Training for health professionals

2 Overview Direct and indirect impacts Projected health impacts Global health impacts

3 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.

4 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

5 Climate Change is Happening Now Source: IPCC 2007 (4 th Assessment)

6 IPCC 2007: Human Impact is Evident Source: IPCC 2007 (4 th Assessment)

7 1°C2°C5°C4°C3°C Sea level rise threatens major cities Falling crop yields in many areas, particularly developing regions Food Water Ecosystems Risk of Abrupt and Major Irreversible Changes 0°C Falling yields in many developed regions Rising number of species face extinction Increasing risk of dangerous feedbacks and abrupt, large-scale shifts in the climate system Significant decreases in water availability in many areas, including Mediterranean and Southern Africa Small mountain glaciers disappear – water supplies threatened in several areas Extensive Damage to Coral Reefs Extreme Weather Events Rising intensity of storms, forest fires, droughts, flooding and heat waves Possible rising yields in some high latitude regions 450 ppm CO2 eq 650 ppm CO2 eq Projected Impacts of Global Temperature Change Source: L. Rudolph, 2008

8 Climate Change’s Impacts on Health Source: Haines, et al, JAMA 2004

9 Extreme Weather Events & Disease Clusters Source: Epstein, Harvard Center for Health & Global Environment

10 Human Changes to Global Activated Nitrogen Cycle, Human health risks include: –Decreased crop yields –Nitrogen oxides (air pollution)

11 National Carbon Dioxide Emissions

12 Total CO 2 Emissions UNEP 2009

13 Health Burden of Climate Change Impacts Deaths from malaria and dengue fever, diarrhoea, malnutrition, flooding, and (in OECD countries) heatwaves

14 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

15 Air quality Water safety Food safety Pest control Housing Climate change affects the current responsibilities of Environmental Health

16 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.

17 China Haze 10 January 2003 NASA

18 Health impacts of climate change

19 Projected impacts 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

20 Pathways for Weather to Affect Health: Example = Diarrheal Disease Temperature Humidity Precipitation Distal Causes Proximal CausesInfection HazardsHealth Outcome Living conditions (water supply and sanitation) Food sources and hygiene practices Survival/ replication of pathogens in the environment Contamination of water sources Rate of person to person contact Consumption of contaminated water Consumption of contaminated food Contact with infected persons Incidence of mortality and morbidity attributable to diarrhea Vulnerability (e.g. age and nutrition) Contamination of food sources WHO

21 Daily Temperature Daily Diarrhea Admissions Diarrhea increases by 8% for each 1ºC increase in temperature Effect of Temperature Variation on Diarrheal Incidence in Lima, Peru Checkley et al., 2000

22 Corvalan et al., 2003 Pathways from Driving Forces to Potential Health Impacts

23 Climate Change may entail changes in variance, as well as changes in mean

24 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

25 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

26 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

27 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

28 Comparative Risk Assessment 2020s 2050s 2080s Greenhouse gas emissions scenarios Global climate modelling: Generates series of maps of predicted future climate Health impact model: Estimates the change in relative risk of specific diseases Campbell-Lendrum et al., 2003 Time 2080s2050s2020s

29 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 Campbell-Lendrum et al., 2003

30 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 Potential health benefits

31 Global health impacts of climate change

32 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. Global health impacts

33 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.

34 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)

35 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 Why the health sector? Climate Negotiations

36 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 Main objectives for international public health

37 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, Raising awareness

38 Why health should be central: Main reasons for concern (e.g. disasters, food shortage, displacement, disease) are health and wellbeing issues Most energy and environment decisions (e.g. choice, use of fuel sources) have major direct health implications 2. Partnerships to raise the profile of health in climate change policy

39 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:

40 "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 3. Providing Evidence: Improving health while reducing greenhouse gas emissions

41 4. Strengthening public health systems Strengthened action on diseases of poverty: Including wider coverage with vector control and vaccination programmes. 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

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43 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.