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D2E.1: REVIEW OF LITERATURE
HEALTH EFFECTS OF CLIMATE CHANGE: REVIEW OF IMPACT STUDIES
!Sari Kovats, Simon Lloyd
Centre on Global Change and Health
Department of Social and Environmental Health Research London School of Hygiene and Tropical Medicine 15-17 Tavistock Place, London, United Kingdom
Grant Agreement: Project acronym: Project title: Research area:
212774 ClimateCost Full Costs of Climate Change ENV.2007.1.1.6.1.
Deliverable Number: D2E.1 Actual submission date: December 2009
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Title:! Health!effects!of!climate!change:!review!of!impact!studies
Purpose:! Deliverable D2E.1
Filename:!
Date: December!2009!(version!2)
Authors:! Sari!Kovats,!Simon!Lloyd
Citation:! Kovats!S!and!Lloyd!S!(2010)!Health!effects!of!climate!change:!a!review!of!impact!studies.!London!School!of!Hygiene!and!Tropical!Medicine,!London.!
Copyright:! London!School!of!Hygiene!and!Tropical!Medicine
Copyright!statement:!
Working!paper!number:
ISBN: "
!Project Coordinator: Thomas E Downing Stockholm Environment Institute, Oxford 266 Banbury Road, Suite 193 Oxford OX2 7DL, U.K. Tel: +44 1865 426316; Fax: +44 1865 421898 Mobile: +44 7968 065957 [email protected], www.sei.se/oxford Technical Coordinator: Paul Watkiss Paul Watkiss Associates [email protected] Tel +44 797 1049682 http://www.climatecost.cc/
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Abstract Climate!change! is! likely! to!have! important! implications! for!human!population!health! in!Europe.! In!this!report,!we!reviewed!the!journal!papers!that!reported!the!impact!of!climate!scenarios!on!future!health!outcomes! (deaths,!years!of! life! lost,!etc).!Overall,!we! found!25!studies! that!were!published!since!2001!(see!Table).!The!majority!of!these!quantified!the!impact!of!climate!change!on!future!heat"related!mortality.!!!Table:!Health!climate!impact!studies!published!since!2001!Health!topic! No!of!published!
studies!Geographical!scope!
Health!metric!
Heat/cold! 10! Mainly!city level Heat!attributable!deaths!Wild!fires!! 0! n/aWind!storms! 0! n/aCoastal!or!river!floods! 0! n/aDiarrhoeal/food!poisoning 3! Country!level Incidence/cases!Vector"borne!diseases! 7! Country!level,!
regions!Populations!at!risk!
Malnutrition! 1!(0!in!Europe) Global! Population!at!risk!of!hunger!(1)Proportion!children!underweight!(1)!
Air!quality/ozone! 4! Mostly!city"level Ozone"related!mortality!!
!!Overall,!there!has!been!very!limited!quantification!of!future!health!burdens!attributable!to!climate!change.!The!studies!however,!indicate!that!climate!change!is!likely!to!increase!some!health!risks!in!Europe!and!in!India!and!China.!No!robust!estimates!of!the!costs!of!future!impacts!of!climate!change!on!health!(direct!or!indirect)!were!found.!!!Although!there!have!been!advances!in!the!methods!used!to!quantify!the!associations!between!climate/weather!and!health!outcomes,!there!has!been!little!development!in!climate"health!risk!assessment.!In!particular,!there!has!been!inadequate!consideration!of!how!health!status!(such!as!baseline!mortality)!will!change!in!the!future,!and!the!benefit!of!specific!adaptation!measures!to!reduce!the!health!impacts!of!climate!change.!!
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Table of Contents Abstract!......................................................................................................................................!3!Table!of!Contents!.......................................................................................................................!4!Introduction!...............................................................................................................................!5!Objectives!and!methods!........................................................................................................!5!
Climate!change!and!population!health!......................................................................................!5!Review!of!health!impact!studies!by!outcome!...........................................................................!8!Heat,!cold,!and!heat!waves!....................................................................................................!8!Wild!fires!..............................................................................................................................!11!Wind!storms!.........................................................................................................................!12!Flooding!................................................................................................................................!13!Vector"borne!diseases!.........................................................................................................!15!Tick"borne!diseases!..........................................................................................................!15!
Foodborne!disease!...............................................................................................................!17!Food!security!and!malnutrition!...........................................................................................!18!Outdoor!air!pollution!...........................................................................................................!20!Aeroallergens!and!atopic!disease!....................................................................................!20!
Key!issues!.................................................................................................................................!21!Treatment!of!climate!change!...........................................................................................!21!Exposure"Response!Relationships!...................................................................................!21!Geographical!and!temporal!scales!...................................................................................!22!Adaptation!.......................................................................................................................!22!Treatment!of!sectoral!inter"linkages!...............................................................................!23!Consideration!of!major!events!........................................................................................!23!Analysis!of!monetary!values!............................................................................................!23!
Health!adaptation!costs!...........................................................................................................!24!Annex:!Tables!...........................................................................................................................!25!References!...............................................................................................................................!36!!!
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Introduction !This! report! is! the! first! deliverable! for! Workpackage! 2E! Health! for! ClimateCost,! the! EU! FP7!collaborative!project.!The!overall!objective!of!Climatecost! is! to!provide! improved!estimates!of! the!damage!costs!of!climate!change,!including!health!costs.!In!this!paper,!we!have!reviewed!the!recent!literature!on!health!impact!studies!for!future!climate!change.!!!The! health! effects! of! mitigation! policies! are! not! addressed! in! this! paper,! although! these! are!potentially! large! (see!WP5! on! Ancillary! Benefits).! In! addition,! the! emerging! literature! on! health!adaptation!activities!and!costs!will!be!reviewed!elsewhere.!The!health!co"benefits!of!adaptation!and!mitigation! policies! are! likely! to! be! significant! and! represent! an! important! component! of! the!Climatecost!project.!!!
Objectives!and!methods!
!We!have!reviewed!only!published!peer"reviewed!original!impact!studies!and!not!review!papers.!Only!papers!that!report!a!quantitative!estimate!of!the!future! impact!of!climate!scenario(s)!on!a!specific!measured!health!outcome!are!included.!!!Papers!that!described!the!current!effects!of!climate!variability,! including!extreme!events,!were!not!included.!Papers!that!only!measure!health"relevant!exposure! indices!(e.g.!heat!stress! indices)!were!also!not! included.!However,!where!such! indices!have!been!validated!as!a!measure!of!mortality!or!morbidity!risk,!they!will!be!discussed.!!!We!have! reviewed!only!papers! that! address!health!outcomes! in!Europe! [EU27],! India! and!China.!Studies! that!are!considered! to!be!of!high!quality!but!are!not! in! the!peer"reviewed! literature!were!included! where! appropriate.! We! limited! the! search! to! studies! published! after! 2001! as! those!published!before!do!not!use! the!SRES!climate!scenarios!and!are! likely! to!be!out!of!date!given! the!rapid! progress! in! this! area.!We! included! studies! published! up! to!May! 2010.! Studies! have! been!undertaken!in!high!income!countries!in!North!America,!Oceania!and!Asia!were!also!included!where!relevant!(e.g.!for!heat"related!mortality).!!!The!impacts!studies!are!categorised!by!health!outcome.!Papers!are!summarised!in!Tables!A1!to!A5,!according!to!health!outcome.!!!!
Climate!change!and!population!health!!
!Observational!studies!have!shown! that!climate!and!weather! factors!currently!affect!human!health!through!a!wide!range!of!mechanisms!and!for!a!wide!range!of!diseases!or!health!outcomes!(Table!1).!Most!is!known!about!the!effect!of!extreme!weather!events!and!short"term!(day!to!day)!variability!in!temperature!and!rainfall.!There!are!relatively!few!studies!that!look!at!longer!term!“climate”!effects,!such!as! the! impact!of! long! term!shifts! in!areas!suitable! for! food!production.!However,!spatial! risk!mapping!for!vector"borne!diseases!is!a!well!developed!area!for!several!important!diseases!as!it!is!a!useful!risk!management!tool!used!to!guide!(current)!disease!control!measures.!!!The!health!chapter!of!the!Fourth!Assessment!Report!of!the!IPCC!concluded!that!negative!impacts!on!health!will!outweigh! the!benefits,!and! that!populations! in! low! income!countries!will!be! the!worst!
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affected! (Confalonieri! et! al.,! 2007).! The! key! impacts!on!heath! identified! for! the! European! region!include:!heat!related!mortality,!health!risks!of!flood,!and!emerging!infectious!diseases!(Alcamo!et!al.,!2007):!!
“Climate"related! hazards! will! mostly! increase,! although! changes! will! vary!geographically! (very! high! confidence).! Winter! floods! are! likely! to! increase! in!maritime!regions!and!flash!floods!are! likely!to! increase!throughout!Europe.!Coastal!flooding!related!to!increasing!storminess!and!sea"level!rise!is!likely!to!threaten!up!to!1.6!million!additional!people!annually.!Warmer,!drier! conditions!will! lead! to!more!frequent!and!prolonged!droughts,!as!well!as! to!a! longer! fire! season!and! increased!fire!risk,!particularly!in!the!Mediterranean!region.!During!dry!years,!catastrophic!fires!are!expected!on!drained!peatlands!in!central!Europe.!The!frequency!of!rock!falls!will!increase!due!to!destabilisation!of!mountain!walls!by!rising!temperatures!and!melting!of! permafrost.!Without! adaptive!measures,! risks! to! health! due! to!more! frequent!heat"waves,!particularly! in!central!and! southern!Europe,!and! flooding,!and!greater!exposure! to! vector"! and! food"borne! diseases! are! anticipated! to! increase.! Some!impacts! may! be! positive,! as! in! reduced! risk! of! extreme! cold! events! because! of!increasing!winter!temperatures.!However,!on!balance,!health!risks!are!very! likely!to!increase“!
!!Definitions!of!health!
Health!is!here!defined!as!being!"a!state!of!complete!physical,!mental,!and!social!well"being!and!not!merely!the!absence!of!disease!or!infirmity"!according!to!the!WHO.!The!papers!in!this!review!look!at!climate!change! impacts!on!specific!health!end"points.!This!reflects! the!general!approach! to!health!and!medical!research!that!is!reductionist.!In!addition,!quantitative!risk!model!has!generally!focussed!on! specific! exposures! (e.g.! chemicals)! or! specific! outcomes.! Health! impact! assessment,! which!advocates!a!broader!approach! to! take! into!account!multiple!exposures!and!outcomes,! is!only! just!being!developed!and!has! rarely!been!applied! to!environmental!change! issues!or! impacts! in! longer!term!future!time!frames.!!
The!“burden!of!disease”!is!the!term!used!to!describe!the!total!impact!of!disease!or!health!condition!in!a!population,! including!deaths,! cases,!and!years! lived!with!disability! (for! chronic!diseases).!The!metrics!used!in!environment!and!health!decision!making!include:!deaths,!DALYS!(Disability"Adjusted!Life!Years),!QALYs!(Quality"adjusted!life"years)!(Hofstetter!and!Hammitt,!2001;Mathers!et!al.,!2003).!!
