Public health services facing the twin challenge of climate change and petroleum peak

7/27/2019 Public health services facing the twin challenge of climate change and petroleum peak

1/92

Public health servicesfacing the twin challenge

of climate changeand petroleum peak

G S Leonardi

Medical Epidemiologist, Fellow of the Faculty of Public Health

Chilton Seminar, 30th November 2012


2/92

What does the future hold?

Increases are of sluggish growth, but the

way to ruin is rapid.

Lucius Anneaus Seneca

If a man takes no thought about what is

distant, he will find sorrow near at hand.Confucius, Analects 15, 11


3/92

Outline

Global climate and environmental change

Examples of impacts, including epidemiology

Petroleum peak

Changes to public health services

Increase focus on water


4/92

Public Health Action

Empedocles (490-440BC), accordingto Diodorus, managed to makeSelinunta a healthy town throughirrigation.

The area suffered from malaria andcontaminated water.

By opening up two rivers to the sea,he channelled slack water anddrained the swamps making thewater drinkable.

Sanitary works minimised the

epidemic of fever in Selinunta.This is one of the earliest PublicHealth Projects

Changes in malaria can be mitigatedby public health action
http://upload.wikimedia.org/wikipedia/commons/7/79/Empedokles.jpeg


5/92

Acknowledgements

Tony McMichael Andy Haines

Paolo Vineis

Sari Kovats

And many others


6/92

Health is influenced by

lifecourse factors (early infections and other experiences)socio-economic position

psychology

educationnutrition

health care systems

environment (physical, chemical, ecological, mediated byhousing, workplace, transport)

(see articles on Health, Wealth, and Ways of life,

Social Science & Medicine Volume 74, Issue 5, March 2012Available at: http://bit.ly/zKr6AT)
http://bit.ly/zKr6AThttp://bit.ly/zKr6AT


7/92

Public health service definition and functions

Definition

Environmental public health: the science and art of

prevent ing disease, pro long ing l i fe and promot ing

health where env ironmental hazards are the key factor ,

through organised efforts of society

Functions

Environmental health services implement this by risk

assessment, management and communication, in

relation to accidents, water quality, air quality, food

quality and safety, waste management and soil

pollution, human ecology and settlements

(WHO 2001)

(Spiby 2006)


8/92

200 2,000 20,000

Societal economic growth: GNP/person over time

(in notional US dollars)

Air pollutants:particulates, O3, Nox

Lead Occupational hazards

Water quality Urban noise

Atmospheric carbon dioxide Persistent Organic Pollutants Ozone-depleting gases Urban nonbiodegradable waste

Exposureor

environmentaldamage

Household sanitation Aflatoxin in food Black smoke

(Wilkinson, 2006)


9/92


10/92

(Rockstrom et al, Nature 2009)

Exponential rise of everything

(Rockstrm et al, Nature 2010)


11/92

The Nature and Value of Ecosystem Services:An Overview Highlighting Hydrologic Services

(Brauman 2007)


12/92

Climate Changeoccurring faster

than expected

1m: half of Bangladesh rice fields2m: most of Mekong Delta

IPCCs Fourth Assessment Repo rt(2007) now looksconservative[in addition to cautious review process]

Subsequent research shows increasing rates of:

Global Greenhouse Gas emissions

Ice melting (Arctic sea ice, Greenland/Antarctic ice-sheets, alpine glaciers)

Sea level rise

Also:

Increasing saturation of carbon sinks (land and oceans)

Estimated amount of carbon stored in permafrost

= twice the atmospheric carbon


13/92(Source: Munich Re 2009)

Overall losses and insured lossesabsolute values and long-term trends of majorweather-related catastrophes 1950-2009


14/92

Health Risks:Looking to wider horizons

Acid rain

(regional)

Global climatechange

Direct, toxic, hazard

Disruption oflife/health-support

systems

Environmentaltobacco smoke

Local air pollution


15/92

Climate Change and theGlobal Burden of Disease

WHO World Health Report2002estimated that, in 2000,global climate change was already responsible, indeveloping countries, for:

