weather
events (storms, tornadoes, hurricanes, and precipitation extremes); 3. air pollution related health effects; 4. water and
food borne diseases; and 5. vector and rodent borne diseases. Levels of uncertainty preclude definitive statement on
direction of future change. Some positive health outcomes are possible: reduced cold weather mortality; Most U.S.
population is protected against weather related health impacts-but vulnerable populations exist.
Improvements in public health systems and response to CC needed to protect the population from adverse health
outcomes.
Patz JA, McGeehinn MA, Bernard SM, et al. The potential health impacts of climate
variability and change for the United States. Executive summary of the report of the
health sector of the U.S. National Assessment. J Environ Health 2001;64(2):20-8.
Abstract not available.
Patz JA. Engelberg D, Last J. The effects of changing weather on public health. Annu
Rev Public Health 2000;21:271-307.
Many diseases are impacted by climate change. Scientists are re-examining climate-disease relationships. Three
projected physical consequences of climate change: temperature rise, sea level rise, and extremes in the hydrologic
cycle. This century the Earth has warmed 0.5C; mid-range estimates are increase 2.0C and 49 cm sea level by 2100.
Extreme variability in weather may add new stress to developing nations. Regional impacts of CC will vary depending
on existing population vulnerability. Health outcomes of CC can be grouped: a. direct physical consequences: heat
mortality or drowning; b. physical/chemical sequelae: atmospheric transport and formation of air pollutants; c.
physical/biological consequences: response of vector and waterborne diseases, and food production; d.
sociodemographic impacts: climate or environmentally induced migration or population dislocation. Better
understanding of climate variability as a determinant of disease will be important in constructing predictive models to
guide public health interventions.
Patz JA, Khaliq M. Global climate change and health: Challenges for future practitioners.
JAMA 2002;287(17):2283-84.
Global CC expected to have broad health impacts: heat waves, floods, droughts; regional air pollution and spread of
aeroallergens; disruption of ecosystems and of water and food supplies with influence on infections diseases and
nutritional status; and sea level rise with population displacement and economic disruption. Small changes in global
mean temperatures can have large effects on frequency of extreme temperatures that can: increase both hot and cold
related mortality for elderly and those with preexisting diseases; heat wave mortality a result of cardiovascular,
cerebrovascular, and respiratory diseases. 1995 heat wave in Chicago caused 514 heat related deaths (12/100000
population.) Heat waves cause “heat islands” where heat retaining surfaces (asphalt, tar roofs) sustain higher
temperatures during the night. Heat waves worsen urban air pollution with ozone contributing to asthma is children.
Human health impacts are most likely to occur where extreme weather and population vulnerability converge. Health
impacts of extreme weather: physical injury; poorer nutritional status, especially children; increases in respiratory and
diarrheal diseases due to overcrowding of flood survivors and limited access to potable water; increased risk of waterrelated diseases; and release of dangerous chemicals from storage sites and waste disposal sites into flood waters.
Epidemics of malaria are associated with El Nino-driven climate extremes. Floods increase risk of traumatic injuries
but long term: increased communicable diseases (cholera and hepatitis A) leptospirosis and respiratory infections from
overgrowth of molds in flooded homes. Droughts threaten food supply and diseases result from poor sanitation (lack of
water for washing) such as: diarrheal diseases, scabies, conjunctivitis and trachoma. Drought induced wildfires cause
direct injury, adversely affect air quality. Water related infectious diseases in marine environments where warm water
and nitrogenous waste favor blooms of dinoflagellates: red tides can cause paralytic, diarrheic, and amnesiac shellfish
poisoning. Sea level rise poses major risks: 13 of the 20 major metropolises are at sea level. A 1-meter rise in sea level
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would inundate low-lying areas affecting 18.6 million people in China, 13 million in Bangladesh, 3.5 million in Egypt
and 3.3 million in Indonesia.
Patz JA, Campbell-Lendrum D, Holloway T, Foley JA. Impact of regional climate
change on human health. Nature 2005;438(17):310-17.
Excellent review by leading scientists involved internationally. WHO estimates that warming and precipitation trends
due to anthropogenic CC over the past 30 yrs cause 150,000 lives annually and about 5 million “disability adjusted life
years (DALYs) per year from diseases such as: diarrhea, malaria, malnutrition and CV disease. Data in this paper re
global burden of CC attributable disease (Table 1) from McMichael AJ et al. in Comparative Quantification of health
Risks: Global and Regional Burden of Disease due to Selected major risk factors, Ch 20, 1543-1649, WHO, Geneva,
2004) Human diseases are linked to CC: CV and respiratory (heat waves); altered transmission of ID and malnutrition
from crop failures. Uncertainty exists regarding the relationship between CC and disease owing to lack of long-term,
high quality data sets as well as difficult to control variables such as socio-economic factors, changes in immunity and
drug resistance. However, evidence is mounting that CC-human disease is worsening globally and mortality will
increase from: extremes of heat and cold; drought or storms; changes in air and water quality and changes in ecology of
ID. Projects are that by 2030, the CC induced excess risk of various health outcomes will more than double. Temperate
latitudes are most vulnerable as they will warm disproportionately and will be subjected to large rainfall variability due
to El Nino.
Pengelly LD, Campbell ME, Cheng CS, et al. Anatomy of heat waves and mortality in
Toronto: lessons for public health protection. Can J Pub Health 2007;98(5):364-8.
Methodology was developed to predict daily mortality risk to historical daily weather. Over the period of study (5
decades) there were 120 heat-related deaths on average per year, primarily July and August. The method can be used to
forecast the risk of heat-related mortality and to facilitate the development of public health responses to mitigate the
risk.
Peperzak L. Future increase in harmful algal blooms in the North Sea due to climate
change. Water Sci & Technol 2005;51(5):31-6.
In temperate seas (North Sea) harmful (toxic) algal blooms will probably increase as a result of CC. Conclusion
reached after investigation of projected effect of CC for the year 2100 in Dutch coastal waters on growth rates of 6
harmful and 2 non-harmful phytoplankton species. Toxin producing species may seriously disrupt the food web: with
fish kills and human intoxication. Future toxic phytoplankton blooms may further devaluate ecosystem deliverables
such as fish production or recreational use. This may be estimated by monetary value assessments needed in costbenefit analyses for policy guidance. Research is need to improve knowledge on coastal ecosystem functioning and its
resilience.
Perez Perez F. Eco-pathologies: effect on public health and animal health. (Review-0 ref)
(Spanish). Anales de la Real Academia Nacional de Medicina 2001;118(1):137-65.
Discusses ecopathologies from human activities: industry; deforestation, etc. Atmospheric pollution with gases and
metals and pathogens including prions extending through utilization of feed of animal origin.
Plotnikoff RC, Wright MF, Karunamuni N. Knowledge, attitudes and behaviours related
to climate change in Alberta, CA: implications for public health policy and practice.
Intern J Environ Health Res 2004;14(3):223-9.
Random survey of 600 Alberta CA households re CC. Survey re knowledge, attitudes and behaviours related to CC.
Albertans are highly concerned, particularly about health problems related to the environment and air pollution. They
are engaged in environmental behaviors at home but fewer consider energy efficiency when purchasing consumer
goods. A smaller percentage makes environmentally conscious transportation decisions. Mass media approaches may
be appropriate. The public health sector has a major role in addressing this public health issue.
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Poulsen TG, Hansen JA. Strategic environmental assessment of alternative sewage sludge
management scenarios. Waste Man & Res 2003;21(1):19-28.
For a Danish municipality (Aalborg) with 160,000 inhabitants, Strategic environmental assessment of sewage sludge
management scenarios that included global warming were carried out.
Powell RI. Readers respond to “global warming may be a graver public health threat than
nuclear war. Part 1—getting your attention”. (Comment) Comment on: MedGenMEd
2006;8(1):71
Preti A, Lentini G, Maugeri M. Global warming possibly linked to an enhanced risk of
suicide: data from Italy, 1974-2003. J Affective Disorders 2007;102(1-3):19-25.
Monthly data on suicide mortality and temperature were obtained for a 30-yr period (1974-2003). For males increasing
anomalies in monthly average temperature associated to a higher monthly suicide mean from May to August and to a
lower extent in November and December. For females the links were less consistent.
Rabl A, Spadaro JV. Environmental impacts and costs of energy. Ann New York Acad
Sci. 2006;1076:516-26.
The European Commission has studied environmental damages vis a vis energy consumption. This article summarizes
the external costs of the major energy technologies. The results provide substantial evidence that air pollutants:
particles; NOx and SO2 from fossil fuels impose significant PH costs comparable to the cost of GW from CO2
emissions. External costs of coal are much higher than for natural gas. External costs for nuclear, wind, and
photovoltaics are very low. Costs for hydro are extremely variable from site to site and the ones of biomass depend
strongly on the specific technologies used and can be quite large for combustion.
Radtke T, Gist GL, Wittkopf TE. National Environmental Health Association position on
global climate change. J Environ Health 2001;64(2):30-2.
Abstract not available.
Radtke T, Gist GL, Wittkopf TE. National Environmental Health Association position on
climate change. Environ Health September 2001, pp. 30-32. NEHA Statement adopted
July 2, 1997.
