global environmental change & health paul r. epstein, m.d., m.p.h. center for health and the...
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Global Environmental Global Environmental Change &Change &
HealthHealth
Paul R. Epstein, M.D., M.P.H.Paul R. Epstein, M.D., M.P.H.
Center for Health and the Global EnvironmentCenter for Health and the Global Environment
Harvard Medical SchoolHarvard Medical School
http://med.harvard.edu/chgehttp://med.harvard.edu/chge
The loss of forests, freshwater and biodiversity, The loss of forests, freshwater and biodiversity, inadequate and inefficient use of energy, and the inadequate and inefficient use of energy, and the explosive growth in the world’s urban centers explosive growth in the world’s urban centers undermine long-term economic growth and undermine long-term economic growth and threaten ecological systems. They also endanger threaten ecological systems. They also endanger human health, and increase developing countries human health, and increase developing countries vulnerability to natural disasters and conflict. …vulnerability to natural disasters and conflict. …Furthermore, increases in global greenhouse gas Furthermore, increases in global greenhouse gas emissions, approximately fifty percent of which emissions, approximately fifty percent of which are produced in developing countries, threaten to are produced in developing countries, threaten to disturb the delicate ecological balance, disturb the delicate ecological balance, disproportionately affecting the world's poor who disproportionately affecting the world's poor who are the least able to adapt to these changes. are the least able to adapt to these changes. Long-term economic growth depends upon Long-term economic growth depends upon managing a country’s natural resources base, managing a country’s natural resources base, using energy to increase human productivity, using energy to increase human productivity, helping cities to provide services and markets, helping cities to provide services and markets, and having predictable seasonal and long-term and having predictable seasonal and long-term climatic conditions.climatic conditions.
-- US Agency for International Development (2002)
Agent
Host Environment
Social
Ecological Global
Traditional Epidemiological
Framework
Ecological Epidemiological
Framework
Disease Epidemics
SYSTEMS
-2-2
-3-3
-4-4
-5-5
33
22
11
00
Agriculture Agriculture emergesemerges
MesopotamiaMesopotamiaflourishesflourishes
Vikings inVikings inGreenlandGreenland
End ofEnd oflastlastice ageice age YoungerYounger
DryasDryas
IPCC (2001) forecast:IPCC (2001) forecast:+ 1.4-5.8+ 1.4-5.8ooC, with band C, with band of uncertaintyof uncertainty
Little Ice Little Ice Age in EuropeAge in Europe(15th-18th(15th-18thcenturies)centuries)
21stcentury:
rapid rise
BlackBlackDeathDeath
HoloceneHoloceneOptimumOptimum
Global Temperature: the Past 20,000 Years, & the Next 100 Years
Temp. Temp. change (ºC)change (ºC)
10,00010,000 2,0002,000 1,0001,000 300300 100100 NowNow +100+10020,00020,000
MedievalMedieval WarmWarm
Av. temp. over past 10,000 years =15 ºC
19401940
420 kya Present
VOSTOK ICE CORE
CO2
T
180 ppm
280 ppm
370 ppm
Observed vs. modeled temperature rise since 1860Observed vs. modeled temperature rise since 1860
Deep Deep OceanOcean
WarminWarmingg
SST Anomalies May 2003SST Anomalies May 2003
Health Impacts of Climate ChangeHealth Impacts of Climate Change
HEATWAVES
HUMIDITY & HEAT INDICES
TMINS
May 2003
Andhra Pradesh
T 122•F
>400 deaths
ASTHMA
2-3x Since 1980s
AIR POLLUTION AIR POLLUTION AND CLIMATE AND CLIMATE
CHANGECHANGEIndoor pollutants
SES/emotional factors
Ground-level Ozone(T-dependant)
Pollen
Diesel(& pollen)
Droughts & Fires
Floods & Mold
IPCC 2001: New FindingsIPCC 2001: New FindingsExtreme Weather Events
Heatwaves, Droughts & Floods
Intensity & Frequency
(rains >2”/d)
Biological Systems
are Responding
• Plant migrations
• Insects & butterflies
• Bird egglaying
• Marine species
Emerging Infectious DiseasesEmerging Infectious Diseases 30 DISEASES “NEW” TO MEDICINE SINCE 1976
HIV/AIDS Ebola
Legionnaires’E. coli O157:H7
SARS Antibiotic-Resistant Agents
Hantavirus Pulmonary Syndrome
Lyme Disease Nipah Virus
Vibrio cholerae O139 Arenaviruses
RESURGENT & REDISTRIBUTING
Malaria, Dengue Fever, West Nile Virus, Cholera
