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Global Environmental Change & Health Paul R. Epstein, M.D., M.P.H. Center for Health and the Global Environment Harvard Medical School http://med.harvard.edu/chge The loss of forests, freshwater and biodiversity, inadequate and inefficient use of energy, and the explosive growth in the world’s urban centers undermine long-term economic growth and threaten ecological systems. They also endanger human health, and increase developing countries vulnerability to natural disasters and conflict. … Furthermore, increases in global greenhouse gas emissions, approximately fifty percent of which are produced in developing countries, threaten to disturb the delicate ecological balance, disproportionately affecting the world's poor who are the least able to adapt to these changes. Long-term economic growth depends upon managing a country’s natural resources base, using energy to increase human productivity, helping cities to provide services and markets, and having predictable seasonal and long-term climatic conditions. -- US Agency for International Development (2002) Traditional Epidemiological Framework Ecological Epidemiological Framework Agent Social SYSTEMS Host Environment Disease Ecological Global Epidemics Global Temperature: the Past 20,000 Years, & the Next 100 Years Av. temp. over past 10,000 years =15 ºC 3 IPCC (2001) forecast: Mesopotamia oC, with band + 1.4-5.8 flourishes 2 of uncertainty Vikings in Agriculture 1 emerges 0 Temp. change (ºC) -2 -3 -4 End of last ice age Greenland Black Death Holocene 1940 Optimum Medieval Warm Little Ice Age in Europe (15th-18th centuries) Younger Dryas 21st century: rapid rise -5 20,000 10,000 2,000 1,000 300 100 Now +100 370 ppm VOSTOK ICE CORE 280 ppm CO2 T 420 kya Present 180 ppm Observed vs. modeled temperature rise since 1860 Deep Ocean Warming SST Anomalies May 2003 Health Impacts of Climate Change HEATWAVES May 2003 Andhra Pradesh T 122•F >400 deaths HUMIDITY & HEAT INDICES TMINS AIR POLLUTION AND CLIMATE CHANGE Indoor pollutants SES/emotional factors Diesel ASTHM A Pollen (& pollen) 2-3x Floods & Mold Since 1980s Droughts & Fires Ground-level Ozone (T-dependant) IPCC 2001: New Findings Extreme Weather Events Heatwaves, Droughts & Floods Intensity & Frequency (rains >2”/d) Biological Systems are Responding • Plant migrations • Insects & butterflies • Bird egglaying • Marine species Emerging Infectious Diseases 30 DISEASES “NEW” TO MEDICINE SINCE 1976 HIV/AIDS Ebola Legionnaires’ E. coli O157:H7 SARS Antibiotic-Resistant Agents Hantavirus Pulmonary Syndrome Lyme Disease Vibrio cholerae O139 Nipah Virus Arenaviruses RESURGENT & REDISTRIBUTING Malaria, Dengue Fever, West Nile Virus, Cholera VECTORS Mosquitoes Ticks Rodents Bats Tsetse Flies Fleas Lice Snails Algae INFECTIOUS DISEASE A DRIVING FORCE IN HISTORY The “Good” News The Bad News PLAGUE 541 AD 1346 AD Cholera, TB, Smallpox Climate Models and Potential Malaria Distribution T ~1ºC/C ~2ºC/C 1950 2000 THE CRYOSPHERE PLANT COMMUNITIES Geographic Shifts of Mosquitoes 450 ft. ~2•F warming 1970-1990 Diaz & Graham, Science: 19967 LYME DISEASE PREDATORS OF DEER 1980s WARMER WINTERS 1990s TICK DISTRIBUTION IN SWEDEN Lindgren & Gustafson. Lancet 2001;358:16 HURRICANE MITCH 1998 HURRICANE MITCH HURRICANE MITCH IMPACTS ON HEALTH AND DEVELOPMENT DISEASE CLUSTER -- Malaria (>30,000 cases) -- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis 4161 cases WNV HUMAN CASES & DEATHS 284 deaths BLOOD ORGAN TRANS IN-UTERO 62 ? BREAST MILK 66 ………………… 21 POLIO-LIKE PRESENTATION 1999 2000 2001 2002 & NEURO SEQUELAE Science 2002:297:1988 WNV: A DISEASE OF WILDLIFE 230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES • 138 Bird spp., RAPTORS - 37 spp. of mosquitoes • HORSES • ZOO animals • REPTILES AVIAN FLYWAYS INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGE SPECIES LOSS VECTOR Raptors Rodents DISEASES Lyme, Hantaviruses, Leptospirosis, Plague Vulture die off India Feral Dogs Rabies Hantavirus Pulmonary Syndrome 1993 Drought, Then Early Rains 10X Explosion of Mice Populations Range Expansion of Soybean Cyst Nematode in North America Crop Pests Generations/Year DISEASES OF TREES US •West Coast •Alaska fungi (Phytophthora) spruce bark beetles 2 generations/year •East Coast hemlock woolly adelgid N w/ warm winters Droughts vulnerability to pests. Diseased trees susceptible to fire. Coral Diseases Color Variants on M. cavernosa Photo: Raymond Hayes Red Band Disease on M. annularis Photo: Laurie Richardson SARS Severe Acute Respiratory Syndrome CORONAVIRUS 1. Species X-over 2. Genetic reshuffling 3. Farming practices & food handling $50-100 BILLION TRADE, TRAVEL, TOURISM Bio Economic Research Associates, Cambridge, MA HIV/AIDS SOCIAL AND ENVIRONMENTAL DETERMINANTS Transmission Informal sector, Mining, Conflict Viral Evolution Coxsackie virus Levander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528 Malnutrition & disease burden Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754 Stress proteins & mutations Immune surveillance system Costs of Extreme Weather Events Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies UNEP $150b/y w/in this decade Levels of Solutions I. Surveillance and Response Capacity II. Health Early Warning Systems III. Environmental, Energy & Economic Policies CHALLENGES CLEAN ENERGY HARMONIZING ADAPTATION & MITIGATION Solar-powered •clinics, homes, schools & enterprises •water purification, pumping & desalination MDGs HEALTH, NUTRITION, POVERTY AGENDA 21 FISHERIES, FORESTS, POPs CLEAN DEVELOPMENT Framework Reg Funds EE and RE Inst THE ENGINE OF GROWTH for the 21st CENTURY “Green Buildings” & Smart Growth Rationalized Transport & Transit Retrofitting Infrastructure Ecological Reconstruction