c enter for h ealth and the g lobal e nvironment harvard medical school climate instability and...

CENTER FOR HEALTH AND THE GLOBAL ENVIRONMENT

HARVARD MEDICAL SCHOOL

CLIMATE INSTABILITY AND

PUBLIC HEALTH

NRELJanuary 13, 2005

Paul R. Epstein, M.D., M.P.H.

http://www/med.harvard.edu/chge



Algal Blooms Algal Blooms PeruPeru19911991



United Nations United Nations Intergovernmental Panel on Intergovernmental Panel on

Climate Change Climate Change Third Assessment Report 2001Third Assessment Report 2001

1. Climate is changing2. Human activities are contributing3. Biological systems are being

affected on all continents4. Weather is becoming more

extreme.

All weather = All weather = f f (CC + (CC + NV)NV)



Sea Surface Temperatures: Sept. 2004Sea Surface Temperatures: Sept. 2004



Since 2001 We Have LearnedSince 2001 We Have Learned

1. CO2 rise is accelerating: 3ppm/yr, up from 1.82. Tropical oceans are warmer & saltier

surface waters near the poles cooler & fresher

*In August water entering the Arctic Ocean

was 1o F warmer than a year ago! 3. Polar and mountain glacial ice is diminishing

at surprising rates4. Winds around both poles are

becoming more forceful.



379 379 ppmppm



The Changing Shape of the The Changing Shape of the CurveCurveOO

UU

TT

LL

II

EE

RR

SS



Deep Ocean Deep Ocean Warming Warming

Levitus et al. Science 2000; 287: 2225Levitus et al. Science 2000; 287: 2225

OceansOceans 18.2 x 1018.2 x 102222 J JAtmosphereAtmosphere 6.6 x 10 6.6 x 102121 J J



Precipitation Precipitation ExtremesExtremes

Past century Average annual precipitation 7%

“Heavy rain events" (>2”/day) 14%

“Very heavy rain events" (>4”/day) 20%

Western drought – worst in 500 years - Groisman et al. 2004- Groisman et al. 2004



Greenland Ice SheetGreenland Ice Sheet

Geological Survey of Greenland and Denmark

772,000 square miles of ice 1.9 miles thick

Melting Melting 1 meter/yr 20001 meter/yr 2000

10 meters/yr 200410 meters/yr 2004



Sources: OFDA / Center for Research in the Epidemiology of Disasters (CRED) "Natural.xls" Intl database of Disasters (http://www.cred.be/emdat/intro.html) and U.S. Census Bureau's International Database (http://www.census.gov/ipc/www/idbagg.html). From analysis completed by Padco's Climate Change Solutions Group for USAID's Global Climate Change Team. "Population Impacted" includes those persons that have either been killed, injured, left homeless, or otherwise adversely affected.

The Frequency of Weather-Related Disasters Has Risen in Less-Developed Countries: 1950-2001

0

200

400

600

800

1000

1200

1400

1600

1800

Number of Events

Wind storm 59 121 121 207 300

Wild fire 0 4 11 25 54

Wave/surge 2 5 2 3 12

Slide 11 15 34 63 114

Insect infestation 0 1 6 43 13

Flood 50 110 170 276 489

Famine 0 2 4 11 45

Extreme temp 4 10 9 19 70

Epidemic 0 31 44 86 317

Drought 0 52 120 177 195

1950-59 1960-69 1970-79 1980-89 1990-2001



Assessing Climate Assessing Climate Stability Stability

Rates of ChangeRates of Change

VariabilityVariability

GradientsGradients

Number of Components Number of Components ChangingChanging



Agent

Host Environment

EpidemiologicalEpidemiologicalFrameworkFramework

Disease

Social

Ecological Global

Ecological-epidemiologicalEcological-epidemiologicalFrameworkFramework

Epidemics



MODEL MODEL PROJECTIONS:HEATWAVESPROJECTIONS:HEATWAVES


HARVARD MEDICAL SCHOOL Source: NASASource: NASA2003 Summer Temperatures 10oC (18oF) >30year average