The NEHA published this statement in 1997. The conclusions: anthropogenic sources, specifically greenhouse gases,
are responsible for a significant portion of the measured change in global climate. NEHA also supported the association
between GW and increased risk to public health. NEHA recommended: Support legislation to mitigate source
emissions in the environment that negatively affect human health; Target research to help predict effects of pollution
sources on global CC; Support research necessary to bring to the forefront the association between CC and changes in
global health conditions; Encourage and facilitate intergovernmental cooperation and multilateral agreements on
important environmental issues related to CC; Support existing technologies that result in a “cleaner” environment and
sustainable resources; Educate key public health and policy institutions.
In 2001, NEHA republished the above Statement from 1997 since recent “developments in international and
environmental policy heave rejuvenated the public’s need for and interest in) credible information about the subject.”
Rawlins SC, Chen A, Rawlins JM et al. A knowledge, attitude and practices study of the
issues of climate change/variability impacts and public health in Trinidad and Tobago
and St Kitts and Nevis. West In Med J 2007;56(2):115-21.
Aim: to determine level of understanding of CC and Climate variability and public health and determine whether
respondents would be willing to incorporate these values into strategies for dengue fever prevention. In a sample of
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650, about 50%-60% showed some understanding about CC. They ranked life issues affected by CC/CV as: health;
water resources; agriculture; biodiversity; coastal degradation. About 80% saw the use of CC/CV information for
Dengue prevention as strategic, but only about 50% were inclined to become personally involved. There is a need to
demonstration of efficacy of CC/CV information and promotion of its usefulness for community DF control.
Reiter P. Climate change and mosquito-borne disease. (Review-189 ref) Environ Health
Perspect 2001;109:141-161. Available online:
http://ehpnet1.niehs.nih.gov/docs/2001/suppl-1/141-161reiter/abstract.html.
From the Dengue Branch, CDC: Elementary models suggest that higher global temperatures will enhance their
transmission rates and extend their geographic ranges. However, the histories of three such diseases-malaria, yellow
fever, and dengue—reveal that climate has rarely been the principal determinant of their prevalence or range; human
activities and their impact on local ecology have generally been much more significant. It is therefore inappropriate to
use climate-based models to predict future prevalence.
Roberts I, Hillman M. Climate change: the implications for policy on injury control and
health promotion. Injury Prevention 2005;11:326-29. Available online:
www.injuryprevention.com
A WHO Report (Ezzati et al, Lancet 2002;360:1347) estimates >150,000 people in developing countries are dying
annually from effects of global warming, mostly attributable to burning of fossil fuels. Without action to reduce GHG
emissions, global temperature will rise. There are uncertainties in CC predictions but it would be inappropriate to wait
until there was complete scientific certainty to make decisions about reducing CC risks.
CC will likely cause increased risk for injuries: WATER SHORTAGE: may spur wars; RISE IN SEA LEVEL:
Thermal expansion of oceans and glacial melting will increase sea level between 10cm and 90 cm by 2100. This will
cause increased risks from storm surges and loss of life from drowning, loss of arable land, and conflict and violence as
people are displaced. A 40 cm sea level rise would increase the number of people at risk from storm surge from 40
million to 160 million. TRANSPORT INJURIES: Traffic accidents cause > 1million deaths annually (2000). This
represents a quarter of injury mortality worldwide. Transport accounts for 25% of CO2 emissions worldwide. In 1973
and 1979 oil crises lowered energy use and traffic accidents were reduced. Use of alternative energy sources instead of
fossil fuels in future may reduce traffic death rates.
Climate Change and Injury control: win-win solutions: Carbon rationing would likely reduce road accidents as a
consequence of steady reduction in the volume of traffic.
Rose JB, Epstein PR, Lipp EK, et al. Climate variability and change in the U.S.: Potential
impacts on water and foodborne diseases caused by microbiologic agents. (Review-175
ref) Environ Health Perspect 2001;109 (supple 2):211-221. Available online at:
http://ehpnet1.niehs.nih.gov/docs/2001/suppl-2/211-221rose/abstract.html.
Weather influences transport and dissemination of microbial agents via rainfall and runoff and the survival and/or
growth through such factors as temperature. If climate variability increases, current and future deficiencies in areas
such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of
contamination events. This assessment recommends a range of future scenarios of improvement plans for current
deficiencies in the public health infrastructure to achieve more realistic risk assessments.
Rosenblatt RA. Ecological change and the future of the human species: can physicians
make a difference? Ann Fam Med 2005;3(2):173-6.
Global environmental change is occurring so rapidly that it is affecting the health and threatening the future of many of
Earth’s inhabitants, including humans. Causes of environmental degradation: human over population, non-sustainable
consumption of natural resources by humans. Everything we have accomplished in the fields of medicine and PH could
be undermined if we do not pay attention to these rapid environmental changes
30
Rosenthal JK, Sclar ED, Kinney PL, et al. Links between the built environment, climate
and population health: interdisciplinary environmental change research in New York
City. (Review-78 ref). Ann Acad Med, Singapore. 2007;36:834-46.
Global CC poses challenges for cities: health; costal development; urban infrastructure, energy demand, water supplies.
This is compounded by the global trend of urbanization of poverty. This article discusses two initiatives of The Earth
Institute at Columbia University: examples of multidisciplinary research into environmental health science and urban
planning to understand potential PH impacts of global CC and mitigative measures. The NY Climate & Health Project
uses integrative modeling to assess PH and land use impacts of CC. the Cool City Project is applied policy oriented.
Both types of research are potentially useful for understanding the impacts of environmental change at the urban scale,
policies needed to address the changes and train scholars capable of collaborative approaches across social and
biophysical sciences.
Rowland MG. Climate change and human health: possible communicable disease
consequences in the United Kingdom. Medicine & War. 1995;11(4):188-94.
In May 1990 a “Think Tank” was constituted to advise the Director of the Public Health Laboratory Service on the
potential effects of global climate change, the epidemiology of infectious diseases.
Russell RC. Vectors vs. humans in Australia—who is on top down under? An update on
vector-borne disease and research on vectors in Australia. (Review-393 ref). J Vector
Ecol 1998;23(1):1-46.
Focus on mosquito-borne arbovirsuses: Ross River virus (35,000 cases 1991-7); Barmah Forest virus; Murray Valley
encephalitis; Dengue; Japanese encephalitis. Tick typhus; Flinders Island Spotted Fever; Lyme disease; Fleas were
responsible for recent outbreak of murine typhus in Western Australia. Mites cause scrub typhus.
Resources for investigation and control of vector-borne disease have been meager. The predicted scenarios of increased
temperature and rainfall with global warming are causing concern for increases in VBD, particularly the endemic
arboviruses. Health authorities is gravitating more towards epidemiological reporting and less towards public health
action.
Sachs JD. Seeking a global solution: The Copenhagen Consensus neglects the need to
tackle climate change. (Commentary). Nature 2004;430:72526.
Sachs reviews the2004 Copenhagen Consensus conference: a good idea regarding building bridges between the
scientific community and policy-makers but the conference fell short in proposing the wrong questions and convening
the wrong participants. The author cites the Intergovernmental Panel on Climate Change and the Commission (IPCC)
in 1988 on Macroeconomics and Health (CMH) of the WHO in 2000-01 as examples of effective consensus initiatives.
Sachs believes that the conclusion of the Copenhagen conference: that the idea of controlling CC received a “bad”
rating among proposals was an incorrect conclusion and not based on the opinions of experts such as William Cline of
the Center for Global Development in Washington who showed long-term benefit-to-cost ratio of 2:1 for mitigation of
CC.
Schmidt CW. Global Earth observations for health. Environ Health Perspec
2005;113(11):A738-9
Abstract not available.
Schirnding Y, Onzivu W, Adede AO. International environmental law and global public
health. Bull WHO 2002;80(12):970-4.
An enhanced capacity to utilize international environmental law could lead to significant worldwide gains in public
health.
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Sellman J, Hamilton JD. Global climate change and human health. Minn Med
2007;90(3):47-50.
Article summarized science of climatology and global climate change caused by human actions and reviews potential
health effects.
Seip HM, Aunan K, Vennemo H, et al. Mitigating GHGs in developing countries.
Science 2001;293(5539):2391-2. (Letter)
Sim F, Mackie P. Health and the hot air of a European summer. (Editorial) Public Health
2005;119:749-50.
Recognizing the impact of GW, in May 2005 the UK government Department of Health published its “Heat wave Plan
for England. The heat wave of 2003 in Europe prompted this action.
Simon F, Lopez-Abente G, Ballester E. et al. Mortality in Spain during the heat waves of
summer 2003. European Communicable Disease Bulletin. 2005;10(7):156-61.
Spain experienced three heat waves in 2003 with total excess deaths 8%. Excess deaths were observed in those aged 75
and over (15% more deaths) and 85 or over (29% excess deaths). Heat associated excess mortality is an emerging PH
problem because of aging population and GW.
Spielman A, Pollack RJ, Kiszewski AE, et al. Issues in public health entomology. Vector
Borne & Zoonotic Diseases 2001;1(1):3-19. (Review: 80 ref)
Public health entomology focuses on the population biology of vector-borne infections. At its centennial, public health
entomology has challenges including erosion in support for field research vs. laboratory research. Basic ecological
questions remain poorly explored: What regulates vector populations? How may mixtures of pathogens be maintained
by a single vector? What factors might limit the invasion of Asian mosquitoes into North American sites? Putative
effects of “global warming” remain speculative given our relative inability to answer such questions.
