34

Sala Horowitz, Ph.D.

Ahallmark of holistic medicine isthat its practices take into accountan individual’s total internal,

social, and external environment whenconsider ing disease prevention andtreatment. The interdisciplinary scienceof biometeorology studies the effects ofweather and cl imate on organisms’adaptation mechanisms and the conse-quences of human and natural impactson the atmosphere. Although the lateUniversity of Maryland Professor Hel-met Landsberg, who is considered thefather of modern climatology, wrote alandmark text on the subject in 1969,1

only recently has broader attention beenfocused on this discipline in the UnitedStates. In Europe, biometeorology hasbeen used for more than a decade to pro-vide publ ic heal th information. Forexample, the national German weatherservice offers, to the public,2 and to doc-tors and medical facilities, area-specificadvisories about conditions that mayaggravate arthritis, depression, and res-piratory and other health problems.3 TheBritish National Health Service is pilot-testing the use of weather reports to pre-dict its workload.4,5

Hippocrates had anticipated the con-tention of biometeorologists and biocli-ma to logis ts that human bodies arehardwired to react to weather cues; circa400 BC, this father of modern medicinewrote: “South winds induce dullness ofhearing, but, if the north winds prevail,coughs, infections. . .occur.”6

According to Laurence S. Kalkstein,Ph.D. , direc tor of the Univers i ty ofDelaware’s Center of Climatic Research inNewark, “we’ve known that weather

affects organisms for 100 years or more.The real breakthroughs today are due tothe fact that we have computers thatallow us to evaluate much more data.”2

This article focuses on what science is dis-covering about environmental influenceson health and how this knowledge maybe utilized in disease prevention, integra-tive treatment, and public health plan-ning.

Weather–Health Links: Epidemiologic Research, Clinical

Observations, and Patient Perceptions

“Epidemiology has met ecology” ishow one writer characterizes this line ofresearch.7 Recent studies have confirmedthe climatic influences and seasonal varia-tions that have been clinically observed inthe incidence of, and mortality from, car-diovascular disease (CVD), and the exac-erbation of asthma, migraine headaches,arthritis, and seasonal affective disorder(SAD).

Cardiovascular Disease and Seasonal Affec-tive Disorder

Epidemiologic research identi f ieswinter as the peak time of year for sud-den cardiac death.8 Extreme cold maystress the circulatory and regulatorysystems. Winter- induced depressionmay also contribute to coronary heartdisease by promoting infect ions andhaving other negative effects on health.9

SAD, a form of depression commonlyknown as “the winter blues,” is the clas-sic example of a health problem associ-a t ed with s ea sonal change s . 10 Theexistence of disorders with seasonal pat-terns underscores the importance ofcomprehensive clinical assessment andconsideration of treatment options for

all illnesses.11 Extreme temperaturesmay also affect reflexes and cognit iveability.1

Asthma and Other Respiratory DisordersHospital admissions for asthma in a

United Kingdom region increased duringthunderstorms irrespective of pollencounts, fungal spores, rainfall, and ozonelevels.12 An Australian case-controlledstudy of emergency hospital admissionsfor asthma also revealed that the atmo-spheric conditions accompanying latespring and summer thunderstorms result-ed in higher-than-expected epidemics ofas thma exacerbat ions .13 Extreme orchangeable weather is among the stressesthat can depress the immune system andincrease susceptibility to flu and colds.1

Migraine HeadachesWeather also appears to be among the

diverse triggers of migraine headaches.Patients and physicians have long sus-pected that changing weather patternsare associated with symptoms and evenwith the ability to forecast upcomingweather changes. Dr. Charles Matthews,director of a headache clinic in Raleigh,North Carolina, found that having abarometer in the office “would kind-oftel l us what our day was gong to belike.” Likewise observing a connectionbe tw ee n m ig r a in e h eada che s andweather conditions, Dr. Alan Rapoporto f t h e N ew E n g l a n d C e n t e r f o rHeadaches in Stamford, Connecticut,investigated this link in a study of 77patients over a 2-year period. More thanhalf of the study patients had an identi-fiable weather trigger that preceded theonset of a migraine attack. A strong,p o s i t i v e r e l a t i o n s h i p w a s f o undbetween migraines and cold weather

BiometeorologyWhat It Is and How It Affects Our Health

and low humidity. Some patients wereaffected most by barometric or tempera-ture changes.14

