Global Climate Change and Health

Rosemary Marotta, LLB, LLM, MPA

Lex Chambers & the Al Gore Climate Project Ambassador;

and

Kevin Chan, MD, MPH, FRCPC, FAAP

Assistant Professor, Faculty of Medicine,

and Fellow, Munk Centre for International Studies,

University of Toronto

October 2008

Prepared as part of an education project of the

Global Health Education Consortium

and collaborating partners

Earth from Space

Page 2 http://images.google.ca/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/6/60/Earth_from_Space.jpg&imgrefurl=http://commons.wikime

dia.org/wiki/Image:Earth_from_Space.jpg&h=4096&w=4096&sz=1887&hl=en&start=6&um=1&usg=__lxiCVPCm0ht5jxLaZItLfQrDisk=&tbnid=eKbgpb1

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Quote “Whoever wishes to investigate medicine

properly, should proceed thus: in the first place to

consider the seasons of the year, and what

effects each of them produces for they are not at

all alike, but differ much from themselves in

regard to their changes. Then the winds, the hot

and the cold, especially such as are common to

all countries, and then such as are peculiar to

each locality. In the same manner, when one

comes into a city to which he is a stranger, he

ought to consider its situation, how it lies as to

the winds, and the rising of the sun; for its

influence is not the same whether it lies to the

north or the south, to the rising or the setting

sun.”

Hippocrates (Airs, waters and places)

Page 3 Source: http://tbhconcepts.com/images/hippocrates.jpg

Learning Objectives

• Explain how global warming occurs and highlight the

evidence of global climate change

• List major impacts of global climate change

• Outline potential infectious disease problems associated

with global climate change

• Highlight potential weather impacts and the implications

• Highlight possible solutions to climate change

Page 4

In this module, we will look at the relationship between Global Climate Change and

Health. For a more extensive review, please read either the Stern Report or visit the

Intergovernmental Panel on Climate Change website (www.ipcc.ch)

Case Study

• You are the planning minister of an island country

off the east coast of Africa. You’ve heard that

global climate change could be disastrous for the

country. You are wondering if that’s true … so

you ask for the evidence, and wonder what

impacts this could have for your country.

Page 5

How does Global Warming Occur?

Page 6

Source:

http://www.grida.no/climate/

vital/03.htm

Greenhouse gases are

essential for the

absorption and retention of

heat from the sun. The

issue with the greenhouse

gas build up is that the

retention of heat is

increasing slowly.

The difficulty with

greenhouse gases is that

this build-up cannot be

reversed quickly or easily.

How does Global Warming Occur?

Global Climate Change

– Caused by increase in greenhouse gases

• Carbon Dioxide

• Nitrous Oxide

• Methane

• Halocarbons (including CFCs)

– Greenhouse gases absorb earth’s infrared

radiation, solar heat and limit radiant heat

loss

Page 7

Why is Global Warming Occurring?

• Burning fossil fuels every year: primarily power plants and

transportation

– 1.2 cubic miles of oil

– 3.5 billion metric tons of coal

– 100 trillion cub feet of natural gas

– 30 billion tons of carbon dioxide

• Decline in carbon intensity reduction and natural sinks

– Forest fires: 22 million acres destroyed each year

• 20% of worldwide carbon dioxide emissions

Page 8

This greenhouse gas build-up continues to occur with increasing burning of fossil fuel, and the

elimination of key carbon dioxide sinks, such as forests and rainforests around the world.

The Intergovernmental Panel on Climate Change (IPCC)

• Scientific intergovernmental body set up in 1988 by:

– World Meteorological Association

– United Nations Environmental Program

• Does not carry out research or monitor climate data

• 2000 Scientists from 100 countries

– 3 working groups: science; socioeconomic impacts

and adaptation; and mitigation

• Concludes: “HUMANS ARE PLAYING A MAJOR

ROLE IN CLIMATE CHANGE” (IPCC 2004)

Page 9

Carbon Dioxide Trends

Page 10

CO2 levels are

currently 384 parts

per million

(historical average:

280 ppm)

Methane levels are

1750 parts per

billion (historical

average: 300-700

ppb)

The Evidence of Global Warming

• 1906-2005: ↑ by 0.56°C

• Next decade: ↑ by 0.28°C

• Top 10 hottest years in the

past 11 years over recorded

temperatures

• Rising sea levels, by about 10

cm over the past century

• Declining snow cover and

glaciers

Source: http://www.ipcc.ch/graphics/graphics/syr/fig1-1.jpg

Page 11

Furthermore, there is evidence of a change in

the ocean currents and also wind patterns

around the world.

