Saturday, 5 October 2019

The Environment and Climate

Change
FAMILY MEDICINE

Gloria Peret-Clarion, MD, DFM, FPAFP

What do we know about climate change?

The earth is getting warmer

A relatively rapid increase in temperature has been

documented during the past century, both at Earth’s 2015 - Warmest Global Year on Record (since 1980) -
surface and in the oceans. The average surface Colours indicate temperature anomalies (NASA/NOAA; 20
temperature for Earth as whole has risen some 1.3 January 2016).

Fahrenheit since 1850. The standing point for a global

What is the Greenhouse Effect

network of thermometers. If emission rates for greenhouse

gasses which trap heat inside Earth’s atmosphere continue It generally comes from the build up of carbon dioxide gas
on this current track, models indicate that the globe will be in the atmosphere. Carbon dioxide is produced when fuels
4.3 to 11.5 F warmer by 2100 than it was in 1990
are burned.

In this type of pollution sun rays go into the atmosphere

and they are trapped by the greenhouse gasses. So the

The average change in temperature per decade from 1950

to 2005. In degrees Celsius (if the scale were in ºF, it would
go from -.72 to 72.1

Rising fossil fuel burning and land use changes have

emitted, and are continuing to emit, increasing quantities
of greenhouse gases into the Earth’s atmosphere.
temperature on the Earth rises.

This greenhouse gasses include CO₂, methane and Nitrous The Greenhouse Effect

Oxide

1. Greenhouse gases allow direct sunlight to pass

Rise in these gasses has caused a rise in the amount of through and reach the Earth’s surface.

heat from the sun withheld in the Earth’s atmosphere -

2. Some of the energy is reflected back to space

heat that would normally be radiated back into space.

3. As the Earth’s surface warms up, some of the energy is

This increase in heat has lead to the GREENHOUSE
radiated back to space.

EFFECT, resulting in climate change.

4. However, less of this heat is able to escape into space

as greenhouse gases absorb the energy and “trap” it in
the lower atmosphere.

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NATURAL GREENHOUSE GASES GREENHOUSE GASES

• Water vapor (H₂0), 36-70%

Carbon dioxide, a major greenhouse gas, is increasing in
the atmosphere faster than at any time measured in the
• Carbon dioxide (CO₂), 9-26%
past, having grown by about 35% since 1850

• Nitrous oxide (N₂0), 4-9%

Methane has increased by 150%; methane is 25 times
more effective per molecule at trapping heat than CO₂.

• Methane (CH₂), 3-7%

Nitrous oxide has increased by more than 20%. Nitrous

oxide is nearly 300 times effective per molecule at trapping
Water Vapour: It’s a Gas!
heat than CO₂.

The top countries emitting CO2 (2016)

Water can take the form of an invisible gas called water

vapour. Water vapour is naturally present in the
atmosphere and has a strong effect on weather and
climate.

As the planet gets warmer, more water evaporates from

the Earth’s surface and becomes vapour in the
atmosphere. Water vapour is a greenhouse gas, so more
water in the atmosphere leads to even more warming. This
is an example of positive feedback loop, which happens
The main characteristics of climate change are:
when warming when warming causes changes that lead to
even more warming.
1. Increases in average global temperature (global
warming);

2. Changes in cloud cover and precipitation particularly

WHY ARE THE GASES IMPORTANT/.

over land;

• Heat would escape back into space

3. Melting of ice caps and glaciers and reduced snow

• Earth’s temperature would plunge to a chilly zero on the cover; and

Celsius scale

4. Increases in ocean temperatures and ocean acidity -

• Makes Earth suitable for life
due to seawater absorbing and carbon dioxide from
the atmosphere

CLIMATE CHANGE

EXAMPLES OF CURRENT IMPACTS:

The release of greenhouse gasses has increased
significantly since the industrial revolution, mostly from:
1. Likely increase in frequency of heatwaves

• The burning of fossil fuels for energy

2. Heavy rainfall events

• Agriculture
3. Storm surges are extremely higher due to ongoing sea
level rise

• Industrial processes

4. Increasing CO2 in the atmosphere is causing the

• transportation
ocean to be more acidic

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Climate Change is Reflected in Extreme Weather