Many! anticipated! effects! of! climate! change! are! not! disease"specific! but! address! broader!determinants!of!health!that!are!not!readily!quantified,!such!as!poverty,!population!displacement!and!access! to! food! or! water! (Woodward! et! al.,! 1998).! This! is! not! a! well"researched! area.! Even! for!common! diseases! like!malnutrition! and!malaria,! the! environmental! and! social! determinants! in! a!wide!range!of!populations!are!not!well!described!(or!quantified).!!
A!review!of!climate!change! impact!assessments!found!that!the! literature! is!heavily!biased!towards!quantitative!assessments!within!the!prescribed!scenarios!for!easily!measured!(and!costed)!outcomes!(Watkiss! and!Downing,!2008).! There!has!been! less!work!on!non"market"based!outcomes! such! as!health! and! ecological! impacts.! Further,! the! issue! of! surprises! or! fundamental! systems! changes!caused!by!climate!change!have!been!poorly!addressed!in!the!health!risks!assessment!domain.!
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!Table!1.!Summary!of!current!evidence!for!observed!weather/climate!affects!!Category!of!health!outcome! Known!effects!of!weather!and!climate!variability!!Heat!stress!
! Deaths!from!cardio"respiratory!disease!increase!with!high!and!low!temperatures!
! Heat"related!illness!and!death!due!to!heat!waves!!!
Air!pollution"related!mortality!and!morbidity!
! Weather!affects!air!pollutant!concentrations!! Weather!affects!distribution,!seasonality!and!production!of!
aeroallergens!!
Health!impacts!of!flood!events!
! Floods,!landslides!and!windstorms!cause!direct!effects!(deaths!and!injuries)!and!indirect!effects!(infectious!disease,!loss!of!food!supplies,!long"term!psychological!morbidity)!!
!Mosquito"borne!diseases,!tick"borne!diseases!(e.g.!malaria,!dengue)!
! Higher!temperatures!reduce!the!development!time!of!pathogens!in!vectors!and!increase!potential!transmission!to!humans!!
! Vector!species!require!specific!climatic!conditions!(temperature,!humidity)!to!be!sufficiently!abundant!to!maintain!transmission!!
! !!
Food"borne!diseases! ! Survival!of!certain!bacterial!pathogens!is!related!to!temperature!! Increases!in!drought!conditions!may!affect!water!availability!and!
water!quality!(chemical!and!microbiological!load)!due!to!extreme!low!flows!
!Water"related!diseases! ! Extreme!rainfall!can!affect!the!transport!of!disease!organisms!into!
the!water!supply.!!! Outbreaks!of!water"borne!disease!have!been!associated!with!
contamination!caused!by!heavy!rainfall!and!flooding,!associated!with!inadequate!sanitation!
! Cross!sectional!studies!have!shown!that!areas!with!low!rainfall!have!comparably!higher!prevalence!of!diarrhoeal!disease!in!children.!!
! Flood!events!shown!to!increase!leptospirosis!in!urban!areas!!
!!
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Review of health impact studies by outcome !Due!to!the!complexity!of!environmental!effects!on!human!health!outcomes!and!the!lack!of!primary!epidemiological!research!in!this!area,!relatively!few!climate"relevant!studies!have!been!undertaken.!These!are!reviewed!in!detail!below,!categorised!by!health!outcome.!It!is!important!to!distinguish!the!impact!studies!where!climate!factors!per!se!(temperature!and!rainfall)!act!on!health!outcomes!(e.g.!malaria,!heat"related!mortality)!and! those!where!a!climate"related!exposure! is! required! (e.g.!crop!yields/food! availability,! flood! risk).! The! latter! studies! require! robust! intermediate! models! that!quantify!these!exposures.!!!!
Heat, cold, and heat waves !The!effect!of!high!and!low!temperatures!on!daily!mortality!(deaths)!is!now!well!established!based!on!multiple! epidemiological! studies! in! populations! from! high! income! countries! in! Europe,! North!American!and!Asia!(Basu!and!Samet,!2003;Kovats!and!Hajat,!2008;Chung!et!al.,!2009;Basu,!2009).!!Populations! in! temperate! climates! show! a! general! U"! or! V"shaped! relationship! between! daily!mortality! counts! and! temperature,! with! deaths! increasing! as! temperatures! fall,! but! also! as!temperatures! rise! above! population"specific! threshold! values! (Curriero! et! al.,! 2002).! Figure! 1!illustrates! this! relationship,!with! the!assumptions! that! the! slopes!are! linear!above!and!below! the!heat/cold! threshold! values,! respectively.! The! key! parameters! in! these! studies! are! the! heat!“threshold”!value!and! the! slope! (or!coefficient)!of! the!change! in!mortality! risk!per!unit!change! in!meteorological!parameter!above!the!threshold!value.!!!!
Figure!1!Schematic!illustration!of!the!U"shaped!temperature!mortality!relationship!
!!We!found!11!studies!(all!populations)!that!estimate!future!heat!impacts!(Table!A1).!These!are!largely!city"based!as!the!underlying!temperature"mortality!functions!were!derived!at!the!city!level.!All!the!studies!show!an!increase!in!heat"related!mortality!due!to!climate!change.!As!the!exposure"response!
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function!is!approximately!linear,!and!increase!in!heat!exposures!necessarily!entails!increase!in!the!heat!effects.!!!!These!studies!use!climate!scenarios!to!estimate!the!future!changes!in!local!temperature!exposures,!and!some!(but!not!all)!use!population!scenarios!to!estimate!the!future!total!population,!and/or!the!proportion! of! older! age! groups! are!who! are!much!more! susceptible! to! heat! related!mortality.!A!limitation!of! these!studies! is! that! they!must!make!assumptions!about!how! future!populations!will!respond!to!exposure!to!high!temperatures,!including!the!rate!of!acclimatization.!Only!three!studies!assumed! some! acclimatization,! often! based! on! observed! heat! effects! in! other! populations.! The!inclusion!of!acclimatization! in! the!models! reduced! the!estimated! impact! considerably!but!did!not!removed!it!completely.!The!rate!at!which!populations!will!acclimatize!to!hotter!temperatures!is!a!key!consideration!in!these!health!impact!studies!but!one!that!has!not!been!adequately!addressed.!!!Also!of! importance! is!the!correct!parameterisation!and!assessment!of! the! temperature!exposures.!Mean! temperature! is!commonly!used,!with!control! for!confounding!by!non"temperature!variables!(e.g.! humidity)! even! though! these! are! highly! correlated.! Combined! indices! of! temperature! and!humidity,!such!as!Apparent!Temperature!(AT)!are!also!used,!as!a!construct!which!characterises!the!physiological! experience! better! than! just! temperature! alone! (Steadman,! 1984;Hajat! et! al.,! 2006).!Very! little!attention!has!been!paid!to!the!downscaling!of!climate!data!from!global!to! local!scale,!or!any!interactions!with!heat!island!effects.!The!majority!of!studies!only!used!changes!in!mean!climate!due!to!climate!change,!although!Gosling!at!al!(2009)!have!shown!that!both!changes!in!the!mean!and!daily! temperature!variability!are! important! for! future!health! impacts.!Future!heat"related!burdens!are! likely! to! be! very! sensitive! to! assumptions! about! the! future! frequency! of! very! hot! (above!threshold)!days.!!!Although!some!major!studies!of!temperature!and!mortality!have!not!controlled!for!the!effects!of!air!pollutants! (Braga! et! al.,! 2001;Curriero! et! al.,! 2002),!more! recent!work! has! suggested! that! heat!effects!are!likely!to!persist!even!after!control!for!air!pollution,!and!weather!risk!assessments!are!best!informed!by!analyses!that!account!for!PM10!and!ozone!in!particular!(O'Neill!et!al.,!2005).!Not!all!the!studies!included!adjustment!of!air!pollution!factors.!!!The!majority!of!heat! studies!have! looked! at! impacts!on!mortality,!because!daily!deaths!data! are!generally!readily!available! in!high! income!countries! in!order!to!create!the!risk!models.!Heat!waves!are! also! associated!with! increases! in! emergency! hospital! admissions! –! but! there! have! been! few!projections!of! future!attributable!admissions,! for! two! reasons.!First,! studies! so! far!have! indicated!that!increases!in!hospital!admissions!during!heat!waves!are!not!as!severe!as!that!seen! in!mortality.!Second,!projecting!future!hospital!admissions!(which!will!depend!on!the!structure!of!future!national!health!services)!is!inherently!more!uncertain!than!projecting!future!baseline!mortality.!!
A! key! concern! about! the! correct! public! health! interpretation! of! the! heat! effect! estimates! is! the!extent! to! which! heat! deaths! occur! in! already! frail! individuals! whose! death!may! only! be! being!brought! forward! by! the! heat! exposure! by! a! matter! of! days! –! so! called! short! term! mortality!displacement!or!“early!harvesting”.!That!is,!what!is!the!true!burden!of!heat"related!mortality.!Recent!studies!to!model!the!mortality!pattern!during!the!Paris!(Le!Tertre!et!al.,!2006)!and!Chicago!(Kaiser!et!al.,!2007)!heat!waves!suggested! little!evidence!of!harvesting!during!these!very!extreme!heat!wave!events.! Time"series! studies! have! demonstrated! some! degree! of!mortality! displacement! following!general! heat"related! deaths! (Braga! et! al.,! 2001;Hajat! et! al.,! 2005).! It! is! important! for! economic!assessments!that!this!factor!is!taken!into!account.!!!
!
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The!direct!heat!and!cold!effects!on!health!are!more!readily!quantified!than!other! impacts!due!the!relative!ease!of!quantifying!the!temperature"mortality!functions.!For!most!countries! in!the!Europe,!the!current!burden!of!cold"related!mortality! is!greater! than! the!burden!of!heat!mortality.!Thus,!a!reduction!in!cold!deaths!is!clearly!a!benefit!of!climate!change!in!temperate!countries.!Some!studies!have!reported!a!net!effect!of!higher!temperatures!increases!temperature!related!mortality!(i.e.!the!reduction!in!cold!does!not!outweigh!the!increase!in!heat!(Doyon!et!al.,!2008).!These!results!are!likely!to!be!due!to!how!the!cold!effect!is!modelled!and!it!is!important!to!investigate!whether!this!is!a!true!effect! in! some! countries.! Cold! effects! need! to! be!modelled! at! longer! lags! as! the! effects! of! low!temperatures!are!often!delayed.!!!
!
!!
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Wild fires !
A!wildfire!is!any!uncontrolled,!non"structure!fire!that!occurs!in!the!wilderness,!forest,!or!bush.!Fires!are!closely!related!to!extreme!climatology!(temperature,!drought)!(Vazquez!et!al.,!2002).!Studies!in!Europe!have!shown!that,!in!fact,!a!few!(large)!fires!account!for!most!of!the!burned!area.!Forest!fires!have!been!increasing,!and!in!some!areas,!part!of!it!has!been!due!to!changes!in!climate.!Thus!in!the!south!west!of!Europe,! there! is!good!evidence! that! the! increase! in! fires! is!due! to! climate! change.!There!is!good!evidence!that!climate!change!will!increase!the!risk!of!fires!in!Europe.!