2.4% of diarrhoeal disease

Up to 6-7% of malaria and dengue in specified groups of high-risk countries

Substantial declines in regional food yields (and, therefore,levels of malnutrition)


16/92

(Patz 2005)

WHO estimated mortality (per million people)attributable to climate change by the year 2000


17/92

Climate Change: Health Impact PathwaysPhysicalsystems

(river flows, soilmoisture, ocean temp)

Biologicalcycles, innature &

Ecologicallinks/function

Economic/socialimpacts:infrastructure,farm/factory production, GDPgrowth, jobs, displacement

Human Health:

Injuries/deaths Thermal stress

Indirecthealthimpactsecologicallymediated

Indirecthealthimpacts

sociallymediated

Direct impacts(extreme weatherevents, heatwaves,air pollutants, etc.)

Infectious diseases Under-nutrition Mental stresses

Other disorders

ClimateChangeImpacts

(McMichael 2009)


18/92

Past FuturePresent

Learn Detect

Forecasting,

modelling

Three Main Types of Research

Empirical studies

Adaptation (incl evaluation)(McMichael 2009)


19/92

Research Category I

Learning about climate variation

and health risks from pastevidence


20/92

Heat waves, warmer

winters, injuries,floods

Mosqui to-borne

diseases, food

pois oning, al lergies

secondary

pr imary

tert iary

Health impacts of climate change

Food scarcity, famine, conflict,

displacement, refugees,

development failure


21/92

2003 = 4th hottest summer

Brogdale (Kent) recorded England'shighest temp 38.5 C on 10 Aug

> 32 C was exceeded 4 - 6 August and 8 -12 August,

June 1976, temperatures exceeded 32 C (90F), somewhere in the UK, on 15 consecutive

days starting 23 June.

Temperature distributionacross Europe on 10

August 2003 at 1500hrsBritish Summer Time

Heatwave: MaximumTemperature, August 10, 2003


22/92

Daily temperatures and deaths in major Parisianhospitals, July -August 2003

50

100

150

200

250

2 4 6 8 10 12 14 16 1825 27 29 31July August

Max daily temp

Min daily

temp20

25

30

35

40

15

Deaths TempoC

Stott et al (Nature, 2004): The

underlying warming trend over recentdecades in Europe (predominantlyhuman-induced) had doubled theprobability of such an extreme

heatwave occurring.


23/92

Drinking Water Salinity and Maternal Health

in Coastal Bangladesh: Implications of

Climate Change

MonthNo. of cases

Total no. of

pregnancies

Prevalence rates of

hypertension (with or

without proteinuria)

(95% CI)

MaySept 20 393 5.09 (2.917.26)

OctApril 70 576 12.2 (9.4814.8)

Total 90 969 9.28 (7.4611.1)

(Khan 2011)


24/92

Flood events in 1994-2005

24

Total:

319 events (8,886 boundaries)

1,095km2 (1,680km2in gloss)

Exposed population (estimate):

67k households

237k persons

Target p/cs : 2,159,132

Flooded 4,814 (0.2%)

N-flooded (


25/92

Climate Change and Infectious Disease

Many infectious diseases are climate-sensitiveespecially vector-borne diseases

Some recent changes in ID patterns mayreflect influence

of climate change:Tick-borne encephalitis (Sweden)

Cholera in Bangladesh

Malaria in east African highlands

Time-trends in food-borne (infectious) disease


26/92

Source: Climate Change Futures, 2005

Malaria

cases

Malaria and Floods in Mozambique

Maputo

precipitation

Malaria cases


27/92

Relative Change in Malaria Incidence Before, During and AfterEl Nio EventsVenezuela, 20th-century annual time series

2.0

-2

1.8

1.6

1.4

1.2

1.0

0.8

Mean Proportional Change

-1 0 (Nio) +1 +2

Time Lag (years)

Coast (1910-1935)

Whole country

Average of both

Bouma & Dye. JAMA 1997


28/92

Fitted values of monthly Salmonel lacounts in relationto monthly temperature in five Australian cities, 1991-2001

