Global Warming and Climate Change:

Why the Health Sector Should be Engaged

SEARO Office, New Delhi, March 2008

AJ McMichael
National Centre for
Epidemiology and Population Health
The Australian National University
Canberra
 Should the Health Sector Engage?
1. Health risks are real … and are increasing.
2. Extreme weather events likely to increase: Could
overwhelm health sector’s capacity.
3. CC jeopardises other ongoing health gains – esp.
in low-income/vulnerable populations
(e.g. Millennium Devt Goals; HIV/AIDS pandemic; etc.)
4. Health sector has, generally, been slow to
recognise and respond to risk. Consequently:
 Inadequate capacity-building (research, prevention, policy)
 Deficient contact/engagement with other sectors

5. Society has been slow to understand that threat to

health is the most serious, fundamental, risk.
 Population health is ultimate marker of ‘sustainability’
 Climate Change: Health Impacts
and Policy Responses
Adaptation:
Reduce impacts
Natural
processes and
forcings Global Environmental Impacts on human
Changes, affecting: society:
Human pressure • Climate
on environment • livelihoods
• Water • economic productivity
• Food yields • social stability
Human society: • Other materials
• culture, institutions • health
• Physical envtl. safety
• economic activity • Microbial patterns
• demography • Cultural assets

Feedback

Mitigation: Reduce
pressure on environment
 Overview of Recent CC Science
Together, the reported GCM model runs for the 6 IPCC
emissions scenarios forecast, for 2100, increases in
temperature (central estimate per scenario) of 1.4-5.8 oC.
Most of the uncertainty reflects unknowable human futures
(the scenarios); the rest is due to model uncertainties.
A further ~0.7 oC is ‘committed’ (on top of the 0.6oC already
realised)
IPCC Fourth Assessment Report (2007) already looks
conservative. Recent studies indicate accelerating change.
Political discourse in high-income countries is now starting
to acknowledge need for 80+% reduction in emissions
relative 2000.
 Projected warming, to 2100: for six future
global greenhouse gas emissions scenarios
Intergovernmental Panel on Climate Change (IPCC), 2007: Wkg Gp I

3 of the 6 emissions
scenarios Uncertainty
range: 1
standard
Warming already in ‘pipeline’ from deviation

existing GHG levels (~0.6oC)

A1F1
+ 4oC
A2

1.8 - 4.0 oC
A1B
Warming + 2oC
(oC) B1
23 models 1980-99 A1T B2 A1F1
(tested against baseline
temperatu
recent record) re

16-21 models
No. of
used for each
models
scenario used

1900 2000 2100 6 different GHG

Year emissions scenarios
 CO2 Concentration Climate Change: Faster
Solid lines = than expected in 1990s
observed
IPCC 4 (2007) was limited to
science published by early 2006
Dashed lines =
1990s projections Subsequent research shows
increasing rates of:
Av Surface Temp
 Global GHG emissions
3.3% p.a. in 2000s, vs 1.3% p.a. in 1990s
 Temperature rise
especially in polar regions
 Ice melt (Arctic: 40% loss since 1980,
accelerating 2006-07)
Sea Level Rise (cm)
 Sea-level rise

Rahmstorf, Church, et
al., Science 2007

1975 1985 1995 2005

 Intergovernmental Panel on Climate Change,
WkGp2 Report (2007): Some Key Findings
Water: 75-250m Africans may face water-shortage by 2020.
Crops:
Rain-fed agriculture could decline by 50% in
some African countries by 2020.
Crop yields could:
increase by 20% in some parts of Southeast Asia … but
decrease by up to 30% in Central/South Asia.

Glaciers and snow cover: Expected to decline, reducing

supply of melt water to major regions, cities.
Species: 20-30% of all plant and animal species face
increased risk of extinction if 1.5-2.5 oC rise.*
Scientific literature review of >29,000 studies of physical and biological changes in
natural world: 89% consistent with accompanying warming.
Excerpt from UNDP
Press Release, Nov 27
 Climate Change & Health
Physical
systems e.g. prime focus of Stern
Report (UK, 2006)
(ice, rivers, etc.)
Climate Economy:
Food yields
Change infrastructure,
Biological output, growth
Impacts & seasonal Indirect
impacts
cycles Wealth (and distribution);
local environment; etc.
Direct health
impacts (heat,
extreme events,
Human Health:
etc.) • Injuries/deaths
• Thermal stress
• Infectious diseases
• Malnutrition
• Mental stresses
• Conflict, drugs, etc.
 Cartogram: Emissions of greenhouse gases

Density-equalling cartogram. Countries scaled according to cumulative emissions

in billion tonnes carbon equivalent in 2002. Patz, Gibbs, et al, 2007
 Cartogram: (Selected) health impacts of
climate change

Malnutrition > diarrhoea > malaria > floods

Density-equalling cartogram: Patz, Gibbs, et al, 2007.

