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Global Environmental Change & 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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Global Environmental Change &Health Paul R. Epstein, M.D., M.P.H. Center for Health and the Global Environment Harvard Medical School http://med.harvard.edu/chge
The loss of forests, freshwater and biodiversity, inadequate and inefficient use of energy, and the explosive growth in the world’s urban centers undermine long-term economic growth and threaten ecological systems. They also endanger human health, and increase developing countries vulnerability to natural disasters and conflict. … Furthermore, increases in global greenhouse gas emissions, approximately fifty percent of which are produced in developing countries, threaten to disturb the delicate ecological balance, disproportionately affecting the world's poor who are the least able to adapt to these changes. Long-term economic growth depends upon managing a country’s natural resources base, using energy to increase human productivity, helping cities to provide services and markets, and having predictable seasonal and long-term climatic conditions. -- US Agency for International Development (2002)
Traditional Epidemiological Framework Ecological Epidemiological Framework Agent Social SYSTEMS Ecological Global Environment Host Epidemics Disease
Global Temperature: the Past 20,000 Years, & the Next 100 Years 3 Av. temp. over past 10,000 years =15 ºC Mesopotamia 2 flourishes Agriculture Vikings in 1 emerges Greenland 0 Temp. change (ºC) End of last ice age IPCC (2001) forecast: + 1.4-5.8oC, with band of uncertainty Black Death Holocene Optimum 21st century: rapid rise 1940 Medieval Warm Little Ice Age in Europe (15th-18th centuries) -2 -3 -4 Younger Dryas -5 20,000 10,000 2,000 1,000 300 100 Now +100
370 ppm VOSTOK ICE CORE 280 ppm CO2 T 180 ppm 420 kya Present
HEATWAVES May 2003 Andhra Pradesh T 122•F >400 deaths HUMIDITY & HEAT INDICES TMINS
AIR POLLUTION AND CLIMATE CHANGE Indoor pollutants SES/emotional factors Diesel (& pollen) ASTHMA 2-3x Since 1980s • Pollen Floods & Mold Ground-level Ozone (T-dependant) Droughts & Fires
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
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 O139Arenaviruses • RESURGENT & REDISTRIBUTING • Malaria, Dengue Fever, West Nile Virus, Cholera VECTORS Mosquitoes Ticks Rodents Bats Tsetse Flies Fleas Lice Snails Algae
INFECTIOUS DISEASE A DRIVING FORCE IN HISTORY The Bad News PLAGUE 541 AD 1346 AD The “Good” News Cholera, TB, Smallpox
Climate Models and Potential Malaria Distribution T Average ~1ºC/C T MINIMUMS ~2ºC/C 1950 2000
Changes in the Cryosphere Geographic Shifts of Mosquitoes
450 ft. ~2•F warming 1970-1990 Diaz & Graham, Science: 19967
LYME DISEASE PREDATORS OF DEER WARMER WINTERS 1980s 1990s TICK DISTRIBUTION IN SWEDEN Lindgren & Gustafson. Lancet 2001;358:16
HURRICANE MITCH 1998 HURRICANE MITCH
HURRICANE MITCH IMPACTS ON HEALTH AND DEVELOPMENT DISEASE CLUSTER -- Malaria (>30,000 cases) -- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis
4161 cases 284 deaths WNV HUMAN CASES & DEATHS 62 66 21 BLOOD ORGAN TRANS IN-UTERO ? BREAST MILK ………………… POLIO-LIKE PRESENTATION & NEURO SEQUELAE • 2000 2001 2002 Science 2002:297:1988
WNV: A DISEASE OF WILDLIFE • 230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES • 138 Bird spp., RAPTORS • - 37 spp. of mosquitoes • HORSES • ZOOanimals • REPTILES AVIAN FLYWAYS
INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGE • SPECIES LOSSVECTORDISEASES • Raptors Rodents • Lyme, Hantaviruses, • Leptospirosis, Plague • Vulture die off • India • Feral DogsRabies
Hantavirus Pulmonary Syndrome 1993 Drought, Then Early Rains 10X Explosion of Mice Populations
Range Expansion of Soybean Cyst Nematode in North America Crop PestsGenerations/Year
DISEASES OF TREES • US • West Coast fungi (Phytophthora) • Alaska spruce bark beetles • 2 generations/year • East Coast hemlock woolly adelgid • N w/ warm winters • Droughts vulnerability to pests. • Diseased trees susceptible to fire.
Coral Diseases Color Variants on M. cavernosa Photo: Raymond Hayes Red Band Disease on M. annularis Photo: Laurie Richardson
SARS Severe Acute Respiratory Syndrome CORONAVIRUS • Species X-over • Genetic reshuffling • Farming practices & • food handling $50-100 BILLION TRADE, TRAVEL, TOURISM Bio Economic Research Associates, Cambridge, MA
HIV/AIDS • SOCIAL AND ENVIRONMENTAL DETERMINANTS • Transmission • Informal sector, Mining, Conflict • Viral Evolution • Coxsackie virus • Levander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528 Malnutrition & disease burden • Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754 • Stress proteins & mutations • Immune surveillance system
Costs of Extreme Weather Events Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies UNEP $150b/y w/in this decade
Levels of Solutions • Surveillance and Response Capacity • Health Early Warning Systems • Environmental, Energy & Economic Policies
CHALLENGES • CLEAN ENERGYHARMONIZING ADAPTATION & MITIGATION • MDGsHEALTH, NUTRITION, POVERTY • AGENDA 21FISHERIES, FORESTS, POPs • 0 • Solar-powered • clinics, homes, schools & enterprises • water purification, pumping & desalination
CLEAN DEVELOPMENT Framework Reg THE ENGINE OF GROWTH for the 21st CENTURY Funds Inst • EE and RE • “Green Buildings” & Smart Growth • Rationalized Transport & Transit • Retrofitting Infrastructure • Ecological Reconstruction