Wmo_1098 - Atlas of Health and Climate

8/10/2019 Wmo_1098 - Atlas of Health and Climate

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ATLAS OF

HEALTH AND CLIMAT


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DISCLAIMER

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of theWorld Health Organization nor on the part of the World Meteorological Organization concerning the legal status of any count ry, territory, city or area or ofits authorities, or concerning the delimitation o f its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not ye t be full agreemen t. Detai led information about maps, such as on data source, map produc tion and copyright , will be provided in endno tes at

the end of the publicat ion. The mention of specic companies or of cer tain manufacturers products does not imply that they are endorsed or recommended by the World Health Organi-zation nor the World Meteorological Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the namesof proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization and the World Meteorological Organization to verify the information containedin this publication. However, the published material is being distributed without warranty of any kind, ei ther expressed or implied. The responsibility for theinterpretation and use of the material lies with the reader. In no event shall the World Health Organization nor the World Meteorological Organization be liablefor damages arising from its use.

WHO LIBRARY CATALOGUING-IN-PUBLICATION DATA

Atlas of health and climate.

1.Communicable diseases. 2.Emergencies. 3.Climate change. 4.Global health. 5.Environmental health. 6.Disasters. 7.Atlases.I.World Health Organization. II.World Meteorological Organization.

Printed in Switzerland

World Health Organization and World Meteorological Organization 2012

WMO-No. 1098 All rights reserved. This publication can be obtained from either the World Health Organization or the World MeteorologicalOrganization at the following addresses:

WHO PressWorld Health Organization (WHO) , Tel.: +41 (0) 22 791 32 6420 Avenue Appia, Fax: +41 (0) 22 791 48 571211 Geneva 27, Switzerland E-mail: bookorders@ who.int

Order online: www.who.int/bookordersor: WMO Bookstore at www.wmo.int/e-catalog/index_en.php or by e-mail at publications@ wmo.int.

Requests for permission to reproduce or translate the publication should be addressed to WHO Press, at the above address(fax: +41 (0) 22 791 48 06; e-mail: [email protected]) or:

Chair, Publications BoardWorld Meteorological Organization (WMO)7 bis, avenue de la Paix Tel.: +41 (0) 22 730 84 03P.O. Box 2300 Fax: +41 (0) 22 730 80 40CH-1211 Geneva 2, Switzerland E-mail: [email protected]

ISBN 978 92 4 1564 52 6 (WHO; NLM classication: WA 30.5); 978-92-6 3-11098-5 (WMO)

Cover illustrations: Stockbyte (front) ; Oli Scarf f / Getty Images (back)


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ATLAS OF

HEALTH AND CLIMAT


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PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

SECTION 1 | INFECTIONS 7

MALARIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

DIARRHOEA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

MENINGITIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

DENGUE FEVER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

SECTION 2 | EMERGENCIES 25

FLOODS AND CYCLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

DROUGHT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

AIRBORNE DISPERSION OF HAZARDOUS MATERIALS . . . . . . . . . . . . . . . . . . 34

CONTENTS


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SECTION 3 | EMERGING ENVIRONMENTAL CHALLENGES 39

HEAT STRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

UV RADIATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

POLLENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

AIR POLLUTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

NOTES AND REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5


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Human health is profoundly affected by weather andclimate. Extreme weather events kill tens of thousandsof people every year and undermine the physical andpsychological health of millions. Droughts directly affectnutrition and the incidence of diseases associated with

malnutrition. Floods and cyclones can trigger outbreaksof infectious diseases and damage hospitals and otherhealth infrastructure, overwhelming health services justwhen they are needed most.

Climate variability also has important consequencesfor health. It inuences diseases such as diarrhoea andmalaria, which kill millions annually and cause illnessand suffering for hundreds of millions more. Long-termclimate change threatens to exacerbate todays prob-lems while undermining tomorrows health systems,

infrastructure, social protection systems, and supplies offood, water, and other ecosystem products and servicesthat are vital for human health.

While the impact of climate change on health is feltglobally, different countries experience these impactsto different degrees. Evidence shows that the mostsevere adverse effects tend to strike the poorest andmost vulnerable populations. In addition, the adversehealth impacts of climate are worsened by rapid andunplanned urbanization, the contamination of air andwater, and other consequences of environmentallyunsustainable development.

Concern about how a changing climate will affect healthis reected in the UN Framework Convention on ClimateChange and the Global Framework for Climate Services.Countries have also recognized the need to protect healthfrom climate-related risks through collaborative action

on managing disaster risk, ensuring access to safe andadequate water and food, and s trengthening prepared-ness, surveillance and response capacities needed formanaging climate-sensitive diseases.

In order to achieve these goals, decision-makers atall levels need access to the most relevant and reli-able information available on the diverse connectionsbetween climate and health. The World Health Organi-zation and the World Meteorological Organization areworking together to meet this need through a practical

and innovative approach that uses climate servicesto strengthen the climate resilience of health sys temsand support proactive decision-making. These climateservices will contribute to protecting public health andachieving better health outcomes.

The Atlas of Health and Climate is a product of thisunique collaboration between the meteorological andpublic health communities. It provides sound scienticinformation on the connections between weather andclimate and major health challenges. These range fromdiseases of poverty to emergencies arising from extremeweather events and disease outbreaks. They also include

PREFACEATLAS OF HEALTH AND CLIMATE: REALIZING THE POTENTIAL TO IMPROVEHEALTH OUTCOMES THROUGH THE USE OF CLIMATE SERVICES


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environmental degradation, the increasing prevalenceof noncommunicable diseases and the universal trendof demographic ageing.

The Atlas conveys three key messages. First, climate

affects the geographical and temporal distribution of largeburdens of disease and poses important threats to healthsecurity, on time scales from hours to centuries. Second,the relationship between health and climate is inuencedby many other types of vulnerability, including the physi-ology and behaviour of individuals, the environmentaland socio-economic conditions of populations, and thecoverage and effectiveness of health programmes. Third,

climate information is now being used to protect healththrough risk reduction, preparedness and response overvarious spatial and temporal scales and in both afuentand developing countries.

It is our hope that the Atlas of Health and Climate willserve as a visual call to action by illustrating not onlythe scale of challenges already confronting us andcertain to grow more acute but also by demonstratinghow we can work together to apply science and evidenceto lessen the adverse impacts of weather and climateand to build more climate-resilient health systems andcommunities.

Margaret CHAN Michel JARRAUDDirector General Secretary-GeneralWorld Health Organization World Meteorological OrganizationGeneva, Geneva,October 2012 October 2012


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A patient suffering from dengue fever lieson a bed covered by a mosquito net at San Felipehospital in Tegucigalpa, Honduras

6 E D G A R D G A R R I D O / R E U T E R S


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SECTION 1INFECTIONSInfectious diseases take a heavy toll on populationsaround the world. Some of the most virulent infectionsare also highly sensitive to climate conditions. Forexample, temperature, precipitation and humidity havea strong inuence on the reproduction, survival and

biting rates of the mosquitoes that transmit malariaand dengue fever, and temperature affects the life-cycles of the infectious agents themselves. The samemeteorological factors also inuence the transmissionof water and food-borne diseases such as cholera, andother forms of diarrhoeal disease. Hot, dry conditionsfavour meningococcal meningitis a major cause ofdisease across much of Africa. All of these diseasesare major health problems. Diarrhoea kills over twomillion people annually, and malaria almost one million.Meningitis kills thousands, blights lives and hampers

economic development in the poorest countries. Some50 million people around the world suffer from denguefever each year. The public health community has madeimportant progress against all of these diseases inrecent decades, but they will continue to cause deathand suffering for the foreseeable future.

One of the important challenges for control of all of thesediseases is to understand and, where possible, predicttheir distribution in time and space, to allow controlprogrammes to target interventions and to anticipateand prevent epidemics. All of these diseases are stronglyinuenced by climate and weather but these effects aremediated by other determinants. For diarrhoea, meningitisand malaria, these are closely associated with povertyand weaknesses in health programmes, which leavespopulations without the protection of reliable water andsanitation services, protective vaccines and life-savingdrugs. In the case of dengue, unplanned urbanization,the proliferation of mosquito breeding sites in household

waste, and population movement, are contributing to are-emergence of the disease. The climate sensitivity ofthese diseases means that there is an important role formeteorological information. The interaction with otherdeterminants means that climate services will only reach

their full potential through a true collaboration betweenthe meteorological and health communities.