A b l inded s tudy o f 7 5 Canad i anpatients at the University of CalgaryHeadache Research Cl in ic , Calgary ,A l b e r t a , Canada , c or r e l a t e d th e i rmigra ine symptom diar ies with theweather phenomenon known as a Chi-nook wind, a warm westerly wind with apredictable annual pattern affecting thatregion of Canada. Migraine headaches in43 percent of patients coincided with theChinook wind. With regard to theseresults, Dr. Werner Becker, a professor inthe University’s department of clinicalneurosciences commented that “i t ’salways nice to validate what patients aresaying.” In addition, this knowledge canbe used to help avert symptoms.15 Asnoted by Michael John Coleman, execu-tive director of the National MigraineAssociation in Washington, D.C., “youcan’t control the weather, so it is particu-larly important to know which triggerscan bring on your migraine. If you knowyour triggers, you are going to manageyour treatment much more proficient-ly.”16

Similarly, at the University of Calgary’sdepartment of community health sci-ences, a study of women patients ages20–49 with histories of chronic conditionsfound that such patients were more likelyto visit a health care professional on daysaffected by Chinook wind conditions.17

Arthritis and Other ConditionsMany patients who have arthritis and

those with allergies, broken bones, andother conditions, such as multiple sclero-sis, have considered themselves to be“human barometers.” Based on his clini-cal experience and a small-scale 1960

study of patients placed in a chamber inwhi ch the baromet r ic pressure andhumidity were adjusted, Dr. RichardPope, chief of rheumatology at North-western Memorial Hospital, Chicago, Illi-nois, believes that these claims are valid.Dr. Pope’s explanation is as follows:

You take a balloon and you put it into avacuum. As the pressure is reducedaround that balloon, it expands. And sothe same thing [happens] within the tis-sues around the joints. If there’s alreadyswelling, inflammation, [and] abnormalmechanics in the joint, as the pressuregoes down, the gas and tissue expand,and thi s i s f e lt a s more pa in by thepatient. This is why they sense a changein barometric pressure.18

How ba romet r ic pre ssure a ffe c tshuman tissues may also account for theapparent re la t ionship be tween theinducement of labor in pregnant womenand drops in atmospheric pressure, asreflected by hospital admissions at thesetimes.1

In the case of atopic eczema, an inverserelationship between itch intensity and airt emperature was s igni f i cant a t th eP<0.001 level in a study of the disease inSwiss patients and fifteen meteorologicconditions over a 7-year period. Howev-er, the link between atopic eczema andmeteorologic variables such as air pres-sure, water vapor pressure, and hours ofsun exposure was more tenuous.19

A retrospective study of more than20,000 deaths in French public hospitalsfrom acute intestinal vasculitis (swollenblood vessels) and hospitalization anddeaths from variceal bleeding (caused byportal hypertens ion) during 1987–1996,likewise revealed that mortality fromsuch causes significantly peaked in Jan-

uary and was at the lowest level in July.The researchers concluded that awarenessof such seasonal patterns could allowpractitioners to reduce mortality via earlydiagnosis and treatment.20,21

A Multivariate Relationship

Seasonal patterns between mortalityand diseases, however, may well turn outto be multivariate rather than univariate,as was demonstrated by investigatorswho examined the relationship betweenmortality caused by CVD and climaticfactors in urban areas in Norway and Ire-l and f r om 1985 t o 1994 . Wh i l e th eresearchers did confirm a link betweenCVD and cold weather for both men andwomen ages 60 and older, the association

ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2002 35

Migraine headaches in 43 percent of patients in one study coincided with the Chinook wind.

Laurence S. Kalkstein, Ph.D., Center of Cli-matic Research, University of Delaware,Newark.

was stronger when wind-chill tempera-ture was factored into air temperature.22

Researchers also found a seasonal factorto be operative in a complex manner inthe quality of life of patients with anky-losing spondylitis (AS), a form of spinalarthritis. Assessed by both a self-adminis-tered questionnaire and a clinical mea-sure (the Schober index), the quality oflife and lumbar spine flexibility of 106patients with AS correlated significantlywith climatic temperature, wind speed,atmospheric pressure, and humidity.Curiously, while higher temperatures andlower wind speed were associated withgreater measured lumbar spine flexibility,subjective quality of life was rated lowerunder the same conditions.23

