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HSS4331 International Health Theory


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Title: HSS4331 International Health Theory

HSS4331 International Health Theory Feb 23,
2009 - Climate Change and Health
But before we begin. Interview with African
economist Dambisa Moyo http//www.nytimes.com/200
Climate Change
Climate Change will affect population health
everywhere But there will be a particularly
dramatic effect on developing and poor nations.
From WHO website
Developing country populations, particularly in
Small Island States, arid and high mountain
zones, and in densely populated coastal areas,
are considered to be particularly vulnerable.
From Stephen Lewis
Those places expected to be hardest hit by
Climate Change are precisely those places
currently being affected by HIV/AIDS, i.e.
Southern Africa. (not a precise quote)?
What are some of the ways that Climate Change can
affect health?
What are the mechanisms with which Climate Change
can affect population health?
  • Heat waves
  • Floods and storms
  • Water scarcity and quality
  • Communicable diseases
  • Air pollution
  • Changing agriculture
  • Migration
  • Insecurity
  • Economic effects

Heat Waves
-heat waves already kill hundreds, even
thousands, every year -in August 2003, 35000
people were killed in one week of intense heat in
Europe -exacerbated in urban environments -less
vegetative cover -artificial surfaces are less
cool -greater local CO2 production -frequency
of heat waves are expected to increase -according
to WHO, heat deaths in California alone will
double by 2100 -will also mean fewer cold waves
globally, but this is only relevant in countries
with winter -poor countries tend to be tropical,
therefore more susceptible to heat waves
Floods and Storms
-the largest and fastest growing cities are on
coasts -construction patterns have led to less
natural protection (eg erosion)? -poor quality
housing makes people more vulnerable -inadequate
drainage in poor cities -according to WHO,
flooding will affect 200 million people by
2080 -in instances of flooding, it is always the
poor who suffer most -eg, Hurricane
Katrina -poor live in less secure
structures -poor live in more exposed areas
Asian tsunami anyone?
Places most susceptible to floods and storms?
-Nile delta in Egypt -Ganges delta in
Bangladesh -small islands like the Maldives, the
Marshall Islands and Tuvalu
Communicable Diseases
-waterborne and vector borne diseases are
strongly influenced by climate -mosquitoes that
carry dengue fever prefer high heat and
humidity -increasing global warming makes more
habitats for mosquitoes -increased population
density means faster spread of such diseases
Water quality and scarcity
Because rivers are changing paths and rainfalls
are misscheduling, the predictability of the
safety of drinking water is uncertain.
  • Already, 2 million deaths a year, mostly among
    young children, are due to diarrhea, directly
    caused by unsafe water.
  • WHO estimates that today 2.4 of diarrheal deaths
    are due to climate change. (WHO uses very
    conservative methods to reach these estimates.)

Air Pollution
-Atmospheric pollutants tend to be greater on
hotter days (eg ozone)? -U.S. model predicts that
by 2050, due to global warming, ozone-related
deaths will increased by 4.5 and there will be
60 more alert days -exacerbated in emerging
nations with lesser urban planning schemes (China)
Changing Agriculture
Agriculture is affected by temperature,
precipitation and soil quality. But in the long
run, Climate Change affects agriculture by
  • productivity
  • agricultural practices (through changes of water
    use, pesticides, etc)
  • environmental effects (frequency and intensity of
    soil drainage, etc)
  • rural space (loss of land due to desertification)
  • adaptation (change in biology of species)

Poor agriculture leads to poor nutrition leads to
poor health
Changing Agriculture
Agriculture is affected by temperature,
precipitation and soil quality
Poorest countries will be hit hardest. Reduction
in crop yield in tropical and sub-tropical
regions caused by decreased water and changed
insect behaviour. -IPCC (2001)
"southern Africa could lose more than 30 of its
main crop, maize, by 2030. In South Asia losses
of many regional staples, such as rice, millet
and maize could top 10". Science (2008)
In Africa and Latin America many rainfed crops
are near their maximum temperature tolerance, so
that yields are likely to fall sharply for even
small climate changes falls in agricultural
productivity of up to 30 over the 21st century
are projected. Marine life and the fishing
industry will also be severely affected in some
places. -IPCC (2001)
In 2005, half of Bhola Island in Bangladesh
became permanently flooded, leaving 500,000
people homeless. They are being called the
world's first Climate Refugees. -Washington Post
There is a long established intersection between
migration and health -sudden stress of large
numbers of people is ecologically
bad -environmental refugees must be fed,
sheltered and cared for -the world has a poor
track record of caring for mass
migrants -?Climate Refugees (first used in
"The growing number of disasters and conflicts
linked to future climate change will push the
numbers far higher unless urgent action is taken.
We estimate that between now and 2050 a total of
1 billion people will be displaced from their
homes. Christian Aid (2007)
1400 residents of Papua New Guinea's Carteret
Islands are permanently homeless because their
islands sank under rising sea levels -Sydney
Morning Herald (2002)
War is bad for health. Need I explain why?
-high tension areas already exist with respect
to water -South Asia (India, Pakistan,
Bangladesh)? -Middle East (Lebanon, Israel,
Iraq, Iran)? -freshwater needed for drinking and
agriculture -flowing water needed for industry,
transportation and clean energy -with fossil
fuels out of fashion, greater need for
hydroelectic power --gtdams --gt denial of flowing
water downstream --gtconflict
Israel and Lebanon almost went to war in 2003
over fresh water from the Hasbani river.
War is bad for health. Need I explain why?
War has been known to be triggered by climate.
Swings in temperature were correlated with times
of war in Eastern China between 1000 and 1911.
-Human Ecology (2007)
Global warming constitutes a security threat to
the USA, as there will be wars based on
diminishing fresh water supplies, refugees, and
higher rates of famine and disease -The Pentagon
"Water at large is the central global warming
problem for the USA" -Princeton University
Less money means less public health.
Economic Effects
Coral bleaching can lead to collapse of the
worlds fisheries in a matter of decades Am J
Prev Med (2008)
Case study Washington State(Dept of Ecology,
  • Direct costs of fighting wildfires gt 75 million
    per year by the 2020s.
  • Water conservation costs 16 million by 2040
  • Public health costs
  • Tourism and recreation losses
  • Hydropower revenues down by 166 million by 2020
  • Water price increases in some basins 680,000
    per million gallons per day.
  • Dairy revenue loss 6 million per year by the
  • Crop losses 66 million
  • Shoreline protection 50 million
  • Flooding costs
  • Cumulative economic effects (As one industry
    declines, another may follow.)