Staropoli JF. The public health implications of Global Warming. JAMA
2002;287(17):2282-84.
In 1861, the Natural Philosopher John Tyndall made the prediction that anthropogenic emissions of carbon dioxide
would trap the radiative energy of the sun within the earth’s atmosphere and raise surface temperatures. (Philosophical
Magazine. 1861;22:169-94, 273-85) . Recent data (IPCC Climate Change 2001; 3rd assessment report) show GW to be
accelerating and due in large part to combustion of fossil fuels. This issue of JAMA brings together several lines of
published evidence that GW is a public health challenge requiring serious, concerted action. The reports cover:
immediate threats; common approaches to CC and air pollution; technologies to track spread of climate sensitive
infectious disease vectors, and public policy tools to respond and adapt to these challenges.
Unfounded alarmism has no place either in clinical practice or in the legislative process, but we cannot simply ignore
extensive, peer-reviewed data on the causes and impacts of climate change. In the absence of domestic leadership on
GW we need to summon health care professionals to nontraditional advocacy roles. A similar approach was used for
the Montreal Protocol of 1987 and treaty that identified depletion of UV absorbing ozone layer by cholrofluorocarbons
(CFCs) as a public health threat of potentially catastrophic proportions requiring immediate action—phasing out CFCs
and related compounds.
Stott R. Carson’s syndrome: a major threat to the public’s health in the twenty-first
century. Med, Conflict & Survival 2000;16(1):94-103.
The name Carson’s Syndrome is proposed to characterize severe non-accidental planetary abuse. A specific example,
overproduction of CO2 is described and illustrated by the concept of a “footprint for the CO2 production on an
individual or group. Transport is responsible for 40% of CO2 production in developed countries. A more rational
32
transport policy, with particular encouragement of walking and cycling, would both reduce CO2 output and benefit our
health especially in reducing cardiovascular disease.
Stott R. Climate change-2057. BMJ 2007;335(7633):1318-19.
The author takes a point of view of the BMJ in 2057 reviewing the results of a survey covering the period 2007-2057
that looks back at the greatest advances in health over this 50 yr period. The author notes that a similar survey asking
BMJ readers what the greatest advance was since BMJ’s first publication in 1840 found that “sanitation” was voted the
most important.
Stott noted that in 2006 there was growing concern from many experts that global warming posed threats to health. The
professionals acted decisively: First they informed all regarding the gravity of the situation; second they affirmed the
importance by being among the first to reduce the individual carbon footprints and to persuade the health institutions to
do likewise. Through this leadership role of information and affirmation, leaders in academics, health professional
institutions, ambassadors, architects, engineers, lawyers, and teachers were asked to join the effort. The adoption of
contraction and convergence at the 2009 UN Framework Convention on Climate Change in Copenhagen, for which
Aubrey Meyer, its author, received the Nobel peace prize in 2013, marked the turning point in the campaign.
A global framework was developed to contract by setting a global carbon budget and reducing this annually so that
atmospheric levels of CO2 didn’t exceed 450ppm, giving us a 50:50 chance of avoiding dangerous climate change.
Convergence entailed giving an equal entitlement of carbon to each of the then four billion adult inhabitants of the
world. Disadvantaged people who were almost all low carbon emitters would have entitlements to sell to the high
carbon emitters of the rich north. Communicating the enormous public health benefits of moving toward a more equal
low carbon world, won the argument for the convergence component of contraction and convergence. Contraction and
convergence created a global virtuous cycle of activity giving environmental, economic, and social benefit, particularly
to the poor. This global virtuous cycle unleashed numerous similar cycles at all levels of society. A global health
catastrophe was averted. The survey respondents in 2057 listed “Action against climate change” first on their list.
Sutherst RW. Global change and human vulnerability to vector-borne diseases. Clin
Microbiol Rev 2004;17(1):136-173.
Extensive 27 p. review: 358 ref. Paper headings include: Scenarios of Global Change; Framework for Assessment of
Impacts to VBD under Global Change; Impacts; Framework for Designing Adaptation Options under Global Change;
Adaptation Options; Framework for Assessment of vulnerability.
Conclusions:
1. Rates of change of all aspects of human and environment-related actions are accelerating
2. This gives rise to numerous opportunities for unexpected or enhanced risks from vector-borne diseases,
arising from the interaction between different types of change such as climate, patterns of travel,
unplanned expansion of megacities, and intensification of agriculture.
3. Increasing risks of spread of VBD from developing to developed countries as globalization quickens
4. Already global incidence of malaria and dengue are increased, largely due to declining PH
infrastructure, development of resistance to drugs and insecticides; and reliance on reactive treatment
rather then prevention
5. Future trends in VBD with CC summarized in Table re what we know, what we can expect, what we do
from here, and how successful our efforts might be. The Global Changes include: Climate and
atmospheric GHGs; Climate change; Travel and trade; Urbanization; and Land Use.
6. There are significant uncertainties but enough is known to galvanize the global community to restore PH
systems, reinstate preventative measures, and take up opportunities to reduce risks of spread of these
diseases.
7. Adaptation must be based on sound understanding of causes of changes in the whole vector-pathogenhost –environment system. A systems approach with comprehensive and testable predictive models to
remove subjectivity from qualitative judgments.
8. Adaptation measures must be culturally, economically, and environmentally sustainable and they must
retain their effectiveness in face of strong environmental variation or social disturbance—they must be
robust.
9. Vulnerability of communities depends as much on their capacity to prevent or respond to increases in
disease transmission as it does on the risks themselves.
10. Key to reducing VBD is to increase standards of living in developing countries and allocate resources
for prevention in developed countries.
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11. Distinction must be made between “Growth” and “Development”. Growth in density of human
populations with attendant demands on resources has natural limits (land for food, water, social stability,
renewable and nonrenewable resources. Development refers to improvements in human health and
personal development.
12. Success of globalization in advancing living standards by providing services that enhance health and
well-being, rather than material goods, will play a large part in reducing vulnerability of disadvantaged
communities.
13. A global focus on provision of public health facilities and preventative measures rather than material
consumption will be a faster rout to reducing incidence of VBD and one step toward saving the human
race and the world’s biological life from future catastrophe.
Taubes G. Apocalypse not (see comment). Comment in: Science 1998;279(5353):968-9.
Science 1997;278(5340):1004-6.
Tong S. The potential public health impact of global environmental change. Austr & New
Zeal J Pub Health 2000;24(1):104-5.
Abstract not available.
Vonnez JL. (Calculating the impact of global warming on human health) (French). Revue
Med Suisse 2005;1(42):2765. (no abstract)
Von Schirnding Y, Onzivu W, Adede AO. International environmental law and global
public health. Bull WHO 2002;80(12):970-74.
Developing countries are at risk for population ill-health from environmental hazards. International environmental law
offers a viable strategy for improving public health through promotion of: increased awareness of linkages between
health and environment; mobilization of technical and financial resources; strengthening research and monitoring;
enforcement of health related standards and promotion of global cooperation.
Many multilateral environmental agreements have health implications:
1. Montreal Protocol on Protection of the Ozone Layer (1987),
2. Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal
(1989);
3. Convention on Biological Diversity (1992);
4. UN FCCC (1992)
5. Kyoto Protocol of the UNFCCC (1997)
6. Rotterdam convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and
Pesticides in Intermational Trade (1998)
7. Stockholm convention on Persistent Organic Pollutants (2001)
The UN Conference on Human Environment (1972); UN Conference on Environment and Development (1992) and
World Summit on Sustainable Development (2002) have led to an increasing awareness of the links between health and
environmental factors. Significant issues include evaluation of the effectiveness of international environmental
agreements; organizing and financing initiatives; involvement of organizations such as UN; WHO.
Warren JA, Berner JE, Curtis T. Climate change and human health: infrastructure
impacts to small remote communities in the north. Intern J Circumpolar Health
2005;64(5):487-97.
In northern regions climate change can include changes in precipitation, sea ice extent and thickness, climate warming
and cooling. Storms, flooding, erosion, drought, degradation of permafrost may result. CC can result in damage to
sanitation infrastructure, spread of disease, local economy, cultural traditions and mental health. Needed: approaches
for managing CC.
34
Waterston T, Lenton S. Sustainable development, human induced global climate-change,
and the health of children. Arch Dis Childhood 2000;82(2):95-97.
Environmental issues in the long-term are as important to children’s health as smoking, accidents, and poor parenting
are in the short term, but they have received little discussion in pediatric circles. Human induced global climate change
(HIGCC) will have a significant impact on future generations of children.
Extremes of temperature affect people directly (increased mortality) and indirectly: Vector borne disease: estimates that
60% of the world population will be exposed to malaria by latter half of this century (Patz JAMA 1996; 275:217-23).
Increased natural disasters; rising sea level (population displacement); increased pollution, will have a larger impact on
health than the direct effects.
Food Production and nutrition: developing countries around the equator will suffer most, lacking resources to adapt.
One estimate of the additional number of hungry people attributable to climate change by 2060: 40-300 million. (Parry.