EVIDENCE TO SUPPORT GLOBAL WARMING It is considered very likely that increasing global
temperatures will lead to higher maximum temperature,
- Rise in average global surface temperatures
more heat waves, and fewer cold days over most land
- 13 warmest years on record since 1990
areas. More severe drought in some areas, combined with
other factors, as contributed to larger and more frequent
- Arctic temperatures have risen twice as fast
wildfires.
- Changes in glaciers, rainfall patterns, hurricanes

- Sea level rise in this century 4-8 inches

A Fast Defrosting Arctic

Warmer temperatures not only causes glaciers and land The Arctic is heating up about twice as rapidly as the rest
ice to melt (adding more volume to oceans) but also cause of the planet. This is due in part to several “feedback
seawater to expand in volume as it warms
loops” in which the consequences of arctic thawing drive
temperatures even higher. For example. As sea ice and
The global average sea level rose by just under 0.07 inches seasonal snow cover melt, previously reflective white
per year during the 20th century, but that number has risen surfaces are converted to darker ocean water or
to 0.21 inches per year since the early 1990’s.
vegetation, respectively. These dark surfaces absorb more
Under a “business as usual” greenhouse gas emissions solar radiation, leading to higher air temperatures which
scenario, models indicate that sea levels could rise 2 feet leads to even more rapid melting and so on.
or more by 2100 compared to 1990 levels.
Thawing permafrost represents another potential feedback
loop. Permafrost, the permanent frozen ground found
throughout the cold regions contains a great deal of
CHANGES ARE RIPPLING THROUGH THE WATER carbon in the form of partially decomposed organic matter.
CYCLE
As permafrost warms, the microbes that decompose the
material become more active, releasing carbon dioxide and
Climate change has complex effects on water supply and methane into the atmosphere.
demand. The seasonal rhythms of streams and rivers have
changed as water precipitation falls increasingly as rain
instead of snow, and as earlier spring temperatures cause
CAUSES OF GLOBAL WARMING
snow in the mountains to melt earlier and faster. Climate
change may mean that some places will still experience • Greenhouse gases increase through human activity

more days with very heavy rain; other places may see more
frequent, intense, and long-lasting droughts. Warmer • Deforestation

temperatures also mean higher evaporation rates and

thirstier plants and people, increasing demands for water. • Use of fertilisers

A warmer world will experience more precipitation on a • Burning of organic matter

global scale, but the changes will not be the same

everywhere. Projections indicate that on average dry areas • Burning fossil fuels

will tend to get drier, and wet areas will tend to get wetter.

EVIDENCE TO SUPPORT GLOBAL WARMING (Graph)

CONSEQUENCES OF GLOBAL WARMING

• Climate change

• Changes in wildlife adaptations and cycles

• Melting of polar ice caps

• Increase in sea level

• Flooding in coastal areas

• Ocean acidification

• Heavy drought

• Spread of diseases

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CLIMATE CHANGE IMPACTS ON HUMAN HEALTH In recent decades, dengue has become an increasing
urban health problem in tropical countries.

Monitoring climate change impacts on human health

The disease is thought to have spread mainly as a result of

Climate change is likely to cause incremental changes in

the frequency of distribution of diseases that are also • ineffective vector and disease
affected by several other factors. In their report on malaria surveillance;

early warning systems Thomson and Connor stressed that

the commonest causative factor of Malaria epidemics is • Inadequate public health structure;

‘abnormal meteorological conditions, which temporarily • Population growth;

change the ecological equilibrium between the host and

the vector(s) and parasite(s). Monitoring to assess climate- • Unplanned and uncontrolled urbanization; and

change impacts on health requires data gathering coupled

with analytical methods for quantifying the climate- • Increased travel

attributable part of such diseases.

The main vector of dengue is the domesticated mosquito,
Aedes aegypti, that breeds in urban environments in
artificial containers that hold water.

Major causes of diarrhoea linked to contaminated water

supplies are:
Dengue can also be transmitted by Aedes Albopictus,
which can tolerate colder temperatures.

• cholera

• cryptosporydium

Malaria is the world’s most important vector-borne

• E. Coli
disease.