There!are!clear!geographical!differences!in!risk!with!the!hotter!drier!areas!in!Southern!Europe!being!most! at! risk.! Further,! these! natural! disasters! particularly! affect! rural! areas.! Due! to! the! lack! of!information! on! wildfire! distribution! or! impacts,! we! found! no! published! information! on! the!populations!most!affected.!!!A!review!of!the!literature!on!fire!events!found!very!little!information!from!Europe.!There!are!several!papers!on!the!effect!of!biomass!smoke!on!respiratory!outcomes!(hospital!admissions)!from!the!US!(Delfino!et!al.,!2009)!and!Australia!(Hanigan!et!al.,!2008)!but!we!found!only!one!study!from!Europe!(Greece)!which!has!not!yet!been!published!(Analitis!et!al.!forthcoming)!!!No!published!information!was!found!about!the!exposure"response!functions!for!wild!fire!injuries!and/or!mortality!in!Europe.!No!studies!that!estimated!the!future!burden!of!deaths!or!injuries!from!wild!fires!due!to!climate!change!was!found.!!!!
Table!2!The!potential!health!effects!of!wild!fires!!
Phase! Health!outcome!
Pre"onset"phase!! ! Injuries![in!evacuation]!
Onset"phase! ! Death!(burns,!trauma)!! Injuries!! Smoke!inhalation!
Post"onset!phase! ! Injuries!during!clean!up.!!!
Long"term!phase! ! Damage!to!health!care!infrastructure!!! Contamination!of!water!!! Stress!associated!with!short!or!long!term!displacement,!and!loss!of!home,!loss!
of!livelihood.!!
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Wind storms There! is!a!risk!that!climate!change!may!affect!the!frequency!or! intensity!of!wind!storms! in!Europe.!There!has!been!considerable!variation,!but!no!clear!long!term!trend!in!storminess!in!Europe.!Storm!frequency!was! relatively!high!during! the! late!19th!and!early!20th! centuries,!and! then!decreased! in!central! and! northern! Europe.! The! recent! high! level! is! similar! to! the! late! 19th! century! level! of!“storminess”.!!!Climate!models! indicate!a!slight!decrease! in!the!number!of!storms!and! increase! in!the!strength!of!the!heaviest!storms.!Extra"tropical!storm!tracks!are!projected!to!move!northward,!with!consequent!changes! in!wind! and! precipitation! continuing! the! broad! pattern! of! observed! trend! over! the! last!century.!There!is!little!evidence!that!wind!speeds!will!increase!or!decrease!with!climate!change.!!!Deaths!from!windstorms!are!not!collated!in!most!countries!in!the!EU!and!there!have!been!very!few!epidemiological!studies!of!non"fatal!impacts.!Floods!are!often!associated!with!some!wind!storms!but!these! are! addressed! separately! in! the! next! section.! The!most! common! effects! on! humans! from!windstorms!appear!to!be!road!traffic!accidents!and!individual!accidents!(being!blown!over,!or!struck!by! flying! debris/masonry)! (Baxter,! 2005;Baker! and! Lee,! 2008).! Road! vehicles! are! potentially!vulnerability!if!driven!in!wind!gusts!exceeding!20!m/s,!and!reasons!for!accidents!include!overturning,!course"deviation!and!collision!with!falling!or!fallen!trees.!Building!failure!represents!a!less!significant,!but!still!important,!impact!on!human!life!(falling!chimneys,!etc).!A!retrospective!study!of!the!injuries!caused!by!high!wind!speeds!during!the!storms!of!early!1990!found!that!that!high!wind!speeds!were!associated!with!an! increased!risk!of! injury,!especially!when!wind!gusts!exceeded!60!knots!(Cugnoni!and!Whitworth,!2002).!!!No!information!was!found!about!the!exposure"response!functions!for!wind!storm!injuries!and/or!mortality!in!Europe.!No!studies!that!estimated!the!future!burden!of!deaths!or!injuries!from!wind!storms!due!to!climate!change!was!found!either.!!!!Table!3:!Wind!event!classification!Classification! Description! Frequency!Temperate!Windstorms!
Large!scale,!low!pressure!systems:!with!strong!winds!occurring!across!a!track!that!may!be!1000!km!
Relatively!frequent!
Downbursts! Strong!winds!produced!when!column!of!sinking!air!hits!ground!level!and!spreads!out!in!all!directions.!!
Associated!with!thunderstorms.!
Tornadoes! Extremely!severe!winds!occurring!on!a!local!scale!affecting!an!area!of!1"10km2!
Varies!by!region.!!
Source:!adapted!from!(Baker!and!Lee,!2008)!!!!
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Flooding !The!impact!of!climate!change!on!disasters!has!gained!more!interest!in!recent!years.!There!are!now!several!models!that!quantify!the!effect!of!climate!scenarios!on!the!populations!at!risk!of!coastal!or!riverine! flooding.! However,! to! date,! there! are! no! published! studies! that! quantify! the! impact! of!climate!change!on!flood"related!mortality.!!!The! current!health!burden! for!weather!disasters! is!high!and! the! risks!are! concentrated! in! certain!geographical!areas.!Within!Europe,!projections!to!the!end!of!this!century!show!a!significant!increase!in!storm!surge!elevation!for!the!continental!north!Sea!and!south!east!England.!Populations!at!risk!of!increased!winter! river! flooding! are! anticipate! to! be! in! central! and! northern! Europe.! The! risk! of!increased!flash!flooding!due!to!climate!change!may!also!increase.!Flash!floods!are!the!most!serious!type!of!flood!for!mortality!risk!(drowning).!!!Globally,! vulnerability! to! disaster!mortality! is! largely! a! function! of! poverty:! for! example,! despite!similar!population!exposure!in!Japan!and!the!Philippines,!the!death!toll!in!the!Philippines!is!17!times!higher! (ISDR,!2009).!The! ISDR! (International!Strategy! for!Disaster!Reduction)! (2009)!has!combined!information!on!hazard,!exposure,!vulnerability!and!mortality!in!a!global!risk!assessment!for!tropical!cyclones.!They!found!that!the!ten!countries!at!highest!mortality!risk! (in!order!of!reducing!risk)!are!Bangladesh!(with!75%!of!all!expected!mortality),!the!Philippines,!India,!Madagascar,!the!Dominican!Republic,!Haiti,!Myanmar,!Vanuatu,!Mozambique!and!Fiji.!Overall,!the!mortality!risk! in! low! income!countries!was!estimated!to!be!around!200!times!higher!than!it!is!in!high!income!countries.!!!!!
Table!4.!The!potential!health!effects!of!flooding,!adapted!from!(Ahern!and!Kovats,!2006)!!
Phase! Health!outcome!
Pre"onset"phase!! ! Injuries!
Onset"phase! ! Death!(drowning)!! Injuries!
Post"onset!phase! ! Faecal"oral!disease!! Vector"!and!rodent"borne!disease!! Respiratory!infections!!! Skin!infections!! Mental!health!consequences!! Drinking!water!shortages!! Carbon"monoxide!poisoning!(inappropriate!use!of!heaters!during!clean!up)!! Injuries,!trauma,!electrocution!during!clean!up.!!
Long"term!phase! ! Damage!to!health!care!infrastructure!!! Chemical!contamination!of!food!and!water!stocks!! Damage!to!water!and!sanitation!infrastructure!! Damage/destruction!of!property!(e.g.!lack!of!shelter!may!lead!to!increased!
exposure!to!vectors!! Damp!housing!can!cause!health!effects!! Stress!associated!with!short!or!long!term!displacement!
!!
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Floods! are! associated! with! a! wide! range! of! health! effects! (Table! 4),! which!may! be! directly! or!indirectly!caused,!may!occur! immediately!or!be!delayed,!and!may!affect!both!physical!and!mental!well"being! (Ahern! et! al.,! 2005).! The! impacts! include! injuries,! faecal"oral! diseases! (e.g.! cholera,!cryptosporidiosis),! rodent"borne! diseases! (e.g.! leptospirosis)! and! mental! health! problems! (e.g.!anxiety,! post"traumatic! stress! disorder).! However,! despite! the! number! of! event"based!morbidity!studies,! translating! the!wide! range!of! impacts! into! generalizable! risk! functions! is!difficult.! In!high!income!countries,!the!risk!of!infectious!disease!is!very!low!and!mental!health!effects!are!considered!to!be!the!most! important!health! impact!requiring! intervention.!Estimating!the!total!morbidity!of!a!single!event! is! challenging.! For!example,!not!all! illnesses!are! cared! for!or! recorded!by!healthcare!providers,! especially! in! emergency! situations,! and! the! population! is! displaced! (temporarily! or!permanently).!The!attribution!of!morbidity!to!a!given!flood!event!is!not!straightforward,!particularly!for!delayed!and!non"physical!health!outcomes.!!Projections!of!future!flood!impacts!!A!number!of! recent!documents!have!attempted! to!quantify! the! future!human! impacts!of! coastal!flooding!(and!other!climate"related!disasters)!by!projecting!the!trend!seen!over!the!last!few!decades!(Webster! et! al.,! 2008;Geneshan! and! Diamond,! 2009).! As! acknowledged! by! the! authors,! it! is!questionable!whether! this!method!makes! a! credible! assessment!of! the! future! impacts!of! climate!change,!as!it!implicitly!assumes!that!trends!emerging!from!very!noisy!data!are!indicative!of!the!likely!climate"driven!impacts!in!future!years.!It!also!fails!to!explicitly!account!for!various!plausible!changes!in!populations,!wealth!and!vulnerability.!Given!this,!estimates!based!on!this!method!are!of! limited!value.!!Projections!of!populations!at!risk!of!flooding!using!SRES!climate!and!socioeconomic!scenarios!have!been!made!using! coastal!models! (Nicholls!et!al.,!2007).!The!model!adjusted!baseline! storm! surge!curves!for!sea! level!rise,! ice!sheet!melt!and! land!subsidence,!and!accounted!for!coastal!population!growth!and!improved!coastal!protection!with!economic!development!(lagged!by!30!years)!(Nicholls,!2004).!In!futures!with!declining!population!growth!and!robust!economic!growth!but!without!climate!change,! increasing! population! exposure! increased! flood! risk! until! the! 2020s,! after! which! time!improved! defences! (associated!with! increased!wealth)! led! to! a! decline! in! risk.! In! less! optimistic!scenarios,! flood! risk! continued! to! increase! beyond! the! 2080s.!When! climate! change!was! added,!depending!on!the!scenario,!an!additional!2!to!50!million!people!were!at!risk!in!the!2080s.!!!Challenges!to!projecting!health!impacts!!The! principal! challenge! to! projecting! health! impacts! is!modelling! future! vulnerability,! that! is! the!health! effect! of! a! given! flood! event.! Good! models! are! able! to! project! flood! risk,! but! factors!determining!population!vulnerability!to!health! impacts!are!complex!and!may!vary! locally.!Regional!vulnerability!estimates!may!be!made,!but,! the! limited!quantitative! socioeconomic!projection!data!that!is!available!(usually!only!GDP!and!population)!would!necessitate!several!generalizations.!!!A! second! challenge! is! generating! morbidity! risk! equations! (exposure! response! functions).! To!generate! general! associations!between! floods! and!morbidity,! the! information! from!observational!!studies!needs!to!be!formally!combined!in!a!meta"analysis.!!!A!more! general! issue! is! the! uncertainty! surrounding! future! storm! intensity! and! frequency.! It! is!currently!common!practice! to!assume!no!change! in!tropical!cyclones!or!storms! (depending!on!the!region! of! interest).!While! this! is! not! unreasonable,! it! results! in!what! could! be! considered! to! be!conservative!estimates!of!future!health!impacts.!!!