Lancet 1993;342:1345-7).
Sea Level: Projected to increase 0.2-1.0 m by 2100. Over half world’s population live within 60 km of sea. An increase
of 0.5 m: double number of people who suffer flooding annually—current 46 million.
Infectious Diseases: Current 45% world’s population lives in zones of potential malaria; this will increase to 60% in
next 100 yrs. Children at high risk.
Impact on child health: World Commission on Environment and Development: Our common future (1987) defined
sustainable development: “fulfils the needs of the present generation without endangering the needs of future
generations.” No environmental burdens (such as build up of greenhouse gases, pollution of seas and rivers, loss of
natural habitats, should be inherited by future generations—the principle of intergenerational equity. Ecological
“footprint”: the surface area required to feed and absorb the waste of a person, group or city. London’s equals the UK’s
entire area of productive land, about 125 times London’s surface area, a total of 19.7 million hectares. European
citizens average footprint (3 hectares per), North Americans (4-5 per) but worldwide only 1.5 hectares of productive
land is available per person. Rio Declaration of Environment and Development (UN Earth Summit in Rio de Janeiro,
1992): first principle: “…human beings are at the centre of concerns for sustainable development. They are entitled to a
healthy and productive life in harmony with nature.” Sustainable development attempts to improve the quality of
human life, while living within the carrying capacity of supporting ecosystems. Developed nations use 50 times more
energy per person that the developing nations. 57.5 million people added to the northern hemisphere population during
this decade will add more greenhouse gases to the atmosphere than the roughly 900 million added to the southern
hemisphere; global warming will likely lead to a rise in sea level which will displace 30 million people living in low
lying areas in India. World conference on sustainable development in Kyoto, Japan (1997) set target of 8% reduction of
1990 emission of CO2 by 2010 for EU nations; 7% for USA; 6% for Japan and Canada. UK has set a target of 20%
reduction.
Pediatricians have 4 roles re sustainable development and child health:
1. Educate themselves and ensure the subject becomes part of the teaching and training of pediatricians.
2. advocate for principles of sustainable development, locally and nationally
3. set a personal example by adopting principles of sustainable development
4. Develop research methods to assess the health impact of policy decisions on children.
Authors outline “A practical personal agenda”.
Watson R. UN conference on climate change will test countries’ commitment to public
health. (News) BMJ 2007;335(7630):1116.
Reviews the upcoming Bali UN conference on climate change and the chapter devoted to health issues that humans are
being directly exposed to through new weather patterns and indirectly through alterations in water, air, and food quality
and evolving ecosystems.
Wayne P, Poster S, Connolly J, et al. Production of allergenic pollen by ragweed
(Ambrosia artemisiifolia L) is increased in CO2-enriched atmospheres (see comment).
Comment in: Ann Allergy Asthma Immunol 2002;88(3):251-2. Ann All, Asthma &
Immunol 2002;88(3):279-82.
35
Potential effects of global climate change on allergenic pollen production are still poorly understood. This study
concluded: there may be significant increases in exposure to allergenic pollen under the present scenarios of GW.
Weart S. The Discovery of Global Warming: Impacts of Global Warming. (Essay) Center
for History of Physics of American Institute for Physics. Available March 23, 2008:
http://www.aip.org/history/climate/impacts.htm
A 9 page essay with 20 references. Excellent review.
At first GW sounded like a good idea, especially for people in colder climates; in the 1960s scientists realized the longrange problems regarding sea-level rise and threats to food supplies. Next scientists addressed threats to ecosystems
and human health. The complexity of planet systems made research in this area difficult and few solid conclusions
were reached.
By the start of the 21st century the potentially major global consequences of GW were clear. In 1965 a U.S. President’s
Scientific Advisory Committee reported that by the year 2000 the increase in atmospheric CO2…may be sufficient to
produce measurable and perhaps marked changes in climate…” They stated that resulting changes “could be
deleterious from the point of view of human beings.” In 1966 a panel of the U.S. National Academy of Sciences
warned against: “dire predictions of drastic climatic changes.” Such dire predictions had long been a staple of
magazine, books and other media colorful speculations about climate catastrophes. However, scientists close to the
issue were concerned and in 1970 a landmark study on “Mans Impact on the Global Environment” (MIT) indicated that
greenhouse warming might bring “widespread droughts, changes of the ocean level and so forth”. A meeting in
Stockholm in 1971 came to similar conclusions but suggested that the Arctic Ocean ice cover could disappear if we
passed a point of no return. They made the point to illustrate “the sensitivity of a complex and perhaps unstable system
that man might significantly alter.”
A CIA study in 1974 concluded that global climate changes could imperil world food supplies with migrations, wars. A
1977 report on Energy and Climate from the U.S. National Academy of Sciences raised serious concerns about melting
of polar ice caps and “Human disasters” such as droughts. The U.S. EPA in 1983 warned that GW would have
profound consequences for ecosystems, agriculture, water, sea level and suggested extreme temperatures could worsen
the “excess human death and illness.” Congress ordered the first official U.S. government report by EPA (1989) on
GW; it reiterated the above concerns and spoke of expansion of ID from spread of vectors.
The WHO in the 1990s formed the IPCC (International Panel on Climate Change) and the pace of research worldwide
quickened. Research focused on vulnerable populations; mitigation, and adaptation to threats. There was resistance
among governments and scientists and the IPCC in addressing scenarios across the spectrum from likelihood-low to
high, unlike the practice for building codes of cities in earthquake zones where likelihood of disaster of one chance in a
hundred over 100 years were considered; the IPCC was preoccupied with impacts that were more likely than not. The
IPCC and others were not considering that complex systems such as global ecosystems and weather are prone to rapid,
surprising, often counter-intuitive changes. There seemed to be a different standard for risk assessment.
In 2006 a preeminent economist published the Stern Review on the Economics of Climate Change produced by the
British Government. Stern, the former chide economist at the World Bank said the Climate Change problem was a risk
management one and worth buying insurance for. He calculated potential costs as about 5% of Global GDP for direct
effects of GW. The cost to prevent major changes would be only 1% reduction in GDP. Stern likened Climate change
to “the greatest market failure the world has ever seen.”
The bottom line conclusions:
 Most places on the globe will get warmer
 Sea levels will continue to rise for many centuries
 Weather patterns will keep changing
 Ecosystems will be stressed
 Increased CO2 levels will affect biological systems
 There will be significant unforeseen impacts
Weinstein P. An ecological approach to public health intervention: Ross River virus in
Australia. Environ Health Perspec 1997;105(4):364-6.
36
Paper addresses ecology and control of infection with the Australian arbovirus Ross River virus (RRV). An
ecologically based control strategy must be developed for RRV to manage the disease when faced with its probable
ecological changes brought about by global warming, increased rainfall, and demographic change.
West JJ, Fiore AM, Horowitz LW, et al. Global health benefits of mitigating ozone
pollution with methane emission controls. PHAS (Proceedings of the National Academy
of Sciences of the United States). PNAS 2006;103(11):3988-3993. Published online
March 6, 2006, 10.1073/pnas.0600201103.
Methane (CH4) contributes to global background concentration of tropospheric ozone (O3), and air pollutant associated
with premature mortality. CH4 and O3 are GHGs. CH4 mitigation results in O3 concentration global decrease and
results in widespread decreases in premature human mortality. A 20% decrease in CH4 beginning 2010 would decrease
average daily maximum 8-h surface ozone by ~1ppb globally and this would reduce ~30,000 premature all-cause
mortalities globally in 2030 and ~370,000 between 2010 and 2030. If only CV and respiratory mortalities are
considered, ~17,000 global mortalities can be avoided in 2030. Marginal cost-effectiveness of this 20% methane
reduction is ~$420,000 per avoided mortality. If lost lives are valued at $1 million each, the benefit is ~$240 per tonne
of CH4 (~$12 per tonne of CO2 equivalent). Methane mitigation offers a unique opportunity to improve air quality
globally and can be cost-effective component of international ozone management, bringing multiple benefits for public
health.
West JJ, Fiore AM. Management of tropospheric ozone by reducing methane emissions
(Review-42 ref). Environ Sci & Technol 2005;39(13):4685-91.
Background concentrations of tropospheric ozone are increasing and are sensitive to methane emissions yet methane
mitigation is currently considered only for CC. Air quality planning should consider reducing methane emissions
alongside NOx and NMVOC and because the benefits of methane controls are shared internationally industrialized
nations should consider emphasizing methane in the further development of CC or ozone policies.
Westphal RG. Commentary on “the public health impact of global climate change”
(comment). Comment on: Fam Community Health 2004;27(3):218-29. Family &
Community Health 2004;27(3):230-1.
Wilson JF. Facing an uncertain climate. Ann Int Med 2007;146:153-56.
Review with 12 ref. Audience for paper: physician specialists in Internal Medicine. Author provides overview of CC
and PH effects. Serious research began in the 1990s. Early reports of findings (WHO & World Meteorological Org and
UN Environment Program 1996) were not taken seriously. That has changed in light of the rapidity of CC. Author
reviews literature on risks to the U.S. and risks to International health as well as preparation and adaptation to CC.
Wolfe AH, Patz JA. Reactive nitrogen and human health: acute and long-term
implications (Review-64 ref). Ambio. 2002;31(2):120-5.
