1. Fourth Ministerial Conference on Environment and Health, Budapest, 23-25 June 2004 Global public health and climate change Roberto Bertollini, MD MPH Senior Adviser Public Health and the Environment WHO – Geneva

2. Fourth Ministerial Conference on Environment and Health, Budapest, 23-25 June 2004 Climate change

3. Fourth Ministerial Conference on Environment and Health, Budapest, 23-25 June 2004 Climate change

4. Global public health and climate change 6 |6 | UN High level meeting on climate change, September 2007 72 Heads of State 67 Senior Ministers

5. Global public health and climate change 7 |7 | Global Climate Change and Human Health How are climate change and human health linked? What health effects have been observed already, and what can we expect in the future? How do we need to respond?

6. Global public health and climate change 8 |8 | The Intergovernmental Panel of Climate Change Fourth Assessment Report 70000 new studies >2500 scientists involved 6 years -1 report 4 governmental approval sessions

7. Global public health and climate change 9 |9 | Rising atmospheric temperature Rising sea level Reductions in North Hemisphere snow cover Warming is Unequivocal

8. Global public health and climate change 10 | Last Ice Age Last interglacial 350 300 250 200 Carbon Dioxide Amount (ppmv) 6005004003002001000 Thousands of Years Before Present [Adapted from Figure 6.3, © IPCC 2007: WG1-AR4] CO2 has not been this high in more than half a million years.

9. Global public health and climate change 11 | Extreme events are more frequent Adapted from IPCC (2007) Summary for Policymakers. Contribution of Working Group I.

10. Global public health and climate change 12 | Stott et al, nature, 2004 Climate change made the European heatwave of 2003 more likely… 2003 Heatwave

11. Climate change Direct exposures (temperature, precipitation, sea level rise, extreme events) Environ- mental conditions Indirect exposures (changes in water, air, food quality; vector ecology; ecosystems, agriculture, industry and settlements) Health impacts Health system conditions Social & economic disruption Social conditions (‘upstream’ determinants of health) Modifying influence * * Confalonieri, Menne et al, 2007 The relationship between health and climate change

12. Global public health and climate change 14 | Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement CLIMATE CHANGE Based on Patz et al, 2000 The health effects of climate change The health effects of climate change Some expected impacts will be beneficial but most will be adverse. Expectations are mainly for changes in frequency or severity of familiar health risks

13. Global public health and climate change 15 | Global Climate Change and Human Health How are climate change and human health linked? What health effects have been observed already, and what can we expect in the future? How do we need to respond?

14. 29 august Established surveillance system. Serological analysis confirms Chikungunya Cronology of an epidemic 21 june First imported case to Castiglione di Cervia from India 23 june First case develops symptoms of Chikungunya 4 july First case of Chikungunya in a locally resident person 18 august Start of disinfection of public areas and information to people on how to protect themselves 13 september 254 cases. 79 laboratory confirmed Age between 1-95 anni. 52% females. 3° week in August Epidemic peak

15. Global public health and climate change 17 | …is exposing additional populations to infection with Schistosoma japonicum… (Yang, Vounatsou, et al. 2005). Freezing zone 1960-90 Freezing zone 1970-2000

16. Global public health and climate change 18 | What will happen, and what could happen? 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 850 600 Even if we stop emitting today 0.6 o C = 1.0 o F IPCC, WG 1

17. Global public health and climate change 19 | Many of the major killers are climate sensitive -Each year: - Undernutrition kills 3.7 million - Diarrhoea kills 1.8 million - Malaria kills 1.1 million Each of these is highly sensitive to temperature and precipitation:

18. Global public health and climate change 20 | How sensitive is health to climate? Diarrhoea How sensitive is health to climate? Diarrhoea Incidence of diarrhoeal disease is strongly related to climate variables. In Lima, Peru, diarrhoea increased 8% for every 1 0 C temperature increase. (Checkley et al, Lancet, 2000) Diarrhoea admissions Daily measurements Jan 1993 – Dec 1998 Temperature

