Health Impacts of Climate Change and Health

Conference: Public health benefits of strategies to reduce

greenhouse gas emissions
London School of Hygiene and Tropical Medicine
25 Nov 2009
A.J. McMichael
National Centre for Epidemiology and Population Health
The Australian National University
Canberra, Australia

Outline
1. Political context
2. Climate change: summary of recent science
3. Health Risks and Impacts
1. Research tasks; impact pathways
2. Examples: infectious disease, food yields/under-nutrition

4. Adaptation, Mitigation and Co-Benefits

5. Conclusion

Climate and Health Council

Letter to Yvo de Boer, Exec Sec, UN Framework
Convention on Climate Change, Nov 10, 2009
Whilst human-induced climate change looms as the
greatest threat to public health this century, the hopeful
health message is:
What is good for the climate is good for health.
There is ample evidence to support this.

The Cassandra Effect

One who foresees, on available evidence,
a likely disaster; yet judges that this cant
be prevented and, that anyway, others
wont believe the forecast.
CC is counter-intuitive: How could
humans do that?
Climate vs. weather confusion
Cover-up of ignorance
Influence of hired pens/lobbyists
Resistance (esp. from ideological Right)
to calls for collective action and
government intervention. Spectre of
world government.

LSHTM as epicentre: Potted History

1993-95: Health chapter, IPCC Second Assessment Report (1996)*: McMichael
(co-chair), Haines, Kovats, et al
1996: WHO/UNEP book Climate Change and Human Health (eds: McMichael,
Haines, Slooff, Kovats)
1999: McMichael AJ, Haines A (eds) Climate Change and Impacts on Human
Health. London: Royal Society
1995-2000: LSHTM as international leader in CC/Hlth research; MRC (first)
Program Grant awarded, 2000 (LSHTM, Univ East Anglia)
1998-2000: Health chapter, IPCC Third Assessment Report (2001)

2003-06: Health chapter, IPCC Fourth Assessment Report (2007)

2001-2004: WHO contract: estimation of burden of disease attributable to CC

2000s: Special reports with/for WHO Vulnerability, Adaptation, etc.
2008: UK Dept Health: Health Effects of Climate Change in UK: ed. Kovats
* no health chapter in IPCC First Assessment Report

Correlation between atmospheric carbon dioxide

concentration and Earths average surface temperature
14.5

390
370

CO2
ppm

350

Earths Temperature
(background wobble due
to natural influences)

14.3

CO2
concentration

330

14.1 Temp

13.9

310

13.7

290
13.5
1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000
270

Year
Graph from: Hanno, 2009

Greenhouse Gas Concentrations and

Temperature Rise: Recent Science
Global av temperature: clearcut (albeit naturally wobbly) uptrend
Geophysical fingerprints implicate increased GHG concentration as
main cause of 0.7oC rise since 1950
Global climate models, now highly-coupled, perform well on record
of past forcings/temperature relationship globally and regionally
Six internationally-agreed plausible human futures scenarios (i.e.
story-lines yielding GHG emissions at high, medium, low levels)
Repeated runs with many models yield a range of best central
estimates for the 6 scenarios of 1.8-4.0oC, by 2100 [IPCC 2007]
Range in projected temperature rise to 2030-40 mostly due to
residual uncertainties about climate system response to existing or
imminent atmospheric GHGs
Uncertainties re warming in later decades mostly reflect unknowable
human futures

Earths Temperature Chart, since

Dinosaur Extinction 65m yrs ago
Arctic ice
sheets
East Antarctic
West Antarctic
ice sheet
ice sheet
Paleocene

12

8
+5oC

4
0
Temp oC * (vs

+3oC

+1.5oC

1961-90 av temp)

60myr

50myr

40myr

30myr

20myr

Millions of Years Before Present

* Temp
measured at
deep ocean

last 2m yr
= iceage

10myr

Now

Sea level 25-40

metres higher
than today
Tripati et al Science
2009

Climate Change
occurring faster
than expected
IPCCs Fourth Assessment Report (2007) now looks
conservative [in addition to cautious review process]
Subsequent research shows increasing rates of:
Global Greenhouse Gas emissions
Ice melting (Arctic sea ice, Greenland/Antarctic ice-sheets, alpine glaciers)
Sea level rise

1m: half of Bangladesh rice fields

2m: most of Mekong Delta

Also:
Increasing saturation of carbon sinks (land and oceans)
Estimated amount of carbon stored in permafrost
= twice the atmospheric carbon

Cyclone Ketsana,
Sept 2009
Approaching Vietnam
Hoi An,
Central Vietnam

Northern Cambodia

Rainfall estimates,
NOAA(USA), Sept 29

Climate Change and Health

Research Tasks and Policy Foci
Unintended
health effects

Natural
environmental
processes

Human pressure
on environment

Human society:
Population size
Economic activity
Culture, governance

Adaptation: Reduce
health impacts/risks
3

Climate - environmental
changes, affecting:

Human impacts:
Livelihoods

Meteorological conditions
Water flows
Food yields
Physical (protective) buffers
Microbial activity
Extreme weather events

Social stability

1a-c

Health

Health Cobenefits?

