Climate Change: Distributive Impacts

IPH, 25th February 2010NUI MAYNOOTHOllscoil na Éireann Má Nuad

Elizabeth Cullen & Elizabeth Cullen & John SweeneyJohn Sweeney, , NUI, MaynoothNUI, Maynooth

Warming relative to 1961-90

Mean January figures are predicted to increase by 1.5oC by mid century with a further increase of 0.5oC-1.0oC by 2075.

By 2050, the extreme south and south west coasts may have a mean January temperature of 8.0oC. By then, winters in Northern Ireland and in the north Midlands will be similar to those presently experienced along the Cork/Kerry coast.

July temperatures will increase by 2.5oC by 2050 and a further increase of 1.0oC by 2075 can be expected. Maximum July temperatures of the order of 22.5oC will prevail generally with areas in the central Midlands experiencing maximum July temperatures of 24.5oC.

Rainfall relative to 1961-90

Overall increases in precipitation are predicted for the winter months of December- February. On average these amount to 11%. The greatest absolute increases are suggested for the north west.

Marked decreases in rainfall during the summer and early autumn months across eastern and central Ireland are predicted. Nationally, these are of the order of 25% with decreases of over 40% in some parts of the south-east.

Differences in Seasonal WarmingDifferences in Seasonal Warming1961-

2005Spring Max

Spring Min

Summer Max

Summer Min

Autumn Max

Autumn Min

Winter Max Winter Min

Valentia 0.68* 1.05* 0.43 1.20** 0.54 0.87* 1.17** 1.34*

Shannon 1.27** 1.58** 1.18* 1.70** 1.01* 1.28** 1.50** 1.83**

Malin 0.75* 1.18** 0.63 1.13** 0.47 0.84** 1.04* 1.20**

Belmullet 1.40** 1.21** 1.30** 1.39** 1.16** 0.80* 1.44** 1.23*

Phoenix Park 1.41** 0.88* 1.43** 0.92** 0.84* 0.41 2.52** 0.85

Clones 1.27** 1.33** 1.36** 1.63** 0.92** 1.04* 1.33** 1.41*

Rosslare 1.06** 1.28** 1.12** 1.19** 0.97** 1.02** 1.62** 1.32**

Claremorris 1.32** 1.19** 1.25** 1.49** 0.92* 0.84* 1.22** 1.32*

Kilkenny 1.40** 1.18** 1.22* 1.46** 0.95* 1.21** 1.52** 1.40**

Casement 1.05** 1.27** 0.83* 1.40** 0.55 1.15** 1.61** 1.36*

Birr 1.18** 0.95* 0.98* 1.21** 0.77* 0.77 1.44** 1.14*

CLIMATE

CHANGE

Temperature Rise 1

Sea level Rise 2

Hydrologic Extremes

Temperature/Heat Stress

Air Pollution

Vector-borne Diseases

Water-borne Diseases

Water resources & food supply

Environmental Refugees

Heat StressCardiorespiratory failure

Respiratory diseases, e.g., COPD & Asthma

MalariaDengueEncephalitisHantavirusRift Valley Fever

CholeraCyclosporaCryptosporidiosisCampylobacterLeptospirosis

MalnutritionDiarrheaToxic Red Tides

Forced MigrationOvercrowdingInfectious diseasesHuman Conflicts

1 3°C by yr. 21002 40 cm “ “IPCC estimates

HEALTH EFFECTS OF CLIMATE CHANGE

Temperature-Related Deaths in 11 Temperature-Related Deaths in 11 Eastern U.S. CitiesEastern U.S. Cities

Source: Curriero, et al., 2002.

LAGGED EFECT

HEAT WAVE - HEAT WAVE - EUROPEEUROPE

Heat Index Summer 2003Heat Index Summer 2003

35,000 Excess 35,000 Excess DeathsDeaths in two in two weeksweeks

Heat Stress: Some Populations Heat Stress: Some Populations Are Particularly VulnerableAre Particularly Vulnerable

European heat-wave 2003 - 35,000 diedEuropean heat-wave 2003 - 35,000 died

extremelyrare

event

(Schär et al. 2004, Nature, 427, 332-336,

Stott et al 2004, Nature 432 610-614)

Swiss Temperature Series for June-August 1864-2003

Analysis shows it likely that most of the risk of the event is due to increase in greenhouse gases - also

- by 2050, likely to be average event

- by 2100, likely to be a cool event

Climate Change and Air QualityClimate Change and Air Quality

U.S. National Assessment of Climate Change

Health Effects of Health Effects of Ground-LevelGround-Level Ozone Ozone

Health Effects of Health Effects of Ground-LevelGround-Level Ozone Ozone

Increased risk of hospital admissions and ER visits for people with asthma (Friedman et al, JAMA, 2001, 285:897-905)

3X greater risk of DEVELOPING asthma3X greater risk of DEVELOPING asthma (McConnell et al, Lancet, 2002, 359: 386-391)

Air pollution Climate change

Allergic Illnesses and Allergic Illnesses and AeroallergensAeroallergens

• Earlier onset of pollen season

• Increased CO2 and temperature

– increase pollen production– Increase length of pollen season

• Increased pollen counts

• Increase in allergenic (reactive) content of pollen appears likely

Source: JL Gamble, et al., 2008. USEPA Report.

