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Foundation Day Lecture 2008

Foundation Day Lecture 2008. “Human population health is a very important component of climate change debate……..our economy, physical infrastructure, production capabilities and material growth risk are also things that bear on human health -Prof A J McMichael. Prof. Anthony J McMichael.

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Foundation Day Lecture 2008

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  1. Foundation Day Lecture 2008

  2. “Human population health is a very important component of climate change debate……..our economy, physical infrastructure, production capabilities and material growth risk are also things that bear on human health -Prof A J McMichael Prof. Anthony J McMichael

  3. Environment, Climate and Health: An Expanded Public Health Research and Policy Agenda for the 21st Century Public Health Foundation of India March 28, 2008 A.J. McMichael National Centre for Epidemiology and Population Health The Australian National University Canberra

  4. Human Wellbeing and Health: KeyCriterion of‘Sustainability’ For humans, the central criterion/measure of ‘sustainability’ is the capacity of a society’s way of life to sustain the wellbeing and good health of the population …. across generations, and without detriment to health in populations elsewhere (now and in future).

  5. Outline • Environment: ‘Cinderella’ of disease causation • Population Perspective: thinking ‘ecologically’ • Large-scale, human-induced, environmental change • Systemic character; new concepts • Climate change – recent science • Health impacts • Categories and examples of research • Food, nutrition, health • Infectious diseases • Mitigation and Adaptation: research needs • Conclusion

  6. Population Strategy for Improving Health Population distribution for some specified risk factor Impact of Social Policies: Environment Urban Planning Technology choices Public health programs Health Promotion Etc. Main focus of Health-Care System No. of persons Medium-Risk Gp, accounts for 80% of cases High-Risk Gp: accounts for 20% of cases 20% 75% 5% High risk Low risk Medium risk Disease Risk 'Score’ e.g. blood pressure, relative weight

  7. Rise-and-Fall of ‘Urban Health Penalties’ The Developed Country experience Health risk/impact (indicative) Greenhouse gas emissions  climate change Infectious diseases Urban air pollution Not Sustainable Road trauma Obesity Time 1800 1900 2000 Industrialisation Modernisation Future Globalisation McMichael, 2007

  8. Estimated Atmospheric PM10 (respirable particulates) Concentration in World Cities (popn >100,000) PM10 (µg/m3) . 5-14 . 15-29 . 30-59 . 60-99 . 100-254 Cohen AJ et al. 2004

  9. PM10 Annual Average Ambient Concentrations in Asian Cities, 2005 160 140 120 3 100 80 concentrations in µg/m 60 40 20 WHO 2005 Guideline Value for Annual Average of PM10 = 20 µg/m3 0 Xi'an Dhaka Beijing Kolkata Mumbai Colombo Bangkok Shanghai New Delhi Surabaya Singapore Hong Kong Kathmandu Chiang Mai Ho Chi Minh Taipei,China City

  10. Life expectancy at birth, by GDP per head, 2000 Life expectancy (years) Source: Deaton, 2004 GDP per head, 2000 (purchasing power parity, in $US)

  11. Obesity, diabetes, rising fast • Number of overweight and obese (~I billion) likely to reach 1.5.billion by 2015 • Obese children: already 155 million worldwide • Prevalence of (type 2) diabetes, ~120 million, may increase three-fold by 2030 • Accounts for 7% of all deaths • Highest prevalence rates in India, China, USA, Indonesia, Russia, Japan, Pakistan, Brazil, Italy • International Obesity Task Force 2005 • New York Herald Tribune 12 September 2005 • WHO, World Heart Day, September 2005

  12. (r = 0.81, P = 0.000) 30 20 10 Poor States Rich States 0 0 10000 20000 30000 40000 50000 Per capita State GDP Prevalence of overweight varies with wealth, by State, in India Percent over-weight (i.e., BMI > 25) From M Vaz, St. John’s, IPHCR Econ Survey India, 1999, NFHS-2 1998-99

  13. Epidemiology since ~1850: Changes in emphasis on different levels/units of analysis Molecules and genes Individuals Sub-groups Esp. occupational groupings Populations Non-Infectious Dis: Individual-level risk factors Germ Theory Micronutrients Sustaining population health: Understanding effects of systemicchanges Social epi 1800 1850 1900 1950 2000