Aside Psychosocial effects
Health Canada 2007 report Climate Change and
Health Vulnerability Assessment The Public
Health Agency of Canada is undertaking a study on
the projected mental health effects of
environmental stressors resulting from Climate
Synergy of Climate Effects
Floods can cause cholera and diarrhea, damage
infrastructure for years, and can contribute to a
pathway making oral vaccines less effective.
Drought exacerbates malnutrition, causes
populations to migrate, where they are exposed o
new patterns of vector-borne diseases.
Climate change causes urban heat waves, causing
increased use of air conditioners, increasing
demand for electricity, leading to further use of
coal plants...
Health Canada breaks down the climate change
health relationship like so
Temperature-related morbidity and
mortality -cold and health related
illnesses -respiratory and CV illnesses -increased
occupational health risks
Health effects of extreme weather
events -damaged public health infrastructure -inj
uries and illnesses -social and mental
stress -occupational health hazards -population
Air pollution related illnesses -changed
exposure to outdoor allergens -asthma, etc -CV
diseases (heart attacks, strokes, etc)? -cancer
Water and food borne contamination -diarrhea -tox
ic algal blooms Vector and zoonotic
diseases -changed patterns of diseases caused by
insects, bacteria, etc Exposure to UV
rays -skin damage and cancer -cataracts -disturbed
immune function Vulnerable populations -seniors
-kids -chronically ill people -poor
people -Northern residents -disabled
people -people living off the land
Socioeconomic impacts -loss of income and
productivity -social disruption -diminished
quality of life -increased costs to health
care -health effects of mitigating technologies
(eg, air conditioners)?
In 2006, the WHO did a study of project health
impacts on Oceania for the year 2050, based on
expected changes in global climate.
VOLUME 114 NUMBER 12 December 2006
Environmental Health Perspectives
In addition, they computed for Sub-Saharan
Africa, for the year 2030
-mortality from flooding would be almost twice as
likely -increase in malaria -increase in
malnutrition due to destruction of crops and
change in harvest season -increase in diarrhea
due to reduced water control
  • Sobering statistic
  • Measurement of health effects from climate
    change can only be very approximate.
    Nevertheless, a WHO quantitative assessment,
    taking into account only a subset of the possible
    health impacts, concluded that the effects of the
    climate change that has occurred since the
    mid-1970s may have caused over 150,000 deaths in
    2000. It also concluded that these impacts are
    likely to increase in the future.

  • WHO's official position
  • WHO considers that rapid climate change poses
    substantial risks to human health, particularly
    among the poorest populations. The organization
    therefore supports actions to reduce human
    influence on the global climate.

Important issues
-climate change denial slows down investment in
projects to address these issues -climate change
affects different regions in very different
ways -poor countries cannot afford to do basic
risk assessment -global rush to cities and to
coasts is ever accelerating -effects on food
production are impossible to predict (though
Africa is thought to be most vulnerable)? -mass
migration (environmental refugees) highly
likely -conflict resulting from both mass
migration and competition for resources is also
likely -a global issue requires a global solution
Another word about water... -Case study
China -In China, by 2030, population will be
1.6 billion and water demand will equal 100 of
China's supply -70 of China's lakes and 5 of
its rivers are too polluted for human
use -China's glaciers are shrinking 7 each
year, due to global warming -gtthis threatens the
source of these rivers Yangtze, Yellow,
Brahmaputra, Mekong and Salween, which feed 500
million people downstream -China uses 7-15 times
more water to produce a unit of GDP than do more
developed nations -gttherefore some of this is
Water Availability Per Capita, 2007
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A word about scientific uncertainty.... the
Canadian Environmental Protection Act (1999)
states ...where there are threats of serious
or irreversible damage, lack of full scientific
certainty shall not be used as a reason for
postponing cost-effective measures to prevent
environmental degradation.
So what is being done?
WHO -continue what they've always done,
addressing infectious disease, malnutrition,
etc -workshops to raise awareness of climate
change in developing world -advocate for green
infrastructure, such as public transportation -adv
ocate for improved urban infrastructure, such as
better drainage -proposed creation of global
climate change fund
More things that need to be done -improved
global disease surveillance -improved response
systems to disease outbreaks -better global risk
assessment, to identify vulnerable areas and
possible interventions -international bodies for
managing shared resources, like water
-research, research, research
--gt how will crops behave as climate
changes? --gt how will vector populations
(insects, rodents) behave? --gt where will
freshwater be most needed? --gtetc
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