Download Climate Change and Mortality: Feedback from Populations Issues

Climate Change and Mortality
By the Resources and Environment Working Group
the International Actuarial Association
Working Draft – 14 May 2016
Table of Contents
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Climate Change and Mortality
Table of Contents
Executive Summary....................................................................................................................................... 4
1.
2.
3.
4.
Introduction .......................................................................................................................................... 5
1.1
Objectives...................................................................................................................................... 5
1.2
Acknowledgments......................................................................................................................... 5
1.3
Roadmap to the report ................................................................................................................. 5
Background ........................................................................................................................................... 7
2.1
Climate change – types of effects ................................................................................................. 7
2.2
Systems thinking ........................................................................................................................... 9
2.3
Climate components ................................................................................................................... 10
2.4
Regional effects........................................................................................................................... 11
2.5
Age related effects (possibly later chapter?) .............................................................................. 12
2.6
Relative wealth (possibly later chapter?) ................................................................................... 12
2.7
Positive and negative impacts .................................................................................................... 13
2.8
Measuring the impact ................................................................................................................. 13
Adverse Mortality Consequences ....................................................................................................... 16
3.1
Background ................................................................................................................................. 16
3.2
Increase in certain diseases ........................................................................................................ 16
3.3
Drought and resulting famine ..................................................................................................... 17
3.4
Increased and more frequent severe weather conditions ......................................................... 19
3.5
Increase in natural disasters ....................................................................................................... 19
3.6
Coastal flooding and rising sea levels ......................................................................................... 20
3.7
Impact of wealth ......................................................................................................................... 20
3.8
Air Pollution ................................................................................................................................ 21
Favorable Mortality Consequences .................................................................................................... 23
4.1
Positive impacts of climate change on future mortality ............................................................. 23
4.2
Direct positive impacts................................................................................................................ 23
4.3
Indirect positive impacts ............................................................................................................. 24
Adaptation measures .......................................................................................................................... 24
Mitigation efforts ................................................................................................................................ 25
5.
Insured / Pension Effects .................................................................................................................... 28
5.1
Direct effects ............................................................................................................................... 28
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6.
5.2
Indirect effects ............................................................................................................................ 28
5.3
Beyond the mortality impact ...................................................................................................... 29
Quantitative Analysis and Modeling ................................................................................................... 30
6.1
Use of scenarios .......................................................................................................................... 31
6.2
Dealing with non-stationary risk ................................................................................................. 32
7.
Case studies ........................................................................................................................................ 34
8.
Need for further research ................................................................................................................... 35
9.
References .......................................................................................................................................... 36
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Executive Summary
[later]
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1.
Introduction
Future climate change represents a long-term peril to our planet. The effects of this change will
arise from several factors, reflecting adverse effects on water, air, weather, oceans, and
ecosystems, from significant increases in greenhouse gases in the Earth’s atmosphere and
oceans, which will consequently result in many other changes in our environment, including
increases in temperature, changes in precipitation including heavy rains and longer-lasting
droughts, increases in the frequency and intensity of extreme weather events and weathercaused conditions, and rises in sea levels – affecting glacier size and water and air quality. These
represent a range of sudden and slowly developing factors.
The ultimate effects of these climatic changes include consequences on human health and life –
the effect on mortality is the focus of this report. It does not address other effects of climate
change, such as adverse consequences to human health (except to the extent directly related to
mortality), property damage, and death and reduction in diversity of other living species, (for
example the bleaching of coral resulting from warmer and more acidic oceans).
This report was prepared by the Resources and Environment Working Group of the
International Actuarial Association (IAA). It does not represent an official opinion of the IAA.
1.1
Objectives
The objectives of this report include providing background information and raising the
awareness of actuaries and others regarding a key component of the effects of climate change.
Secondarily, it is hoped to provide such information to national actuarial associations and
policy-makers, as applicable. One conclusion is that further research is clearly needed to discern
more particular effects over the short, intermediate and long-term future. Such research will
need to be multi-disciplinary in nature, given the complexity of the issues.
1.2
Acknowledgments
[to be filled in later]
1.3
Roadmap to the report
This report first provides a brief overview of this issue in chapter 1, Background, covering the
range of significant effects of climate change on our environment and human health and life. It
is then organized as follows:

Chapter 2, Adverse effects on mortality, covering the major sources of additional deaths,
including the types of events and conditions precipitating death and attributable
diseases likely to be significant in the future.
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
Chapter 3, Favorable effects on mortality, covering the major sources of reduced deaths
due to climate change and adaptation/mitigation efforts to reduce climate change. To
some extent, these offset the effect of adverse climatic trends.

Chapter 4, Quantitative analysis, providing an assessment of the net effect of climate
change on mortality. This reflects the wide range of uncertainties associated with the
future, especially tail risk associated with possible enormous one-off conditions and
exponential or cascading effects of excess greenhouse gas emissions. Both stochastic
effects and stress testing approaches may be of use in analysis of alternative possible
futures.

Chapter 5, Insured effects, addresses the effect of financial programs serviced by
actuaries in contrast to the effect of climate change on overall population

Chapter 6, Case studies, which study the effects of climate change on {TBD}.

