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Working Paper 20
Climate change and Health Across
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United Nations Economic Commission for Africa
African Climate Policy Centre
Working Paper 20
CLIMATE CHANGE AND HEALTH ACROSS AFRICA:
ISSUES AND OPTIONS
November 2011
i
Acknowledgment
This paper is the product of African Climate Policy Center (ACPC) of United Nations
Economic Commission for Africa (UNECA) under the Climate for Development in Africa
(ClimDev Africa) Programme. The paper is produced with guidance, coordination and
contribution of ACPC and contributing authors from various institutions. Contributions to
this paper are made by Owen C. Owens and Chuks Okereke from the University of Oxford,
Smith School of Enterprise and the Environment; Jeremy Webb from the UNECA-ACPC, and
Miriam Musa, York University, Ontario, Canada.
This working paper is prepared as an input to foster dialogue and discussion in African
climate change debate. The findings, interpretations and conclusions presented in this
working paper are the sole responsibility of the contributing authors and do not in any way
reflect the official position of ECA or the management team. As this is also a working paper,
the ECA does not guarantee the accuracy of the information contained in this publication and
will not be held responsible for any consequences arising from their use.
Copyright © 2011, by UNECA. UNECA encourages the use of its material provided that the
organization is acknowledged and kept informed in all such instances.
Please direct inquiries and comments to: [email protected]
A free copy of this publication can be downloaded at
http://www.uneca.org/acpc/publications
ii
TABE OF CONTENTS
LIST OF FIGURES ......................................................................................................... iv LIST OF TABLES ........................................................................................................... iv LIST OF ACRONYMS .................................................................................................... v Abstract ............................................................................................................................. 1 Introduction ...................................................................................................................... 2 ClimatechangeandhealthacrossAfrica:criticalissues............................................................3 ClimatechangetrendsacrossAfrica...................................................................................................4 ImpactsonHealth.......................................................................................................................................5 Indirect impacts ................................................................................................................. 5 Malnutrition...................................................................................................................................................6 Communicablediseases............................................................................................................................7 NeglectedTropicalDiseases...................................................................................................................8 Waterborndiseases................................................................................................................................11 Diarrhoea................................................................................................................................................11 Vectorborndiseases...............................................................................................................................12 Malaria......................................................................................................................................................13 Meningitis–anairbornedisease.......................................................................................................16 HIV/AIDS......................................................................................................................................................18 Socialstatus.................................................................................................................................................18 Direct impacts ................................................................................................................. 21 Extremeweathereventsandtheirdirecteffects........................................................................21 UVrelatedcancersanddiseases........................................................................................................22 Temperatureandprecipitationeffects...........................................................................................23 Airquality....................................................................................................................................................25 Gaps in knowledge and research ..................................................................................... 25 Africa’s response to climate change and health ............................................................... 27 Options for consideration ................................................................................................ 28 References ....................................................................................................................... 31 iii
LIST OF FIGURES
Figure1:Potentialhealtheffectsofclimatechangeandhealth.AdaptedfromPatzetal.
(2000).....................................................................................................................................................................2 Figure2:DistributionoftheprevalenceofNTDsinAfrica.Source:ImperialCollege
London,SchistosomiasisInitiative(availableat:
http://www3.imperial.ac.uk/schisto/whatwedo/ntdsinafrica).................................................9 Figure3:Malariaendemicity:thespatialdistributionofP.falciparum(Hayetal.,2009).
.................................................................................................................................................................................14 Figure4:Africanmeningitisbelt(Palmgren,2009;WHO/EMC/BAC/98.3)........................16 Figure5:AssociationbetweenGDP/personadjustedfor$USPurchasingPowerParity
andlifeexpectancyfor155countriescirca1993(Lynchetal.,2000)....................................19 Figure6:AfricanCO2emissionscomparedwiththeworld(UNEP,2002)............................20 Figure7:TemperaturechangesinAfricacomparedwiththeworld(UNEP,2002)..........24 LIST OF TABLES
Table1:Healthrelatedimpactsofclimatechange(TheSmithSchoolofEnterpriseand
theEnvironment,2010).................................................................................................................................5 Table2:ExamplesofNTDsaffectedbyclimatechange.(Hotez&Kamath,2009
[http://goo.gl/qgFIA&http://goo.gl/XJdpT])...................................................................................10 Table3:Examplesofvectorbornediseasesaffectedbyclimatechangeindecreasing
orderofaffliction.............................................................................................................................................12 Table4:NumberofpeoplekilledinEWEsinthe1980’sand1990’sbyglobalregion
(McMichaeletal.,2003)...............................................................................................................................22 iv
LIST OF ACRONYMS
ACPC AfricanClimatePolicyCentre
AIDS AcquiredImmuneDeficiencySyndrome
CHWGClimateandHealthWorkingGroup
DALYs
DisabilityAdjustedLifeYears
EWE ExtremeWeatherEvent
HESA
HealthandEnvironmentStrategicAlliancefortheImplementationofthe
LibrevilleDeclaration
HIV HumanImmunodeficiencyVirus
IPCC IntergovernmentalPanelonClimateChange
IRI
InternationalResearchInstituteforClimateandSociety
NPJAs
NationalPlansofJointActions
NTDs NeglectedTropicalDiseases
SANA SituationAnalysesandNeedsAssessment
SSA Sub‐SaharanAfrica
UNFCCC
UnitedNationsFrameworkConventiononClimateChange
UNDP UnitedNationsDevelopmentProgramme
UV
Ultra‐Violet
WHO WorldHealthOrganization
v
Abstract
Climatechangeisexpectedtoaltertemperature,airmovement,andprecipitationinvarious
waysandtovaryingdegreesacrossAfricawithconsequencesforhumanhealth.Withthe
strongconnectionbetweenapopulation’shealthandeconomicandenvironmentalhealth,
theimpactofclimatechangeoneachisoneofthemajorwaysinwhichclimatechangemay
impedethedevelopmentoftheAfricancontinent.
Africancountrieswillsufferhealthconsequencesduetoimpactsofclimatechangeasmany
Africancountrieshavepopulationsthatareamongthemostvulnerabletoclimaticchanges
intheworld.Thisvulnerabilityisdueinparttoexistingproblemsofpoverty,weak
institutionsandarmedconflict,whichlimitapopulation’scapacitytodealwiththe
additionalhealthchallengesposedbyclimatechange.Therelativeimpactofclimaticand
socioeconomicfactorsisgenerallydifficulttoquantify.Thiscomplexityinturnaffectsthe
certaintyofstudiesandpoliciesonthehealthimpactofclimatechangeonAfrica.
Themajorityofhumanhealthproblemsthatcanbelinkedtoclimatechangearenotstrictly
speakingcreatedbychangesinclimatebutareproblemsexacerbatedbychangingweather
patternsandclimaticconditionsleavingpopulationsillpreparedfornewhealthimpacts.
Forexample,climatechangemayaffecthealththroughincreasedfrequencyandintensityof
extremeweathereventswhicharedriversofmalnutritionandcandirectlyimpacthealth
forexampleduringheatwaves.Risingtemperatureswillaffectpathogenlifecycleand
rangeaffectingrateofinfections,especiallyvector‐bornediseases.Theoverallbalanceof
effectsfromclimatechangeonhealthgloballyislikelytobenegativeanditispredictedto
bemuchgreaterinAfricanpopulationsthaninEuropeanpopulationsforexample.
WithinAfricathetypeandmagnitudeofthehealthimpactsofclimatechangewillvary
significantlyamongcommunitiesandregions.Variationswillbeduetomanyfactorssuch
asgeographicandmicroclimatedifferences,socio‐economicconditions,thequalityof
existinghealthinfrastructure,communicationcapacityandunderlyingepidemiology.
Thisworkingpaperlaysoutthecurrentstateofknowledgeregardingdirectandindirect
impactsofenvironmentalfactorsonhealthacrossAfrica.Whiletherearemany
uncertaintiesinmagnitudesofclimatechange,particularlywithtiming,theexisting
literaturemakesinterestingobservationsaboutpotentialhealthimpactsandthe
populationsthatcouldbemostatrisk.Theworkingpaperpresentsthepotentialimpacts
climatechangemayhaveonhumanhealthandanalysesthevariousdirectandindirect
impactsthatclimatechangewillhaveonAfricanpopulations.Duetotheemergingnature
oftheissueandliterature,therearemanygapsinknowledgeontheimpactsclimatechange
willhaveonhumanhealth.
ImportantlyAfricaisalreadyaddressingclimateandhealth,andexamplesinclude"The
LibrevilleDeclarationonHealthandEnvironmentinAfrica"byAfricanMinistersofHealth
andMinistersofEnvironment,alongwithgrassrootsactionssuchthosebeingtakenbythe
ClimateandHealthWorkingGroupinEthiopiaandelsewhere.Intermsofpolicyan
importantquestionis:whatshouldbedonedifferentlytoaddresshealthconcernsacross
Africagivenwhatweexpectintermsofclimatechange?Insomecasesitmaybemoreof
thesame(e.g.theuseofmosquitonetsandothermeasurestopreventmalaria).Inother
caseseffectivepreparationorresponsemayrequirecompletelydifferentapproachesto
healthcareacrossthecontinent.
1
Introduction
Itiswellknownthatthehealthofapopulation,ifitistobesustained,requirescleanair,
safewater,adequatefood,tolerabletemperature,stableclimate,andhighlevelsof
biodiversity(WHO,1995;IPCC,2007).Globally,climatechangeisexpectedtoalter
temperature,airmovement,andprecipitationinvariouswaysandtovaryingdegrees
acrossAfricawithconsequencesonhumanhealth.Withthestrongconnectionbetween
apopulation’shealthandeconomicandenvironmentalhealth,theimpactofclimate
changeoneachisoneofthemajorwaysinwhichclimatechangemayimpedethe
developmentoftheAfricancontinent(IPCC,2001;Sperling,2003;Stern,2006).
Africancountrieswillsufferserioushealthconsequencesduetoimpactsofclimate
change.ManyAfricancountrieshavepopulationsthatareamongthemostvulnerableto
climaticchangesintheworld.Thisvulnerabilityisdueinparttoexistingproblemsof
poverty,weakinstitutionsandarmedconflict,whichlimittheircapacitytodealwiththe
additionalhealthchallengesposedbyclimatechange.Therelativeimpactofclimatic
andsocioeconomicfactorsisgenerallydifficulttoquantify.Thiscomplexityinturn
affectsstudiesandpoliciesonthehealthimpactofclimatechangeonAfrica.Ingeneral,
itisrarelypossibletoseparateclimaticandsocio‐economiceffectswhenassessingthe
healthimpactsofclimatechangeonanyspecificpopulation(Figure1).
Figure1:Potentialhealtheffectsofclimatechangeandhealth.AdaptedfromPatzetal.
(2000).
Modulating Influences




Regional Weather Changes
Climate
Change




Health Effects
Population growth
Standards of living
Health care facilities
Demographic change
Disease Pathways
Temperature
Heat waves
Precipitation
Extreme weather events
 Air pollution levels
 Contamination pathways
 Transmission dynamics
Adaptation Measures
 Temperature-related
illness and death
 Extreme weather
related health effects
 Effects of food and
water shortages
 Air pollution related
health effects
 Water and foodborne diseases
 Vector-borne
diseases
Themajorityofhumanhealthproblemsthatcouldbelinkedtoclimatechangearenot
strictlyspeakingcreatedbychangesinclimate.Rather,theyareproblemsexacerbated
orintensifiedbychangingweatherpatternsandotherclimaticconditionsleaving
populationun‐or‐ill‐preparedfornewhealthimpacts.Forexample,climatechangemay
affecthealththroughincreasedfrequencyandintensityofextremeweatherevents
(EWEs)(suchashurricanes,heat‐waves,floods,anddroughts)eachofwhichare
driversofmalnutritionandchangesinthedistributionofdiseases.Risingtemperatures
willaffectpathogenlifecycleandrangeaffectingrateofinfections,especiallyvector‐
bornediseases(Costelloetal.,2009).Anincreaseinglobalmeantemperaturewillalso
2
alterheatandcold‐relateddeathratesaroundtheglobe(Costelloetal.,2009).While
theremightbesomepositivebenefitsassociatedwithweatherchangessuchasa
reductionincold‐relateddeathsinsometemperateregions,theoverallbalanceof
effectsonhealthgloballyislikelytobenegative(IPCC,2007).Theseeffectswillnotbe
evenlydistributedacrosstheworld’spopulationsaslossofhealthylifeyearsasaresult
ofclimatechangeispredictedtobe500timesgreaterinpoorerAfricanpopulations
thaninricherEuropeanpopulations(Ebi,2006;McMichaeletal.,2008).