Reactive-nitrogen (Nr) has a wide variety of beneficial and detrimental effects on human health. Interdisciplinary
studies are needed to determine the nature of these attributes of Nr.
Woodruff RE, McMichael T, Butler T, Hales S. Actioni on climate change: the health
risks of procrastinating. Aust & New Zealand J Pub Health. 2006;30(6):567-71.
The authors estimated health effects in Australia (heat wave mortality, dengue transmission regions) around 2100 under
GHG emissions scenarios: No policy action vs. “Strong Policy action. Mitigation could reduce the number of deaths
caused by hot temperatures among older Australians by 4,000-7,000 a year. The zone of potential transmission of
dengue fever would expand 1800 km south as far as Sydney with No Action vs. about 600 km with strong action. The
37
number of displaced people within the Asia-Pacific region could increase (by orders of magnitude) under the “no
action” scenario. Conclusions: Strong policies are needed to reduce GHG emissions to prevent adverse health effects.
Yoganathan D, Rom WN. Medical aspects of global warming. Am J Indust Med
2001;40:199-210.
Global warming impacts on human health through weather disasters, heat stress, land and water scarcity, nutritional
health, noninfectious diseases, and infectious diseases (Epstein and Leaf, 1998) Weather disaster losses for the world
during 1998 were $89 billion which eclipsed the losses of $55 billion for the entire decade of the 1980s.
Specific Disease:
Infectious. CC impacts ecology re biodiversity, nutrient cycle, physical relocation, internal defense systems, and
transmission dynamics within microbes; CO2 stimulates microbes and their carriers. Vector borne diseases impacted by
CC: mosquito-borne malaria; mosquito-borne dengue fever. Non vector-borne disease cholera is related to CC. Algae
and Vibrio cholerae thrive with increased CO2, nitrogen, phosphorus and global warming. In 1991, a cholera epidemic
in Latin America (500,000 cases) caused 5000 deaths. Cholera epidemic in Rwanda in 1994 killed 40,000 persons.
Hantavirus Pulmonary Syndrome (vector: white-footed mouse) is increasing and associated with CC and global
warming. Cryptosporidiosis, Lyme disease and the encephalitides are possible indicators of global warming.
Pulmonary diseases including asthma from aeroallergens: spores and molds and air pollutants—Ozone—are increased
with warming.
Cardiovascular diseases: heat stress affects CV function. Chicago heat wave in 1995 caused 23% increase in CV
admissions to hospitals.
Psychoneurology: Suicide rates increased 14% after natural disasters. Heat syndromes cause psychoneurological
findings: seizures; disorientation, lethargy; delirium.
Occupational medicine: Heat related illnesses may affect indoor and outdoor workers. NIOSH: heat stress is induced
from: high temperatures; high humidity; heavy sunlight; heavy workloads. Categories of stress: include heat rash; heat
syncope; heat cramps; heat exhaustion; and heat stroke.
Skeptics of global warming: In 1998 50 members of the American Meteorological Society signed a letter regarding
environmental policies highly critical of policies derived from “highly uncertain scientific theories.” But 9 of the 11
hottest years in the 20th century occurred since 1985 which is not consistent with a natural trend. Similarly glacial
melting is occurring at a more rapid rate than can be explained by natural trends. Other observations are not consistent
with a natural trend.
Government Response: UN Framework Convention on Climate Change (FCCC) signed by 150 nations. US
admistration has 3- step approach: scientific research on which political actions can be used; partnerships with private
sector industry and NGOs, and joining with other countries in recognizing that GW is an international problem. Global
warming analysis has been overseen by the U.S. Global Change Research Program (USGCRP) with total funding of
>$1billion, established in 1990 by Congress. IPCC developed by the World Meteorlogical Org and UN Environmental
Program (1988) to assess scientific and technical literature on CC, impacts and options for solutions.
EPA (1993) in EPA Climate Change Action Plan discussed private sector industry and nongovernmental organizations’
partnerships—about 50 federal voluntary programs. Benefits include savings of energy, money and increasing
competitiveness through use of cleaner technologies (EPA 1999). Technologies include: coal gasification; fuel cells
and photovoltaics, c. nickel metal hydride batteries to produce hydrogen for cars.
Kyoto Protocol (1997) has established a framework for action: U.S. agreed to reduce emission of 6 greenhouse gases—
CO2, methane, nitrous oxide, hydrofluoroalkanes, perfluorocarbons, and sulfur hexafluoride to 7% less that emissions
in 1990—targets to be reached over 5 yr budget period, starting in 2008 and concluding in 2012.
Young K. Climate change and health (comment) Comment on: CMAJ 2005 172(4):437,
439, Comment on: CMAJ 2005;172(4):501-2. CMAJ Canadian Medical Association
Journal 2005;173(4):339; author reply 340.
Zhang X, Zwiers FW, Hegerl GC, et al. Detection of human influence on twentiethcentury precipitation trends. Nature 2007;448:461-65.
38
Human influence on climate has been detected in surface air temperature, sea level pressure, and others. Human
induced changes in global precipitation have not been reported. The authors show: anthropogenic forcing has had a
detectable influence on changes in average precipitation in the Northern Hemisphere mid-latitudes, drying in the
Northern Hemisphere, drying in the Northern Hemisphere subtropics and tropics, and moistening in the Southern
Hemisphere subtropics and deep tropics. These changes, which are larger than estimated from model simulations, may
have already had significant effects on ecosystems, agriculture and human health in regions that are sensitive to
changes in precipitation, such as the Sahel.
Zell R. Global climate change and the emergence/re-emergence of infectious diseases.
(Review: 94 ref) Intern J Med Micro 2004;293 Suppl 37:16-26.
Extreme weather events and annual changes in weather conditions cause variation in incidence of vector-borne
diseases. GW may increase ID outbreaks. The complexity of the multiple determinants of pathogen transmission the
issues make it difficult to characterize the relative impacts of variables and risk factors.
Ziska LH, Gebhard DE, Frenz DA, et al. Cities as harbingers of climate change: Common
ragweed, urbanization, and public health. J Allergy Clin Immunol 2003;111:290-5.
The study aim was to assess the impact of climatic change on pollen production of common ragweed. Ragweed grew
faster, flowered earlier, and produced significantly greater above-ground biomass and ragweed pollen at urban
locations than at rural locations. They found a 30% increase in CO2 and temperature in urban vs. rural locations.
Regional urbanization-induced temperature/CO2 increases similar to those associated with projected global climatic
change might already have public health consequences.
Government Reportsz:
Agnew B. Planet Earth, getting too hot for health? WHO Bulletin of the World Health
Organization. 2001;79(11):1090-92.
Most climatologists believe the Earth’s atmosphere is warming; no one knows how high, how fast. There is little doubt
among leading scientists who have taken part in recent studies that CC is a reality, according to WHO environmental
health expert Dr. Carlos Corvalan. A nation’s ability to adapt to CC “depends on such factors as wealth, technology,
education, information, skills, infrastructure, access to resources, and management capabilities.” Dr. Patz, director of
the program on health effects of global environmental change (Johns Hopkins Bloomberg School of Public Health
suggests GW will place huge new demands on PH officials.
The WHO IPCC Report and other reports including US NAS report on GW and ID (April 2001) lists these climate
triggered health threats: Vector-borne diseases; Heat-related deaths; Cold-related mortality might decline; Air pollution
in urban areas; Extreme weather events related outbreaks of disease; Population displacement from rising seas;
Malnutrition risks and diseases associated with malnutrition; Warming oceans promote toxic algal blooms and
associated diarrheal diseases; Emerging infectious diseases.
More research is needed but action is needed now to prevent, mitigate, and adapt to changes.
British Embassy. The Economics of Climate Change Symposium. November 28, 2006.
Available March 24, 2008 online at: http://www.uknow.or.jp/be_e/environment/sternsymposium/ Also see: The Economics of Climate Change. The Stern Review. Nicholas
Stern, Cabinet Office-HM Treasury (ISBN-13:9780521700801, January 2007. Available
online: http://www.cambridge.org/us/catalogue/print.asp?isbn=9780521700801&print=y
Symposium co-hosted by the British Embassy Tokyo and the Nihon Keizai Newspaper at the United Nations
University. Keynote speech by Sir Nicholas Stern who presented findings of his major report on the economics of
39
climate change which was published October 2006. Extensive discussion found online with both favorable and
unfavorable comments.
Department of Health and Human Services. Centers for Disease Control and Prevention.
CDC Policy on Climate Change and Public Health. Available online March 21, 2008:
http://www.cdc.gov/nceh/climatechange/
Recommendations from January 2007 CDC conference. Eleven priority health actions outlined. 1. Serve as credible
source of information on CC and PH; 2. Track data on environmental conditions, disease risks, and disease occurrence
related to CC; 3. Expand modeling and forecasting capacity; 4. Enhance science base; 5. Identify locations and
populations at greatest risk of specific health threats such as heat waves; 6. communicate health-related aspects of CC:
risks and ways to reduce them-to public, decision makers, and providers; 7. develop partnerships with other
government agencies, private sector, NGOs, universities and international organizations; 8 provide leadership to state
and local governments, community leaders, healthcare professionals, NGOs, faith-based communities, private sector
and public; 9 develop/implement preparedness and response plans for health threats such as heat waves, severe weather
events and infectious diseases; 10. Provide technical advice to health departments etc; 11. Promote workforce
development by helping ensure the training of a new generation of competent, experienced PH staff to respond to the
health threats posed by CC.