Chapter 7, Next steps, which outlines some of the further analysis and research which
would provide further insight into likely future effects of the climate of the future.
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2.
Background
2.1
Climate change – types of effects
Robert Glasser, the UN Special Representative for Disaster Risk Reduction said “It is clear that
weather and climate are implicated in 90 per cent of major disaster events attributed to natural
hazards. Droughts, floods, storms and heatwaves have the potential to undermine many
developing states’ efforts to eradicate poverty. Climate change is adding to pre-existing levels
of risk fueled by exposure and socio-economic vulnerability”.
It is the current scientific consensus that climate change has occurred since the industrial
revolution began and will continue to affect the atmosphere and oceans over the next several
centuries. This has primarily been due to an increase in greenhouse gas emissions. However,
international action arising in part as a result of the commitments emanating from the
agreement reached at the 2015 United Nations’ Climate Change Conference, COP21 , significant
adaptation and mitigation activities will be undertaken that may offset some of the adverse
effects of the accumulation of greenhouse gases.
Modelling the impacts of climate change on future levels of mortality presents formidable
challenges. This is due the interconnected nature of the system being modelled. The
Intergovernmental Panel on Climate Change frames it as a combination of: the physical
environment, ecology (“natural processes”), and institutions. These three factors combine to
impact on the relationship between climate and health. They also interact, each with the other.
Thus a change in temperatures (physical) may support the conditions that give rise to an
increase in the population of a disease vector (natural process) in a country that may or may
not have the institutional capacity to deal with such a change (institutions).
A specific example would be higher temperatures leading to the spread of the ranges of deer,
mice, and ticks—“the ecologic causal chain that brings Lyme disease to humans” (John Balbus,
National Institute of Environmental Health Sciences, USA1). This might be described as a slow
onset impact of climate change. Similarly, as a result of significant efforts, death from malaria
has, according to the World Health Organisation (WHO), experienced a 60 percent reduction in
new cases over the last 15 years. This progress may be at risk as temperature increases and
rainfall patterns shift over the long-term future, offset by changing per capita wealth as a proxy
to education and access to healthcare.
Equally, severe storms, such as Hurricane Katrina (U.S.), can overload the functionality of
health-care systems, which in turn may have negative consequences in particular for the elderly
1
Proceedings of the National Research Council’s Standing Committee on Emerging Science for Environmental
Health Decisions workshop in November 2014
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and those who have chronic medical conditions. According to Molly Brown, of the U.S. National
Aeronautics and Space Administration2, an analysis conducted in the wake of Superstorm Sandy
showed that what most affected human welfare and public health factors such as generators
below sea level and unexpected cascading power outages. Hurricane Katrina might be
described as a “complex emergency”. 800,000 people were displaced, and therefore impacts
were felt in a wide number of cities, not just restricted to New Orleans.
Thus, climate impacts are mediated by other physical, environmental and socio-economic
factors. Any approach to modelling will therefore of necessity benefit from being multidisciplinary, involving complex systems thinking. There are many scientific disciplines and tools
in addition to climate science necessary to understand the interactions among the three factors
and to model the associated health outcomes, including hydrology, geography, ecology,
agriculture, sociology, economics, biomedical science, and clinical medicine.
2
Proceedings of the National Research Council’s Standing Committee on Emerging Science for Environmental
Health Decisions workshop in November 2014
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Figure 1 – impact of climate change on human health
Source: George Luber, US Center for Disease Control and Prevention
2.2
Systems thinking
Complex inter-dependent sets of models will require systems thinking. This is clearly true of the
models of slow onset drivers of mortality impacts such as long-term temperature changes or
change in rainfall patterns. But it is also relevant in the context of extreme weather-related
events. According to Georges Benjamin, of the American Public Health Association “many
health systems are designed for just-in-time management for the mean; we cannot afford to
build for extremes.” This implies that increased number and / or severity of weather shocks has
the potential to critically overload albeit temporarily local or even national health systems. Such
shocks will have immediate and medium term consequential impacts which need to be taken
into account.
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Figure 2 – a simplified system representation
Climate change
Climate system
Technology
and GHG
emissions
Socio-economic and
political drivers
Direct
impacts
 Flood
 Hurricane
 Sea level
Mitigation
and
adaptation
Indirect
impacts
 Zoonoses
 Food security
 Migration
Healthcare institutions
Public infrastructure
Demographic,
social,
economic
consequences
Mortality and
health
outcomes
As indicated in Figure 2, the number of deaths around the globe, among other adverse
consequences such as health and property damage, are one of the effects of this process.
Greenhouse gas (GHG) emissions contribute to the amount of greenhouse gasses in the
atmosphere, which can take a very long period of time to naturally dissipate. These, in addition
to other drivers, contribute to climate change. This in turn directly and indirectly, result in
deaths, ill health and property damage.
2.3
Climate components
Four major components of the effects of climate change and related environment influences
will influence the level of future deaths:
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
Temperature3. Possibly the most advertised effect of climate change is the effect on
average global temperature (usually measured from the average temperature level
experienced immediately prior to the industrial revolution), influencing many facets of
water, air and land temperature. An increase in extreme heat and possibly a decrease in
extremely cold weather may also be increasingly common (although see “extreme
events” below for one-off local swings in temperature in either direction). Warmer
temperatures can cause more evaporation of water.

Precipitation. Droughts in already arid regions will continue, may well spread and could
increase in severity. Excessive precipitation can result in flooding. In other areas, water
scarcity can adversely affect human health. Changes in precipitation can lead to both
more intense individual downpours but also swings into drought conditions. The threat
from all this is not just to what people drink but what they eat through agriculture, as the
human activity that consumes the most water is agriculture.

Extreme events. An increase in both the frequency and severity of extreme natural events
are anticipated. These events include hurricanes, tornados, flooding and windstorms.
These not only affect mortality, but also cause infrastructure and property damage.

