1. Tony McMichael, AO Emeritus Professor (Population Health) National Centre for Epidemiology and Population Health The Australian National University tony.mcmichael@anu.edu.au Climate Change and Human Population Health: Past, Present, Future Department of Defence, June 2013

2. Deaths Attributable to Climate Change: Year 2000 14 WHO statistical regions scaled by estimated annual mortality (selected causes, in 2000) due to change in climate during 1970-2000. (Patz et al, 2007: based on McMichael, et al, 2004) Estimated annual deaths attributable to climate change from: malnutrition (~80K), diarrhoea (~50K), malaria (~20K), flooding (~3K)

3. Physical systems (river flow, vegetation, soils, ocean temp, etc.) Biological & ecological processes Economic/social impacts : infrastructure, economic productivity, jobs, coastal displacement, resource- related conflict/warfare Human Health Injuries/deaths; mental stress Thermal stress impacts Indirect (‘secondary’) impacts, ecologically- mediated: changes in food, water, mosquitoes Indirect (‘tertiary’) health impacts – socially & politically mediated Direct (‘primary’) impacts (extreme weather, heatwaves, air pollution) Infectious diseases Under-nutrition Mental stresses Trauma/deaths Climate Change: Impacts Climate Change: Health Impact Pathways

4. Relationship between Rainfall Index (combines rainfall and temperature) in Spring (April-June) and Barley Yields in Czech Republic since 1940s. DryWet Normal Range Spring Barley Yield (deviation, %) Rainfall Index, April-June Brazdil et al, 2008 5-year running mean yield deviation

5. 64 36 20 80 Percentage change in yields to 2050 -50 -20 0 +20 +50 +100 UN Devt Prog, 2009 Not including climate-related: Flood/storm/fire damage Droughts – range, severity Pests (climate-sensitive) Infectious diseases (ditto) CLIMATE CHANGE to 2050: MODELLED CHANGES IN CEREAL GRAIN YIELDS (due to temperature and soil moisture) Poor Countries are Projected to Fare Worst

6. eg. dengue, malaria; Ross River virus, Lyme disease eg. nutrition- related immune function Climate Change: Diverse Influence Paths on Infectious Diseases Social-demographic influences

7. NCEPH/CSIRO/BoM/UnivOtago, 2003 Dengue Fever: Estimated ‘receptive’ region for Ae. aegypti mosquito vector, under alternative climate-change scenarios for 2050 Risk region for medium emissions scenario, 2050 Darwin Katherine Cairns Mackay Rockhampton Townsville Port Hedland Broome........ Carnarvon. Katherine Cairns Mackay Rockhampton Townsville Port Hedland Broome....... Brisbane. Current risk region for dengue transmission Darwin Katherine Cairns Mackay Rockhampton Townsville Port Hedland Broome........ Carnarvon. Risk region for high emissions scenario, 2050

8. Climate Change Influences on Health in Australia Already apparent: baseline risks amplified by underlying climate change Uptrend in av annual no. of heat-days  deaths, hospitalisations Increases in no./severity bushfires  injury/death, resp. hazard, mental health Severe flooding (due to increased sea-surface temp, increased rainfall?) Probable current health impacts: but not yet clearly identified Rising rates of some food-borne enteritis (diarrhoeal) diseases Altered (urban) air quality: ozone formation, aeroallergens Mental health impacts, esp. in some (drying) rural regions: e.g. MD Basin Predicted future health impacts More extreme weather events  trauma/deaths, infectious disease, depression Water shortages, affecting food yields, domestic hygiene Mosquito-borne infections – shifts in range and seasonality: Dengue, Ross River virus, Barmah Forest virus, Japanese encephalitis, etc. Increased thermal stress at work, esp. in outdoor workers and under-ventilated factories: accidents/injuries, organ damage; reduced work capacity

9. Sahara dries Acute cooling: 536 CE ‘Event’ Mediaeval Warm Period, Europe Roman Warm Period Holocene Climatic Optimum I, II Drought & cooling in East Mediterranean region 11 10 9 8 7 6 5 4 3 2 1 0 2 4 6 8 10 12 14 16 18 20 22 Millennia BCE (1000s of yrs)Centuries CE (100s of yrs) Variations in NH Temp, o C (rel. to Holocene average) +4 +3 +2 +1 0 -2 -3 BCE/CE Post-glacial warming following Younger Dryas cooling, 12.8-11.6K BP Modelled range of projected global temperature rise to 2100 (vs.1990) = + 2-5 o C Little Ice Age: Europe, China Holocene Changes in Average Northern Hemisphere Temperature over the Past 11,000 Years Early agrarian societies begin to form: Egypt, Sumer, southern China Faster warming since 1975 Acute cooling: Tambora eruption 1815 AJ McMichael, 2012)

10. 1500 1550 1600 1650 1700 1750 1800 War Fatality Index, Europe Nth Hemi- sphere Temperature Variation o C Rate of Migrations, Europe European Temperature Variation standardised units Cold Period 1570-1660 Zhang et al., PNAS, 2011 Europe’s coldest period, 1570-1660, during Little Ice Age Food yields down, grain prices tripled … conflict, war, displacement Famine-years/decade x 2 Epidemic rate x 3 Adult height ↓1.5cm

11. Adapted from Zhang et al, 2009 The ‘Little Ice Age’

12. Hsiang et al., Nature 2011 Affected (n= 93 countries) (n= 82 countries) Probability of new civil conflicts breaking out in El Niño years is double that seen in cooler La Niña years Annual Civil Conflict Rate (% of countries embroiled) El Niño Index (NINO 3 : May-Dec average Sea-Surface Temperature) Civil Conflicts, 1950-2004, in Countries Affected or Not/Little Affected by ENSO Stronger Weaker

13. Now, over to Colin Butler ………