0

10

20

30

40

50

60

70

80

90

100

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Temperature oC

Salmonellacou

nt

Perth

Brisbane

Adelaide

Melbourne

Sydney

DSouza et al., 2003

2 oC rise 12% increase

5 oC rise 25% increase


29/92

Research Category II

Seeking evidence of currenthealth impacts of climate

change


30/92

Hot weather and calls to NHS Direct

0

10

20

30

40

0 10 20 30Temperature (average of lags 0-1)

Total symptomatic calls

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1-Jul-03

8-Jul-03

15

-Jul-03

22

-Jul-03

29

-Jul-03

5-Aug-03

12

-Aug-03

19

-Aug-03

26

-Aug-03

ProportionofNHSDirectheat/sunstrokecalls(%)

Proportion of heat/sun stroke calls Severe heat periods

(Leonardi, 2006)


31/92

NHS Direct calls in summer 2006

4 peaks:

11th June, 3rd July, 19th July, and 26th July


32/92

Greenland Ice Sheet:Increase in Area Melted in Summer, from

1992 to 2002. (Arctic Climate Impact Assessment, 2004)

Orange area = melt-zone

1992 2002


33/92


34/92


35/92

H i K t i N O l


36/92

Hurricane Katrina, New Orleans,USA, 2005

Natural or Unnatural?

Hurricane Katrina Passing over Gulf of Mexico (NASA 2005)


37/92

Hurricane Katrina Passing over Gulf of Mexico (NASA, 2005)

Yellow, orange, and red areas at or above 82F (27.8C, thetemperature required for hurricanes to strengthen).

Increasing power of tropical cyclones over


38/92

Change incyclonic

power (PDI),and Temp oC

0.8 oC rise1975-2004

1930 2010

Increasing power of tropical cyclones overpast 30 years in Nth Atlanticrelationship

to sea-surface temperature

Emanuel K.Nature 2005; 436: 686-8

Year

Power Dissipation Index, PDI

= f (wind speed3)

September sea-surfacetemperature, SST


39/92


40/92


41/92

Christopher Field, Carnegie Institute for

Science, in testimony to US Congress,

1 August 2012

It is critical to understand that the link between climate

change and the kinds of extremes that lead to disaster

is clear,.There is no doubt that climate has changed, he went

on. There is also no doubt that a changing climate

changes the risks of extremes, including extremes that

can lead to disaster.He later told the committee that those climate-related

disasters would have profound effects on industry and

agriculture.


42/92

Research Category III

Estimating future CC scenario-based health impacts


43/92

Daily maximum temperature:probability of exceedance

Central England

temperature

Baseline (1961-90)

2080s, medium-high

emissions


44/92

Change innumber of"extremely"warm days indifferentemission

scenarios

UK Climate Impact

Programme

1990
http://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.html


45/92

1990

2085

Estimated regionalprobability of

dengue occurrence

under medium

climate change

scenario: 2085 vs

1990Using statistical

equation derived

from observations of

recent distribution of

disease in relation to

meterological

variables

Source: Hales et al.

Lancet, 2002.http://image.thelancet.

com/extras/01art1117

5web.pdf

Probability
http://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdf


46/92

(Boxall et al EHP 2008)


47/92

Food insecurity


48/92

Fischer et al, 2001 (IIASA)

2080: rain-fed cereal production

ECHAM4 model of the Max Planck Institute of Meteorology

Phenology


49/92

Phenology

Changing species range: beech


50/92

Changing species range: beech

baseline 2050s Low 2050s High 2080s High

(Broadmeadow 2008)

Changing distribution of ash


51/92

Changing distribution of ash

1961-90 2020s

2050s 2080s

ECI/BRANCH project: www.branchproject.org.

