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Climate Change Impacts on
Public Health: a Taiwan Study
Huey-Jen Jenny (Jenny) Su
Distinguished Professor
Dept. of Environmental and Occupational Health,
Vice President
National Cheng Kung University,
Tainan, TAIWAN
2017/5/4
National Cheng Kung University
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2017/5/4
How human activities affect climate and
atmosphere activities ?
IPCC, 2007
2017/5/4
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World’s Population Densities
WRI, 2000
2017/5/4
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Temperature changing over the past century
Global
+0.7oC
Taiwan
+1.4oC
IPCC, 2007; Chen, 2008; EPA Taiwan, 2009
2017/5/4
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Global
Taiwan
Precipitation (mm)
Precipitation
Precipitation
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
1000
800
A. (2315)
600
400
200
0
-200
-400
-600
-800
300
Rainhour (hour)
Intensity
Intensity
Intensity (mm/hour)
Dry days
Rain hour(hour)
B. (981)
200
100
0
-100
-200
-300
-400
1.2
1.0
C. (2.9)
0.8
0.6
0.4
0.2
0.0
-0.2
-0.4
-0.6
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
IPCC, 2007; Liu, 2002
2017/5/4
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Climate change and health effects
Climate
Direct impacts (Injury/death)
Primary
fire, wind storm, heat
Change
Global warming
Indirect impacts
Extreme weather
Flooding in Newcastle,
Australia, 2007
Secondary
Tertiary
air/water/soil pollution-related
health effect, food/water security
and sufficiency, allergies,
infectious diseases
Long-term/afterward impacts
mental health, conflict, famine,
migration, refugees, economic loss
Desertification in Hebei
Province, China, 2000
IPCC, 2007; Lovett et al., 2009; Butler et al., 2010
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Climate Change and
Primary Health Effects in Taiwan
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Extreme rainfall and primary health effect
Wettest tropical cyclones in Taiwan
Highest known recorded totals
Rank
Precipitation (mm/in)
Typhoon
Casualties (Death)
1
2777/109.3
Morakot 2009
2255 (643)
2
1736/68.35
Herb 1996
536 (51)
3
1730/68.00
Lynn 1987
--
4
1672/65.83
Carla 1967
--
5
1611/63.42
Sinlaku 2008
48 (15)
6
1561/61.45
Haitang 2005
46 (13)
7
1558/61.34
Megi 2010
96 (13)
8
1546/60.87
Aere 2004
424 (14)
9
1500/59.05
Parma 2009
1 (1)
10
1431/56.34
Nari 2001
369 (94)
CWB Taiwan
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Mean cardiovascular mortality 14 days after
extreme temperature events
Cold event
Heat event
Wu et al., 2011
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Examining the Spatial Relationships among Cardiovascular
Mortality after the Extreme Temperature Events
Extreme temperature events
Cold events (24 events)
R2=0.767
Coefficients
95% C.I.
Heat events (14 events)
R2=0.569
Coefficients
95% C.I.
Cardiovascular mortality before
extreme temperature events
0.539**
( 0.444, 0.635)
0.398**
( 0.289, 0.507)
Mean temperature of extreme
temperature events
0.002
(-0.080, 0.084)
0.025
(-0.066, 0.116)
-0.601**
(-0.829,-0.374)
-0.456**
(-0.705, -0.206)
Factor 2: Susceptible population
1.338**
( 1.014, 1.663)
0.954**
( 0.614, 1.294)
Factor 3: Aborigine population
0.308**
( 0.103, 0.514)
0.760**
( 0.498, 1.020)
Factor 4: Lack of economic
opportunity
-0.076
(-0.268, 0.115)
-0.210*
(-0.438, 0.018)
( 2.659, 5.713)
2.303*
(-0.438, 5.044)
(-0.089, 0.078)
0.098*
(-0.012, 0.208)
Factor 1: Medical resources
and urbanization
Constants
4.186**
Rho
-0.006
Moran’s I value residues
-0.022
-0.041
Baseline of mortality, event temperature, socioeconomic and demographic factors by using spatial analysis.
*p<0.1 **p<0.05
Wu et al., 2011
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Climate Change and
Secondary Health Effects in Taiwan
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Diseases
ICD-9
HAV
701
Enteroviruses
749
Shigellosis
004
Scrub Typhus
812
Dengue Fever
061
Japanese Encephalitis
620
Leptospirosis (2006-08)
100
Melioidosis (2007-08)
025
The category of Disease
Incubation
15-50 days
Intestinal
Infectious Diseases
2-10 days
1 week
6-21 days
Vector-borne
Diseases
3-14 days
5-15 days
2-30 days
Water-Related
Diseases
2 days+
The accumulated cases of climatic-related infectious diseases
between 1994 to 2008
11178
314
3114
Scrub
Typhus
Jap Ence
Dengue
Fever
Shiigelosis
Amoebiasis
HAV
Enteroviruses
45
116
Leptospirosis
4828
3382
1979
1479
Melioid
12000
8000
4000
0
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Reported dengue fever incidence by temperature, relative humidity, rainfall, and
frequency of Breteua Index≧5 from July 1988 to December 2003
Rainfall, mm
1000
400
Relative humidity, %
80
65
Maximum temperature, OC
32
26
Minimum temperature, OC
26
18
Frequency of Breteua index 
70
30
70
Incidence rate, 1/100,000
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JUL 1988 JAN 1990JUL 1991 JAN 1993JUL 1994 JAN 1996JUL 1997 JAN 1999JUL 2000 JAN 2002
Wu et al., 2009
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β
SE
P-value
Td
-0.126
0.062
0.044
Relative
humidity
-0.025
0.013
0.048
Intercept
2.380
1.253