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Vector-borne diseases !Vector"borne!diseases!are! infectious!diseases! that!are! transmitted!by! invertebrate!hosts!between!humans.!The! role!of!weather!and!climate! in!determining! spatial!and! temporal! (including! seasonal!patterns)!of!malaria!is!well!described.!However,!other!diseases!have!been!much!less!well!studied.!In!Europe,!there!are!few!endemic!vector"borne!diseases!and!most!of!these!are!transmitted!by!ticks.!!!The!most!important!vector!borne!disease!in!Western!Europe!is!tick"borne!encephalitis!(TBE),!which!has!been!increasing!in!recent!years!in!Central!and!Eastern!European!countries.!This!is!due!to!a!range!of! factors! including! changes! in!human!behaviour,! changes! in!agricultural!practices,!and! increased!unemployment!(leading!to!increased!human"tick!contact)!rather!than!climate!factors!(Sumilo!et!al.,!2007;Sumilo!et!al.,!2008).!!Climate!change!could,!in!the!future,!change!habitats!for!ticks!and!other!disease"transmitting!agents!and! could! extend! their! ranges! to! the!north! and!higher! altitudes!within! Europe.!However,!even! a!change!in!vector"distribution!would!not!necessarily!translate!into!an!increase!in!cases!or!the!burden!of!disease.!There!is!an!effective!vaccination!for!some!diseases!(e.g.!TBE).!Where!a!disease!is!rare!or!transmission! is! localised,! it! is! a! difficult! step! to! convert! area! suitable! for! transmission! into! the!number!of!prevalent!or!incident!cases.!!!Mapping! of! many! vector! borne! diseases! and/or! their! vectors! has! been! rapidly! advanced! by!improvements! in!computing!as!well!as! in!the!geo"referencing!of!disease!and!exposure!data.!These!spatial!models!are!able!to!be!validated!with! limited!data!that!are!available,!although!there! is!great!uncertainty!about!edges!of! the!distribution!–!precisely! the!areas!where! climate! change!would!be!expected!to!have!an!effect!(both!latitudinal!and!altitudinal).!The!core!climate"disease!models!are!of!two!basic!types!–!empirical/statistical!and!biological/deterministic.!There!has!been!much!discussion!in!the!literature!about!the!relative!merits!of!each!approach.!For!example,!empirical/statistical!model!have! been! shown! to! over"emphasise! relative! changes! in! risk,! when! the! projected! absolute! risk!remained!small!(Rogers!and!Randolph,!2000)!!!Many!vector"borne!diseases!have! complex! transmission! cycles! involving!a! range!of!hosts! that!are!poorly! understood,! and! therefore! there! is! insufficient! information! on! the! parameters! to! develop!biological/deterministic!models!(Randolph!and!Rogers,!2000).!However,!there!is!general!progression!in!mapping! vectors! and! disease! and! looking! at! a! range! of! factors! that! determinate! distribution,!particularly! land! cover/land! use,! and! these! studies! will! improve! the! scientific! basis! for! climate!change!assessment.!We! found!7!studies!on! the! impact!of!climate!change!on!vector"borne!disease!health!risks!(Table!A2).!The!majority!of!these!studies!were!on!malaria!or!tick!borne!diseases.!!!
Tick"borne!diseases!
!Zoonotic!tick"borne!diseases!(Lyme!borreliosis!and!tick"borne!encephalitis)!are!an! increasing!health!burden! in!Europe.!There!has!been! some!debate! about! the! role!of! climate! variability! and! climate!change!in!the!observed!changes!in!vectors!and!disease!incidence!in!the!last!decades.!There!are!few!published!studies!of!the!impact!of!climate!change!on!future!vector!or!disease!distributions.!Climate!suitability! models! project! that! tick! species! may! expand! north! in! Europe! with! climate! change!(Randolph!and!Rogers,!2000)! (Table!A2).!Climate!change!models!need! to! take! into!account!of! the!dynamic!biological!processes! involved! in!vector!abundance!and!pathogen! transmission! in!order! to!predict!future!tick"borne!disease!scenarios.!!
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!!Aedes!albopictus!
ECDC! has! recently!mapped! the! current! and! past! distribution! of! the!Asian! tiger!mosquito! (Aedes!albopictus)! in! Europe! (ECDC,! 2009).! This! is! a! key! vector! of! dengue! and! other! arboviruses! (e.g.!chikungunya! virus).! There! are! currently! established! populations! of! Aedes! albopictus! in! Albania,!Croatia,! France,! Greece,! Monaco,! Montenegro,! Italy,! San! Marino,! Slovenia,! and! Spain.! The!distribution!of!the!vector!is!not!yet!within!its!climate!limits.!An!assessment!of!the!potential!impact!of!climate! change! indicated! the! potential! for! eastward! expansion! in! its! distribution! in! Europe,!with!some!areas!in!the!Balkans!becoming!unsuitable.!!!Leishmaniasis!!Visceral!leishmaniasis!is!present!in!the!Mediterranean!region.!The!leishmania!parasite!is!transmitted!by! the! sandfly! and! has! a! significant! non"human! reservoir.!With! climate! change,! the! distribution!ranges! of! both! the! sandfly! vectors! and! the! pathogens!may! extend! northwards! and! into! higher!altitudes! (Lindgren!et!al.,!2005).! In! currently!endemic!areas,!higher! seasonal! temperatures!would!lead! to! a! prolonged! activity! period! and! shorter! diapause! period! leading! to! increased! number! of!sandfly!generations!per!year.!Higher!temperatures!may!accelerate!the!maturation!of!the!protozoan!parasite,!thereby!increasing!the!risk!of!infection.!However,!climate!may!become!too!hot!and!dry!for!vector! survival! in! some! areas.! There! has! been! little! formal!modeling! or! climate"risk!mapping! of!Leishmaniasis! in!Europe.!We! found!no! studies! that!quantified! the! impact!of! climate! scenarios!on!future!cases!of!leishmaniasis.!!!Malaria!!In!the!EU27!region,!major!tropical!infections!such!as!malaria!or!dengue!are!not!present!(i.e.!are!not!endemic).! In! the!wider!European! region! (as!defined!by!WHO),!endemic!malaria! is!only!present! in!Azerbaijan,!Georgia,!Kyrgyzstan,!Tajikistan,!Turkey!and!Uzbekistan.!!!A!risk!study!on!the!potential! impact!of!climate!change!on!malaria!distribution!was!undertaken! for!the!Foresight!project!on!emerging!infections!for!Africa!(Hay!et!al.,!2005).!One!study!was!found!that!assessed!the!risk!of!imported!or!locally"transmitted!(autochthonous)!malaria!in!Europe.!However,!it!did! not! quantify! the! number! of! possible! cases! under! specific! climate! scenarios.! The! risk! of! re"emergence!of!malaria!in!the!Camargue!region!of!southern!France!was!assessed!using!the!MALCAM!model! (Linard! et! al.,! 2009).! Disease! re"emergence!would! depend! upon!many! factors! including! "!introduction!of!a! large!population!of! infectious!people!or!mosquitoes,!high! levels!of!people"vector!contact,!resulting!from!significant!changes!in!land!use,!as!well!as!climate!change.!
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Foodborne disease !Food! safety! is! an! emerging! issue! for! climate! change! impacts! and! has! both! health! and! economic!implications.!Food!safety!covers!a!range!of! issues,!and! includes!both!microbiological!and!chemical!contamination! of! food.! There! have! been! some! recent! review! papers! that! discuss! a! range! of!mechanisms!by!which!climate!change!may!affect!food!or!water!safety!(Boxall!et!al.,!2009;Miraglia!et!al.,!2009),!however,!there!is!very!little!quantification!in!this!area.!Risk!modelling!is!often!developed!for! single!exposure!agents! (e.g.!a!pesticide)!with!known! routes!of!exposure.!These!are!difficult! to!scale!up! to! the!population! level.!The!multiple!mechanisms!by! climate!may!affect! transmission!or!contamination!routes!also!makes!this!very!complex!(Boxall!et!al.,!2009).!!!!Foodborne! disease! can! include! both! infectious! and! non"infectious! causes.! However,! in! terms! of!weather!effects,!most!research!has!been!on! the! infectious!causes.!The!main!causes!of! food!borne!diarrhoeal!disease!in!Europe!are!the!bacteria!of!the!Campylobacter!and!Salmonella!types.!The!main!cause!of!hospital!admission!for!diarrhoea!is!from!viruses!rather!than!bacterial!infection!(in!children).!!!Several!studies!have!been!published!that!quantify!the!effect!of!temperature!on!diarrhoeal!disease!in!temperate! climates.! Temperature!was! found! to! increase! the! risk! of! diarrhoeal! disease! (hospital!admissions)!and!reported!salmonellosis!(passive!health!surveillance)!(Kovats!et!al.,!2004).!The!effect!of! temperature! on! reported! campylobacteriosis! is! unclear! –! and! this! is! consistent!with!what! is!known!about!the!behaviour!of!the!pathogen!in!the!environment.!Campylobacters!do!not!multiply!at!room! temperature.! All! studies! reported! estimates! of! the! change! in! risk! per! degree! change! in!temperature!(weekly!or!monthly).!Extrapolation!of!this!relationship!to!the!future!assumes!that!there!is!no!change!in!the!temperature"disease!relationship.!This!is!unlikely.!For!example,!the!sensitivity!of!food"borne!infections!to!temperature!has!been!seen!to!decline!in!England!in!recent!decades!(Lake!et!al.,!2009).!Further,!there!is!potential!bias:!if!the!temperature"responsiveness!is!indeed!greater!at!low!temperatures,!extrapolation!of!an!average!value!will! tend! to!underestimate!effects! in!areas!which!are!on!average!colder,!and!overestimate!in!hotter!regions.!!!We!found!3!studies!that!quantified!the!impact!of!climate!change!on!diarrhoeal!diseases!(Table!A3).!These!studies!all!assumed!that!the!temperature"diarrhoeal!relationship! is!unchanged! in!the!future.!The!studies!also!did!not!take!into!account!that!rates!of!diarrhoeal!disease!are!likely!to!decline!in!the!future,!and!therefore!are!likely!to!over"estimate!the!impact!of!climate!change.!!
