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CIS oƒ HDGC Carnegie Mellon Effects of climate change on infectious diseases Hadi Dowlatabadi Funded BY: My Thanks to: Science Foundation, Center National for Integrated Study the Human Dimensions of Elizabeth Casman, IlyaofFischhoff, Baruch GlobalUSDOE, Change, Carnegie Mellon University, & ExxonMobil, Fischhoff, Lester lave, Emilio Moran, EPRI, NOAA, USEPA, and University Fellow, Resources theAPI Future Richard Tol,for Duane Gubler & the organizers of the conference Outline of this talk 2 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon Climate determines the conditions permissive of infectious diseases • For vector borne diseases this would be the conditions suitable for mutual development of the vector and pathogen. • Climate conditions can determine whether the pathogen and humans come into contact with one another by affecting human behaviour and pathogen ecology. • Extreme climate events can overwhelm waste water management infrastructures. • Adverse climate conditions can affect food production, lead to hunger and hence immune suppression. • … 3 CIS oƒ HDGC Carnegie Mellon How important is climate change? • Climate change can overwhelm the adaptive capacity of human-habitat interactions, especially where there is little access to resources and technology. • Climate change is important to health in affecting: » Ecology of managed and unmanaged systems. » Patterns of human activity and movement. » Frequency of extreme events. » Changes in atmospheric chemistry. • The key question is whether climate change is important vis-à-vis other global change processes. 4 CIS oƒ HDGC Carnegie Mellon Many fear climate change will spread tropical diseases like Malaria 5 CIS oƒ HDGC Carnegie Mellon Outline of this talk 6 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon What is climate change? • The idea is that we have changed the surface of the earth, and its atmosphere to such an extent that: » Incoming solar radiation is bounced back into space differently, with more energy staying in the atmosphere. » This will affect the flow of energy & water between land, atmosphere and oceans. » Changing patterns of temperatures, clouds and precipitation. • We bring about climate change through: burning fossil fuels, agriculture, draining wetlands, building dams, cutting down trees and paving over paradise... 7 CIS oƒ HDGC Carnegie Mellon Monthly temperatures for Pittsburgh 1871-1993 8 CIS oƒ HDGC Carnegie Mellon Monthly precipitation for Pittsburgh 1871-1993 9 CIS oƒ HDGC Carnegie Mellon Change in annual average temperature 1871-1993 TSP & SO2 SO2 CAA/OPEC 2.5°C 10 CIS oƒ HDGC Carnegie Mellon Trends in mean monthly temperature 11 CIS oƒ HDGC Carnegie Mellon Change in total annual precipitation 1871-1993 12 CIS oƒ HDGC Carnegie Mellon Change in total annual precipitation 1871-1993 13 CIS oƒ HDGC Carnegie Mellon Outline of this talk 14 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon Other global change phenomena which can impact prevalence of infectious diseases • Prosperity. • Demographics. • Movement of people and goods. • Immunity status. • Land use and cover. • Knowledge & technology. • Social norms. • Security. 15 CIS oƒ HDGC Carnegie Mellon Economic Prosperity • The US has seen sustained growth in the overall economic prosperity of its population over the past century averaging more than 2% p.a. • There has been miraculous growth in Far Eastern countries, at times 3 to 4 times faster than the US, but these miracles have recently floundered. • Meanwhile, there has not been any improvement in living conditions of a large fraction of the world’s population. 16 CIS oƒ HDGC Carnegie Mellon Population • Population growth rates are falling. • The earth’s population is not expected to exceed 12 billion by 2100. • Populations are expected to grow significantly older, from ~ 5% over 60 today to ~20% over 60 in 2100. • Urban and peri-urban populations are growing rapidly, especially in less prosperous and lower-middle income countries. 17 CIS oƒ HDGC Carnegie Mellon Comparing Under 5 mortality rates: Urban/Rural by income class 1.6 1.4 1.2 1 0.8 0.6 0.4 Philippines 19 India Brazil Q1 Q2 Nigeria Uganda Q3 Q5 Q4 Kenya Pakistan CIS oƒ HDGC Carnegie Mellon Forced migrations 8 • Internally displaced populations and international refugees rarely have access to health services & can be potent vectors. • Their rate in (#/1000) has grown 50% over the past 30 years. 