Current Burden of Climate Change

2000: Loss of 150,000 lives and 5,500,000 DALY*

50% caused by malnutrition

Page 12

0-2

2-4

4-70

70-120

No Data

Mortality per million

people

Climate change has differential effects. It tends to affect tropical and poor countries more than temperature and wealthy

countries. These impacts and differentials will likely increase as global warming worsens.

Sources: McMichael AJ, Campbell-Lendrum, Kovats S, et al. Global climate change. In Ezzati M, Lopez A, Rodgers A, et al.

(editors). Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors.

Geneva: WHO, 2004. pp. 1543-1649. --- Patz JA, Campbell-Lendrum D, Holloway T, Foley JA. “Impact of regional climate

change on human health.” Nature. 2005; 438: 310-317. *DALY = Disability Adjusted Life Years

Current Trends

• ↑ temperature by 1.8-4.0 °C by 2100

• ↑CO2 to 500 ppm by 2050. By 2100, the range is 486-1248 ppm.

• 14.9 billion metric tons of carbon emissions in the US, EU, China and India in 2005 will increase to 25.6 billion metric tons in 2030

• Sea levels should rise by 7 to 23 inches and could rise by 20 feet if Greenland, Arctic and western Antarctic sea ice disappears

Page 13 See supplementary note on next slide

Page 14

Supplementary note

One of the most frightening aspects is that the models done in 2000 for IPCC and

the worse case scenarios for CO2 are being exceeded by the most recent current

data on CO2 emissions. It implies that global climate change is accelerating over

our current worse-case models.

Source: IPCC: summary for policymakers. In: Climate change 2007: the

physical science basis. Contribution of Working Group I to the Fourth

Assessment Report of the Intergovernmental Panel on Climate Change.

Solomon S, Qin D, Manning M, et al, editors. Cambridge: Cambridge University

Press, 2007.

http://images.google.ca/imgres?imgurl=http://www.photosfan.com/images/polar-

bears-on-an-ice-b-erg1.jpg&imgrefurl=http://www.photosfan.com/polar-

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Decrease in Arctic Ice

Page 15

There has been a significant decrease in

the arctic ice, especially over the past

decade.

If both the Greenland ice and the western

shelf of the Antarctic disappear, sea levels

would increase by 20 feet, flooding New

York, San Francisco Bay, the Florida Keys,

the Netherlands, Calcutta and Beijing.

There is increasing evidence that there is a loss of arctic ice.

In fact, and increase of 1-2ºF at the equator would be

equivalent to an increase of 12ºF at the poles.

A similar effect could occur in the Antarctic. The potential for

damage and effects on over 200 million people include

putting under water: the Netherlands, New York City, the

Florida Keys, and much of San Francisco’s Bay Area.

Economic Impact

The risk of climate change would be “equivalent to

losing at least 5% of global GDP each year ... [and that

if] a wider range of risks and impacts is taken into

account, the damage could rise to 20% of GDP each

year.”

-- UK Stern Review (2007)

Page 16

What Impacts Will Global Climate Change Have?

• Increase Infectious Disease

• Extreme Weather Events

• Decrease in Fresh Water Supplies and Food;

Desertification

• Increase in Air Pollution

• Decrease Biodiversity

• Impacts on the Economy

Page 17

Summary Slide of Climate Change

Page 18

Source: McMichael AJ,

Woodruff RE, Hales S,

“Climate change and

human health: present and

future risks.” Lancet.

2006; 367: 859-869.

Increase in Infectious Diseases

• Increase in malaria

– Increased rate of reproduction, prolonged breeding

season, and shortened maturation period

– Mosquito migration to higher grounds

• Dengue fever

• Tick-borne disease, including Lyme disease

• Leishmaniasis and trypanosomiasis

Page 19

A number of infectious diseases may rise with increase in temperatures. Many insects

have no homeostatic mechanisms, meaning that they do not self-regulate temperature.

