Global Warming and the Future of Healthcare

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Global Warming and the Future of Healthcare
Nursing

• Geoffrey Hunt BSc (Hons) MLitt PhD FIoN
• Professor of Ethics Global Policies
• University of Surrey, UK
• g.hunt _at_surrey.ac.uk
• The Mary Seacole Memorial Lecture
• Royal College of Nursing Annual Congress 2007
• Harrogate 18th April 2007

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• Sir David King, UK chief scientist,
• calls climate change
• "the biggest
• danger
• humanity has
• faced in 5,000
• years of
• civilization."

Geoff Hunt 2007
Geoff Hunt 2007
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Global warming effects

• EFFECT
• global annual average temperature has already
  risen by 0.6C since pre-industrial times, mostly
  due to human activities.
• By 2100, average global temperatures are
  projected to rise by 2.0-2.5C (range 1.5-4.0C).
  
• glaciers are retreating world wide
• Spring plant development has advanced av. 5 days
• Sea surface temperature rising
• Coral reefs bleaching
• Marine plankton affected impact on fish and
  birds
• Sea levels are rising
• Permafrost is melting in Alaska and Siberia
• Collapse of the massive Larsen B ice shelf in
  Antarctica in 2002
• Increasing prevalence of forest fires
• Increasing prevalence severity of floods and
  droughts
• HEALTH
• The temperature change has been small over the
  last 150 years, but it has been enough to alter
  disease patterns across the globe.
• The WHO has calculated that 150,000 lives are now
  being lost each year to climate change that has
  occurred since the 1970s.
• Different kinds of impact Direct impacts
  (heat/cold) pathogen impacts environmental
  impacts social-economic impacts

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Global warming cause
Burning of fossils fuels (coal, gas, oil) has
increased carbon dioxide, methane and nitrous
oxide gases in atmosphere and these retain
more heat of solar energy.
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Pathogen-related impacts

• The World Health Organization has identified
  more than 30 new or resurgent diseases in the
  last three decades, and changing patterns in
  distribution of
• Malaria
• West Nile Virus
• Tick-Borne Encephalitis (TBE)
• Dengue fever
• Cholera
• Lyme Disease
• .and others

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Malaria

• Malaria now kills 3,000 African children a day -
  a dramatic increase from the 1950s and '60s, when
  control and containment seemed possible.
• By the end 21st century, warming will enlarge the
  zone of potential malaria transmission from an
  area containing 45 of the worlds population to
  an area containing about 60. No vaccine is
  available, and the causative parasites are
  becoming resistant to standard drugs.
• The geographic range of malaria is generally
  limited to the tropics and subtropics because the
  Plasmodium parasite requires an average
  temperature above 16C to develop.
• Malaria moving northward and uphill. A WHO report
  in 2000 found that warming had caused malaria to
  spread from three districts in western Kenya to
  13 and led to epidemics of the disease in Rwanda
  and Tanzania.

• Europe may be affected in future. Turkey is
  already danger zones for
• malaria. The WHO says its likely to spread
  within eastern Europe, and
• from there, possibly, to western areas.
• NB The relationship between climate and
  malaria is complex and controversial.

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West Nile Virus

• Spreading fast West Nile virus (Uganda 1937),
  carried by mosquitoes, never seen in N America
  until 1999, has infected more than 21,000 people
  across the USA and Canada and killed more than
  800. Also spreading in Mexico, Puerto Rico, the
  Dominican Republic, Jamaica, Guadeloupe and El
  Salvador. Largely spread in bird infections, and
  animals such as horses and dogs.
• Three degrees WNV has three different effects
  on humans, the 1st is an asymptomatic infection
  the 2nd is a mild febrile syndrome West Nile
  Fever
• the 3rd is a neuroinvasive disease West Nile
  encephalitis. In infected individuals the ratio
  between the three states is roughly 110301.
• Symptoms of WNV Fever Fever, headache, body
  ache, swollen lymph glands and occasionally a
  rash on the trunk. The elderly and those with
  compromised immune systems are more susceptible.
• Symptoms of WNV EncephalitisHeadache, high
  fever, neck stiffness, stupor, disorientation,
  coma, tremors, convulsions, muscle weakness, and
  paralysis. Usually leave permanent neurological
  effects.
• There is currently no vaccine for humans.