Additional resources include: 1. Intergovernmental Panel on Climate Change (UN Environment Programm (UNEP)
and World Meteorological Organization (WMO); 2. U.S. Climate Change Science Program (cosponsored by 13 federal
agencies with oversight by Office of Science and Technology Policy, Council on Environmental Quality; the National
Economic Council and the Office of Management and Budget; 3. U.S. EPA-Climate Change.
Intergovernmental Panel on Climate Change 2007 Synthesis Report. United Nations
Environment Program (UNEP) and World Meteorological Organization (WMO).
Available online March 21, 2008: http://www.ipcc.ch/pdf/assessmentreport/ar4/syr/ar4_syr.pdf
Excellent 123 pp report by IPCC. Core writing team 40 persons, including 9 from the U.S. Report was reviewed by 193
member governments of the IPCC and > 2,400 individual experts. Contains extensive Glossary. The Report is
organized as follows: Introduction; 1. Observed changes in climate and their effects; 2.Causes of change; 3. Climate
change and its impacts in the near and long term under different scenarios; 4. Adaptation and mitigation options and
responses, and the inter-relationship with sustainable development, at global and regional levels; 5. The long-term
perspective: scientific and socio-economic aspects relevant to adaptation and mitigation, consistent with the objectives
and provisions of the Convention, and in the context of sustainable development; 6. Robust findings, key uncertainties.
Annex’s I-VII.
The impacts of future climate changes include: 1. health status of millions of people is projected to be affected through:
malnutrition, increased deaths, diseases and injuries from extreme weather events; increased diarrheal diseases;
increased cardio-respiratory diseases due to higher levels of air pollution; altered spatial distribution of some infectious
diseases. Some benefits: fewer deaths from cold exposure but benefits will be outweighed by negative health effects of
rising temperatures, especially in developing countries. Critically important will be factors that directly shape the health
of populations such as education, health care, public health infrastructure and initiatives and economic development.
United Nations Chronicle With climate, including global warming, as complicators
Malaria, in second place, sees fewer victims, but greater difficulty of control.
1999;36(1):19.
The geographical area affected by malaria has decreased over the past 50 years but control is becoming more difficult
and gains have been eroded. A variety of causes may account for this, including global climate change.
U.S. Centers for Disease Control and Prevention. Climate Change: Protecting Public
Health. Available online March 22, 2008: http://www.cdc.gov/Feathures/ClimateChange/
40
Dr. Gerberding testified October 23 before the US Senate Committee on Environment
and Public Works during hearings on Climate Change and Public Health. Available
online March 22, 2008: http://www.cdc.gov/Features/ClimateChange/ The White House
redacted Gerberding’s original 14 page written testimony of October 23, 2007, to 6
pages. See AP story by Hebert, Oct 24, 2007.
http://www.climatesciencewatch.org/file-uploads/Draft_CDC_testimony_23oct07.pdf
http://epw.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id=7c34e37a
-8a6f-4753-bc2e-26d19b8a2794
Dr. Gerberdin’s original and censored written testimony and the Senate Hearings chaired
by Senator Boxer: “Examining the Human Health Impacts of Global Warming” are
available online March 22, 2008:
http://www.climatesciencewatch.org/index.php/csw/details/censored_cdc_testimony
U.S. Climate Change Science Program. Available online on March 22, 2008:
http://www.climatescience.gov
U.S. Climate Change Science Program: Vision for the Program and Highlights of the
Scientific Strategic Plan. July 2003. A Report by the Climate Change Science Program
and the Subcommittee on Global Change Research. Prepared in compliance with Section
515 of the Treasury and General Government Appropriations Act for Fiscal Year 2001
(Public Law 106-554. Available online on March 22, 2008:
http://www.climatescience.gov/Library/stratplan2003/vision/ccsp-vision.pdf
The Secretaries of Energy (Spencer Abraham), Commerce (Donald Evans) and Director, Office of Science and
Technology Policy (John Marburger) wrote to Congress (July 2003): “The Strategic Plan for the Climate Change
Science Program” responds to the President’s direction that climate change research activities be accelerated to provide
the best possible scientific information to support public discussion and decision-making on climate-related issues. The
plan also responds to Section 104 of the Global Change Research Act of 1990, which mandates the development and
periodic updating of a long-term national global change research plan coordinated through the National Science and
technology Council. …The President established the U.S. Climate Change Science Program in 2002 as part of a new
cabinet-level management structure to oversee public investments in climate change science and technology.”
U.S. Environmental Protection Agency (EPA). Climate change and public health. EPA
Office of Policy Planning and Evaluation (2171) 236-F-97-005, October 1997.
“The balance of evidence suggests that there is a discernible human influence on global climate.” (Intergovernmental
Panel on Climate Change of the United Nations and World Meteorological Organization.” Exactly how much risk is
entailed is difficult to quantify since human populations differ in vulnerability and factors such as crowding, food
scarcity, poverty, and local environmental decline make populations in some developing countries especially
vulnerable. Also aging population raises health risks. Potential health impacts from global climate change include:
 Heat Waves: More heat-related deaths and illnesses
 Air Pollution: Aggravation of cardiovascular and respiratory diseases from worsening air quality
 Terrestrial Changes: Risk of ID because of new geographic ranges and activity of disease-carrying
animals, insects, and infective parasites
 Altered Marine Ecology: Changes in incidence of cholera and food poisoning from toxic algae
 Storms: Deaths and injuries from storms and floods and intestinal illnesses from flooding of sewage
treatment plants
 Droughts: Rising malnutrition in some countries
 Population displacement: Injuries and increased risk of disease due to migration and crowding
41

Saltwater Encroachment in Costal Aquifers: Greater risk of intestinal illnesses from inadequate
water supplies.
What needs to be done? 1. Everyone has a part to play in preventing probable negative health effects from climate
change; 2. Reduce burning fossil fuels; 3. Conservation measures (gains of 10-30% above present levels feasible at
little or no cost through use of available technologies, development of new energy technologies and better land
management practices; 4. Federal, State, and local government need to enact flexible and cost-effective policies to
reduce greenhouse gas emissions; 5. Physicians and PH practitioner improved primary health care for vulnerable
populations; better PH monitoring, disease surveillance and control, disaster preparedness, vaccination, and public
education. 6. Communities and state government better management of ecosystems, wider use of protective
technologies such as sea walls and levees, and improved water purification. 7. Research to assess risks from adaptive
strategies.
This EPA paper references: McMichael AJ, et al 1996 Human population health (Chapter 18). In Climate change
1995—impacts, adaptations, and mitigation of climate change: Scientific-technical analyses. Intergovernmental Panel
on Climate Change (IPCC) pp 563-84.
U.S. Environmental Protection Agency (EPA). U.S. Greenhouse Gas Inventory Reports:
Draft Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-2006, February
2008. Available online, March 22, 2008:
http://www.epa.gov/climatechange/emmissions/usinventoryreport.html.
The Draft Report is open for public comment till April 6, 2008. The Report provides an emissions inventory for
primary anthropogenic sources and sinks of GHG regarding CC. The Report uses a consistent mechanism that enables
Parties to the UN Framework convention on Climate Change (UNFCCC) to compare the relative contribution of
different emission sources and GHG to climate change. The Report is revised annually. Of 14 members of the
Subcommittee, two are from health related agencies (DHHS and EPA). There is little mention of public health
implications of climate change in this Report. In the Section Human Contributions and Responses is the statement:
“Assessments of the potential consequences of global change for human health in the United States.” In Appendix B a
brief list of related activities are provided for the DHHS and NIH (UV radiation: skin, eyes, etc); NIEHS
(Chlorfluorcarbons); NIH and CDC: global change and human health re infectious diseases.
In Appendix C: Key Gaps in the Science of Climate Change, the following statement appears: “ Health outcomes in
response to climate change are the subject of intense debate…The understanding of the relationships between
weather/climate and human health is in its infancy and therefore the health consequences of climate change are poorly
understood. The costs, benefits, and availability of resources for adaptation are also uncertain.” (p.20)
U.S. Environmental Protection Agency (EPA). Climate Change. Available online March
22, 2008; Last updated January 15, 2008: http://www.epa.gov/climatechange/
Provides basic information and frequent questions regarding U.S. Climate Policy; What You Can Do; Climate
Economics and Other Resources.
U.S. Environmental Protection Agency (EPA). Climate Change-Climate Economics.
Available online March 22, 2008:
http://www.epa.gov/climatechange/economics/economicanalyses.html#s2191
Economic analyses conducted by EPA regarding the economic and environmental effects of potential domestic climate
change mitigation programs and strategies, including: The U.S. EPA Analysis of Senate Bill S.2191 in the 110
Congress, the Lieberman-Warner Climate Security Act of 2008; Part 2 of the US EPA analysis of Senate Bill S.1766 in
the 110th Congress, the Low Carbon Economy Act of 2007 and other Bills.
U.S. Global Change Research Act of 1990. Public Law 101-606 (11/16/90) 104 Stat.