Similarly, from epidemiologic correla-t ions of weather reports to medicalreports, Dr. Kalkstein’s research team hasalso found that “[w]e need to take intoaccount many more things than just tem-perature and humidity. It’s the whole airmass that’s over us at any given time thataffects us—cloud cover, sunshine, rain

and so on. Our scheme evaluates howthese other variables also affect humanhealth.”2

An Application of Biometeorologic Research

As an application of his findings, Dr.Kalkstein developed a Heat/Heal thWarning System to alert people in citiesof impending unusually hot weather thatcan result in increased depression, hospi-t a l adm i s s i o n s , a n d h e a t - r e l a t e d deaths—particularly in elderly, immune-impaired, and poor patients. This systemis currently being used in selected citiesin the United States including Philadel-phia and Washington, D.C., and is sched-uled to be deployed soon in other citiesin the U.S. and abroad.24 Dr. Kalksteinhas also been involved in projects explor-ing the links between climate and asthmaand Lyme disease deer tick populationsand the evaluation of methods to gaugeweather effects in pollution–mortalitycorrelations.25

Empirical Research on the Weather–Health Link

Most of the research in this area hasunderstandably focused on the correla-tion of weather variables and healtheffects. However, Michael Persinger,Ph .D. , a c linical psychologis t at theBehavioral Neuroscience Laboratory atLaurentian University, Sudbury, Ontario,Canada, has made a somewhat controver-sial career of claiming that, and attempt-ing to measure how, organisms react togeophysica l s t imuli . 6 Dr. Persingerbelieves that sudden infant death syn-drome and, in adults, cardiac arrhythmiasare both consistent with the role of weath-er-related geomagnetic variables in pro-ducing electrical anomalies in brainfunction.26 Dr. Persinger asserts that:“biometeorology matters because the wayin which we order our lives in the twenty-first century leaves us especially vulnera-b l e to weathe r insu l t s . Our indoo renvironments have become extraordinari-ly physically constant. . . .One thing we

36 ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2002

Dr. Kalkstein developed a warning system to alertpeople in cities of impending unusually hot weather that can result in increased depression, hospital admissions, and heat-related deaths.

American Academy of EnvironmentalMedicine (AAEM)7701 East Kellogg, Suite 625Wichita, KS 67207Phone: (316) 684-5500Fax: (316) 684-5709e-mail: administrator@aaem.comWeb site: www.aaem.comEmphasizing that the human body is dyna-

mically coping with its environment, theAAEM promotes an integrated, proactive,preventative approach to environmentallytriggered diseases.American Institute of Biomedical

Climatology (AIBC)1050 Eagle RoadNewtown, PA 18940Phone: (215) 968-4483Web site: www.aibc.ccThis volunteer organization promotes better

multidisciplinary understanding of the effects ofthe geophysical environment on health. TheAIBC disseminates information via the Journal of the AIBC, other resources, seminars, andconsultations. The organization was known asthe American Institute of Medical Climatologyfrom 1958–1988.International Society of Biometeorology

(ISB)Department of Physical GeographyMaquarie UniversitySydney, New South WalesAustralia 2109Phone: +61-2-9850-8399 Fax: +61-2-9850-8420Web site: www.es.mq.edu.au/ISBe-mail: pbeggs@ocs1.ocs.mq.edu.au

Since 1956, the ISB has promoted inter-disciplinary collaboration of meteorologists,physicians, biologists, ecologists, and other

scientists who are interested in environmentalproblems. The ISB maintains close ties withagencies such as the World Health Organizationand holds international forums such as theInternational Congress of Biometeorology.Contact: Dr. Paul Beggs, Secretary General ofthe ISB.National Environmental Health

Association (NEHA)720 South Colorado Boulevard, Suite 970-SDenver, CO 80246-1925Phone: (303) 756-9090Fax: (303) 691-9490e-mail: staff@nehaWeb site: www.neha.org

The NEHA offers credentialing in severalenvironmental health professions and continuingeducation in the field, as well as publishing theJournal of Environmental Health and policyposition papers.