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Tick-borne encephalitis (TBE)
Geoff Hunt 2007

• In Sweden,
• warmer winter days
• have encouraged the northward movement of ticks,
  which has coincided with an increase in cases of
  tick-borne encephalitis since the 1980s.

In the last 25 years of the 20th C. the
prevalence of tick-borne encephalitis in Russia
and many European countries rose
enormously.10,000 cases p.a. in Russia.
 In 1996, health authorities reported a human
case of tick-borne encephalitis in the Czech
village of Borova Lada, elevation 3,000 feet.
Until then, the Ixodes rinicus tick (photo),
which is the carrier, had never been seen above
2,600 feet.
Long-lasting or permanent neuro- psychiatric
sequelae are observed in 10-20 of infected
patients.
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Dengue fever

• Dengue fever is now considered the most serious
  viral infection transmitted in man by insects,
  measured in terms of the number of human
  infections or the number of deaths.
• Today Dengue afflicts an estimated 50m -100m in
  the tropics subtropics (mainly in urban areas).
  It has broadened its range in the Americas over
  the past 10 years and reached down to Buenos
  Aires by end of 1990s. Now found in
• N Australia.
• Asian Tiger Mosquitoes, which carry dengue
  fever, have been reported recently as far north
  as the Netherlands.

The incidence of dengue has increased in areas
where temperature has increased. Dengue fever
spreads to higher elevations. Dengue fever is
spreading above its former limit of 3,300 ft
(1,006 m) and has been reported above 4,000 ft
(1,219 m). In Mexico when dengue reached an
altitude of 1,700 meters during an unseasonably
warm summer in 1988. In an earlier study in
Mexico, the most important predictor of dengue
prevalence in communities was found to be the
median temperature during the rainy season.
Neither a vaccine nor a specific drug treatment
is yet available.
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Estimated 2.5 billion people are currently at
risk from dengue, and since the late 1970s
Dengue has re-emerged in the Americas, with
280,000 reported cases reported in Latin America
in 1995 alone. Urban outbreaks can involve up to
70-80 of a population.
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Cholera

• Caused by Vibrio cholerae, a bacterium - severe
  diarrhea, and without rapid treatment often leads
  to dehydration and death.
• As the seas warm Cholera, a waterborne disease,
  emerged in South America in 1991 for the first
  time in the 20th century. Facilitated by poverty
  and poor public health, it swept from Peru across
  the continent and into Mexico, killing more than
  10,000 people.
• A study examined disease rates and climatic
  conditions, including rainfall, from 1966 to
  2002. The severity of cholera outbreaks
  corresponded to harsh conditions stimulated by El
  Niño, a weather pattern with global effects that
  stems from warming in the Pacific Ocean.
• V. cholerae has been found to be associated with
  marine zooplankton, and blooms from warmer sea
  surface temperatures could expand this reservoir
  of cholera epidemics.
• Increased floods and droughts will increase
  cholera outbreaks. (Droughts can wipe out
  supplies of safe drinking water and concentrate
  contaminants that might otherwise remain dilute.)
  

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Lyme disease

• Lyme disease (a Borrelia spirochete - photo) was
  not fully recognized until a cluster of cases was
  identified in the area of Lyme, southeastern
  Connecticut, USA in 1975, and has spread widely
  since then.
• Carried by Ixodes tick.
• Symptoms Rash, fever, headache etc.,
• and very wide range of symptoms at late stage.
  Deaths have occurred but not common, but drain on
  healthcare resources.

