.

A Framework for Health Effects of Climate Change

Regional Weather Changes CLIMATE CHANGE
(Natural and Human Caused)

Moderating Influences

Heat-related Illnesses and Deaths Extreme Weather Eventsrelated Health Effects

Air Pollution Levels

Air Pollution-related Health Effects Water- and Foodborne Diseases Vector- and Rodentborne Diseases

Heat Waves Extreme Weather Temperature Precipitation

Contamination Pathways Transmission Dynamics

Research
2

Adaptation Measures

Vulnerable Populations
Climate Sensitive Health Outcomes Illnesses and Deaths Related To. Heat Examples of Particularly Vulnerable Groups Elderly, those with chronic medical conditions, infants and children, urban and rural poor, outdoor workers, the socially isolated Children, pre-existing heart or lung disease, diabetes, athletes, outdoor workers The poor, pregnant women, people with chronic medical conditions, mobility and cognitive constraints Elderly, infants, the immunocompromised, specific risks for specific consequences (e.g., Campylobacter and Guillain-Barre syndrome, E. coli O157:H7) Children, outdoor workers Rural poor, occupational groups Infants, elderly Children, the immunocompromised, pregnant women, the genetically predisposed (e.g. G6PD status)

Air Quality Extreme Weather Events Water- and Food-borne Pathogens

Vector-borne Pathogens - Lyme Disease - Hantavirus - Dengue - Malaria

Source: Derived from SAP 4.6, Chapter 2

Extreme Weather-Related Health Effects Weather-

Adverse health

Hurricanes

outcomes including:
 Traumatic Injuries

Floods

 Deaths  Mental Health Effects  Diarrheal Illnesses

Wildfires
4

 Respiratory Illnesses

Mental Health Needs and Hurricane Katrina

In the aftermath of Hurricane Katrina, mental health services in New Orleans were challenged by an increased incidence of serious mental illness Nearly half of all survey respondents indicated a need for mental health care with less than 2% receiving professional care
6

(Weisler et al. 2006).

Wildfires and Associated Health Endpoints

Wildfire health risk is determined by: the population in the affected area the speed and intensity with which it moves through the area Climate conditions affect wildfire incidence and severity. A 4-fold increase in the incidence of large Western wildfires has occurred within the past 20 years, especially in California
8

UV

Skin Cancer

Climate Change and Ozone

Maximum Daily Ozone Concentrations by Temperature in New York City: 1988-1990 1988Maximum Daily Ozone (ppbv) 240 210 180 150 120 90 60 30 0 0
13

10

15

20

25

30

35

40

Maximum Temperature (Co)

Source: Sillman and Sampson, 1995

Allergic Illnesses and Aeroallergens Earlier onset of pollen season Increased CO2 and temperature
increase pollen production Increase length of pollen season
14

Increased pollen counts

15

Vector longevity
Altered length of transmission season Altered intensity of transmission Altered distribution of diseases Increased or diseased disease risk (disease specific)

Climate Change

Regional weather Changes Temperature Precipitation Humidity

Pathogen development

Diseases transmission dynamics

Natural Vertebrate Host distribution and abundance

Vector and Rodent habitat

Water and Food-borne Disease: FoodClimateClimate-Susceptible Pathogens

Rising temperatures Salmonella Campylobacter Vibrio Leptospira Enteroviruses Naergleria fowleri Cryptosporidium Giardia
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Increasing rainfall X X X X X

Shifts in reservoir ranges X X

Sea level changes

X X X X X X X X

X X

( (
2,500 2,400

)
50 / 300-500/

++ +++ + ++ +

1,094

117

Schistosomiasis

600

200

Leishmaniasis

Sandflies

350

12

Cryptosporidiosis Outbreak Milwaukee 1993

405,000 cases 100 fatalities Preceded by heaviest rainfall in 50 years

20

Environmental Factors Determining the Survival of Vector of Disease causing agents

Temperature Relative humidity Solar radiation Precipitation Wind Topography

Abiotic

Fresh water pond, Lakes, Rivers

Biotic

Vegetations

Parasites

Hosts (mammals, reptiles, birds) Natural predators Pathogen of the vectors

Human Induce Climate Change

Environmental Factors

Parasite

Vector population Human population

Climate Effects on the Malaria Transmission Cycle

Human population temperature Biting rate mosquito Biting rate mosquito mortality

Parasite development Mosquito population precipitation

Vectorial Capacity (VC)