Instead, the numbers of insects tend to increase with global warming temperatures . This

will likely lead to an increase in infectious disease.

Increase in Infectious Disease (con’t)

• Hantavirus and West Nile virus

• With increased flooding: increased

cryptosporidium, norovirus and toxins

• Plague in South America

Page 20

Malaria

• Caused by Plasmodium falciparum, vivax,

ovale and malariae

• Carried by Anopheles mosquitoes

• Between 0.7-2.7 million people affected

• Best temperature: 33-39°C

• Minimum temperature: 15-18°C

• Malaria epidemics increase following an

El-Nino event in the South Pacific

• Estimated risk of malaria 16-28% higher

in 2100

Page 21

Source: http://static.howstuffworks.com/gif/mosquito6a.jpg

Dengue Fever

• Caused by Dengue virus

• Carried by Aedes mosquitoes

• 2.5 billion people at risk

• Increased significantly in tropical

developing regions

– Weakened control programs

– Rapid urbanization

– High population densities

– Increased travel

Page 22

Biological models have been made to explore the influence of projected temperature change on the incidence of dengue

fever. The cycle of dengue ranges from 10-40 years, but the current global pandemic has intensified in the past two

decades. This corresponds with an increasing distribution of Aedes aegypti. The current global distribution of dengue fever

risk is 2.5 billion people, which is on par with malaria

Source: http://www.radiobaragua.cu/Palma%20Soriano/noticias/imagen-noticias/aedes-aegypti-2.jpg

Extreme Weather Events

• Flooding and fire risk

• Increase intensity of cyclones and hurricanes

– Katrina (2005)

– Mozambique, 3 cyclones (2000) in 6 weeks

• Increased malaria: 5-fold

• Heat waves

– Europe (summer 2003): Killed 21,000 - 45,000 additional

people from heat exhaustion/stroke

• Increased tectonic and volcanic activity

• Environmental Refugees

Page 23

Katrina (2005)

• This shows Hurricane

Katrina coming to the

Gulf Shore. The

orange/red color shows

the warmth of the Gulf of

Mexico.

Page 24

Source: Epstein PR. “Climate Change and Human Health.” New England Journal of

Medicine. 2005; 353 (14): 1433-1436. Also: Reprinted by permission from Massachusetts

Medical Society. New England Journal of Medicine. Epstein PR. "Climate Change and

Human Health." 353 (14), 1433-1436, 2005

Decrease in Water Supplies - Food; Desertification

• By 2025: 5 billion persons under severe water stress

• Climate change leads to 1-7% decreases in cereal production

– Developing countries: 9-11% decrease in cereal production

– Developed countries: small increases in cereal production

– 500 million presently at risk from hunger; climate change would

increase the risk by 20 million by 2050, and 80 million by 2080

(this factors in to account the impact of economic and social

development).

• Mitigating climate change, decreases the risk from hunger

Page 25

One of the major concerns of climate change is that in some parts, there could be an increase in famine from significant

droughts. The changing microclimates will lead to some areas getting more food and others less, leading to higher regional

inequality. There may be an associated breakdown in sanitation leading to higher diarrheal disease.

Source: Parry M, Rosenzweig C, Livermore M. “Climate change, global food supply and risk of hunger.” Philosophical

Transaction of the Royal Society of Britain. 2005; 360: 2125-2138.

Increase in Air Pollution

• Increased Smog and Ozone

– Ozone: Reduces lung function, increases coughing,

aggravates asthma, and worsens symptoms of

emphysema and bronchitis. Increases UV-damage.

• Increase in asthma in US: quadrupled in past 2 decades

• Dust clouds in the Caribbean come from dust clouds in

Africa that cross the ocean via the trade winds

• Increasing levels of plant pollen and soil fungi

Page 26

Climate change may also increase ozone levels, leading to a worsening of respiratory problems. Carbon dioxide also leads to

increase in plant pollen, especially ragweed. As well, increased flooding will increase mold and soil fungi.

