Climate change is now widely considered to be a serious public health issue, because it interacts with so many of the important determinants of health, feeding into our largest current health burdens.
References for all figures given in WHO, 2009. Protecting Health From Climate Change: Connecting Science, Policy and People, World Health Organization, Geneva; page 7. http://www.who.int/globalchange/publications/reports/9789241598880/en/index.html
References: McMichael, A. et al., 2004. Climate Change. In: M. Ezzati, A. Lopez, A. Rodgers and C. Murray (Editors), Comparative Quantification of Health Risks: Global and Regional Burden of Disease due to Selected Major Risk Factors. World Health Organization, Geneva. Patz, J., Gibbs, H., Foley, J., Rogers, J. and Smith, K., 2007. Climate Change and Global Health: Quantifying a Growing Ethical Crisis. Ecohealth, 4: 397–405. WHO, 2009. Protecting Health From Climate Change: Connecting Science, Policy and People, World Health Organization, Geneva.
Reference: UNDP World Development Report, 2007.
Protecting Human health from climate, is recognized as a global priority by major environmental accords.
To take another example; Environmental management for malaria in Africa is rarely done, and it is even rarer to find an economic assessment. But they do exist if you go back far enough. The MA highlights an assessment of the malaria control programme in the Zambian copper belt in the 1930s. This was based entirely on environmental management, mainly reduction in breeding sites, for the first 15 years, and succeeded in cutting deaths by about 80%. More importantly, this was achieved at a cost of about US$ 850 in 1995 dollars – which is within the range estimated for ITN programmes in several African countries in the 1990s. The bottom line is that environmental management can in some cases be as cost-effective as more familiar public health interventions. Our estimated costs of US$ 858 per death averted was between the cost-range of US$ 219 and 2958 estimated for insecticide treated bednets in The Gambia, Ghana, Kenya and South Africa (Goodman&Mills 1999; Goodman et al. 2001). Our estimated cost of US$ 22.20 per malaria attack averted was only slightly higher than the one estimated for insecticide treated nets in The Gambia, which was US$ 15.75 (Graves 1998).
I've mainly been talking about managing existing problems. But there is another kind of risk highlighted by the assessment, which is that of emergence of new diseases from inappropriately managed ecosystems. There is a constant flow of pathogens from the natural environment to human populations. Over 60% of pathogenic infections in humans are transmitted by animals, with humans as dead-end hosts.
Classic case of globalization of health risks; Interaction between globalization, development, environmental change, interconnectivity, and health. The MA highlights particular examples where we have not managed the environment particularly well, increasing the chances of overflow from the natural environment to cause major impacts on public health. The origin of the coronavirus that cases SARS, is still not known, but it appears to be associated with consumption or contact with wild animals in live animal markets in China. It's rapid control was probably one of the great successes of international public health of recent years, so it was a disaster narrowly averted. Avian influenza - Currently a cause for concern. Agricultural practices, specifically contact between wild fowl, domestic fowl and pigs, raises the possibility of mixing of the H5N1 strain of avian influenza with human influenza. There is substantial concern that this produce a strain which can be rapidly and directly transmitted between humans, with the potential for a devastating pandemic. Other examples include agricultural practices promoting transfer of BSE (mad-cow disease) to cause new Variant-CJD in humans, and possibly, consumption of bushmeat as the origin of HIV transmission in humans. The key message here is that we cannot afford to be complacent about the potential risks that rapid ecosystem changes pose for emergence of new diseases. (Live-animal markets, termed “wet markets,” are common in most Asian societies and specialize in many varieties of live small mammals, poultry, fish, and reptiles (Brieman et al. 2003).) The majority of the earliest reported cases of SARS were of people who worked with the sale and handling of wild animals. The species at the center of the SARS epidemic are palm civet cats (Paguna larvata), raccoon dogs (Nyctereutes procuyoinboides), and Chinese ferret badgers (Melogale moschata) (Bell at al. 2004). As of July, 2003, there had been 8,096 cases and 774 deaths reported worldwide (WHO 2004).