EvenwithinAfrica,thetypeandmagnitudeofthehealthimpactsofclimatechangewill
varysignificantlyamongcommunitiesandregions.Variationswillbeduetomany
factorssuchasgeographicdifferencesintemperatureandprecipitation,socio‐economic
conditions,thequalityofexistinghealthinfrastructure,communicationcapacityand
underlyingepidemiology.Therefore,inthisreportwelayoutthecurrentstateofdirect
andindirectimpactsofenvironmentalfactorsonhealthinAfrica.Whiletherearemany
uncertaintiesinmagnitudesofclimatechange,particularlywithtiming,theexisting
literaturemakesinterestingobservationsaboutpotentialhealthimpactsandthe
populationsthatcouldbemostatrisk.
Thesectionsbelowwill:
 identifycurrenthealthissuesacrossAfrica;
 introducethecurrentunderstandingofchangesintemperature,precipitation,
andextremeweathereventsexpectedaspartofclimatechangeacrossAfrica;
 presentthepotentialimpactsclimatehasonhumanhealth;
 analysethevariousdirectandindirectimpactsthatclimatechangewillhaveon
Africanpopulations;
 acknowledgeanddiscussgapsinknowledgeoftheimpactsclimatechangewill
haveonhumanhealth,and;
 assessoptionsandthewayforwardtoaddressclimatechangeandhealthacross
Africa.
Climate change and health across Africa: critical issues
Inouranalysis,carefulattentionispaidtodistinguishingclimateandhealthissuesfrom
climatechangeandhealth.Theformerreferstotheexistingstatusquoandthehistoric
linksbetweenclimateandhealth.Thelatterrelatesmorespecificallytotherelationship
betweencurrentandfutureanthropogenicclimatechangeandconditionsofhealth.For
example,itisevidentthattheprevalenceofmalariainthecontinentisrelatedto
tropicalclimateacrossAfrica.Infuture,however,thenatureandspreadofmalaria
acrossthecontinentmaywellbeaffectedbythechangesintemperatureand
precipitationexpectedwithinthecontinent.
Ingeneral,climatechangewillacttoincreaseordecreasetheprevalenceofdisease,
injuryorotherhealthissues.However,itisdifficulttogauge,intermsofnumbers,how
manymoreorlesspeoplewillbeaffectedindifferentpartsofAfrica,whatchangesin
mortalitytheremaybeorthechangesinDisabilityAdjustedLifeYears(DALYs).This
uncertaintyisduemainlytothescarcityofmodelsthatcanrobustlypredictpatternsof
climatechangeatnationalandlocalscales.Inadditiontothis,manyAfricancountries
currentlyexperiencealotofsocio‐economicchallenges,whilecompoundingtheeffects
ofclimatechangeonhealth,aredifficulttoseparateoutfromthosecausedbyclimate
change.
3
Accordingly,acriticalissueforAfricancountriesandgovernmentsisnotjustthe
influenceclimatechangemayhaveonhealth,butwhatneedstobedonetoimprove
healthservicesandconditionsgenerallyandespeciallytakingintoaccountclimate
change.Thiscanbereferredtoasthepolicydimensionofclimatechangeandhealth
aimedatdrivingmitigationandadaptationmeasurestoimproveAfricanhumanhealth.
Perhapsthemostimportantquestionis:whatshouldbedonedifferentlytoaddress
healthconcernsacrossAfricagivenwhatweexpectintermsofclimatechange?Insome
casesitmaybemoreofthesame(e.g.theuseofmosquitonetsandothermeasuresto
preventmalaria).Inothercaseseffectivepreparationorresponsemayrequire
completelydifferentapproachestohealthcareacrossthecontinent.
Climate change trends across Africa
TheIPCCreport(2007)andtheAfricanClimateTrendsandProjectionsreport(2007)
provideagoodsummaryofkeytrendsandoutlinesbasedonthebestavailable
projectionsforclimatechangeinAfrica.Thesearesummarisedbelow:



Withrespecttotemperature:
o LandareasoftheSaharaandsemi‐aridpartsofsouthernAfricamay
warmbyasmuchas1.6°C(Hernesetal.,1995;Ringiusetal.,1996).
o Inthattime,equatorialcountries(eg:Cameroon,Uganda,andKenya)
mightwarmabout1.4°C.
o Sea‐surfacetemperaturesintheopentropicaloceanssurroundingAfrica
areexpectedtoincreaselessthantheglobalaverage,onlyabout0.6‐0.8°C,
thereforethecoastalregionsofthecontinentareexpectedtowarmmore
slowlythanthecontinentalinterior.
PrecipitationchangesexpectedbymostGCMsindicaterelativelymodest
moistureincreasesovermostofthecontinent.
o AlthoughsouthernAfricaandpartsoftheHornofAfricashouldexpecta
declinebyabout10%.
o Seasonalchangesinrainfallarenotexpectedtobelarge(Joubert&Tyson,
1996;Hewitson&Crane,1996).
o PartsoftheSahelcouldexperiencethegreatestincreasesinrainfallbyas
muchas15%overrecentaverages.Itisimportanttonotehere,however,
thatthisriseinrainfallwouldfollowadroughtthathaslasted30yearsin
theregion.
o EquatorialAfricacouldexperienceasmall(5%)increaseinrainfall.
Extremeweatherevents(EWEs)arestillpoorlyunderstoodandconclusive
evidenceastochangesintheirfrequencyisnotagreeduponintheliterature.
o CurrentlyoccurringEWEsthattheAfricanpopulationneedtocontend
withareheatwaves,droughts,andheavyprecipitation).
o Althoughtheirprevalenceisnotexpectedtochangemuch(IPCC,2007),
theircompoundingeffectsonotherclimatechangesareacausefor
concern.
Thelikelyandpotentialimpactsthesechangesinclimatemayhaveonhealthare
discussedbelow.
4
Impacts on Health
Whenaddressingclimatechangeandhealthitisimportanttobeawarethatclimate
changecandirectlyandindirectlyimpacthealth.Directhealthimpactsaffecthuman
biologydirectlyandincludeinjury,morbidityandmortalitycausedbyclimate‐induced
EWEs(suchascyclones,floods,anddroughts),thermalstress(heatwavesandcold
periods),skinandeyedamage(viaUVradiation),andcardio‐respiratorydiseases
directlyrelatedtochangesintemperatureandairquality(Table1).Howevermostofthe
healthimpactsofclimatechangeareindirect.Indirectimpactsaffectnon‐human
biogeochemicalsystemsandincludemalnutrition(duetodecreasecropsuccess),water
insecurityandqualitychanges,lifecycleandrangeofpathogensviawaterandvectors.
Theclassificationofdirectandindirectheathimpactsofclimateisabitcomplexbut
Table1belowprovidesasummaryofthebreakdownusedforthepurposesofthis
paper.
Table1:Healthrelatedimpactsofclimatechange(TheSmithSchoolofEnterpriseand
theEnvironment,2010).
ClimateChanges
EWEs
Direct
Temperature
HealthImpacts
Highlevelsofmortalityandmorbidity,
changeindiseaseprevalenceandpatterns
Thermalstress,skincancer,eyediseases
Cardio‐respiratorydiseases,allergic
disorders
Foodavailability,malnutrition,famine,
Temperature
infectiousdiseasesofmigrants,droughts
Water‐bornediseases,vector‐borne
Precipitation
diseases,droughts,foodandwater
availability
EWEs(+rainfall+temperature Diseasesofmigrants,conflicts,foodand
+ecosystem)
wateravailability,malnutrition,famine
Airquality
Indirect
Ecosystemcompositionand
function
Foodyieldsandquality,aeroallergens,
vector‐bornediseases,water‐bornediseases
Itisimportanttostressthatclimateandclimatechangeareonlysomeoftheimpacts
humanhealthisinfluencedby.Asstated,healthoutcomesareusuallytheresultof
complexinteractionsbetweensocial,cultural,andeconomiccharacteristics,geographic
settings,andpre‐existinghealthstatus.Giventhatmuchofthehealthimpactofclimate
changeinAfricawillbeviatheindirectroute,wediscussthesefirstbeforeturningto
thedirectheatheffects.
Indirect impacts
Thepotentialindirecthealtheffectsofclimatechangeonacommunities’healthwill
occurpredominantlythroughchangestonon‐humanbiologicalorbiogeochemical
systems.Thisincludeschangesincropyield,geographicalrangeanddistributionof
infectiousdiseasesandtheirmethodsoftransportandresultsofadditionalsocial
5
pressuresthatresultfromchangesinrainfallandtemperature.Ultimatelytheseclimatic
changesplacepressureonill‐preparedhumansupportsystemsbeyondfoodandwater
securityandthecapacitytomanagealreadystressedhealthcaresystems.
Malnutrition
Goodnutritionisessentialforgoodhealth.Deficienciesinenergy,fat,protein,nutrient
orvitaminintakeleadtomalnutritionwithmajorconsequencesforpeoples’physical
andmentalhealth.Malnutritionhasdetrimentalandlastinghealthconsequencesoften
limitingaperson’sphysicalandintellectualdevelopment,particularlythosewhoare
affectedasinfantsorasyoungchildren.Additionally,malnutritionvastlyincreases
peoples’susceptibilitytoacquiring,anddyingfrominfectiousdiseases(Baro&Duebel,
2006;Schaible&Kaufmann,2007;Confalonierietal.,2007).Itaffectsgroupsofpeople
whoaremostvulnerabletochangingenvironmentalpatterns,suchasfarmersand
coastalcommunities,andthosewhoareleastabletopurchasefoodsuchasthepoor
andlandlesswagelabourers.
Malnutritionisconsideredthemostimportanthealthriskgloballyasitaccountsforan
estimated15%oftotaldiseaseburdeninDALYs.Atpresent,under‐nutritioncauses1.7
milliondeathsperyearinAfricaandiscurrentlyestimatedtobethelargestcontributor
toclimatechangerelatedmortalityaroundtheworld(Patzetal.,2005).Moreover
leadingscientistsindevelopmentandhumanitarianresearchagreethatclimatechange
willlikelyworsenexistingproductionandconsumptionstressesinfood‐insecure
countries(Bloemetal.,2010,p.133S;Schmidhuber&Tubiello,2007,p.19704).Bloem
etal.(2010)explainthataccesstofoodreliesontwokeyfactors:availability(through
themarketorsubsistentproduction)andaffordability(throughmonetaryincome).
Availableevidencestronglyindicatesthatclimatechangewillnegativelyaffectfood
availabilityandaffordabilityacrossAfricancountries.
Intermsofavailability,changingtemperatures,humidity,andprecipitationare
expectedtodisruptagriculturalproductionsystemsindifferentpartsofAfrica
requiringtheneedforadaptation.Examplesofclimateimpactsaffectingfoodsecurity
includesalinisationofagriculturalregions,changesincroprange,andmigratingcrop
pests(Confalonierietal.2007;Schmidhuber&Tubiello,2007,p.19704).InEthiopia,
forexample,significantrainfallreductionshavealreadybeenobservedwithincritical
crop‐growingareas(Funketal.,2007,p.11086)andthishasbeenattributedto
anthropogenicallyinfluencedwarmingoftheIndianOcean(Funketal.,2007).Effectsof
thisarebeingobservednowasseveredrought,resultinginfamine,intheeastern
AfricannationsofDjibouti,Somalia,EthiopiaandKenya.