Sources: EPA. Ozone and Your Health. United States Environmental Protection Agency. Washington DC, USA. EPA-

152/F99-003, 1999. -- Epstein PR. “Climate Change and Human Health.” New England Journal of Medicine. 2005; 353

(14): 1433-1436. -- Watson RT, Patz J, Gubler DJ, Parson EA, Vincent JH. “Environmental health implications of global

climate change.” Journal of Environmental Monitoring. 2005; 7: 834-843.

Increase in Air Pollution (con’t)

• Ragweed, with double the

ambient carbon dioxide, grow

10% taller, but have 60% more

pollen

• Diesel particles deliver

allergens deeper into our

alveoli (in our lungs)

Page 27

Decrease Biodiversity

• 60% of resources and life-

support systems are in decline

or used in unsustainable ways

(Millennium Ecosystem

Assessment, 2005)

• Decline in coral reefs: decline

protection for fish, loss of

potential medicines

Page 28

Do We Need More Evidence?

• Is there uncertainty in climate change, and is more research

required?

– Overwhelming scientific evidence that climate change is being

caused by human beings.

• Management of environmental and public health risks should use

a “precautionary principle”

– We should not take undue risks when there is the potential for

serious and perhaps irreversible environmental and human

damage.

Page 29

Possible Solutions

• Carbon Capture and Storage

• Renewable Energy Sources

• Changing Transportation

Methodologies

• Create Carbon Emission Caps

• Mitigation and Adaptation

Page 30

Carbon Dioxide Capture and Storage

Store CO2 from large sources of fossil-fuel combustion

(three methods)

1. Post-combustion capture: Separation of CO2 from flue

gases derived from combustion of fuel in air; uses

organic solvent to capture CO2

2. Pre-combustion capture: Primary fuel is mixed with

stem and air/oxygen to give CO and hydrogen; more

steam to give CO2 and hydrogen at lower volumes

3. Oxyfuel: Uses 90-95% O2 to produce CO2 and water.

Gas dried and compressed; stored in ground, deep

ocean water or used for mineral carbonation.

Page 31

Renewable Energy Sources

• Hydroelectric: constant source and store of energy

– Problems with CO2 and methane emission from

anaerobic fermentation in static water

• Solar: expensive, large requirements for land, and

intermittent, but can be used locally

• Biomass: cleaner technology, but impacts food prices

• Wind, wave and geothermal

• Nuclear fusion: theoretical potential to provide lots of

energy with less radioactivity than fission, safer

Page 32

Markandya A, Wilkinson P. Energy generation and health. Lancet. 2007; 370: 979-990.

Changing Transportation Methodologies

• Reducing or avoiding travel: using information and

communication technologies (e-mail, teleconferencing)

• Increasing energy efficiency and alternative fuel

sources in vehicles

• Decreasing trip distances

• Group traveling (buses and car pooling)

• Improve access for walking and cycling, especially in

inner cores of cities

Page 33

Source: Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and transport. Lancet.

2007; 370: 1078-1088.

Create Carbon Emission Caps and Taxes

• Create a greenhouse gas inventory

– Create carbon emission targets and credits

– Force companies to pay for overuse with the need to

purchase carbon emission credits

• Create a carbon tax

– Implemented in Sweden and British Columbia

(Canada), on the value of carbon dioxide produced

• Proceeds can be used in part to reduce impacts on

poor or generalized across the board, so as to be

revenue neutral

Page 34

Mitigation and Adaptation

• Protecting water and sanitation impacts

– Especially in the Middle East and North Africa

• Providing support for environment health emergencies

– Increasing training in complex humanitarian emergencies

• Developing strong infectious disease surveillance systems

– Build capacity to monitor new disease and outbreaks

• Building human health capacity

Page 35

As water and sanitation becomes an increasingly pressing matter from climate change

impacts, it will be important to place an emphasis on protecting existing water sources and

reducing the burden of disease caused by poor water protection and sanitation.

