Global Environmental Change

&
Health

Paul R. Epstein, M.D., M.P.H.

Center for Health and the Global Environment
Harvard Medical School
http://med.harvard.edu/chge
The loss of forests, freshwater and biodiversity,
inadequate and inefficient use of energy, and the
explosive growth in the world’s urban centers undermine
long-term economic growth and threaten ecological
systems. They also endanger human health, and increase
developing countries vulnerability to natural disasters
and conflict. …
Furthermore, increases in global greenhouse gas
emissions, approximately fifty percent of which are
produced in developing countries, threaten to disturb the
delicate ecological balance, disproportionately affecting
the world's poor who are the least able to adapt to these
changes. Long-term economic growth depends upon
managing a country’s natural resources base, using
energy to increase human productivity, helping cities to
provide services and markets, and having predictable
seasonal and long-term climatic conditions.
-- US Agency for International Development (2002)
 Traditional Ecological
Epidemiological Epidemiological
Framework Framework

Agent Social
SYSTEMS

Host Environment Ecological Global

Disease Epidemics
Global Temperature: the Past 20,000 Years,
& the Next 100 Years
Av. temp. over past 10,000 years =15
3 ºC IPCC (2001) forecast:
Mesopotamia + 1.4-5.8oC, with band
2 flourishes
Agriculture Vikings in of uncertainty
1 emerges Greenland
Black
0 Death
Holocene 21st
Temp. Optimum Medieval 1940
change (ºC) Warm Little Ice century:
Age in Europe
-2 (15th-18th
-3 End of centuries) rapid
last
ice age Younger rise
-4
Dryas
-5
20,000 10,000 2,000 1,000 300 100 Now +100
 370 ppm

VOSTOK ICE CORE

280 ppm

CO2
T

180 ppm
420 kya Present
Observed vs. modeled temperature rise since 1860
 Deep
Ocean
Warming
SST Anomalies May 2003
Health Impacts of Climate Change
 HEATWAVES
May 2003
Andhra Pradesh
T 122•F
>400 deaths

HUMIDITY & HEAT INDICES

TMINS
 AIR POLLUTION
AND CLIMATE CHANGE
Indoor pollutants SES/emotional factors

Diesel
(& pollen)
 ASTHM
Pollen A
2-3x
Since
Floods & Mold
1980s
Droughts & Fires Ground-level
Ozone
  (T-dependant)
 IPCC 2001: New Findings
Extreme Weather Events
Heatwaves, Droughts & Floods
Intensity & Frequency
(rains >2”/d)
Biological Systems

are Responding
• Plant migrations

• Insects & butterflies

• Bird egglaying
• Marine species
 Emerging Infectious Diseases
30 DISEASES “NEW” TO MEDICINE SINCE 1976
HIV/AIDS Ebola
Legionnaires’ E. coli O157:H7
SARS Antibiotic-Resistant Agents

Hantavirus Pulmonary Syndrome

VECTORS
Lyme Disease Nipah Virus Mosquitoes
Vibrio cholerae O139 Arenaviruses Ticks
Rodents
Bats
Tsetse Flies
RESURGENT & REDISTRIBUTING Fleas
Malaria, Dengue Fever, West Nile Virus, Lice
Snails
Cholera
Algae
INFECTIOUS DISEASE
The “Good” News
A DRIVING FORCE IN
HISTORY

The Bad News

PLAGUE
541 AD
1346 AD

Cholera, TB, Smallpox

Climate Models and Potential Malaria Distribution

T
~1ºC/C

~2ºC/C

1950 2000
THE CRYOSPHERE
PLANT COMMUNITIES
Geographic Shifts of Mosquitoes
450 ft.
~2•F warming
1970-1990

Diaz & Graham, Science: 19967

 LYME DISEASE
PREDATORS OF DEER WARMER
WINTERS

1980s 1990s

TICK DISTRIBUTION IN SWEDEN

Lindgren & Gustafson. Lancet 2001;358:16
 HURRICANE
HURRICANE MITCH 1998
MITCH
 HURRICANE MITCH
IMPACTS ON HEALTH
AND DEVELOPMENT

DISEASE CLUSTER
-- Malaria (>30,000 cases)
-- Dengue fever (>1,000)
-- Cholera (>30,000)
-- Leptospirosis
 4161 cases
WNV
HUMAN CASES & DEATHS
284 deaths

BLOOD
ORGAN TRANS
IN-UTERO
? BREAST MILK
62 66
21 …………………
POLIO-LIKE
PRESENTATION
1999 2000 2001 2002
&
NEURO SEQUELAE
Science 2002:297:1988
 WNV: A DISEASE OF WILDLIFE
230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES

• 138 Bird spp., RAPTORS

- 37 spp. of mosquitoes

• HORSES
• ZOO animals
• REPTILES

AVIAN FLYWAYS
INFECTIOUS DISEASES: FORCES OF GLOBAL CHANGE

SPECIES LOSS VECTOR DISEASES

Raptors Rodents

Lyme, Hantaviruses,
Leptospirosis, Plague

Vulture die off

India
Feral Dogs Rabies
Hantavirus Pulmonary Syndrome

1993 Drought, Then Early Rains

10X Explosion of Mice Populations
Range Expansion of Soybean Cyst
Nematode in North America
Crop Pests
Generations/Year
 DISEASES OF
US TREES
•West Coast fungi (Phytophthora)
•Alaska spruce bark beetles
2 generations/year
•East Coast hemlock woolly adelgid
N w/ warm winters

Droughts vulnerability to pests.

Diseased trees susceptible to fire.
 Coral Diseases
Color Variants on M. cavernosa
Photo: Raymond Hayes Red Band Disease on M. annularis
Photo: Laurie Richardson
SARS Severe Acute Respiratory Syndrome
CORONAVIRUS

1. Species X-over
2. Genetic reshuffling
3. Farming practices &
food handling

$50-100 BILLION
TRADE, TRAVEL, TOURISM
Bio Economic Research Associates,
Cambridge, MA
HIV/AIDS
SOCIAL AND ENVIRONMENTAL DETERMINANTS

Transmission
Informal sector, Mining, Conflict

Viral Evolution
Coxsackie virus
Levander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528

Malnutrition & disease burden

Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754

Stress proteins & mutations

Immune surveillance system
 Costs of Extreme Weather Events
Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies

UNEP
$150b/y w/in this decade
 Levels of Solutions
I. Surveillance and Response Capacity

II. Health Early Warning Systems

III. Environmental, Energy & Economic

Policies
 CHALLENGES

CLEAN ENERGY HARMONIZING ADAPTATION &

MITIGATION
Solar-powered
•clinics, homes, schools & enterprises
•water purification, pumping &
desalination

MDGs HEALTH, NUTRITION, POVERTY

AGENDA 21 FISHERIES, FORESTS, POPs

 CLEAN DEVELOPMENT
Framework
Reg

Funds Inst THE ENGINE OF

GROWTH
for the
21st CENTURY
 EE and RE
 “Green Buildings” & Smart Growth
 Rationalized Transport & Transit
 Retrofitting Infrastructure
 Ecological Reconstruction