Climate space

retained

Climate space

gained

Climate space

lost

Current

distribution

ESC it bilit f NVC dl d


52/92

ESC suitability for NVC woodland

1961-90 2050s High2050s Low

Lowland ash

Upland ash

Lowland oak

Upland oak

Yew

Beech woodland

Acid oak

Upland oak/birch

Unsuitable

Wet woodland

Alder woodland

European variations in the temporal trend of bird


53/92

European variations in the temporal trend of birdand butterfly community temperature index

(EEA 2012)

Observed latitudinal shifts of four species groups


54/92

Observed latitudinal shifts of four species groupsover 25 years in Britain

(Chen, 2011)

Projected spatial mismatches of the Portuguese


55/92

j p gDappled White butterfly and its host plants

(EEA 2012)

Ph t hth ff ti t d f


56/92

Phytophthora ramorum affecting a stand ofJapanese larch (Larix kaempferi) in Plym Woods,east of Plymouth

(Sturrock

2011)

Range expansion of soybean cyst nematode


57/92

g p y y

(Heterodera glycines) from 1971 to 1998

(Niblack, 1999)


58/92

David

Waltner-Toews and

Tim Lang,

2001

The severe drought in the Midwest is affecting


59/92

The severe drought in the Midwest is affecting

prices for corn and soybeans as well as other

field crops which should, in turn, drive up

retail food prices. However, the transmissionof commodity price changes into retail prices

typically takes several months to occur, and

most of the impact of the drought is expected

to be realized in 2013.

From website of USDepartment of Agriculture


60/92


61/92

(Health Impacts of Catastrophic Climate Change, 2011)

Stationarity is dead


62/92

Stationarity is dead.

Times have changed, and the change isongoing. The full extent and nature of the

change are uncertain. The impacts are

even foggier. In view of this, what are the

appropriate adaptations to address thoseimpacts?

Addressing this question will be a major

challenge for water science during the

21st century.(Milly 2007)

The growing gap between oil discovery and


63/92

g g g yproduction

(Hanlon 2008)

Progressively higher production costs ($/b) related to globalit (Mb/d)


64/92

capacity (Mb/d)

(The Oil Crunch. A wake-up call for the UK economy, Industry

Taskforce on Peak Oil & Energy Security, February 2010)


65/92

Peak oil

the point where "the cost of

incremental supply exceeds the

price economies can pay withoutdestroying growth at a given

point in time.

Chris Skrebowksi, petroleum economist

Rising energy costs a challenge for


66/92

Rising energy costs a challenge fordevelopment (social, cultural and economic)

(Orlov 2011)


67/92

(Moss 2010)

Population transitions, past and current


68/92

(UN 2004)(Gignoux 2011)


69/92


70/92

Public health services baseline trend


71/92

Public health services baseline trend

Local health departments are a critical yet increasingfragile component of governmental infrastructure

Budgetary shortfalls

Shifting public health workforce demographics

New set of emergency response expectations

departments have been forced to do

more with fewer resources

advice and monitoring, not directlyresponsible for actions/interventions

(Barnett 2011)

Climate impacts add to the health burden now


72/92

Climate impacts add to the health burden nowand more in future

Temperature

An increase in mean temperature of 2.0C (0.2 C) in winter and about 4.0 C (0.3 C) in summerby the end of the century.

The longest cold spell per year (days below 0 C) will decrease, with the greatest reduction of about7 days (1 day) over Scotland.

Hot spells (defined as periods with daily maximum temperature higher than 25 C) are projected to

be prolonged on average by up to 10 days (+1 to 2 days) over Central and Southern England, andby less than 5 days over the rest of the UK.

Rainfall

Total summer rainfall has decreased by about 50 mm over the last 250 years

Autumn and winter rainfall have both increased by about 50 mm.

Wind

Episodes of very high wind speeds are expected to decline in the UK.

Increases predicted over Wales, Northeast England, and Northwest Scotland.

Public health role in managing crises, eg


73/92

Public health role in managing crises, egflooding, cold weather emergencies

Ni l f h


74/92

Nine meals from anarchy

(Lord Cameron of Dillington, 2008)

Petroleum scarcity and public health:


75/92

Petroleum scarcity and public health:considerations for local health departments

-Further tightening of budgets

-Dependence on transportation

-Dependence on petroleum-based medical supplies

Most affected essential services might be:

-Monitoring

-Diagnosis and investigation

-Access to vulnerable communities

(Barnett , AJPH 2011)

Public health will be affected in numerous ways


76/92

ub c ea be a ec ed u e ous aysin a phase when energy is limited. Redefinitionof public health role may be a part of redefinition

of roles for many other agents in society.