Organizations

do know about biological systems is thatthey tend to respond to contrast. And oneof the things that fluctuates most thesedays is the weather.”6

Long-Term Adverse Environmental Effects

Long-term climatic changes, such asglobal warming with its “greenhouseeffect” caused by an increase in carbondioxide and subsequent disruption in theplanetary ecosystem, have serious impli-cations, directly and indirectly, for publichealth. Many experts believe that globalwarming caused by air pollution and nat-ural forces is already resulting in greatermortality and morbidity caused by heatstress in response to higher tempera-tures27 and in new patterns of infectiousdisease outbreaks.28 Skin cancer causedby overexposure to ultraviolet radiation,which is the result of a diminished protec-

t i ve ozone laye r , ha s drama t ic a l l yincreased in recent decades. Deaths frommelanoma, the malignant form of skincancer, has escalated by 1800 percent since1930 (over a period of 70 years).1 It hasbeen estimated that 40 percent of deathsglobally can be attributed to environmen-tal factors, such as long-term overexpo-su re to t h e sun , a i r po l lu t i on , andpesticides.29 The World Health Organiza-tion has ranked deaths from air pollutionamong the top ten causes of preventablemortality.30

The weather patt ern known as ElNiño was significantly related to hospi-talization of females with viral pneu-monia in several California countiesfrom 1983 to 1998. The investigatorsconcluded that “an understanding ofpopulation sensitivity under differentweather conditions could lead to animproved understanding of virus trans-mission.”31

In a Greek study of the effects of atmo-spheric circulation, specific air circulationtypes were correlated with daily and sea-sonal death rates in Athens , Greece.Southeasterly air flows correlated signifi-cantly with the highest daily mortalityand northwesterly flows correlated withthe lowest mortality. Potential confound-ing variables such as ambient tempera-ture and particle concentrations werecon t r o l l ed fo r s t a t i s t i c a l l y . The s eresearchers at the Laboratory of Meteorol-ogy at the University of Ioannina, in Ioan-n ina , Gree ce , conc luded that the irweather classification scale is useful forstudying weather–health associations.32

A meta-analysis of 59 peer-reviewedstudies found that the risk of Parkinson’sdisease increases with exposure to pesti-cides and other environmental factors inrural living.33 A survey of rural healthcare providers on environmental healthissues facing their communities reported

ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2002 37

It has been estimated that 40 percent of deaths globally can be attributed to environmental factors.

Summary of Research That Supports Weather and Climate Effects on Health Conditions

Health condition Weather/climate effects Research reference numbers in text

Asthma Spring/summer thunderstorms have resulted in increased Refs. 12, 13, 30hospitalizations; air pollution increases incidence

Arthritis Barometric pressure changes produce joint pain and swelling Ref. 18Atopic eczema Inverse relationship between itch and air temperature Ref. 19Cardiovascular disease/ Cold weather may produce depression, which, in turn, Refs. 9, 22sudden cardiac death can affect the immune systemHeat stress Temperature extremes can depress immune system and result Refs. 1, 2, 24, 27

in death, especially in elderly peopleInfectious diseases El Niño and climate change may increase disease incidence Refs. 28, 31Labor in pregnancy Drops in atmospheric pressure may induce labor, as reflected Ref. 1

in higher hospital admissions of women in laborMigraine headaches Triggers include cold weather, low humidity, barometric Refs. 14–17

changes, and warm westerly Chinook windsPsychiatric illness Small, significant correlation found between inpatient length Ref. 37

of stay and cold weatherSeasonal affective disorder Decreasing light in winter results in depression, weight gain Ref. 10Skin cancer Increased exposure to ultraviolet radiation as a result of Ref. 1

diminished ozone layer protectionVasculitis Mortality found to peak in winter Refs. 20, 21

water pollution and pestic ide effectsamong the main concerns .34 Bri t i shresearchers found urban neighborhoodenvironment stressors, such as continualhigh levels of noise and pollution, to beassociated with chronic stress and self-reported poor health, regardless of anindividual’s socioeconomic status.35

Environmental stresses, such as particu-late air pollution, appear to elevate a riskfactor for CVD, namely, high blood pres-sure. Therefore, these investigators recom-mend “w i d e r u s e o f n o n i n v a s i v ecardiovascular measurements in studies ofair pollution and weather stresses” inorder to understand response mechanismsbetter and to identify populations at risk.36