Sea levels. A rise in sea levels can affect water quality, cause coastal flooding and insect
related diseases. It could impact on food security and may have direct and indirect
consequences for mass migration.
In addition, a wide range of secondary effects are possible, including deteriorating air quality,
excessive amounts of ozone and particulate matter, and food and water insecurity including
malnutrition. Secondary effects may also include mass migration / human conflict, and changes
in insect population and other disease vectors. In addition, economic damages may also result
in increased challenges to human longevity.
2.4
Regional effects
Although it is clear that climate change will happen in the future, many of its characterizations
and consequences have been expressed in terms of global averages (e.g., average global
temperature rises). Even more dramatic changes will arise on a regional, if not local basis.
3
There has been some discussion on whether heat or cold is a greater cause of mortality. An article in the Lancet
sparked a debate on this topic via reporting in the Wall Street Journal. The Lancet article noted that “more
temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme
cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality. However, this study was
limited to a selected number of countries and did not purport to discuss future changes. It would therefore be
wrong to draw a simple conclusion that global warming will overall be beneficial by reducing numbers of deaths
from extreme or sub-optimal cold temperatures. In any event this would ignore indirect impacts such as drought,
food scarcity, sea level rises, etc.
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Figure 3 – IPCC projections under two future scenarios
The IPCC (Intergovernmental Panel on Climate Change) gives the above projections in its 5 th
Assessment Report (Working Group 1, Summary for Policymakers). Broadly speaking RCP 2.6 is
a greenhouse gas emissions scenario, whereby very substantial mitigations are rapidly put in
place. RCP 8.5 by contrast shows a projection assuming little change in emissions levels. In
either case, the point is that there will be substantial regional variation. Some regions will
experience wider, more violent temperature and precipitation swings and significant adverse
natural events. Of course, everyone is exposed to such risks; nevertheless, everyone will be
exposed to different hazards, some of them adverse.
It has been often noted that these changes will arise to different extent or even in opposite
directions by region and demographic groups. Thus, for example, in the United States, the
Northeast and Midwest are expected to experience significant increases in precipitation, while
the southwest will receive less precipitation and increased drought.
2.5
Age related effects (possibly later chapter?)
It is also expected that climate change will affect age segments to a different extent. For
example, the oldest and youngest may be most at risk to many mortality hazards. The oldest
will likely be most affected in the case of weather extremes (particularly heat). Many of the
youngest will in experience stunting arising from malnutrition, which can in turn expose those
affected to other diseases. Children and infants will also suffer higher rates of mortality from
diarrhoeal disease
2.6
Relative wealth (possibly later chapter?)
The effects of many climate change effects will especially affect more vulnerable populations,
e.g., those with lower income and areas with weaker health infrastructures, many of which
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have not contributed to the causes of climate change in the first place. This is expected to be
particularly true of Africa and South Asia.
2.7
Positive and negative impacts
Climate change will have some positive impacts on human health. There are likely to be
reductions in cold-related mortality and morbidity in high-income populations. The most recent
assessment report of the IPCC concludes, however, that the impacts on health of more
frequent heat extremes greatly outweigh the benefits of fewer cold days, and that the few
studies of the large developing country populations in the tropics, point to effects of heat, but
not cold, on mortality (Smith et al., 2014). These are discussed in chapter 4.
2.8
Measuring the impact
Of course, not all increased deaths from natural causes can be attributed to climate change. For
instance, there have always been climate or weather related deaths, and there will continue to
be. As a result, it is important to attempt to assess the marginal effect of climate change from
these intermediate causes.
As set out above, this is a highly complex projection problem crossing over into many different
scientific disciplines, with multiple feedback loops from the socio-economic through to planning
and infrastructure, adaptation and mitigation, technology and so on.
The most sophisticated attempts to examine impacts of climate change on mortality have not
attempted to model all of the above. Rather, they have concentrated on a limited set of specific
health models for a range of health outcomes known to be sensitive to climate change.
For example, WHO (2014) examined the following climate related factors:






heat-related mortality in elderly people
mortality associated with coastal flooding
mortality associated with diarrhoeal disease in children aged under 15 years
malaria population at risk and mortality
dengue population at risk and mortality
undernutrition (stunting) and associated mortality.
It did not attempt an overall “prediction” of the possible impacts of climate change on health or
mortality. A main limitation is the inability of current models to account for major pathways of
potential health impact, such as the effects of:





major heatwave events
river flooding
other extreme weather events
water scarcity
consequential increases in migration or conflict
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
consequential economic damage.
Indeed, we are not aware of any major studies examining the mortality impacts of potential
discontinuities in climatic, social or ecological conditions. Nor are there extensive studies of
what is referred to as slow-onset events, such as increasing sea height or acidification levels
Instead, the mortality forecasts are based on empirical models of specific key mortality causes
examining observed mortality trends in relation to major drivers such as socioeconomic
development, education and technology, together with projections of the future trajectories of
these drivers on a national scale.
This is done with regression equations that quantify the current and historical relationships
between mortality and a set of independent variables such as gross domestic product (GDP) per
capita, years of education and time (which is assumed to be a proxy for health benefits arising
from technological developments). For example, malaria is a modeled as a function which
incorporates temperature, precipitation and GDP per capita.
Figure 4 – Example of a general model examining impacts of climate change on diet-related
mortality
Source: Springmann et al. (2016)4
The projections therefore attempt to look relative or comparative levels of mortality in the
future on the footing of “with and without climate change”. Thus, by looking at different future
GHG emissions pathways (or “radiative concentration pathways”) and by using different climate
models, a range of “before and after” climate scenarios can be generated. These are combined
with world population projections and different future economic-growth scenarios. In addition,
assumptions are required for future levels of adaptation responses.
4
Springmann, Marco, D. Mason, D’Croz, S. Robinson, T. Garnett, H. Charles, J. Godfray, D. Gollin, et.al. 2016.
“Global and regional health effects of future food production under climate change: a modelling study. ” The
Lancet. Vol. 387, No. 10031, 1937–1946.
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Existing models and considerations for their development and use are discussed further in
chapter 6.
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3.
Adverse Mortality Consequences
3.1
Background
It has been estimated that some 12.6 million deaths globally are attributable to the
environment, about 23% of all deaths and 22% of the disease burdens in Disability-Adjusted Life
Years (DALYs)5. However, although it is expected that climate change will have a significant
effect on society in the decades ahead, there is a great deal of uncertainty regarding the nature
of these impacts, only a fraction of these deaths can be attributed to climate change. This
chapter will cover areas for which additional deaths will arise, while the next chapter areas for
which there will be a reduction in deaths.
In sum, there is considerable potential for increased deaths from the consequences of climate
change. They will certainly have a more adverse effect on vulnerable populations and
subpopulations, ranging from those in less developed countries to those who cannot afford to
move to less affected areas or who cannot afford adaptation / mitigation tools. The very young
and very old are also at more vulnerable, as they may be more sensitive to some of these
effects.
3.2
Increase in certain diseases
The incidence of certain diseases will certainly be affected and will likely increase as a result of
the overall warming of our planet.
For instance,

Diarrheal disease. Compared with a future without climate change, it has been
estimated that about 48,000 deaths annually6, especially in children younger than
age 15, can be attributed to climate change by the year 2030.

Malaria and dengue. These diseases are due to mosquitoes that are sensitive to
climate change. Although focused in Africa, they are not limited to those areas. The
number at risk of malaria will increase by some 5 per cent or 150 million if
temperatures rise 2oC to 3oC higher than pre-industrial levels7. There have been
significant reductions of deaths from these conditions over the last several decades.
5
WHO (2016). “Preventing disease through healthy environments »
WHO (2014). “Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s
and 2050s”. This figure is the mean of the results of five different global climate models, all on a “base case”
economic scenario and a “medium-high” emissions scenario (known as A1b). The highest and lowest projections
from the five models were 21,000 to 68,000.
7. WHO (2003). Summary Booklet: Climate Change and Human Health – Risks and Responses. Geneva, Switzerland:
World Health Organization.
6
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However, the WHO estimates8 that, compared with a future without climate change,
by 2030 there will be an additional 60,000 deaths per annum due to malaria alone.
3.3

Gastrointestinal-tract illnesses and infections due to increases in water temperature.
Climate change may be associated with staple food shortages, malnutrition, and
food contamination of seafood from chemical contaminants, biotoxins, pathogenic
microbes, and of crops by pesticides.

