Transcript Global Environmental Change & Health Part I

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
Host
Environment
Disease
Ecological
Global
Epidemics
Global Temperature: the Past 20,000 Years,
& the Next 100 Years
Av. temp. over past 10,000 years =15 ºC
3
IPCC (2001) forecast:
Mesopotamia
oC, with band
+
1.4-5.8
flourishes
2
of uncertainty
Vikings in
Agriculture
1
emerges
0
Temp.
change (ºC)
-2
-3
-4
End of
last
ice age
Greenland
Black
Death
Holocene
1940
Optimum Medieval
Warm Little Ice
Age in Europe
(15th-18th
centuries)
Younger
Dryas
21st
century:
rapid
rise
-5
20,000 10,000 2,000
1,000
300
100
Now
+100
370 ppm
VOSTOK ICE CORE
280 ppm
CO2
T
420 kya
Present
180 ppm
Observed vs. modeled temperature rise since 1860
Deep
Ocean
Warming
SST Anomalies May 2003
Health Impacts of Climate Change
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
ASTHM
A
Pollen
(& pollen)
2-3x
Floods & Mold
Since
1980s
Droughts & Fires
Ground-level
Ozone
(T-dependant)
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
Vibrio cholerae O139
Nipah Virus
Arenaviruses
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 “Good” News
The Bad News
PLAGUE
541 AD
1346 AD
Cholera, TB, Smallpox
Climate Models and Potential Malaria Distribution
T
~1ºC/C
~2ºC/C
1950
2000
THE CRYOSPHERE
PLANT COMMUNITIES
Geographic Shifts of Mosquitoes
450 ft.
~2•F warming
1970-1990
Diaz & Graham, Science: 19967
LYME DISEASE
PREDATORS OF DEER
1980s
WARMER WINTERS
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
WNV
HUMAN CASES & DEATHS
284 deaths
BLOOD
ORGAN TRANS
IN-UTERO
62
? BREAST MILK
66
…………………
21
POLIO-LIKE
PRESENTATION
1999
2000
2001
2002
&
NEURO SEQUELAE
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
• ZOO animals
• REPTILES
AVIAN FLYWAYS
INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGE
SPECIES LOSS
VECTOR
Raptors
Rodents
DISEASES
Lyme, Hantaviruses,
Leptospirosis, Plague
Vulture die off
India
Feral Dogs
Rabies
Hantavirus Pulmonary Syndrome
1993 Drought, Then Early Rains
10X Explosion of Mice Populations
Range Expansion of Soybean Cyst
Nematode in North America
Crop Pests
Generations/Year
DISEASES OF TREES
US
•West Coast
•Alaska
fungi (Phytophthora)
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
1. Species X-over
2. Genetic reshuffling
3. 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
I.
Surveillance and Response Capacity
II. Health Early Warning Systems
III. Environmental, Energy & Economic
Policies
CHALLENGES
CLEAN ENERGY
HARMONIZING ADAPTATION &
MITIGATION
Solar-powered
•clinics, homes, schools & enterprises
•water purification, pumping &
desalination
MDGs
HEALTH, NUTRITION, POVERTY
AGENDA 21
FISHERIES, FORESTS, POPs
CLEAN DEVELOPMENT
Framework
Reg
Funds
 EE and RE




Inst
THE ENGINE OF
GROWTH
for the
21st CENTURY
“Green Buildings” & Smart Growth
Rationalized Transport & Transit
Retrofitting Infrastructure
Ecological Reconstruction