• A percentage of patients with Lyme disease
  have symptoms that last months to
• years after treatment with antibiotics.
  These symptoms can include muscle and
• joint pains, arthritis, cognitive
  defects, neurological complaints or fatigue.
• Investigation is under way into connection
  with global warming.
• The most common tick-borne disease in N
  America and Europe, and one
• of the fastest-growing infectious
  diseases in the USA.
• A GSK vaccine was taken off the market
  after only a few years
• class action litigation followed
  side-effects.

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Physical impacts

• The cascading consequences of global warming
  include a rise in extreme weather events such as
• heat waves and extreme cold
• hurricanes
• storms
• river-floods
• sea-flooding
• droughts
• soil erosion and desertification
• landslides and mudslides

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Non-pathogen health impacts

• Besides the spread of pathogen-related disease
  we can expect big increases in
• malnutrition
• trauma
• cardiac and respiratory illness
• allergies and the like
• Heat wave deaths, esp among elderly and very
  young In 2003, a record summer heat wave killed
  35,000 people, most of them elderly, in Western
  Europe. In France alone that year (the hottest
  3-month period recorded in France), there were an
  estimated 15,000 extra deaths.
• A review of climate and weather disasters in the
  United States, from 1980, shows the top 2 killers
  were heat waves and associated drought, in 1980
  and 1988. Combined, at least 15,000 people died
  owing to hot and dry conditions those two years.

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Non-pathogen health impacts -2

• People with heart problems are vulnerable because
  their cardiovascular system must work harder to
  keep the body cool during hot weather. Heat
  exhaustion and some respiratory problems
  increase.
• Higher air temperatures also increase the
  concentration of ozone at ground level. Ozone
  damages lung tissue, and causes particular
  problems for people with asthma and other lung
  diseases. 
• Drought contributes to famines and disease
  outbreaks in less developed countries that kill
  millions.
• Warmer temperatures combined with increased
  ambient UV radiation could worsen photochemical
  smog, especially over urban areas.
• In other areas, cold-related deaths

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Ecological Impacts

• The disruption of ecological systems with..
• the spread (and withdrawal) of pests and
  blights
• rats and mice
• ticks
• flies
• weevils
• locusts
• moulds
• bacteria, etc.
• an impact on food chains
• interruption or dwindling of human food supplies

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Ethical / legal aspects -1

• Responsibility? Most affected will be developing
  nations, yet developed nations have contributed
  most to global warming. Therefore, the latter
  have greater responsibility.
• Human migrations caused by climate disaster will
  stress hospitality and health resources of
  neighbouring nations and world community (Cf.
  Bangladesh)
• Still, it will affect everyone on the planet
  regardless of class, race and culture if
  differentially
• Economic, financial, industrial, transport,
  social and political systems (compounded by a
  coming oil demand crisis) will be put under
  severe strain. Migrations, refugees, conflicts
  and wars will almost certainly increase too.
• A global problem requires a strategy of
  international dimensions that can translate into
  regional and local actions. (WHO Bulletin, 85(3)
  2007)
• Shift needed in priorities for healthcare
  resources from high-tech curative to public and
  environmental health.

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Ethical / Legal aspects -2

• Stern Report No region would be left untouched
  by changes of this 3ºC inc. magnitude, though
  developing countries would be affected especially
  adversely. This applies particularly to the
  poorest people within the large populations of
  both sub-Saharan Africa, and South Asia. By 2100,
  in South Asia and Sub Saharan Africa, up to 145 -
  220 million additional people could fall below
  the 2-a-day poverty line, and every year an
  additional 165,000 - 250,000 children could die
  compared with a world without climate change.
  first page of Part II
• Will there be equity in the adaptation to climate
  change what scale of compensation is required?
• Tyndall Centre suggests principles for fair
  adaptation in the climate change regime include
  avoiding dangerous climate change,
  forward-looking responsibility, putting the most
  vulnerable first and equal participation of all.
• Need for a global ethics Cf Mary Seacole, whose
  global ethics was greater than that of the
  authorities who would not support her going to
  Crimea war, but she funded herself.