SUMMER 2003 SUMMER 2003 HEATWAVEHEATWAVE

FRANCE, GERMANY, ITALY, SPAIN, PORTUGAL

21-35, 000 deaths

WILDFIRESWILDFIRES CROP CROP FAILURESFAILURES SURPRISESSURPRISES



INDIAJune 2003 T 122•F >1400 deaths

July Floods

Japanese B encephalitis

Andhra Pradesh



ASTHMA

2-3x Since 1980s

AIR POLLUTION AIR POLLUTION AND CLIMATE AND CLIMATE

CHANGECHANGEIndoor pollutants

Socio/economic/emotional factors

Ground-level Ozone

&

Pollen & CO2

Diesel Particles

mold & pollen

Droughts & Fires

Floods & Fungi

HeatwavesHeatwaves



RAGWEED POLLEN RAGWEED POLLEN PRODUCTIONPRODUCTION

and COand CO22

0

10

20

30

40

50

60

70

CO2 350ppm

CO2 700ppm

Height

Seed Mass

Pollen

Biomass

Wayne et al., 2002: Annals of Allergy, Asthma and Immunology 8:279

p = 0.005



COCO22 DomeDome



Emerging Infectious Emerging Infectious DiseasesDiseases

30 “NEW” TO MEDICINE SINCE 1976

HIV/AIDS Legionnaires’

E. coli O157:H7 MDRTB & others

SARS nvCJD

HPS Vibrio cholerae O139

Nipah virus EbolaArenaviruses Lyme disease

RESURGENT & REDISTRIBUTING

Malaria, DF, WNV, Leptospirosis,

Cholera, Avian Flu

VECTORSVECTORSMosquitoesMosquitoes

TicksTicksRodentsRodents

BatsBatsTsetse FliesTsetse Flies

FleasFleasLiceLice

SnailsSnailsAlgaeAlgae



INFECTIOUS INFECTIOUS DISEASEDISEASE

A DRIVING FORCE IN A DRIVING FORCE IN HISTORYHISTORY

The Bad News

PLAGUE PLAGUE

541 AD541 AD

1346 AD1346 AD

The “Good” News

Cholera, TB, SmallpoxCholera, TB, Smallpox



MONTANE REGIONSMONTANE REGIONS



WNVWNVHUMAN CASES & DEATHSHUMAN CASES & DEATHS

1999 2000 2001 2002 2003

25 Nov

62 66 21

4161

284

93899389

246246

Jeff ShamanJeff Shaman

Paul EpsteinPaul Epstein

DROUGHTDROUGHT

1999, 2002, 20031999, 2002, 2003



WNV: A DISEASE OF WILDLIFEWNV: A DISEASE OF WILDLIFE 230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES

• 138 Bird spp., RAPTORSRAPTORS

- 37 spp. of mosquitoes

• HORSES

• ZOO animals

• REPTILES

AVIAN FLYWAYSAVIAN FLYWAYS



INFECTIOUS DISEASES AS FORCES OF GLOBAL INFECTIOUS DISEASES AS FORCES OF GLOBAL CHANGECHANGE

RaptorsRaptors RodentsRodents

Lyme disease Lyme disease HantavirusesHantaviruses

Arenaviruses Arenaviruses Leptospirosis Leptospirosis

ToxoplasmosisToxoplasmosis

PlaguePlague

Ecological RipplesEcological Ripples



WARM WEST COLD EAST

PACIFIC ANOMALIESPACIFIC ANOMALIES

Hoerling and Kumar: Hoerling and Kumar: The perfect ocean for The perfect ocean for drought.drought. Science Science 2003; 299: 691 2003; 299: 691

AMERICAS

AFRICA

AUS

ASIA



EXTREME WEATHER EVENTS & EXTREME WEATHER EVENTS & DISEASE CLUSTERSDISEASE CLUSTERS



HURRICANE MITCHHURRICANE MITCHHURRICANE MITCH HURRICANE MITCH 19981998



HURRICANE HURRICANE MITCHMITCH

IMPACTS ON HEALTHAND DEVELOPMENT

-- Malaria (>30,000 cases) -- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis

