indicators

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CLIMATE CHANGE AND PUBLIC HEALTH Paul R. Epstein, M.D., M.P.H. Center for Health and the Global Environment Harvard Medical School http://med.harvard.edu/chge

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Agent Host Environment Social Ecological Global Traditional Epidemiological Framework Ecological Epidemiological Framework Disease Epidemics SYSTEMS

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ATMOSPHERIC FORCING FACTORS

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-2 -3 -4 -5 Younger Dryas IPCC (2001) forecast: + 1.4-5.8oC, with band of uncertainty Little Ice Age in Europe (15th-18th centuries) 21st century: rapid rise Black Death Holocene Optimum Global Temperature: the Past 20,000 Years, & the Next 100 Years 10,000 2,000 1,000 300 100 Now +100 20,000 Medieval Warm 1940

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420 kya Present VOSTOK ICE CORE CO2 T 180 ppm 280 ppm 370 ppm

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Observed vs. modeled temperature rise since 1860 WWW.IPCC.CH SPM 2001

Deep Ocean Warming: 

Deep Ocean Warming Levitus et al. Science 2000; 287: 2225

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SST Anomalies May 2003

Slide10: 

Hoerling and Kumar: Science 2003 January 31; 299: 691-694 FRESHENING OF THE ARCTIC

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N. Polar ice thickness 44% since 1970s

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THE ARCTIC NADW “pump” 20%

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El Niño Since 1976 El Niño Events Have Increased in Frequency, Intensity & Duration

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Greenhouse Gas Emissions Heat-Related Deaths Infectious Diseases Injuries from Extreme Weather Events Allergies Climate Change The Health Impacts of Fossil Fuels Burning Fossil Fuels Air Pollution Asthma Attacks Other Respiratory Illnesses Premature Death from Lung and Heart Diseases

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HEATWAVES HUMIDITY & HEAT INDICES TMINS May/June 2003 Andhra Pradesh T 122•F >1400 deaths July Floods- Japanese B encephalitis

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  ASTHMA 2-3x Since 1980s     AIR POLLUTION AND CLIMATE CHANGE Indoor pollutants     SES/emotional factors Ground-level Ozone (T-dependant) Pollen & CO2 Diesel, NOx s (& pollen) Droughts & Fires Floods & Mold

RAGWEED POLLEN PRODUCTION: 

RAGWEED POLLEN PRODUCTION Wayne et al., Annals of Allergy, Asthma and Immunology 2002;8:279 p = 0.005

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IPCC 2001: New Findings Extreme Weather Events Heatwaves, Droughts & Floods Intensity & Frequency (rains >2”/d) Biological Systems are Responding Plant migrations Insects & butterflies Bird egglaying Marine species

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Emerging Infectious Diseases 30 DISEASES “NEW” TO MEDICINE SINCE 1976 HIV/AIDS Ebola Legionnaires’ E. coli O157:H7 SARS Antibiotic-Resistant Agents Hantavirus Pulmonary Syndrome Lyme Disease Nipah Virus Vibrio cholerae O139 Arenaviruses RESURGENT & REDISTRIBUTING Malaria, Dengue Fever, West Nile Virus, Cholera VECTORS Mosquitoes Ticks Rodents Bats Tsetse Flies Fleas Lice Snails Algae

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INFECTIOUS DISEASE A DRIVING FORCE IN HISTORY The Bad News PLAGUE 541 AD 1346 AD The “Good” News Cholera, TB, Smallpox

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Lindgren & Gustafson. Lancet 2001;358:16 1980s 1990s TICK DISTRIBUTION IN SWEDEN LYME DISEASE WARMER WINTERS PREDATORS OF DEER

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1950 2000 T ~1ºC/C ~2ºC/C Climate Models and Potential Malaria Distribution

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CHANGES IN THE MOUNTAINS

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Temperature, oC 15 20 25 30 Number of days, n a b c d b/a = 0.5 d/c = 0.75 n = No. of degree-days required Temp — Tempmin +2oC +2oC Temperature Dependence of Plasmodium Extrinsic Incubation Period Tempmin = 16oC

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THE CRYOSPHERE

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Geographic Shifts of Mosquitoes Changes in the Cryosphere

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PLANT COMMUNITIES

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450 ft. ~2•F warming 1970-1990 Diaz & Graham. Nature 1996;383:152

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Average T ~1ºC/C WINTER & NIGHTTIME TEMPS ~2ºC/C Since 1950

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HURRICANE MITCH HURRICANE MITCH 1998

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HURRICANE MITCH IMPACTS ON HEALTH AND DEVELOPMENT -- Malaria (>30,000 cases) -- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis DISEASE CLUSTER

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EXTREME WEATHER EVENTS: IPCC 2001 Prolonged droughts Daily Rains >2”/day Heatwaves Timing, intensity and location of precipitation Becker A, Grünewald U. DISASTER MANAGEMENT, Flood Risk in Central Europe, Science 2003;300:1099 Aug 2002 European Floods 12.5”/d PMP 14”/d Peak water level 28 ft 10 extreme floods in Dresden since the 13th Century Recurrence interval 500-1000 years