Thereareanumberofothergrimpredictionsregardingclimatechangeandfood
productioninAfrica.Forinstance:increasedtemperaturescanbeexpectedanddry
areasareexpectedtoexperienceincreasedevaporationresultinginlowersoilmoisture;
tropicalgrasslandsmaybecomemorearid.Therefore,semi‐aridandaridregions
shouldexpect:decreasedlivestockproductivity;wintersurvivalofpestspeciesshould
increaseputtingmorespringcropsatrisk;and,humanpathogensurvivalisexpectedto
increasealongwiththeprobabilityoffoodpoisoning.Thelatterhasbeenobservedas
foodbacteriasuchasSalmonellaproliferatemorerapidlyinwarmertemperatures
(Schmidhuber&Tubiello,2007,p.19704;McMichaeletal.,2006.p,860).Whileclimate
changemayhavetheeffectofimprovingfoodproductioninsometemperateregionsof
6
theworld‐duetoelevatedCO2concentrationsintheatmosphereandextendedgrowing
seasons‐itislargelyexpectedtohavenegativeeffectsacrossAfricaandotherrelatively
food‐insecureregions(Schmidhuber&Tubiello,2007,p.19704).
Withregardstoaffordability,decadesofdatashowcorrelationsbetweenfoodprices
andthenutritionalstatusofthepoor(Bloemetal.,2010,p.133S).Worldfoodpricesare
particularlyimportantforfoodaccessacrossAfricaanddevelopingcountriesingeneral,
becausethesesocietiesaremorereliantonpurchasedfoodthandomesticallyproduced
food(Bloemetal.,2010,p.133S).Although,itisrecognisedthatevenforcountriesthat
arenetfoodexporters,theremaystillbeinsecurityofaccesstofoodattheindividual
level(SchmidhuberandTubiello2007).Withoutsignificantimprovementsin
agriculturalyieldsthroughimprovedpractices,acrossAfrica,relianceonfoodimports
willmakeAfricancountriesvulnerabletotheglobalfoodprices.
Grainisasignificantindicatoroffoodproductionasitaccountsfor70%ofglobalfood
energy(McMichael,etal.,2003).Someoftheeffectsofincreasedfoodpriceshave
alreadymanifestedinmanyAfricancountries.Theupsurgeinfoodpricesprecedingthe
financial,andglobaleconomiccrisisof2008,resultedinadeclineinfoodaccessand
overallmicro‐nutrientmalnutritionforthedevelopingworld,asindividuals
simultaneouslylostpurchasingpowerasaresultofreducedincomeinfailing
economies(Bloemetal.,2010,p.133S).
Generally,expectationsarethatfoodpriceswillrisemoderatelyinlinewithincreasesin
temperatureuntil2050.After2050,however,foodpricesareexpectedtoincrease
substantiallyastemperaturesfurtherincrease,withthevalueofsugarandrice,for
example,expectedtoriseby80%(Schmidhuber&Tubiello,2007,p.19706).Some
studiesindicatethefirstcoupleofdegreesofclimatewarmingmayleadtoanoverall
increaseinsomegrainoutputsbutthatanyprofitinthismaybecancelledoutby
increasesinweedinfestations.Onestudypredictsthata1.1°Cincreaseintemperature
wouldreduceglobalgrainoutputby10%(Brown,2003).GiventhattheIPCCestimates
a2°Ctemperatureincreaseinthe21stcenturyonecan,onthebasisofBrown’sstudy
predict20%reductioningrainoutputworldwidebytheendofthiscentury.Meanwhile,
othersindicatethatgrainyieldmayincreasemarginallywithinanarrowrangeof
temperaturechange.Theseconflictingconclusionsarebasedonlackofcertaintyand
understandingofchangingprecipitation.
AcrossAfrica,climatechangeisexpectedtohavetheeffectofcompoundingreduced
accesstofoodwhichasstatedisalreadyamajorprobleminmanyAfricancountries
(Schmidhuber&Tubiello,2007,p.19703).AWHOreportindicatesthatmultiplesocial
andpoliticalfactorswillgoverntheoveralleffectthatclimatechangewillhaveonfood
security(McMichaeletal.,2003).Moreunderstandingofthecontributionofclimate
changetomalnutritionisanimportantsteptowardseffectiveadaptationthroughgood
governance.Similarly,furtherunderstandingoflocaleffectsofclimatechangeonfood
yields,nutritionalqualityandpricewillcontributetodevelopingstrategiestoprotect
futurepopulationsfromthepotentialdangerofchangingweatherpatterns.
Communicable diseases
Communicablediseasesresultfrominfectionbypathogenssuchasviruses,bacteria,
fungi,protozoa,andparasites.Communicablediseasesaretransmittedbyphysical
7
contactwithinfectedhumans,vectororganismsorwithcontaminatedsubstances
(water,food,objects,andair).Climatechangesareexpectedtoaffectthelifecycleand
modesoftransmissionofmanyinfectiousdiseases.Theabilityofapathogentospread
isaffectedbyitsabilitytomatureandreplicate.Temperatureandmoistureavailability
aretwoenvironmentalfactorsinfluencedbyclimatechangethataffectpathogen
proliferation.Temperaturehasaparticularlystrongaffectontherateofpathogen
replicationandmaturation.Further,thesetwoclimatefactorsalsoaffectthe
survivabilityanddensityofvectorsinaparticularareathereforeincreasingthe
likelihoodofinfectionuptocertainthresholds(WHO,2004).
Althoughtheenvironmenthasadominantinfluenceonthediversityofpathogensina
region,thisdiversityisalsoinfluencedbyhumanpopulationsizeanddensity,theageof
asettlementandthepopulation’sdiseasecontrolefforts(Shuster‐Wallaceetal.,2008;
Dunnetal.,2010).Dependingontheregion,carrier(waterorvector),disease,and
mitigationstrategies,thechangeinclimatewillimpactdiseasedistribution,rateof
contagionandtransmissionseasonswithdifferentlevelsofintensity.Thisreport
focusesonselectedwater‐borneandvector‐bornediseasesbasedontheircurrentand
expectedtollonpeopleacrossAfrica.
Transmissionofpathogensbetweenhumanscanoccurinvariouswaysthatinclude
physicalcontact,contaminatedwaterorobjects,airborneinhalation,vectororganisms,
orbodyfluids.Inourreport,wedivideourfocuscommunicablediseasesintoa
discussionofneglectedtropicaldiseases(NTDs);waterborndiseases,withemphasison
diarrhoea;thenontovectorborndiseases,withemphasisonMalaria;weintroduce
meningitisseparatelyasanairbornedisease;followedbyHIVandsocialstatusfortheir
compoundingeffectsoncommunityhealth.
Neglected Tropical Diseases
TheNeglectedTropicalDiseases1(NTDs)arethemostcommonconditionsaffectingthe
poorest500millionpeoplelivinginSub‐SaharanAfrica(SSA).TheNTDsareagroupof
13majordisablingconditions1thataredistributedthroughoutAfricatovarying
degrees.InfactmanycountriesinAfricasufferundertheburdenofbeinghosttoabout
halfofallthepathogensdefinedasNTDsbytheWHO1(Figure2).Together,NTDs
produceaburdenofdiseasethatmaybeequivalenttouptoone‐halfofSSA'smalaria
diseaseburdenandmorethandoublethatcausedbytuberculosis,twomuchmore
commonlyknowncausesofdeathinAfrica.HotezandKamath(2009)indicatesoil‐
transmittedhelminthsinfections(seefootnote1)accountforupto85%ofthedisease
burdencausedbyNTDsandoccurinmorethanhalfofSSA’spoorestpeople(Table2;
Hotez,2003&2009).Theysuggestthattheprevalenceofthisdiseaseisconnectedtoa
numberoffactorsincludingflooding,irrigationprojectconstructionandclimatechange
(Mangaletal.,2008).Otherfactorscitedincludedisplacementofpopulations,
urbanization,otherEWEs,andairpollution(Campbell‐Lendrum&C.Corvalan,2007).
Duetotheirconnectionwithwaterandotherorganisms,theeffectthatclimatechange
1
The WHO listed NTDs include soil transmitted helminths (roundworms such as Ascaris lumbricoides
which causes ascariasis, whipworm which causes trichuriasis, hookworms which cause necatoriasis
and ancylostomiasis), snail fever (schistosomiasis), lymphatic filariasis, Trachoma, leishmaniasis,
Chagas disease (American trypanosomiasis), leprosy, Human African Trypanosomiasis, Guineaworm (dracunculiasis), buruli ulcer, Cysticercosis, Dengue/dengue haemorrhagic fever,
Echinococcosis, Fascioliasis, Onchocerciasis, Rabies, and Yaws.
8
hasonthespreadingofcommunicablediseasesisinincreasingtherangeandseasonal
durationofsuitableconditionsforcommunicablepathogenstosurvive.Alsonotethatin
thesurvivablerangeoftemperaturesapathogencansurvive,thereisamaximum.
Figure2:DistributionoftheprevalenceofNTDsinAfrica.Source:ImperialCollege
London,SchistosomiasisInitiative(availableat:
http://www3.imperial.ac.uk/schisto/whatwedo/ntdsinafrica).
Note:Theboundaries,thenamesshown,andthedesignationsusedonthismapdonotimplyofficialendorsement
oracceptancebytheUnitedNations.
9
Table2:ExamplesofNTDsaffectedbyclimatechange.(Hotez&Kamath,2009
[http://goo.gl/qgFIA&http://goo.gl/XJdpT]).
NTDs
Trans‐ Estimated African SSAdisease
mission %ofSSA* country
burdenof
via
populationwithhighest Globaltotal
infected prevalence
Hookworms
H2O
29%
Nigeria
34%
Ascariasis
Vector
25%
Nigeria
21%
Schistosomiasis
H2O
25%
Nigeria
93%
Trichuriasis
H2O
24%
Nigeria
27%
Lymphaticfilariasis Vector
6‐9%
Nigeria
37‐44%
Onchocerciasis
Trachoma
Drancunculiasis
Vector
H2O
H2O
5%
3%
<0.01%
Yemen
Ethiopia
Sudan
>99%
48%
100%
Leishmaniasis
Vector
<0.01%
Sudan
NoData
HumanAfrican
Trypanosomiasis
Buruliulcer
Leprosy
Vector
<0.01%
DRCongo
100%
H2O
H2O
<0.01%
<0.01%
Coted’Ivoire 57%
DRCongo 14%
Source
Molyneuxetal.,
2005;deSilvaetal.,
2003
Molyneuxetal.,
2005;deSilvaetet
al.,2003
Steinmannetal.,
2006
Molyneuxetal.,
2005;deSilvaetal.,
2003
Michael&Bundy,
1997;GAELF,2005
&2008;Zagaria&
Savioli,2002
WHO,2008
WHO,2008
WHO,2008
Alvaretal.,2008;
Reithingeretal.,
2007;
Bernetal.,2008;
Collinetal.,2004
WHO,2006;WHO,
2006
WHO,2008,2008
WHO,2008
*SSA–sub‐SaharanAfrica.
Untilrecently,veryfewstudieshavebeencarriedoutregardingtheconnectionofNTDs
withclimatechange,althoughsomereviewershavediscussedthesituationwithafocus
onvector‐borneNTDs(Campbell‐Lendrun,2003).Table2ranksNTDs(andtheir
primarycarrier)accordingtheproportionofSSA’spopulationaffected,fromthehighest
percentagetothelowest.
