Training for health professionals

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Training for health professionals
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Overview

• Direct and indirect impacts
• Projected health impacts
• Global health impacts

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Direct / indirect impacts

• Climate change can impact directly on health
  e.g. through UV radiation, heat stress, accidents
  caused by storms.
• It can also impact indirectly e.g. by altering
  conditions for disease vectors, reducing
  agricultural productivity, and triggering
  conflict over scarce resources.

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Direct / indirect impacts
"The intimate connection between food security,
water security, energy security and climate
change - to deal with one in isolation is to
present enormous problems Professor John
Beddington, Chief Scientific Advisor to the
Government, speaking at The Climate Connection
national launch, 2nd December 2008
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Climate Change is Happening Now
Source IPCC 2007 (4th Assessment)
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IPCC 2007 Human Impact is Evident
Source IPCC 2007 (4th Assessment)
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Projected Impacts of GlobalTemperature Change
1C
2C
5C
4C
3C
0C
Food
Falling crop yields in many areas, particularly
developing regions
Falling yields in many developed regions
Possible rising yields in some high latitude
regions
450 ppm CO2 eq
Water
Significant decreases in water availability in
many areas, including Mediterranean and Southern
Africa
Small mountain glaciers disappear water
supplies threatened in several areas
Sea level rise threatens major cities
Ecosystems
Extensive Damage to Coral Reefs
Rising number of species face extinction
650 ppm CO2 eq
Extreme Weather Events
Rising intensity of storms, forest fires,
droughts, flooding and heat waves
Risk of Abrupt and Major Irreversible Changes
Increasing risk of dangerous feedbacks and
abrupt, large-scale shifts in the climate system
Source L. Rudolph, 2008
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Climate Changes Impacts on Health
Source Haines, et al, JAMA 2004
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Extreme Weather Events Disease Clusters
Source Epstein, Harvard Center for Health
Global Environment
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Human Changes to Global Activated Nitrogen Cycle,
1900-2050

• Human health risks include
• Decreased crop yields
• Nitrogen oxides (air pollution)

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National Carbon Dioxide Emissions
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Total CO2 Emissions
UNEP 2009
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Health Burden of Climate Change Impacts
Deaths from malaria and dengue fever, diarrhoea,
malnutrition, flooding, and (in OECD countries)
heatwaves
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Painful spots

• Core knowledge the effects of climate change on
  current responsibilities of Environmental Health
• air, water, food, pest control, home health
• Areas for development Environmental Health
  Practitioners as agents for carbon reduction and
  adaptation.
• air, carbon, water, food, housing

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Climate change affects the current
responsibilities of Environmental Health

• Air quality
• Water safety
• Food safety
• Pest control
• Housing

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Air qualityClimate change impacts

• Increasing temperatures combine with air
  pollution to increase ground level ozone, causing
  morbidity from respiratory disease.
• Tighter controls on pollution to air may be
  needed just to maintain current air quality.
• Surveillance and early warning systems for
  vulnerable groups.

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China Haze 10 January 2003
NASA
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Health impacts of climate change
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Projected impacts

• Heatwave-related health problems
• Cold-related illness deaths
• Air pollution
• Flooding
• Infectious diseases - food borne, waterborne and
  vector-borne diseases
• Exposure to UV radiation
• Extreme weather-related events
• New threats appropriate responses
• Possible supplementary health benefits

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Pathways for Weather to Affect Health Example
Diarrheal Disease
Distal Causes
Proximal Causes
Infection Hazards
Health Outcome
Temperature Humidity Precipitation
Survival/ replication of pathogens in
the environment
Consumption of contaminated water
Incidence of mortality and morbidity attributable
to diarrhea
Contamination of water sources
Consumption of contaminated food
Living conditions (water supply and sanitation)
Contact with infected persons
Contamination of food sources
Food sources and hygiene practices
Vulnerability (e.g. age and nutrition)
Rate of person to person contact
WHO
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Effect of Temperature Variation on Diarrheal
Incidence in Lima, Peru
Daily Diarrhea Admissions
Daily Temperature
Diarrhea increases by 8 for each 1ºC increase in
temperature
Checkley et al., 2000
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Pathways from Driving Forces to Potential Health
Impacts
Corvalan et al., 2003
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Climate Change may entail changes in variance, as
well as changes in mean
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Methods for

• Estimating the current distribution and burden of
  climate-sensitive diseases
• Estimating future health impacts attributable to
  climate change
• Identifying current and future adaptation options
  to reduce the burden of disease

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Estimate Potential Future Health Impacts

• Requires using climate scenarios
• Can use top-down or bottom-up approaches
• Models can be complex spatial models or be based
  on a simple exposure-response relationship
• Should include projections of how other relevant
  factors may change
• Uncertainty must be addressed explicitly

After Kovats et al., 2003
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Sources of Uncertainty

• Data
• Missing data or errors in data
• Models
• Uncertainty regarding predictability of the
  system
• Uncertainty introduced by simplifying
  relationships
• Other
• Inappropriate spatial or temporal data
• Inappropriate assumptions
• Uncertainty about predictive ability of scenarios

Kovats et al., 2003
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Estimating the Global Health Impacts of Climate
Change

• What will be the total potential health impact
  caused by climate change (2000 to 2030)?
• How much of this could be avoided by reducing the
  risk factor (i.e. stabilizing greenhouse gas
  (GHG) emissions)?