0.060
Weather as an
Effective Predictor
for Occurrence of
Dengue Fever in
Taiwan
Actual incidence
Predicted incidence (Jul. 1988-Dec. 2003)
Forecast incidence (Jan. 2004-Jun. 2006)
Incidence rate (1/100,000)
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The actual incidence, predicted
incidence and forecast incidence
from Jan. 2004 to May 2006 by
auto-regressive integrated
moving average (ARIMA) model
of weather variation in
Kaohsiung City, Taiwan
40
20
0
0
50
100
150
200
Wu et al., 2009
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The risk assessment model of dengue fever
Wu et al., 2009
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Risk map of dengue fever transmission
The areas with high risk of reporting dengue fever infection would likely to expand
from south to north, and human population at high risk for dengue fever transmission
would increase 1.95 times (from 3,966,173 to 7,748,267) along with increasing temperature.
Risk map of dengue fever
transmission based on temperature
and population density data
between 1998 to 2002
48 high risk areas
Risk map of dengue fever
transmission estimated when
average monthly temperature
increased by 1 °C across the year
86 high risk areas
Risk map of dengue fever
transmission estimated when average
monthly temperature under CCCma
A2 scenario (increased about 2°C)
102 high risk areas
Wu et al., 2009
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Precipitation and typhoon impacts on infectious
diseases in Taiwan
 There were 73 Typhoon
events during 1994 to
2005 around Taiwan .
 The Central weather
Bureau defined that 62
Typhoon attacked
Taiwan.
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Pre- and post-typhoon and infectious disease incidence rate
using Poisson regression
Disease Name
ICD-9
Week&
Lag-day#
RR※
Japanese Encephalitis
620
8
5-15
1.11 (0.74-1.65)
Scrub Typhus
812
8
6-21
0.97 (0.79-1.19)
Dengue Fever
061
8
3-14
1.36 (1.26-1.47)*
Amoebiasis
006
8
14-28
1.83 (1.03-3.26)*
HAV
701
8
15-50
0.85 (0.52-1.40)
Scarlet Fever
341
4
1-3
1.37 (1.16-1.60)*
Typhoid fever
002
8
7-21
1.91 (1.14-3.20)*
Enterovirus
749
4
2-10
1.39 (1.02-1.91)*
&The
weeks Pre- and Post-Typhoon
※Rate Ration
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# Information
*
from CDC
p<0.05
Su et al., 2007
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The rainfall density (mm/day) and Shigellosis
cases after Typhoon Nari 2 weeks
Logistic regression
Odds ratio
95% C.I.
rainfall density >=63 (mm/day)
4.53
(1.72-11.96)
tap-water supply rate <65%
1.26
(0.43 - 3.60)
elevation>=249.2m
1.85
(0.62 - 5.41)
the percent of aborigine >=1.45%
4.30
(1.61-12.08)
Typhoon Nari, 2001
Chen et al., 2011
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Water/soil pollutants after
extreme precipitation in Taiwan
Rejection in Feitsui reservoir,
Taiwan after Typhoon attracted
Drinking Water
Rejection after Extreme
Precipitation (Megi Storm, Oct.
2010) in Taiwan
Agricultural land
Lovett et al., 2009
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Flooding and outbreak of
Melioidosis (2005)
 40 cases in southern
Taiwan.
 97.5% cases resided in the
flooded zones.
 70% cases contacted with
mud or flooding waters.
 67.5% cases had existing
chronic illness.
Typhoon Haitang, Taiwan (2005)
HR Guo, et. al., 2007; Chen et al., 2011
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Extreme precipitation affects infectious disease distributions in Taiwan,
1994–2008
Meteorological Data
The accumulated daily precipitation and
mean daily temperature data from
Central Weather Bureau (CBW) of
Taiwan during 1994 to 2008 were
acquired.
Extrapolation
Study extrapolated the available
precipitation and temperature
data for every townships.
Definition of Extreme Precipitation
130-200 mm/day: heavy rain
200-350 mm/day: torrential rain
>350 mm/day: extreme torrential rain
(As defined by Taiwan CBW)
Averaged 99th percentile of precipitation for the 352
townships in Taiwan was 92.80 mm/day
Infectious Disease Definitions
The computerized database with recorded daily
notification of 8 legal infectious disease cases from
Taiwan CDC, 1994–2008.
Statistical Analysis
•
Spearman’s correlation coefficient
identified that extreme precipitation were
associated with the occurrence of 8 climaterelated infectious diseases with lags of 0–70
days
1. Time series analysis for Log-term effects in
overall Taiwan
2. Grating Models of every townships for
regional assessment
Chen et al., 2011
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Relative risk of precipitation on 8 climate-related infectious
diseases in Taiwan
Chen et al., 2011
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The risk map of 8
climate-related
infectious diseases
in Taiwan
Chen et al., 2011
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Climate Change and
Tertiary Health Effects in Taiwan
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Pathways linking climate change and mental health
www.AlertNet.org
Berry et al., 2011
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A multidimensional anxiety assessment of adolescents
after Typhoon Morakot-associated mudslides