By working with disease control programmes, meteoro-logical services can help to identify where their informa-tion can be applied most effectively. Early experienceshows that providing the relatively simple meteoro-logical monitoring data that are collec ted by NationalMeteorological Services can often bring the greatestvalue to health programmes. These include short-termobservations of local precipitation to provide an alert

for epidemics of cholera or malaria, or gridded maps ofroutinely collected temperature and humidity data, togenerate maps of suitability for meningitis or malariatransmission, in order to improve targeting and efciencyof disease surveillance and control. Disease controlprogrammes, meteorological services and research-ers, are also beginning to work together to explore thepotential of more sophisticated climate products, suchas seasonal forecasts, to provide more advance warningof risks of infectious disease.

While the evidence base in favour of collaborationbetween health and climate services continues to expand,these techniques are not currently used to their fullpotential. This requires building the capacity of themeteorological services to collect information and toprocess it into useful products, and the capacity ofhealth services to interpret and apply these productsto health challenges and thereby increase their owndemand for climate services.

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THE BURDEN OF MALARIA

Malaria is a parasitic disease spread by the bites ofinfected Anopheles mosquitoes. There are many speciesof malaria parasites but, of the ve affecting humans, the

greatest threat to health comes from the Plasmodiumvivax and Plasmodium falciparum . Malaria remains adisease of global importance despite much progress inrecent years. It is a persistent threat to health in devel-oping nations where it represents a major constraintto economic development measures and reduces thelikelihood of living a healthy life, especially amongwomen, children and the rural poor.

Over the last century, the surface area on which malariaremains a risk has been reduced from half to a quarter of

the Earths landmass, but due to demographic changesthe number of people exposed to malaria has increasedsubstantially over the same period. Estimates of casesand deaths differ greatly: the number of cases standsbetween 200 million and 500 million while the deathestimate is around 1 million per year. According to theWorld Malaria Report in 2011, malaria remains prevalentin 106 countries of the tropical and semi-tropical world.Thirty-ve countries in central Africa bear the highestburden of cases, more than 80 per cent, and deaths,more than 90 per cent. This is due to a number of factors:most deadly parasite species, most efcient mosquitovectors and poor rural infrastructure. 1

SECTION 1| INFECTIONS

MALARIA

Temperaturesuitability index

1

0

Unsuitable

W H O / S T E P H E N I E H O L L Y M A N


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Estimates of the percentage of mortality in children aged under 5 yearsthat was related to malaria cases in 2010 3

Proportion of child deathsfrom malaria

0


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REDUCING THE INCIDENCE OF MALARIA

Where malarial control is inadequate, the climate canprovide valuable information about the potential distri-bution of the disease in both time and space. Climatevariables rainfall, humidity and temperature arefundamental to the propagation of the mosquito vectorand to parasite dynamics. Rainfall produces mosquito-breeding sites, humidity increases mosquito survivaland temperature affects parasite development rates.Mapping, forecasting and monitoring these variables,and unusual conditions that may trigger epidemics suchas cyclones or the breaking of a drought in a region,enable health services to better understand the onset,intensity and length of the transmission season.

WHO, WMO and the Famine Early Warning Systems 4have routinely produced such information products forcontinental Africa for a number of years. More recentcollaboration with National Meteorological Services havebuilt capacity in seasonal forecasting 5 and enabled amuch denser network of ground station data to be com-bined with the extensive coverage of satellite data. 6 Theresulting mapping, forecasting and monitoring productsare made available to health services through NationalMeteorological and Hydrological Services websites andjoint training workshops encourage mutual learning and

negotiation around information needs. Regional OutlookFora 7 and National Climate and Health Working Groups 8

have been established in a number of countries to elicitpriorities for research, policy, practice and training.

CASE STUDY: MALARIA EARLY WARNING IN SOUTHERN AFRICAThe WHOs Global Malaria Programme in the southernAfrican countries of Angola, Botswana, Namibia,Madagascar, Mozambique, South Africa, Swaziland,Zambia and Zimbabwe offers a good example of thepractical use of weather and climate informationin combating disease. The programme uses theseasonal climate forecasts issued by the SouthernAfrican Regional Climate Outlook Forum to predictmalaria epidemics several months ahead of time,allowing effective control, and other preventive mea-

sures, to be put in place. The climate forecas ts havebeen central to the development of the Malaria Early

Warning System. Through programmes co-sponsoredby WMO, several projects based on the Learningthrough Doing concept have been launched to helpNational Meteorological and Hydrological Services(NMHSs) collaborate and build partnerships withtheir health communities. Thus, in Botswana andMadagascar, the health ministries now have longerlead times on the likely occurrence of malaria, plagueand Rift Valley Fever epidemics, based on climatepredictions provided by the NMHSs. Similar projects

have been launched in Ethiopia, Burkina Faso, Chile,Panama and Peru.

W H O / S T E P H E N I E H O L L Y M A N


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Number of months suitable for malaria transmission 10

Jan Apr Jul Oct Jan

Month

0

2 0

4 0

6 0

8 0

1 0 0

P e r c e n

t O

c c u r r e n c e

i n H i s t o r i c a

l R e c o r d

Climatology for~11 km x 11 km grid boxcentred on 36.15E, 6.35N(located within Ethiopia).

for parasite: falciparum

11km 36.15E 6.35N

View Climatology

Percent Occurence of Climate ConditionsSuitable for Malaria Transmission

Jan Apr Jul Oct Jan

Month

0

1 0 0

P e r c e n

t O c c u r r e n c e

Precipitation

Jan Apr Jul Oct Jan

Month

0

1 0 0

P e r c e n


Temperature

Jan Apr Jul Oct Jan

Month

0

1 0 0

P e r c e n


Relative Humidity

National Meteorological Services can supply more accurate local assessments 9


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DIARRHOEA

Around two million people die every year due to diar-rhoeal disease 80 per cent are children under 5. Cholerais one of the most severe forms of waterborne diarrhoealdisease. There are sporadic incidences of the diseasein the developed world, but it is a major public health

concern for developing countries, where outbreaks occurseasonally and are associated with poverty and useof poor sanitation and unsafe water. Extreme weatherevents, such as hurricanes, typhoons, or earthquakes,cause a disruption in water systems resulting in themixing of drinking and waste waters, which increasethe risk of contracting cholera.

In 1995 a combined average of 65 per cent of the worldspopulation had access to improved drinking watersources and sanitation facilities. 1 That left two billion

people relying on drinking water that could potentiallycontain pathogens, including Vibrio cholerae , the caus-ative organism of cholera. There is a denite correlationbetween disease outbreaks and inadequate access tosafe water and lack of proper sanitation. Thereforepeople in the least developed regions of the world whoonly have access to unsafe water and poor sanitationalso have the greatest burden of related diseases, likecholera or other diarrhoeal diseases.

Extreme weather-related events such as increasedprecipitation and ooding further contaminate watersources, contributing to an oral-faecal contaminationpathway that is difcult to manage and which increasesthe cases of disease and fatalities. When such eventstake place, Vibrio cholerae persists in aquatic ecosys-tems, causing the rapid spread of seasonal epidemicsin many countries.