7 6 5 4 3 2 1 0 1965 1975 IDP 20 Source: CIPEC REF 1985 1995 World Pop 2005 Total Disp CIS oƒ HDGC Carnegie Mellon Immunity status 1000 • Over 500M are malnourished, but their rate and numbers have been falling. • Over 35M are HIV positive, but their rate and numbers have been rising 800 600 400 200 0 1960 1980 Malnourished 21 Sources: FAO and WHO 2000 2020 HIV + CIS oƒ HDGC Carnegie Mellon Where & When? Indiana ~1820 cf. ~1990 Forest Wetland Prairie Water Row Crop Pasture/Grassland Urban 22 Courtesy of the Center for the Study of Institutions, Population and Environmental Change, Indiana University, Bloomington CIS oƒ HDGC Carnegie Mellon Deforestation along the TransAmazon Highway: from before 1970 through 1991 CIS oƒ HDGC 23 Courtesy of the Anthropological Center for Training and Research on Global Environmental Change, Indiana University, Bloomington Carnegie Mellon Knowledge and technology • Genetic engineering • Designer pharmacology • Remote sensing • Diagnostics on a chip • But few, if any, of these innovations are within reach of and address the needs of the poorest nations. Source: Nature 1997 24 CIS oƒ HDGC Carnegie Mellon Social norms • All syntheses on how to succeed in combating infectious disease draw attention to the importance of the following factors: » Equity. » Political resolve to provide public health. » Synergy of intervention with other social goals. 25 CIS oƒ HDGC Carnegie Mellon Security • Extreme natural events and absence of services can lead to: » Internal displacements, » International refugees, and » Hunger • More often though, these are caused by war and social discord. 26 CIS oƒ HDGC Carnegie Mellon Global change is about multiple interaction paths Local Ecology Famine Climate change Population War Infectious disease Immune status Prosperity Knowledge Mobility 27 Social Norms CIS oƒ HDGC Carnegie Mellon Climate change, extreme events and Cryptosporidiosis day 1 day 2 day 3 day 4 day 5 day 6 week 2 year 2 year 20 Climate change Torrential rain Overwhelm s sewage system Reconside r land use patterns 28 Revise sewage handling Detection in water Boil water advisory Detection in patients Cryptoin water supply Indirect alert Epidemic Understand what happened R&D for better detection CIS oƒ HDGC Carnegie Mellon Outline of this talk 29 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon Climate determines the potential range of vectors but public health determines disease outbreaks 30 Source: WHO CIS oƒ HDGC Carnegie Mellon Reported cases of Dengue 1980-96: Does climate change abruptly at the border? 31 Source: US National Assessment CIS oƒ HDGC Carnegie Mellon Life expectancy is a political map not a climatic one 32 CIS oƒ HDGC Carnegie Mellon Life expectancy & GDP 80 y = 4.2Ln(x) + 34.9 R2 = 0.8 60 40 20 0 0 34 Africa Asia-CP 10000 America Europe 20000 America-CP Europe-CP 30000 ANZ Log. (Asia) 40000 Asia CIS oƒ HDGC Carnegie Mellon Disruption of health services can be disastrous, but easily recoverable Diphtheria Cases (x1000) in SU & FSU 60 50 40 30 20 10 0 1965 35 1970 1975 1980 1985 1990 1995 CIS oƒ HDGC Carnegie Mellon Disruption of health services can be disastrous, and evolve into a long-term nightmare Malaria Incidence in Newly Independent States 40,000 30,000 20,000 10,000 0 1990 36 Source: WHO 1991 1992 1993 1994 1995 1996 1997 CIS oƒ HDGC Carnegie Mellon Outline of this talk 37 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon Revisiting malaria & climate change predictions (x1000 excess deaths) 800 600 400 200 0 2000 2020 Climate Change 38 Source: Tol & Dowlatabadi (2000) 2040 2060 +Population Growth 2080 2100 +Economic Growth CIS oƒ HDGC Carnegie Mellon Challenges in projecting future conditions • Today’s climate-malaria prevalence models are calibrated to regions with endemic malaria. These are not suitable for assessment of the malaria transition other regions. • Will there be far-reaching technological advances? • Where people prosper will they devote resources to fighting malaria? • Where malaria is the social norm, how might it become socially compatible to fight it? What about the reverse?. 39 CIS oƒ HDGC Carnegie Mellon Outline of this talk 40 Background on climate and disease Climate & politics of disease What is climate change? Projecting malaria & climate change Other determinants of disease Challenges ahead CIS oƒ HDGC Carnegie Mellon Projections of global change are fraught with uncertainty • We have trouble projecting socio-economic changes. HIV-AIDS, fall of the Soviet Block, miracle and faltering of the Asian Tigers. • We have trouble projecting how the climate system will react to human induced changes? H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, CO2, CO2, CO2, CO2, CO2, CO2, CO2, 41 H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, H2O, CO 2, CO2, CO2, N2O, N2O, O3, O3, CFCs, All else. CIS oƒ HDGC Carnegie Mellon Summary 42 • Climate change can impact health outcomes through many pathways. • Nevertheless, demographic, socio-economic, technological and political factors are more important than climate in public health outcomes over the next century. • Non-climate factors change more rapidly and are generally easier to manipulate than the climate system. • A poorly designed climate policy will do more harm than good. • We are ill equipped to address key global public health challenges in the years ahead. CIS oƒ HDGC Carnegie Mellon