WHO regions scaled according to estimated mortality (per million people) in the
year 2000. Based on burden-of-disease attribution to the climate change that
occurred from 1970s to 2000 (McMichael et al., 2003).
Health Impacts Summary:
(IPCC, 2007)
IPCC AR4 (2007)
 Health Impacts: Examples
Thermal stress (esp. heat-waves)
Diarrhoeal disease
Vector-borne infectious disease
Dengue fever
Food yields: nutrition, child development
Disasters: damage, dislocation, displacement
Heatwave:
August 2003 Land surface temperatures, summer of 2003, vs.
summers of 2000-04. NASA satellite spectrometry

35,000-50,000
extra deaths over
a 2-week period
 Seasonal variation in daily
mortality pattern, Delhi, 1991-94

60

40
Daily
deaths
20

0
1jan,1991 1jan,1993 1jan,1995
 Heat-related mortality, Delhi, 1991-94:
Generalised additive model, with cubic-spline smoothing
Relative mortality
(% of daily
average)

140

120

100
Uncertainty
range: 95% CI
80
0 10 20 30 40
Daily mean temperature (oC)
McMichael et al, ISOTHURM Study
 Diagram of Typical Influence of Seasonal
Rainfall, Surface Water, and Crowding on
Cholera Occurrence, Madras region
Ro = ‘reproductive number’ Based on Ruiz-Moreno, Pascual, Bouma,
et al, EcoHealth 2007; 4: 52-62.
Study of 26 districts, Madras Presidency,
south-east India, 1901-1940.

Ro primary water human Ro secondary

(water-borne) dilution crowding (human-to-human)
effect effect
transmission transmission

1.0 1.0

Shallow Flood
Water Depth
Domestic bamboo pole holders
Found in public housing estates

KT Goh, Singapore Ministry of Health

Dengue’s principal vector: Aedes aegypti

Principal vector is female Aedes aegypti mosquito. Infected

mosquito remains infective for life.
Indonesia: reported dengue cases doubled in 2007 vs. 2005.
 Effects of Temperature Rise
on Dengue Transmission
 Shorten viral incubation period in
mosquito
 Shorten breeding cycle of mosquito
 Increase frequency of mosquito feeding
 More efficient transmission of dengue
virus from mosquito to human
 Global Dengue Epidemiology

1960s

Thousand-fold
increase in reported
incidence

1990s
Dengue fever only
DHF/DSS

Dengue007/CMH/260302
1990 Estimated
regional
probability of
dengue
occurrence
under medium
climate change
scenario: 2085
vs 1990
2085 Using statistical
equation derived
from observations of
recent distribution of
disease in relation to
meterological
variables

Source: Hales
et al. Lancet,
2002.
http://image.thelancet
Probabili
ty
 Schistosomiasis: Northwards extension of potential transmission
(limited by ‘freezing zone’), in Jiangsu province, due to rise in average
January temperature since 1960

Freezing zone 1970-2000 Temperature change

from 1960s to 1990s
Freezing zone 1960-1990 0.6-1.2 oC
1.2-1.8 oC
Baima lake
Hongze lake

planned
Sth-to-Nth
water
canal

Yang et al, 2005: Increase in reported incidence of Yangtze River

schistosomiasis over past decade. May reflect recent warming?
Northwards extension of “freeze line” (which limits survival of Shanghai
water snails) puts 21 million extra people at risk.
Zhou X-N, Yang G-J, et al. Potential Impact of Climate Change
on Schistosomiasis Transmission in China
Now 2030: + 0.9oC

“Recent data suggest that schisto- 2050: + 1.6oC

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
Climate Change & Malaria (potential transmission) in
Zimbabwe
Baseline 2000 2025 2050
Harare

Ebi et al., 2005

Climate Change & Malaria (potential transmission) in
Zimbabwe
Baseline 2000 2025 2050

Ebi et al., 2005

Climate Change & Malaria (potential transmission) in
Zimbabwe
Baseline 2000 2025 2050

Ebi et al., 2005

 General Relationship of
Temperature and Photosynthesis

100%

Photo-
synthetic 2oC 
activity 2oC 

0%
20o C 30o C 40o C

C Field & D Lobell. Environmental Research Letters, 2007:

A 1oC increase reduces global cereal grain crop yields by 6-10%. So,
a rise of 2oC could mean 12-20% fall in global production. [Note: this
estimate is higher than most others.]
Climate change impacts on rain-fed
cereal production, 2080
(IIASA: Fischer et al, 2001)
Vietnam Population
Bangladesh
 Climate Change: Health Impacts
and Policy Responses
Adaptation:
Reduce impacts
Natural
processes and
forcings Global Environmental Impacts on human
Changes, affecting: society:
Human pressure • Climate
on environment • livelihoods
• Water • economic productivity
• Food yields • social stability
Human society: • Other materials
• culture, institutions • health
• Physical envtl. safety
• economic activity • Microbial patterns
• demography • Cultural assets

Feedback

Mitigation: Reduce
pressure on environment
 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
 Use of climate-health time-series data to develop a
Malaria Early Warning System (Botswana)
Observed summer Forecast (advance-
(Dec-Feb) rain modelled) summer rain

Highest

Log malaria incidence

malaria
incidence
years

(versus)

Relationship between
summer rainfall and
Lowest subsequent annual
malaria malaria incidence …
incidence
years

Summer Precipitation (mm / day)

Precipitation anomaly (mm / day)
Thomson M, et al. Summer rain and subsequent malaria
annual incidence in Botswana. Nature 2006; 439: 576-9
 Climate Change and Health
Dual Purpose of Research

Enhance Health Protection, at two levels:

1. Recognition of health risks will potentiate true
primary prevention – i.e. the reduction of GHG
emissions. (Which may also revitalise Health
Promotion) Meanwhile ….