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This map demonstrates that in 1995 there was a widespread correlation between cholera prevalence and

poor access to water and sanitation as well as precipitation anomalies 2

% of households having access to water and sanitation

0.01 - 25.00

25.01 - 50.00

50.01 - 75.00

75.01 - 90.00

90.01 - 100.00

Data not available

Not applicable

Number of cases of cholera reported by the country

0 -10

11-100

101-1000

1001-10000

10001-100000

100001-1000000

Precipitation departure from normal

Above Normal

Normal

Below Normal

Left: Trends in the use of piped water on premises, improved drinking water sources, unimproved sourcesand surface water in least developed countries by urban and rural areas 1

Right: Trends in the use of improved, unimproved and shared sanitation facilities and open defecation inleast developed countries by urban and rural areas 1

18%

30%

44%

8%

10%

27%

52%

11%

3%

16%

50%

31%

2%

16%

52%

30%

22%

33%

43%

2%

14%

30%

53%

3%

1990 2010 1990 2010 1990 2010

Ten percent of the population in leastdeveloped countries rely on surface water

Total

Piped on premises Other improved Unimproved Surface water

Urban Rural

45%

23%

11%

21%

24%

25%

16%

25%

14%

21%

24%

41%

7%

20%

25%

48%

53%

24%

7%

16%

32%

25%

13%

30%

1990 2010 1990 2010 1990 2010

Open defecation is practised by nearly a quarter ofthe population in least developed countries

Total

Improved Shared Unimproved Open defecation

Urban Rural


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THE CLIMATE DATA LAYER

In 2010, the world met the Millennium Develop Goalstarget on water, as measured by its proxy indicator: (by2015) halving the proportion of (1990) population withoutsustainable access to an improved source of drinkingwater (see the gure below). Despite such progressnearly eight hundred million people still lacked accessto water from such sources, and public health research 3 has shown that billions are still using unsafe water. Atthe same time we are still badly off track to meet theMillennium Develop Goal on sanitation. Access to waterand sanitation improved from 1995 to 2010, but notsubstantially in the parts of the world where cholera isrecurring. Cases of cholera continue to rise in parts ofpoverty-stricken Africa and Asia where access to water

and sanitation are already poor and progress towardsimproving such services is slow or stagnant.

Extreme weather-related events have made diseasetransmission pathways worse. Thus, climate services havean important role to play if effective prevention is to beput in place. By adding a climate layer such as precipita-tion anomalies, including ooding, to maps containingother datasets such as disease burden, one can pinpointhotspots where further analyses would be needed anddata gathering should be improved and enhanced. Such

maps can help decision-makers to visualize the water,sanitation and the environmental problems in their regionand to put measures in place to avoid outbreaks and thusdiminish the spread of such diseases.

This complex topic is part of an ongoing research.Nevertheless, these high level maps can contributeto informing policymakers on measures to reduce thedisease burden of cholera.

CASE STUDY: GLOBAL INFORMATION MANAGEMENT SYSTEM ONHEALTH AND ENVIRONMENT

The goal of the WHO project Global Information Man-agement System on Health and Environment (GIMS) 4 is to save lives by preventing communicable waterborne diseases through providing an evidence basefor ensuring good environmental health modalities likeaccess to safe water and basic sanitation in a sustain-able manner under changing global environmental

conditions. Prevention of environment-related diseaserequires a comprehensive information system for

adequate planning and targeted resource use forassisting the most vulnerable populations in hotspotanalyses. GIMS plans to produce these maps on areal time basis and with its in-built predictive toolalso aims to contribute to an early warning systemfor diarrhoeal diseases. In its initial phase, which willlast until 2015, the project will focus on cholera and

be tested in selected pilot countries where cholerais present.

W A T E R A I D / J U T H I K A H O W

L A D E R


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Information on precipitation anomalies, overlaid with 2010 reported cholera cases from

the countries where access to water and sanitation remains poor, indicate priority areas forfurther research and health intervention 2

The MDG proxy indicator for the drinking water target, which is showing steady improvement,has been met 1

% of households having access to water and sanitation

0.01 - 25.00

25.01 - 50.00

50.01 - 75.00

75.01 - 90.00

90.01 - 100.00

Data not available

Not applicable

Number of cases of cholera reported by the country

0 -10

11-100

101-1000

1001-10000

10001-100000

100001-1000000

Precipitation departure from normal

Above Normal

Normal

Below Normal

24

76

21

79

17

83

14

86

11

89

8

92

1990 1995 2000 2005 2010 2015 (projected)

Improved sources Unimproved sources- - -

Open defecation

Trends in global drinking water coverage,19902010, projected to 2015

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%


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MENINGITIS

MENINGITIS THE HEALTH CHALLENGE

Meningitis cases increase in the dry, hot and dusty season. Data from Burkina Faso (2005-2011) 2

Meningococcal meningitis is a severe infectious diseaseof the meninges, a thin layer around the brain and spinalcord. Several micro-organisms can cause meningitis.

The bacterium with the greatest epidemic potential isNeisseria meningitidis .

Although meningitis is a ubiquitous problem, most ofthe burden of disease lies in sub-Saharan Africa in anarea called the Meningitis Belt. The Meningitis Beltis regularly hit by epidemics that occur only during thedry season, from December to May. Over the past 10years, more than 250 000 cases and an estimated 25 000deaths have been reported. The disease is an obstacle tosocio-economic development: outbreak management is

extremely costly and paralyses the health system about10 per cent of the survivors suffer life-long sequels suchas deafness and blindness. A study in Burkina Faso 1 oneof the worlds poorest countries with an annual incomeof US$ 300 indicated that the nancial burden for the

family of a patient suffering from meningitis is on aver-age US$ 90 and up to US$ 154 more when meningitissequels occur.

There is a clear seasonal pattern of meningitis casesthat corresponds to the period of the year when thereare increases in dust concentrations as well as reduc-tions in humidity levels linked to the movement of theInter Tropical Convergence Zone. While the temporalassociation between climate and meningitis is evident,what triggers or ends an epidemic is as yet unknown.One hypothesis is that dry, hot and dusty air irritatesthe respiratory mucosa thus facilitating invasion ofthe bacteria.

0

1000

2000

3000

4000

5000

6000

1 1 1

2 1

3 1

4 1

5 1

6 1

7 1

8 1

9 1

1 0 1

1 1 1

1 2 1

1 3 1

1 4 1

1 5 1

1 6 1

1 7 1

1 8 1

1 9 1

2 0 1

2 1 1

2 2 1

2 3 1

2 4 1

2 5 1

2 6 1

2 7 1

Meningitis casesper week

2005 2006 2007 2008 2009 2010

Week

Dust(kgm/m 3)

0.8

0

RH (%)80

20

Rain(mm)

150

0

Year


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Number of suspect cases of meningitis per year in the Meningitis Beltbetween 1970 and 2012 5

African Meningitis Belt:Loosely dened as areas that experience

frequent epidemics during the dry season 4

Dust surface concentration (g/m 3 ) across the Meningitis Belt in December to February,

averaged over 1979-2010 3

500

200

100

40

10

5

2.5

1

200 000

180 000

160 000140 000

120 000

100 000

80 000

60 000

40 000

20 000

1 9 7 0

1 9 7 2

1 9 7 4

1 9 7 6

1 9 7 8

1 9 8 0

1 9 8 2

1 9 8 4

1 9 8 6

1 9 8 8

1 9 9 0

1 9 9 2

1 9 9 4

1 9 9 6

1 9 9 8

2 0 0 0

2 0 0 2

2 0 0 4

2 0 0 6

2 0 0 8

2 0 1 0

2 0 1 2

Years

C a s e s


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ADDRESSING THE MENINGITIS CHALLENGE

The public health strategy to control meningitis epidemicsrelies on the implementation of large-scale vaccinationcampaigns in a timely manner to prevent further cases.

Knowing if, where and when an outbreak is likely to occurwould help public health decision makers prepare forvaccination campaigns and procure sufcient vaccinequantities to immunize the population at risk and ulti-mately reduce the impact of the disease. By increasingthe understanding of meningitis risk factors and howthey inuence the occurrence of an epidemic, publichealth ofcials will have greater capacity to predictand prepare for potential outbreaks through reactivevaccination campaigns.

A preventive vaccination strategy, involving a conjugatevaccine against Neisseria meningitidis serogroup-A,is being implemented in the highest risk countriesin sub-Saharan Africa. This offers great potential toeliminate large meningitis outbreaks as a public healthproblem. While the introduction of the meningitis Aconjugate vaccine promises to signicantly reduce theproblem of meningitis epidemics in Africa, the reactivevaccination approach remains an important part of thecontrol strategy. 6

Improving the prevention and control of meningitisepidemics is the focus of numerous research projects inAfrica and internationally. Under a collaborative partner-ship initiative known as Meningitis Environmental RiskInformation Technologies MERIT constituted by WHO,WMO, the International Research Institute for Climateand Society and other leaders within the environmentaland public health communities, research projects havebeen designed and developed to respond directly topublic health questions and priorities.