Mitigation and Adaptation

• Air conditioning, to reduce risks from heat waves and help

control pollution exposure

• Improve architecture design to cope with heat waves and

extreme weather events

• Public education about various risks

– Winter anomalies, increased pollution, droughts/floods

• Strengthen and increase heights of sea walls and levees

• Strengthen pollution controls

• Stop deforestation and restore forests

Page 36

Climate Change Affects Global Health and Development

• With increasing temperatures we can expect more

infectious disease, especially in the tropical and peri-

tropical areas

• Increased droughts, floods, and natural disasters will make

large populations poorer

• Water supplies and lower food yields could affect the poor

• Increased problems with air pollution

• Energy solutions are required that balance the need for

development with environmental impacts

• Poor populations have the lowest ability to cope

Page 37

Quiz Introduction

• Now we invite you to take the module quiz and

test your recent learning.

• This quiz has 5 multiple choice questions.

• Write down the letter code for each of your

answers on the next 3 slides and then check

the answers on the slides that follow

• After completing your quiz, come back for the

summary of this module presentation.

Page 39

1. What is the cause of global warming? A. Earth is wobbling closer to the sun.

B. An increase in greenhouse gases

C. There are more forest fires today

D. There is more volcanic activity in the Atlantic Ocean

2. What is the current level of carbon dioxide in the atmosphere? A. 280

B. 320

C. 380

D. 500

E. 750

Quiz questions

Page 40

Quiz questions

4. Climate change will lead to which of these conditions? A. Improved food yield in developing countries

B. Decreased food yield in developed countries

C. Less famine around the world

D. Less respiratory problems in children

E. Decline in coral reefs

3. How high will the sea rise if the Arctic and western shelf of

the Antarctic melt away? A. 1 foot

B. 2 feet

C. 5 feet

D. 10 feet

E. 20 feet

Page 41

Quiz questions

5. Which are possible solutions for climate change? A. Carbon capture and storage

B. Hybrid technology

C. Creating carbon emission caps

D. More wind power

E. All of the above

Page 42

1. What is the cause of global warming? A. Earth is wobbling closer to the sun. - Incorrect

B. An increase in greenhouse gases - CORRECT

C. There are more forest fires today – True but not main cause

D. There is more volcanic activity in the Atlantic Ocean – True but not

main cause

2. What is the current level of carbon dioxide in the atmosphere? A. 280 – Historical average in history

B. 320 – Approximate level in 1960

C. 380 - CORRECT

D. 500 – Projection for the year 2050

E. 750

Quiz answers

Page 43

4. Climate change will lead to which of these conditions? A. Improved food yield in developing countries – Estimated 9-11% decline

B. Decreased food yield in developed countries – May be a small increase

C. Less famine around the world – Climate change will increase hunger

D. Less respiratory problems in children – There will be more air pollution and

probably increased levels of asthma

E. Decline in coral reefs – CORRECT. Warmer climates more leeching of

reefs and reduced fish stocks

3. How high will the sea rise if the Arctic and western shelf of

the Antarctic melt away? A. 1 foot

B. 2 feet

C. 5 feet

D. 10 feet

E. 20 feet - CORRECT

Quiz answers

Page 44

5. Which are possible solutions for climate change? A. Carbon capture and storage – Although correct there is a better

answer

B. Hybrid technology – Although correct there is a better answer

C. Creating carbon emission caps – Although correct there is a better

answer

D. More wind power – Although correct there is a better answer

E. All of the above - CORRECT

Quiz answers

Summary

• Global warming and climate change are caused by the

production of greenhouse gases such as CO2

• Uncontrolled climate change will lead to greater

incidences of ill health and morbidity.

• Ignoring these health impacts will lead to economic

consequences.

• The result will be an increase in infectious disease,

extreme weather events and a shortage of clean water

and food.

• Solutions are available, but the political will is required.

Credits

Rosemary Marotta, LLB, LLM, MPA

Lex Chambers & the Al Gore Climate Project Ambassador;

and

Kevin Chan, MD, MPH, FRCPC, FAAP

Assistant Professor, Faculty of Medicine,

and Fellow, Munk Centre for International Studies,

University of Toronto

Acknowledgement

We would like to acknowledge the "Al Gore

Climate Change Project" for its

contribution to this module.

For more information you can go to:

http://www.theclimateproject.org/

Sponsors The Global Health Education Consortium gratefully acknowledges the

support provided for developing these teaching modules from:

Margaret Kendrick Blodgett Foundation

The Josiah Macy, Jr. Foundation

Arnold P. Gold Foundation

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0

United States License.