Publications by HC120831202244


									Health Impacts of Climate
 Variability and Change

     Kristie L. Ebi, Ph.D., MPH
             June 2006
  Pathways for Weather to Affect
    Health: Diarrheal Disease

Distal Causes       Proximal Causes     Infection Hazards Health Outcome

Temperature         Survival/ replication Consumption of
Humidity            of pathogens in the   contaminated water   Incidence of
Precipitation       environment
                                                               mortality and
Living conditions   Contamination of    Consumption of         attributable
(water supply and   water sources       contaminated food      to diarrhea
                    Contamination of    Contact with
                    food sources        infected persons
Food sources and
hygiene practices
                    Rate of person                         (e.g. age and
                    to person contact                      nutrition)
Potential Health Effects of Climate
     Variability and Change
   IPCC TAR–Potential Health
   Impacts of Climate Change

• Increase in the geographic range of potential
  transmission of malaria & other vector-borne
• Increase in heatwaves, often exacerbated by
  increased humidity & urban air pollution
• Any increase in flooding could increase drowning,
  diarrheal & respiratory diseases
• Increase in water- and food-borne diseases

 The severity of impacts will depend on the capacity
         to adapt & its effective deployment
      Drivers of Health Issues

• Population growth
• Urbanization
• Public health funding
• Scientific developments
• Environmental conditions
• Populations at risk
  –   Poor
  –   Children
  –   Increasing population of elderly residents
  –   Immunocompromised
Estimating the Global Health
 Impacts of Climate Change
          Campbell-Lendrum et al. 2003

• 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)?
    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
                                                  2020s       2050s       2080s

Campbell-Lendrum et al. 2003
                Criteria for Selection of
                   Health Outcomes

        • Sensitive to climate variation
        • Important global health burden
        • Quantitative model available at the global
            –   Malnutrition (prevalence)
            –   Diarrhoeal disease (incidence)
            –   Falciparum malaria (incidence)
            –   Inland and coastal floods (mortality)
            –   Heat and cold related CVD mortality

Campbell-Lendrum et al. 2003
     Exposure: Alternative Future
     Projections of GHG Emissions

        • Unmitigated current GHG emissions trends
        • Stabilization at 750 ppm CO2-equivalent
        • Stabilization at 550 ppm CO2-equivalent
        • 1961-1990 levels of GHGs with associated
                               Source: UK Hadley Centre models

Campbell-Lendrum et al. 2003
         Estimated Death and DALYs
        Attributable to Climate Change




               120 100 80      60   40   20   0   2     4    6    8      10

                       Deaths (thousands)             DALYs (millions)

Campbell-Lendrum et al. 2003
       Climate Change vs. Urban Air
                                                     Millions of DALYs
                                          Climate change             Urban Air Pollution
                Africa Region

      South-East Asia Region

Eastern Mediterranean Region

 Latin America and Caribbean

      Western Pacific Region

        Developed Countries

                                3000 2500 2000 1500 1000 500    0    500 1000 1500 2000 2500 3000

 Burden of disease by region: Climate change and urban air pollution. Disability
 Adjusted Life Year per million. World Health Report 2002.
    • Climate change may already be causing a
      significant burden in developing countries
    • Unmitigated climate change is likely to
      cause significant public health impacts out
      to 2030
       – Largest impacts from diarrhea,
         malnutrition, and VBD
    • Uncertainties include:
      – Uncertainties in projections
      – Effectiveness of interventions
      – Changes in non-climatic factors

Campbell-Lendrum et al. 2003
Maximum Temperature
  August 10, 2003
              Chicago – Midway
            (July Daily Maximum)
                                      Now GFDL 2095
                                     29.2° C 33.7° C
                                     84.6° F 92.7° F

Standard deviation = 3.7° C
                     6.7° F

                                                                      p = 36.3%

                                                                       p = 5.7%
                                           35.0° C
                                           95.0° F

          18.1° C 21.8° C     25.5° C 29.2° C 32.9° C 36.6° C 40.2° C 43.9° C 47.6° C
          64.6° F 71.2° F     77.9° F 84.6° F 91.2° F 97.9° F 104.4° F 111.0° F 117.7° F
Emission Pathways, Climate Change,
     and Impacts on California

            Scenario         B1     A1fi
 Heatwave days (Los
 Angeles)                    4X     6-8X

 Length of heatwave          5-7     9-13
 season                    weeks   weeks
 mortality (Los Angeles)    2-3X    5-7X