Thisisalargediseasecategorythat,basedonregionsofhighestprevalence(Table2),
appearstobeprimarilytheresultofpoverty(Manderson,2009).Duetolackof
attentionoutsidetheseareas,littleiscurrentlyknownaboutthepatternofthespreadof
thesediseasesandtheirpotentiallinkstoclimatechangeormorebroadly,the
“environmentalconstraintskeepingaspecieswithinitscharacteristicrange”(Rogers
andPacker,1993).Belowwelookatthediseasesintwocategoriesbasedonprimary
modesofpathogentransmission:waterbornandvectorborndiseases.
10
Water born diseases
Water‐bornediseasesarecausedbyprotozoa,virusesorbacteriawhichtypically
populatetheintestinesofhumans.Waterisoftenconnectedtodiseasespreadduetoits
roleinthelifecycleofvectorsoritsdirecteffectonthehealthofpeople.Climatechange
alterationstothehydrologiccyclewillaffectwaterdistributionsworldwide(IPCC,
2007).TheIPCCexpectswateravailabilityandqualitytobeaffectedinvariouspartsof
Africaposingathreattohumanpopulations.
Currentlyalmosttwomilliondeathsayear,mostlyinyoungchildren,arecausedby
conditionsthatareattributabletounsafewaterandlackofbasicsanitation
(Confalonierietal.,2007).Water‐bornediseaseisextremelyprevalentinAfrica(Figure
2andTable2)where334water‐borneepidemicsoccurredbetween1980and2006
(PWRI,2008;Leroy,2009).Thespreadofwater‐bornediseaseafterextremeclimate‐
change‐relatedweatherevents,suchasfloodsorheavyrainfallorunseasonablywarm
seasons(suchaslongerwarmperiods,extendinggrowingseasons)areexpectedtobe
particularlyhighinAfricaduetolimitedinfrastructureandcontrolprogramsatthe
sourcesofthesediseases(Schmidhuber&Tubiello,2007,p.19705).
Perhapssurprisingly,droughtsmayalsocauseincreasesincommunicablediseases,as
reducedriverflowmayresultinincreasedpathogenloadingasseenintheAmazon,
wherecholeraoutbreaksareassociatedwiththedryseason(Confalonierietal.,2007).
Epidemicmeningitis,althoughadiseasespreadviaairborneparticlesanddroplets,also
appearstobelinkedwiththeoccurrenceofdroughtsasreflectedbytherecentspread
ofthediseaseintoWestAfrica.
ThewaterborneNTDsaremostlypreventablebywaterfiltration,casecontainment,
andaccesstosafewater.Thistechniquealonehasbeensuccessinbringingthe
transmissionandannualcasesofDrancunculiasis(guineaworm)downtoonly4
countriesworldwidesinceaneradicationprogrambeganin1989.Infacttherehasbeen
areductionincasesinthe20yearperiodfrom1986to2009of99.91%(from
~3,500,000in1986to3,190in2009;WHO,2010).Asidefromsafewatersupplies,
treatmentcampaignshavealsoincreasedinprevalence,withsomediseasetreatments
provingtoberelativelyinexpensive.
Diarrhoea
InSSA,diarrhoealdiseasesaresecondonlytoacuterespiratoryinfectionsasacauseof
mortalityofchildrenunder5,withanestimated4.3episodesperchildperyearandan
attributedmortalityrateof4.2/1000representing27%ofalldeathsinthisagegroup
(ZimbabwePublicHealthReview,1987).Themajorityofpathogensthatinduce
diarrhoeainhumansarewaterborn,makingthissusceptibletoclimatechangeas
temperatureandprecipitationchangesareexpected.Deathiscausedbyinfection,
malnutrition,and/ordehydration.Inadditiontothewell‐documentednutritional
effectsofdrought,causedbyreduceddietaryrangeandconsumption(Confalonieriet
al.,2007;Campbell‐Lendrum&Bertollini,2009).
In1998,diarrhoeawasthe10thbiggestcauseofdeathsforallagesinSouthAfrica(SA).
By2005diarrhoeawasthethirdbiggestkillerinSA.Whenthisdatawascomparedwith
thefactorscontributingtodiarrhoealdiseaseitindicatedaninterestingcorrelation
11
betweenthenumberofpeoplewithHIV/AIDSandpeoplenothavingaccesstoprivate
watersupply.Essentially,itisexposuretonewdiseases,onesthatapersonmaynot
alreadyhaveimmunitytothatputpeopleatthemostrisk.Thisexposuretonew
diseasesistheresultofshiftingpathogenhabitatsorhumanmovement(directlyor
indirectlyinducedbyclimatechange).
Environmentallyinducedconditionsthatareexpectedtochangeunderanticipated
climatechangeinAfrica,suchasprecipitationandtemperaturechangesarethevery
environmentalfactorsthatsupportdiarrhoea‐causingpathogensinwater.Conditions
thatmakeapopulationpronetodiarrhoeaoccurredinthemonthsfollowing
Mozambique’sfloodingin2000:8000additionalcasesofdiarrhoeaand447resultant
deathswererecorded(IPCC,humanhealthchapter,2007,p.399).Ahealthysupport
systemcoupledwithsufficientinfrastructurethatcanhandletheconditionswill
increasetheresilienceofanunsuspectingpopulationtothis,andotherhealthimpacts
affectedbywateravailability(cleanliness,access,regulatedavailability,etc.).
Vector born diseases
Therehasbeenaworldwideresurgencein,andaredistributionofmanyoldinfectious
diseases(Table3).TheWHO(1996)estimates30newinfectiousdiseasesemerged
from1975to1995withsomeexpertssuggestingthatsomeofthesearepossibly
connectedtoclimatechange(Costelloetal.,2009;McMichael,2004).Globalclimate
changemayhaveamajorinfluenceonvector‐bornediseaseepidemiology(Dobson&
Carper,1992;Epstein,2000;Epstein,2007;Githekoetal.,2000;Sutherst,2004).
Vector‐borneinfectiousdiseasesmaybetransmittedtohumansbycontaminated
arthropods(i.e.fleas,mosquitoes,ticks,sandflies,andlice)andanimals(typically
mammalssuchasratsandlessoftenbirds).Morethan1,400speciesofhumanpathogen
havebeenidentified.Ofthese,58%aretransmittedfromanimalstohumansandare
twiceaslikelytobeemergingorre‐emergingasothervector‐borneandwater‐borne
pathogens.Thetablebelowshowsthegeographicdistributionofvectorbornediseases
andtheprinciplevectorresponsibleforeach.Notethatthetop6vectorbornediseases
allexistinAfrica.Table2liststheprevalenceofvectorborndiseases,inrelationto
waterborndiseases.
Table3:Examplesofvectorbornediseasesaffectedbyclimatechangeindecreasing
orderofaffliction.
Disease
Currentgeographical
distribution
Tropics
Vector
1.Malaria
2.DengueFever
3.WestNile
Africa,Caribbean,Pacific,FarEast
Mosquitoes
Worldwide
4.YellowFever
Africa,SouthAmerica
5.Leishmaniasis
Sandflies
Africa,Central&SouthAmerica
6.Trypanosomiasis
Tsetseflies
Africa,Central&SouthAmerica
12
Mosquitospecies,suchasthegenusAnopheles(approximately40specieswhichspread
malaria),Culex(C.quinquefasciatus;WestNileVirus)andAedes(A.aegypti;dengueand
yellowfever)areresponsibleforthetransmissionofmostvector‐bornediseases
globallyandacrossAfrica(Githekoetal.,2000).Mosquitoescarryingdiseasessuchas
malariaanddenguefever,twoofthemostprominentmosquito‐bornediseasesin
Africa,areamongthoseundergoingresurgenceandredistribution(Gubler&Kuno,
1997;Gubler,2005;Coelho,2008).
Threeofthekeycomponentsthatdeterminetheoccurrenceofvector‐bornediseases
arepresentedintheWorldHealthOrganizationTaskGroup's(1990)reportPotential
HealthEffectsofClimaticChange.Theyare:
 Occurrence:theabundanceofvectorsandreservoirhosts;
 Environment:theprevalenceofdisease‐causingparasitesandpathogenssuitably
adaptedtothevectors,thehumanoranimalhostandthelocalenvironmental
conditions,especiallytemperatureandhumidity,and;
 Resilience:theresilienceandbehaviourofthehumanpopulation,whichmustbe
indynamicequilibriumwiththevector‐borneparasitesandpathogens.
Thecombinedeffectsofchangingtemperatures,precipitationmayleadtoamore
suitableenvironmentforthespreadofvector‐bornediseasesandtheemergenceofnew
onesindifferentpartsofAfrica.Forexample,temperaturechangesaffectvector‐borne
diseasesbyinfluencingreproductivecyclesandbehaviours.Bitefrequencygenerally
riseswithtemperatureandatmosphericCO2content(deLucia,2008).Ingeneral,higher
ambienttemperatures(toamaximum)shortentheviralincubationperiodand
breedingcycleinvectors(Campbell‐Lendrum&Bertollini,2009).Forinstance,
reproductionofP.vivax(aprotozoalparasite)inmosquitoestakes55daysat16°C;29
daysat18°Candonlysevendaysat28°C.ForP.falciparum,whichcausesthemajority
ofseveremalaria,16.5–18°Cistherequiredminimumtemperaturefordevelopment.
Thereishighmortalityinmosquitoesfrom32‐39°C,andat40°Ctheirdailysurvival
becomeszero(Craigetal.,1999).
Someepidemiologicalmodelsillustratethepotentialofthesevector‐bornediseasesto
rapidlyspread.allieddatafromweatherstationswithsatellitedatatodeterminewhich
combinationofpredictorvariablesismostusefulfordescribingvectordistributionsofa
numberofNTDs,andperhapsforforetellingalterationsindistributionwithclimate
change.Theresultsfoundonlyveryslightdifferencesbetweenthemeantemperatures
ofplaceswheretsetsedoanddonotoccurnaturally(Rogers,1993;Rogers&Randolph,
1993;Rogers&Packer,1993).Thisfinding,theysay,indicatesthatasmallchangein
temperaturemightconsiderablyaffecttheirdistribution.
Malaria
Outofthe700,000to2.7millionpeoplethatdieofmalariaannuallyaroundtheworld,
94%occurredinAfricawith90%inSSA,and75%ofthesearechildren(Thompson,
2004;Patzetal.,2005;Ramin&McMichael,2009;WHO,2008;Figure3).Asof2010,the
41countrieswiththehighestdeathratefrommalariaper100,000populationarein
Africa,startingwithCoted'Ivoire(86.2),Angola(56.9)andBurkinaFaso(50.7;WHO,
2010).ThesefiguressuggestthatperhapsoneofthegreatesthealththreatstoAfrica,
aftermalnutrition,ismalaria.Themajorityofclimate‐malariaresearchinAfrica,
suggeststhatmalariatransmission,especiallyepidemicoutbreaks,isassociatedwith
13
increasedrainfallintypicallydryregionsandincreasedtemperaturesinhigh‐altitude,
typicallycoolregions(Connoretal.,2006,p.22).Thereasonforthisisthatrainfall
producesthemoistureconditionsandsurfacewaterthatfacilitatesbreedingformalaria
transmittingmosquitoesandwarmertemperaturesfacilitatefasterdevelopmentfor
mosquitolarvaeandsurvivalforadultmosquitoes;moreimportantlythough,warm
temperaturesallowsthemalariaparasite,plasmodium,tomultiplymorequicklyin
mosquitohosts(Grover‐Kopecetal.,2006,p.2).
Figure3:Malariaendemicity:thespatialdistributionofP.falciparum(Hayetal.,2009).
Note:Theboundaries,thenamesshown,andthedesignationsusedonthismapdonotimplyofficialendorsement
oracceptancebytheUnitedNations.