Asthma, respiratory and lung diseases, such as reduced lung function, coughing and
wheezing. Respiratory allergies and diseases may become more prevalent because of
increased human exposure to pollen (due to altered growing seasons), molds (from
extreme or more frequent precipitation), air pollution and aerosolized marine toxins
(due to increased temperature, coastal runoff, and humidity) and dust (from droughts).

Cardiovascular and respiratory diseases due to increased ozone and other air
pollutants. Climate change may exacerbate existing cardiovascular disease by
increasing heat stress, increasing the effect of airborne particulates, and changing
the distribution of zoonotic vectors that cause infectious diseases linked with
cardiovascular diseases.

Cancer. Many potential direct effects on cancer risk, such as increased duration of
exposure and intensity of ultraviolet (UV) radiation.
Drought and resulting famine
Many areas of the world will experience extreme droughts. This lack of water will seriously
affect agriculture and the production of food. Drought and severe lack of rainfall can have
severe health ramifications. Two of the impacts are:

Food security. Severe decreases in water availability can contribute to severe loss of
food and liquid input. The obvious result is significant increases in malnutrition and
undernutrition, which in children can lead to stunting. Both immediate deaths and a
long-term increase in mortality can be the result.

Conflicts and violence. Drought, especially when the result of extreme increases in
temperature, have been known to result in conflicts and violence.9 The World Bank
(2016) report expresses the view that the likelihood of future conflicts may increase
significantly at or near a 4oC global temperature increase compared to pre-industrial
climate, although this has already occurred, although it can be difficult to attribute a
conflict to a single cause. “In Syria, a devastating drought beginning in 2006 forced
8
As above
World Bank (2016). “High and Dry: Climate Change, Water and the Economy”. Publishing and Knowledge Division.
World Bank.
9
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many farmers to abandon their fields and migrate to urban centers. There’s some
evidence that the migration fueled the civil war there” says Aaron Wolf, a water
management expert at Oregon State University, who frequently visits the Middle
East.”10 The Economist, discussing the Arab Spring11 noted that “… Middle East and
North Africa depend more on imported food than anywhere else. Most Arab
countries buy half of what they eat from abroad and between 2007 and 2010, cereal
imports to the region rose 13%, to 66m tons. Because they import so much, Arab
countries suck in food inflation when world prices rise. In 2007-08, they spiked, with
some staple crops doubling in price. In Egypt local food prices rose 37% in 2008-10”.
Projecting deaths from possible future conflicts sparked at least in part by mass
migration or other pressures arising as a result of changes in climate has not to the
best of our knowledge been attempted. Even if that modelling were carried out,
there would still be questions of attribution. How many of the deaths caused by
warfare in Syria could reasonably be said to have been the initial four year drought
which may have created in part the conditions in which warfare became inevitable?
And, a further layer of questioning would ask, “how much of that drought was
attributable to (anthropomorphic) climate change”? The same questions of
attribution can then be asked of those who have died fleeing the conflict, or those
that have died because of excessive strain on medical facilities as a consequence of
large influxes of people. The difficulty of such questions notwithstanding, it does
appear likely that increased pressure, whether caused by drought or sea level rises,
will give rise to increased mortality through conflict.
In the WHO report of 2014, one of the most substantial health effects of climate change in 2050
was undernutrition (an additional 85 000 deaths per annum on the central economic scenario).
However, an article in the Lancet published March 2016 went on to examine not just the impact
of climate on calories consumed / available, but also the composition of future diet. This
compositional effect is said to have greater impact than all the climate factors considered by
the WHO combined.
The model developed by the team in the Lancet report projected that by 2050, climate change
will be associated with 529,000 annual climate-related deaths worldwide (95% CI 314,000–
736,000), representing a 28% (95% CI 26–33) reduction in the number of deaths that would be
avoided because of changes in dietary and weight-related risk factors between 2010 and 2050.
10
Smithsonian Magazine (June 2013). “Is a Lack of Water to Blame for the Conflict in Syria?”
11
The Economist, 17 March 2012
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Twice as many climate-related deaths were associated with reductions in fruit and vegetable
consumption than with climate-related increases in the prevalence of malnutrition. Most of the
climate-related deaths were projected to occur in South and East Asia. This model was based on
broadly comparable greenhouse gas emissions and future economic growth projections.
The Global Burden of Disease study reported that in 2010, the greatest number of deaths,
worldwide and in most regions including developing countries, was attributable to dietary risk
factors associated with imbalanced diets, such as those low in fruits and vegetables and high in
red and processed meat. This represents a shift, as communicable disease (often associated
with malnourishment, poverty and poor sanitation) used to be the dominant cause.
3.4
Increased and more frequent severe weather conditions
Increasing average global temperatures will likely increase the frequency and severity of
extreme heat conditions and may moderate the frequency of cold weather incidences. Extreme
heat surges can especially affect the elderly and most vulnerable. Deaths will increase from
heat stress (for example in 2003 during the European heat wave, there were an additional
70,000 deaths). There has been a great deal of study of heat waves – there can be many deaths,
especially of the elderly. However, the use of air conditioning can reduce these effects. But it is
important to keep in mind that significant increases in air conditioning can increase electricity
demand which in turn can contribute to more greenhouse gas emissions, which will then
exacerbate the underlying climate change cycle.
On its central or base case economic assumptions, the WHO projected 38,000 extra deaths per
annum by 2030 as a result of heat. This figure relates to over 65 year olds only, and assumes a
fairly high level (50%) of adaptation12. With no adaptation this would have been 92,000
annually. These figures rise to a central estimate of around 100,000 extra deaths per annum by
2050 (with 50% adaptation) or over 250,000 with no adaptation. The increases are not
distributed evenly: impacts are greatest in the South, East and Southeast Asia regions.
3.5
Increase in natural disasters
Extreme events may result in both direct deaths and consequential environmental degradation.
It is expected that there will be a significant increase in natural disasters, including the number
of them and their intensity. Examples of sudden events, include hurricanes, tornadoes,
cyclones, wild fires and storms. Extremely dry conditions can result in increased wild fires, such
as the one that forced abandonment of
12
100% adaptation means that the assumed optimum temperature for people is whatever temperature climate
change brings, while 0% adaptation means that the optimum temperature is whatever it is currently. 50%
adaptation is the midpoint.
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In addition, there will likely be an increase in intensity of these natural disasters. For example,
although not agreed by all, the el Niño of 2014-16 was the most intense on record – if due to
climate change, certain of the deaths caused by this warming of the Pacific Ocean could be
attributed to climate change.
Increased refugees, destabilization of communities, reduced access to life-support systems and