  14. We Are Now Living Beyond Earth’s Limits[WWF “Living Planet Report 2006”] Three Ecological Footprint Scenarios, to 2100 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 No. of Planet Earths needed to meet human demands Moderate ‘business as usual’ (to 2050) Ecological Footprint, 1961-2003 Slow shift in economic and social practices Rapid transition to environmental sustainability No. of Planet Earths available 1961 2003 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100 Year Source: World Wildlife Fund, 2006 See also Wackernagel et al, PNAS, 2002

  15. Global Environmental Changes: paths, health risks Skin damage/cancer Stratospheric ozone depletion Eyes (cataracts, etc.) Immune suppression Thermal stress: death, disease events, injury Direct impacts Climate change Storms, cyclones, floods, fires Sea-level rise: physical hazards, displacement Infectious disease risks Land cover (forest, etc) Human predation Biodiversity changes, & ecosystem disruption Changes in host species, vectors (mosquitoes, etc.) Land use e.g. pollination Food yields: nutrition and health Water–sheds, systems Avian ‘flu, Nipahvirus, etc. Food-production systems Urbanisation; human settlements Poverty, slum, hygiene; physical hazards; infectious disease risks (mobility, density)

  16. UNDP Human Development Report, 2007/2008 ‘Fighting Climate Change: Human Solidarity in a Divided World’ Excerpt from UNDP Press Release, Nov 27

  17. Projected warming, to 2100: for six future global greenhouse gas emissions scenariosIntergovernmental Panel on Climate Change, 2007: Wkg Gp I 3 of the 6 emissions scenarios Uncertainty range: 1 standard deviation Warming already in ‘pipeline’ from recent/current GHG levels (~0.6oC) A1F1 + 4oC A2 1.8-4.0 oC A1B Warming (oC) + 2oC B1 1980-99 baseline temperature 23 models (tested against recent record) A1T B2 A1F1 16-21 models used for each scenario No. of models used 1900 2000 2100 6 different GHG emissions scenarios Year

  18. More Variable Weather in Future Intergovernmental Panel on Climate Change (2007) “…very likely that hot extremes, heatwaves and heavy precipitation events will continue to become more frequent.” UN World Meteorological Organization (2007) “…increasing trend in extreme events observed over the last 50 years. …. Record extremes in many regions across the world since Jan 2007.”

  19. Ethiopia Somalia Kenya Mogadishu Nairobi Extreme rainfall event, 2006, in Somalia/Kenya border region Flooding, after drought, produced cholera outbreak, and high abundance of mosquitoes

  20. CO2 atmos concentration Solid lines = observed Dashed lines = 1990s projections Av Surface Temp Sea-level Rise (cm/decade) Rahmstorf, Church, et al., Science 2007 1975 1985 1995 2005 Climate Change: NowFaster than Expected IPCC Report 4 (2007) is already conservative/out-dated Recent research shows increasing rates of: Global GHG emissions Surface temperature rise - esp. polar regions Ice melt (Arctic, Antarctic, mountain glaciers) Sea-level rise Saturation of carbon ‘sinks’ (oceans, terrestrium)

  21. Arctic Sea Ice Meltdown: A hundred years ahead of schedule? IPCC Projections: Serious under-estimates? IPCC central projection Satellite observations projection Bjeknes Centre for Climate Research, Svalbard, Norway (2008)

  22. Environmental/Climate Change: Health Impacts, Responses – and Research Needs Adaptation:Reduce impacts c Natural processes and ‘forcings’ Feedback change • Global Environmental Changes, affecting: • Climate • Water • Food yields • Other materials • Physical envtl. safety • Microbial patterns • Cultural assets • Impacts on human society: • livelihoods • economic productivity • social stability • health Pressure on environment • Human society: • culture, institutions • economic activity • demography a Feedback change Mitigation: Reduce pressure on environment b Based on: McMichael et al., Brit med J, 2008

  23. Climate Change and Health Five‘Core’ Research Categories Empirical data-based studies Scenario-based health risk projections 1.Determine baseline climate/health relations 2.Detect impacts 3.Estimate current CC-related burden 4. Prediction of future risks (modelling) Past Present Future 5. Adaptive strategies