Therelationshipbetweenmalariaandclimatesystemshasbeenthemostextensively
studiedclimate‐relatedillnessinAfrica(Connoretal.,2006).Thisispartlyduetothe
factthatclimateinformationcanbeusedtoproducemalariariskmapsintheabsenceof
high‐qualityepidemiologicalinformation(Connoretal.,2006)aswellasthefactthe
malariaisamajorhealthissueinAfrica.Theresultingresearchhasshedlighton
‘associations’,‘correlations,and‘links’betweenmalariatransmissionratesandclimate
conditions(Grover‐Kopecetal.,2006,p.2).
Anumberofstudieshavelinkedwarmertemperaturestoincreasedmalariacasesinthe
highlandsofeastAfricaanddecreasedmalariacasestothedroughtintheSahelregion
(McMichaeletal.,2003,p.51).InEthiopia,analysisofmalariamorbiditydataindicates
thathigherminimumtemperaturescorrelatewithincreasedinstancesofmalaria
outbreaks(Confalonierietal.,2007).Furtherincreasingcaseloadoccurswhencoupling
increasedtemperaturewithasimultaneousincreaseinprecipitation(Confalonierietal.,
2007).ForinstancefollowingtheElNiñ oeventin1997,Kenyaexperiencedasix‐fold
increaseinthenumberofmalariacasescomparedwiththepreviousyear(McMichael,
etal.,2003).ResearchhasalsofoundastatisticallysignificantrelationshipbetweenEl
Niñ oeventsandmalariaepidemicsinColombia,Guyana,Peru,andVenezuela(Ibid.).
Controversiesremainamongmalariologistsabouttheextentofthecontributionof
climatechangetomalaria‐changingpatterns.Somethinkitisrelativelyminor,witha
greaterriskfordengueandotherviruses,eg,arboandhantaviruses.
Socialandpoliticalconditions,increasingresistancetoinsecticidesandanti‐malarial
drugs,andthedeteriorationofvectorcontroloperationsexplainmuchoftherecent
resurgenceanddeathsduetomalaria(James,1929;Dobson,1980;Martens&Hall;
14
Wingate,1997;Hutchinson&Lindsay,2006;Pascualetal.2006;Chavesetal.2008).
ScientistsalsosaythereareanincreasingnumberofdeathsandmorbidityacrossAfrica
thatareduetomalaria(Snalletal.2009)anddenguefever(Cazellesetal.2005).
Asignificantbodyofresearchhassuggestedthatoverallglobalwarmingisexpectedto
increasetheseasonalityandrangeofmalaria,bothacrossAfricaandonaglobalscale
(McMichaeletal.,2003,).Malariainfectionrateisexpectedtoincreaseby16‐28%in
person‐monthsbytheyear2100inAfrica(Patzetal.,2005).TheMappingMalariaRisk
inAfrica(MARA/ARMA)projectreportsthatbetween2050and2080,malariais
expectedtodeclineinwesternSahelandsoutherncentralAfricaastheseareasare
likelytobecomeunsuitableforMalariatransmission(Thomasetal.,2004).TheIPCC
reportsthatby2050previouslymalariafreeareasinBurundi,Ethiopia,Kenyaand
Rwandamaysuffer“modestincursions”ofMalaria.Further,thechangedrangeof
malariacarryingmosquitosisexpectedtoincreasethelikelihoodofepidemicsin
highlandareassuchasEastAfricaduetoalackofgeneticresistanceinthepopulationto
malaria(IPCCWGII2007,Chapter9).Elsewhere,inDebreZeit,Ethiopia,withcontrolon
changesindrugresistance,mosquitocontrolprograms,andhumanmigration,warming
temperatureshavebeenidentifiedasthemostlikelycauseforincreasedmalaria
transmissionobservedbetween1968to1993(Patz,2005,p.311).Thisexamplerefers
toan‘association’betweenmalariatransmissionandwarmingtemperaturesbecause
theremaybeotherfactors,perhapsunidentifiedthatcouldhaveplayedamajorrole
(Patz,2005,p.311).
Whileamajorityofresearchsupportstheideathatmalariatransmissionratesare
affectedbyclimate,therearesomestudiesthatasserttheopposite.Confirminglinks
withclimatechangeastheprimarycauseforchangesinmalariatransmissionrates
requiresaseriesofotherfactorsthatcontributetotransmissionratestobeconsidered,
suchas:theuseofdrugresistanceandmosquitocontrolprograms,humanmigration
andimmunestatus,andchangesinland‐usepatterns(Patzetal.,2005,p.311).For
example,despiteseveralstudieslinkingmalariaprevalenceandclimatechangeinthe
highlandsofEastAfrica(e.g.Pascualetal.,2006),Hayetal.(2002),studiedfoursitesin
thatregionwhichexperiencedincreasedmalariatransmissionandfoundthatclimatic
factorsthatwouldhaveenhancedsuitabilityformalariatransmission,didnotchange
verymuch;thusmakingclimateunaccountableforincreasedmalariaprevalence.
Similarly,Jacksonetal.(2010)foundverylittlecorrelationbetweenratesofmalaria
prevalenceandclimateconditionsinamalaria‐endemicregionofWestAfrica.Veryfew
studieshavelinkedincreasedmalariatransmissiontochangesinclimatewhile
controllingforotherconfoundingfactors.
Malariatransmissionrateshavenotrisensimplybecausehumansareencountering
moremalaria‐carryingmosquitosandbeingbittenmorefrequently.Manyfactorsplaya
roleinmalariatransmissionratesinapopulation.Socialandpoliticalconditions,
increasingresistancetoinsecticidesandanti‐malarialdrugs,andthedeteriorationof
vectorcontroloperationsexplainmuchoftherecentresurgenceanddeathsdueto
malaria(James,1929;Dobson,1980;Martens&Hall;Wingate,1997;Hutchinson&
Lindsay,2006;Pascualetal.2006;Chavesetal.2008).
Inspiteoftheconflictingfindingsregardingthecorrelationbetweenmalariaprevalence
andchangesinclimate,itremainsafactthatMalariaisaserioushealthproblemacross
15
SSAandcontrolprogramsagainstthisdiseaseneedtobeamplifiedwhetherornot
climatechangewillexpanditsspread.
Meningitis – an airborne disease
MeningococcalmeningitisiscausedbythebacteriaN.meningitidisthatexistsallover
theworld.However,innoregionoftheworldisitasgreataproblemasintheSahel
regionofAfrica(Figure4).ForAfricaasawhole,meningitisisoneofthecontinent’stop
threeclimatesensitivediseases,withroughly350millionpeoplelivinginendemic
zonesforthisdisease(McMichaeletal.,2003;Palmgren,2009).Humansaretheonly
naturalreservoirforthisdiseaseanditisoftenspreadbetweenhumansviarespiratory
dropletsorsaliva(i.e:throughcoughing,sneezing,kissingorotherformsofcloseand
directcontact),withthesymptomsapparentonsomeindividualsandnon‐apparenton
others.Thedisease,asitischaracterizedbytheinfectionofthemeninges,canhave
lifelongdamagingeffectstothecentralnervoussysteminsomesurvivorsandittends
tokillfrom4‐17%ofitsvictims.Themostsusceptiblevictimsofthisdiseaseare
typicallychildren,adolescentsandyoungadults(Menactra,2011).
Figure4:Africanmeningitisbelt(Palmgren,2009;WHO/EMC/BAC/98.3).
Note:Theboundaries,thenamesshown,andthedesignationsusedonthismapdonotimplyofficialendorsement
oracceptancebytheUnitedNations.
16
Meningococcalmeningitisisanairbornedisease,forwhichepidemicsaremostoften
reportedinyearsofseveredrynessanddrought,industladenenvironmentsandrarely
inareasofdenseforestandhighhumidity.Theassociationbetweenthisdiseaseand
duststemsoutofsuggestionsfromanumberofstudies,thatdustislikelythekey
elementthatconvertstheN.meningitidisbacteriafromitsbenignformtoitspathogenic
one.Themechanismsforhowthisconversionmightoccur,however,areunclear.
Althoughaclearcausallinkbetweenincreasedmeningitisincidenceandclimatefactors
ismissing,thedistributionandseasonalityofmeningitisiswidelybelievedtobe
associatedwithdustyconditionsthatariseoutofdrynessanddrought(IPCC,2007,
p.400).Forexample,SouthAfricahasbeensubjectedtoseasonalincreasesduringthe
winterandspringmonths(May–October)ofendemicmeningococcaldiseaseoutbreaks
(Küstner,1979).Thereforeareaspronetoincreasingdroughtconditionsasaresultof
climatechangecanexpecttobesubjecttoanincreaseinmeningitisoccurrences.
Meningitisisconcentratedinthesemi‐aridSahelregionofAfrica.Infactthestripof
landalongtheSahelwithhighestconcentrationsofmeningitisisoftenreferredtoasthe
‘meningitis‐belt.’ThisspansfromEthiopiaandSudanintheEasttoSenegal,Maliand
Guineainthewest(Figure4;Palmgren,2009).Epidemicsofmeningococcalmeningitis
breakoutin5to‐10yearsintervalsinthemeningitisbelt.Inrecentyears,thewidthof
thismeningitisbeltappearstobeexpandingsouthwardasaresultofregionalclimate
changeandchangesinlanduse(IPCC,2007,p.400).CountriessuchasKenya,Uganda,
Tanzania,Togo,Coted’Ivoire,CameroonandBenin,whicharetypicallynotaccustomed
toexperiencingsevereepidemicsofmeningitis,andwhichdonottechnicallybelongto
themeningitisbelt,havebeguntoexperiencelargescaleepidemicsofthedisease.This
southwardexpansionofthemeningitis‐beltintothesecountriesisalsoassociatedwith
theexpansionofincreasinglyhotanddryconditionsintotheseareas(McMichaeletal.,
2003).
TheclimatechangeprojectionsfortheSahelregionincludemorefrequentandlonger
droughtasaresultofexpectedincreasesintemperatureanddecreasesinrainfall.Ithas
beensuggestedthatthiswillcauselongerdurationsoftheepidemicsandperhapseven
higherratesofincidenceofthedisease.However,becauseepidemiologicalresearchhas
notbeenabletoconfirmthecorrelationbetweenthediseaseandclimate,thiscannotbe
declaredcertainly.
Furtherstill,thedisease’suniqueregionalcharacteristicsanditsprevalencedrivenby
environmentalconditionshasshownclearpatternsofoutbreaksofthediseaseinSouth
Africa.Thoughnotinthemeningitisbelt,inrecentdecades,SouthAfricahasbeen
subjecttoincreasingnumberofepidemicoutbreaksofmeningitis(Küstner,1979).
Here,theburdenofdiseaseoccursinacyclicalpatternatintervalsof8–10years
(Bikitsha,1998).
Successhasbeenobserved,theincidenceofclinicalnotificationtothenational
DepartmentofHealth(Pretoria,SouthAfrica)hasdecreasedsincethelate1980s:for
theperiod1992–1997,therewere1–2casesper100,000persons(Bikitsha,1998).By
July2002(overthethreepreviousyears),854casesoflaboratory‐confirmeddisease
caseswerereportedinSA.Thisisanannualdiseaseincidencerateof0.64/100,000
population(Incidencewashighestininfants<1yearofage;Coulson,2007).
Furthermore,withtherecentavailabilityofthegroupAconjugatevaccine,whichis
meanttotargetthemostsignificantstrainoftheN.meningitidisbacteria,
17
epidemiologistsarehopefulthattheproblemofmeningitis,acrossAfrica‐andnotjust
themeningitisbelt‐willbegintobecontrolled.Thedevelopmentofthisvaccineisnot
thebeallandendallforcurbingmeningitisinAfrica,however.Epidemiologistsconfer
thatepidemiologicalandenvironmentaldatasetsofthedryseasoninAfrica,needtobe
improvedinordertoenhancemeningitisearlywarningsystems,andtherebyefficiently
targetanddispersethisvaccine.
