Climate Change and Health; impact and adaption issues

1. Climate Change and Health;impact and adaption issues Professor Philippa Howden-Chapman Dr Simon Hales Dr Nick Wilson He Kainga Oranga/ Housing and Health Research Programme NZ Centre for Sustainable Cities University of Otago, Wellington

2. Adaptation • Adaptation is the adjustment in natural or human systems in response to actual or expected climate changes and their effects • For social systems, adaptive capacity, resilience and vulnerability all matter • Projections come from past observation, observed interventions and modelling • Precautionary action essential & equitable

3. Outline • Potential health effects – “2°C” scenario • Local effects of heat, air pollution • Altered infectious disease distribution (IPCC) • Potential health effects – 4°C scenario • Increase in above effects • Likely major impact of global (incl. Pacific) social disruption • Adaptation measures (both scenarios) • Housing, infrastructure (e.g. energy, water) • Adaptation measures (high carbon scenario) • “Lifeboat NZ”

4. Estimated health impacts of low-carbon scenarios

5. Heat-related diseases • In Auckland and Christchurch, a small number of heat-related deaths occur annually in people aged over 65 and will increase (McMichael et al., 2003). • Current 1600 excess winter deaths likely to decline • N.B. European heat-waves in 2003 killed 70,000 people… epidemiological models did not predict this scale of mortality

6. Health effects of increasing temperatures • Warmer temperatures and increased rainfall variability are likely to increase the intensity and frequency of food-borne and water-borne diseases. • Higher than average temperatures lead to ~30% of reported European cases of salmonellosis. In UK, monthly incidence of food poisoning most strongly associated with the temperatures occurring in the previous two to five weeks.

7. Health effects of increasing temperatures • Deaths in forest fires • Impacts on aero-allergens and photochemical smog in cities uncertain. Increase in bushfires and smoke would increase hospital admissions for cardio-respiratory conditions.

8. Infectious disease • Warmer temperatures and increased rainfall variability are likely to increase food-borne and water-borne diseases. • Infectious agents (protozoa, bacteria and viruses) and vector organisms (mosquitoes, ticks and sand-flies) no thermostatic mechanisms, so reproduction and survival rates are strongly affected by fluctuations in temperature.

9. Water quality • Increasing irregularity of supply • Social gradient in water quality in New Zealand • Water metering and charging could further increase inequalities and infectious diseases • Households need right to minimum amount of water at no charge -- important for cleanliness and contagion control

10. Rise of respiratory diseases • Rise of tuberculosis globally and nationally • Crowding from population movement increases transmission of TB Baker M, Das D, Venugopal K, Howden-Chapman P. Tuberculosis associated with household crowding in a developed country. Journal of Epidemiology Community Health 2008;000:1–8:doi:10.1136/jech.2007.063610.

11. Rise of infectious diseases • Parts of the North Island likely to become suitable for breeding of the mosquitoes that are major dengue vector • Much of NZ becomes receptive to other less-efficient vector species • The risk of dengue in NZ likely to remain below the threshold for local transmission beyond 2050, under both scenarios.

13. Vulnerability • People living in remote communities are likely to be at increased risk due to their particular living conditions and poor access to services. • Relationship between drought, suicide and severe mental health impacts in rural communities

14. Not all have equal opportunity Vulnerable populations have • Low income and little wealth • Less educated • The very young and old • Sole parents with children • Those with chronic illnesses and disabilities • Those living in socio-economically disadvantaged, residentially segregated areas • Those who suffer racial discrimination

15. Vulnerable are risk averse • Those with economic power are risk-takers • Poor bear consequences • (Paul Slovic)

16. Drowning • Number of people at risk from flooding by coastal storm surges projected to increase • Currently 75 million people at risk • Projected 200 million in mid-range climate scenarios (40cm rise in sea level by 2080s) • Patz JA, Campbell-Lendrum D, Holloway T, Foley JA. Impact of regional climate change on human health. Nature 2005;Vol 438:doi:10.1038/nature04188.

17. Extreme climate events:Hurricane Katrina • Structural factors affected poor black people most • Levees poorly maintained • Residentially segregated to low lying areas • Little public transport • Corruption, no functional emergency plan • Poor policy implementation

22. Adaptation to 2°C

23. Adaption at different societal levels • Structural changes - shifting whole towns • Food production • Population movements - refugees • Urban design • Housing • Regulation of markets in energy & water- equity as well as efficiency

24. Adaptive capacity differs • Capability and functioning both important • Wealth, income, social and cultural capital increase ability to adapt • Adaptive responses should not increase health inequalities • Social gradients in health vs tipping point

25. Structural changes • Location of settlements (in relation to availability of secure water supplies, sea level rise and extreme events) • Infrastructure (water, electricity, transport, communications) and ability to withstand climate extremes • Such as floods…