  24. Heatwave: August 2003 Land surface temperatures, summer of 2003, vs. summers of 2000-04. NASA satellite spectrometry 35-50,000 extra deaths over a 2-week period

  25. Seasonal variation in daily mortality, Delhi, 1991-94 60 summer 40 Daily deaths 20 winter 0 1991 1992 1993 1994 From: ISOTHURM Study, McMichael et al., in press

  26. Heat-related daily mortality, Delhi, 1991-94Generalised additive model, cubic-spline smoothing Relative mortality 140 120 100 Uncertainty range: 95% CI 80 0 10 20 30 40 Daily mean temperature, oC

  27. Delhi: Decadal changes, 1960s-present, in key climate variables and heat index ‘WBGT-at-work’ 35.0 Temp, max 30.0 WBGT 25.0 Temp, average Abs Humidity Temp, min 20.0 x Degrees C, hPa, m/s 15.0 10.0 5.0 Wind speed 0.0 1960-79 1980-89 1990-99 2000-07 Decade From: Kjellstrom T, Lemke B, Hales S, unpublished

  28. Number of fully workable days Fully workable days in Delhi per year, with future temperature increases of up to 7o C Delhi, reduced workable days with climate change 300 250 200 Watts (light) 200 150 100 500 Watts (heavy) 50 0 Av temp 2000-07 +1oC +2oC +3oC +4oC +5oC +6oC +7oC Increase in WBGT-at-work From: Kjellstrom T, Lemke B, Hales S, unpublished

  29. ‘Disease Burden’ attributable to Climate Change: 2000,2030 Selected conditions in developing countries Deaths Total Burden Now (2000) Future (2030) Deaths (thousands) DALYs (millions) McMichael et al/WHO, 2004 2000 2030

  30. Estimated Regional Mortality* Attributable to Climate Change in Year 2000 (relative to 1961-90 average climate) * , Deaths per million population 0-2 2-4 4-70 70-120 No data * Deaths from malaria & dengue fever, diarrhoea, malnutrition, flooding and (in OECD countries) heatwaves Based on: McMichael et al., 2004 (WHO Comparative Risk Assessment 2000)

  31. Cartogram:Emissions of greenhouse gases Countries scaled according to cumulative emissions in billion tonnes carbon equivalent in 2002. (Patz, Gibbs, et al, 2007)

  32. Cartogram: Health impacts of climate change Deaths from malaria & dengue fever, diarrhoea, malnutrition, flooding and (OECD countries) heatwaves 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 (Patz, Gibbs, et al, 2007)

  33. Two Major Risks to Health Food and Nutrition Decreased food yields, affordability  malnutrition Infectious Disease Patterns Geographic range, seasonality and outbreak rates

  34. March 2008: UN World Food Program anticipates global hunger crisis Threat of widespread malnutrition due to dramatic rise in world food prices Price increases of up to 40% in 2007(highest on record) WFP head, J Sheeran, describes price rise as“due to perfect storm” … -demand foranimal feed (China, India, etc.) - biofuels production - climate change - rising costs of fertiliser and fuel-energy

  35. Global Hunger Map, 2005-06 Sources: FAO 2005; WHO 2006; UNICEF 2005 Global Hunger Index Most Least No data Not included

  36. Drought: Recent and likely future expansion under climate change Percentage of world’s land area in drought 50 40 30 20 10 0 Severe drought (5% circa 2000) Extreme drought (1% circa 2000) % land in drought 1960 1980 2000 2020 2040 2060 2080 2100 Burke EJ, Brown SJ, Christidis N. 2006. Journal of Hydrometeorology

  37. General Relationship of Temperature and Photosynthesis 100% Photo-synthetic yield 2oC  2oC  0% 20o C 30o C 40o C C Field, D Lobell. Env Res Letters, 2007: A 1oC increase reduces global cereal grain crop yields by 6-10%. So, a rise of 2oC could cause 12-20% fall in global production. [Note: this estimate is higher than most others.]