HIV/AIDS
HIVisnotlikelytobedirectlyaffectedbyclimatechange.However,HIVinfected
individualsareatincreasedriskofcommunicablediseasesandthosewhoare
malnourishedorunhealthymaybeatgreaterriskofHIV.Giventheselinksitislikely
thatclimatechangewillhaveaneffectondiseasepatterns(BlaserandCohn,1986).By
2007,anestimated33.2millionpeoplecontractedthediseaseworldwidekillingan
estimated2.1millionpeople,withgreaterthan75%ofthesedeathsinSSA.
Theoccurrencesofopportunisticdiseases,whichdefinetheAcquiredImmune
DeficiencySyndrome(AIDS),includeprotozoans(Cryptosporidium,Microsporidium),
bacteria(Mycobacteriumaviumcomplex)andviruses(Astroviridae,Adenoviridae,
RotavirusandCytomegalovirus).Eachofthesecanbewaterandvectorbornpathogens,
highlightingtheneedforeradicationprograms.Theseappeartobemoreheavily‐
dependentongeographythanotherfactorssuchasdemographicsandsoitseemslikely
thatasgeographicaldistributionofcommunicablediseasesevolves,infectionsinHIV‐
affectedpopulationswillchangeaccordingly.
Theexpectationisthatclimatechangemaygeneratemoremigrantsaspeoplesearch
forsecurity,whetheritisforfood,water,safety,orhealthcare.Aspopulationsare
forcedtomigrateasaresultofclimatechange,HIVinfectionrateswouldincreasein
certainregions,aspeoplefromdifferentareasmixorifsexworkbecomesameansof
sustenanceforrural/farmermigrantswhoareforcedtomakealifeforthemselvesin
thecity(McMichael,2008).
Social status
Geopolitical,socioeconomic,demographicandtechnologicalevolutioncompoundsocial
andeconomicunpredictability.Culturaladjustmentsintimethatprotectusfromsocial
andeconomicuncertaintiesaretheretolessentheimpactontherelationshipbetween
environmentalstressandmortalityrates,forexample,improvementsinhousing
conditionsandbetterclothing.Thereisstrongevidencethatdisadvantagedgroupshave
poorersurvivalchances,anddieatayoungeragethanmorefavouredgroups(Figure5).
Thescaleofthedifferencesinmortalityisimmense(Marmotetal.,2008).Whileachild
borninsomedevelopedcountriestoday,suchasJapanorSweden,canbeexpectedto
liveto80years,childrenborninacountryinSSAarenotexpectedtolivepast50years.
Furthermore,whilethecarbonfootprintoftheworld’spoorest1billionpeople
accountsforroughly4%oftheworld’stotalcarbonfootprint,itisthesevulnerable
populationsthatwillbearthehighestcostsofclimatechange(Costelloetal.,2009).In
fact,somehaveassertedthatthenegativeimpactsofclimatechangewillbesuffered
moreseverelyinSSA‐inspiteofthecontinentsrelativelylowemissions(seeFigure6)‐
thaninotherregions(RaminandMcMichael,2009).Thisislargelyattributabletothe
continent’soveralllimitedadaptivecapacity.Manyofthehumanhealthissues
18
discussedarenotjustcommonlyassociatedwithpovertybutarealsoacauseofpoverty
andamajorhindrancetoeconomicdevelopment.Thesediseasesareassociatedwith
majornegativeeconomiceffectsinregionswheretheyarewidespread.Countrieswith
poororweakhealthservicesandwaterdistributioninfrastructurefindtheyareamajor
factorintheirsloweconomicdevelopment(forexample,MalariainSSA;Sachs&
Malaney,2002).Incountrieswheremalariaiscommon,averagepercapitaGDPhas
risen(between1965and1990)only0.4%peryear,comparedto2.4%peryearinother
countries(Ettlingetal.,1994).TheestimatedeconomicimpactofmalariaonAfricais
$12billionUSDeveryyear(Greenwoodetal.,2005;includescostsofhealthcare,
workingdayslostduetosickness,dayslostineducation,decreasedproductivitydueto
braindamagefromcerebralmalaria,andlossofinvestmentandtourism).
Figure5:AssociationbetweenGDP/personadjustedfor$USPurchasingPowerParityand
lifeexpectancyfor155countriescirca1993(Lynchetal.,2000).
19
Figure6:AfricanCO2emissionscomparedwiththeworld(UNEP,2002).
Note:Theboundaries,thenamesshown,andthedesignationsusedonthismapdonotimplyofficialendorsement
oracceptancebytheUnitedNations.
Asaresultofpoverty,conflict,andchangingenvironments,forcedmigrationand
displacementisoccurringinvariousregionsoftheworld.Somecausesformigration
relatedtoclimatechangeandhealthincludeincreasedEWEs,droughts,desertification,
sealevelrise,anddisruptionofseasonalweatherpatternswhichcausedisease
outbreaksandmalnutrition.Also,migrantsmaycarrytheinfectiousdiseasesoftheir
placeoforigintotheirdestinationsand,oncethere,theymaybesusceptibletodiseases
theyhadnotbeenpreviouslyexposedto.Oftentheyliveoutsidetheestablishedsocial
20
systemandmaynothaveaccesstoadequatehealthcareservices.TheWorldDisasters
Report2001publishedbytheInternationalFederationofRedCrossandRedCrescent
Societiesestimatesapproximately25millionpeoplearecurrentlyonthemoveasforced
migrantsduetoclimatechangerelatedissues.
Direct impacts
Potentialdirecthealtheffectsofglobalclimatechangeuponanindividual’sor
population’shealthwilloccurpredominantlythroughtheimpactsofclimatevariables
uponhumanbiology.Themainclimatic‐environmentalvariablesconcernedhereare
temperature,precipitationandairquality.Itisimportanttopointoutwhilstthemain
driversareclimaticvariables,impactsaremodulatedbyhumanpopulationdensity,the
vulnerabilityoflocalsettlements,regionaleconomicwealthandthestrengthof
infrastructure.Asaresult,theseimpactsarefeltmorestronglyacrossAfricathanin
richerregionswheretheyareoftenneglectedasissues.Theseissuesaretheresultof
specificevents,suchasheatwaves,floods,airqualitychanges,oftenleadingtoindirect
effects.Betterunderstandingoftheseconnectionscanleadtothedevelopmentof
appropriateadaptationandmitigationtechniquesforthebenefitofapopulation’s
health.
Extreme weather events and their direct effects
Thedirecthealtheffectsofclimatechangewiththepotentialforgreatestimpactsare
theforcesthatcreatedroughtsandfloods.Unfortunatelythisisanareaforwhichthere
isinsufficientdata(IPCCWGII2007,Chapter9).WorkingGroupIIoftheIPCC,inits
discussionofclimatechangesinAfrica,isinconclusivewithregardstoanychangesin
thefrequencyorsizeofEWEsbutsuggeststheremightbeaslightincreaseindroughts
forexampleinthesecondhalfofthe21stcenturyandthattheremaybemorefrequent
andstrongertropicalstormsoffthesouthernIndianOcean.SinceEWEsarerelatively
locationspecific,regionswithahistoryofaspecificEWEwilltendtocontinueto
experiencesuchevents.InlandandcoastalfloodshavebeenthemostfrequentEWE
(EpsteinandMills,2005).
Evenwithoutclimatechange,theimpactofEWEscanbe,andhavebeen,devastating.
TheimpactofEWEsistypicallythegreatestinthemostvulnerableregions,where
populationsareleastabletodefendthemselves,resultingindisproportionatedeath
tolls,typicallyamongstthepoor.Extremeweatherevents,suchas,cyclones,droughts
andhurricaneshaveanextraordinaryimpactonhumanmortality.Table4outlinesthe
numberofpeoplekilledbyEWEsbyregion.OfnoteisthatwhilethefrequencyofEWEs
isincreasingthenumberkilledwassignificantlysmallerinthe1990sthaninthe1980s.
21
Table4:NumberofpeoplekilledinEWEsinthe1980’sand1990’sbyglobalregion
(McMichaeletal.,2003).
Deathsin1980s
Region
(‘000s)
1.Africa
416.9
2.EasternEurope
2.0
3.EasternMediterranean 161.6
4.LatinAmericaandthe
11.8
Caribbean
5.SouthEastAsia
53.9
6.WesternPacific
35.5
7.Developed
102.1
Total
691.9
(%oftotal)
Deathsin1990s
(‘000s)
(%oftotal)
60.3
0.3
23.4
10.4
5.1
14.4
1.7
0.8
2.4
1.7
59.3
9.9
7.8
5.1
14.8
100.0
458.0
48.3
5.6
601.2
76.2
8.0
0.9
100.0
TheeffectsonindividualsofEWEsarecompoundedbydamagetoinfrastructureand
healthsystems,forexampleitwasdifficultforHIVretroviraldrugstobedeliveredto
NorthernNamibiaduetothefloodsthereearlierthisyear.Oncetheinitialdisasterhas
passed,secondaryissuesmayemerge,suchasalackoffoodandadequatecleanwater
(Shultzetal.,2005)andincreasesincommunicableandnon‐communicablediseases.
Survivorshaveanincreasedriskofcontractingrespiratory,diarrhoealand
communicablediseasesintheaftermathofanextremeeventduetopopulation
overcrowding,limitedornoaccesstopotablewaterandfood,andexposureto
chemicals,pathogensandwaste(Kovatsetal.,2003).Poordrainageandstorm‐water
managementinlow‐incomeurbancommunitiesincreasesratesofinfectiousdisease
transmission(Confalonierietal.,2007).Extremeweathereventscancausevariationin
thepatternsofvector‐bornediseaseseitherbycreatingfavourableenvironmentsfor
vectorsorthroughthedestructionofavector’senvironment.Forexample,floodingcan
intensifythetransmissionofhydrophilicvectorsanddiseases(Connor,1999).Long‐
termimpactsincludeincreasesininfectiousdiseaseandmentalstresses,lossesof
infrastructureandterritoryandenvironmentally‐inducedmigrationwhichcanleadto
furtherincreasesininfectiousdiseases,conflictsoverwater,energyandother
increasinglyscarceresources,resultinginpoliticaltension.
UV related cancers and diseases
Thisisarangeofhealtheffectsthatwillincreaseinimportanceaspopulation’slifespan
begintolengthen.ClimatechangemayalterhumanexposuretoUVRinseveralways,
withlimitedpredictabilityandvariationamongregions(McMichaeletal.,2003).The
IPCCconcludedthatexcessiveUVRexposurewasresponsiblefor1.5milliondisability‐
adjustedlifeyearsand60,000prematuredeathsworldwidein2000fromskin,eye,and
cardio‐respiratorydiseases(Confalonierietal.,2007).SmallamountsofUVRare
beneficialtohealth,andplayanessentialroleintheproductionofvitaminD.However,
excessiveexposuretoUVRisassociatedwithdifferenttypesofskincancer,sunburn,
acceleratedskinageing,solarkeratoses,cataractandothereyediseasesthatreducethe
effectivenessoftheimmunesystem.
22
Worldwide,approximately18millionpeopleareblindasaresultofcataracts,withthe
rateofcataractssurgerythelowestinAfrica(Yorstonetal.,2001).Asaresult,in
developingcountriescataractscauses50–90%ofallblindness(Murray&Lopez,1996).
Ofthese,5%ofallcataract‐relateddiseasesaredirectlyattributabletoUVRexposure.