Campbell-Lendrum et al., 2003
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Comparative Risk Assessment
Greenhouse gas emissions scenarios
Global climate modelling Generates series of
maps of predicted future climate
Health impact model Estimates the change in
relative risk of specific diseases
Campbell-Lendrum et al., 2003
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Criteria for Selection of Health Outcomes

• Sensitive to climate variation
• Important global health burden
• Quantitative model available at the global scale
• Malnutrition (prevalence)
• Diarrhoeal disease (incidence)
• Vector-borne diseases dengue and falciparum
  malaria
• Inland and coastal floods (mortality)
• Heat and cold related CVD mortality

Campbell-Lendrum et al., 2003
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Potential health benefits

• Due to both direct indirect effects
• Increased physical activity due to extended warm
  weather. But, outcomes could be worse due to
  extreme heat
• Reduced obesity and road traffic injuries through
  active transport
• Possibly healthy eating through adoption of
  sustainable farming food policy and diets
  containing less animal products
• Reduced respiratory illness by improvements in
  air quality
• Increased home energy efficiency reducing
  temperature-related illness

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Global health impacts of climate change
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Global health impacts
Climate change affects the most fundamental
determinants of health air, food, water,
shelter, freedom from disease. The impacts on
human health are not evenly distributed.
Developing country populations, particularly in
small island states, arid and high mountain
zones, and in densely populated coastal areas,
are first and hardest hit.
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WHO five major health impacts of climate change

1. Malnutrition
2. Deaths and injuries caused by storms and floods.
   (Flooding can also be followed by outbreaks of
   diseases, such as cholera)
3. Water scarcity / contamination (droughts and
   sudden floods) increased burden of diarrhoeal
   disease.
4. Heatwaves direct increases in morbidity and
   mortality indirect effects via increases in
   ground-level ozone, contributing to asthma
   attacks.
5. Vector-borne disease malaria and dengue.

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Major global killers are affected by climate

• Each year
• Weather related disasters kill over 60,000
• Undernutrition kills 3.5 million
• Diarrhoea kills 2.2 million
• Malaria kills 900,000
• (WHO, 2003, 2008)

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Climate Negotiations
Why the health sector?

• Can take the long view
• Understands the science
• Other health initiatives will be overtaken by the
  effects of climate change
• Action on climate change has health effects
  itself
• Positive (health co-benefits)
• Negative

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Main objectives for international public health

• Raising awareness of the health implications of
  climate change
• 2) Strengthening partnerships to place health at
  the centre of climate change policy
• 3) Generating evidence on the health effects of
  adaptation and mitigation policies
• 4) Strengthening public health systems to cope
  with additional threats posed by climate change

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1. Raising awareness
With impoverished populations in the developing
world the first and hardest hit, climate change
is very likely to increase the number of
preventable deaths. The gaps in health outcomes
we are trying so hard to address right now may
grow even greater. This is unacceptable. Climate
change and health preparing for unprecedented
challenges. WHO Director General Margaret
Chan. December, 2007
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2. Partnerships to raise the profile of health in
climate change policy

• Why health should be central
• Main reasons for concern (e.g. disasters, food
  shortage, displacement, disease) are health and
  wellbeing issues
• Most energy and environment decisions (e.g.
  choice, use of fuel sources) have major direct
  health implications

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3. Providing Evidence - Health Adaptation

• Describing risks from national to global level
• Measuring the effectiveness of interventions
• Evaluating health effects from decisions in other
  sectors
• Improving decision-support tools
• Assessing the financial costs

Protection of handwashing against diarrhoea,
highlighting studies in water-stressed
situations. Adapted from Curtis V, Cairncross S.
2003 Lancet Inf Dis 3275-281
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3. Providing Evidence Improving health while
reducing greenhouse gas emissions
"Health benefits from reduced air pollution as a
result of actions to reduce greenhouse gas
emissions may offset a substantial fraction of
mitigation costs" IPCC, 2007 We have an
opportunity to reduce - The 800,000 annual
deaths from urban air pollution, and the 1.6
million from indoor air pollution - The loss of
1.9 million lives, and 19 million years of
healthy life, from physical inactivity - The 1.2
million deaths and over 50 million injuries from
road traffic accidents

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4. Strengthening public health systems

Much of "adaptation" is basic, preventive public
health Improved surveillance and response E.g.
heatwave warnings, compliance with International
Health Regulations to prevent international
spread of disease. Better management of
environmental health determinants Provision of
safe water and sanitation, control of air
pollution

• Strengthened action on diseases of poverty
  Including wider coverage with vector control and
  vaccination programmes.

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DISCLAIMER The views expressed in this
presentation are those of the authors within the
Climate TRAP project and do not necessarily
reflect the views or policies of any
participating organisation.