RAINER SAUERBORN Heidelberg University, Germany

1. Climate change destabilizes infectious diseases: challenges for research and policy Key points: #1 Increasing instability of infectious diseases #2 Improving the scientific basis for predictive modelling RAINER SAUERBORN Heidelberg University, Germany #3 Adaptation policies now, while evidence improves #4 Bringing health to the mitigation policy debate 2008 GLOBAL MINISTERIAL FORUM ON RESEARCH FOR HEALTH BAMAKO, NOVEMBER 16-19, 2008

2. #1 Instability of infectious diseases (re-)emerging diseases 1994-1999 (Re-)emerging diseases 1994-99 http://www.who.int/infectious-disease-report/pages/graph30.html

3. Simultaneous influences on infectious diseases Climate change Vector ecology Malnutrition Dysfuntional health services, Low uptake of control measures by population Resistance development, new drugs/vaccines Mobility of people, vectors, microbes Land use change, irrigation, urbanization

4. The convergence model for infectious diseases (IOM, 2008)

5. # 2 Improving the scientific basis for predictive modelling • Understanding the interactions between climate change and infectious diseases: process-based modelling - Plausible biological assumption - Mathematical process based models - Decade-long data sets • Prediction modelling for better early warning and intervention design • Using climate to predict disease • Using ecological changes • Using animal diseases • Using human cases There is no treatment without diagnosis. Hippocrates

6. Three Main Types of Research 1960 Empirical studies Forecasting, modelling Detect Learn 2050 Past Present Future McMichael 2007

7. Currently 37 sites in 19 countries 26 sites in Africa 9 sites in Asia 1 site in Oceania,1 site in Latin America Geo-referenced, individual data on death by cause, age, sex and socio-economic indicators Over 2,000,000 people under health surveillance International Network of Developing Countries with continous longitudinal health surveillance INDEPTH INDEPTH Network

8. 2006 Health data from over 45 years 1962 INDEPTH Network

9. Linking health and environmental monitoring:Nouna district, Burkina Faso Meteo stations Health Surveillance: 47 villages, 73 000 people Satellite imagery

10. # 3 Adaptation policies now, while evidence improves„precautionary principle“ • Early warning systems for climate-sensitive infectious diseases: malaria, cryptosporidiosis, leishmaniasis, dengue, Hanta, Chikungunya, RVF, TBE, MBE, WNF leptospirosis, plague, cholera, Lyme, Ebola and more • „No regrets strategies“ • top priority: strengthen health systems • Risk pooling strategies (health insurance) • Invest in water and sanitation • Food security • Priority for existing control of climate-sensitive infectious diseases

11. # 4 Put the health argument into the mitigation debate • Protecting health is the central motivation for most people everywhere • Mitigation has important health co-benefits, reducing: • 800,000 deaths to outdoor air-pollution • 1,200,000 deaths to injuries • 1,900,000 deaths to physical inactivity • Mitigation and adaptation are poverty reduction strategies

12. From emissions to Health Vulnerability GHG Emissions Population * GDP/Person * energy/GDP * GHG emissions/energy = „Kaya identy“ GHG concentrations Climatesensitivity Warming and variabilty Health sensitivity Exposure Health impact Disease Death, Disab. + Mitigation: emission control carbon sinks, sequestration Adaptation Vulnerability

13. Climate Impacts Climate and climate impact: health matters (Stern 2007) Notes: Baseline climate: CC as assumed by TAR IPCC High climate: Incorporating 2 types of feedback: 1. thawing of permafrost areas 2. weakened carbon sinks Stern, 2007

14. Annual losses of GDP/capita due to climate change-projections until 2200- Stern, 2007

15. INDEPTH Network

16. DISCUSSION SLIDES

17. So what? • Assume valid & generalizable malaria risk maps • Regardless of whether climate will change the malaria burden: • Need to improve and target interventions • Regrets or no regrets?

