Mary Seacole Lecture 2007

Global Warming and the Future of Healthcare & Nursing: 

Global Warming and the Future of Healthcare & Nursing Geoffrey Hunt BSc (Hons) MLitt PhD FIoN Professor of Ethics & Global Policies University of Surrey, UK g.hunt @surrey.ac.uk The Mary Seacole Memorial Lecture Royal College of Nursing Annual Congress 2007 Harrogate 18th April 2007

Slide2: 

Sir David King, UK chief scientist, calls climate change "the biggest danger humanity has faced in 5,000 years of civilization." Geoff Hunt 2007 Geoff Hunt 2007

Global warming – effects: 

Global warming – effects EFFECT global annual average temperature has already risen by 0.6°C since pre-industrial times, mostly due to human activities. By 2100, average global temperatures are projected to rise by 2.0-2.5°C (range 1.5-4.0°C). glaciers are retreating world wide Spring plant development has advanced av. 5 days Sea surface temperature rising Coral reefs bleaching Marine plankton affected – impact on fish and birds Sea levels are rising Permafrost is melting in Alaska and Siberia Collapse of the massive Larsen B ice shelf in Antarctica in 2002 Increasing prevalence of forest fires Increasing prevalence & severity of floods and droughts HEALTH The temperature change has been small over the last 150 years, but it has been enough to alter disease patterns across the globe. The WHO has calculated that 150,000 lives are now being lost each year to climate change that has occurred since the 1970s. Different kinds of impact: Direct impacts (heat/cold); pathogen impacts; environmental impacts; social-economic impacts Geoff Hunt 2007

Global warming – cause: 

Global warming – cause Burning of fossils fuels (coal, gas, oil) has increased carbon dioxide, methane and nitrous oxide gases in atmosphere – and these retain more heat of solar energy. Geoff Hunt 2007

Pathogen-related impacts: 

Pathogen-related impacts The World Health Organization has identified more than 30 new or resurgent diseases in the last three decades, and changing patterns in distribution of… Malaria West Nile Virus Tick-Borne Encephalitis (TBE) Dengue fever Cholera Lyme Disease ….and others Geoff Hunt 2007

Malaria: 

Malaria Malaria now kills 3,000 African children a day - a dramatic increase from the 1950s and '60s, when control and containment seemed possible. By the end 21st century, warming will enlarge the zone of potential malaria transmission from an area containing 45% of the world’s population to an area containing about 60%. No vaccine is available, and the causative parasites are becoming resistant to standard drugs. The geographic range of malaria is generally limited to the tropics and subtropics because the Plasmodium parasite requires an average temperature above 16°C to develop. Malaria moving northward and uphill. A WHO report in 2000 found that warming had caused malaria to spread from three districts in western Kenya to 13 and led to epidemics of the disease in Rwanda and Tanzania. Geoff Hunt 2007 Europe may be affected in future. Turkey is already danger zones for malaria. The WHO says it’s likely to spread within eastern Europe, and from there, possibly, to western areas. NB: The relationship between climate and malaria is complex and controversial.

West Nile Virus : 

West Nile Virus Spreading fast: West Nile virus (Uganda 1937), carried by mosquitoes, never seen in N America until 1999, has infected more than 21,000 people across the USA and Canada and killed more than 800. Also spreading in Mexico, Puerto Rico, the Dominican Republic, Jamaica, Guadeloupe and El Salvador. Largely spread in bird infections, and animals such as horses and dogs. Three degrees: WNV has three different effects on humans, the 1st is an asymptomatic infection; the 2nd is a mild febrile syndrome ‘West Nile Fever’; the 3rd is a neuroinvasive disease ‘West Nile encephalitis’. In infected individuals the ratio between the three states is roughly 110:30:1. Symptoms of WNV Fever: Fever, headache, body ache, swollen lymph glands and occasionally a rash on the trunk. The elderly and those with compromised immune systems are more susceptible. Symptoms of WNV Encephalitis Headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Usually leave permanent neurological effects. There is currently no vaccine for humans. Geoff Hunt 2007

Tick-borne encephalitis (TBE) : 

Tick-borne encephalitis (TBE) In Sweden, warmer winter days have encouraged the northward movement of ticks, which has coincided with an increase in cases of tick-borne encephalitis since the 1980s. Geoff Hunt 2007  In 1996, health authorities reported a human case of tick-borne encephalitis in the Czech village of Borova Lada, elevation 3,000 feet. Until then, the Ixodes rinicus tick (photo), which is the carrier, had never been seen above 2,600 feet. In the last 25 years of the 20th C. the prevalence of tick-borne encephalitis in Russia and many European countries rose enormously. 10,000 cases p.a. in Russia. Long-lasting or permanent neuro- psychiatric sequelae are observed in 10-20% of infected patients.