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Ethical / Legal aspects - 3

• A taste of things to come
• ..in Canada a 50 million class action lawsuit
  is being brought against the Ontario government
  on behalf of about 40 victims of West Nile Virus,
  claiming that the government did too little to
  inform the public about the risks (Canadian Lyme
  Disease Foundation (2006).

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Official responses

• Kyoto Protocol a pact agreed by government
• delegates at a 1997 U.N. conference in Kyoto,
• Japan, to reduce the amount of greenhouse
• gases emitted by developed countries by
• 5.2 of 1990 levels during 2008-2012.
• A total of 141 nations have ratified it.
• The World Health Organization has recognised the
  health impacts of climate change (WHO, 2006).
• See WHO (2006) Climate Change and Health.
  http//www.who.int/globalchange/climate/en/
• The Stern Review on the Economics of Climate
  Change (Cf. Tyndall Centre) has concluded that
  transition to a low-carbon (60 CO2) economy in
  UK by 2050 is possible. Note that energy
  efficiency measures would not only forestall
  future health harms of GW but would reduce
  current health harms by e.g. reducing harmful
  fine particle emissions of fossil fuels.
• In the UK the Department of Environment convened
  an Expert Group on Climate Change and Health,
  which produced a comprehensive national report
  (DoE, 2001).

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Example of official action

• In Aug 2003 heat-related deaths in London among
  over-75s rose by 60.
• See NHS Heat Wave Plan for England. During a
  Level 3 (Heatwave) alert
• Primary care trusts and local social services
  authorities will
• Continue to distribute advice to people at risk
  and managers and staff of care homes.
• Commission additional care and support, involving
  at least daily contact, as necessary for at-risk
  individuals living at home. This may involve
  informal carers, volunteers and care workers. It
  will be particularly targeted at people with
  mobility or mental health problems, or receiving
  medication likely to give rise to heat-related
  risks, and those living in accommodation that
  cannot easily be kept cool. Informal carers
  should be consulted about additional arrangements
  wherever possible.
• Ensure Department of Health advice reaches local
  authority-funded residential
• and nursing care home managers as soon as a
  heatwave starts.
• Primary care trusts and NHS trusts will ensure
  hospital services are in a state of
• readiness in case there is a rise in admissions.
  Discharge planning should reflect
• local and individual circumstances so that
  people at risk are not discharged to
• unsuitable accommodation or reduced care during
  a heatwave.
• (Thresholds for London are 32ºC in day and 18ºC
  at night).
• Is this adequate? Is nursing policy-making
  involved?

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Implications for Nursing

• What general implications does global warming
  have on the global institution of nursing in next
  50 years?
• Nursing resources will be severely stressed in
  many places where, how?
• Impact on migration of nurses?
• Unresponsive skill mixes?
• All public sector finances put under strain?
• Refugees and displaced people?
• New disease patterns nursing response?

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Professional Action

• We must think and act now just to mitigate the
  coming disasters.
• I recommend that nursing professional
  organizations, international, regional and
  national, do the following as a matter of
  urgency
• 1) Support calls for adequately funded research
  on the public health and disease impacts of
  global warming.
• 2) Research and draw up publicly available
  policy documents on the long term assessment of
  the impact of climate change on the need for
  nursing care and on the nursing profession.
• 3) Urge governments, and international agencies
  to act now both to mitigate the impact of
  industrial and economic policy on the
  environment, and to prepare for the enormous
  impact of global warming on health.
• 4) Urge all bodies involved in nurse education
  to put climate change and health on the
  curriculum, especially at the higher and CPD
  levels.
• 5) Urge UK government to institute an adequate
  national severe weather event action team
  SWEAT for a healthcare response strategy to
  severe heat, cold, flood, epidemic etc. Cf.
  Civil Contingencies Act 2004

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Personal actionreduce consumption
The Royal Society of Arts (London) in April 2005
(together with Canon) unveiled a 7m tall
sculpture called 'WEEE Man' on the South Bank. It
is made from 3.3 tonnes of electrical goods,
which is the average electrical waste one UK
person generates in their lifetime. The sculpture
was later taken on a UK tour.
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Personal Action Life style changes reduce your
carbon footprint