A few possible strategies:

Surveillance: ensure electronic data collection, use of

home-based office for conducting inspection visits

Diagnosis and investigation: develop and test

nonpetroleum substitutes for medical and lab supplies

Microlocalization: including neighbourhood pods

Consider need for geographic access to care when

developing interventions

(Barnett , AJPH 2011)

Climate


77/92

(Leonardi, Chapter 12.How to Prepare for theHealth Effects ofClimate Change)

Climate

change:

challengesto public

health,

and possibleresponses

Th i bl di (NCD) ff t f


78/92

The noncommunicable disease (NCD) effects ofclimate change mitigation and adaptation strategies

(Friel 2011)

noncommunicable disease (NCD) effects (continued)


79/92

(Friel 2011)

Resilience


80/92

(i) Disaster resilience describes the capability of a community

or society to resist and recover from a disaster.

(ii) Community resilience describes the capability (or process)of a community adapting and functioning in the face of disturbance.

(iii) Ecosystem socialecological resilience describes

the capacity of natural and social systems to absorb disturbancewhile remaining within the same functional state.

(iv) Infrastructure resilience describes the capacity of builtinfrastructure to continue functioning during disasters. This might

include roads, buildings and bridges.

(v) Individual or psychological resilience describes thecapacity of individuals or groups of people to cope with adversity

and continue functioning.

(Castleden 2011)


81/92

(export),th i l k f


82/92

their lack ofwater for food production with trade (import), and

to meet their remaining deficits

(Rockstrm 2010)

Blue water and green water


83/92

(Rockstrm 2010)

Redistribution of Water Resources


84/92

Redistribution of Water ResourcesChanging risk of unmet water demands

Changing risk of floods

Changing risk of droughts

Legal and operational roles and responsibilities of

public agencies in relation to water management willneed to be clarified and specified accordingly

(Milly, 2005)

Model-Projected Changes in Annual Runoff, 2041-2060


85/92

j g ,Percentage change relative to 1900-1970 baseline. Any color indicates that >66%of models agree on sign of change; diagonal hatching indicates >90% agreement.

(After Milly, P.C.D., K.A. Dunne, A.V. Vecchia, Global pattern of trends in streamflow andwater availability in a changing climate, Nature, 438, 347-350, 2005.)

Climate Change and Water:


86/92

Climate Change and Water:

The Big Questions

The past: What has been happening?The future: Where are we headed? What areas areat risk?Mitigation: How much change is avoidable?Adaptation: What will the unavoidable changeslook like?

(Milly 2005)

Scientific Information


87/92

Scientific Information

for Adaptive Adaptation

Identification and quantification ofvulnerabi l i t ies

Hydrologic and climatic moni tor ing

Comprehensive environmental model ingInterpretive research

Enhanced communicat ionwith resource managers

(Milly 2005)


88/92

Haines 2006

An essential public health service is maintaining


89/92

p gand managing supplies of water for essentialuses: drinking and crop growing

Priority is for public health services to have a clear

picture of the crucial role of provision of water fordrinking and crop growing

If distribution of water and food is ensured, the

remaining human activities, however limited and

changed by circumstances, are possible

Public health service cannot act on behalf of


90/92

Public health service cannot act on behalf ofeverybody else only advise

BUT in a crisis, provision, management, andallocation of water has been and likely will be ofmajor importance to public health

Water will be a priority. Available energy

resources should be directed to it

All hands to the pumps!

Conclusions:


91/92

Climate and other environmental change, and rising

energy costs pose new challenges to public healthservices

A multi-disciplinary (health, forestry, agriculture,

engineering, meteorology, geology) recognition is

needed of:

-Influences on water by ecological parameters and human activities

- water availability affects healthOn that basis, a framework is needed for developing

public health services that will ensure appropriate

advice/action is taken to provide water for essential

health needs

Outline


92/92

Outline

Global climate and environmental change

Examples of impacts, including epidemiology

Petroleum peak

Changes to public health services

Increase focus on water

Public health services facing the twin challenge of climate change and petroleum peak

Documents

Transcript of Public health services facing the twin challenge of climate change and petroleum peak