Dengue fever: 

Dengue fever Dengue fever is now considered the most serious viral infection transmitted in man by insects, measured in terms of the number of human infections or the number of deaths. Today Dengue afflicts an estimated 50m -100m in the tropics & subtropics (mainly in urban areas). It has broadened its range in the Americas over the past 10 years and reached down to Buenos Aires by end of 1990s. Now found in N Australia. Asian Tiger Mosquitoes, which carry dengue fever, have been reported recently as far north as the Netherlands. Geoff Hunt 2007 The incidence of dengue has increased in areas where temperature has increased. Dengue fever spreads to higher elevations. Dengue fever is spreading above its former limit of 3,300 ft (1,006 m) and has been reported above 4,000 ft (1,219 m). In Mexico when dengue reached an altitude of 1,700 meters during an unseasonably warm summer in 1988. In an earlier study in Mexico, the most important predictor of dengue prevalence in communities was found to be the median temperature during the rainy season. Neither a vaccine nor a specific drug treatment is yet available.

Slide10: 

Estimated 2.5 billion people are currently at risk from dengue, and since the late 1970s Dengue has re-emerged in the Americas, with 280,000 reported cases reported in Latin America in 1995 alone. Urban outbreaks can involve up to 70-80% of a population. Geoff Hunt 2007

Cholera: 

Cholera Caused by Vibrio cholerae, a bacterium - severe diarrhea, and without rapid treatment often leads to dehydration and death. As the seas warm: Cholera, a waterborne disease, emerged in South America in 1991 for the first time in the 20th century. Facilitated by poverty and poor public health, it swept from Peru across the continent and into Mexico, killing more than 10,000 people. A study examined disease rates and climatic conditions, including rainfall, from 1966 to 2002. The severity of cholera outbreaks corresponded to harsh conditions stimulated by El Niño, a weather pattern with global effects that stems from warming in the Pacific Ocean. V. cholerae has been found to be associated with marine zooplankton, and blooms from warmer sea surface temperatures could expand this reservoir of cholera epidemics. Increased floods and droughts will increase cholera outbreaks. (Droughts can wipe out supplies of safe drinking water and concentrate contaminants that might otherwise remain dilute.) Geoff Hunt 2007

Lyme disease: 

Lyme disease Geoff Hunt 2007 A percentage of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint pains, arthritis, cognitive defects, neurological complaints or fatigue. Investigation is under way into connection with global warming. The most common tick-borne disease in N America and Europe, and one of the fastest-growing infectious diseases in the USA. A GSK vaccine was taken off the market after only a few years – class action litigation followed side-effects.

Physical impacts: 

Physical impacts The cascading consequences of global warming include a rise in extreme weather events such as: heat waves and extreme cold hurricanes storms river-floods sea-flooding droughts soil erosion and desertification landslides and mudslides Geoff Hunt 2007

Non-pathogen health impacts: 

Non-pathogen health impacts Besides the spread of pathogen-related disease we can expect big increases in: malnutrition trauma cardiac and respiratory illness allergies and the like Heat wave deaths, esp among elderly and very young: In 2003, a record summer heat wave killed 35,000 people, most of them elderly, in Western Europe. In France alone that year (the hottest 3-month period recorded in France), there were an estimated 15,000 extra deaths. A review of climate and weather disasters in the United States, from 1980, shows the top 2 killers were heat waves and associated drought, in 1980 and 1988. Combined, at least 15,000 people died owing to hot and dry conditions those two years. Geoff Hunt 2007

Non-pathogen health impacts -2: 

Non-pathogen health impacts -2 People with heart problems are vulnerable because their cardiovascular system must work harder to keep the body cool during hot weather. Heat exhaustion and some respiratory problems increase. Higher air temperatures also increase the concentration of ozone at ground level. Ozone damages lung tissue, and causes particular problems for people with asthma and other lung diseases.  Drought contributes to famines and disease outbreaks in less developed countries that kill millions. Warmer temperatures combined with increased ambient UV radiation could worsen photochemical smog, especially over urban areas. In other areas, cold-related deaths Geoff Hunt 2007

Ecological Impacts: 

Ecological Impacts The disruption of ecological systems with.. the spread (and withdrawal) of pests and blights: rats and mice ticks flies weevils locusts moulds bacteria, etc. an impact on food chains interruption or dwindling of human food supplies Geoff Hunt 2007

Ethical / legal aspects -1: 