Mitigation of Climate
Change: Reduce GHG
emissions
Based on: McMichael et al., Brit med J, 2008

Need for local

prevention

Risks to
humans better
understood

Climate Change: Health Impact Pathways

Physical
systems

(river flows, soil

moisture, ocean temp)

Climate
Change
Impacts
Direct impacts

(extreme weather
events, heatwaves,
air pollutants, etc.)

Biological
cycles, in
nature &
Ecological
links/function
Human Health:

Injuries/deaths
Thermal stress
Infectious diseases
Under-nutrition
Mental stresses
Other disorders

Economic/social
impacts: infrastructure,

farm/factory production, GDP

growth, jobs, displacement
Indirect
health
impacts
ecologically
mediated

Indirect
health
impacts
socially
mediated

Climate Change: Multiplier of

Conflicts and Regional Tensions

Regions afflicted by problems

due to environmental stresses:
population pressure
water shortage
climate change affecting crops
sea level rise
pre-existing hunger

armed conflict, current/recent

From UK Ministry of Defence

[May RM, 2007 Lowy Institute Lecture. Sydney]

Deaths and DALYs attributable to Climate Change, 2000 & 2030

Selected conditions in developing countries

Deaths

Total Burden

Flo o d s

M a lar ia

Now (2000)
D ia rr h oea

Future (2030)

Ma ln u tritio n

120

10 0

80

60

40

20

Deaths (thousands)

10

DALYs (millions)
2000

2030

WHO/McMichael,Campbell-Lendrum, Kovats et al,

2004

Climate and Infectious Disease

Climatic conditions set geographic and
seasonal limits of potential transmission.
Other environmental, social and
behavioural factors and public health
strategies determine where/when
actual transmission occurs.

Model-fitted relationship of monthly Salmonellosis

case counts in relation to monthly av. temperature in
five Australian cities, 1991-2001
100

Sydney
Melbourne
Brisbane
Perth
Adelaide

Salmonella count

90
80
70
60
50
40
30
20
10
0
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Average MonthlyTemperature oC

DSouza et al., 2003

Daily hospitalizations for diarrhoea, by daily

temperature: Lima, Peru.
(Shaded region is 1997-98 El Nio event)
Checkley et al, Lancet 2000

Daily Hospitalisations

Overall estimate from

regression analysis:
7% increase in daily cases
o
per
1
C rise
Daily temperature

1993

1997

Estimated Mortality Impacts of Climate Change: Year 2000

Estimated annual deaths due to climate change: malnutrition
(~80K), diarrhoea (~50K), malaria (~20K), flooding (~3K)

14 WHO regions scaled according to estimated annual death rates

due to the change in climate since c.1970.
(Patz, Gibbs et al, 2007: based on McMichael, Campbell-Lendrum, Kovats, et al, 2004)

Bluetongue virus: Has

climate change caused a
northwards extension,
in Europe, of Culicoides
midge vectors?

2004: Northern range* of virus (in sheep)

2004: Northern limit C. imicola midge
1998: Northern range of virus (in sheep)
1998: Northern limit C. imicola midge
* Suggests
additional midge
species are also
now contributing

Midge species: potential vectors of BT Virus

C. pulcaris
C. obselitus
C. imicola
Northern limit

Current northern limit

Southern limit

Northern limit < 1998

[European Midge species]

Source: Purse et al, 2005

Nature Reviews Microbiology

Schistosomiasis: Modelled Future Impact of Climate

Change on Schistosoma japonicum Transmission in China
Now

Recent data suggest that

schistosomiasis is reemerging in some settings
[with previous successful
disease control]. .
Along with other reasons,
climate change and ecologic
transformations have been
suggested as the underlying
causes.

o
2030:
+
0.9
C
Northwards

drift, over
past 4 decades, of the
winter freezing zone
that limits water-snail
survival associated with
1-1.5oCotemperature rise
2050: + 1.6 C
in SE China

Source: Zhou et al., Potential Impact of Climate

Change on Schistosomiasis Transmission in China
Am J Trop Med Hyg 2008;78:188194.

DENGUE FEVER: Estimated geographic region suitable

for A. aegypti vector, and hence transmission:
Climate conditions now and in alternative scenarios for 2050
Darwin

Darwin

Broome

Port Hedland

.
.

Katherine

.
.

Katherine

..