18. Gefahr einer Zunahme tropischer Infektionskrankheiten Rainer Sauerborn Universität Heidelberg WARNSIGNAL KLIMA. Öffentliches Symposion, Hamburg, 26.-28.2008

19. Emissions of greenhouse gases Density equalling cartogram. Countries scaled according to cumulative emissions in billion tonnes carbon equivalent in 2002. Gibbs et al, in prep.

20. Health impacts of climate change Density equalling cartogram. WHO regions scaled according to estimated mortality (per million people) in the year 2000, attributable to the climate change that occurred from 1970s to 2000. Gibbs et al, in prep.

21. Mitigating and adapting to climate change is inherently pro-poor

22. Stage of Stage of intervention intervention Social Social Surveillance Surveillance Hlth Hlth systems systems Primary Primary Primary Primary Tertiary Tertiary Tertiary Tertiary Vaccination Vaccination Vaccination Vaccination Early Early Early Early treatment treatment treatment treatment Dams Dams Dams Dams Secondary Secondary Secondary Secondary Early Early Early Early warning warning warning warning Stellschrauben der Adaptation: Malaria Mode Mode of intervention intervention Social Social Social Social Biological Biological Biological Biological Behavioral Behavioral Behavioral Behavioral Surveillance Surveillance Surveillance Surveillance Adaptive Adaptive Adaptive Adaptive Use Use Use Use of of of of Hlth Hlth Hlth Hlth systems systems systems systems immunity immunity bednets bednets bednets bednets Other institutions Community Community Global or group or group Individual Individual National National National National Level of Level of intervention intervention

23. ppm CO2 Eq 850 3.4oC = 6.1oF 2.8oC = 5.0oF 600 1.8oC = 3.2oF Even if we stop emitting today 0.6oC = 1.0oF IPCC, WG 1

24. Prospective monitoring of demographic and health events INDEPTH Network

25. Estimated current health impact of climate change

26. Economic growth Energy mix Energyefficiency Population growth Basis for mitigation policies:The “Kaya identity” CO2 = Population x GDP/Person x kJoule/GDP x CO2 emissions/kJoule

27. INDEPTH International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries INDEPTH Network

28. Figure SPM.2. Key impacts as a function of increasing global average temperature change(Impacts will vary by extent of adaptation, rate of temperature change, and socio-economic pathway)

29. Applications of definitions in comparative risk assessment to climate change

30. Europe Africa S.-Asia Latin-A SIS Based on: McMichael and Kovats, 2000

31. Diseases affected by climate Infectious disease surveillance Integrated vector management Environmental health capacity building Health action in emergencies Healthy development Safe drinking water

32. Health Co-Benefits from Mitigation • Reduced fossil fuel combustion: • Reduce cardio-respiratory deaths/hospitalisations from local air pollution (esp. fine particulates). • Low-emission urban (public) transport system: • Increase physical activity (walking, cycling)  reduce over-weight, improve lipid/endocrine profiles, increase social contact and wellbeing. • Road trauma should decline. • Reduced red (ruminant) meat consumption(livestock-CH4) • Reduce risks of some disease: large bowel cancer, ?breast cancer; also heart disease (meat fat content). • More energy-efficient housing • Reduce thermal/acoustic stresses

33. Economics of mitigation (Stern, 2007) • To avoid worst effects, stabilization of CO2 should be at least 550 ppm* • To achieve 550ppm, CO2 emissions must be brought down to 80% of 1990 level • Economic costs of climate change, if we do business as usual: 5% to 20% of GDP • Mitigation costs to achieve stabilization at 550 ppm CO2: 1% of GDP starting now Current level of CO2: 430ppm, pre-industrial: 270ppm Maximum in past 600,000 years: 300ppm

34. How sensitive is health to climate? Diarrhoea Incidence of diarrhoeal disease is related to variations in temperature and precipitation, over both space and time. In Lima, Peru, diarrhoea increased 8% for every 10C temperature increase. (Checkley et al, Lancet, 2000)