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Food security and malnutrition !Food! security! is!only! included!here!with! respect! to! impacts! in! India!and!China! (that! is,! studies! in!Africa!are!excluded).!Although!climate!change! is! likely!to!affect!crop!production!everywhere! (both!positive!and!negative),!the!key!issue!for!health!are!changes!in!access!to!food!at!the!local!level.!Over!the!last!decade,!the!number!of!undernourished1!people!has!increased!to!close!to!billion!(FAO,!2008).!The!health!impacts!are!heavily!concentrated!in!children!under!five!in!low!income!countries,!in!whom!about!a! third!of! the!burden!of!disease! is!attributable! to!malnutrition! (Black!et!al.,!2008).!Climate!change! is! expected! to! increase! this! burden! –! or! at! the! very! least! impair! efforts! to! reduce!malnutrition!"!however!as!the!pathway!is!complex,!quantifying!the!impact!is!difficult.!!Climate! change!will! impact!on!malnutrition!via!altered! crop!productivity;!hotter!growing! seasons,!changed! rainfall!patterns,!and!more!extreme!weather!events,! for!example,!could!all! reduce!yields!(Schmidhuber!and!Tubiello,!2007).!The!evidence!for!this!comes!from!crop!models!and!international!scientific!assessments,!including!the!IPCC!Fourth!Assessment!Report.!!!Malnutrition! (the! health! outcome)! is! associated! with! several! key! factors! in! addition! to! food!availability!and!stability!of!supply.!These!factors!relate!to!effective!demand!–!and!utility!–!referring!to! the! ability! of! the! body! to! utilise! nutrients,!which! is! impaired! by! infections! such! as! diarrhoea!(Schmidhuber!and!Tubiello,!2007).!Further,!the!risk!of!malnutrition!is!influenced!by!a!range!of!distal!socioeconomic!factors! including!women’s!access!to!education,!water!and!sanitation!provision,!and!the!prevalence!of!low!birth!weight!(UNICEF,!1990).!!!Food"health!impact!studies!!Climate! is! likely! to!have! influences!at!various!points!along! the! causal! chain! (e.g.! crop!production,!water! access,! infectious! diseases! rates),! and,! socioeconomic! conditions.! No! impact! studies! have!considered!the!full!range!of!causes!of!malnutrition.!The!few!studies!that!have!estimated!the!impact!of!climate!change!on!malnutrition!have! just! focused!on! the!mechanism!of!climate!change!altering!cereal! food!yields!by!direct!effects!of! temperature!and! rainfall!changes!on!cereal! food!yields.!The!impact! models! employ! a! series! of! sub"models.! In! general,! modelling! begins! by! using! climate!scenarios! to!drive!models! for! selected! crops.! Production! changes! are! extrapolated! to!other! food!groups! and! then! fed! into! a! global! trade!model! to! estimate! national! calorie! availabilities.! Finally,!assumptions! about! within"country! food! distribution! are! used! to! estimate! the! proportion!‘undernourished’,!which!is,!at!times,!used!to!estimate!malnutrition.!!!Two!papers!are!included!in!this!review!(see!Table!A4)!"!although!only!one!actually!estimates!a!health!outcome.! It! is! important! to!note! that! the!undernourishment!and! related!metrics! (e.g.!“millions!at!risk! of! hunger”)! are! poorly! correlated! with! health! outcomes! (e.g.! malnutrition)! and! should! be!interpreted!with!extreme!caution.!!!Parry!et!al!(2004),!used!four!SRES!scenarios!(A1FI,!A2,!B1,!B2)!to!drive!one!climate!model!(HadCM3),!four!crop!models!(wheat,!rice,!maize,!soy),!and!the!Basic!Linked!System!(BLS)!trade!model.!Various!adaptations!were! considered:! ‘farm! level’,!accounting! for!basic! changes! such!as! changed!planting!date,!and!the!use!of!extra!fertilizer!and!irrigation!(where!irrigation!already!exists);!‘regional!level’!in!
1 ‘Undernourishment’!is!defined!by!the!Food!and!Agricultural!Organization!(FAO)!as!having!insufficient!calorie!intake!to!meet!individual!needs!to!sustain!life!and!perform!essential!tasks,!and!to!perform!light!to!moderate!work;!it!related!entirely!to!food!intake!and!is!modelled!by!the!FAO.!In!contrast,!‘malnutrition’!is!a!measurable!outcome!commonly!measured!using!anthropometrics!(eg.!‘stunting’!as!height"for"age,!‘underweight’!as!weight"for"age);!it!has!multiple!causes!of!which!a!lack!of!food!is!one.!
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which!developed!countries!use!more!costly!means!such!as!new!cultivars!or!extension!of! irrigation;!and,! ‘economic! adjustments’! in! which! yield! changes! and! crop! price! drive! shifts! in! investment!patterns! and! land! use.! The! final! outcome!measure!was! ‘millions! at! risk! of! hunger’! in! the! 2020s,!2050s!and!2080s.!At!the!global!level!under!the!SRES!scenarios,!the!study!estimates!that!there!will!be!sufficient!food!throughout!the!21st!century.!However,!disparities!will!exist!and!“hunger”!will!remain!a!problem,!as!production!is!expected!to!increase!in!developed!but!decrease!in!developing!countries,!with!greater!differences!in!production!and!hunger!under!A1FI!and!A2.!!!The!second!paper,!by!Nelson!et!al.!(2009),!used!a!similar!chain!of!models.!It!focused!on!the!2050s,!used!the!A2!emissions!scenario! (but!with!UN!medium!variant!population!projections),!two!climate!models! (NCAR,! CSIRO),! five! crops!models! (as! above! with! the! addition! of! ground! nut),! and! the!IMPACT! trade!model! (which!makes!some!allowance! for!biofuel!production).!For!adaptation,!some!autonomous! changes! in! crop! mix! and! input! use! were! considered,! but! costly! strategies! were!examined! in! an! explicit! assessment! of! the! costs! of! adaptation! (an! output! of! the!model).! Other!outputs!were! calorie! availability! per! capita! (corresponding! to! the! undernourishment!metric)! and!prevalence!of!underweight!in!children!(which!more!closely!relates!to!malnutrition).!!!With!climate!change,!per!capita!calorie!availability!was!project!to!decrease!by!an!average!of!7%!from!2000!levels!in!developing!countries!(3"7%!less!than!this!if!carbon!fertilization!in!included).!Compared!to!the!2050s!without!climate!change!(but!with!socioeconomic!changes).!The!proportion!of!children!underweight!was!projected!to!increase!by!about!20%!across!developing!countries!in!the!2050s!with!climate!change!(~15%!if!carbon!fertilisation!is!included).!!!New!models!and!methods!are!required!to!allow!estimates!of!food!access!and!future!socioeconomic!conditions!to!be!combined!to!estimate!the!health!impacts!of!malnutrition!caused!by!climate!change.!Further,!beyond!average!food!availability!and!general!socioeconomic!conditions,!possible!means!of!assessing!the! impacts!of!shocks!(e.g.!droughts,!floods,!rapid!price! increases)!and! loss!of! livelihoods!need! to! be! considered.! Until! these! challenges! are! met,! it! is! likely! future! impacts! will! be!underestimated.!!
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Outdoor air pollution !Outdoor!air!pollutants!are!the!major!environmental!health!concern!in!Europe.!There!has!been!much!research! to! quantify! the! health! effects! of! the!main! ambient! (outdoor)! air! pollutants.! So! far! the!epidemiological!evidence! is!strongest! for!particulates!to!effect!daily!mortality,!based!on!both!time!series! and! cohort! studies.! The! evidence! for! tropospheric! ozone! is! much! weaker.! Several! risk!assessment!models!have!been!developed! to!quantify! the! impact!of!pollution!policies! in! terms!of!health!benefits!and!direct!and!indirect!health!costs.!!!A! recent! review! found! four! health! impact! studies,! nearly! all! on! tropospheric! ozone! (Ebi! and!McGregor,!2008)!(see!Table!A5).!Methods!for!estimating!the!health!impacts!of!ambient!tropospheric!ozone!are!fairly!robust!and!have!been!used!to! investigate!current!emissions!policies!for!air!quality!regulation.! The! four! studies! all! estimated! an! increase! in! ozone"related!mortality! due! to! climate!change.!Only!one!study!considered!other!outdoor!air!pollutants!(particulates,!SOx)!and!these!were!anticipated!to!experience!a!decrease!in!peak!events!due!to!climate!change.!!!The! impact! of! climate! change!on! future! ambient! air!pollution! is!dependent!on!both! climate! and!future!pre"cursor!emissions.!It!is!important!to!note!that!the!health!impacts!studies!rely!on!a!subset!of!the!“climate"pollution”!models.!All!the!health!impact!studies!published!rely!on!models!that!show!an! increase! in! tropospheric! ozone! under! climate! change! conditions.! However,! not! all! pollution!models!show!an!increase!in!ground!level!ozone!with!climate!warming.!In!addition,!the!uncertainty!in!these! estimates! is! future! emissions! has! not! been!well! addressed.! So! far,! there! has! not! been! a!comprehensive!review!of!the!models!themselves,!which!would!support!the!health!impact!modelling.!!!
Aeroallergens and atopic disease !Climate! change!may! influence! the! seasonality!and! abundance!of! certain!pollen! species! in!Europe!that! cause! allergenic! disease.! The! links! between! pollen"induced! allergies! and! exacerbations! of!asthma,!hay"fever!and!other!allergies! is!well!described! in!the!clinical! literature.!Although!hay"fever!(allergic!rhinitis)!is!mostly!attributable!to!pollen,!this!is!a!very!mild!disease!and!of!little!public!health!importance.!Exacerbations!of!asthma,!particularly!in!children,!are!more!serious!but!the!evidence!for!a!significant!role!of!pollen!is!very!weak!(Anderson!et!al.,!2000).!!!Several! reviews! have! implicated! climate! change! in! potential! future! increases! in! asthma! but! the!evidence! is!unconvincing! (Verlato!et! al.,!2002;Beggs,!2004).!Climate! change!may! cause! an!earlier!onset!of! the! flowering!and!pollen!seasons!but! it! is!unclear! if! it!will!also!entail!an!extension! to! the!pollen!season!(and! it!will!depend!upon!the!species!of!pollen)! (van!Vliet!et!al.,!2002).!The!evidence!that!climate!change!will!affect!pollen!amount!and!allergenicity!remains!speculative!(Beggs,!2004).!!!
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Key issues !This!section!discusses!key!cross"cutting!issues!from!the!review!of!the!previous!papers.!!!
Treatment!of!climate!change!
