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HSS4331 – International Health Theory Feb 23, 2009 - Climate Change and Health But before we begin…. Interview with African economist Dambisa Moyo: http://www.nytimes.com/2009/02/22/magazine/22wwln-q4-t.html Climate Change Climate Change will affect population health everywhere But there will be a particularly dramatic effect on developing and poor nations. From WHO website: “Developing country populations, particularly in Small Island States, arid and high mountain zones, and in densely populated coastal areas, are considered to be particularly vulnerable.” From Stephen Lewis: “Those places expected to be hardest hit by Climate Change are precisely those places currently being affected by HIV/AIDS, i.e. Southern Africa.” (not a precise quote) What are some of the ways that Climate Change can affect health? What are the mechanisms with which Climate Change can affect population health? •Heat waves •Floods and storms •Water scarcity and quality •Communicable diseases •Air pollution •Changing agriculture •Migration •Insecurity •Economic effects Heat Waves -heat waves already kill hundreds, even thousands, every year -in August 2003, 35000 people were killed in one week of intense heat in Europe -exacerbated in urban environments -less vegetative cover -artificial surfaces are less cool -greater local CO2 production -frequency of heat waves are expected to increase -according to WHO, heat deaths in California alone will double by 2100 -will also mean fewer cold waves globally, but this is only relevant in countries with winter -poor countries tend to be tropical, therefore more susceptible to heat waves Floods and Storms -the largest and fastest growing cities are on coasts -construction patterns have led to less natural protection (eg erosion) -poor quality housing makes people more vulnerable -inadequate drainage in poor cities -according to WHO, flooding will affect 200 million people by 2080 -in instances of flooding, it is always the poor who suffer most -eg, Hurricane Katrina -poor live in less secure structures Asian tsunami anyone? -poor live in more exposed areas Places most susceptible to floods and storms? -Nile delta in Egypt -Ganges delta in Bangladesh -small islands like the Maldives, the Marshall Islands and Tuvalu Communicable Diseases -waterborne and vector borne diseases are strongly influenced by climate -mosquitoes that carry dengue fever prefer high heat and humidity -increasing global warming makes more habitats for mosquitoes -increased population density means faster spread of such diseases Water quality and scarcity Because rivers are changing paths and rainfalls are misscheduling, the predictability of the safety of drinking water is uncertain. •Already, 2 million deaths a year, mostly among young children, are due to diarrhea, directly caused by unsafe water. •WHO estimates that today 2.4% of diarrheal deaths are due to climate change. (WHO uses very conservative methods to reach these estimates.) Air Pollution -Atmospheric pollutants tend to be greater on hotter days (eg ozone) -U.S. model predicts that by 2050, due to global warming, ozone-related deaths will increased by 4.5% and there will be 60% more alert days -exacerbated in emerging nations with lesser urban planning schemes (China) Changing Agriculture Agriculture is affected by temperature, precipitation and soil quality. But in the long run, Climate Change affects agriculture by affecting: •productivity •agricultural practices (through changes of water use, pesticides, etc) •environmental effects (frequency and intensity of soil drainage, etc) •rural space (loss of land due to desertification) •adaptation (change in biology of species) Poor agriculture leads to poor nutrition leads to poor health Changing Agriculture Agriculture is affected by temperature, precipitation and soil quality "southern Africa could lose more than 30% of its main crop, maize, by 2030. In South Asia losses of many regional staples, such as rice, millet and maize could top 10%". –Science (2008) Poorest countries will be hit hardest. Reduction in crop yield in tropical and sub-tropical regions caused by decreased water and changed insect behaviour. -IPCC (2001) In Africa and Latin America many rainfed crops are near their maximum temperature tolerance, so that yields are likely to fall sharply for even small climate changes; falls in agricultural productivity of up to 30% over the 21st century are projected. Marine life and the fishing industry will also be severely affected in some places. -IPCC (2001) Migration There is a long established intersection between migration and health: -sudden stress of large numbers of people is ecologically bad -environmental refugees must be fed, sheltered and cared for -the world has a poor track record of caring for mass migrants -”Climate Refugees” (first used in 1988) "The growing number of disasters and conflicts linked to future climate change will push the numbers far higher unless urgent action is taken. We estimate that between now and 2050 a total of 1 billion people will be displaced from their homes.“ –Christian Aid (2007) In 2005, half of Bhola Island in Bangladesh became permanently flooded, leaving 500,000 people homeless. They are being called the world's first Climate Refugees. Washington Post (2007) 1400 residents of Papua New Guinea's Carteret Islands are permanently homeless because their islands sank under rising sea levels -Sydney Morning Herald (2002) Insecurity War is bad for health. Need I explain why? -high tension areas already exist with respect to water: -South Asia (India, Pakistan, Bangladesh) -Middle East (Lebanon, Israel, Iraq, Iran) -freshwater needed for drinking and agriculture -flowing water needed for industry, transportation and clean energy -with fossil fuels out of fashion, greater need for hydroelectic power -->dams --> denial of flowing water downstream -->conflict Insecurity War is bad for health. Need I explain why? War has been known to be triggered by climate. Swings in temperature were correlated with times of war in Eastern China between 1000 and 1911. Human Ecology (2007) "Water at large is the central [global warming] problem for the USA" Princeton