resulting conflicts will all result in increases in deaths.
3.6
Coastal flooding and rising sea levels
Water-related deaths will arise from two sources: specific disasters, such as coastal flooding
and slow-onset conditions, such as rising ocean levels. If known far enough in advance, and if
economically possible, there may be migration away from exposed areas (such as low-lying
areas next to the sea or from islands, such as those in the Louisiana delta area in the United
States in 2016). Assuming sufficient warning, immediate deaths may be minimal, although
consequential effects of crowded emigration areas (e.g., water-borne and infectious diseases
and violence) can also impact on mortality.
If in the process medical facilities and resources are destroyed, there will be likely be resulting
slower delivery of health services (as well as adverse effects on mental health), which will
inevitably result in increased mortality. In extreme situations, the effects of water-related
events could result in migration of masses of people, with the consequential increase in disease
and conflict.
3.7
Impact of wealth
Climate change will affect the air, water, food and shelter in many areas of the world. The most
vulnerable may not be able to afford the adaptation and mitigation tools that may be available
to avoid these effects. For example, there are over half a million premature deaths per year due
to air pollution in India13, although a switch to cleaner energy and away from coal is likely to
reduce this horrific effect. Food and water-borne infectious diseases are also likely to increase –
technology will be used to fight the sources of these diseases, although it is unlikely that they
will be able to eliminate them.
It has long been understood by actuaries that wealth and income are closely correlated to
increased longevity. It is therefore unsurprising that the WHO (2014) noted “(Climate change)
impacts are greatest under a low economic growth scenario because of higher rates of
mortality projected in low- and middle-income countries”.
However, they go on to say that even under optimistic scenarios of future socioeconomic
development and with adaptation measures assumed to be effective, climate change is still
projected to have substantial adverse impacts on future mortality.
13
. “Pollution in India: Gasping for Air”, Financial Times November 17, 2015.
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Climate Change and Mortality
They conclude “This indicates that avoiding climate-sensitive health risks is an additional reason
to mitigate climate change, alongside the immediate health benefits that are expected to
accrue from measures to reduce climate pollutants, for example through lower levels of
particulate air pollution. It also supports the case for strengthening programmes to address
health risks including undernutrition, diarrhoea, vector-borne disease and heat extremes, and
for including consideration of climate variability and change within programme design. The
strong effect of socioeconomic development on the projections of future risks emphasizes the
need to ensure that economic growth, climate policies and health programmes particularly
benefit the poorest and most vulnerable populations”.
The WHO work indicate that the most substantial impacts of climate change on health are
projected to be caused by undernutrition and infectious diseases (diarrhoeal disease and
malaria). In 2030, sub-Saharan Africa is projected to have the greatest burden of mortality
impacts attributable to climate change. By 2050, South Asia is projected to be the region most
affected by the health effects of climate. However, this work only focused on a number of
specific drivers of mortality and did not look at a number of major factors such as impacts on
economic development, conflict, mass migration, river flooding, or increased incidence of fast
onset (extreme) events such as major heatwaves or hurricanes.
3.8
Air Pollution
In addition to and in part as a result of climate change, a large number of premature deaths are
caused by air pollution. Since a large part of the contributing causes of climate change is also
involved with air pollution, it is worth mentioning here some background of this risk, taken
from Lelieveld (2016). This study that used a global atmospheric chemistry model, assessed the
effect of seven emission sources, including ozone and fine particulate matter (diameter smaller
than 2.5 micrometres) on global premature mortality.
Lelieveld estimated that premature deaths from outdoor air pollution will increase from 3.3
million per annum in 2010 to 6.6 million per annum by 2050, to a large extent due to increases
in population and economic activity. This is in addition to estimates of 3.54 million premature
deaths per annum from indoor pollution (e.g., from residential heating and ovens).
Immediate causes of death that result from air pollution include chronic obstructive pulmonary
disease (COPD), acute lower respiratory disease, cerebrovascular disease, ischaemic heart
disease and lung cancer. Although the relative importance of these causes differ significantly by
country and region, the top seven sources of death globally are: residential and commercial
(31%), agricultural (20%), natural sources such as desert sand (18%), power generation (14%),
industry (7%), land transportation (5%), and biomass burning (5%). Premature deaths from
outdoor air pollution are heavily concentrated in Asia, with China (about 41%) and India (about
20%), Pakistan (about 4%), Bangladesh (3%) and Nigeria (3%).
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Climate Change and Mortality
This number of premature deaths is quite large, but the sources of premature deaths from both
outdoor and indoor air pollution points to a number of sources of possible mitigation, including
reduced use of coal, more efficient agricultural practices and more fuel-efficient cars/trucks. It
appears that although air pollution is decreasing in many more developed cities, it is moving in
the wrong direction in developing cities, including in countries such as China, India and Iran.
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Climate Change and Mortality
4.
Favorable Mortality Consequences
4.1
Positive impacts of climate change on future mortality
While the most likely overall impact of climate change is a worsening of mortality outcomes,
there are a number of positive outcomes that may arise either directly from future changes in
temperatures and precipitation but also indirectly resulting from the mitigation and adaptation
efforts that governments and other stakeholders will take in response to the challenges ahead.
As with the impacts of climate change, these trends will significantly vary by region, social class
and income. However, despite these possible positive outcomes, overall the likely health effects
of climate change are likely to be negative14
This section considers likely positive outcomes. Firstly, it will consider direct positive impacts
solely resulting from climate change ahead. Secondly, it will look at the indirect impacts
referred to above.
4.2
Direct positive impacts
This section analyses possible impacts by type.
 Warmer winter temperatures.
While increasing the number of heatwaves, average winter temperatures will also increase
with likely less cold related deaths. However, there will still be extreme cold events with
some debate regarding whether these will increase, remain stable or decrease.
 Better agricultural outcomes in certain regions due to temperature.
The migration of warm weather will make it possible to grow certain crops in some regions
where it was previously difficult or impossible. An anecdotal example – although not a food
staple – would be the increasing areas where grapes can now be grown. On its own this may
locally improve health outcomes but needs to be considered in conjunction with the
increasing number of extreme events including more variable precipitation patterns. This will
therefore be offset to some extent by such factors as more extreme events, the loss of
agricultural land to sea level rises (particularly in Southeast Asia) and increased drought. It is
estimated that climate variation explains a round one third of global crop yield variability15