• Use less Fossil-fuel Energy
• Use a Green energy supplier
• Insulate home
• Condenser boiler
• Switch off electrical devices not in use
• Turn down the water heating setting
• Set the central heating timer accurately and at
  19ºC
• Fill your dish washer / washing machine with a
  full load
• Fill the kettle with only as much water as you
  need
• Hang out the washing to dry rather than using a
  tumble-dryer
• Wash dishes with as little hot water as possible,
  rather than in dishwasher
• Change light bulbs to energy-saving bulbs (saving
  about 230kg C02/yr)

Transport Use public transport instead of a
car Walk or use a bicycle more If you buy a car
small or green one Do your weekly shopping in a
single trip Cut air travel use cyberspace
instead Campaign to Save forests Reduce
waste Recycle Join NGO campaigns asking banks
and corporations to change their energy
policies Support campaigns for national
legislation
Geoff Hunt 2007
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References

• Canadian Lyme Disease Foundation (2006) Victims
  launch 50 M lawsuit over West Nile.
  http//www.canlyme.com/wnvaction.html
• Civil Contingencies Act 2004 http//www.opsi.gov.
  uk/acts/acts2004/20040036.htm
• Davis, R.E., et al., 2003. Changing heat-related
  mortality in the United States. Environmental
  Health Perspectives, 14, 1712-1718.
• Diarmid Campbell-Lendrum,a Carlos Corvalan a
  Maria Neiraa. (2007) Global climate change
  implications for international public health
  policy. Bulletin of World Health Organization,
  85 (3) 235-37.
• DoE (2001) Health Effects of Climate Change in
  the UK.
• http//www.dh.gov.uk/assetRoot/04/10/80/61/041080
  61.pdf
• Epstein, P. 1999. Global Warming Health and
  Disease. World Wildlife Fund.
• Houghton, J. Global Warming The Complete
  Briefing. Cambridge University Press, 3rd edn.,
  2004.
• Khasnis A, Nettleman M.(2005) Global warming and
  infectious disease. Arch Med Res 36 (6) 689-96.
  
• Reiter, P., Thomas, C J., Atkinson, P M et al.
  (2004) Reflection Reaction Global warming and
  malaria a call for accuracy, The Lancet
  Infectious Diseases Vol 4 323-24.
• Lindgren, E. (1998) Climate and tickborne
  encephalitis. Conservation Ecology online
  2(1) 5. Available from the Internet. URL
  http//www.consecol.org/vol2/iss1/art5/
• NHS (2004). Heatwave Plan for England. NHS,
  London. See www.dh.gov.uk/publications.
• Ochoa, G., Hoffman, J Tin, T. Climate. Rodale
  International Ltd, London, 2005.
• Patz, J. A., Campbell-Lendrum, D., Holloway, T.
  and Foley, J. A. (2005) Impact of regional
  climate change on human health. Nature 438,
  310-317.
• Patz, J. A. Climate Change and Health Need for
  Expanded Scope of Occupational and Environmental
  Medicine. Available at
• http//yosemite.epa.gov/oar/globalwarming.nsf/con
  tent/ResourceCenterPublicationsPatz_health.html
• Pruss-Ustun A, Corvalan C. Preventing disease
  through healthy environments Towards an estimate
  of the environmental burden of disease. Geneva
  World Health Organization, 2006.
• Rogers, D.J. and Randolph, S.E. (2006) Climate
  change and vector-borne diseases. Advances in
  Parasitology 62 345-381
• WHO. Potential health effects of climatic change.
  World Health Organization, 1990.

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RCN Congress 2007Mary Seacole MemorialGlobal
Warming the Future of Healthcare Nursing
Thank you for listening

• Geoffrey Hunt BSc(Hons) MLitt PhD FIoN
• University of Surrey, UK.
• g.hunt _at_surrey.ac.uk