Recognizing the impact of such contextualfactors as climate on health care utilizationis also advised by researchers at the Bed-ford Veterans Affairs Medical Center inBedford, Massachusetts, who found amodest but significant positive correlationbetween inpatient length of stay for itspsychiatric patients and weather variablessuch as cold temperatures.37

Positive Environmental Effects

Contact with nature can also be measur-ably beneficial to health. From a review ofthe scientific literature, Howard Frumkin,M.D., Dr.P.H., professor and chair of envi-ronmental and occupational health atEmory University in Atlanta, Georgia,

concluded that: “Contact with nature maybe right up there with some medicationsor surgery as ways of improving health.”Dr. Frumkin’s view extends sociobiologistE.O. Wilson’s “biophilia” hypothesis thathumans are innately attracted to other liv-ing organisms, to nature more generally.Dr. Frumkin has reviewed studies thatcited positive impacts from even minimalinteraction with nature on such popula-tions as hospital patients and prisoners.Direct weather impacts were not investi-gated, although the effects of plants, viewsof landscapes, wilderness, and animalcontact were considered. Because the rea-sons for this environment–health link areunknown, Dr. Frumkin advocates furtherresearch as well as consideration of suchfactors in medical practice and urbanplanning.38

A recent study unexpectedly found sci-entific validation for the preference formountaintop locations for health sanitari-ums in the nineteenth and early twentiethcenturies. Environmental challenges tocells, such as from high altitudes and pol-lution, activate the production by mono-cytes and macrophages of cytokines suchas interleukin-1- b that mediate physiolog-ic adaptations to stress.39

Conclusions

Empirical evidence lends support topatients’ complaints and the clinicallyobserved re la t ionship between theeffects of weather and climatic condi-tions on morbidity and mortality in casesof cardiovascular and other health condi-tions. Such effects interact in complexways with atmospheric pollution andglobal warming trends. While scientistsconcur about the effects of sunlight, tem-perature, and perhaps barometric pres-sure on health, many scientists are not asreceptive to the possibility that the bodychemist ry is altered by gases releasedfrom soil during turbulent weather andthe effect of the Earth’s magnetic fields.

Nor does epidemiologic evidence provecause-and-effect or even clinical signifi-cance.

At the very least, however, weatherinfluences behavior indirectly, which canhave health consequences, such as theeffect of lessened physical activity ininclement weather on the blood sugar lev-els of patients with diabetes.40

Further research could identify thecharacteristics of patients who appear tobe par t icular ly sens i t ive to spec if icweather conditions. Another interestingresearch question to pursue is whetherpredicted higher winter temperaturescould actually result in one positive con-sequence: a decline in cardiovasculardeaths, which tend to be higher in win-ter. Even allopathic medicine is recogniz-ing that “we can’ t jus t focus on themicrobe anymore. . . ,” as observed byJonathan Patz, M.D., of the Johns Hop-kins Univers i ty Program on Heal thEffects of Global Environmental Change,Baltimore. With regard to infectious dis-eases, Dr. Patz said that “it is not just asimple relationship between weathervariables and pathogens. We need to con-nect existing databases on such factors asland use patterns, deforestation, and soilmoisture to public health outcomes.”7

As these statements indicate, there isrecognition that that environmental fac-tors deserve as much focus as the currentemphasis on lifestyle factors in health.Consequently, indirectly, we can counterthe cliché that there is nothing that candone about the weather by investigatingits health impact and taking biometeorol-ogy into account in disease prevention,diagnosis, and treatment. Conversely, itmust be remembered that the naturalenvironment can also affect well-beingpositively.

Regarding long-range climatic changes,the authors of a major report released in2000, “Human Health & Global ClimateChange: A Review of Potential Impacts inthe United States,” caution that “uncer-

38 ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2002

“Contact with nature may be right up there with some medications or surgery as ways of improving health.”

Recommended ReadingHuman Health & Global Climate Change: A

Review of Potential Impacts in the UnitedStatesBy John M. Balbus, M.D., M.P.H., and Mark L. Wilson, Ph.D.Prepared for the Pew Center on GlobalClimate ChangePew Center Web site.Online document at: www.pewclimate.org/projects/humna_health.cfm December 2000

tainty about adverse effects should not beinterpreted as certainty of no adversehealth effects.”

As with short-term weather effects,design of better methods of evaluatingsuch impacts can ass is t hea l th andresource development planning.

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ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2002 39