Intheyear2000,UVRexposurehadledtomorethan200,000casesofmelanomaand
65,000melanoma‐associateddeathsglobally.Aprogramtoeliminatecataractblindness
inAfricaby2020hasbeenproposed,andtherearegroundsforthisoptimismthatthis
ispossible.Firstly,thenumberofcataractoperationsisincreasingrapidlyinsome
countries.InKenya,therewerealittleover5000cataractoperationsin1996(as
reportedtotheNationalPreventionofBlindnessCommittee).By1999,thishad
increasedtoover12000,withthequalityofsurgeryalsoimproving(Yorstonetal.,
2001).Secondly,humanresourcesdevelopmentandaccesstolowcostmaterialsis
makingcataractsurgerymorewidelyavailable(Brian&Taylor,2001).Manysurgeons
havebeensuccessfullytrainedorretrainedinvarioustypesofcataractsurgerywith
educationclinicssetupinsuchcountriesasGhana,Nigeria,SouthAfricaandTanzania.
IthasbeennotedthatFrancophoneandPortuguese‐speakingAfricahasfewertraining
programmesatthemoment(Alhassanetal.,2000).
TheWHOconfirmsthatinstancesofskincancerhavebeenincreasingsteadilyinthe
twodecades,especiallyinregionswithhighUVRexposure,withSouthAfrica
highlighted(McMichael,etal.,2003).Therelationshipbetweenozonedepletionand
poorskinandeyehealthisunclear.Scientistspointoutthedifficultiesofdistinguishing
ozonedepletionbetweenpollutionandclimate.Researchisneededonattitudestoward
sunbathingandtheuseofprotectivemeasures.Protectivemeasures,suchassunscreen
ointmentsandcreams,andprotectiveeyewear,requireevaluation.Toomuchreliance
onsunscreenshasbeenidentifiedasapotentialcauseofincreasingskinandeyedisease
(Garlandetal.,2002).
TheeffectUVRhasonthehumanimmunesystemappearstobeareductionin
effectivenessbychangingtheactivityanddistributionofthecellsresponsiblefor
triggeringimmuneresponses(DeFabo&Noonan,1983).Fortheeyesandtheimmune
system,thisisindependentofskinpigmentation,soallpeopleeverywhereareatrisk
frompotentialadverseeffectsincludingincreasedincidenceandseverityofinfectious
disease,andenhancedriskofmalignantchanges(Last,1993).Theabilitytorespondto
increasesofskinandeyediseaseswillbelowerinlowerandmiddleincomecountries.
Populationsrequiredtoworkoutdoorswillbemostaffected,aswellasthosethatspend
theiryouthinthesun.
Temperature and precipitation effects
Increasesinaveragetemperaturerepresentaverysignificantsourceofpotentialdirect
climatechangeimpactsonhumanhealth.Amajorconcernisthatsuchincreasesmay
leadtotemperaturesbeyondthosecomfortable(calledheatstress)foraregion
affectingmortalitythroughthermalstress(Figure7).Heatstressaffectsindividuals
duringextremes(inintensityand/orfrequency)oflocalweather‐inthecoldestor
warmestseasonsforexample.Theseenvironmentalconditionscanbefurther
exacerbatedbyhumanactivitiessuchasdeforestationandurbanisationbyaffecting
localclimatesbyincreasinglocaltemperaturesby3+°C(Hamilton,1989).
23
Figure7:TemperaturechangesinAfricacomparedwiththeworld(UNEP,2002).
Seasonalvariationinmortalityhasbeendescribedinmanycountriesthroughoutthe
ages.InancientGreece,Hippocrates(HippocratesVol.1.,McKEE,1989)describedthe
occurrenceofsuddendeathsandstrokeswhenacoldspringfollowedamildwinter.
Researchsuggeststhatinwarmerclimatespatientsmayhaveoptimumcardiovascular
healthathighertemperatures(Panetal.1995).ForexampleinTaiwan,elderlypatients
haveoptimumcardiovascularhealthandthefewestdeathsfromcoronaryartery
diseaseatatemperaturerangecorrespondingto26‐29°C(Ibid).
Thoughrarelydiscussedintheliterature,mortalityduetoheatwaveshavebeen
extensivelystudiedinEuropeandNorthAmerica,howeverdataisvirtuallyabsentfor
SouthAmericaandAfrica(McMichaeletal.,2006).Risingtemperatureswillbemost
dangerousforpoorpeopleindevelopingcountriesandamongthemostvulnerable
(youngandelderly,sickandpoor).AswiththeotherhealthaffectsafflictingAfrica,this
isexacerbatedduetolimitedresourcesavailabletopoorerpopulations.Thereis
difficultyinpredictingtheeffectsofchangesinfrequencyandintensityofheatwaveson
24
mortalityratesinhightemperatureregionslikeinAfricaduetothelackofdataabout
mortalityintheseregions.
Air quality
Climatechangeisexpectedtoreduceairqualityinsomeareas(IPCC,2007)contributing
torespiratorydisorders(Kinney,2008;McMichael,etal.,2003).Therelationship
betweenclimatechangeandairqualityiscomplexwithmanyinteractingmechanisms.
Forexample,airqualityinfluencescanbeofclimatic/meteorologic(temperature,
humidity,windspeed,winddirectionandmixingheight),natural(ground‐levelozone
andlight‐catalysedairchemistryreactions,aeroallergens,forestfires,anddustfromdry
soils),oranthropogenic(usingcarbonbasedfuelsforlocalenergyuse,transportation,
andagriculture)origin,resultingineventualdepositionofairpollutants(Sapkota,
2005;Confalonieri,etal.,2007;Kovats,Ebi,&Menne,2003).Particulatematterisa
pollutantofconcernasitisacomplexmixtureofextremelysmallparticlesandliquid
droplets.Wheninhaled,theseparticlescanreachthedeepestregionsofthelungs.
Exposuretoparticlepollutionislinkedtoavarietyofsignificanthealthproblems.
Vulnerabilityisdeterminedbythequalityofhousing,theavailabilityofairconditioning
andtheurbanheatislandeffect,resultinginincreaseddeathsamongtheelderlyand
urbanpoor(McMichealetal.,1996;Piver,1999aandb;Epstein&Mills,2005).
Sunlightandhightemperatures,combinedwithotherpollutantssuchasnitrogen
oxidesandvolatileorganiccompoundscancauseground‐levelozonetoincrease.Ozone
formsinthetropospherebytheactionofsunlightonozoneprecursors(through
photochemistry)fromtheby‐productsofburningcarbon‐basedfuels.Atthesurface,an
increaseintemperatureacceleratesphotochemicalreactionrates(strongcorrelation
betweenhigherozonelevelsandwarmerdays–butnotalways).Ground‐levelozone
candamagelungtissueandisespeciallyharmfulforthosewithasthmaandother
chroniclungdiseases.Eventhosewithmoderatediseasemaybeatriskfrom
temperaturerisesabove16.5°C(Levy,2005).
Theincreasesofairpollutantsduetoclimatechangediscussedabovemayinfluence
cardio‐respiratorydisease(McMichaeletal.,2003)aswellasbyexposingpatientswith
pre‐existingconditionstodangeroustemperatureextremes,whichstressthe
cardiovascularsystem.TheWHO(2002)hasestimatedthatpoorairqualitycausedby
climatechangewasresponsibleforover2.4millionprematuredeathsin2000alone
(1/3byoutdoorand2/3byindoorpoorairquality)andaccountsforapproximately2%
oftheglobalcardiopulmonarydiseaseburden(Prüss‐Üstün&Corvalán,2006;Watts,
2009).Exposuretooutdoorairpollutionaccountedforapproximately2%oftheglobal
cardiopulmonarydiseaseburden(WHO,2002;Cohenetal.,2004).Thearrayofhealth
impactsincludesheadaches,nausea,cardio‐respiratorydiseasesandcancer.
Gaps in knowledge and research
Climateandhealthresearchisstillinaratherprimitivestageandmanyofthedirect
andindirecthealtheffectsofclimatechangeinbothregionalandglobalcontexthave
notbeenfullyidentifiedorunderstood.Hence,althoughalotisknownaboutthescience
ofclimatechange,thereremainmanyuncertaintiesofitspotentialimpactonhealth
(IPCC,2007).Theseuncertaintiesrelatemostlytothreemainareas:
1. Climatechangeuncertainties;
25
2. Linksbetweenclimatechangeandhealthandtheirmechanisms,and;
3. Humanmitigationandadaptationcapabilities.
Climatechangeuncertaintiesareduetoinsufficientdataanduncertainclimatedata.
Theglobalclimatesystemiscomplex:simulationsinvolvemanyvariablesthatdescribe
andrelatetonature'schemical,physical,andbiologicalprocesses.Theseleadto
difficultiesinpredictingfutureclimatetrendsintemperature,precipitation,cloud
cover,windsandthetimingandscaleofweathereventsatregionalandlocallevelswith
accuracy.Thedifficultyinpredictingthesenaturalphenomenaarecompoundedby
uncertaintyinfutureratesofGHGemissionsandgovernments’willingnessandability
tomitigateandadapttochangingconditions.Ultimately,newtechniquesand
approachestoclimatechangescienceareneededtodealwiththeuncertaintiesthat
inevitablysurroundtheseestimates.Improvedmodellingofclimatechange,including
regionalmodelswillallowformorereliablepredictionsofthepotentialimpactson
humanhealth,andimprovedregionalunderstanding.
Sofar,themajorityofwidescopingclimate‐healthresearchhasbeencarriedoutinthe
developedworld,wherethetools,technologyandcapacityforcarryingoutthis
researchareavailable.Thisleadstoverytentativeresultsnottheleastbecausethe
greatesthealthrisksduetoclimatechangeareexpectedtobeborneamongstthose
leastcapabletoresponding,inthedevelopingworld(RaminandMcMichael,2009).
LimitedtoolsandtechnologyacrossAfricahasproducedinaccuratefindingsinclimate‐
healthrelationships(Connoretal.,2006).Forexample,climatologydata,usedfor
surveyingmalariahavenotgivenconsistentinformationonthelinksbetweenmalaria
andclimate(e.g.Tulu,1996vs.Hayetal.,2002).Furthermore,thenumberof
meteorologicalstationsacrossAfricaisinsufficientformanyanalyticalpurposes,thus
providinganobstacletotrackingclimatetrends(Connoretal.,2006).Also,climatology
datawidelyusedinAfricahasoftenbeenbasedonout‐datedandinconsistent
observations(Connoretal.,2006).
Thesecondsetofchallengesareuncertaintiesregardingmechanismswhichlinkhealth
impactstoclimatechange.Forinstance,accuracyinpredictingtheeffectofclimate
changeonimportanthealth‐relatedfactorssuchascropyieldandpests(weeds,insects,
plantdiseases,etc)canbeimproved.Improvementscanalsobemadeinepidemiologic
researchmethodstopredicthealthimpactsthroughmodelaccuracyoftheprocesses
throughwhichimpactswilloccur.Partofthechallengeinachievingthese
improvementsisthatclimateexpertsandhealthexperts(suchasepidemiologists)tend
tooperateseparately,andarenotfullyinformedonhowtoeffectivelyemploy
informationfrombothsectorstogenerateinsightfuldataontheinterrelationofclimate
andhealth(Connoretal.,2006).Overall,ithasbeendifficulttobuildandmaintain
cross‐sectoralrelationshipsbetweentheresearchersofclimate‐basedearlywarning
systemsandthesubsequentresponsesneededfromthepublicsector(Connoretal.,
2006).
Thirdly,itisdifficulttopredicthowhumanswillmitigateandadapttoclimatechange,
confoundingmodellingattempts.Mostoftheeffectsofclimatechangeonhealth
discussedabovecanbeminimisedthroughappropriatemitigationandadaptive
measures.Geopolitical,socio‐economic,demographicandtechnologicaladvanceswill
determinetheultimateimpactofclimatechangeonhumanpopulations.Forinstance,
developmentofnewvaccinesmayattenuatetherelationshipbetweentemperature
26
increaseandmalariaspread.Agoodexamplecanbefoundinthecaseofmeningitis
wheretherecentavailabilityofthegroupAconjugatevaccine,whichismeanttotarget
themostsignificantstrainofthemeningococcusbacteria,offerhopethattheproblemof
meningitisacrossAfricamightultimatelytobecontrolled.
