Socioeconomic inequalities in health: the facts and the options

1
Climate change pathway Heatwave, August 10, 2003
Excess Mortality - France 14,800 - Italy 10,00
0 - Portugal Spain 5,000
Source McMichael 2005
2
Climate change pathwayChanges in distribution
of infectious diseases

• Many infectious diseases are climate-sensitive
  especially vector-borne diseases
• Some recent changes in infectious disease
  patterns may reflect influence of climate change
• Tick-borne encephalitis (Lyme disease, Sweden)
• Cholera in Bangladesh
• Malaria in east African highlands
• Time-trends in food-borne (infectious) disease

3
Changes in the frequency of Lyme disease in the
Netherlands, 1994-2001
4
Extreme weather events and disease outbreaks
related to climate change, 1998
5
Climate changeLong term impacts on human health
(1) (Netherlands Environmental Planning Agency)

• Temperature rise 1 to 6 (2100)
• Precipitation more droughts, more heavy rainfall
• Sea level rise 20 to 110 cm (2100)
• Nature species boundaries 400 km North (2100)
• Agriculture higher yields, more frequent
  failures
• Recreation more attractive for tourists,
  likelihood Elfstedentocht far below 10 per
  winter

6
Climate changeLong term impacts on human health
(2) (Netherlands Environmental Planning Agency)

• Less cold-related, more heat-related mortality
• Higher frequency of Lyme disease, perhaps of
  food- and water-borne infections
• More allergies related to pollen
• Includes reliably predictable impacts only. Risks
  of flooding? Food security? Non-linear ecosystem
  disturbances? Economic and political instability?
  

7
Public health researchHow can it help?

• Better understanding current health impacts,
  scenario-analyses
• Adaptation health management of extreme weather
  events, control emerging infections
• Improve sustainability of health care
  footprinting, improve health care practice

8
Three Main Types of Research(Source McMichael
2005)
Forecasting, modelling
9
Barriers to implementing a global environmental
change research agenda

• Uncertainty about risks gives uncertainty about
  research priority
• New research methodologies needed (indirect,
  delayed, multiple health impacts)
• Public health researchers tend to be prisoners
  of the proximate (McMichael 2000)

10
Conclusions

• Global environmental changes pose potentially
  great, but currently uncertain risks to human
  health
• It is public healths responsibility to help
  society cope with these risks
• Global environmental changes therefore are one of
  the main challenges for public health
• Reducing uncertainty and developing solutions
  where necessary are crucial