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