3096-3124. Available online March 18, 2008 at: U.S. Global Change Research
Information Office. http://www.gcrio.org/gcact1990.html
42
Global (climate) change may significantly alter the Earth habitat within a few generations: global warming; increased
sea levels with adverse effects on: agricultural and marine production, coastal habitability, biological diversity, human
health and global economic and social well-being.
U.S. Senate Committee on Environment and Public Works: Hearing: Examining the
Human Health Impacts of Global Warming. Tues, Oct. 23, 2007, EPW Hearing Room406 Dirksen. Panel 1: Dr. Gerberding and Frumkin; Panel 2: Drs. McCally, Roberts, and
Susan Cooper MSN, RN. Video available online March 22, 2008:
http://www.climatesciencewatch.org/index.php/csw/details/censored_cdc_testimony/
Senator Boxer D. CA Chair. Video of entire Senate Committee hearing. Panelists: McCally (PSR) and Susan Cooper
Commissioner, TN Department of Health, representing Association of State and Territorial Health Officials (ASTHO)
http://www.astho.org/index.php?template=about_astho.html&PHPSESSID=b1543f448b04b5f327448f14f7e73445:
Urged strong Congressional action on Climate Change related Public Health problems. CDC Director J.Gerberding
agreed that CC is a problem but there is uncertainty with much of the science; she called for significant increase in
leadership and action so CDC can participate more with WHO in addressing pressing issues regarding CC. Panelist
Roberts, Retired Professor from the Uniformed Services University of the Health Sciences expressed skepticism about
the relationship between CC and VBDs.
White House: Key Gaps in the Science of Climate Change. From the White House
document at: http://www.whitehouse.gov/news/releases/2001/06/climatechange.pdf.
Advancing the Science of Climate Change.
This material also found in Appendix C of The U.S. Climate Change Science Program Vision for the Program and
Highlights of the Scientific Strategic Plan, p. 33 (see above)
Under the heading: The details and impacts of regional climate change resulting from global climate change are
uncertain: “ Health outcomes in response to climate change are the subject of intense debate…The understanding of the
relationships between weather/climate and human health is in its infancy and therefore the health consequences of
climate change are poorly understood. The costs, benefits, and availability of resources for adaptation are also
uncertain.” (p.20)
Science-based NGO Advocacy Organizations:
Physicians for Social Responsibility (PSR), Washington, D.C. Reports regarding Climate
Change and health are available online (March 22, 2008): http://www.psr.org




The medical and public health impacts of global warming: A factsheet.
(2pp) (All references available at PSR:
http://www.psr.org/site/PageServer?pagename=enviro_resources.
Responsible actions to reduce climate change and energy use (4pp)
Coal-fired power plants: Understanding the health costs of a dirty energy
source (2pp and 14 ref)
Fighting global warming: Ending our dependence on oil. (2pp with 16 ref)
Physicians for Social Responsibility (PSR), Washington, D.C. Environment & Health
Resources: Air Pollution and Health; Children’s Environmental Health; Chronic Disease
and the Environment; Global Warming, Energy and Health; Safe Drinking Water; Toxics
and Health. Available online March 22, 2008:
http://www.psr.org/site/PageServer?pagename=enviro_resources
43
Under heading: Global Warming, Energy and Health, a section titled: “Death by Degrees” provides state by state
reports of the public health implications of climate change for 15 states. Indiana is not included on this list. The Report
for California (2003) is 59 pp and has 195 references; the Ohio Report (2000) has 39 pp and 247 references.
Union of Concerned Scientists: California enacts nation’s toughest global warming bill.
August 31, 2006. Available March 23, 2008 online at:
http://www.ucsusa.org/news/press_release/california-enacts-nations.html
California Legislature passed landmark legislation to create the nation’s first economy-wide cap on global warming
emissions, and Gov. Schwarzenegger agreed to sight the bill into law.
Union of Concerned Scientists: Global Warming. Policy Solutions: Three Climate Bills
Working Their Way through the Senate. Available March 23, 2008 online at:
http://www.ucsusa.org/global_warming/solutions/senate-climage-bills.html.
Reviews three climate bills approved by the Senate Commerce, Science and Transportation Committee in early
December 2007: Climate Change Adaptation Act; Global Change Research Improvement Act; Federal Ocean
Acidification Research and Monitoring Act.
Union of Concerned Scientists News. Senate Committee Passes Historic Bill to Reduce
Global Warming Pollution. Statement by UCS President Kevin Knobloch, December 5,
2007. Available March 23, 2008 online at:
http://www.ucsusa.org/news/press_release/senate-committee-passes-0083.html
The Senate Committee on the Environment and Public Works Committee passed a bill introduced by Sens. J.
Lieberman (D-Conn) and John Warner (R-Va) that would establish the first nationwide cap-and-trade-system to reduce
global warming pollution. UCS President praises Lieberman, Warner and Committee Chair: B. Boxer for leadership,
suggesting that this bill suggests to the world that the U.S. is taking its responsibility for its own global warming
emissions. Knobloch notes shortcomings of the bill: “it would give away a large share of emission allowances to
polluters.”
Newspaper/magazine/other media articles:
Cooke R. Impact of global warming on health debated. Harvard University Gazette
Online. Available on March 23, 2008:
http://www.news.harvard.edu/gazette/2008/02.21/01-aaas.html
Differing views on hot topic clash at AAAS symposium. February 18, 2008 at the Annual meeting of the American
Association for the Advancement of Science a colloquium: “Sustaining Human Health in a Changing Global
Environment” featured contrary views regarding hazards that can be expected as a result of climate change.
Paul Epstein, associate director of the Center for Health and Global Environment at Harvard Medical School argued of
real danger in CC: heat waves, flooding, infectious diseases through spread of pests and diseases among livestock,
wildlife and agricultural systems, forests, and coastal marine life.
Duane Gubler: director of Asia-Pacific Institute of Tropical Medicine and Infectious Disease (Honolulu) said it is too
easy to blame GW for dangerous problem of ID spreading, or re-emerging, in areas where they’ve been absent for a
century or more. Gubler says that reemergence of ID in the 1980s has little to do with GW; instead they include
increases in population density of vectors: mosquitoes and ticks with too little attention being paid to public health
practices, increased crowding in cities, genetic changes in disease organisms, rapid transportation of harmful viruses
and bacteria around the globe and complaisance about the dangers—a sense that ID had bee conquered. Gubler noted
that preventive medicine is not emphasized in medical schools—they now focus on “curative” medicine: “we don’t
even emphasize hand-washing anymore.” Gubler sites examples where emergence of ID seems related to other causes
44
than GW: increased deer population in NE U.S. with expansion of the tick population. The deer population increased
because of farmlands returning to forests and advent of people building homes in the woods where deer ticks abound.
In Asia, livestock producers set up large piggeries adjacent to forests, the home of fruit bats that carry the Nipah virus
which causes flu symptoms and may be fatal. The virus got into pigs and from pigs to humans. Malaria re-emergence in
tropical regions is a result of a breakdown in public health practices, such as mosquito control.
Epstein argued that excess CO2 in air carries health consequences: ragweed grown in elevated CO2 levels produces
pollen disproportionate to its stem growth. Fossil fuel mining, extraction, refining, transport and combustion harm
health and the environment, especially in developing nations. Clean energy and technology transition can improve
public health, help stabilize the climate, and become the engine of economic growth and poverty alleviation in the 21 st
century.
Gardner A. Global warming will cause rise in death rates: Toll won’t be offset by milder
winters, researchers predict. Available online at:
http://www.healthonnet.org/News/HSN/605977.html
News article reviews paper by Mercedes Medina-Ramon, a research fellow at Harvard School of Public Health and
published in the online issue June 28, 2007, Occupational and Environ Medicine. Study based on analysis of daily
death and weather data for more than 6.5 million deaths (1989-2000 in 50 U.S. cities. During two-day cold snaps,
deaths increased 1.59% (many due to heart attacks and cardiac arrest); but during scorchers, death rates went up by
5.74%. Installing air-conditioners in every home isn’t a solution since it would add to global warming. “We should
increase the use of air-conditioning but stop the abuse.”
Global Warming Newspaper Archive. History of Global Warming. Available online
March 23, 2008 at: http://www.globalwarmingarchive.com/History.aspx
The first theory of GW came in 1824 when French mathematician Jean Baptists Joseph Fourier discovered that the
Earth’s temperature was slowly increasing. Fourier argued the earth’s atmosphere traps solar radiation and reflects it
back toward earth.
Global Warming News: Ignoring science and law, Bush administration blocks state
progress on curbing global warming emissions from cars. Environment California.
Available March 23, 2008 online at:
http://www.environmentcalifornia.org/newsroom/global-warming-news/global-warmingnews2/ignoring-s...
U.S. EPA formally denied CA’s request for a Clean Air Act waiver of preemption, blocking the efforts of CA and 12
other states that seek to require automakers to cut pollution from automobile tailpipes.
Hebert HJ, Gross D. White House denies editing CDC testimony. Associated Press, Wed,
24 Oct 2007 20:28;48 GMT.
“The White House significantly edited testimony prepared for a Senate hearing on the impact of climate change on
health, deleting key portions citing diseases that could flourish in a warmer climate, documents obtained by AP showed
Wednesday.”
