RAINER SAUERBORN Heidelberg University, Germany 2008 GLOBAL MINISTERIAL FORUM ON RESEARCH FOR HEALTH BAMAKO, NOVEMBER 16-19, 2008 Climate change destabilizes infectious diseases: challenges for research and policy #1 Increasing instability of infectious diseases #2 Improving the scientific basis for predictive modelling #3 Adaptation policies now, while evidence improves #4 Bringing health to the mitigation policy debate Key points:

(Re-)emerging diseases #1 Instability of infectious diseases (re-)emerging diseases #1 Instability of infectious diseases (re-)emerging diseases

Simultaneous influences on infectious diseases Malnutrition Vector ecology Dysfuntional health services, Low uptake of control measures by population Resistance development, new drugs/vaccines Mobility of people, vectors, microbes Land use change, irrigation, urbanization Climate change

The convergence model for infectious diseases (IOM, 2008)

Understanding the interactions between climate change and infectious diseases: process-based modelling - Plausible biological assumption - Mathematical process based models - Decade-long data sets Prediction modelling for better early warning and intervention design There is no treatment without diagnosis. Hippocrates # 2 Improving the scientific basis for predictive modelling - Using climate to predict disease - Using ecological changes - Using animal diseases - Using human cases

Future Present Learn Detect Forecasting, modelling Three Main Types of Research Empirical studies McMichael

INDEPTH Network Currently 37 sites in 19 countries 26 sites in Africa 9 sites in Asia 1 site in Oceania,1 site in Latin America Geo-referenced, individual data on death by cause, age, sex and socio-economic indicators International Network of Developing Countries with continous longitudinal health surveillanceINDEPTH International Network of Developing Countries with continous longitudinal health surveillanceINDEPTH Over 2,000,000 people under health surveillance

INDEPTH Network Health data from over 45 years

Meteo stations Health Surveillance: 47 villages, people Satellite imagery Linking health and environmental monitoring: Nouna district, Burkina Faso

# 3 Adaptation policies now, while evidence improves precautionary principle 1.Early warning systems for climate-sensitive infectious diseases: malaria, cryptosporidiosis, leishmaniasis, dengue, Hanta, Chikungunya, RVF, TBE, MBE, WNF leptospirosis, plague, cholera, Lyme, Ebola and more 2.No regrets strategies top priority: strengthen health systems Risk pooling strategies (health insurance) Invest in water and sanitation Food security Priority for existing control of climate-sensitive infectious diseases

Protecting health is the central motivation for most people everywhere Mitigation has important health co-benefits, reducing: – 800,000 deaths to outdoor air-pollution – 1,200,000 deaths to injuries – 1,900,000 deaths to physical inactivity Mitigation and adaptation are poverty reduction strategies # 4 Put the health argument into the mitigation debate

GHG Emissions Adaptation GHG concentrations Warming and variabilty Health impact Disease Death, Disab. From emissions to Health Vulnerability Mitigation: emission control carbon sinks, sequestration Exposure Climate sensitivity Health sensitivity Vulnerability + Population * GDP/Person * energy/GDP * GHG emissions/energy Kaya identy =

Climate and climate impact: health matters (Stern 2007) Stern, 2007 Notes: Baseline climate: CC as assumed by TAR IPCC High climate: Incorporating 2 types of feedback: 1. thawing of permafrost areas 2. weakened carbon sinks Climate Impacts

Annual losses of GDP/capita due to climate change -projections until Stern, 2007

INDEPTH Network

DISCUSSION SLIDES

So what? Assume valid & generalizable malaria risk maps Regardless of whether climate will change the malaria burden: Need to improve and target interventions Regrets or no regrets?

Gefahr einer Zunahme tropischer Infektionskrankheiten Rainer Sauerborn Universität Heidelberg WARNSIGNAL KLIMA. Öffentliches Symposion, Hamburg,

Emissions of greenhouse gases Density equalling cartogram. Countries scaled according to cumulative emissions in billion tonnes carbon equivalent in Gibbs et al, in prep.

Health impacts of climate change Density equalling cartogram. WHO regions scaled according to estimated mortality (per million people) in the year 2000, attributable to the climate change that occurred from 1970s to Gibbs et al, in prep.

Mitigating and adapting to climate change is inherently pro-poor

Stellschrauben der Adaptation: Malaria Biological Adaptive Behavioral Useof bednets Biological Adaptive immunity Social Surveillance Hlthsystems Social Surveillance Hlthsystems Behavioral Useof bednets Mode intervention National Level of intervention Community or group Individual Biological Adaptive Behavioral Useof bednets Biological Adaptive immunity Social Surveillance Hlthsystems Social Surveillance Hlthsystems Social Surveillance Hlthsystems Social Surveillance Hlthsystems Behavioral Useof bednets National Level of intervention Community or group Individual Other institutions intervention ofMode Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Stage of intervention Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Primary Vaccination Dams Secondary Early warning Tertiary Early treatment Stage of intervention Global

1.8 o C = 3.2 o F 2.8 o C = 5.0 o F 3.4 o C = 6.1 o F ppm CO 2 Eq Even if we stop emitting today 0.6 o C = 1.0 o F IPCC, WG 1

INDEPTH Network Prospective monitoring of demographic and health events

Estimated current health impact of climate change

Basis for mitigation policies: The Kaya identity CO2 = Population x GDP/Person x kJoule/GDP x CO2 emissions/kJoule Economic growth Energy efficiency Energy mix Population growth

INDEPTH Network INDEPTH I nternational Network for the Demographic Evaluation of Populations and Their Health in Developing Countries

Figure SPM.2. Key impacts as a function of increasing global average temperature change (Impacts will vary by extent of adaptation, rate of temperature change, and socio-economic pathway)

Applications of definitions in comparative risk assessment to climate change

Europe Africa S.-Asia Latin-A SIS sea level sea level ? + +? + ? ? Based on: McMichael and Kovats, 2000

Healthy development Environmental health capacity building Integrated vector management Health action in emergencies Infectious disease surveillance Safe drinking water Diseases affected by climate

Health Co-Benefits from Mitigation Reduced fossil fuel combustion: – Reduce cardio-respiratory deaths/hospitalisations from local air pollution (esp. fine particulates). Low-emission urban (public) transport system: – Increase physical activity (walking, cycling) reduce over-weight, improve lipid/endocrine profiles, increase social contact and wellbeing. – Road trauma should decline. Reduced red (ruminant) meat consumption (livestock-CH4) – Reduce risks of some disease: large bowel cancer, ?breast cancer; also heart disease (meat fat content). More energy-efficient housing – Reduce thermal/acoustic stresses

Economics of mitigation (Stern, 2007) To avoid worst effects, stabilization of CO2 should be at least 550 ppm* To achieve 550ppm, CO 2 emissions must be brought down to 80% of 1990 level Economic costs of climate change, if we do business as usual: 5% to 20% of GDP Mitigation costs to achieve stabilization at 550 ppm CO2: 1% of GDP starting now Current level of CO2: 430ppm, pre-industrial: 270ppm Maximum in past 600,000 years: 300ppm

How sensitive is health to climate? Diarrhoea How sensitive is health to climate? Diarrhoea Incidence of diarrhoeal disease is related to variations in temperature and precipitation, over both space and time. In Lima, Peru, diarrhoea increased 8% for every 1 0 C temperature increase. (Checkley et al, Lancet, 2000)