Global Climate Change and Global Health

Developing an NIH Research Agenda

Joshua Rosenthal, Ph.D.

Fogarty International Center, NIH

Impacts of Climate Change on Infectious Disease

Fondation Merieux, Annecy France

November 26,2008

Microbial Threats To Health Institute of Medicine 2003

Factors in Disease Emergence - Convergence Model

The climate change commitment

IPCC, 2001 SYR FIG 5-2

Climate change is expected to disproportionately impact the most vulnerable populations

Direction and magnitude of change of selectedhealth impacts of climate change

IPCC 2007 Figure 8.3

Direction and magnitude of change of selectedhealth impacts of climate change

No discernible impact

From Bunyavanich et al 2003 The Impact of Climate Change on Child Health. Ambulatory Pediatrics. Vol 3. Issue 1: 44-52

Change pathways & impacts

Howard Frumkin, CDC

MissionNIH is the steward of medical and behavioral research for the Nation. Its

mission is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.

Trans NIH Working Group on Climate Change and Health Research

Develop a forward looking strategy for research and capacity building

• Analyze current portfolio

• Assess research needs - literature, consensus reports, expert opinions

• Identify opportunities and gaps

• Develop appropriate research, training and funding activities

Analysis of NIH Research PortfolioRCDC text-mining software science-related concepts in all NIH funded projects

Climate Change,Global Warming and Climate Change, - Health Effects of Climate Change -

RCDC System identified • 576 projects in 2006 (draft fingerprint)• 920 projects in 2007 (completed fingerprint)

Categories for post hoc portfolio analyses

Heat stress

Water pollution

Air pollution

Extreme weather

Wildfire

Flooding

Harmful algal blooms

Freshwater decline

Infectious disease

Malnutrition

Cardiovascular

Mental health

Neurological

Trauma

Cancer

Reproductive

Vision

Toxicity

Respiratory disease

Immune suppression

Population

Clinical

Animal model

Modeling

Cell & molecular

Effector/Pathway

Health Effects

Emergency preparedness

Prediction

Capacity building

Intervention development

Tool development

Basic research

Children

Adult

Senior

Rural

Minority

Health care

Public health

Non-health (infrastructure, policy)

Acute

Developmental

Chronic

Population

Study type

Response mechanism Time frameof disease

Study objective

United States

International

Developing countries

Geography

Selected projects 2006

The ecology of African highland malaria (NIAID)

Developing genomic resources for the toxic dinoflagellate Alexandrium tamarense (NIEHS)

Heat stress and circulatory control (NHLBI)

Ecological approaches to understanding post-disaster distress (NIMH)

Leptospirosis transmission in the Peruvian Amazon (FIC)

Social and economic effects of natural disasters (NICHD)

The joint risks of hazardous air pollutants among childhood cancer histotypes (NCI)

Improving the trauma system response to disaster (NLM)

Typology based on relevance to climate change

I. Studies on health impact or interventions directly related to long range climate change

II. Studies on the effects of climate change-sensitive parameters (temperature, UV, humidity…) on biological systems, disease, public health

III. Studies of disease, biological systems, public health needs that are very likely to be affected by climate change, but climate effectors are not explicitly addressed, measured or estimated in the project

Relevance I

I. Studies on health impact or interventions directly related to long range climate change

a) Multi-variate studies based on climate scenariosb) Interannual variation: observations and experimentsc) Tools and systems developed for climate related rare events

ExampleProject Title: Dynamic Ecological Simulation Model of Tsetse Transmitted Trypanosomosis in Kenya

“The overall goal of the proposed study is to examine, build, and test a predictive multiscale model that defines the relationships between climate change, landuse and cover change, social systems, and ecological disturbance on the ecological distribution of tsetse flies and sleeping sickness across Kenya.“

Relevance IIII. Studies on the effects of climate change-sensitive

parameters on biological systems, disease, and/or public healtha) temperature, humidity, UV, C02 etc ‘dose - response’ studiesb) Day to day weather - focused projects

ExampleProject Title: Toxic Harmful Algal Blooms (HABs)

“In addition, the population dynamics of non-toxic species, toxin-producing non-HAB species, and HAB species will be compared to determine if there are any fundamental differences between HAB and non-HAB species in how they respond to environmental factors [i.e., temperature, salinity, oxygen, turbidity, light, and nutrients] and elucidate any possible ecological function for toxin production in sub/tropical marine environments.”

Relevance III

III. Studies of disease, biological systems, public health needs that are very likely to be affected by climate change, but climate effectors are not explicitly addressed, measured or estimated in the project

ExampleProject Title: Point-of-Use Diagnostic Tests for Intestinal Protozoa

IPCC Fourth Assessment Report, Working Group IIImpacts, Adaptation and Vulnerability

Chapter 8: Human Health

1. Improve characterization of exposure-response relationships, particularly at regional ...

2. Collect data on the early effects of changing weather patterns on climate-sensitive ...

3. Collect and enhance long-term surveillance data on health issues of potential concern

4. Develop quantitative models of possible health impacts of climate change that can be

5. Increase understanding of the processes of adaptation, including social and

behavioral

6. Evaluate the implementation of adaptation measures...

7. Understand local and regional scale vulnerability and adaptive capacity to …

8. Improve comprehensive estimates of the co-benefits of adaptation and mitigation …

9. Improve collaboration across the multiple agencies and organizations .. health..

10. Anticipate infrastructure requirements that will be needed to protect against …

11. Develop downscaled climate projections at the local and regional scale …

1. Improve characterization of exposure-response relationships, particularly at regional ...

2. Collect data on the early effects of changing weather patterns on climate-sensitive ...

3. Collect and enhance long-term surveillance data on health issues of potential concern

4. Develop quantitative models of possible health impacts of climate change that can be

5. Increase understanding of the processes of adaptation, including social and

behavioral

6. Evaluate the implementation of adaptation measures...

7. Understand local and regional scale vulnerability and adaptive capacity to …

8. Improve comprehensive estimates of the co-benefits of adaptation and mitigation …

9. Improve collaboration across the multiple agencies and organizations .. health..

10. Anticipate infrastructure requirements that will be needed to protect against …

11. Develop downscaled climate projections at the local and regional scale …

CCSP RecommendationsSAP 4.6 Chapter 2 Section 2.7 Expanding the knowledge base

A preliminary goal set

A. Understand etiology and epidemiology of health threats from global climate change

B. Identify most vulnerable populations/subpopulations and their health and medical concerns

C. Develop predictive models with enough resolution to inform surveillance, medical and public health planning

D. Develop clinical, translational and implementation science to address principal health concerns

Challenges

• “The ultimate systems biology” problem - interpreting the climate signal in health outcomes in context of numerous other social and biological influences.

• SCALE really matters:

• a) Spatial: cellular and molecular to individual to population studies

• b) Temporal: microclimate fluctuations, weather, cyclical (including seasonal patterns), long term change?

• Interdisciplinary studies - close partnerships with atmospheric scientists and public health community.

• Cultivating individual vines can obscure decline of the field

• But don’t underestimate the skill of the arborist