                                      Hayhoe et al. 2004
           Health Impacts of Floods
•Immediate deaths and
•Non specific increases
in mortality
•Infectious diseases –
leptospirosis, hepatitis,
diarrhoeal, respiratory,
& vector-borne diseases
•Exposure to toxic
•Mental health effects
•Increased demands on
health systems

 Philip Wijmans, LWF/ACT Mozambique, March 2000
                          Floods in Europe
        1992: 1346 killed in Tajikistan
        1993: 125 died in Yekaterinburg, Russia
        1996: 86 died in the Biescas campsite, Spain
        1998: 147 died in Sarno, Italy
        2002: 120 died in Central Europe

Source: "EM-DAT: The OFDA/CRED International Disaster Database, - Université Catholique de
Louvain - Brussels - Belgium" Created on: May-23-2005. - Data version: v05.05
  2000 Flood in Mozambique

• Heavy rains from Cyclones Connie and Eline in
  February 2000 caused large scale flooding of the
  Limpopo, Incomati, Save, and Umbeluzi rivers
   – Environmental degradation and poor river system
     management and protection contributed to the crisis
• 700 people died, 250,000 people were displaced
  and 950,000 required humanitarian assistance (of
  which 190,000 were children under the age of 5)
   – 14,800 people were rescued by helicopter
 Average Relative Change in Malaria
Incidence Before , During, and After El
       Niño Events, Venezuela
Mean Change
              Coast (1910-1935)
   1.8        Whole country
              Average of both




         -2     -1     0 (Niño) +1       +2
                      Time Lag (years)
                                          Bouma & Dye 1997
0°C average in Jan
“freeze line”
                    Malaria in Zimbabwe
                 Cases by Month

                                                  • Patterns of stable
                                                    transmission follow
                                                    pattern of
                                                    precipitation and
                                                    elevation (which in
                                                    turn influences
                                                  • >9,500 deaths and
                                                    6.4 million cases
                                                    between 1989-1996
       Source:                                    • Recent high-altitude
       South African Malaria Research Programme     outbreaks

Ebi et al. Submitted
   Climate and Stable Malaria
• Climate suitability is a primary determinant
  of whether the conditions in a particular
  location are suitable for stable malaria
• A change in temperature may lengthen or
  shorten the season in which mosquitoes or
  parasites can survive
• Changes in precipitation or temperature may
  result in conditions during the season of
  transmission that are conducive to increased
  or decreased parasite and vector populations

                                          Ebi et al. 2005

           Ebi et al. 2005

       Ebi et al. 2005

       Ebi et al. 2005

       Ebi et al. 2005

       Ebi et al. 2005
     Climate Change and Malaria Under
         Different Scenarios (2080)
     • Increase: East Africa, Central Asia, Russian Federation
     • Decrease: Central America, Amazon
     [within current vector limits]

                              Change of consecutive months

                                   > +2
A1                                        A2


                                   < -2

B1                                        B2                 Van Lieshout et al. 2004
 Effect of Temperature Variation on
 Diarrheal Incidence in Lima, Peru



Diarrhea increases by 8% for each 1 ºC increase
in temperature

                                      Checkley et al. 2000
  Temperature-Salmonella Models [fully adjusted]
               lcl                                 rr                              lcl                          rr
               ucl                                                                 ucl

1500                                                                 300

           England & Wales                                                     Switzerland
1000                                                                 200

 500                                                                 100

   0                                                                  0
       0             5                   10                15   20             0                      10                20
                             Average 2 month temperature                                  Average 2 month temperature

               lcl                                 rr                              lcl                          rr
               ucl                                                                 ucl

           Netherlands                                                         Scotland

  50                                                                 40

   0                                                                 20
           0             5                 10              15   20         0             5                     10       15
                             Average 2 month temperature                                  Average 2 month temperature
China Haze 10 January 2003

     Air Pollution and Health
Number of days with surface ozone >180 µg/m3

           1999            Summer 2003     EEA
         Current and projected ranges of beech trees in the U.S.

                       Current                         GFDL                           GISS
                        range                         scenario                       scenario

                          Current growth                          Projected new growth

GFDL — Geophysical Fluid Dynamics Laboratory            GISS — Goddard Institute for Space Studies
Source: U.S. Environmental Protection Agency, 1998.
  Adaptation Needed Because:

• Climate change can not be totally avoided
• Climate change may be more rapid and more
  pronounced than current estimates
• The severity of impacts will depend on the
  capacity to adapt and its effective deployment
  – Immediate benefits can be gained from better
    adaptation to climate variability and extreme events
• Climate change brings opportunities as well as
Thank you

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