26. Experts called in to help solve Kaeo's flooding dilemma 5:00AM Tuesday Jul 17, 2007By Tony Gee Engineers and technical experts will be called to flood-hit Kaeo in about two weeks to identify long-term options aimed at reducing the constant risk of flooding in the small Far North town. Kaeo copped 273mm of rain in 12 hours last Tuesday, adding fresh recovery woes to those almost overcome since the deluge that swept through the area on March 29. The future of the flood-prone town and others like it was raised last week by Prime Minister Helen Clark, who suggested it might be time to consider whether such centres should be relocated. More rain yesterday flooded some bridges in the North, stranding Kerikeri pilot Gary Hansen at Wellsford. Photo / Greg Bowker The big storm - North Island 2007 July month of weather extremes and contrasts Tower says July weather claims $2.7m over budget

27. Urban Form • 85% of New Zealander live in cities • Urban sprawl increases carbon emissions • Heat islands increase surrounding temperatures ~ 2°C, 5-11°C warmer than surrounding rural areas • People in suburbs and exurbs have longer commutes & less exercise, more obesity

28. Urban form adaptations • Need intensification of inner-city housing • Unless work, housing and amenities are close together people will use their cars • Public transport should be dominant mode of transport • Government 2009 Policy Statement on Land Transport $10.7 billion over next 10 years for State highways - $0.6 billion for public transport

29. Adaptation to heat-waves • Reduction of urban heat island effects • Passive cooling of buildings • Close monitoring through social networks important to prevent deaths in extreme weather • Lack of trust can keep people locked in over-heated rooms

30. Other examples of adaptation policy in housing: a strong case for • greater provision of extended family housing for families in chain migration • increases in social and health service • higher proportion of social housing in all regions (presently only 5%) • ethnically integrated suburbs -strength of weak ties • Household right to minimum amount of water important for cleanliness and contagion control • Greater use of grey water and rain water in cities (with appropriate safeguards against mosquito breeding)

31. Likely (NZ) health impacts in a high carbon world?

32. Health impacts would intensify • However, not appropriate to simply extrapolate existing quantitative models of health impact • Effects of global social dislocation likely to predominate (major indirect effect on NZ via migration)

33. Vince (2009) in New Scientist: a high carbon world

34. Adaptation to a high carbon world: • National adaptation measures likely to be increasingly ineffective (especially in poor countries) • Challenge to optimise global land use (Schellnhuber, 2009) • (Mitigation+ Adaptation+ Development)

35. Mind Game - Optimizing Allocation of Agricultural Sites 1995 share of agriculture (Müller et al. 2006)

36. Mind Game - Optimizing Allocation of Agricultural Sites Globally optimized production scheme (pop. of 12 billion, diet of 1995) (Müller et al. 2006)

37. Global solutions • In exchange for protection of critical biodiversity in the poor “South” • … the rich “North” provides food security, and a guarantee of migration rights…

38. Population movements:NZ as lifeboat • Worsening of extremes: floods, droughts, storms, fires • Sea level rise (esp Pacific islands, low lying deltas) • Reduced food security (esp Africa, Asia) • Global solutions needed?

39. Co-benefits of NZ shifting to a low-carbon society WIN/WIN policies • More energy efficient housing benefiting health & education & reducing energy costs • Better support for active transport (cycling, walking) will improve health (heart health, lower cancer risks etc) • Cleaner non-carbon energy sources will reduce air pollution • Improved urban design will have benefits for social capital, mental health • Lower carbon diets (less meat) will reduce risks of heart disease and cancer

40. Conclusions • Health effects of climate change should be an important driver of adaptation policy • Predominant health effects through extreme weather events & infectious diseases • Adaptation possible in urban form and housing • Building ‘linking social capital’ important • Co-benefits of moving to low-carbon economy • Possibility of positive contribution to GDP

41. Conclusions • High carbon scenario likely to involve major global social disruption. • Can’t extrapolate health impacts in a simple linear fashion… • Need global optimisation of land use, exchange of migration rights and food security in return for protection of “terrestrial commons”?

42. References • Hales S, Black W, Skelly C, Salmond C, Weinstein P. Social deprivation and the public health risks of community drinking water supplies in New Zealand. Journal of Epidemiology and Community Health 2003;57:581-583. • Hales S, Woodward A. Potential health impacts and policy responses. In: Chapman R, Boston J, Schwass M, editors. Confronting Climate Change: Critical issues for New Zealand. Wellington: Victoria University Press, 2006:117-123. • Hales S, Howden-Chapman P, Baker M, Menne B, Woodruff R, Woodward A. Implications of global climate change for housing, human settlements and public health. Review of Environmental Health 2007;22(4):295-302. • Hennessy, K., B. Fitzharris, B.C. Bates, N. Harvey, S.M. Howden, L. Hughes, J. Salinger and R. Warrick, 2007: Australia and New Zealand. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, Eds., Cambridge University Press, Cambridge, UK, 507-540. • Schellnhuber (Copenhagen talk) http://climatecongress.ku.dk/presentations/webcasts/