Climate Change and Health in Developing Countries: overcoming challenges and barriers
Climate change and health in developing countries: Challenges and Opportunities for the OneHealth Approach Diarmid Campbell-Lendrum Team Leader, Climate Change and Health, Public Health and the Environment Department
The largest disease burdens in developing countries are highly climate sensitive <ul><li>Each year: - Undernutrition kills 3.5 million - Diarrhoea kills 2.2 million - Malaria kills 900,000 </li></ul><ul><li>- Extreme weather events kill 60,000 These, and others, are highly sensitive to changing climate. </li></ul>
Climate change undermines the environmental determinants of health <ul><li>Without effective responses, climate change will compromise: </li></ul><ul><li>Water quality and quantity : Contributing to a doubling of people living in water-stressed basins by 2050. </li></ul><ul><li>Food security : In some African countries, yields from rain-fed agriculture may halve by 2020. </li></ul><ul><li>Control of infectious disease : Increasing population at risk of malaria in Africa by 170 million by 2030, and at risk of dengue globally by 2 billion by 2080s. </li></ul><ul><li>Protection from disasters : Increasing exposure to coastal flooding by a factor of 10, and land area in extreme drought by a factor of 10-30. </li></ul>
Climate impacts on health are unfairly distributed (movement of people, and resentment) Cumulative emissions of greenhouse gases, to 2002 WHO estimates of per capita mortality from climate change, 2000 Map projections from Patz et al, 2007; WHO, 2009.
<ul><li>Almost all countries now identify health as a priority for climate change, but less than 30% of least developed countries have adequate health vulnerability assessments and health adaptation plans. </li></ul><ul><li>International investment in health adaptation is currently less than 0.5% of expected health damage costs. </li></ul>Health challenges are recognized - but are not properly addressed:
We are not yet serious enough about sustainable, preventive public health Source: Estimated from OECD, WHO, and Prevention Institute data <ul><li>Each year from 2000-2008: </li></ul><ul><li>life expectancy rose 0.5% </li></ul><ul><li>health costs rose 6 % </li></ul>Other Alcohol Unsafe Sex Tobacco Physical Inactivity Illicit drugs Environment Treatment & Overhead Prevention < 5% Factors influencing health World-wide health expenditures US $ 5.3 Trillion
Public make the connection between climate change and health Globescan poll in 30 countries (UNDP 2007): “ Now I would like to ask you some questions about climate change, which is sometimes referred to as global warming or the greenhouse effect. Which ONE of the following possible impacts most concerns you personally, if any?”
Health in global sustainable development & climate agreements; and vice versa <ul><li>1992 Rio declaration </li></ul><ul><li>Principle 1: " Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature ." </li></ul><ul><li>2008 World Health Assembly Resolution 61.19 </li></ul><ul><li>Commits counties, and WHO, to assess evidence and strengthen health systems to respond to climate change. </li></ul>
Cutting greenhouse gas emissions could bring very large "co-benefits" to health: <ul><li>Sustainable urban transport – could cut heart disease and stroke by up to 20%. </li></ul><ul><li>Improved stoves could save 2 million lives over 10 years in India alone, and reduce warming from black carbon. </li></ul><ul><li>"Health benefits from reduced air pollution as a result of actions to reduce greenhouse gas emissions… may offset a substantial fraction of mitigation costs" – IPCC, 2007 </li></ul>
In the Zambian Copper Belt in the 1930s, malaria had major impacts on health, and productivity Environmental-management based control reduced malaria by about 80%, at a cost of US$ 858 per death averted Modern ITN programmes achieve US$ 219 - $2958 per death averted Can we afford to manage the environment? CDC Public Health Image Library Utzinger et al, Tropical Medicine and International Health, 2001
Benefit/Cost ratios for environmental management interventions: US Clean Air Act: 42:1 (USEPA, 1999) Improved water and sanitation throughout 15:1 (WHO, 2004) poor regions of Latin America Environmental management of Catskills 2:1 (MEA, 2005) watershed versus new filtration plant Can we afford to manage the environment?
Can we afford NOT to manage the environment? WHO Image Library
Conclusions <ul><li>Climate change presents very large health risks – mainly through ecosystem degradation. </li></ul><ul><li>The risks are not yet being managed either from the health or the environment side. </li></ul><ul><li>We have much of the necessary mandate, public support and evidence, and Onehealth is an appropriate conceptual model. </li></ul><ul><li>We need better incentives for integrated approaches and long-term risk management. </li></ul>
World Health Organization http:// www.who.int / Public Health and Environment Department http:// www.who.int / phe Health and climate change http://www.who.int/globalchange/en/ Thank you for your attention