Illinois Wesleyan: News-Founders’ Day Speaker James Hansen: Global Warming an
Immediate Threat. February 20, 2008, Bloomington, Illinois. Available on March 23,
2008 online at: http://www2.iwu.edu/CurrentNews/newsreleases08/spk_Hansen208.shtml
NASA’s Goddard Institute Director James Hansen discussed GW. Hansen called on the young people in the audience
to slow the devastating damage being done to the planet through the use of fossil fuels. Hansen expressed fear that the
planet is reaching an irreversible tipping point with GW. One such tipping point has already been reached according to
Hansen: the alarming loss in polar ice. Even as the Earth stands on the precipice of global change, Hansen can see hope
for the planet. “There can also be a tipping point of social change,…If we follow business as usual, then the Earth will
45
warm past a point of no return. Hansen is member of the National Academy of Sciences and twice received the NASA
Presidential Rank for Meritorious Executive Award. He was named by Time Magazine in 2006 as one of the world’s
100 most influential people.
Kay J. Global warming health effects: Smog, heat waves may contribute to big rise in
illness. San Fran Chronicle April 17, 2008.
This Chronicle Environment Writer summarizes findings presented Monday (April 16, 2007) by the UN
Intergovernmental Panel on Climate Change.
Kay J. Global warming health effects: Smog, heat waves may contribute to big rise in
illness. San Fran Chronicle April 17, 2008.
This Chronicle Environment Writer summarizes findings presented Monday (April 16, 2007) by the UN
Intergovernmental Panel on Climate Change.
Kerry J. Bush takes a backseat. Time. 2002;160(9):A49.
John Kerry: “Nowhere is presidential leadership more lacking than in the debate over global warming. It took the Bush
Administration 16 months to acknowledge what scientists have known for more than a decade: the same pollution—
primarily from fossil fuels—that causes asthma and respiratory illness is also altering and warming the atmosphere.
Refusing to address climate change may being unprecedented environmental damage to the health and well-being of
people throughout the world.”
Makhijani A. Institute for Energy and Environmental Research. Bad news on climate;
good news on energy. March 3, 2008. Available March 24, 2008 online:
http://ieer.typepad.com/ieer/
Review of this authors publications and media presentations regarding climate change. Featured on Dallas PBS TV
program Think, talking about the author’s publication: Carbon-Free and Nuclear Free.
Osborne H. Guardian.co.uk: Stern report: the key points. October 30, 2006. Available
March 23, 2008 online at:
http://www.guardian.co.uk/politics/2006/oct/30/economy.uk/print
Economist from London School of Economics outlines dangers of climate change and recommended actions with
economic impacts. All countries will be affected by CC, the poorest will suffer the most. Global stabilization of
temperature and CO2 is critical. Policies needed: carbon pricing, through taxation; technology policies and energy
efficiencies. Unabated CC could cost the world at least 5% of GDP but if dramatic predictions came to pass it could be
20% of GDP. We need to start now in addressing this major global challenge.
Public Broadcasting System (PBS). NOW. Science and Health: The Political Climate.
Available March 23, 2008, online at:
http://www.pbs.org/now/science/climatechange.html
History and timeline of GW, from 1904 Swedish scientist Svante Arrhenius, the first person to investigate the effect
that doubling atmospheric CO2 would have on global climate to 2005 Senator James Inhofe Senate floor speech
condemning the idea of global warming as “the greatest hoax ever perpetrated on the American people.”
David Brancaccio, PBS host of the program NOW, narrates a 10 minute video regarding the extent to which
corporations involved in current fossil fuel energy production have led a major effort by lobbying Congress and the
White House to slow initiatives that would shift resources from fossil fuel energy production to alternative energy
sources. The majority of scientists believe the latter strategy will be critical to stabilize global CO2 and temperatures to
avert major potentially catastrophic impacts on the planet.
46
Public Broadcasting System (PBS). NOW. Science and Health: The Political Climate.
Available March 23, 2008, online at:
http://www.pbs.org/now/science/climatechange.html
History and timeline of GW, from 1904 Swedish scientist Svante Arrhenius, the first person to investigate the effect
that doubling atmospheric CO2 would have on global climate to 2005 Senator James Inhofe Senate floor speech
condemning the idea of global warming as “the greatest hoax ever perpetrated on the American people.”
David Brancaccio, PBS host of the program NOW, narrates a 10 minute video regarding the extent to which
corporations involved in current fossil fuel energy production have led a major effort by lobbying Congress and the
White House to slow initiatives that would shift resources from fossil fuel energy production to alternative energy
sources. The majority of scientists believe the latter strategy will be critical to stabilize global CO2 and temperatures to
avert major potentially catastrophic impacts on the planet.
San Bernardino Global Warming Plan Settles California Lawsuit. Available March 23,
2008 online at: http://www.ens-newswire.com/ens/aug2007/2007-08-21-091.asp
August 21, 2007 a unique greenhouse gas reduction plan to combat global warming was agreed upon today to settle a
lawsuit brought against the county by the state of California.
Schmidt CW. Global earth observations for health. NIEHS News. Environ Health
Perspectives 2005;113(11):A738-39.
Discusses recent meeting of the NIEHS, U.S. EPA and Earth scientists in a workshop to explore the potential role of
Earth satellite remote sensing technology for research in climate and public health sciences. NOAA and NASA were
involved. Web-based pilot studies that integrate existing remote-sensing data with ground-based analyses will be a
preliminary step of exploring this technology.
Shoof R. Panel: Global-warming mass extinctions preventable. McClatchy Washington
Bureau, February 19, 2008. Available March 23, 2008 online:
http://www.mcclatchydc.com/homepage/story/28095.html
Schoof reports on a recent meeting of IPCC that suggested that, based on more than 40 scientific studies, unless there is
mitigation regarding GW, more than 40% of known plant and animal species could become extinct by 2100. Some
paleontologists have suggested the world is already witnessing a sixth mass extinction. In January 2008, 600 scientists
wrote to Congress saying that it is time to act re GW.
Taubes G. Global Warming: Apocalypse Not. Sci Magazine 1997;278(5340):1004-1006.
Predictions that global warming will spark epidemics have little basis, according to infectious disease specialists, who
argue that public health measures will inevitably outweigh effects of climate. Harvard physician Paul Epstein says GW
will mean spread of infections (malaria, dengue, yellow fever, cholera, hantavirus, Ebola.) Others such as Duane
Gubler (Dir. division of vector-borne ID at CDC and Johns Hopkins epidemiologist DA Henderson argue that
breakdown in public health rather than climate shifts are to blame for recent disease outbreaks and that public health
measures will be far more important than climate in future disease patterns.
United Nations Environment Programme. The Environment News, Thursday, November
1, 2007. Available March 23, 2008 at: http://www.unep.org/cpi/briefs/2007Nov01.doc
Presents numerous news accounts from around the world regarding Climate Change: current effects on human
existence and concerns about the future. Excellent “grass roots” accounts of the impact of GW on the planet and plans
for mitigation and adaptation.
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Selected examples of scientists who are skeptical
about the link between climate change and
adverse impacts on the environment or human
health:
U.S. Senate Committee on Environment and Public Works. Majority Chairman, Barbara
Boxer (D. CA): Minority Ranking Member: James M Inhofe, (R. OK.) Available online:
http://epw.senate.gov/public/index.cfm?FuseAction=Home.Home
Provides access to the global warming statements, speeches, press releases and hearings as well as links to other
sources, from the Majority and Minority Parties. The Chair, Boxer is very supportive of international efforts to address
what she considers is a major global problem. The Minority member, Senator Inhofe, long a critic of GW, presents a
highly critical view of GW, calling it a “scam” on the American people.
The Inhofe EPW Press Blog: U.S. Senate Committee on Environment and Public Works.
Skeptical scientists urge world to “Have the courage to do nothing: at UN conference.
Posted by Marc Morano ([email protected]. December 11, 2007.
Available at the website above.
Article highly critical of the Bali, Indonesia UN conference on global warming. Quotes Lord Christopher Monckton, a
UK climate researcher: “Climate change is a non-problem. The right answer to a non-problem is to have the courage to
do nothing.” “The UN conference is a complete waste of our time and your money and we should no longer pay the
slightest attention to the IPCC (Intergovernmental Panel on Climate Change).”
Milloy S. Publisher. JunkScience.com. Available March 23, 2008 online:
http://www.junkscience.com/
March 4, 2008 Milloy features a presentation (Powerpoint) by Dr. Gray: The Global Warming Scam, at the
International Conference on Climate Change, New York, 3 March, 2008. This presentation denigrates the idea of
Global Warming and the scientists who propose that GW is real and the world needs to address the problem.
Moore TG. Warmer Days and Longer Lives. Hoover Institution, Stanford University.
Available March 23, 2008 online: http://www.stanford.edu/~moore/history_health.html
Moore posits that “warmer is healthier.” He traces human history from the Ice Age (10,000-12,000 yrs ago) to present
suggesting that humans have done will when the weather is mild and suffered when it is cold. “They (humans)
multiplied more rapidly; they lived longer; and they were healthier. If the IPCC is right and the globe does warm,
history suggests that human health is likely to improve.”