2. Health risks already exist and more are

unavoidable. So, we must develop and evaluate
adaptive (secondary prevention) strategies.
 Conclusion
Plenty to be
worried about –
but big chance to
play a key role in
achieving a
global solution,
revitalised health
promotion – and
true
 Climate Change & Health:
‘Core’ Categories of Research
Empirical data- Scenario-based future-
based studies health risk assessment

2. Detect 4.Predictive
1. Learn: impacts
CC-health
estimation
3. Estimate (eg, modelling)
relations current burden

Past Present Future

Adaptive
strategies
 Climate Change and
Geopolitical Security
“Climate change of the order and time
frames predicted by climate scientists
poses fundamental questions of human
security, survival and the stability of
nation states which necessitate
judgments about political and strategic
risks as well as economic cost.”

Heating Up the Planet: Climate Change and Security.

Dupont A, Pearman G, Lowy Institute Paper 12, 2006
Deaths and DALYs attributable to Climate Change, 2000 & 2030
Selected conditions in developing countries
Deaths Total Burden
Flo o d s

M a lar ia

Now (2000)
D ia rr h oea Future (2030)

Ma ln u tritio n

120 10 0 80 60 40 20 0 2 4 6 8 10

Deaths (thousands) DALYs (millions)

2000 2030
McMichael et al/WHO, 2004
 Impacts, Vulnerability, Adaptations
Characteristics of
exposed group
(location, wealth, resources, health
status, culture, etc.)

Adaptations
Vulnerability
of group Learning

Actions in
Exposure Health response to
Impact impact

Mitigation:
Reduced
exposure
 Projected warming, to 2100: for six future
global greenhouse gas emissions scenarios
Intergovernmental Panel on Climate Change (IPCC), 2007

3 of the 6 emissions
scenarios Uncertainty
range: 1
standard
Warming already in ‘pipeline’ from deviation

existing GHG levels (~0.6oC)

A1FI
+ 4oC
A2

1.8 - 4.0 oC
A1B
Warming + 2oC
(oC) B1
23 models 1980-99 A1T B2 A1FI
(tested against baseline
temperature
recent record)

16-21 models
No. of Range of estimates
used for each
models for all GCM model
scenario used runs of B1
scenarios emissions
1900 2000 2100 6 different GHG
Year emissions scenarios
 Malaria in Tawau, Sabah

25000 7

6
20000
No. of cases, ABER & ANB

15000
4

Rainfall
3
10000

2
5000
1

0 0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

cases Bed-net Rainfall

Source: VBDCP, MOH

 Global rise in dengue cases reported
annually to WHO, 1955-2005
1,000,000 925,896
One thousand-fold increase
800,000

600,000 479,848

400,000 295,554

200,000 122,174

908 15,497
0

1955-59 1960-69 1970-79 1980-89 1990-99 2000-

2005
Lancet 2006;368:2194
Health Co-Benefits from GHG Emissions Mitigation
Actions: Revitalised Health Promotion?
Reduce 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.
Reduce red (ruminant) meat consumption (livestock sector is major source of GHG
emissions, esp. methane)
Reduce risks of some disease: large bowel cancer, ?breast cancer; also heart
disease (meat fat content).
More energy-efficient housing
Reduce family costs, and (especially for lower-income households) reduce thermal
stress – and debt-related mental stress.
 Tasks for policy-makers
1. Integrate health risk assessment into impact assessments
carried out by non-health sectors
2. Understand the intrinsic uncertainties in this topic, including
unavoidable uncertainties about projected future risks
3. Identify vulnerable communities and sub-populations
4. Develop and evaluate adaptive strategies/interventions to
reduce both present and likely future risks to health from
climate change
5. Coordinate development of policy and programs at local,
national and international levels
6. Recognise need for governmental regulatory involvement as
basis of societal response to this (and other) global
environmental problem(s)
 Achieving Sustainability:
Citizens, or Society – or Global Governance?
Individual citizen/consumer actions can solve ~5% of
problem. (But useful contribution, and good for engagement.)
Large-scale (global) environmental changes need
large-scale (governmental) policy changes
We need a Cultural Transformation (‘Third Industrial
Revolution’; Sustainability Transition)

Global climate/envtl changes arise from systemic

market failures. Government’s role is to remedy
these (Adam Smith also recognised that!) ……………..
‘mutually-agreed mutual coercion’