  38. Expected climate change impacts on global cereal grain production, 1990-2080 (% change) World -0.6 to -0.9 Developed countries +2.7 to +9.0 Developing countries -3.3 to -7.2 Southeast Asia -2.5 to -7.8 South Asia -18.2 to -22.1 Sub-Saharan Africa -3.9 to -7.5 Latin America +5.2 to +12.5 Based on: Tubiello and Fischer 2007

  39. Poor Countries: More vulnerable to Climate Change impacts on food production Geography (hotter, less rain, more variable weather) High dependence on agriculture and natural resources (forests, wetlands, fisheries) Limited infrastructure (e.g. 95% of agriculture in SSAfrica is rain-fed) Poverty, poor access (‘entitlement’) Existing malnutrition, infectious disease Overall, lower adaptive capacity (professional, technical, health-care system, etc.)

  40. Pattern of Influence of Seasonal Rainfall, Surface Water, and Crowding on Cholera Occurrence, Madras region, 1901-40 Based on: Ruiz-Moreno et al, EcoHealth 2007; 4: 52-62. Study of 26 districts, Madras Presidency, south-east India, 1901-1940. Ro = ‘reproductive number’ Cholera Risk human crowding effect water dilution effect Rosecondary (human-to-human) transmission Roprimary (water-borne) transmission 1.0 1.0 Flood Shallow Water Depth

  41. Fruit orchards Virus-contaminated fruit, bat droppings Pig farming Infected (sick) pigs Apparent combination Deforestation El Niño conditions Smoke haze  Decline in fruit Eaten by pigs 265 humans infected: JE-like illness ~40% fatal ~105 deaths Forest-fire smoke ? Nipah Virus Disease: Outbreak in Malaysian Pig Farmers, 1997-1999 Fruit bats (with “their” virus: ~40% positive) Forest clearing El Niño drying Rain Forest, with seasonal fruiting – bat diet

  42. Ross River Virus, Rainfall and Mosquito Density: Queensland, 1998-2001 Ross River Virus, Rainfall and Mosquito Density: Queensland RRV Disease RRV Incidence (per 105) Mosquito Density Mosquito Density / Rainfall (mm) Rainfall Year Tong et al Rainfall, mosquito density and RRV in Brisbane Positive relationship between rainfall and mosquito density, with increased mosquito density after lag of 1-2 months. RRV Disease RRV Incidence (per 105) Mosquito Density Mosquito Density; Rainfall (mm) Rainfall Tong et al, date? Year Tong S, McMichael A, et al

  43. Dengue’s principal vector: Aedes aegypti

  44. Effects of Temperature Rise on Dengue Transmission Faster viral incubation in mosquito Shorter mosquito breeding cycle Increased mosquito feeding frequency More efficient transmission of dengue virus from mosquito to human

  45. (WHO) Countries/areas at risk of dengue transmission, 2007 (DengueNet, WHO)

  46. 1990 2085 Probability Estimated regions at risk of Dengue Fever under climate change:2085 vs 1990 Hales et al. Lancet, 2002

  47. Now 2030: + 0.9oC 2050: + 1.6oC Zhou X-N, Yang G-J, et al. Potential Impact of Climate Change on Schistosomiasis Transmission in China “Recent data suggest that schisto-somiasis is re-emerging in some settings that had previously reached the [successful disease control] criteria of either transmission control or transmission interruption. …. Along with other reasons, climate change and ecologic transformations have been suggested as the underlying causes.”

  48. ‘Mitigation’ and ‘Adaptation’ Mitigation (avoiding the unmanageable) First-order task Especially since climate change is accelerating …. Also: assess health impacts (hopefully mostly benefits) of mitigation strategies Adaptation (managing the unavoidable) Necessary transitional task Spontaneous adaptation (need to study/understand) Planned adaptation near-term and long-term health protection Implement and evaluate adaptive strategies

  49. Health Promotionlinking the individual with the planet!“Think Global, Act Local”

  50. CC and Health: Main Types of Adaptive Strategies Public education and awareness Early-alert systems: heatwaves, other impending weather extremes, infectious disease outbreaks Community-based neighbourhood support/watch schemes Climate-proofed housing design, and ‘cooler’ urban layout Disaster preparedness, incl. health-system ‘surge’ capacity Enhanced infectious disease control programs vaccines, vector control, case detection and treatment Improved surveillance: Risk indicators (e.g. mosquito numbers, aeroallergen concentration) Health outcomes (e.g. inf dis outbreaks, rural suicide rates, seasonal asthma peaks) Appropriate workforce training and mid-career development

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