VC
m= a = p = n =

m x a2 x pn -In(p)

. .
2540

2541

Plasmodium falciparum
2542

2544 2548

: WHO Regional Office for South- East Asia

Provinces Affected with Recent Outbreak of Malaria in Thailand,

1980-1984 Epidemics in provinces along the Thai-Lao and Thai-Cambodia borders 1986-1987 Epidemic in the southern provinces 1988-1997 Epidemic in Thai-Cambodia border 1998-2005 Epidemic in Surat Thani, Yala, Nakhon Si Thammarat, Krabi Provinces and spreading throughout the southern provinces of Thailand

Global Scenario of DHF

No.of countries experienced DHF epidemics

2552

2551

2550

2549

2548

( (

) )

52,91 86,67 62,999 42,456 44,725 9 0 46 101 90 59 82 83.4 137. 100. 68.0 72.1 8 49 27 2 7 0.09 0.12 0.14 0.14 0.18

(%)

 

1.1 120
:

Wuchereria bancrofti nocturnally subperiodic type long strain Wuchereria bancrofti nocturnally subperiodic type sthort strain Brugia malayi nocturnally periodic type

Brugia malayi nocturnally subperiodic type

Brugia malayi diurnally periodic type

( . )

Nipah Virus Outbreak

1998-1999, Malaysia
Respiratory and neurologic syndrome in swine Encephalitis in humans
More than 250 cases More than 100 deaths

Initially mistaken for Japanese encephalitis Discovered new Paramyxovirus

Nipah Virus
Virus isolated in March 1999 Quick national response with international assistance 1.1 million pigs culled (out of 2.4 million total) No new cases in Malaysia since 1999

Reservoir
Flying foxes (fruit bats)
Carry the virus Are not affected Virus found in
Urine Partially eaten fruit

Migratory

plaque (Yersinia pestis)

2009
Qinghai

Ziketan

3
1. 2. 3. reservoir

2009

H1 N1

H1N1 (Influenza A virus subtype H1N1)

Bacteriophages: Lysogenic Cycle

Adaptation Strategies to Reduce ClimateClimate-related Health Risks

Heat waves Decision Enhance early warning systems Support Tools Technology Development Surveillance and Monitoring Infrastructure development Improve building design to reduce heat loads during summer months Alter health data collection systems to monitor for increased morbidity and mortality during a heatwave Improve urban design to reduce urban heat islands by planting trees, increasing green spaces, etc. Conduct research on effective approaches to encourage appropriate behavior during a heatwave Alter health data collection systems to monitor for disease outbreaks during and after an extreme events Design infrastructure to withstand projected extreme events Extreme weather events Enhance early warning systems and emergency response plans

Other

Conduct research on effective approaches to encourage appropriate behavior during an extreme event

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Adaptation Strategies to Reduce ClimateClimate-related Health Risks

Vectorborne Diseases Decision Support Tools Enhance early warming systems based on climate and environmental data for selected diseases Waterborne Diseases Develop early warming systems based on climate and environmental data for conditions that may increase selected disease Develop more rapid diagnostic tests Enhance surveillance and monitoring programs for waterborne diseases Consider possible impacts of placement of sources of water and food borne pathogens Enhance health data collection systems to monitor for health outcomes due to air pollution Improve public transit systems to reduce traffic emissions. Air Quality Enhance alert systems for high air pollution days

Technology Development Surveillance and Monitoring

Develop vaccines for West Nile and other vectorborne diseases Enhance vector surveillance and control programs and monitor disease occurrence Consider possible impacts of infrastructure development such as water storage tanks

Infrastructure development 42

Key Messages
Human health is inextricably bound to weather and climate as well as to many complex natural and man-made systems. There are many uncertainties, but projected changes in climate are likely to impose risks to human health. Health impacts are multi-factorial with interactions that cascade across a range of confounding and moderating factors. An extensive suite of adaptation strategies will be key to addressing climate-related health outcomes.

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Examples of Reports on the Global Health Impacts of Climate Change

IPCC Working Group II Synthesis and Assessment Fourth Assessment Product 4.6: Analyses of the effects of global change on Report . 2007. human health and welfare and http://www.ipcc-wg2.org/ human systems. 2008 http://www.climatescience.gov/L ibrary/sap/sap4-6/final-report/ WHO Climate Change and Human Health. 2005 http://www.who.int/glo balchange/climate/en/

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