The combined output of operational research activitiesis being assessed to determine the effectiveness ofpredictive models in strengthening the public healthstrategy. For example, the expected probability of anepidemic occurring based on climatic and environmentalfactors combined with epidemiological spatio-temporalmodels at the district level, may in the future help publichealth ofcials respond to potential outbreaks. Theclimate service in support of the public health ofcials inmeningitis-affected countries, should supply forecasts ofthe likely duration and end of the dry season and update

these with any pertinent meteorological forecasts.

Observed annual meningitis incidence (purplebars) and predictions based on meridional

winds (red lines); offering potential to informoutbreak response 7

Burkina Faso

Time (years)

L o g

( i n

c i d

e n c e

)

1 9 6 9

1 9 7 1

1 9 7 3

1 9 7 5

1 9 7 7

1 9 7 9

1 9 8 1

1 9 8 3

1 9 8 5

1 9 8 7

1 9 8 9

1 9 9 1

1 9 9 3

1 9 9 5

1 9 9 7

1 9 9 9

2 0 0 1

2 0 0 3

2 0 0 5

7

0

6

5

4

3

2

1


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Early vaccination prevents many cases. Data and modellingfor Reo district, Burkina Faso, 1997 9

Target countries for the meningitis A conjugate vaccine, containing approximately450 million people at risk of meningitis 8

Legend

MVP target countries forMenAfriVac introduction

Countries not covered

Not applicable

Niger

Time (years)

L o g

( i n

c i d

e

n c e

)

1 9 6 9

1 9 7 1

1 9 7 3

1 9 7 5

1 9 7 7

1 9 7 9

1 9 8 1

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1 9 8 9

1 9 9 1

1 9 9 3

1 9 9 5

1 9 9 7

1 9 9 9

2 0 0 1

2 0 0 3

2 0 0 5

7

0

6

5

4

3

2

1

Weeks of 1997

C a s e s

/ C a s e s p r e v e n

t e d Cases prevented

Cases

Vaccinationcampaign

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1716

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W H O / C H R I S T O P H E R B L A C K


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DENGUE FEVER

DENGUE FEVER THE GROWING CHALLENGE

Transmitted by Aedes mosquitoes, dengue is the mostrapidly spreading mosquito-borne viral disease in theworld. It is estimated to cause over 50 million infections,

and around 15,000 deaths every year across approxi-mately 100 countries. 1, 2

Infection could range from a mild u-like fever to thepotentially fatal severe dengue, which particularly affectsindividuals who are exposed to one of the four differ-ent strains of the virus as a secondary infection. Theimpact of dengue, and other mosquito-borne viruses,goes beyond the immediate medical effects. Oftenoccurring as epidemics, including in large cities, theycan have an important impact on economic develop-

ment for example, it may affect tourism and strainhealth systems, crowding hospitals.

Dengue is particularly prevalent in cities in tropical andsubtropical areas, where the combination of abundantmosquito breeding sites and high densities of humanpopulations support high rates of infec tion. Climate alsoexerts a strong inuence, in combination with thesesocio-economic determinants. Heavy rainfall can causestanding water, while drought can encourage peopleto store more water around the home, both providingbreeding sites for Aedes mosquitoes. Warm temperaturesincrease the development rates of both the mosquitovector and the virus, fuelling more intense transmission.

Dengue is now increasing in many parts of the world,driven by development and globalization the combina-tion of rapid and unplanned urbanization, movement ofgoods and infected people, dispersal of mosquitoes tonewer territories, spread and mixing of strains of thevirus, and more favourable climatic conditions. 3

Complete (absence)

Good

Moderate

Poor

Intermediate

Poor

Moderate

Good

Complete (presence)

Data not available

Not applicable

Agreement on occurrenceof transmission

A S I A N E T - P

A K I S T A N / S H U T T E R S T O C K

. C O M


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Surveillance of dengue is often incomplete and inconsistent.The map combines information from different sources to show the degree of consensus as to

whether dengue transmission occurs in each country 4

Climate exerts a strong inuence on dengue transmission - in interaction withmany other non-climate factors 5

Vector density(& tness & longevity)

Dengue transmission

Vectorecology

Temperatureand precipitation

Aquaticbreedingsites

Vector capacityand feeding

opportunities

Social &ecological

context

Vectorcontrol

Individual virological andimmunological factors

Dengue disease

Epidemiology

Herd immunity

Community infrastructureand behaviour

Population sizeand distribution

Community action

Control policiesand services

Epidemicor endemic

disease

Clinical severity


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Dengue risk

High suitability

Low suitability

Unsuitable/non-endemic

USING CLIMATE SERVICES TO SUPPORTDENGUE CONTROL

There is currently no effective vaccine or drugs fordengue. Control programmes rely on environmental orchemical control of the vectors, rapid case detection andcase management in hospitals for severe dengue. Butthese interventions are challenging, and there has beenonly very limited success in disease outbreak controlwithin the most suitable transmission zones. Futureinitiatives are likely to depend not just on developmentof better interventions, but also on more effective tar-geting of control in time and space. In such scenarios,meteorological information can make an importantcontribution to understanding where and when denguecases are likely to occur.

For example, statistical models, based on correlationsbetween climate and other environmental variables andincidence of dengue in areas with good epidemiologicaland entomological surveillance, can be used to makepredictions of the likelihood of transmission in locationswhere disease surveillance is weak or absent. Suchinformation can also be used to alert authorities tothe potential spread of dengue by mapping where theclimate and other conditions either are, or may become,more suitable for transmission. Such information can be

shared with neighbouring countries for sound planningand effec tive control of transmission.

Meteorological information knowledge of seasonalpatterns and weather forecasts can also play a role intargeting resources in time. Combining information onprecipitation and temperature, with an understanding of

W H O / J I M H O L M E S

non-climate factors such as availability of breeding sitesand the previous exposure of populations to infection,can help to predict when and where epidemics mayoccur, or be particularly severe.


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Climate information can be used to improve dengue surveillance. The map shows the estimatedsuitability for dengue in specic locations, based on a combination of disease surveillance data, andpredictions based on climate and other environmental factors 6

3500 1000

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Year

T o t a l r a i n

f a l l ( m m

)

D e n g u e c a s e s

In many locations, dengue shows a strong seasonal pattern, and understanding of meteorological effectsmay help preparedness and targeting of control efforts. The gure shows pooled monthly dengue cases

(red line) and monthly rainfall (blue bars) in Siem Reap and Phnom Penh, Cambodia 7


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A girl is helped off a truck afterbeing evacuated from the ooded areaof Thailands Ayutthaya province

24 C H A I W A T S U B P R A S O M / R E U T E R S


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SECTION 2EMERGENCIESEvery year, emergencies caused by weather-, climate-and water-related hazards impact communitiesaround the world, leading to loss of life, destruc tionof social and economic infrastructure and degrada-tion of already fragile ecosystems. Between 80 and

90 per cent of all documented di sasters from naturalhazards during the last ten years have resulted fromoods, droughts, tropical cyclones, heat waves andsevere storms.

STATISTICS AND THE HIDDEN IMPACT

In 2011, 332 disasters from natural hazards were recordedin 101 countries, causing more than 30 770 deaths, andaffecting over 244 million people. Recorded damagesamounted to more than US$ 366.1 billion. 1

But statistics cannot reect the full health impact or thedepths of human suffering felt during such emergencies.Millions of people have suffered injuries, disease andlong-term disabilities as well as emotional anguish fromthe loss of loved ones and the memories of traumaticevents. 2

Over the past 30 years the proportion of the worlds popu-lation living in ood-prone river basins has increasedby 114 per cent and those living on cyclone-exposedcoastlines by 192 per cent. 3

Reports of extreme weather events and disasters havemore than tripled since the 1960s and scientists expectsuch events to become more frequent and severe in thefuture due to climate change in many parts of the world.There is also growing evidence that links escalationsin violence and conict over access to food and waterresources to climate. 4

CLIMATE SERVICES AND HEALTH EMERGENCIES

Adopted by 168 Member States at the World DisasterReduction Conference in Kobe, Japan in 2005, the HyogoFramework For Action describes the work that is required

from all different sectors and actors, including healthand climate communities, to reduce disaster losses. TheGlobal Framework for Climate Services will contribute tothe implementation of the Hyogo Framework by makingtailored science-based climate-related information avail-able to support informed investment and planning atall levels as a critical step in disaster risk management. 5

Climate services support health and other sectors to savelives and reduce illness and injury in emergencies by:

assisting health emergency response operations, forexample, by providing early warnings of extreme hotand cold temperatures;

providing seasonal forecasting and early warningsystems to enable planning and action;

determining which populations and health carefacilities are at risk of hydrometeorological hazardsusing risk assessment tools;

applying climate change models to forecast the long-term effects of climate change, information whichcould be used, for example, to decide where to locatenew health facilities away from high risk areas; and,

providing real-time meteorological and hydrologicaldata, properly integrated with related health servicesdata and information, to support local and nationaldecision-making.