Cairns
Townsville

Townsville

.
2050 risk region: Medium GHG.
.
emissions scenario
Port Hedland

Mackay
Rockhampton

.
Current risk region, for

.
.

Cairns

Broome

Mackay

Carnarvon

Brisbane

Rockhampton

dengue transmission

Brisbane

Darwin

Katherine

Townsville

Port Hedland

Global statistical model (Hales), applied to

Australia: mosquito survival in relation to
water vapour pressure (rainfall, humidity).

.
.

Cairns

Broome

Mackay

2050 risk region: High GHG

Carnarvon
emissions scenario

Rockhampton

Brisbane

NCEPH/CSIRO/BoM/UnivOtago, 2003

Malaria Transmissibility: Temperature and Biology

Plasmodium

---------------- Mosquito -----------------Survival probability

Biting frequency

Incubation time

50

20
10
0

(per day)

(days)

30

0.3

(per day)

P.vivax
P.falciparum

40

0.2
0.1

20

25

30

35

40

0.4

0
10

Temp (C)

0.6

0.2

0
15

0.8

15

20

25

30

35

40

10

Temp (C)

15

20

25

30

35

Temp (C)

TRANSMISSION POTENTIAL
1

0.8
0.6
0.4
0.2
0
14 17 20 23 26 29 32 35 38 41

Temperature (C)

Based on Martens
WJM, 1998

40

Climate Change and Malaria

Potential transmission in Zimbabwe

Baseline 2000 2025 2050

Climate suitability:
red = high; blue/green = low

Harare

Low probability

Highland
s

Medium probability

High probability

Bulawayo

Ebi et al., 2005

Climate Change and Malaria

Potential transmission in Zimbabwe

Baseline 2000 2025 2050

Climate suitability:
red = high; blue/green = low

Harare

Bulawayo

Ebi et al., 2005

Climate Change and Malaria

Potential transmission in Zimbabwe

Baseline 2000 2025 2050

Climate suitability:
red = high; blue/green = low

Harare

Bulawayo

Ebi et al., 2005

Food Yields: General Relationship

of Temperature and Photosynthesis
100%

Photosynthetic
activity

+2oC

+2oC
0%

20o C

Plus:
Floods, storms, fires
Droughts range, severity
Pests
o
o
30
C
40
C
Diseases

Example: Field & Lobell. Environmental Research Letters, 2007:

Globally averaged: +0.5oC reduces crop yields by 3-5%.

So: +2oC would mean 12-20% fall in global grain production.

Modelled impact of climate change on

global cereal grain production:
Percent change, 1990-to-2080

% Change (range)
World

-0.6

to-0.9

Developed countries

+2.7

to

+9.0

Developing countries

-3.3

to

-7.2

Southeast Asia
-2.5 to -7.8
South Asia
-18.2
to
-22.1
Sub-Saharan Africa
-3.9 to
-7.5
Latin America
+5.2 to +12.5
From: Tubiello & Fischer, 2007

Australia: Climate change, seasonal rainfall

zones, farm yields, health impacts

and here?

Health
Consequences?

Are the zones

being pushed
south, by
warming?

Crucial for
wheat-belt
Summer dominant
Marked wet
summer and
dry winter
Winter
Wet winter and
low summer
rainfall

Summer
Wet summer
and low winter
rainfall
Winter dominant
Marked wet
winter and
dry summer

Uniform
Uniform
rainfall

Arid
Low rainfall

Avoiding the
Unmanageable

Mitigation and
Adaptation
Managing the
Unavoidable

Vulnerability and Adaptation

D Schroter et al, 2004

Vulnerability, Adaptation and Malaria Risk

External exposure:
climatic and
environmental conditions

Adaptive Capacity:
Local governance
Community cohesion
Funds available

Sensitivity of exposed population:

immune status, nutritional status,
housing conditions, etc.

Potential health impact risk of occurrence

of malaria

Public health capacity

Actual adaptive actions e.g.
Regional government
Meteorological forecasts

Community
Surface-water control
Mosquito spraying
Rapid case treatment

Household/personal
House repairs
Bed-nets

Net Vulnerability
to risk of malaria

Population
Health Impact:
actual outcome

Reducing Health Impacts of Climate

Change Health Co-Benefits as bonus
Disease
burden
Mitigation begins
emissions reduction (etc.)

lt h
a
e
e
h
ial limat
t
n
c
e
Pot act of ge
n
imp cha

Health impact
averted by
mitigation

Impact
avoidance via
adaptation
Baseline burden

now

Health Co-Benefits (local/regional)

2050

2100

Urgent Policy Tasks to reduce:

Atmospheric GHG concentrations
Vulnerability of populations
Pre-existing (amplifiable)
disease rates

Watch out on
Starboard !!

WAIT: We are in the

middle of a conference
on iceberg avoidance

TITANIC