This survey was conducted with 271 adolescents in three junior high schools in
mountainous regions of southern Taiwan which were worst-affected by Typhoon
Morakot.

In total, 73 students (26.9%) had a diagnosis of PTSD. Of these, 65 had PTSD related
to Typhoon Morakot, 3 had PTSD related to traumatic events other than Typhoon
Morakot (one experienced a traffic accident, one witnessed a brother’s traffic
accident, and one was severely hurt in a fight), and 5 had PTSD related to both
Typhoon Morakot and other factors.
Yen et al., 2010
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Relationship between mean daily ambient
temperature range and hospital
admissions for schizophrenia: results from a
national cohort of psychiatric inpatients
Relationships between mean and mean daily range of temperature and
relative risks with 95% confidence intervals (CIs) of schizophrenia
admissions in Taipei city, 1996–2007.Analyzed by generalized linear
models with Poisson regression, and adjusted for age, gender, daily
precipitation, calendar month, and hospital authority
Sung et al., 2011 (in press)
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The Health Effects under Climate Change in Taiwan
Impacts
Temperature
Heat wave
and cold spell
Increase
temperature
Precipitation
Extreme
Precipitation
Direct 2-3,5-6, 8-11
 Increase RTD and CVD
morbidity
 Decrease cold-related diseases
mortality and morbidity
 Increase the risk of mental
disease
Increase the risk of accidental
death
Drought
Social –
Economic
Risk Factors
The mobility of CVD and RTD:
High risk group (Elders, Elders
living alone, Disability), High
percent of aborigine and Low
Urbanization
Indirect 1, 4, 7, 11
--



Extending climate-related infectious diseases
The risk areas of dengue fever were increased
The cases of Scrub Typhus were increased

Increase the occurrence of water-borne infectious
diseases


Increase the occurrence Shigellosis
Drought was associated with HAV
Dengue fever: High urbanization
Shigellosis: High percent of aborigine and
elevation
Scrub Typhus: High percent of aborigine
HAV: High urbanization
1 Acta Tropica 2007, 103: 50–57
2 Climatic Change 2009, 94: 457–471
3 Sci Total Environ 2009, 407: 3421-3424
4 Sci Total Environ 2009, 407: 2224-2233
5 Sci Total Environ 2010, 408: 2042-2049
6 Occup. Eevr. M. 2011, 68: 525-530
7 PLoS ONE (in revision)
8 Climatic Change (in revision)
9 Sci Total Environ 2011 (in press)
10 Sci Epidemiology (in submission)
11 Current Opinion Envirion Sustainability (in revision)
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Future collaboration
Health impacts
Regional weather changes
Diverse pathway
Chronic diseases (CVD, RTD, enterogastritis, water
intoxication, food intoxication, eyes, skin)
UV ray
Pollution (Water, land, food, air)
Rainfall
(Extreme, drought)
Temperature
(Extreme, variation)
Wide
(Storm, cyclone)
Microbial contamination pathways
Death (all cause, CVD, RTD)
Infectious diseases (vactor-, mosquito-, sandfly-, tick-,
rodet- , food-, water-, air-borne)
Transmission dynamics
Injury (Nature disaster, accident)
Socioeconomics, demographics
Food/water insufficient, food/water security
Agro-ecosystems, hydrology
Allergic diseases (Asthma)
Mental health
Continuing the adaptation process,
Adaptation
international
comparison and
international collaboration
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Thank you for your attentions