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
19501950 20002000
TT~1ºC/C~1ºC/C
~2ºC/C~2ºC/C
Climate Models and Potential Malaria Climate Models and Potential Malaria DistributionDistribution
THE CRYOSPHERETHE CRYOSPHERE
PLANT COMMUNITIESPLANT COMMUNITIES
Geographic Shifts of MosquitoesGeographic Shifts of Mosquitoes
450 ft.~2•F warming1970-1990
Diaz & Graham, Science: 19967
Lindgren & Gustafson. Lancet 2001;358:16Lindgren & Gustafson. Lancet 2001;358:16
1980s 1990s
TICK DISTRIBUTION IN SWEDENTICK DISTRIBUTION IN SWEDEN
LYME DISEASE LYME DISEASE WARMER WINTERS
PREDATORS OF DEER
HURRICANE MITCHHURRICANE MITCHHURRICANE MITCH 1998
HURRICANE HURRICANE MITCHMITCH
IMPACTS ON HEALTH
AND DEVELOPMENT
-- Malaria (>30,000 cases) -- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis
DISEASE CLUSTERDISEASE CLUSTER
WNVWNVHUMAN CASES & DEATHSHUMAN CASES & DEATHS
Science 2002:297:1988
1999 2000 2001 2002
62 66 21
4161 cases
284 deaths
BLOOD
ORGAN TRANS
IN-UTERO
? BREAST MILK
…………………
POLIO-LIKE
PRESENTATION
&
NEURO SEQUELAE
WNV: A DISEASE OF WILDLIFEWNV: A DISEASE OF WILDLIFE 230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES
• 138 Bird spp., RAPTORS
- 37 spp. of mosquitoes
• HORSES
• ZOO animals
• REPTILES
AVIAN FLYWAYSAVIAN FLYWAYS
INFECTIOUS DISEASES: FORCES OF GLOBAL INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGECHANGE
SPECIES LOSSSPECIES LOSS VECTORVECTOR DISEASESDISEASES
RaptorsRaptors RodentsRodents
Lyme, Hantaviruses,Lyme, Hantaviruses, Leptospirosis, Leptospirosis,
PlaguePlague
Vulture die offVulture die off IndiaIndia
Feral DogsFeral Dogs RabiesRabies
Hantavirus Pulmonary SyndromeHantavirus Pulmonary Syndrome
1993 1993 Drought, Then Early RainsDrought, Then Early Rains
10X Explosion of Mice 10X Explosion of Mice PopulationsPopulations
Range Expansion of Soybean Cyst Nematode in North America
Crop PestsCrop Pests Generations/YearGenerations/Year
DISEASES OF DISEASES OF TREESTREES US
•West Coast fungi (Phytophthora)
•Alaska spruce bark beetles
2 generations/year
•East Coast hemlock woolly adelgid
N w/ warm winters
Droughts vulnerability to pests.
Diseased trees susceptible to fire.
Coral Coral DiseasesDiseases
Color Variants on Color Variants on M. cavernosaM. cavernosaPhoto: Raymond HayesPhoto: Raymond Hayes Red Band Disease on Red Band Disease on M. annularisM. annularis
Photo: Laurie RichardsonPhoto: Laurie Richardson
SARS Severe Acute Respiratory Syndrome
CORONAVIRUS
1. Species X-over
2. Genetic reshuffling
3. Farming practices &
food handling
$50-100 BILLION
TRADE, TRAVEL, TOURISM
Bio Economic Research Associates, Cambridge, MA
HIV/AIDSHIV/AIDSSOCIAL AND ENVIRONMENTAL DETERMINANTS
TransmissionInformal sector, Mining, Conflict
Viral EvolutionViral EvolutionCoxsackie virusCoxsackie virusLevander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528Levander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528
Malnutrition & disease burden Malnutrition & disease burden Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754
Stress proteins & mutationsStress proteins & mutations
Immune surveillance systemImmune surveillance system
Costs of Extreme Weather Costs of Extreme Weather EventsEvents
UNEP
$150b/y w/in this decade
Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, CompaniesInsurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies
Levels of SolutionsLevels of Solutions
I.I. Surveillance and Response Surveillance and Response CapacityCapacity
II.II. Health Early Warning SystemsHealth Early Warning Systems
III.III. Environmental, Energy & Environmental, Energy & Economic PoliciesEconomic Policies
CHALLENGESCHALLENGES
CLEAN ENERGY HARMONIZING ADAPTATION & MITIGATION
MDGs HEALTH, NUTRITION, POVERTY
AGENDA 21 FISHERIES, FORESTS, POPs
0
Solar-powered •clinics, homes, schools & enterprises•water purification, pumping & desalination
CLEAN DEVELOPMENTCLEAN DEVELOPMENT
THE ENGINE OF THE ENGINE OF GROWTHGROWTH
for thefor the 21st CENTURY21st CENTURY
RegReg
FundsFunds InstInst
EE and REEE and RE “ “Green Buildings” & Smart Green Buildings” & Smart GrowthGrowth Rationalized Transport & Rationalized Transport & TransitTransit Retrofitting InfrastructureRetrofitting Infrastructure Ecological ReconstructionEcological Reconstruction
FrameworkFramework
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