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Training for health professionals
Overview
• Direct and indirect impacts
• Projected health impacts
• Global health impacts
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Direct / indirect impacts
• Climate change can impact directly on
health – e.g. through UV radiation, heat
stress, accidents caused by storms.
• It can also impact indirectly – e.g. by
altering conditions for disease vectors,
reducing agricultural productivity, and
triggering conflict over scarce
resources.
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Direct / indirect impacts
"The intimate connection between food
security, water security, energy security
and climate change - to deal with one in
isolation is to present enormous problems”
Professor John Beddington, Chief Scientific Advisor to the
Government, speaking at The Climate Connection national
launch, 2nd December 2008
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Climate Change is Happening Now
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Source: IPCC 2007
(4th
Assessment)
IPCC 2007: Human Impact is Evident
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Source: IPCC 2007
(4th
Assessment)
Projected Impacts of Global
Temperature Change
0°C
Food
Water
1°C
2°C
3°C
4°C
5°C
Falling crop yields in many areas, particularly
developing regions
Falling yields in many
Possible rising yields in
developed regions
some high latitude regions450 ppm CO2 eq
Small mountain glaciers
disappear – water
supplies threatened in
several areas
Significant decreases in water
availability in many areas, including
Mediterranean and Southern Africa
Sea level rise
threatens major cities
Ecosystems
Extensive Damage
to Coral Reefs
Rising number of species face extinction
650 ppm CO2 eq
Extreme
Rising intensity of storms, forest fires, droughts, flooding and heat waves
Weather
Events
Risk of Abrupt and
Increasing risk of dangerous feedbacks and
Major Irreversible
abrupt, large-scale shifts in the climate system
Changes
Source: L. Rudolph, 2008
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Climate Change’s Impacts on Health
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Source: Haines, et al, JAMA 2004
Extreme Weather Events & Disease Clusters
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Source: Epstein, Harvard Center for Health & Global Environment
Human Changes to Global Activated
Nitrogen Cycle, 1900-2050
• Human health risks
include:
– Decreased crop
yields
– Nitrogen oxides
(air pollution)
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National Carbon Dioxide
Emissions
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Total CO2 Emissions
UNEP 2009
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Health Burden of Climate Change
Impacts
Deaths from malaria and dengue fever, diarrhoea, malnutrition,
flooding, and (in OECD countries) heatwaves
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Painful spots
• Core knowledge: the effects of climate change
on current responsibilities of Environmental
Health
– air, water, food, pest control, home health
• Areas for development: Environmental Health
Practitioners as agents for carbon reduction and
adaptation.
– air, carbon, water, food, housing
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Climate change affects the current
responsibilities of Environmental Health
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Air quality
Water safety
Food safety
Pest control
Housing
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Air quality
Climate change impacts
• Increasing temperatures combine with air
pollution to increase ground level ozone,
causing morbidity from respiratory disease.
• Tighter controls on pollution to air may be
needed just to maintain current air quality.
• Surveillance and early warning systems for
vulnerable groups.
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China Haze 10 January 2003
NASA
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Health impacts of
climate change
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Projected impacts
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•
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Heatwave-related health problems
Cold-related illness & deaths
Air pollution
Flooding
Infectious diseases - food borne, waterborne and
vector-borne diseases
Exposure to UV radiation
Extreme weather-related events
New threats appropriate responses
Possible supplementary health benefits
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Pathways for Weather to Affect
Health: Example = Diarrheal Disease
Distal Causes
Temperature
Humidity
Precipitation
Living conditions
(water supply and
sanitation)
Food sources and
hygiene practices
Proximal Causes
Infection Hazards
Survival/ replication
of pathogens in the
environment
Consumption of
contaminated water
Contamination of
water sources
Consumption of
contaminated food
Contamination of
food sources
Contact with
infected persons
Health Outcome
Incidence of
mortality and
morbidity
attributable
to diarrhea
Vulnerability
(e.g. age and
nutrition)
Rate of person
to person contact
WHO
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Effect of Temperature Variation on
Diarrheal Incidence in Lima, Peru
Daily Diarrhea
Admissions
Daily
Temperature
Diarrhea increases by 8% for each 1ºC increase in temperature
Checkley et al., 2000
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Pathways from Driving Forces to
Potential Health Impacts
Corvalan et al., 2003
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Climate Change
may entail
changes in
variance, as well
as changes in
mean
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Methods for:
• Estimating the current distribution
and burden of climate-sensitive
diseases
• Estimating future health impacts
attributable to climate change
• Identifying current and future
adaptation options to reduce the
burden of disease
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Estimate Potential Future
Health Impacts
• Requires using climate scenarios
• Can use top-down or bottom-up
approaches
– Models can be complex spatial models or be
based on a simple exposure-response
relationship
• Should include projections of how other
relevant factors may change
• Uncertainty must be addressed explicitly
After Kovats et al., 2003
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Sources of Uncertainty
• Data
– Missing data or errors in data
• Models
– Uncertainty regarding predictability of the system
– Uncertainty introduced by simplifying relationships
• Other
– Inappropriate spatial or temporal data
– Inappropriate assumptions
– Uncertainty about predictive ability of scenarios
Kovats et al., 2003
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Estimating the Global Health
Impacts of Climate Change
• What will be the total potential health
impact caused by climate change
(2000 to 2030)?
