1. Climate Change and health Paul Fisher Specialty Registrar in Public Health Honorary Research Fellow Room 412, 4th Floor School of Geography, Earth and Environmental Sciences College of Life and Environmental Sciences University of Birmingham 13.00 – 15.30

2. Overview Climate change Global Issues Health impacts of climate change - National document - MPH Dissertation - Regional Project Surveillance Planning NHS Projects in the region Internet resources

3. Human activities global emissions by sector, 2000

4. Are greenhouse gas concentrations and temperatures really rising?

5. Source: IPCC 4 th Assessment Report

6. Are temperatures rising? Annual anomalies of global land-surface air temperature (°C), 1850 to 2005, relative to the 1961 to 1990 mean. Source: IPCC 4 th Assessment Report

7. Aren’t temperature variations a natural phenomenon?

8. Natural cycles occur due to tilt of the earth in relation to the sun, and volcanic eruptions releasing particles into the air. Based on those factors, models would predict a cooling over the last 50 years. Only when human activities are factored in, are the current temperature rises explained.

9. Aren’t even scientists unsure about global warming?

10. More than 2,500 scientific expert reviewers were involved in the Intergovernmental Panel on Climate Change (IPCC) 2007 report. The report concludes: Warming of the climate system is unequivocal. Greenhouse gas concentrations have increased as a result of human activities. There is very high confidence* that the net effect of human activities since 1750 has been one of warming. * = >9/10 probability The IPCC Source: IPCC 4 th Assessment Report (2007)

12. Cumulative emissions of greenhouse gases, to 2002 WHO estimates of per capita mortality from climate change, 2000 Why the response needs to be global Map projections from Patz et al, Ecohealth 2007. WHO Comparative Risk Assessment estimated that by 2000, climate change that had occurred since the 1970s was causing over 150,000 additional deaths per year (WHO, 2002, McMichael et al 2004)

13. Climate extremes Simple extremes Heavy rainfall, high temperature Complex extremes Cyclones, ice storms, drought, El Nino-Southern Oscillation (ENSO) events Unique phenomena Collapse of ice sheets, cessation of thermohaline circulation

15. Major flood disasters 1971-1995 318,000 dead, 81 million homeless,1.5 billion affected Decadenumbercost 1950s6$35 bn $300 bn 1960s7 1970s8 1980s18 1990s26

16. Projected EU climate in 2071

17. For summer average temperature, we see significant increases to the 2080s 2080 +3.7ºC 2040 +2.2ºC 2020 +1.5ºC 17 West Midlands central estimate Medium emissions Increased Tourism Increased Heat stress Infrastructure risks Risks to biodiversity Heat related deaths Risk to Food Security Increased Tourism Increased Heat stress Infrastructure risks Risks to biodiversity Heat related deaths Risk to Food Security The change for the 2080s is very unlikely to be less than 2ºC and very unlikely to be more than 6.1ºC But the temperature on the hottest day of the year could increase by up to 10ºC

18. For rainfall we could see significant summer decreases 18 Reduced stream flow and water quality Increased drought Subsidence Decreased crop yields Serious water stress Reduced stream flow and water quality Increased drought Subsidence Decreased crop yields Serious water stress 2080 -20% 2040 -11% 2020 -6% For the 2080s the change is very unlikely to be lower than -43% and very unlikely to be higher than +6% West Midlands central estimate Medium emissions

19. For rainfall we see significant winter increases 19 Increased winter flooding Increased subsidence Risks to urban drainage Severe Transport disruption Risks of national Infrastructure Increased winter flooding Increased subsidence Risks to urban drainage Severe Transport disruption Risks of national Infrastructure 2080 +18% 2040 +11% 2020 +5% For the 2080s the change is very unlikely to be lower than +3% and very unlikely to be higher than +39% West Midlands central estimate Medium Emissions But rainfall on the wettest day of the year could increase by up to 30%

20. The major areas identified in ‘Health Effects of Climate Change in the UK’, 2001/02; updated 2008 Climate change: gradual change + sudden events Flooding, windstorms Vector-borne diseases Foodborne disease Waterborne disease Direct effects of rising temperatures Changes in air pollution Ultraviolet radiation

21. Malaria Pre 1820: malaria common in –Thames estuary –Somerset levels –Severn estuary Draining marshes + better domestic hygiene = decline in malaria

22. Cold related illness Food poisoning Waterborne diseases due to increases in temperature Waterborne diseases and water pollution Psychological and mental health impacts Pests Sunburn and skin cancer Food poverty and security

23. Salmonellosis and temperature rise Modelled association between temperature and number of reported cases of salmonellosis in England and Wales (adjusted for outbreaks, seasonal factors and holidays) © S. Kovats (Data supplied by HPA)

24. Global Minimum Mortality Temperatures (T MM )

27. Summer, winter and net daily mortality for the West Midlands with increasing temperature

28. Uncertainties and confounders

29. …cont

32. Cardiovascular Disease A class of diseases involving the heart and/or blood vessels Epidemiology: Detected most in adults >65 years Can be exacerbated by high and low temperatures Current trend: Increased mortality during winter and hot summer weather Minimum mortality between 15-18 o C Minimum mortality between 15-18 o C Source: WMPHO and BADC (British Atmospheric Data Centre)

33. Source: WMPHO and Met Office UK Projections for Excess CVD Mortality (High Emissions Scenario: Central Estimate)

34. Respiratory Disease A disease effecting the respiratory system Excess RD Admissions per year in 2080s (High Emissions Scenario) Annual Decrease of up to 7209 admissions High number of respiratory disease admissions during cold and very warm weather Minimum hospital admissions at 18-20 o C Minimum hospital admissions at 18-20 o C

35. Allergens and Pollution Hay Fever Allergy to pollens in the atmosphere Epidemiology: Frequently seen in children and adolescents Incidence has increased throughout the last century Worst effects in spring and summer Hay Fever and Climate Change: 2 in every 10 people in the UK Milder winter and earlier spring means prolonged allergenic conditions Ozone Episodes Can lead to respiratory problems High concentrations of Ozone can: Impair pulmonary function Cause lung inflammation Affect lung permeability Affect lung permeability An increase in 8 hour mean ozone levels to 50ppb could lead to a 53% increase in deaths and admissions

36. Food and Water Borne Diseases Diseases caused by ingestion of contaminated food or water Transmission: Contaminated food Contaminated food Direct contact with animals Direct contact with animals Drinking or bathing in contaminated water Drinking or bathing in contaminated water As a result of heavy rain and floods As a result of heavy rain and floods Many different food and water borne diseases… Many different food and water borne diseases…

37. Campylobacter and Temperature Sources: REU (Regional Epidemiological Unit) UKMO (UK Met Office) There might be an additional 179,000 cases of food poisoning in the UK by the year 2050 as a result of climate change Excess Campylobacter cases per year in 2080s (High Emissions Scenario) AnnualIncrease of up to 1277 reported cases