!Overall,! it!can!be!seen! the!health! impacts!models! rely!on!either!primary!climate!variables! (almost!always!temperature)!or!other!impact!models!(crop!yield,!flood!risk,!pollution!exposures).!In!general,!a! very! limited! number! of! climate! scenarios! has! been! used.! Few! studies! have! been! able! to! take!advantage!of!the!most!recent!climate!model!ensemble!runs!in!order!to!quantify!some!uncertainty!in!the! range!of! future! temperature!changes.! In!addition,!most!climate! impact! studies!have!not!used!downscaled!estimates!when!apply!global!climate!model!output!to!higher!resolution!populations.!!!Treatment!of!socioeconomic!change!!It!is!important!to!break!down!the!socio"economic!data!into!its!component!parts.!As!nearly!all!aspects!of!our!natural,!physical!and!social!environments!will!change!in!the!future,!it!is!important!that!those!changes!are! reflected! in! the! scenarios!used! in! climate! impacts! studies.! In!practice,!however,!only!population! growth! and! economic! growth! (in! GDP/capita)! have! been! quantified! and! routinely!included!in!climate!impact!studies.!!!Health! impact! studies! reviewed! here! have! often! not! considered! any! changes! in! future! socio"economic!status.!Some!studies!have!considered!population!growth! (which! intends! to! increase! the!final!estimates!in!term!of!absolute!burdens/deaths,!etc).!!!This! is! clearly! a! key! consideration! for! future! climate"health! impact! models.! Given! the! large!uncertainty!regarding!future!socio"economic!conditions!(and!the!lack!of!an!association!between!GDP!and!health!status!in!high!income!population)!a!wider!range!of!scenarios!need!to!be!developed!to!be!included! in! future! studies.! It! is! also! important! that!both! secular! changes! in!baseline!disease! and!vulnerability!are!included!in!the!model!(i.e.!those!unrelated!to!climate!change)!and!consideration!of!specific!adaptation!measures!(which!do!consider!the!response!to!climate!change)![see!below].!!!!
Exposure"Response!Relationships!
!The!exposure!response! functions! that!have!been!used! in!climate"health! impact!models!have!been!discussed!in!more!detail!in!the!relevant!sections.!In!summary,!temperature"related!mortality!models!have! been! based! on! observed! relationships! and! are! generally! linear! models! with! a! defined!threshold.!The!most! recent!publications!of!heat"related!mortality!have!used!non"linear!models! to!better!characterise!the!relationship!as!there! is!good!evidence!that!the!relationship! is!non"linear!at!the! more! extreme! temperature! exposures.! The! temperature"diarrhoea! models! are! based! on! a!similar!approach.!Threshold!effects!are!an!important!issue!for!quantitative!risk!assessment!models.!The!evidence!for!a!threshold!in!the!ozone"mortality!function!is!less!clear!and!so!estimates!are!often!produced!with!and!without!assuming!a!threshold!effect.!!!For!disease!where!spatial! risk!mapping!has!been!used,! these!are!often!based!on! linear! regression!models.! However,!more! deterministic!models! have! also! been! developed!which! entail! non"linear!functions.!!!
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!!!
Geographical!and!temporal!scales!!
!Table! 5! below! summarises! the! geographical! and! temporal! scales! reported! in! the! studies! in! this!review.! It! is! important! to! note! that! very! few! studies! assess! risks! for! the!whole! European! region!which!is!the!spatial!coverage!required!for!the!Climatecost!project.!!!Health!outcomes!are!often!reported!as!the!average!for!a!single!year,!as!this! is!common!practice! in!quantitative!health!risk!assessment.!These!are! linked!to!future!climate!exposures! (expressed!as!30!year!averages)!as!is!common!practice!in!climate!impact!studies.!!!Health"climate! studies! that! are! based! on! spatial! risk!models! (e.g.! for! vector"borne! diseases)! are!often!at!the!regional!or!national!scale.!This!is!because!the!methods!can!be!confidently!extrapolated!to! that!population! (or! the!model!was!created! for! the!wider! scale).!However,! risk!models! for!heat!wave! often! rely! on! observed! (temporal)! temperature"health! functions! derived! from! a! single!population.! Therefore,! there! is! less! confidence! in! extrapolating! from! this! population! to! other!regions.!For!this!reason,!results!are!often!reported!at!the!city! level!and!not!scaled!up.!Only!where!the!results!of!several!studies!can!be!pooled!in!a!meta"analysis!is!it!considered!valid!to!scale!up!to!a!wider!population!(e.g.!in!air!pollution!studies).!!!!!Table!5:!Summary!of!health!climate!impact!studies!!Health!topic! No!of!
published!studies!
Geographical!scale!
Time!periods
Heat/cold! 10! Mainly!city!level Near!and!long!termAnnual!estimates!for!2030,!2050s,!or!2080s!
Diarrhoeal/food!poisoning 3! Country!level Near!term" impacts!in!2030s!Vector"borne!diseases! 7! Country!level,!
regions!Longer!term, >2050s!
Malnutrition! 1!(0!in!Europe)!
Global! 2050s
Air!quality/ozone! 4! Mostly!city"level 2030,!2050s,!2080s!
!
Adaptation!
!Adaptation! (planned)! is!not!considered! in!any!climate"health!studies.!This! is!because! there! is!such!limited! information! about! modifiers! of! the! temperature"heath! functions.! The! affect! of! specific!policies,!strategies!and!measures!could,!in!theory,!be!modelled!if!empirical!information!was!available!on!either!changes!to!the!exposure!or!the!exposure"response!function!(see!for!example!the!benefits!to!health!from!different!pollution!abatement!measures).!!!Where!health!models!are!linked!to!other!climate"related!exposure!models,!these!models!often!have!assumptions!regarding!adaptation!built!into!them.!For!example,!Parry!et!al!considered!adaptation!as!autonomous! adaptation! (e.g.! changed! planting! date).! Sensitivity! to! adaptation!assumptions/modelling!methods!should!be!assessed.!
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!Further,! for! health! outcomes,! multiple! intervention! points! are! possible! and! this! makes! it! very!difficult! to!model! these! processes.! For! example,!malnutrition! can! be! reduced! by! increasing! crop!yields,! but,! from! a! public! health! perspective! interventions!might! include! health! service! provision!(preventative! and! treatment),!water! and! sanitation! provision,! increased! access! to! education,! or!more!generally,!alleviation!of!poverty.!!!The! limits!of!adaptation!have!also!not!been!explicitly!considered! in!the!health! impact!studies.! It! is!well! known! –! and! assumed! –! that! adaptation!measures! are!not! 100%! effective! and! are! likely! to!include!some!residual!damages.!!!
Treatment!of!sectoral!inter"linkages!
!There! is!has!been!no!assessment!of! intersectoral! linkages! in! the!published!studies.!Climate"health!impact!studies!remain!simple!models!that!address!only!single!health!outcomes!and!pathways.!!!
Consideration!of!major!events!
!None!of! the! studies! in! this! review!have!considered!major!events.!Because!of! the!need! for! robust!projections!of!population!and!other!socio"economic!data,!most!studies!have!not!estimated! impacts!beyond!2050,!and!also!most!have!relied!on!the!SRES!or!other!standard!scenarios.!!!In!addition,! the!climate"health!studies!do!not!consider!extreme!weather!events.!For!example,! the!assessments!of!heat"related!mortality!do!not!consider!major!heat!wave!events,!such!as!occurred!in!Europe!in!August!2003.!Future!temperature!exposures!mostly!based!on!using!mean!climate!changes!to!adjust!current!daily!temperature!distributions.!Drought!events!are!not!considered!within!the!crop!yield/food!models.!!!
Analysis!of!monetary!values!
!There!have!been!increasing!number!of!studies!that!quantify!climate!change!impacts!at!the!national!or! local! level,!but!very! few!estimate! the!costs!of!these!health!effects,!either!as!direct!health!costs!(deaths,!welfare!costs)!or!in!terms!of!health!service!usage.!For!example,!the!PESETA!study!monetized!the! impact!of!climate!change!on!heat!and!cold!related!mortality!and!on!food!poisoning! in!Europe,!assuming!some!acclimatization!(Watkiss!et!al.,!2007).!!!The! choice! of! health! and! economic!metrics! has! clear! implications! for! the! final! cost! estimates.!Heat/cold!impacts!are!an!example!of!this,!as!they!predominantly!affect!persons!in!older!age!groups,!and! in!poor!health!(as!with!air!pollution!effects).!Therefore,! impacts!are!greater! if!counted!as! lives!lost! than! as! life"years! lost.! Conversely,! a! hazard! that! affects! children! disproportionately! (e.g.!malnutrition)!will!be!greater!if!estimated!as!life"years!lost.!!!Health! outcomes! have! been! incorporated! into! some! integrated! assessment! models! (IAM)! as! a!damage!function!or!an!impairment!to!economic!productivity!(Tol,!2002;Bosello!et!al.,!2006).!Health!costs,!when!estimated,!make!a!considerable!contribution!to!overall!damage!costs,!as!the!statistical!value!of!a! life! is!high.! In!general,!the! IAM!have! incorporated! into!their!damage!estimates!only!the!very!basic!health!models!for!heat/cold!effects!on!mortality!and!malaria.!These!have!been!reviewed!elsewhere.!!
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Health adaptation costs !The!potential!impacts!of!climate!change!on!population!health!include!a!wide!range!of!diseases!and!health!outcomes,!as!discussed! in!the!previous!sections.!Adaptation,!broadly!defined,!would! include!all! activities! that! reduce! or! prevent! these! “additional”! cases! or! deaths.! Several! reviews! of! such!adaptation! strategies,! policies! and!measures! have! now! been! published! (UNFCCC! 2005;Ebi! et! al.,!2006).!!!The! health! sector! is! considered! to! be! conventional! public! health! activities! and! the! provision! of!primary,!secondary!and!tertiary!care.!However!it!is!well!recognised!that!adaptation!in!other!sectors!is! probably!more! important! for! reducing! the! health! impacts! of! climate! change! (through! disaster!mitigation,!food!and!water!security,!and!providing!robust!infrastructure).!!!Health!“adaptation!costs”!include!the!following!(Kovats,!2009):!!!1. Costs!of!improving!or!modifying!health!protection!systems!to!address!climate!change,!for!
example,!expanding!health!or!vector!surveillance!systems.!This!includes!the!costs!associated!with!building!new!infrastructure,!training!new!health!care!workers,!increasing!laboratory!and!other!capacities,!etc.!
2. Costs!of!introducing!novel!health!interventions!(e.g.!heat!wave!warning!systems).!3. Additional!costs!for!meeting!environmental!and!health!regulatory!standards!(e.g.!air!quality!
standards,!water!quality!standards).!!4. Costs!of!improving!or!modifying!health!systems!infrastructure,!for!example,!adapting!hospitals!to!
hotter!summers.!!5. Occupational!health!costs,!for!example,!measures!to!prevent!the!adverse!impacts!of!increased!
heat!load!on!the!health!and!productivity!of!workers.!!6. Costs!of!health!research!to!address!to!reduce!the!impact!of!climate!change,!for!example,!
evaluation!studies.!!7. Costs!of!preventing!the!additional!cases!of!disease!due!to!climate!change!as!estimated!by!
scenario"driven!impact!models!!The!last!type!could!also!be!considered!as!“damage”!or!impact!costs!–!rather!than!adaptation!costs.!!Given!that!many!of!the!relevant!preventive!activities!are!outside!the!remit!of!the!health!sector,!and!are!currently!not! implemented,!a!key!role!for!the!health!sector!will!be!to!simply!prevent,!or!treat,!the!additional!disease!cases!caused!by!climate!change.!!!No!case!studies!of!health!adaptation!costs!have!been!published!in!high!income!countries.!However,!many! countries,! including! the!UK,!have! implemented!health! adaptation!measures! in! the! form!of!heat!wave!plans!(Department!of!Health,!2005).!The!costs!of!these!plans!can!be!estimated.!Heat!early!warning! systems! are! relatively! inexpensive,! unless! they! include! active! measures! that! are!implemented!following!an!alert.!The!reported!costs!for!European!countries!range!from!200,000!Euro!to! 6!million! per! year! (WHO! Regional!Office! for! Europe,! 2008).! Structural! interventions! are!more!expensive.!France!spent!more! than!150!million!Euro! in!2004! in!providing!additional!staff!and!cool!rooms! in!residential!homes! for!the!elderly! (Michelon!et!al.,!2005).!Mortality! in!this!group!doubled!during! the! 2003! heat! wave.! Estimates! for! the! costs! of! adapting! dwellings! in! London! to! hotter!summers!has!also!been!estimated.!This!is!an!emerging!area!of!research!and!it!is!likely!that!more!case!studies!and!estimates!will!be!published!in!the!next!year.!