Relationship between temperature and malaria parasite development time inside mosquito (“extrinsic incubation period” or EIP). EIP shortens at higher temps, so mosquitoes become infectious sooner.

Vector-borne and Vector-borne and Zoonotic (VBZ) Zoonotic (VBZ)

DiseasesDiseases•Disease vectors are widely

present in temperate regions

•Forces underlying VBZ

disease risk:

–weather/climate

–ecosystem change

–social and behavioral factors

–globalization

Infectious Disease: Infectious Disease: Dengue RiskDengue Risk

• In 1990, almost 30% of the world population, 1.5 billion people, lived in regions where the estimated risk of dengue transmission was >50%

• In 2085, an estimated 50-60% of the projected estimated 50-60% of the projected global population, 5-6 billion peopleglobal population, 5-6 billion people, would be at risk of dengue transmission, compared with 35% (3.5 billion) if climate change didn’t happen.

Hales, de Wet, Maindonald, Woodward, The Lancet, 2002, 360:830

Dengue along the Texas – Mexico borderDengue along the Texas – Mexico border

How Bad is the Water Problem?How Bad is the Water Problem?

• 1/3 of the world’s population, about 2 billion people, currently lives in water-stressed countries (UNEP, IPCC)

• By 2025, that number is expected to increase to 5 billion (UNEP, IPCC)

• Nearly 1/3 of the world’s land surface may be at risk of extreme drought by 2100 (Burke et.al. Journal of Hydrometeorology, Sept. 2006)

Water UsageWater Usage• 70% for agriculture globally (90% in some

countries)• 10% global food production depends on over-

pumping of groundwater (India 25%)• 1Kg of grain requires 1,000 to 3,000 litres

water• Grain-fed beef requires 20 X more water per

calorie than wheat

Extreme Rainfall Events are Unhealthy

• 67%67% of waterborne disease outbreaks in the US were preceded by precipitation above the 80th percentile (across a 50 yr. climate record), p < 0.001

• 51%51% of outbreaks were preceded by precipitation above the 90th percentile, p < 0.002

• Surface water-related outbreaks had strongest correlation with extreme precipitation in the month of outbreak; groundwater-related outbreaks lagged 2 months following extreme precipitation.

Curriero, Patz*, Rose, Lele, 2001.

Health Effects of FloodsHealth Effects of Floods

• Cause injuries and deaths

• Long term psychological and physical effects

• Increased risk of infectious disease

• Mold• Contaminate Contaminate

water water supplies: supplies: surface & surface & wellswells

Photo courtesy of FEMA

New Orleans

after Hurricane Katrina

Ballinasloe (Credit: Sean Collins)

Athlone (Credit: Paula Murray)

Health Effects of DroughtsHealth Effects of Droughts

Concentrate micro-organisms and contaminants in water supplies

Crop failures ~1 billion people hungry 5 million children die

starvation Water shortages for hygiene Increase risk of forest fires Increase risk of infectious

disease

Deaths Attributed to Climate Change Deaths Attributed to Climate Change NOWNOW150,000 per year150,000 per year

Patz, Jonathan, et. al (November, 2005). Impact of regional climate change on human health. Nature, Vol. 438.

xxx

Patz, Jonathan, et. al (November, 2005). Impact of regional climate change on human health. Nature, Vol. 438.

Relative vs Attributable RiskRelative vs Attributable Risk

Water and Food-borne Disease:Water and Food-borne Disease:Climate-Susceptible Pathogens Climate-Susceptible Pathogens

Rising temperatures

Increasing rainfall

Shifts in

reservoir ranges

Sea level changes

Salmonella X X X

Campylobacter X X X

Vibrio X X X

Leptospira X X

Enteroviruses X X

Naergleria fowleri

X

Cryptosporidium X X

Giardia X X

• 405,000 cases

• 100 fatalities

• Preceded by heaviest rainfall in 50 years

CryptosporidiosisCryptosporidiosis

Mental Health Needs Mental Health Needs and Hurricane Katrinaand Hurricane Katrina

In the aftermath of Hurricane

Katrina, mental health services in

New Orleans were challenged by

an increased incidence of serious

mental illness

Nearly half of all survey

respondents indicated a need for

mental health care with less than

2% receiving professional care

(Weisler et al. 2006).

What does climate What does climate change mean for change mean for

environmental health in environmental health in Ireland?Ireland?