25


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WIDESPREAD EFFECTS

Floods can cause widespread devastation, resulting inloss of life and damages to personal property and criticalpublic health infrastructure that amount to billions of

dollars in economic losses.

Floods and cyclones may directly and indirectly affecthealth in many ways, for example by:

increasing cases of drowning and other physicaltrauma;

increasing risks of water- and vector-borne infectiousdiseases;

increasing mental health effec ts associated withemergency situations; 1

disrupting health systems, facilities and services,leaving communities without access to health care 2 when they are needed most; and

damaging basic infrastructure such as food and watersupplies and safe shelter. 3

SECTION 2| EMERGENCIES

CASE STUDY: BANGLADESHIn 1970, the worlds most devastating cyclone to dateclaimed approximately 500 000 lives in Bangladesh,and another in 1991 claimed around 140 000 lives.Since 1991, the government with the support of the

UN, including WHO and WMO, has established earlywarning systems, shelters along coastal areas, searchand rescue teams and rst-aid training and equipment.

Bangladesh now has the capacity to evacuate hun-dreds of thousands of people from the path of oodsand cyclones. When Sidr, a very s trong, Category-4cyclone struck Bangladesh in November 2007, the

devastation it wreaked was widespread. Sidr was ofsimilar strength as the cyclone of 1991, but its deathtoll, 3000 lives, was much lower. 4

FLOODS AND CYCLONES

W H O


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29,780

77,640

NORTHAMERICA

CENTRAL ANDSOUTH AMERICA

AFRICAASIA

AUSTRALIANEW ZEALAND

640

850

3,640Average PhysicalExposure to Floods AssumingConstant Hazardin thousands of people per year

CARIBBEAN *

EUROPE

in 2030

in 1970

Circles are proportionalto the number of persons affected

1,190

550

1,320

3060

* Only catchments bigger than 1,000 km 2 were included in this analysis. Therefore, only the largest islands in the Caribbean are covered.

70180

1,6501,870

The projected increase in the number of people (in thousands) exposed to oods in 2030compared to those in 1970 6

A number of major ood events from 2000 2010 5


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FORECASTING FLOODS AND CYCLONES: PREPARE AND PREDICT TO SAVE LIVES

Climate information about flood and cyclone risks,routinely prepared by national meteorological services,inform billions of people around the world of the hazardsthey face, of ways of reducing their vulnerability and ofemergency preparedness measures. These same servicesprovide advice to government and other organizationsconcerning disaster response.

The El Nio/La Nia cycle is an episodic changebetween large scale warming and cooling either sideof the equator in the Pacic Ocean. When El Nio andLa Nia are at their most intense extreme weather

events may result in disaster when communities areill-prepared to face them.

Making hospitals safe from disasters, either by reinforc-ing existing hospitals or ensuring that all new hospitalsare built to withstand local hazards, protects patientsand staff, and enables them to provide health servicesin the af termath of an emergency, when they are mostneeded. Using climate information about ood hazards,health facilities can be built in areas that are not proneto ooding, and early warnings can ensure that staffare ready to respond to emergencies. 7

0.1 - 7

14.1 - 21

7.1 - 14

Tropical Cyclonecentres count asa function ofSOI index

0.1 - 7

14.1 - 21

21.1 - 28

7.1 - 14

Tropical Cyclonecentres count asa function ofSOI index

CASE STUDY: PAKISTANDuring Pakistans 2010 ood emergency, monsoonalrains and raging oodwaters damaged or des troyedmore than 500 hospitals and clinics. 9 Informationon the extent of the ooding enabled the Ministry

of Health, supported by WHO and Health Clusterpartners, to plan and position health services for theaffected populations.

Facilities damaged during the 2010 oods had beenidentified as at risk of damage in a flood hazardmodelling analysis conducted by the Ministry ofHealth and WHO in 2008. 10 WMO continues to work

with the National Meteorological Service to improvetheir capability to forecast extreme events such asthe 2010 ood.

Tropical cyclone tracks vary substantially between times El Nio and times of La Nia. The locations oftropical cyclones is shown above for months of La Nia conditions (upper panel), and months of El Nio

conditions (lower panel) 8


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Map produced in 2008, indicating ood hazard prone areas and gradingthe level of exposure of health facilities 12

Flood Hazard (index)

Very low

Very high

International boundaries

Low

Medium

High

(WHO, 2008)

Not applicable

Flood hazard intensity levelVery highHighMediumLowVery low

N u m

b e r o

f h e a

l t h f a c i

l i t i e s

90

80

70

60

50

40

30

20

10

0

4

3731

78

30

Status of

(WHO, 04/10/2010)

Established

In Progress

Not Yet Established

WHO Hubs and Health Clusters

Flood Extent (UNOSAT Satellite Imagery Analysis,08/08/2010 to 16/09/2010)

Flood-Affected Areas

(Official, NDMA, 20/09/2010)

Medium

Severe

International Boundaries

Not applicable

Diarrhoea Treatment Centers (DTCs)

P ro vi nc e E st ab li sh ed I n p ro gr es s Not E st ab li sh ed Tot al

Balochistan 11 4 0 15

Khyber Pakhtunkhwa 27 0 0 27

Punjab 12 4 2 18

Sindh 11 7 2 20

Grand Total 61 15 4 80

0 200 400100Km

0 200 400100Km

Flood-affected districts of Pakistan during 2010 and the location of diarrhoea treatment centres 11


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DROUGHT: THE BIGGER PICTURE

Drought is a prolonged dry period in the natural cli-mate cycle that can occur anywhere in the world. It isa slow-onset phenomenon caused by rainfall decit.

Compounding factors such as poverty and inappropriateland use increase vulnerability to drought.

When drought causes water and food shortages, therecan be many impacts on the health of the affectedpopulation which may increase morbidity and result indeaths. In recent years, most drought-related mortalityhas occurred in countries also experiencing politicaland civil conicts.

Drought may have acute and chronic health effects:

malnutrition due to the decreased availability of food;

increased risk of communicable diseases due toacute malnutrition, inadequate or unsafe water forconsumption and sanitation, and increased crowdingamong displaced populations;

psycho-social stress and mental health disorders;

overall increase of population displacement; and

disruption of local health services due to a lack ofwater supplies and/or health care workers beingforced to leave local areas. 1,2


DROUGHT

Undernutrition contributes to a rangeof diseases, and causes 35 per cent of all

under-ve deaths 3,5

Neonatal41%Globally, more

than one third ofchild deaths areattributable toundernutrition

Others16%

Measles1%

Diarrhoea14%

Malaria8%

Pneumonia14%

HIV/AIDS2%

Injuries3%

W H O


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Percentage of underweight children under 5 years of age(based on latest available data from 2000) 6

A number of major drought events from 2000 2010 4

Childrenaged < 5 yearsunderweight (%)

30

Data not available

Not applicable


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CASE STUDY: HORN OF AFRICA CRISIS 2010-2011Two consecutive seasons of signicantly below aver-age rainfall made 2011 one of the driest years in theEastern Horn of Africa since 1995. The on-goingconict in Somalia aggravated the situation, leadingto a signicant outow of refugees into neighbouringstates. Famine was declared in six regions of Somalia,with large areas of Kenya, Ethiopia, and Djibouti fac-ing severe food insecurity, which led to high levelsof acute malnutrition.

As of September 2010, climate services gave clear earlywarnings of the reduced rainfall and of the emergingcrisis situation, but coordinated and proactive actionaimed at alleviating the predicted effects of the crisis

did not take place. As a result, 13.3 million peoplewere in need of humanitarian assistance in the region.