• How much of this could be avoided
by reducing the risk factor (i.e.
stabilizing greenhouse gas (GHG)
emissions)?
Campbell-Lendrum et al., 2003
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Comparative Risk Assessment
Greenhouse gas
emissions scenarios
Time
2020s
2050s
Global climate modelling:
2080s
Generates series of maps
of predicted future climate
Health impact model:
Estimates the change in relative
risk of specific diseases
2020s
Campbell-Lendrum et al., 2003
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2050s
2080s
Criteria for Selection of
Health Outcomes
• Sensitive to climate variation
• Important global health burden
• Quantitative model available at the global
scale
– Malnutrition (prevalence)
– Diarrhoeal disease (incidence)
– Vector-borne diseases – dengue and
falciparum malaria
– Inland and coastal floods (mortality)
– Heat and cold related CVD mortality
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Campbell-Lendrum et al., 2003
Potential health benefits
Due to both direct & indirect effects:
• Increased physical activity due to extended warm
weather. But, outcomes could be worse due to
extreme heat
• Reduced obesity and road traffic injuries through
active transport
• Possibly healthy eating through adoption of
sustainable farming & food policy and diets containing
less animal products
• Reduced respiratory illness by improvements in air
quality
• Increased home energy efficiency reducing
temperature-related illness
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Global health impacts of
climate change
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Global health impacts
Climate change affects the most fundamental
determinants of health: air, food, water, shelter,
freedom from disease.
The impacts on human health are not evenly
distributed. Developing country populations,
particularly in small island states, arid and high
mountain zones, and in densely populated coastal
areas, are first and hardest hit.
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WHO: five major health
impacts of climate change
1. Malnutrition
2. Deaths and injuries caused by storms and floods.
(Flooding can also be followed by outbreaks of
diseases, such as cholera)
3. Water scarcity / contamination (droughts and sudden
floods) – increased burden of diarrhoeal disease.
4. Heatwaves – direct increases in morbidity and
mortality; indirect effects via increases in ground-level
ozone, contributing to asthma attacks.
5. Vector-borne disease – malaria and dengue.
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Major global killers are
affected by climate
Each year:
• Weather– related disasters kill over
60,000
• Undernutrition kills 3.5 million
• Diarrhoea kills 2.2 million
• Malaria kills 900,000
(WHO, 2003, 2008)
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Climate Negotiations
Why the health sector?
• Can take the long view
• Understands the science
• Other health initiatives will be overtaken by the
effects of climate change
• Action on climate change has health effects itself
– Positive (“health co-benefits”)
– Negative
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Main objectives for international
public health
1) Raising awareness: of the health implications of climate
change
2) Strengthening partnerships: to place health at the
centre of climate change policy
3) Generating evidence: on the health effects of adaptation
and mitigation policies
4) Strengthening public health systems to cope with
additional threats posed by climate change
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1. Raising awareness
With impoverished populations in the developing world
the first and hardest hit, climate change is very likely to
increase the number of preventable deaths. The gaps
in health outcomes we are trying so hard to address
right now may grow even greater.
This is unacceptable.
Climate change and health: preparing for unprecedented challenges.
WHO Director General Margaret Chan.
December, 2007
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2. Partnerships to raise the profile of health in
climate change policy
Why health should be central:
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Main reasons for concern (e.g. disasters,
food shortage, displacement, disease)
are health and wellbeing issues
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Most energy and environment decisions
(e.g. choice, use of fuel sources) have
major direct health implications
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3. Providing Evidence - Health Adaptation
• Describing risks from national to
global level
• Measuring the effectiveness of
interventions
• Evaluating health effects from
decisions in other sectors
• Improving decision-support
tools
• Assessing the financial costs
Protection of handwashing against diarrhoea, highlighting studies
in water-stressed situations.
Adapted from Curtis V, Cairncross S. 2003; Lancet Inf Dis 3:275281
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3. Providing Evidence:
Improving health while reducing greenhouse gas
emissions
"Health benefits from reduced air pollution as a
result of actions to reduce greenhouse gas
emissions… may offset a substantial fraction of
mitigation costs" – IPCC, 2007
We have an opportunity to reduce:
- The 800,000 annual deaths from urban air
pollution, and the 1.6 million from indoor air
pollution
- The loss of 1.9 million lives, and 19 million years of
healthy life, from physical inactivity
- The 1.2 million deaths and over 50 million injuries
from road traffic accidents
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4. Strengthening public health systems
Much of "adaptation" is basic, preventive public health:
Improved surveillance and response: E.g. heatwave warnings,
compliance with International Health Regulations to prevent
international spread of disease.
Better management of environmental health determinants:
Provision of safe water and sanitation, control of air pollution
Strengthened action on diseases of poverty:
Including wider coverage with vector control and
vaccination programmes.
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DISCLAIMER
The views expressed in this presentation are
those of the authors within the Climate TRAP
project and do not necessarily reflect the views or
policies of any participating organisation.
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