Temperature/Mortality in IrelandTemperature/Mortality in Ireland

mean temperature

242321191715131197531-1-3-5-7

Va

lue

me

an

mo

rta

lity a

t 2

de

gre

e in

terv

als

140

130

120

110

100

90

80

70

Source: E. Cullen

1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

Day

1.8

2.0

2.2

2.4

2.6

2.8

3.0

3.2M

ort

ali

ty p

er 1

00

,00

0Total mortality per 100,000

Maximum temperature divided by 10

Maximum temperatures (Kilkenny) and total mortality in Ireland on the hottest day in recent decades (13th July 1983)

Source: E. Cullen

Milder wintersMilder wintersReduced hospital admissions

2-3% reduction in winter deaths with

2-2.5 C increase in temperature (2050)

Impact of hot summersImpact of hot summers

Increased Heat-related deaths Increased Heat-related deaths are likelyare likely

• Hot weather increases daily mortality in Ireland, though less than in most EU countries

• Elderly particularly vulnerable– >80 years– Bedridden– Heart disease– Diabetes

• Reduction in winter cold mortality will greatly exceed any increase in summer heat mortality

Some infectious diseases are Some infectious diseases are likely to increase in incidence likely to increase in incidence

• Food poisoning

• Water borne disease

• Malaria?

• Tick borne disease?

SalmonellaSalmonella

• Approximately 500 cases per annum in Ireland

• August maximum 5 times higher than February minimum

• Highly significant correlations with maximum temperature

Salmonella Salmonella

(Sources: Kovats, Cullen)

1 6 11 1621 26 31 36 41 46 51

Week

0

10

20

30

40

50

60

Cas

es o

f cam

pylo

bact

er Mean temp

Mean cases

Salmonella incidence in Republic of Ireland

Vector-borne and Water borne Vector-borne and Water borne DiseasesDiseases

• Local outbreaks of malaria may occur by mid century, though it is considered unlikely that the most dangerous strains are unlikely to become established in Ireland

• Tick borne diseases are not likely to become major concerns before mid century

• Cholera and typhoid are not likely to become a problem in Ireland

• Decreased dilution water in rivers may pose problems for public water quality, however.

Increased UV exposureIncreased UV exposure

Vulnerable PopulationsVulnerable PopulationsClimate Sensitive Health Outcomes

Illnesses and Deaths Related To….

Examples of Particularly Vulnerable Groups

Heat Elderly, those with chronic medical conditions, infants and children, urban and rural poor, outdoor workers, the socially isolated

Air Quality Children, pre-existing heart or lung disease, diabetes, athletes, outdoor workers

Extreme Weather Events The poor, pregnant women, people with chronic medical conditions, mobility and cognitive constraints

Water- and Food-borne Pathogens Elderly, infants, the immunocompromised, specific risks for specific consequences (e.g., Campylobacter and Guillain-Barre syndrome, E. coli O157:H7)

Vector-borne Pathogens

- Lyme Disease

- Hantavirus

- Dengue

- Malaria

- Children, outdoor workers

- Rural poor, occupational groups

- Infants, elderly

- Children, the immunocompromised, pregnant women, the genetically predisposed (e.g. G6PD status)

Source: Derived from SAP 4.6, Chapter 2

Environmental Health Actions for Environmental Health Actions for Coping with Climate Change in Coping with Climate Change in

IrelandIreland• Raise awareness of health implications of climate

change in Ireland

• Raise awareness of potential health benefits of action to reduce impact of climate change

• Increased monitoring of food

• Health impact assessments to identify and develop adaptation strategies for vulnerable sectors

• Interdisciplinary research

Vectorborne Diseases Waterborne Diseases Air Quality

Decision Support Tools

Enhance early warming systems based on climate and environmental data for selected diseases

Develop early warming systems based on climate and environmental data for conditions that may increase selected disease

Enhance alert systems for high air pollution days

Technology Development

Develop vaccines for West Nile and other vector-borne diseases

Develop more rapid diagnostic tests

Surveillance and Monitoring

Enhance vector surveillance and control programs and monitor disease occurrence

Enhance surveillance and monitoring programs for waterborne diseases

Enhance health data collection systems to monitor for health outcomes due to air pollution

Infrastructure development

Consider possible impacts of infrastructure development such as water storage tanks

Consider possible impacts of placement of sources of water and food borne pathogens

Improve public transit systems to reduce traffic emissions.

Adaptation Strategies to Reduce Climate-Adaptation Strategies to Reduce Climate-related Health Risksrelated Health Risks

ConclusionsConclusions

• Human health is inextricably bound to weather and climate as well as

to many complex natural and man-made systems.

• There are many uncertainties, but projected changes in climate are

likely to impose risks to human health.

• Health impacts are multi-factorial with interactions that cascade across

a range of confounding and moderating factors.

• An extensive suite of adaptation strategies will be key to addressing

climate-related health outcomes.