Preventive action is possible. The Tana River DroughtRecovery Project in Kenya supported modern agri-cultural practices and health activities, includingconducting monthly mobile clinics in hard to reachareas, a house-to-house campaign on immunizationand malaria, distribution of mosquito nets and theconstruction of a maternity wing at Mulago hospital.The 33 farms created by the Project provided long-termfood security for almost 10 000 people. The samemoney, spent on food aid, would have given only1 250 people a par tial food ration for six months. 7-10

333333

354025

253540

253540

I

II

III

IV

A Above normalN Near normalB Below normal

No information

Wetter than normal

Drier than normal

Water bodies

Figures represents probabilities of

Legend

Drought as a risk factor for complex public health impacts and the possible areasfor public health response 12

The probabilities of above, near or below normal rainfall in the Horn of Africafor September to December 2010 11

Communityimpact

Drought

1. Food supplementation andhealth care

2. Epidemic surveillance, earlywarning, response

3. Health services(immunization, child & maternal

health, referrals, education)

4. Special services:outreach, mobile teams

5. Emergency funding tosupport health action

Watershortage

Food crisis

Cropfailure

Livestockloss

Diarrhoea,

cholera,etc.

Otherhealth risks

(eg low birthweight)

Malnutrition

Healthimpact

Climateevent

Health emergencyresponse


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CASE STUDY: THE SAHEL EARLY WARNING, EARLY RESPONSE

As predicted by the regional Famine Early WarningSystem Network (FEWS NET) below-average rains inthe Sahel in late 2011 resulted in drought conditionsin 2012 and widespread food insecurity throughoutthe region. The UN estimated that over 18 millionpeople were at risk in areas in nine countries wherefood insecurity and malnutrition were already chronic.

In the Sahel the humanitarian communitys responseto the early warning included:

Providing food assistance, including specialfoods designed to combat malnutrition;

Treating malnutrition, by training nurses,providing medical supplies and supporting freeaccess to health care;

Preventing communicable diseases throughvaccination, disease surveillance, and prepared-ness for outbreaks; and

Improving water and sanitation servicesthereby, promoting hygiene. 13

Frequency of drought (WRSI for Millet) from 1996-2011 across the Sahel region 15

(Integrated Food Security Phase Classification Scale)

Normal or minimal

Stressed

Crisis

Emergency

Catastrophe/Famine

Food Security Conditions April-June 2012

Data not available

Not applicable

Drought frequencyin number of years (yrs)

0

Less than 1 in 15

1 in 7 - 9

1 in 5 - 6

1 in 4

1 in 3

Data not available

Most likely food security conditions in theSahel Region between April-June (at 2 April

2012). Senegal, Gambia, northern Nigeria andnorthern Cameroon was also affected 14


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CASE STUDY: SOUTH-EAST ASIA FOREST FIRES OF 1997South-East Asia witnessed one of its worst smoke andhaze episodes in autumn 1997 due to forest res thatwere exacerbated by the El Nio-related drought. Itis estimated that more than two million hectares offorests burned in the Indonesian islands of Kalimantanand Sumatra, emitting the equivalent level of carbondioxide as a whole year of CO 2 emissions in Europe.

2

Meteorological services tracked the resulting smokeand haze, which adversely affected the health ofpopulations of Indonesia and neighbouring countries.In Indonesia, among the 12 360 000 people exposedto the haze, it was estimated that there were over1 800 000 cases of bronchial asthma, bronchitis andacute respiratory infection. Health surveillance inSingapore from August to November 1997 showed a30 per cent increase in hospital outpatient attendance

for haze-related conditions, as well as an increase inaccident and emergency attendances. 3

AIRBORNE DISPERSIONOF HAZARDOUS MATERIALS

The image shows the pollution over Indonesiaand the Indian Ocean on October 22, 1997.White represents the aerosols (smoke) thatremained in the vicinity of the res. Green,yellow, and red pixels represent increasing

amounts of tropospheric ozone (smog) beingcarried to the west by high-altitude winds. 4

Large-scale dispersion of airborne hazardous materialssuch as smoke from large res, chemicals releasedfrom hazardous facilities and radiological materialsfrom nuclear incidents can adversely affect human andanimal life and the environment. 1

WILDFIRES AND FOREST FIRES

Wildres and forest res occur in all vegetation zones.Caused by natural phenomena or by human activity,emissions from res contain gas and particle pollutantsthat can cause diverse health problems, as well as disrupttransportation, tourism and agriculture. Extreme radiantheat and smoke inhalation may cause injury and deathto people directly exposed to the res. The occurrenceof wildres is strongly determined by the incidence of

drought and heat waves. Climatologists believe thatclimate change will increase in the incidence of wildresas the associated droughts and heat waves are expectedto increase in frequency and intensity.


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Red areas show global distribution of re occurrences over a10-day period from 08/ 08/ 2012 - 17/08 /2012. 5

CASE STUDY: CHERNOBYL NUCLEAR ACCIDENTOn 26 April 1986 a nuclear accident at the ChernobylNuclear Power Plant in the former Union of SovietSocialist Republics (in what is now Ukraine) releasedlarge quantities of radioactive materialswhich were carried in the atmosphere overmuch of Eastern and Western Europe. Thesereleases caused radiation exposure of theworkers involved in the emergency andclean-up operations after the accident, thoseevacuated from nearby settlements, andpeople living in contaminated areas out-side the immediate vicinity of Chernobyl. Asubstantial increase in thyroid cancer wasrecorded among children due to radioactiveiodine exposure during the rst few monthsfollowing the accident. 6

The Chernobyl accident was the main reasonfor the development of modelling systems to

forecast atmospheric transport of radioactivity and tostart the Emergency Response Activities programmeof WMO.

0

1

2

3

4

5

6

7

8

9

1986 1988 1990 1992 1994 1996 1998 2000 2002

I n c

i d e n c e

, p e r

1 0 0

, 0 0 0

Years

Belarus

Ukraine

The graph illustrates the number of cases of thyroidcancer, per 100 000 population, for children and

adolescents in Belarus and Ukraine who wereexposed to radiation after the Chernobyl accident 7


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METEOROLOGICAL SERVICES

National Meteorological Services can provide informa-tion on the dispersion and spread of the re and smokeplumes to support health and emergency managementauthorities in taking decisions on, for example, theevacuation of neighbourhoods, the closing of roads oradvising the population of water and foods likely to becontaminated. The occurrence of wildres is stronglydetermined by the incidence of drought and heat waves.

Meteorology can play an important role in reducing thehealth effec ts of hazardous material suddenly releasedinto the environment. Meteorological information such as

weather forecasts support local and regional emergencyresponse operations and meteorological modelling andmapping systems can assess and predict the move-ment, spread and concentration of airborne hazardoussubstances from the location of sudden release. Themeteorological services provide an analysis of howwind, rain and other meteorological phenomena willaffec t the dispersion of the hazardous substances.

S H U T T E R S T O C

K . C

O M / P E T E R J . W I L S O N


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CASE STUDY: MAJOR FIRE AT BUNCEFIELD, UNITED KINGDOMOn 11 December 2005, there was a major explosionat the Bunceeld Oil Depot in Hemel Hempstead,United Kingdom, resulting in the largest peacetimere in Europe to date. The re burned for four daysbefore it was extinguished. 1

The Met Ofce Operations Centre in the United King-dom provided immediate and hourly data as well asforward-looking modelling on the smoke plume togovernment departments across the United Kingdom,including the Health Protection Agency. Data onthe composition of the smoke was compiled with

information from the modelling of the plume spread

and dispersal. The areas at risk from grounding of thesmoke plume were thus identied and the high-levelcommand decisions on evacuation and emergencyresponse were facilitated. 9

In summary 244 individuals attended hospital inthe aftermath of the re, 43 were directly injured bythe blast but there were no fatalities. The incidentdemonstrates the value of an integrated health protec-tion service, informed by the meteorology service,able to work across different sectors and providecomprehensive advice and support to emergency

responders and the population at risk. 9

The dispersion model mapping the density of the plume across the south-east ofthe UK from the Bunceeld re, 2005 8

Air concentrationof particulates

Lowest

Medium

High

Highest


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Vehicles clog a major thoroughfare as smog shrouds the skyline in Beijing, China

38 C L A R O C O R T E S / R E U T E R S


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SECTION 3EMERGING ENVIRONMENTACHALLENGESCurrent development patterns, and individual behav-ioural choices, are bringing a range of new challengesto public health. Many of the most important relate toenvironmental changes.