Ethical / legal aspects -1 Responsibility? Most affected will be developing nations, yet developed nations have contributed most to global warming. Therefore, the latter have greater responsibility. Human migrations caused by climate disaster will stress hospitality and health resources of neighbouring nations and world community (Cf. Bangladesh) Still, it will affect everyone on the planet regardless of class, race and culture – if differentially Economic, financial, industrial, transport, social and political systems (compounded by a coming oil demand crisis) will be put under severe strain. Migrations, refugees, conflicts and wars will almost certainly increase too. “A global problem requires a strategy of international dimensions that can translate into regional and local actions.” (WHO Bulletin, 85(3) 2007) Shift needed in priorities for healthcare resources from high-tech curative to public and environmental health. Geoff Hunt 2007

Ethical / Legal aspects -2: 

Ethical / Legal aspects -2 Stern Report: “No region would be left untouched by changes of this [3ºC inc.] magnitude, though developing countries would be affected especially adversely. This applies particularly to the poorest people within the large populations of both sub-Saharan Africa, and South Asia. By 2100, in South Asia and Sub Saharan Africa, up to 145 - 220 million additional people could fall below the $2-a-day poverty line, and every year an additional 165,000 - 250,000 children could die compared with a world without climate change.” [first page of Part II] Will there be equity in the adaptation to climate change; what scale of compensation is required? Tyndall Centre suggests principles for fair adaptation in the climate change regime include “avoiding dangerous climate change, forward-looking responsibility, putting the most vulnerable first and equal participation of all.” Need for a global ethics – Cf Mary Seacole, whose global ethics was greater than that of the authorities who would not support her going to Crimea war, but she funded herself. Geoff Hunt 2007

Ethical / Legal aspects - 3: 

Ethical / Legal aspects - 3 A taste of things to come: ..in Canada a $50 million class action lawsuit is being brought against the Ontario government on behalf of about 40 victims of West Nile Virus, claiming that the government did too little to inform the public about the risks (Canadian Lyme Disease Foundation (2006). Geoff Hunt 2007

Official responses: 

Official responses Kyoto Protocol: a pact agreed by government delegates at a 1997 U.N. conference in Kyoto, Japan, to reduce the amount of greenhouse gases emitted by developed countries by 5.2 % of 1990 levels during 2008-2012. A total of 141 nations have ratified it. The World Health Organization has recognised the health impacts of climate change (WHO, 2006). See: WHO (2006) ‘Climate Change and Health’. http://www.who.int/globalchange/climate/en/ The ‘Stern Review on the Economics of Climate Change’ (Cf. Tyndall Centre) has concluded that transition to a low-carbon (60% CO2) economy in UK by 2050 is possible. Note that energy efficiency measures would not only forestall future health harms of GW but would reduce current health harms by e.g. reducing harmful fine particle emissions of fossil fuels. In the UK the Department of Environment convened an ‘Expert Group on Climate Change and Health’, which produced a comprehensive national report (DoE, 2001). Geoff Hunt 2007

Example of official action: 

Example of official action In Aug 2003 heat-related deaths in London among over-75s rose by 60%. See NHS ‘Heat Wave Plan for England’. During a Level 3 (Heatwave) alert “Primary care trusts and local social services authorities will: Continue to distribute advice to people at risk and managers and staff of care homes. Commission additional care and support, involving at least daily contact, as necessary for at-risk individuals living at home. This may involve informal carers, volunteers and care workers. It will be particularly targeted at people with mobility or mental health problems, or receiving medication likely to give rise to heat-related risks, and those living in accommodation that cannot easily be kept cool. Informal carers should be consulted about additional arrangements wherever possible. Ensure Department of Health advice reaches local authority-funded residential and nursing care home managers as soon as a heatwave starts. Primary care trusts and NHS trusts will ensure hospital services are in a state of readiness in case there is a rise in admissions. Discharge planning should reflect local and individual circumstances so that people at risk are not discharged to unsuitable accommodation or reduced care during a heatwave.” (Thresholds for London are 32ºC in day and 18ºC at night). Is this adequate? Is nursing policy-making involved? Geoff Hunt 2007

Implications for Nursing: 

Implications for Nursing What general implications does global warming have on the global institution of nursing in next 50 years? Nursing resources will be severely stressed in many places – where, how? Impact on migration of nurses? Unresponsive skill mixes? All public sector finances put under strain? Refugees and displaced people? New disease patterns – nursing response? Geoff Hunt 2007

Professional Action: 