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Annex:!Tables!!
!Table!A1:!Projected!impacts!of!climate!change!on!heat"!and!cold"related!mortality!
Area! Health!effect! Model! Climate!scenario;time!slices!
Temperature!increase!and!baseline!
Population!projections!and!other!assumptions!!
Main!results Reference!
UK! Heat" and!cold"related!mortality!
Empirical"statistical!model!derived!from!observed!mortality!
UKCIP!scenarios.2020s,!2050s,!2080s!
0.57!to 1.38°C!in!2020s;!0.89!to!2.44°C!in!2050s;!1.13!to!3.47°C!in!2080s!compared!with!1961to!1990!baseline!
Population!held!constant!at!1996.!No!acclimatisation!assumed.!!
Annual!heat"related!deaths!increase!from!798!in!1990s!to!2793!in!2050s!and!3519!in!the!2080s!under!the!medium"high!scenario.!Annual!cold"related!deaths!decrease!from!80,313!in!1990s!to!60,021!in!2050s!and!51,243!in!2080s!under!the!medium"high!scenario.!
(Donaldson!et!al.,!2001)!
Germany,!Baden"Wuertemberg!
Heat" and!cold"related!mortality!
Thermo!physiological!model!combined!with!conceptual!model!for!adaptation!
ECHAM4"OPYC3!driven!by!A1B!emission!scenario.!2001!to!2055!compared!with!1951to!2001.!
Population!growth!and!ageing!and!short"term!adaptation!and!acclimatisation!!
About!a!20%!increase!in!heat"related!mortality.!Increase!not!likely!to!be!compensated!by!reductions!in!cold"related!mortality.!
(Koppel,!2005)!
Lisbon,!Portugal!!
Heat"related!mortality!
Empirical"statistical!model!derived!from!observed!summer!mortality!
PROMES!and!HadRM2.!!2020s,!2050s,!2080s!
1.4!to!1.8°C!in!2020s;!2.8!to!3.5°C!in!2050s;!5.6!to!7.1°C!in!2080s,!compared!with!1968!to!1998!
SRES!population!scenarios.!Assumes!some!acclimatisation.!!
Increase!in!heat!related!mortality!from!baseline!of!5.4!to!6!deaths/100,000!to!5.8!to!15.1!deaths/100,000!by!the!2020s,!7.3!to!35.9!deaths!per!100,000!by!the!2050s,!19.5!to!248.4!deaths/100,000!by!the!2080s!!
(Dessai,!2003)!
Four!cities!in!California,!US
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Fresno,!Shasta!Dam]!
of!heat!wave!season,!and!heat"related!mortality!
summer!mortality scenarios.2030s,!2080s!
under!B1!and!6!to!8"fold!under!A1FI.!Annual!number!of!heat"related!deaths!in!Los!Angeles!increases!from!about!165!in!the!1990s!to!319!to!1,182!under!different!scenarios.!!
Australian!capital!cities!!
Heat" related!mortality!in!people!older!than!65!years!
Empirical"statistical!model,!derived!from!observed!daily!mortality!
CSIROMk2,!ECHAM4,!and!HADCM2!driven!by!A2!and!B2!emission!scenarios!and!a!stabilization!scenario!at!450!ppm.!2100!!
0.8°C!to!5.5°C!increase!in!annual!maximum!temperature!in!the!capital!cities,!compared!with!1961to!1990!
Population!growth!and!population!ageing.!No!acclimatisation.!
Increase!in!temperature"attributable!death!rates!from!82/100,000!across!all!cities!under!the!current!climate!to!246/100,000!in!2100;!death!rates!decreased!with!implementation!of!policies!to!mitigate!GHG.!!
(McMichael!et!al.,!2003b)!
30!counties!in!New!York!City!region,!US!!
Heat"related!mortality.!
Spatial!distribution!of!temperature!exposures!(grid).!Linear!threshold!risk!model!–!coefficient!from!Curreiro!et!al.!study!of!11!US!cities.!13%!increase!in!mortality!risk!per!degree!#F.!!!!
GISS!GCM!model!downscaled!with!Meso"scale!model!36!km!grid.!A2!and!B2!SRES!emissions!scenarios!!
Increase!in!summer!mean!daily!temp!for!NYC!region,!by!2050s,!of!2.9#F!(B2)!and!3.8#F!(A2).!!
Acclimatisation!assumption!based!on!observed!exposure"response!functions!in!2!US!cities!with!current!climates!similar!to!projected!future!climate!for!NYC.!!Population!growth.!!
Increases in!heat"related!mortalityby!2050s!range!from!47"95%,!compared!to!1990s.!Acclimatisation!assumption!reduced!increases!by!about!25%.!!!
(Knowlton!et!al.,!2007)!
South!and!East!Asia!!!
Heat"related!mortality!
Linear!threshold!model!(v"shaped)!
CCSR/NIES/!FRGCC!GCM!model.!!
Not!reported.! No!adaptation.!No!population!growth!or!ageing!
Large!increases!in!heat"related!mortality!by!country,!100!to!1000%!by!2080s.!!
(Takahashi!and!Honda,!2007)!
27
6!cities:!Boston,!Budapest,!London,!Dallas,!Lisbon,!Sydney!
Heat"related!mortality!rates!(per!100,000!population)!
Linear!risk!model!based!on!observed!associations.!!
HadCM3"changes!in!mean!and!daily!temperate!variability.!!
Sensitivity!analyses.!Acclimatization!to!2deg!C!increase!in!mean!temperatures"!reduces!future!heat"related!mortality!by!50%.!!
2080s,!increased!rates!of!heat"related!morality.!Greatest!under!changes!in!mean!and!variability!
(Gosling!et!al.,!2007;Gosling!et!al.,!2009)!
3!cities!in!Quebec,!Canada![Montreal,!Quebec,!Saguenay]!
Heat"related!mortality!(all!ages),!as!%!of!baseline!mortality!(1981"99)!
Linear!model,!based!on!Poisson!regression!of!daily!total!mortality.!![adjusting!for!season!removes!cold!effects].!Threshold!18C.!!
A2!and!B2!emissions!scenarios.!HadCM3.!Downscaled!using!SDSM.!!
Not!reported.! None!(but!methods!are!unclear)!
Increase!in!summer!and!annual!mortality:!2%!and!0.5%!in!2020!10%!and!3%!in!2080!
(Doyon!et!al.,!2008)!
Europe!–!15!cities![PHEWE!cities]!
Annual!average!number!deaths!due!to!heat!(temperature!above!threshold!values.!!!
Age"specific!estimates!of!slope,!based!Poisson!regression!of!daily!mortality!data,!lag!0"3!days.!!
IPCC!3!emissions!scenarios.!Scenario!data!not!clear.!!
IPCC!scenarios.!B1!–!1.8°C!A1B"!2.8°C!A2!–!3.4°C!by!2080s!No!downscaling!
None.! City!specific!increase!in!heat"related!deaths!by!2030.!Greatest!impacts!in!Budapest!(112)!and!Athens!(185)!for!A2!in!2030.!Least!impact!in!Dublin,!Zurich!and!Ljubljana.!!Attributable!fractions!varied!from!0%!(Dublin)!to!2%!in!Budapest,!Rome!and!Valencia,!approx.!!
(Baccini!et!al.,!2010)!
!!!!!!!!
28
!Table!A2:!Projected!impacts!of!climate!change!on!vector"borne!diseases!
Health!effect! Metric! Model! Climate!scenario,!with!time!slices!
Temperature!increase!and!baseline!
Population!projections!and!other!
assumptions!
Main!results! Reference!
Malaria,!global!and!regional!
Population!at!risk!in!areas!where!climate!conditions!are!suitable!for!malaria!transmission!
Biological!model,!calibrated!from!laboratory!and!field!data,!for!falciparum!malaria!!
HadCM3,!driven!by!A1FI,!A2,!B1,!and!B2!SRES!scenarios.!2020s,!2050s,!2080s!
SRES!population!scenarios;!current!malaria!control!status!used!as!an!indicator!of!adaptive!capacity!
Estimates!of!the!additional!population!at!risk!for!>1!month!transmission!range!from!>!220!million!(A1FI)!to!>!400!million!(A2)!when!climate!and!population!growth!are!included.!The!global!estimates!are!severely!reduced!if!transmission!risk!for!more!than!3!consecutive!months!per!year!is!considered,!with!a!net!reduction!in!the!global!population!at!risk!under!the!A2!and!B1!scenarios.!
(van!Lieshout!et!al.,!2004)!
Malaria,!Britain! Probability!of!malaria!transmission!
Statistical!multivariate!regression,!based!on!historic!distributions,!land!cover,!agricultural!factors!and!climate!determinants!!
1°C!to!2.5°C!average!temperature!increase!2050s!
1°C!to!2.5°C!average!temperature!increase!
None.!No!changes!in!land!cover!or!agricultural!factors.!!!
Increase!in!risk!of!local!malaria!transmission!of!8!to!15%;!highly!unlikely!that!indigenous!malaria!will!be!re"established.!
(Kuhn et!al.,!2002)!
! !
29
!!!!!
!
Malaria,!India,!all!states!
Climate!suitability!for!falciparum!and!vivax!malaria!transmission!
Temperature!transmission!windows!based!on!observed!associations!between!temperature!and!malaria!cases!
HadRM2!driven!by!IS92a!emission!scenario!
2!to!4°C!increase!compared!with!current!climate!
None By!2050s,!geographic!range!projected!to!shift!away!from!central!regions!toward!south!western!and!northern!states.!The!duration!of!the!transmission!window!is!likely!to!widen!in!northern!and!western!states!and!shorten!in!southern!states.!
(Mitra!et!al.,!2004)!
Malaria,!Portugal Percent!days!per!year!with!favourable!temperature!for!disease!transmission!
Transmission!risk!based!on!published!thresholds!!
PROMES!for!2040s!and!HadRM2!for!2090s!
Average!annual!temperature!increase!of!3.3°C!in!2040s!and!5.8°C!in!2090s,!compared!with!1981to!1990!and!2006!to!2036,!respectively!
Some!assumptions!about!vector!distribution!and/or!introduction!