The clearest example is climate change. The accumulationof greenhouse gases in the atmosphere, driven mainlyby the use of fossil fuels, is increasing temperaturesand exposing populations to more frequent and intenseweather extremes as well as undermining environmentaldeterminants of health, such as clean water and adequatenutrition. Similarly, the accumulation of Chlorouoro-carbons (CFCs) and other industrial chemicals in theatmosphere has degraded the stratospheric ozone layer,increasing levels of ultraviolet radiation the major riskfactor for developing skin cancers.

The health impacts of these environmental changes,however, are strongly mediated by local factors. Airpollution, both inside and outside the home, is causedby a combination of global development patterns,and weak control of polluting energy sources at thenational and local level, making it one of the largest,and fastest growing, contributors to global ill health.The health issues related to the increasing frequencyof heat waves is compounded by a rapid increase in thesize of the most vulnerable populations: older people,particularly those living in large cities in the tropicsand subtropics. The hazard of ultraviole t radiation hascombined with a tendency over recent decades for fair-skinned populations to spend increasing amounts oftime in the sun. In some cases, such as with the rapidrise in asthma and other respiratory conditions associ-ated with pollen exposure the mechanisms are poorlyunderstood but the early evidence suggests that the

rise in observed cases is also caused by a combinationof more conducive climate and environmental condi-tions, more active surveillance by health services, andindividual susceptibility.

A combined response to emerging environmental chal-lenges is needed from the individual up to the local,national and international levels. A close collabora-tion between climate and health services can make animportant contribution to all of these efforts. At thelocal level, weather forecasts in many parts of the worldnow routinely provide information on levels of ozoneand particulate air pollutants, of pollen, of exposure toultraviolet radiation, and warnings of when high tem-peratures may become hazardous to health. When thisservice is properly connected with guidance or plans for

preventive action, it can enable individuals, and healthservices, to avoid or limit harm to health.

Meteorological and other environmental monitoringservices also provide information on environmentalhazards over wider spatial scales, and over longertime periods. This includes, for example, monitoringof the dispersal of particulate air pollution within andacross national boundaries over weeks or months, andof the condition of the ozone layer over years. Perhapsmost fundamentally, meteorological services providethe essential data allowing us to track, and to predict,the progress of global climate change over decades tocenturies. Health services can use this information toensure that health protection services adapt as much aspossible to changing conditions. They can also use it toadvocate for environmental protection, and sustainabledevelopment, as fundamental contributions to sustainhealthy human lives.

39


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THE DANGERS OF THE SUN

Excessive heat is a growing public health threat forevery degree Centigrade above a threshold level, deathscan increase by 2 5 per cent. Prolonged, intense heat

waves heighten the risks. Elderly, chronically-ill andsocially-isolated individuals, people working in exposedenvironments and children are particularly vulnerable. 1, 2

While extreme heat affects populations around theworld in both developing and developed countries,some of the most dramatic heat waves have occurredin relatively wealthy regions of the world with cooleraverage temperatures and mid-latitude climates. Theextended heat of the European summer of 2003 causeda rise in death rates that was 4 to 5 times expected levels

at the peak of the event in some cities, eventually causingover 70 000 additional deaths across twelve countries. 3,4 Heat stress affects rural areas but is particularly severein cities, where the urban heat-island effect can raisetemperatures by more than 5C, 5 and high temperaturesexacerbate the harmful effects of ozone and particulateair pollution.

Climate change which is expected to increase theintensity and frequency of such extremes will worsenthe hazards to human health. By the 2050s, heat eventsthat would currently occur only once every 20 years willbe experienced on average every 2 5 years. 6 Populationgrowth, ageing and urbanization are also expected toincrease the numbers of people at high risk. By 2050, itis estimated that there will be at least 3 times as manypeople aged over 65 living in cities around the world,with developing regions seeing the greatest increases. 7

The combined effects of escalating hazards and growingvulnerable populations will make heat stress a healthpriority for the coming decades.

SECTION 3| EMERGING ENVIRONMENTAL CHALLENGES

HEAT STRESS

Older people living in cities are at particularrisk; and their number is expected to increase

dramatically by the middle of the Century 7

A f r i c a

A m e r

i c a s

E a s t e r n

M e d

i t e r r a n e a n

E u r o p e

S o u

t h - E a s

t A s i a

W e s

t e r n

P a c i

f i c U r b a n

P o p . >

6 5

y r s

( M i l l i o n s ) 500

400

300

200

100

0

2010 2050

1

2

4

8

161

2

4

8

16

1

2

4

8

16

1

2

4

8

16

1

2

4

8

16

1

2

4

8

16

1

2

4

8

16

Alaska/N.W. CanadaE. Canada/Greenland/Iceland

1

2

4

8

16

E. North America

1

2

4

8

16

C. North America

1

2

4

8

16

W. North America

Central America/Mexico

Amazon

N.E. Brazil

W. Coast South America

S.E. South America

Population

increase factor

(2010 to 2050)

1 - 2.99

3 - 4.99

5 - 6.99

7 - 9.99

>10

Data not available

Not applicable


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Extreme heat is lethal in developed and developing countries: Daily maximum and minimumtemperatures, and number of deaths: Paris, Summer 2003 9

1

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16

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16

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1

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8

16

S. Africa

W. Africa E. Africa

Sahara

urope/Mediterranean

W. Asia

C. Europe

N. EuropeN. Asia

C. Asia Tibetan Plateau E. Asia

S. Asia

S.E. Asia

N. Australia

S. Australia/New Zealand

Increasingly frequent heatwaves will combine with growing vulnerable populations. Bar graphs showhow frequently a heat event that would have occurred only once in 20 years in the late 20 th Century,

is expected to occur in the mid 21 st Century, under different climate change scenarios. 6 Lower numbersindicate more frequent events. Countries are shaded according to the expected proportional increase in

urban populations aged over 65 8

250 45.0

40.0

35.0

30.0

25.0

20.0

15.0

200

150

100

50

0

Deaths in hospitals

Deaths reported by fire brigades

Daily min. temperature

Daily max. temperature

25.07 26.07 27.07 28.07 29.07 30.07 31.07 1.08 2.08 3.08 4.08 5.08 6.08 7.08 8.08 9.08 10.08 11.08 12.08 13.08 14.08 15.08 16.08 17.08 18.08


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PROTECTING POPULATIONS FROM HEAT STRESS

Protection from extreme heat requires a range of actions,from providing early warning, surveillance and treatmentfor vulnerable populations through to long-term urbanplanning to reduce the heat-island effect as well asinitiatives to reduce greenhouse gas emissions to limitthe severity of global climate change.

Collaboration between health and climate services iscritical to implement all of these ac tions. For example,following the devastating 2003 heat wave, 17 countriesacross Europe established heat-health action plans.The essential components of such action plans arethe identication of weather situations that adverselyaffect human health, the monitoring of meteorological

forecasts, mechanisms to disseminate warnings, andpublic health activities to reduce or prevent heat relatedillness and death. Hence, a pre-dened meteorologicalforecast will trigger a series of pre-dened actions, suchas the broadcasts of health warnings, targeted care forvulnerable population groups, real-time surveillanceand evaluation, and the preparation of the health andsocial care services. Such systems provide accurate andtimely alerts and are also cost-effective as European andNorth American experience shows. Broader use couldbe made of such actions in other regions of the world. 1,10

Through observation and study of essential data recordedover years, meteorologists are also providing a clearerunderstanding of how the combination of energy use,changes in land use and global warming are modifyingthe pattern of extreme temperatures over the long-term.Meteorological data provide essential inputs to developclimate scenarios, and allow verication of how weathereventually changes over time. Such information is criticalto planning local health adaptation, and monitoring theprogress of global climate change.

A large number of European countries now haveoperational heat-heath action plans 11

Countries withoperational heat-healthaction plans

National plans

Sub national plans

A N D R E Y S M I R N O V

, A F P / G E T T Y I M A G E S


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The information generated by meteorological agencies needs to be connected to preventive actionsby health and other sectors to form a heat-health action plan 13

Temperature forecasts can be automatically converted into the probability of exceedinga pre-dened threshold for a heat wave 12

Heat-waveprobability (%)

0.01 - 9.99%

0%

10.0 - 19.9%20.0 - 29.9%

30.0 - 39.9%

40.0 - 49.9%

50.0 - 59.9%

60.0 - 69.9%

70.0 - 79.9%

80.0 - 89.9%

90.0 - 99.9%

Priority actors: Health,Local Government, social

services, others.