• giardia
Over 2.5 billion people are at risk, and there are estimated
to be 0.5 billion cases and more than 1 million deaths from
• Shigella
malaria per year.

• Typhoid
Malaria incidence is influenced by:

• Viruses, such as hepatitis A

• The effectiveness of publich health infrastructure;

• Insecticide and drug resistance;

RODENT-BORNE DISEASES
• human population growth;

Rodents act as reservoir for a number of diseases whether • immaturity;

as intermediate infected hosts or as hosts for arthropod

vectors such as ticks
• travel;

Certain rodent borne diseases are associated with flooding • land use changes and

including:

• climate factors

• Leptospirosis

Very high temperatures are lethal to the mosquito and the

• tularemia, and
parasite.

• viral haemorrhagic diseases

• In areas where temperatures are close to the
physiological tolerance limit of the parasite, a small
Other diseases associated with rodents and ticks include
temperature increase would be lethal to the parasite and
malaria transmission would therefore decrease.

• plague

• Lyme disease
• However, at low temperatures a small increase in
temperature can greatly increase the risk of malaria
• tick-borne encephalitis (TBE) and
transmission

• Hantavirus pulmonary syndrome (HPS)

HEALTH IMPACTS OF NATURAL DISASTERS INCLUDE:

• Physical injury;

Dengue is the most important arboviral disease of • Decreasing nutritional status, especially in children;

humans, occurring in tropical and subtropical regions

worldwide.

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• increases in respiratory and diarrheal diseases due to Table 5.2 Mechanisms by which below-average rainfall
crowding of survivors, often with limited shelter and can affect health
access to potable water;

Event Type Description Potential

• Impacts on mental health which may be long lasting in Health
some cases;
Impact

• Increased risk of water-related infectious diseases due Drought Meteorological Evaporation Changes in vector
exceeds water abundance if
to:
absorption; soil vector breeds in
water decreases
dried up river
• disruption of water supply or sewage systems;
beds, for example
Several indices
have been
• population displacement and
developed based
on meteorological
• overcrowding
variables, e.g.,
Palmer

• Release and dissemination of dangerous chemicals from Drought Agricultural Drier than normal Depends on
storage sites and waste disposal sites into flood waters
conditions leading socioeconomic
to decreased crop factors, i.e., other
production sources of food
available and the
means to acquire
Table 5.1 Mechanisms by which above-average rainfall them
can affect health Social Reduction in food Food shortage,
Drought
supply or income, illness,
reduction in water malnutrition
Event Type Description Potential supply and quality (increased risk of
Health infection)
Impact
Drought Food shortage / >10 killed, and/or Health impacts
famine / drought 200 affected, or associated with
Heavy meteorological “extreme event” Increased
disaster government population
precipitation mosquito
calling for external displacement
abundance or
assistance
decreased (if
breeding sites are
washed away

Flood Hydrological river/stream Changes in

overtops its banks mosquito CLIMATE CHANGE

abundance;

contamination of
surface water;
Developing countries are the most vulnerable to climate
change because they have fewer resources to adapt;
Flood Social Property or crops changes in
damaged mosquito
socially, technologically and financially

abundance;

contamination of Many developing countries’ governments have given

water with faecal
matter and rat
adaptation action a high, even urgent, priority

urine
(leptospirosis)

Flood Catastrophic Flood leading to Changes in

flood / “disaster” >10 killed, and/or mosquito
ADAPTATION MEASURES BY VULNERABLE SECTORS
200 affected, and/ abundance;
HIGHLIGHTED IN NATIONAL COMMUNICATIONS OF
or government contamination of
calling for external water with faecal
DEVELOPING COUNTRIES

assistance matter and rat

urine and VULNERABLE SECTOR: HUMAN HEALTH

increased risk of
respiratory and
diarrhoeal disease
REACTIVE ADAPTATION:

deaths; drowning
injuries; health 1. Public health management reform

effects associated
with population
displacement;
2. Improved housing and living condition

Koss of food
supply; 3. Improved emergency response

psychosocial
impacts
ANTICIPATORY ADAPTATION:

1. Development of early warning device

2. Better and/or improved disease/vector

surveillance and monitoring

3. Changes in urban and housing design

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**90% - stratosphere

FUTURE OUTLOOK OF GLOBAL WARMING

• UV-A (400-315 nm) - not screened (reaches the earth)

Natural resources depleted, need balance betwen • UV-B (315-280 nm) screened out by ozone

environment and industry environment and industry by

reducing Greenhouse gas emissions by 80%
• UV-C (280-100 nm) - screened out by dioxide and ozone

Conserve energy, use of 3R’s, reforestation

OZONE DEPLETION IN STRATOSPHERE

Key messages - climate changes conference advocacy A concentration of pollution at the poles and other factors
toolkit
caused chlorine pollution to be concentrated in Antarctica.

Climate change is increasing diseaster risk for millions of • When the sun returns in the spring, the energy liberates
the world’s most vulnerable people.
the chlorine from ice

Local action is the key to adaptation. Empowering • Chlorine causes ozone (O3) to be broken down into
communities through knowledge about climate change is oxygen (O2)

crucial to ensure informed and appropriate action at the - Cl･ + O₃ ➡ ClO + O₂

local level.

More investment is needed for disaster risk reduction, - Cl･ + O₃ ➡ Cl･ + 2 O₂

including effective early warning systems across all

timescales.

Youth engagement is pivotal for developing sustainable Ozone thinning/hole

solutions into the future.

• First identified in 1985 over Antarctica

More attention is needed for solutions that harness

• A 1% decrease in ozone results in a 2% increase in UV
synergies between climate change adaptation and climate rays reaching the earth.

change mitigation.

• Caused by:

• ODS - Ozone Depleting Substances

THINNING OF THE UPPER OZONE

• Human-produced bromine and chlorine-containing
LAYER
chemicals

• Ex. CFCs

OZONE-DEPLETING SUBSTANCES

Ozone depleting substances are mainly CFC/s, HCFC’s,

Halons, etc. which are found in Refrigerators, Cleaning
agents, sprays, pesticides, Air conditioners, car emissions,
etc.

OZONE

OZONE-OXYGEN CYCLE:

O₂+ hv UV ➡ 2O

O+ O₂ ➡ O₃

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HOW CFCs CAUSE OZONE DEPLETION

RECOVERY OF OZONE LAYER

• The MONTREAL PROTOCOL was passed in 1987.

• Countries agreed to phase out CFC use by the year

2000.

• CFC levels in the atmosphere decreased and the ozone

layer is beginning to recover.

• Full recovery will not occur until 2050.

Sep 16 = World Ozone Day

STRATOSPHERIC OZONE DEPLETION

Stratospheric ozone depletion, climate change and health

Stratospheric ozone depletion essentially is different

process from climate change.

1. UV causes a chlorine atom to break away from the

CFC molecule
However, the phenomenon of the climate’s greenhouse-
warming shares many of the chemical and physical
2. The free chlorine atom hits an ozone molecule
processes involved in the depletion of stratospheric ozone.

3. The chlorine atom pulls one oxygen atom away

Some greenhouse gases contribute to stratospheric ozone
4. A free oxygen atom hits the chlorine monoxide destruction.

molecule
Agreements among nations (Montreal Protocol) have
5. The result is another free chlorine atom
achieved reductions in ozone-depleting gases and it is
expected that stratospheric ozone depletion will begin to
6. Free chlorine will continue to deplete ozone in the decline in a decade or so.

stratosphere

With all other sources assumed constant, the recovery of

OZONE DEPLETION IN STRATOSPHERE stratospheric ozone is expected to be underway by the
second quarter of this century, and should be substantially
Ozone protects the earth from UV radiation
complete by the third quarter.

(a) stratospheric ozone absorbs about 99% of incoming Unfortunately for climate change, the result is not all
solar ultraviolet (UV) radiations, effectively shielding the positive.

surface

Substitutes for the CFCs are known to contribute to

(b) When stratospheric ozone is present at reduced levels, greenhouse-warming, confirmed by global observations.

more high-energy UV radiation penetrates the

atmosphere to the surface, where its presence harms Another confounding effect is that as ozone depletion acts
organisms
to cool the climate system, ozone recovery is actually
expected to contribute to climate warming.