Africa’s response to climate change and health
Theprecedingsectionsindicatethatdespiteabidinguncertaintiesandcomplexities,
therearearangeofindirectanddirecthealthimpactsassociatedwithclimatechange.
MinistersofHealthandMinistersofEnvironmentfromacrossAfricaareawareofthe
potentialimpactofclimatechangeonhealthandassuchhaverespondedwith:
 TheLibrevilleDeclarationonHealthandEnvironmentinAfrica(Libreville,
2008);
 TheAfricanMinistersofHealthandEnvironmentJointStatementonClimate
ChangeandHealth(Luanda,2010a),and;
 TheHealthandEnvironmentStrategicAlliancefortheImplementationofthe
LibrevilleDeclaration(Luanda,2010b).
TheseresponsesreflectaproactiveintentamongstAfricanleaderstoprotecttheir
peoplefromtheanticipatednegativehealthconsequencesofclimatechange.Theabove
mentioneddocumentscontainanumberofrecommendationsandactionsaimedat
improvingAfrica’sunderstandingofclimateandhealthandatthesametimeaddressing
thehealthimpactsofclimatechangeacrossAfrica.
AnimportantelementcontainedintheLibrevilleDeclarationisthecommitmentto
establishaHealthandEnvironmentStrategicAllianceasaplatformforplanningand
coordinatingjointcontinent‐wideaction.Similarly,theAfricanMinistersofHealthand
EnvironmentJointStatementonClimateChangeandHealth(Luanda,2010a),which
recalledtheLibrevilleDeclarationcontainsacommitmentbyAfricangovernmentsto
interalia:
 Undertakeacomprehensivehealth‐andenvironment‐climatechange
vulnerabilityassessmentsbytheendof2012;
 CompletetheSituationAnalysesandNeedsAssessment(SANA)processaswell
astheyprepareNationalPlansofJointActions(NPJAs)
 Developanessentialpublichealthpackagetoenhancetheclimatechange
resiliencestatusofallcountriesby2014,and;
 Reducevulnerabilityanduseecosystemsservicestobuildnaturaladaptive
resilienceagainsttheimpactofclimatechange.
Already,followingthemeetinginLibrevilletheHealthandEnvironmentStrategic
AlliancefortheImplementationoftheLibrevilleDeclaration(HESA)hasbeen
establishedtoserveastheprimarymechanismforcoordinatingeffortsataddressing
climatechangeandhealthacrossAfrica.ThecoremandateofHESAistosupport
countryeffortsinaddressinghealthandenvironmentissues(includingclimatechange
andhealth)throughadvocacy,collaboration,resourcemobilization,capacitybuilding,
technicalsupportandprogressmonitoring.
27
ItishopedthatthefullimplementationoftheLibrevilleDeclarationandtheJoint
Statementwouldhelpensureevidencebased,andproperlycoordinatedpolicies,plans
andactions.
Atgrassrootsleveltherearealreadyclimateandhealthactivitiesunderway,notablyin
EthiopiawheretheClimateandHealthWorkingGroup(CHWG)hasbeenoperatingfor
over10years,andhasbeenaddressingtheissueofclimateandmalaria.Similargroups
havebeenestablishedinKenyaandMadagascar.
InAprilof2011,a“ClimateandHealth:10YearOn”washeldinAddisAbabaandco‐
organisedbytheInternationalResearchInstituteforClimateandSociety(IRI),the
AfricanClimatePolicyCentre(ACPC),CHWG,theWorldHealthOrganisation,UNDP,The
UKMetOffice,andtheUniversityofExeter.Theworkshopreflectedonnearlyadecade
ofpracticeandexperienceinAfricasincetheBamakoWorkshop(1999)onClimate
PredictionandDiseases/HealthinAfrica.FromtheClimateandHealth:10YearsOn
Workshop(2011)aseriesof23recommendations2tosupporttheeffective
implementationoftheJointStatementonClimateChangeandHealthinAfrica(Luanda,
2010)wereagreedregardingpolicy,practice,servicesanddata,andresearchand
education.Theseincluded,forexample:
 Bridgingthegapbetweenpoliciesandpracticesthroughlegislationand
guidelines,appropriateplanning,includingrelevantvulnerabilityassessments,
programmaticsupportandmulti‐sectoralandparticipatoryprocessesthatare
gendersensitive.
 Supportingcountriestoestablishintegratedhealthsurveillanceandclimate
observationandprocessingsystems;
 Integratingclimatehealthriskmanagementintocross‐sectorplanningand
practiceforadaptationtoclimatevariabilityandchangebydevelopingclimate
servicesandproductsthataddressdiseasepreventionatend‐userlevel.
 Ensuringthatclimatechangemitigationandadaptationstrategiesareinformed
bymultidisciplinaryresearch.
Options for consideration
Baseduponareviewoftheliterature,thereareaseriesofoptionsthatmaybe
consideredbyAfricangovernments,coordinatingbodiessuchasHESA,andbyother
organizationstoaddressclimatechangeandhealth.Theseoptionsneedadeeper
investigationandmuchfurtherresearch,dialogueanddiscussion,butforthepurposes
ofstimulatingsuchaprocess,optionsthatmightbeconsideredinclude:

Giventhattheabilitytoaddressthehealthimpactofclimatechangedependsinpart
onthequalityofpre‐existinghealthcareandfacilities,animportantstepistoinvest
resourcesintheoverallhealthandrelatedinfrastructuredevelopmentinAfrican
countries.
2
The complete set of recommendations are available online
(http://portal.iri.columbia.edu/portal/server.pt/gateway/PTARGS_0_2_7668_0_0_18/Final%2010%20Y
ears%20On%20Recommendations_April%206.11.pdf) and the report of the meeting is also available
on-line with an elaboration of related presentations and discussions
(http://portal.iri.columbia.edu/portal/server.pt/gateway/PTARGS_0_4972_7730_0_0_18/TR1101_10YearsOn_WorkshopReport.pdf).
28

ManyofAfrica’scurrenthealthproblemsarearesultoffrequentcontactwith
contaminatedwaterandopensewerage(UNFCCC,2007,p.18;IPCC,2007,p.399,
416;Labonte,2004).Improvedinfrastructurecouldreducethedamageandhealth
dangersassociatedwithEWEs.

Comprehensivedrugtherapyandothermitigativeorpreventativemeasuresare
usefulsothatthehealthsectorinAfricacancombatthemostprominent,andoften
climate‐sensitive,infectiousdiseases,forexamplemalariaandmeningitis,plusthe
NTDs,etc.Medicationandotherparaphernalia(i.e.mosquitonets,condoms,
sterilizationtabletsandsanitizers)forcuringorpreventingAfrica’scommon
infectiousdiseasesarerequiredinordertobuildtheoverallhealthstatusofAfrica’s
population.Thesemeasuresalone,however,wouldnotsuffice.

Anincreasedpresenceofclinicsandhealthprofessionals,providingsupport,
explainingoptionsandgivingdirectionsontheuseofdrugsandpreventative
paraphernaliaarealsorequiredtoimprovetheeffectivenessofthesemeasures.A
healthierpopulaceiscriticaltodevelopmentandinturnadequatelevelsof
developmentareneededtoimprovetheoverallhealthstatusofthepopulace.The
GlobalStrategicPlanforRollBackMalaria,2005–2015,agrees,havingasserted"six
outofeightMillenniumDevelopmentGoalscanonlybereachedwitheffective
malariacontrolinplace"(Kopec‐Groverwtal.,2006,p.1;Connoretal.,2006,p.21).

Thereisaneedtotackletheproblemoffoodsecurityandmalnutritioninthe
contextofclimatechange.Therearemanywaysofdoingthis,aswellasmany
complications.Healthoutcomesmightbenefitfrominvestmentinagricultural
productionsystems,improvedlandpolicyandinvestmentinirrigationsystemsfor
example.Thereareanumberoforganizationsresearchingsuchissuesinthefield
andatthepolicylevel.Itisimportantthattheoutcomesofsuchresearchcontinueto
beusedtoinformgovernmentpoliciesandinterventions,coupledwithbuilding
climateresilienceintheagriculturesector.

AcrossAfricathereissignificantdevelopmentpotential,andassuchthereisthe
opportunitytoensureakeyelementofdevelopment,infrastructure,isclimate
resilientbytakingclimatechangeintoaccountwhenplanninganddesigning
infrastructure.Achievingthisrequiressignificantincreaseintheawarenessof
climatechangeamongdevelopmentplannersandministriesinAfricancountries.
Infrastructureisimportantbothforthedeliveryof,andaccessto,healthservices.

Africangovernmentscanincreasetheeffectivenessofaddressingthehealthimpacts
ofclimatechangethroughthecreationofknowledgemanagementplatformsfor
sharinginformation,skills,andtechnologybetweenandwithingovernments,
privateinvestors,localandinternationalagencies,andacademicgroupsworking.A
keyissueforconsiderationistheneedforincreasedresearch.Itisimportantto
ensurethatresponses,actionsandpoliciesarebasedonthebestavailableresearch.
Itisalsoimportant,asstatedbytheWHO(2009)toimproveunderstandingof
currentclimate‐relatedhealthrisksbeforetryingtounderstandfutureorlong‐term
healthrisks.Robustresearchisalsoneededtoidentifyrelativelyhiddenorunclear
climate‐healthlinks,ensureproperprioritizationofresponsemeasuresandidentify
themostcost‐effectiveinterventionsmeasures.
29

Asclimatechangeisnotacompletelynewphenomenon,itwouldbeveryinsightful
tolearnhowindigenouscommunitieshavedealtwithchangesoverprevious
generationsandhowthesecouldbeadaptedforscaled‐upeffectiveresponsesto
climatechange.

Thereisneedforimprovedregionalandlocalmodellingofclimatechangetoallow
formorereliablepredictionsofthepotentialimpactsonhumanhealth.Improved
dataandresearchcapacityisimportant.Therearealreadycollaborative
programmesinvolvingresearchorganisationswithtechnicalandcomputing
capacityworkinginpartnershipwithNationalHydrologicalandMeteorological
Organisationstoimprovingnationalcapacitiesandimprovemodellingand
downscalingoftheeffectsofclimatechangeonallsectorsincludinghealth.Such
initiativescanbescaledupandwhencoupledwithhealthandothersocialand
economicinformation,canbeutilisedintheformulationofpolicy.

Duetotheirlifesavingpotential,governmentsshouldworkhardtomakehydro
meteorologicaldatasetseasilyaccessibleandusethemtoinformplanningand
development.Further,thisinformationcanbeimprovedandtheapplicationand
developmentofearlywarningsystemspromoted.Examplesofsuchtechnology
appliedacrossAfrica,butnotaspervasivelyasneeded,includemalariaandfamine
earlywarningsystems.

Manyofthecurrentlimitationsonadaptationandmitigationresponsestoclimate
changerelatedhealthconcernsforAfricaareduetolimitedaccesstofinanceand
budgetarylimitations.Strategicallocationofclimatefinancewiththeaimof
mitigatingclimate‐relatedhealthrisks,includingthosethatarealreadyvery
prevalent,couldbecrucialtoimprovingAfrica’soverallhealthstatusinawarming
world.
Ashighlightedinthisworkingpaper,climatechangeandhealthisacomplexissue,and
addressingclimatechangeandhealthrequiresintegratedanalysisofsocial,economicas
wellasenvironmentalandclimaticdimensionsofdevelopmentandhealth.Thelistof
optionsaboveisnotexhaustiveandeachrequiressuchanintegratedanalysesand
furtherinvestigation.Assuchanyfeedbackonthecontentofthisworkingpaperand
theoptionspresentedwillbegreatlyappreciatedandwarmlyreceivedbytheACPC
([email protected]).
30
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