University Israel and Lebanon almost went to war in 2003 over fresh water from the Hasbani river. Global warming constitutes a security threat to the USA, as there will be wars based on diminishing fresh water supplies, refugees, and higher rates of famine and disease -The Pentagon (2007) Less money means less public health. Economic Effects Coral bleaching can lead to collapse of the world’s fisheries in a matter of decades –Am J Prev Med (2008) Case study: Washington State(Dept of Ecology, 2008): •Direct costs of fighting wildfires > $75 million per year by the 2020s. •Water conservation costs = $16 million by 2040 •Public health costs •Tourism and recreation losses •Hydropower revenues down by $166 million by 2020 •Water price increases in some basins = $680,000 per million gallons per day. •Dairy revenue loss = $6 million per year by the 2040s •Crop losses = $66 million •Shoreline protection = $50 million •Flooding costs •Cumulative economic effects (As one industry declines, another may follow.) Aside: Psychosocial effects Health Canada 2007 report “Climate Change and Health Vulnerability Assessment: The Public Health Agency of Canada is undertaking a study on the projected mental health effects of environmental stressors resulting from Climate Change. Synergy of Climate Effects Floods can cause cholera and diarrhea, damage infrastructure for years, and can contribute to a pathway making oral vaccines less effective. Drought exacerbates malnutrition, causes populations to migrate, where they are exposed o new patterns of vectorborne diseases. Climate change causes urban heat waves, causing increased use of air conditioners, increasing demand for electricity, leading to further use of coal plants... Health Canada breaks down the climate change – health relationship like so: Temperature-related morbidity and mortality: -cold and health related illnesses -respiratory and CV illnesses -increased occupational health risks Health effects of extreme weather events: -damaged public health infrastructure -injuries and illnesses -social and mental stress -occupational health hazards -population displacement Air pollution related illnesses: -changed exposure to outdoor allergens -asthma, etc -CV diseases (heart attacks, strokes, etc) -cancer Water and food borne contamination: -diarrhea -toxic algal blooms Vector and zoonotic diseases: -changed patterns of diseases caused by insects, bacteria, etc Exposure to UV rays -skin damage and cancer -cataracts -disturbed immune function Vulnerable populations -seniors -kids -chronically ill people -poor people -Northern residents -disabled people -people “living off the land” Socioeconomic impacts: -loss of income and productivity -social disruption -diminished quality of life -increased costs to health care -health effects of mitigating technologies (eg, air conditioners) In 2006, the WHO did a study of project health impacts on Oceania for the year 2050, based on expected changes in global climate. VOLUME 114 | NUMBER 12 | December 2006 • Environmental Health Perspectives In addition, they computed for Sub-Saharan Africa, for the year 2030: -mortality from flooding would be almost twice as likely -increase in malaria -increase in malnutrition due to destruction of crops and change in harvest season -increase in diarrhea due to reduced water control Sobering statistic: “Measurement of health effects from climate change can only be very approximate. Nevertheless, a WHO quantitative assessment, taking into account only a subset of the possible health impacts, concluded that the effects of the climate change that has occurred since the mid1970s may have caused over 150,000 deaths in 2000. It also concluded that these impacts are likely to increase in the future.” WHO's official position: WHO considers that rapid climate change poses substantial risks to human health, particularly among the poorest populations. The organization therefore supports actions to reduce human influence on the global climate. Important issues: -climate change denial slows down investment in projects to address these issues -climate change affects different regions in very different ways -poor countries cannot afford to do basic risk assessment -global rush to cities and to coasts is ever accelerating -effects on food production are impossible to predict (though Africa is thought to be most vulnerable) -mass migration (environmental refugees) highly likely -conflict resulting from both mass migration and competition for resources is also likely -a global issue requires a global solution Another word about water... -Case study: China -In China, by 2030, population will be 1.6 billion and water demand will equal 100% of China's supply -70% of China's lakes and 5 of its rivers are too polluted for human use -China's glaciers are shrinking 7% each year, due to global warming ->this threatens the source of these rivers: Yangtze, Yellow, Brahmaputra, Mekong and Salween, which feed 500 million people downstream -China uses 7-15 times more water to produce a unit of GDP than do more developed nations ->therefore some of this is preventable! Water Availability Per Capita, 2007 www.earthtrends.wri.org A word about scientific uncertainty.... the Canadian Environmental Protection Act (1999) states: “...where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing costeffective measures to prevent environmental degradation.” So what is being done? WHO: -continue what they've always done, addressing infectious disease, malnutrition, etc -workshops to “raise awareness” of climate change in developing world -advocate for green infrastructure, such as public transportation -advocate for improved urban infrastructure, such as better drainage -proposed creation of “global climate change fund” More things that need to be done: -improved global disease surveillance -improved response systems to disease outbreaks -better global risk assessment, to identify vulnerable areas and possible interventions -international bodies for managing shared resources, like water -research, research, research --> how will crops behave as climate changes? --> how will vector populations (insects, rodents) behave? --> where will freshwater be most needed? -->etc