14
15
CO2 Fertilisation effect
World Health Organisation,2015, Fact sheet 266, September 2015
Nature, 2014 : Ray, Gerber, MacDonald, West
23
Climate Change and Mortality
In addition to the temperature effect above, there is also a “CO2 fertilisation effect”, which
increases carbohydrate production in plants with improved growth and yield as CO 2 levels
rise16.
While the effect has been known about for a number of years, it has recently been
highlighted in a paper called “Greening of the Earth and its Drivers" in the journal Nature
Climate Change17. This showed significant “greening” or increased leaf production data
from NASA and NOAA satellites over the past 33 years. Green leaves produce sugars using
energy in the sunlight to mix carbon dioxide (CO2) drawn in from the air with water and
nutrients pumped in from the ground. These sugars are the source of food, fibre and fuel
for life on Earth. More sugars are produced when there is more CO2 in the air – this is called
CO2 fertilization.
However, some studies have shown that plants acclimatize, or adjust, to rising CO2
concentration and the fertilization effect diminishes over time," according to the report’s
co-author Dr. Philippe Ciais, Associate Director of the Laboratory of Climate and
Environmental Sciences, Gif-suvYvette, France and contributing lead author of the Carbon
chapter for the IPCC Assessment Report 5.
4.3
Indirect positive impacts
This section looks at both mitigating and adaptation efforts whose effects will likely be to
reduce mortality.
Adaptation measures
Adaptation is essentially the use of (sometimes new) technology to reduce the impact of
climate events. Examples include buildings / infrastructure that can withstand greater levels of
sudden events such as flood and storms; or which can be put back to use more rapidly following
such an event (e.g., “wet-proofing” buildings in flood prone areas). Increased access to air
conditioning in hot temperatures is a further example.
Increased use of air conditioning has reduced the impact of hotter weather and extreme heat
events and therefore the effect on mortality of climate change in hot areas of the world.
However, this also has an impact on the climate itself. In addition, living in unaired airconditioned buildings is thought to be connected to the increase in the number of allergies over
recent decades. Thus adaptation measures may themselves have side effects.
While migration away from the most badly affected areas may be possible for some, those who
are most vulnerable often do not have the resources to move or may lose much of their wealth
when migrating. Therefore whether there is a net positive impact on mortality is debatable.
16
17
http://www.fao.org/docrep/w5183e/w5183e06.htm
http://phys.org/news/2016-04-co2-fertilization-greening-earth.html
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Climate Change and Mortality
Mitigation efforts
Mitigation in the context of climate change means reducing emissions. Measures taken to
reduce climate change emissions are the most likely area where actions may reduce mortality.
Particularly important are those leading to a reduction in either household air pollution (which
causes some 4.3 million deaths per year) and ambient air pollution which causes around 3.7
million deaths per year18. These mitigation efforts have arguably another positive impact – in
contributing towards a more efficient use of limited resources, the increase in prices of such
resources resulting from their rarefaction - which in general would hit the least well of most are mitigated.
i. Transport. Increasing car use (and ownership) and a move away from public transport is a
significant contributor to climate change 19.Therefore reduced use of cars, favouring public
transport, encouraging car sharing, cycle use and walking (e.g., Nashville which is putting
back pavements initially removed to create more room for car use ) are all examples of
effective measures that can be taken. A number of positive impacts are likely to arise from
such measures. Firstly, a reduction in air pollution directly improves population health.
Secondly, increasing physical activity leads to direct health benefits. Finally, mental wellbeing is improved; indeed it is widely accepted that there is a direct positive correlation
between exercise and mental well-being (Helliwell, Layard and Sachs, 2013). In addition,
the switch to low impact transport options leads to fewer road traffic accidents and injuries
freeing up health resources for other uses. The switch from petrol to electric powered cars
can also have positive impacts depending on how electricity is generated but the ‘grey’
energy used to construct the vehicle also needs to be taken into account.
ii. Energy. Reduced fossil fuel use and a move to renewable energy and more energy
efficiency measures is a large positive contributor to population health. The mining and
burning of coal causes contributes to air pollution which has significant health impacts
including respiratory infections, cardio vascular diseases, asthma and cancer with between
20% and 40% due to environmental20 reasons.
18
Ibid WHO 2015
The amount of CO2 emissions per passenger-kilometre is between 50 and 100 times greater for a car than a
bicycle and between 5 and 10 times greater than for a bus.
20
Ibid WHO 2014
19.
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Climate Change and Mortality
Solar home systems in Bangladesh
Since 2003, the installation of solar home systems (“SHS”) has been a priority of the Government of
Bangladesh and contributes to a number of objectives including meeting renewable energy targets and
poverty reduction. By 2013, nearly 2 million households had been equipped. The project has:
 Reduced the number of households without energy, a significant factor in reducing poverty.
 Partially replaced the use of less powerful, polluting and climate-change contributing kerosene lamps.
SHS households consume less than 1 litre of kerosene per month, compared to almost 3 litres per month
by households without SHS. There are also direct health benefits; SHS adoption reduces respiratory
disease of women by 1.2 per cent.
 Reduced the time of fuel collection (traditionally carried out by women and children).
 Encouraged a number of small scale projects (e.g. households sell mobile phone charging facilities).
 Increased the hours during which children can study for school and access to information (e.g. health
related) obtained via internet, TV or radio.
 Has created an estimated 100,000 directly related jobs.
 Resulted in an increase in food consumption (with positive health impacts).
The World Bank estimates that the accrued benefits of a solar unit exceed its cost by 210 per cent.
Source: Samad et al. (2013).
Reducing fossil fuel use has another potentially positive impact on population health –
redirecting fossil fuel subsidies to financing social protection. Subsidies for fossil fuels are
estimated at approximately USD 500 to USD 600 billion annually. Contrary to public
perception, the level of fossil fuel subsidies are significantly higher than those for renewable
energy which amount to around USD 100 billion annually (IEA, 2013). Fossil fuel subsidies are
also regressive; the majority of the benefit of such subsidies accrues to the better off with
the wealthiest 20 per cent of the population enjoying some 43 per cent of the benefit from
fossil fuel subsidies, while the poorest quintile gets only 7 per cent (Arze del Granado, Coady,
and Gillingham, 2010). Removing such subsidies and replacing them with targeted social
programmes, redistributive measures improve and the correct incentives to reduce fossil
fuel consumption are put in place. The IMF (2013) notes that if negative externalities from
energy consumption are factored in, subsidies actually cost around USD 1.9 trillion annually
– some 8 per cent of government revenues worldwide – which if reformed, could provide
much needed financing for social security extension. A World Bank (2012) study indicates
that those most in favour of retaining such subsidies are indeed those who most benefit –
the rich – and that with detailed explanation of the merits and design of a social programme