Juan Almendares

DISEASE CLUSTERDISEASE CLUSTER



WEATHER ANOMALIES, TRAVEL WEATHER ANOMALIES, TRAVEL HAZARDS HAZARDS

and TRAUMA and TRAUMA

Fog, Ice Storms & Road TravelFog, Ice Storms & Road Travel

Floods & MudslidesFloods & Mudslides

Ice Instability, Heavy Precipitation & AvalanchesIce Instability, Heavy Precipitation & Avalanches

Infrastructure Damage and Water Q&QInfrastructure Damage and Water Q&Q

HEALTH & ECONOMIC IMPACTSHEALTH & ECONOMIC IMPACTS



Range Expansion of Soybean RustRange Expansion of Soybean Rust

North AmericaNorth AmericaCrop PestsCrop Pests

Generations/YearGenerations/Year

XB Yang, C Rosenzweig, P AndersonXB Yang, C Rosenzweig, P Anderson

R Quiroz, G Baigorria, A IglesiasR Quiroz, G Baigorria, A Iglesias



Drought,Drought,

Bark BeetlesBark Beetles

&&

FiresFires

Respiratory Respiratory diseasedisease



Costs of Emerging Infectious DiseasesCosts of Emerging Infectious Diseases

BIO ECONOMIC RESEARCH ASSSOCIATION, Cambridge, MA



Costs of Extreme Weather Costs of Extreme Weather EventsEvents

UNEPUNEP

$150B/y w/in this decade$150B/y w/in this decade

Insurance & Reinsurance, Corporations,Insurance & Reinsurance, Corporations,FEMA, OFDA, NGOs, Nation States, UN Agencies FEMA, OFDA, NGOs, Nation States, UN Agencies

Av. $4 B/yAv. $4 B/y

Av. $40 B/yAv. $40 B/y



Exploration

Extraction

Transport

Refining

Transport

Air Pollution

Acid Rain

Climate Change

EutrophicationNOxs

Warming OceansCoral ReefsSLREWEsMelting Polar Ice

Harm

Marine

Mammals

Shore birds

Fisheries

Consumers

Livelihoods

OIL OIL LIFE CYCLE LIFE CYCLE COSTSCOSTS

Spills

&

Leaks MERCURY



CLIMATE CHANGE FUTURES: CLIMATE CHANGE FUTURES:

HEALTH, ECOLOGICAL AND ECONOMIC DIMENSIONSHEALTH, ECOLOGICAL AND ECONOMIC DIMENSIONS

Swiss Re, UNDP, JMFSwiss Re, UNDP, JMF

A.A. Community-building: Scientists, UN agencies, Community-building: Scientists, UN agencies, NGOs, CorporationsNGOs, Corporations

B.B. Knowledge-building: Economic evaluation Knowledge-building: Economic evaluation

C.C. Awareness-building: RISKS and OPPORTUNIIESAwareness-building: RISKS and OPPORTUNIIES



Harmonizing Adaptation with Harmonizing Adaptation with MitigationMitigation

Distributed GenerationDistributed Generation

WaterWater SchoolsSchools

PurificationPurification ClinicsClinics

PumpingPumping HomesHomes

IrrigationIrrigation ComputersComputers

DesalinizationDesalinization CookingCooking



ENABLING FINANCIAL ARCHITECTURE ENABLING FINANCIAL ARCHITECTURE FOR SUSTAINABLE FOR SUSTAINABLE

DEVELOPMENTDEVELOPMENT

THE ENGINE OF THE ENGINE OF

GROWTHGROWTHfor thefor the

21st CENTURY21st CENTURY

RegulatoryRegulatory

InstitutionalInstitutional

EE, RE and DGEE, RE and DG “ “Green Buildings” & Smart Green Buildings” & Smart GrowthGrowth Rationalized Transport & TransitRationalized Transport & Transit Retrofitting InfrastructureRetrofitting Infrastructure Ecological ReconstructionEcological Reconstruction

Funds, Funds, subsidies, subsidies,

tax tax incentivesincentives

c enter for h ealth and the g lobal e nvironment harvard medical school climate instability and...

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