Media

General public, vulnerablepopulation groups

Real-timesurveillance system

Alert

Historical data/experience

Selection ofheat event denition

Weather forecast Warning criteria

Criteria fullledNo Yes


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A N D R E A S G . K A R E L I A S / S H U T T E R S T O C K

. C O M

UV RADIATION

Melanoma incidenceper 100,000 population

< 0.4

0.5 - 0.7

0.8 - 1.5

1.6 - 3.8

3.9 - 36.7

Data not available

Not applicable

THE DANGERS OF THE SUN

While small doses of ultraviolet (UV) radiation from thesun help the body produce vitamin D, excessive exposureis damaging to human health. Excessive exposure may

have consequences ranging from premature ageing ofthe skin to skin cancer. The number of cases of malignantmelanoma has doubled every 7 to 8 years over thelast 40 years mostly due to a marked increase in theincidence of skin cancers in fair-skinned populationssince the early 1970s. This is strongly associated withpersonal habits : the societal view is that a tan is desirableand healthy. Children are most at risk, as exposure tothe sun during childhood appears to set the stage forthe development of skin cancer later in life.

UV radiation can also severely damage the cornea, lensand retina of the human eye long exposures can resultin photo keratitis and a lifetime of cumulative exposurecontributes to the risk of cataracts and other forms ofocular damage. In addition to the above risks, a growingbody of evidence suggests that levels of UV radiationin the environment may enhance the risk of infectiousdiseases and limit the efcacy of vaccinations.

Aggravating the situation is the hole in the ozone layerover Antarctica, which was discovered in 1985. Chlo-rouorocarbons (CFCs), and other industrial chemicalsreleased into the atmosphere, are destroying the strato-spheric ozone, which shields the Earth from harmfulUV radiation. That hole has now expanded to about25 million km 2.


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Incidence rates of skin melanoma in Australia, for different age groups (left hand side)and Los Angeles, USA for different skin types (right hand side) 2

80+

70-79

60-69

50-59

40-49

30-39

20-29

10-19

0-9

300

200

250

150

100

50

0

1983 1988 19981993

year

r a

t e p e r

1 0 0

, 0 0 0

Age

Black : MaleBlack : FemaleNon-Hispanic White : MaleNon-Hispanic White : Female

25

20

15

10

5

0

1973 1983 1993

year

r a

t e p e r

1 0 0

, 0 0 0

Estimated age-standardized incidence rate of melanoma, per 100,000 population 1


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ENJOYING THE SUN WISELY

Awareness on how to behave in the sun is important forcurbing the rapid increase in skin cancer observed inmany populations. The Global Solar UV Index is a dailyreminder to stay alert in the sun. It is a simple measureof the solar UV radiation level received at a particulartime on the Earths surface and an indicator of thepotential for skin damage. It was introduced in 1995 asa harmonized measure to monitor long-term changes inUV irradiation and UV spectrum on the Earths surfacecaused, for example, by ozone depletion.

The UV Index also serves as a vehicle to raise publicawareness and to alert people about the need to adoptprotective measures when exposed to UV. It is reported

along with the weather forecast during the summermonths in many countries. Encouraging individualsto protect themselves by seeking shade and wearingsuitable clothes remains the key to preventing the66 000 deaths from skin cancer every year.

Environmental protection is also necessary. WMO andUNEP played a leading role in setting up the 1985 ViennaConvention for the Protection of the Ozone Layer. TheMontreal Protocol, signed in 1987, controls the use ofsubstances that could damage the ozone layer. WMO and

the scientic community monitor the development ofozone worldwide by using meteorological data obtainedfrom the ground, balloons, aircraft and satellites. Withthe prospect of global climate change compounding theskin cancer risk through systemic and unprecedentedinuences on stratospheric ozone, hopefully, the les-sons learnt can help us meet even greater challengesto preserve our planets and our health.

THE BASIC SUN PROTECTION MESSAGES3 Limit exposure during midday hours.

Seek shade.

Wear protective clothing.

Wear a broad-brimmed hat to protect the eyes, face and neck.

Protect the eyes with wrap-around-design sunglasses or sunglasses with side panels.

Use and reapply broad-spectrum sunscreen of sun protection factor (SPF) 15+ liberally.

Avoid tanning beds.

Protect babies and young children: this is particularly important.


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Global UV index under cloudy conditions 4

6am 8 10 12 2 4 6 8pm

20

15

11

86

3

EXTREME

U V

I N D E X

VERY HIGH

HIGH

MOD

LOW

UV Alert: 10.10 am to 3.30 pmMAX UV Index:

9

How to read the SUNSMART UV ALERT

Daily maximum of UV Index cloudy, 15.08.12 00:00 UTC period= +12 h

0 0.5 1.5 2.5 3.5 4.5 5.5 6.5 7.5 8.5 9.5 10.5 12.5 14.5 UVI

Example of Global UV index incorporating information on time of day 5

W H O / D I A R M I D C A M P B E L L - L E N D R U M


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THE IMPACT OF NATURAL ALLERGENS

WHO estimates that around 235 million people currentlysuffer from as thma worldwide. It is the most prevalentchronic childhood disease. Asthma can be caused by

many factors, including poor air quality and the presenceof strong airborne allergens. Asthma costs Europe anestimated 17.7 billion per year, including the cost of lostproductivity estimated at 10 billion per year.

The European Federation of Allergy and Airway DiseasesPatients Associations estimates that 80 million (over24 per cent) adults living in Europe suffer from variousallergies, while the prevalence in children is 30 40per cent and increasing. One of the most widespreadtypes of allergies is related to the presence of allergenic

pollen in air. Its seasonal outbreaks cause a quick riseof symptoms and an increase in the consumption ofantihistamines.

The reasons for the increase in susceptibility to aller-gens, in particular to pollen allergens, remain elusive;however, environment and life-style factors appear tobe the driving forces. Evidence shows that chemicalair pollutants and anthropogenic aerosols can alter theimpact of allergenic pollen by changing the amountand features of the allergens thereby simultaneouslyincreasing human susceptibility to them.

Climate change is also affecting natural allergens inseveral ways. Over most of Europe, the growing seasonof many trees and grasses starts earlier and lasts longerthan 10 20 years ago. The total amount of pollenobserved in the air is also growing, probably due to theinteraction between changing land use, temperatureand CO 2 concentrations, although how they correlateis not yet fully understood. However, experiments inclimate chambers with controlled CO 2 showed that pollenproductivity of ragweed increases by 60 per cent when

CO 2 concentration is doubled.


POLLENS Ambrosia Pollen 2011none

very low

lowmedium

highvery high

Annual observed ambrosiapollen count in 2011 1


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Correlation between the presence of several types of pollenin the air with allergy symptom score (upper panel) andmedication intensity (lower panel) in the Netherlands 2

1

2

3

4

5

6

m e a n m a x

i m u m

s y m p

t o m

s c o r e

0

2 0 0

4 0 0

6 0 0

8 0 0

1 0 0 0

P o

l l e n

/ m 3

01jan2010 01apr2010 01jul2010 01oct2010 01jan2011

date

1

2

3

4

5

6

P e r c e n t a g e o

f p a r

t i c p a n

t s u s i n g m e d

i c a t

i o n

0

2 0 0

4 0 0

6 0 0

8 0 0

1 0 0 0

P o

l l e n

/ m 3

01jan2010 01apr2010 01jul2010 01oct2010 01jan2011

date

Birch Hazel Grass Alder Mugwort


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MITIGATING THE IMPACT OFNATURAL ALLERGENS

Pollen concentrations in air change strongly over timeand space. A single plant usually pollinates only fora few hours or days, mainly releasing pollen duringdaytime, but pollen can remain suspended in air severaltens of hours, causing allergy outbreaks far away fromtheir source at any time of the day. However, pollenconcentration decreases rapidly with distance fromthe source, so that a single tree in a garden can havestronger health impact than a large forest 10 km away.

Wmo_1098 - Atlas of Health and Climate

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