Professional Action We must think and act now just to mitigate the coming disasters. I recommend that nursing professional organizations, international, regional and national, do the following as a matter of urgency: 1) Support calls for adequately funded research on the public health and disease impacts of global warming. 2) Research and draw up publicly available policy documents on the long term assessment of the impact of climate change on the need for nursing care and on the nursing profession. 3) Urge governments, and international agencies to act now both to mitigate the impact of industrial and economic policy on the environment, and to prepare for the enormous impact of global warming on health. 4) Urge all bodies involved in nurse education to put ‘climate change and health’ on the curriculum, especially at the higher and CPD levels. 5) Urge UK government to institute an adequate national ‘severe weather event action team [SWEAT]’ for a healthcare response strategy to severe heat, cold, flood, epidemic etc. [Cf. Civil Contingencies Act 2004] Geoff Hunt 2007

Personal actionreduce consumption: 

Personal action reduce consumption The Royal Society of Arts (London) in April 2005 (together with Canon) unveiled a 7m tall sculpture called 'WEEE Man' on the South Bank. It is made from 3.3 tonnes of electrical goods, which is the average electrical waste one UK person generates in their lifetime. The sculpture was later taken on a UK tour. Geoff Hunt 2007

Personal Action Life style changes – reduce your carbon footprint: 

Personal Action Life style changes – reduce your carbon footprint Geoff Hunt 2007 Use less Fossil-fuel Energy Use a Green energy supplier Insulate home Condenser boiler Switch off electrical devices not in use Turn down the water heating setting Set the central heating timer accurately – and at 19ºC Fill your dish washer / washing machine with a full load Fill the kettle with only as much water as you need Hang out the washing to dry rather than using a tumble-dryer Wash dishes with as little hot water as possible, rather than in dishwasher Change light bulbs to energy-saving bulbs (saving about 230kg C02/yr) Transport Use public transport instead of a car Walk or use a bicycle more If you buy a car: small or green one Do your weekly shopping in a single trip Cut air travel; use cyberspace instead Campaign to Save forests Reduce waste Recycle Join NGO campaigns asking banks and corporations to change their energy policies Support campaigns for national legislation Geoff Hunt 2007

References: 

References Canadian Lyme Disease Foundation (2006) ‘Victims launch $50 M lawsuit over West Nile’. http://www.canlyme.com/wnvaction.html Civil Contingencies Act 2004: http://www.opsi.gov.uk/acts/acts2004/20040036.htm Davis, R.E., et al., 2003. Changing heat-related mortality in the United States. Environmental Health Perspectives, 14, 1712-1718. Diarmid Campbell-Lendrum,a Carlos Corvalan a & Maria Neiraa. (2007) ‘Global climate change: implications for international public health policy’. Bulletin of World Health Organization, 85 (3) 235-37. DoE (2001) Health Effects of Climate Change in the UK. http://www.dh.gov.uk/assetRoot/04/10/80/61/04108061.pdf Epstein, P. 1999. Global Warming: Health and Disease. World Wildlife Fund. Houghton, J. Global Warming: The Complete Briefing. Cambridge University Press, 3rd edn., 2004. Khasnis A, Nettleman M.(2005) ‘Global warming and infectious disease.’ Arch Med Res 36 (6): 689-96. Reiter, P., Thomas, C J., Atkinson, P M et al. (2004) ‘Reflection & Reaction: Global warming and malaria: a call for accuracy’, The Lancet Infectious Diseases Vol 4: 323-24. Lindgren, E. (1998) ‘Climate and tickborne encephalitis’. Conservation Ecology [online] 2(1): 5. Available from the Internet. URL: http://www.consecol.org/vol2/iss1/art5/ NHS (2004). Heatwave Plan for England. NHS, London. See: www.dh.gov.uk/publications. Ochoa, G., Hoffman, J & Tin, T. Climate. Rodale International Ltd, London, 2005. Patz, J. A., Campbell-Lendrum, D., Holloway, T. and Foley, J. A. (2005) ‘Impact of regional climate change on human health’. Nature 438, 310-317. Patz, J. A. ‘Climate Change and Health: Need for Expanded Scope of Occupational and Environmental Medicine’. Available at: http://yosemite.epa.gov/oar/globalwarming.nsf/content/ResourceCenterPublicationsPatz_health.html Pruss-Ustun A, Corvalan C. Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease. Geneva: World Health Organization, 2006. Rogers, D.J. and Randolph, S.E. (2006) ‘Climate change and vector-borne diseases’. Advances in Parasitology 62: 345-381 WHO. Potential health effects of climatic change. World Health Organization, 1990. WHO (2006) Climate Change and Health. Available at: http://www.who.int/globalchange/climate/en/

RCN Congress 2007Mary Seacole Memorial‘Global Warming & the Future of Healthcare & Nursing’: 

RCN Congress 2007 Mary Seacole Memorial ‘Global Warming & the Future of Healthcare & Nursing’ Geoffrey Hunt BSc(Hons) MLitt PhD FIoN University of Surrey, UK. g.hunt @surrey.ac.uk Thank you for listening