“Failure to comply with the Montreal Protocol and its

amendments would significantly delay or even prevent the
ozone layer’s future recovery, jeopardising, among others,
public health.”

A review of evidence has been presented, for thee main

categories of health impact:

• Skin cancers (adverse impact)

• Eye disorders (adverse impact)

• Immune-related processes and disorders (mixed impact

- some adverse, some potentially beneficial)

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POSSIBLE EFFETS OF SOLAR UV RADIATION ON THE • Possible decreased risk for schizophrenia, breast
HEALTH OF HUMAN BEINGS
cancer, prostate cancer

EFFECTS ON SKIN • Possible prevention of type 1 insulin dependent

diabetes mellitus

• Malignant melanoma

• Non-melanocytic skin cancer - basal cell carcinoma,

squamous cell carcinoma
INDIRECT EFFECTS::

• Sunburn
Effects on climate, food supply, infectious disease vectors,
air pollution, etc.

• Chronic sun damage

• Photodermatoses

POSSIBLE EFFECTS OF UV RADIATION

Figure 8.3 Estimates of ozone depletion and skin cancer

POSSIBLE EFFECTS OF UV RADIATION
incidence to examine the Montreal Protocol achievements

EFFECTS ON THE EYE

• Acute photokeratitis and photoconjunctivitis

• Climate droplet keratopathy

• Pterygium

• Cancer of the cornea and conjunctiva

• Lens opacity (cataract) - cortical, posterior subcapsular

• Uveal melanoma

• Acute solar retinopathy

• Macular degeneration

EFFECT ON IMMUNITY AND INFECTION

• Suppression of cell mediated immunity

The majority of the known health consequences of
increased UVR exposure are detrimental. However, UVR
• Increased susceptibility to infection

exposure also has some beneficial effects. Therefore, while

• Impairment of prophylactic immunization
excessive solar exposure should be avoided — the more
so during current and foreseeable period of stratospheric
• Activation of latent virus infection
depletion — so should excessive sun avoidance. Future
public health advice about solar exposure should take
account of the changing ambient UVR environment and
OTHER EFFECTS: the available knowledge about the health risks of UVR
exposure.

• Non-hodgkins lymphoma

• Altered well-beiong

The beneficial Role of UVR for Vitamin D synthesis in

• sleep-wake cycles
humans
• seasonal affective disorder
The active metabolite of Vitamin D (1,25(OH)₂D₃) is a
human hormone with an important role in calcium and
• mood

phosphorous regulation in humans. It also has other

• Cutaneous Vitamin D production
important roles. In 1822, the link between sunlight
deprivation and the bone disease Ricketts was postulated.
• Prevention of rickets and osteoporosis
This link was confirmed in the early 1900s by experiments
that showed that sunlight exposure could cure rickets.
• Possible benefit for hypertension, ischemic heart
disease and tuberculosis
More recently, vitamin D has been shown to have an

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important role in the immune system and also may be
important in the growth of neural tissue during early life.
Furthermore, Vitamin D receptors (VDR) have now been
located in a variety of cells (e.g., brain, breasts and
pancreas).

Sun exposure is the primary determinant of Vitamin D

levels in terrestrial vertebrates including humans. UVB rays
enter the epidermis and release energy that converts a pre-
existing cholesterol metabolite to previtamin D and its
isomer cholecalciferol. Cholecalciferol 25(OH)D is carried in
the blood stream to the liver and the kidneys, where, after a
series of biological reactions, the acitve Vitamin D hormone
(1,25(OH)₂D) is formed, Circulating serum 25(OH)D
concentration provides an integrated assessment of
Vitamin D intake and stores.

The exact dose of UVR exposure for optimal vitamin D

levels is not known particularly as the required UVR dose
will be influenced by host-factors such as skin
pigmentation, active vitamin D receptor gene allelic status
and dietary Vitamin D intake. Whole body exposure in a
bathing suit to one minimum eurythermal dose of UVR is
equivalent to ingesting 10,000 international units of vitamin
D. It is important to note that while excessive Vitamin D can
lead to Vitamin D toxicity, excessive UVR exposure cannot
lead to Vitamin D toxicity

+++ end +++

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