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EXTREME WEATHER EVENTS & DISEASE CLUSTERS

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WEATHER ANOMALIES, TRAVEL & TRAUMA WIDER SWINGS IN WEATHER Fog, Ice Storms & Road Travel Floods & Mudslides Ice Instability, Heavy Precipitation & Avalanches Infrastructure Damage, Water & Sanitation Systems TRADE, TRAVEL, TRANSPORT, TOURISM STORM OF 2003

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WARM WEST COLD EAST PACIFIC ANOMALIES Hoerling and Kumar: Science 2003; 299: 691 AMERICAS AFRICA AUS ASIA

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CLIMATE CHANGE & ENVIRONMENTAL JUSTICE Oil-related Extraction: Nigeria, Ecuador, Mexico Refining & benzene: locations and communities Air pollution & inner city truck routes Extreme Weather Events Economic inequities Vulnerabilities – coping, adaptation, restoration, prevention, public health infrastructure But no nation is immune Mozambique

Slide40: 

The Geographic Distribution of Japanese B Encephalitis Family NYC 1999

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-CDC WEST NILE VIRUS

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WNV: METEOROLOGICAL FACTORS

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WNV and DROUGHT: CASE REPORTS Romania 1996: Neurological disease – Hundreds, Fatalities 17 Prolonged drought and heatwave. Bucharest cases concentrated in blockhouses over aging sewage system where C. pipiens was breeding in abundance.   Volgograd 1999: Hospitalized 626, Meningoencephalitis 84, Fatalities 40 Followed a drought.   Israel 2000: Serologically confirmed 417, Fatalities 35 Drought across southern Europe and Middle East. C. pipiens identified as a vector.   US 1999: Neurological disease 62, Fatalities 7, Sequelae >½   Severe spring/summer drought, mild winter and 3-week July heatwave.   US 2002: Human cases 3737, Fatalities 214, 43 US states, DC and 5 Canadian Provinces   Severe drought West and Midwest. Absence of snowpack in the Rockies.

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WNV HUMAN CASES & DEATHS Science 2002:297:1988 2000 2001 2002 62 66 21 4161 cases 284 deaths BLOOD ORGAN TRANS IN-UTERO ? BREAST MILK ………………… POLIO-LIKE PRESENTATION & NEURO SEQUELAE

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WNV: A DISEASE OF WILDLIFE 230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES 138 Bird spp., RAPTORS - 37 spp. of mosquitoes HORSES ZOO animals REPTILES AVIAN FLYWAYS

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INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGE SPECIES LOSS VECTOR DISEASES Raptors Rodents Lyme, Hantaviruses, Leptospirosis, Plague Vulture die off India Feral Dogs Rabies

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Range Expansion of Soybean Cyst Nematode in North America Crop Pests Generations/Year

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DISEASES OF TREES West Coast fungi (Phytophthora) Alaska, Montana, Arizona spruce bark beetles overwintering & generations/year East Coast hemlock woolly adelgid N w/ warm winters Droughts vulnerability to pests. Diseased trees susceptible to fire.

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COASTAL MARINE ECOSYSTEMS HEALTH CONSEQUENCES Red Tides: PSP, ASP, NSP Spread of cholera Fisheries & nutrition Salinization Cone snails & medicines Nutrient overload Loss of wetlands – “Nature’s kidneys” Warming and weather extremes Diseases of sea urchins & Overfishig – reef cleaners

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Algal Blooms Peru 1991

Coral Diseases: 

Coral Diseases Color Variants on M. cavernosa Photo: Raymond Hayes Red Band Disease on M. annularis Photo: Laurie Richardson

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Coral Bleaching: Warming and Microbes Vibrio shiloi & V. coralyticus -infection and immunity are temperature-dependent -optimal infection and lysis at 29ºC release of zooxanthellae ENSO

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Costs of Emerging Infectious Diseases BIO ECONOMIC RESEARCH ASSSOCIATION, Cambridge, MA FLOODING P&C $1.64bn

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Costs of Extreme Weather Events UNEP $150b/yr w/in this decade Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies

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Exploration Extraction Transport Refining Transport Air Pollution Acid Rain Climate Change Eutrophication NOxs Warming Oceans Coral Reefs SLR EWEs Melting Polar Ice Harm Marine Mammals Shore birds Fisheries Consumers Livelihoods OIL LIFE CYCLE COSTS Spills & Leaks MERCURY

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Levels of Solutions Surveillance and Response Capacity Health Early Warning Systems Environmental, Energy & Economic Policies

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CLEAN DEVELOPMENT THE ENGINE OF GROWTH for the 21st CENTURY Regulatory Funds Institutional EE and RE “Green Buildings” & Smart Growth Rationalized Transport & Transit Retrofitting Infrastructure Ecological Reconstruction Framework