the worse off are generally open to the change (e.g. in Morocco).21
iii.
Agriculture and diet. Agriculture is a key contributor to climate change. The trend to
more meat eating is particularly harmful to the environment and produces significant
21
. www.worldbank.org/en/news/feature/2012/05/09/real-costs-fossil-fuel-subsidies.
26
Climate Change and Mortality
amounts of climate change gases.22 At the same time, the increase in consumption of
sugar, dairy products and meat has provoked a number of important and expensive
health effects (e.g. cancer, diabetes and other obesity related diseases) which put
pressure on medical systems and leads to significant losses in productivity. Healthier
nutrition initiatives e.g., reduction in eating red meat , soda taxes and promoting physical
activity are all effective ways to improve population health whilst at the same time, likely
to have related positive impacts on climate change.
The overall impacts of mitigation measures on mortality and population health are difficult to
quantify as they will depend on the interaction of a number of factors. However, where
measures have been taken, results have been positive. There is particular potential for those
less well-off who, without intervention measures, are likely to be worse hit by climate change.
22
. Around 10 to 35 per cent of climate change emissions are due to agriculture, with 80 per cent of this amount
related to livestock farming. Beef cattle farming is a particularly inefficient way to produce protein, producing four
times as much CO2 as the same quantity of chicken and around 15 times more than for soya. See <www.ewg.org>
and <www.unep.org>.
27
Climate Change and Mortality
5.
Insured / Pension Effects
5.1
Direct effects
In general, it appears likely that climate change will have a larger direct mortality effect on
vulnerable populations, whether in developed or developing countries. Since the population
who are more likely be covered by life insurance or pension programs are more likely to be
among the less-vulnerable, those participating in these programs may be less affected.
Nevertheless, there may be exceptions. For instance, although the affluent may live, on
average, in buildings with better storm-protection than those who are less-well off, they may
still live in a highly concentrated area. If, for instance, a hurricane or tornado hits that area,
there may be a higher number of deaths in that concentrated area than otherwise. In some
ocean-front property areas, the better-off may be able to afford to live there, thus being more
exposed to risks related to rising sea levels, for example as a result of increasingly severe storm
surges or slow onset due to melting glaciers.
For vulnerable populations living in areas with increased risk of mosquito infestation or
drought, there may still be actuarial issues despite the lack of traditional pension / life
insurance penetration. In Africa, for example, there has been a rapid rise in mobile phone usage
for day-to-day transactions. This in turn has driven an explosion in microinsurance, often on a
“loyalty” basis as part of a phone package. For example, it is said that EcoLife Zimbabwe
reached 20% of the adult population within 7 months on a loyalty model23. The spread of
mobile insurance via mobile phone (including life, accident, hospital cover as well as funeral
plans) is not limited to Africa. Telenor Talkshawk Pakistan / MicroEnsure reached 400,000 in
two months also with a loyalty scheme. Other distribution models also have proved successful,
whether “freemium” distribution (also via mobile) or through other “traditional”
microinsurance routes. Millions of people now have coverage, including some of the poorest
and most vulnerable. Clearly, an increasing number of deaths attributable to climate change (or
more properly a drag on mortality improvements that otherwise might have been anticipated)
will have actuarial ramifications in these markets.
5.2
Indirect effects
Mortality impacts indirectly related to climate change include, for example, deaths caused by a
sustained surge in demand beyond the capacity of a healthcare system to cope. As discussed in
Section 2.1, in the U.S. Hurricane Katrina and caused massive displacement of people and
consequential overloading of healthcare services which were not designed to carry significant
amounts of spare capacity.
23
Presentation dated 7 April 2016 by Henry Yan, Chair of the IFoA MicroInsurance Working Group.
https://www.actuaries.org.uk/documents/microinsurance-and-rise-mobile-insurance
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Climate Change and Mortality
As with the direct effects, it seems probable that the more vulnerable (poorer) sections of
society will be most vulnerable, which implies that South and Southeast Asia and large parts of
Africa will feel the indirect mortality consequences most severely. However, Katrina and Sandy
serve as powerful reminders that these mortality effects may not be limited to developing
economies.
5.3
Beyond the mortality impact
In discussing the potential impact of climate change related effects on pension and insurance
programs, we have limited our remarks above to mortality effects. However, if the projections
are borne out, with the potential for significant discontinuities to arise in the social and
economic fabric of countries across the world, there will of course be other and possibly more
profound impacts arising in relation to investment strategies of financial institutions such as
insurance and retirement programs, and indeed the political backdrop within which these
programs operate. Discussion of these effects is outside the scope of this paper.
29
Climate Change and Mortality
6.
Quantitative Analysis and Modeling
To understand the direct effect of climate change induced temperature changes we need: 1) a
model of how changes in temperature affects the mortality rates experienced by a particular
population, and; 2) a time series model of the expected changes in average daily temperature
for a particular location. A time series model is needed because daily mortality rates might be
expected to depend on the temperature experienced by people in the preceding days, not just
on the day on which mortality is measured
Models of the direct temperature effects attempt to replicate the short-term effect of changes
in weather-related temperature on a population (for example that of a large city) by modelling
the changes in mortality associated with changes in the average daily temperature. Studies
taking this approach have found that the curve of mortality versus temperature has a “J” shape
with a minimum at a particular temperature (the “optimum” temperature). The rate at which
mortality increases as temperature increases above the optimum is typically greater than the
rate of increase as temperature falls below the optimum. A Key finding is that the optimum
temperature varies with the location studied, but it is above the average ambient temperature
in most places (Gasparrini et al. 2015)
Temperature effects on mortality resulting from climate change were reviewed in the IPCC
Fourth Annual Assessment Report (“ar4-wg2-chapter8.pdf” 2016), and more recently in WHO
(2016).
A large scale study of the mortality risk attributable to high and low ambient temperatures was
published in the Lancet in 2015 (Gasparrini et al. 2015) and attracted significant comment
(“Climate and Health: Mortality Attributable to Heat and Cold - The Lancet” 2016) [Add other
links]. There is clearly more, and high-profile, work to be done in this area.
The statistical model underlying this paper (Gasparrini 2013) is open source and published as a
package for the R language (“Distributed Lag Linear and Non-Linear Models in R: The Package
Dlnm | Gasparrini | Journal of Statistical Software” 2016). The same type of statistical model
underlies the quantitative modelling in WHO (2014). (Honda et al. 2014).
The fact that the model has been published as an R package means that the whole modelling
process is transparent and could be reproduced by anyone with access to the data. Actuaries
would therefore engage with the modelling of temperature related mortality in various ways:


Attempting to reproduce the results of existing research groups;
Using the same model to calculate different results;
Present results from the DLNM in different ways, perhaps ones which are more relevant to
actuarial applications or which are designed to provoke discussion of different aspects of the
30
Climate Change and Mortality
results. The R modelling ecosystem includes tools which make creating and sharing interactive
visualisations relatively easy: here is an example https://actsci.shinyapps.io/dlnm_app-1/ ;



6.1
Applying the model to different data sets;
Extending or otherwise adapting the DLNM model;
Comparing the DLNM with completely different modelling approaches.
Use of scenarios
Modelling climate related impacts on mortality is discussed in chapter 6. A powerful alternative
to modelling is the use of scenarios to illustrate possible impacts. Actuaries in all sectors who
carry out any form of modelling work need to subject their projections to sensitivity testing.
Typically in relation to mortality this might include variations in the underlying base table, or
the (rate of) projected improvements. Another common approach is to add or subtract a year
to the calculated age.
In 2014, the UK’s National Association of Pension Funds (since renamed the Pensions and
Lifetime Savings Association or PLSA) commissioned a study to examine possible future trends
in longevity, based in part on analysis of 2.5 million pensioners from some of the UK’s largest
occupational pension schemes. It considered a number of possible future scenarios, shown in
the table below taken from their report24. The following table highlights the potential climate
change scenarios used.
In the PLSA’s scenario of increasing costs of energy, economic growth is severely impacted and
consequentially health service provision is challenged. Reduced access to and increased costs of
food are a further consequence. The poorer sectors of UK society would as a result be unable to
24
http://www.plsa.co.uk/~/media/Policy/Documents/0414_Longevity_model_Nov14_2.pdf
31
Climate Change and Mortality
afford a trio of basic needs: heating, medicine and a balanced diet. They also posit two
consecutive harsh winters early on in the projection. Their results are shown below.
This particular scenario therefore led to a lowering of life expectancy versus the central
assumptions, with a greater impact on the poorer sections of society. However, it is not the
specific scenario that is of most interest, but rather the technique used. Actuaries in different
countries could construct similar scenario-based sensitivity analysis of their model results. If
combined with consistent economic scenarios this could potentially prove to be a far more
powerful test of a model or of a proposed solvency level that simply altering the rate of
longevity improvement / discount rate by varying amounts.
6.2
Dealing with non-stationary risk
Whilst not a direct link to insurance or pensions disciplines, it is instructive to realise that the
climate scientists looking at the impact of climate on, say, grain production, are dealing with
non-stationary risk. This is illustrated in the following diagram taken from The Global Food
Security programme (2015)25.
The diagrams below show how distributions for the annual yield in cereal crops are expected to
change. On each row the left hand (blue) diagram shows the current observed yield. The middle
diagram shows the projected yields for the period 2011-40. The final right hand diagram shows
25
Final Project Report from the UK-US Taskforce on Extreme Weather and Global Food System Resilience, The
Global Food Security programme, UK.
32
Climate Change and Mortality
how this distribution / volatility change over longer periods. The top row shows the effect
including the effect of CO2 fertilisation (see section 4.2 above), and the bottom row excludes
this effect (as recently questions have been raised as to its real magnitude)26.
This analysis suggests that what is referred to as an extreme food production shock in the late
20th century will become more common in the future. These data indicate that a 1-in-200 year
event for the climate in the late 20th century equates to a loss of approximately 8.5% (top left)
and over the next decades (2011-2040) a 1-in-200 year event is about 15% larger in magnitude
and equivalent to the loss of 9.8% of calorie production. Furthermore, according to the model,
an event that we would have called 1-in-100 years over the period 1951-2010 may become as
frequent as a 1-in-30 year event before the middle of the century.
Similar techniques may be needed to project for example impacts of climate change on
mortality or economic development.
26
Feng, Z., Rütting, T., Pleijel, H., Wallin, G., Reich, P.B., Kammann, C.I., Newton, P.C.D., Kobayashi, K., Luo, Y.,
Uddling, J., 2015. Constraints to nitrogen acquisition of terrestrial plants under elevated CO 2. Global Change Biol.
(in press); Myers, S.S., Zanobetti, A., Kloog, I., Huybers, P., Leakey, A.D., Bloom, A.J., Carlisle, E., Dietterich, L.H.,
Fitzgerald, G., Hasegawa, T., 2014. Increasing CO2 threatens human nutrition. Nature 510, 139-142
33
Climate Change and Mortality
7.
Case studies
 United Kingdom
 [others]
34
Climate Change and Mortality
8.
Need for further research
35
Climate Change and Mortality
9.
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37