Significant!increase!in!the!number!of!days!suitable!for!survival!of!malaria!vectors;!however,!if!no!infected!vectors!are!present,!then!the!risk!is!very!low!for!vivax!and!negligible!for!falciparum!malaria!
(Casimiro!and!Calheiros,!2002)!
Dengue,!global! Population!at!risk!! Statistical!model!based!on!vapour!pressure.!Baseline!number!of!people!at!risk!is!1.5!billion.!
ECHAM4,!HadCM2,!CCSR/NIES,!CGCMA2,!and!CGCMA1!driven!by!IS92a!emission!scenarios!
Population!growth!based!on!region"specific!projections!
By!2085,!with!both!population!growth!and!climate!change,!global!population!at!risk!5!to!6!billion;!with!climate!change!only,!global!population!at!risk!3.5!billion.!!
(Hales et!al.,!2002)!
30
!
!
Lyme!disease,!Canada!
Geographic!range!and!abundance!of!Lyme!disease!vector!Ixodes!scapularis!
Statistical!model!based!on!observed!relationships;!tick!abundance!model!
CGCM2!and!HADCM2!driven!by!A2!and!B2!emission!scenarios.!2020s,!2050s,!2080s!
None Northward!expansion!of!approximately!200!km!by!2020s!under!both!scenarios,!and!approximately!1000!km!by!2080s!under!A2.!Under!the!A2!scenario,!tick!abundance!increases!30!to!100%!by!2020s!and!2"!to!4"fold!by!2080s.!Seasonality!shifts.!
(Ogden et!al.,!2006)!
Tick"borne!encephalitis,!Europe!
Geographic!range! Statistical!model!based!on!present!day!distribution!
HadCM2!driven!by!low,!medium"low,!medium"high,!and!high!degrees!of!change!(not!further!defined),!2020s,!2050s,!2080s!
3.45°C!increase!in!mean!temperature!in!2050s!under!high!scenario,!baseline!not!defined!
None From!low!to!high!degrees!of!climate!change,!tick"borne!encephalitis!is!pushed!further!northeast!of!its!present!range,!only!moving!westward!into!southern!Scandinavia.!Only!under!the!low!and!medium"low!scenarios!does!tick"borne!encephalitis!remain!in!central!and!eastern!Europe!by!the!2050s.!
(Randolph!and!Rogers,!2000)!
31
Table!A3:!Projected!impacts!of!climate!change!on!diarrhoeal!diseases!!
Modified!from!(Confalonieri!et!al.,!2007)
Health!effect! Metric! Model! Climate!scenario,!with!time!slices!
Temperature!increase!and!baseline!
Population!projections!and!other!assumptions!
Main!results! Reference!
Diarrhoeal!disease,!global,!14!world!regions!
Diarrhoea!incidence![mortality]!!
Statistical!model,!derived!from!cross"sectional!study,!including!annual!average!temperature,!water!supply!andsanitation!coverage,!and!GDP!per!capita!
A1B,!A2,!B1!and!B2!emission!scenarios.!2025,!2055!
SRES!population!growth!
Results!vary!by!region!and!scenario.!Generally,!diarrhoeal!disease!increases!with!temperature!increase.!!
(Hijioka!et!al.,!2002)!!
Diarrhoeal!disease,!Aboriginal!community,!central!Australia!(Alice!Springs)!
Hospital!admissions!in!children!under!age!10.!!
Exposure"response!relationship!based!on!published!studies!
CSIROMk2!and!ECHAM4!driven!by!B1,!A1B!and!A1FI!emission!scenarios.!2020,!2050!
0.4°C!to!2.0°C!annual!average!temperature!increase!in!the!2030s,!and!1.0°C!to!6.0°C!in!the!2070s,!relative!to!1990!(CSIRO)!
None Compared!with!baseline,!no!significant!increase!by!2020!and!an!annual!increase!of!5!to!18%!by!2050.!!
(McMichael!et!al.,!2003)!
Food!poisoning,!England!and!Wales!
Notified!cases!of!food!poisoning!(non!specific)!
Statistical!model,!based!on!observed!relationship!with!temperature!
UKCIP!scenarios.!2020s,!2050s,!2080s!
0.57!to!1.38°C!in!2020s;!0.89!to!2.44°C!in!2050s;!1.13!to!3.47°C!in!2080s!compared!with!1961to!1990!baseline!
None For!+1,!+2!and!+3°C!temperature!increases,!absolute!increases!of!approximately!4,000,!9,000,!and!14,000!notified!cases!of!food!poisoning!
(Bentham,!2001)!
32
!!Table!A4:!Projection!impacts!of!climate!change!on!food!security!and!malnutrition!Health!effect Metric! Model Climate!scenario,!
with!time!slices!Temperature!increase!and!baseline!
Population!projections!and!other!assumptions!
Main!results Reference
‘Million!at!risk!of!hunger’,!globally!by!region!
Undernourishment:!access!to!insufficient!calories!to!sustain!life,!perform!essential!functions!and!light"moderate!work.!Model!based!on!FAO!methodology.!
‘Yield!transfer!functions’!for!crops!(rice,!wheat,!maize,!soy);!BLS!global!trade!model!(general!equilibrium!model);!variant!of!FAO!undernourishment!model.!
A1FI,!B1!(a),!A2!(a,!b!and!c)!,!B2!(a!and!b)!emission!scenarios!driving!HadCM3.!2020s,!2050s,!2080s!
Temperature!increase!not!reported.!CO2!in!2080s:!527"810ppm.!!1961"1990!!
CIESIN!SRES!population!projections.!!!Adaptation:!farm!level!(planting!date,!more!fertilizer,!more!irrigation!where!irrigation!exists);!regional!level!(developed!countries!only:!e.g.!new!cultivars,!new!irrigation);!economic!adjustments!in!response!to!yield!changes!(e.g.!investment!increases!or!shifts)!
Over!time,!increasing!yields!in!developed!and!decreasing!yields!in!developing!countries.!Compared!to!2080s!with!no!climate!change:!50!to!600!million!additional!at!risk!of!hunger!if!no!CO2!fertilization;!"30!to!+30!with!CO2!fertilization.!Greater!differences!between!developed!and!developing!under!A1FIand!A2.!!!Regional!impacts!not!reported.!
Parry!et!al,!2004!
Calories!per!capita;!underweight!in!children!under!5;!adaptation!costs!
Calories!per!capita!is!population!divided!by!total!calorie!availability!(i.e.!does!not!account!for!within!
Biophysical!(DSSAT)!crop!models!(rice,!wheat,!maize,!soy,!groundnut);!IMPACT!trade!
A2!emission!scenario!driving!NCAR!and!CSIRO.!2050s.!
Average!temperature!increase!of!around!~1.3!to!2!C;!rainfall!global!average!increase!
UN!medium!variant!(i.e.!lower!than!conventional!A2!population!estimates).!
With!climate!change,!per!capita!calorie!consumption!will!decline!in!2050s!relative!to!2000.!
Nelson!et!al,!2009.!
33
country!distribution).!Underweight!as!a!function!of!calories!per!capita,!life!expectance,!access!to!improved!water!supply,!maternal!education!(final!three!held!constant!at!baseline)!
model;!underweight!model!based!on!Smith!and!Haddad!.!
of!2%!for!CSIRO!and!10%!for!NCAR.!!Baseline!climate!based!on!1950"2000!to!represent!2000.!
Child!underweight!will!increase!by!20%!relative!to!2050s!without!climate!change.!To!offset!climate!change"attributable!impacts!on!underweight,!need!to!invest!US$7.1"7.3!billion/year.!
34
Table!A5!Projected!impacts!of!climate!change!on!air!pollution!"related!health!effects!!Area! Health!
effect!Model! Climate!
scenario!Time!slices!
Temperature!increase!and!baseline!
Population!projections!and!other!assumptions!
Main!results Reference!
New!York!metropolitan!region,!US!
Ozone"related!deaths!by!county!
Concentration!response!function!from!published!epidemiologic!literature.!Gridded!ozone!concentrations!from!CMAQ!(Community!Multiscale!Air!Quality!model).!!
GISS!driven!by!A2!emissions!scenario!downscaled!using!MM5.!2050s!
1.6!to!3.2°C!in!2050s!compared!with!1990s!
Population!and!age!structure!held!constant!at!year!2000.!Assumes!no!change!from!United!States!Environmental!Protection!Agency!(USEPA)!1996!national!emissions!inventory!and!A2"consistent!increases!in!NOx!and!VOCs!by!2050s.!
A2!climate!only:!4.5%!increase!in!ozone"related!deaths.!Ozone!elevated!in!all!counties.!!A2!climate!and!precursors:!4.4%!increase!in!ozone"related"deaths.![Ozone!not!elevated!in!all!areas!due!to!NOx!interactions]!
(Knowlton!et!al.,!2004)!
50!cities,!eastern!US!
Ozone"related!hospitalisations!and!deaths!
Concentration!response!function!from!published!epidemiologic!literature.!Gridded!ozone!concentrations!from!CMAQ.!
GISS!driven!by!A2!emissions!scenario!downscaled!using!MM5.!2050s!
1.6!to!3.2°C!in!2050s!compared!with!1990s!
Population!and!age!structure!held!constant!at!year!2000.!Assumes!no!change!from!USEPA!1996!national!emissions!inventory!and!A2"consistent!increases!in!NOx!and!VOCs!by!2050s.!
Maximum!ozone!concentrations!increased!for!all!cities,!with!the!largest!increases!in!cities!with!currently!higher!concentrations.!68%!increase!in!average!number!of!days/summer!exceeding!the!8"hour!regulatory!standard,!resulting!in!0.11to!0.27%!increase!in!non"accidental!mortality!and!an!average!0.31%!increase!in!cardiovascular!disease!mortality.!
(Bell!et!al.,!2007)!
England!and!Wales!
Exceedance!days!(ozone,!particulates,!NOx)!
Statistical,!based!on!meteorological!factors!for!high!pollutant!days!(temperature,!wind!speed)!
UKCIP!scenarios!2020s,!2050s,!2080s!
0.57!to!1.38°C!in!2020s;!0.89!to!2.44°C!in!2050s;!1.13!to!3.47°C!in!2080s!compared!with!1961to!1990!baseline!
Emissions!held!constant Over all!time!periods,!large!decreases!in!days!with!high!particulates!and!SO2,!small!decrease!in!other!pollutants!except!ozone,!which!may!increase!
(Department!of!Health/Health!Protection!Agency,!2008)!
35
10!world!regions!
Premature!mortality!from!acute!ozone!exposure!
Ozone"mortality!coefficient!from!a!study!of!95!cities!in!the!US!
Coupled!GCM!with!interactive!chemistry!(LMDz"INCA)!driven!by!SRES!A2!for!2030!
Baseline!simulated!for!2000!
Population!growth!and!emissions!under!SRES!A2.!One!realization!including!recently!enacted!legislative!control!ozone,!and!another!assumed!maximum!possible!feasible!reduction!in!ozone!precursors!
(West!et!al.,!2007)!
Modified!from!(Confalonieri!et!al.,!2007;Ebi!and!McGregor,!2008)
References!
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