19. Global public health and climate change 21 | Climate change is expected to increase the proportion of the global population exposed to dengue from about 35% (upper figure), to 50-60% (lower figure), by 2085. Hales et al, Lancet 2002 Future climate change and dengue

20. Global public health and climate change 22 | Cumulative emissions of greenhouse gases Countries scaled according to cumulative emission in carbon equivalent to 2002. Patz et al, Ecohealth, December 2007

21. Global public health and climate change 23 | Health impacts of climate change WHO regions scaled according to WHO estimates of mortality per million people in the year 2000, attributable to the climate change that occurred from 1970s to 2000. Patz et al, Ecohealth, December 2007

22. Global public health and climate change 24 | Global Climate Change and Human Health How are climate change and human health linked? What health effects have been observed already, and what can we expect in the future? How do we need to respond?

23. Global public health and climate change 25 | 1. Health security 2. Strengthening health systems 3. Health development 4. Evidence and information 5. Delivery 6. Partnerships Six focus areas for WHO, public health, and climate change

24. Global public health and climate change 26 | 1. Health Security

25. Global public health and climate change 27 | 2. Strengthening health systems

26. Global public health and climate change 28 | Health sector actions as climate change adaptations Healthy development Environmental health capacity building Integrated vector management Health action in emergencies Infectious disease surveillance Safe drinking water Diseases affected by climate

27. Global public health and climate change 29 |

28. Global public health and climate change 30 | 3. Health Development

29. Global public health and climate change 31 | Buildings Indoor air pollution Heat and cold protection Protecting health while reducing Emissions Energy supply & conversion Occupational risks; Construction and transport Agriculture Nutrition, Water / vector-borne disease Transport Air pollution Traffic injuries Physical inactivity Industry Occupational risks, mining and transport Waste Occupational, chemical Greenhouse Gas Emissions

30. Global public health and climate change 32 | The opportunity for improving health determinants Can we reduce: The 800,000 annual deaths from urban air pollution The loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity The 1.2 million deaths and over 50 million injuries from road traffic accidents

31. Global public health and climate change 33 | Evidence, Delivery, Partnerships

32. Global public health and climate change 34 | Research for Improved Tools Can you accelerate development of tools to control diseases which are increasing rapidly, such as dengue? Can you help us measure the effectiveness of interventions to address emerging health threats, such as heatwaves?

33. Global public health and climate change 35 | Research for Improved Health Systems Can you help us adapt existing surveillance systems, anticipate risks and reduce human health impact? Can you help us improve delivery systems to meet the new challenges of climate change?

34. Global public health and climate change 36 | Research for Improved Policies Can you help assess better the health impacts of major policies related to climate change? Can you help assess the costs to health of (in)action to mitigate and adapt to climate change?

35. Global public health and climate change 37 |

36. Global public health and climate change 38 | “The health sector has been much too separatist in the past. It has been thinking that all it has got to do is run a healthcare system and traditional public health. Climate change is telling us that no, that’s not good enough. We’re going to have to be more imaginative, more collaborative, and be prepared to look to a more distant future as well as deal with the problems that press on us in the here and now.” “We’ve got to get more imaginative about working with other sectors, other arms of government, making the argument that every ministry is a health ministry. British Medical Journal, 29 September 2007; 335:636

37. Global public health and climate change 39 | La salute e l’ambiente Strumenti di prevenzione sanitaria – R. Bertollini, OMS Europa

38. Global public health and climate change 40 | Just as we fought so long to secure a high profile for health on the development agenda, we must now fight to place health issues at the centre of the climate agenda. I personally believe that the inevitability of climate change makes it all the more imperative for us to reach the Millennium Development Goals. Director General’s Speech at the 57 session of the WHO Regional Committee for Europe Beograd, 18 September 2007

39. Global public health and climate change 41 | The face of climate change ?

40. Global public health and climate change 42 | World Health Day April 7 th 2008 Protecting Health from Climate Change www.who.int/globalchangewww.who.int/globalchange/climate