Health and environmental change: evidence, trends and challenges

Transcription

1 Health and environmental change: evidence, trends and challenges Roberto Bertollini MD MPH Coordinator Public Health and Environment WHO Headquarters - Geneva

2 Global Environmental Changes: health risks Stratospheric ozone depletion Skin damage/cancer Eyes (cataracts, etc.) Immune suppression Social disruption, conflict, impoverishment, mental health impacts Climate change Direct impacts Thermal stress: death, disease events, injury Storms, cyclones, floods, fires Sea-level rise: physical hazards, displacement Land cover (forest, etc) Land use: soils Fresh water: glaciers river flows chemistry Human predation Biodiversity changes, & ecosystem disruption Food production: systems/methods Infectious disease risks Changes in ecology/numbers of host species, vectors (mosquitoes, etc.) e.g. pollination Food yields: nutrition and health Immune function: susceptibility Avian flu, Nipah virus, BSE, etc. Oceans: Anoxic zones Algal blooms Warming Acidity (CO 2 ) Urbanisation: population size, consumerism, energy use, etc. Marine food web Poverty, crowding, hygiene; physical hazards; infectious disease risks Impacts on urban coastal populations, esp. Based on original, prepared for Earth System Science Partnership (McMichael, 2006)

3 Environmental Health Risks Widening our field of vision Reduced farm yields Impaired livelihoods Nutritional status Health impacts Specific chemical exposure Cancer Agriculture Crop farming Livestock production Use of chemicals Effects of temperature and soil moisture on plant growth Nitrogenous fertiliser Nitrous oxide Methane Potent greenhouse gases Climate change Health impacts

4 The evidence

5 Reduced exposures SO 2 emissions have been substantially reduced between 1980 and 2000, preventing many respiratory diseases European Region European Union Commonwealth of Independent States WHO Health for All database Sulphur dioxide emissions, kg per capita per year

6 Some exposures pose a challenge After decrease, PM 10 concentrations are stable, leading to a loss of life expectancy Source: EMEP and IIASA Loss of life expectancy in months

7 Improved knowledge Changes in threshold values and corresponding regulatory standards following increased knowledge on health effects of lead

8 WHO air quality guidelines, 2005 Improved knowledge Air quality guideline values 2000 vs PM10 Daily mean No value 50 Annual mean No value 20 SO2 10 minutes mean Daily mean Annual mean 50 Not needed NO2 Daily mean Annual mean Ozone Daily maximum 8 hour mean

9 WHO % of the global burden of disease could be prevented by healthier environments - 34% of the burden in children under age 14

10 Method systematic reviews and expert opinion Systematic reviews or CRA cover only about one third of expected environmental contributions (10 risks, 45 diseases) Completed systematic literature reviews with expert opinion Experts from or selected by WHO programmes, and authors from key publications Global representation of experts More than 100 experts contributed

11 What is the modifiable environment? Pollution UV and ionizing radiation, noise, EMF Occupational risks Built environment, incl. housing, land use, roads Agricultural methods, irrigation schemes Man-made climate change, ecosystem change Related behaviour, e.g. hand-washing

12 How much disease could be prevented by modifying the environment? Current evidence - best conservative estimate 24% 40% World average 30% 20% 10% 0% Attributable fraction AFR-D AFR-E AMR-A AMR-B AMR-D EMR-B EMR-D EUR-A EUR-B EUR-C SEAR-B SEAR-D WPR-A WPR-B Sub-region

13 Diseases with largest environmental contributions (I) Diarrhoea Lower resp. infections Other unintentional inj. Malaria Road traffic injuries COPD Perinatal conditions Ischaemic heart dis. Childhood cluster Lead-caused MMR Drownings HIV/AIDS 0 1% 2% 3% 4% 5% 6% % of global disease burden in DALYs Environmental fraction non-environmental

14 Diseases with largest environmental contributions (II) Malnutrition Cerebrovascular dis. Asthma Tuberculosis Suicide Depression Poisonings Falls Hearing loss Violence Lymphatic filariasis Lung cancer 0 1% 2% 3% 4% 5% 6% % of global disease burden in DALYs Environmental fraction non-environmental

15 Inequalities of impacts DALYs due to environmental factors/1000 capita Data from WHO, Country profiles of environmental burden of disease, 2007

16 60 Health inequalities in Europe DALYs due to environmental factors/1000 by country, Russian Federation Iceland Israel Switzerland Sweden Monaco Malta Netherlands Italy Norway San Marino Austria Germany France Spain Cyprus Andorra Ireland Luxembourg United Kingdom Belgium Denmark Finland Portugal Slovenia Greece Czech Republic Croatia TFYR of Macedonia Slovakia Poland Bosnia-Herzegovina Armenia Serbia-Montenegro Georgia Hungary Bulgaria Albania Uzbekistan Turkey Romania Lithuania Republic of Moldova Azerbaijan Latvia Estonia Ukraine Belarus Kyrgyzstan Tajikistan Turkmenistan Kazakhstan WHO, 2007

17 Within Region BoD differences in children ,000 40,000 5,000 30,000 24,000 20,000 42,000 10, ,000 19,000 0 EURO A EURO B EURO C Outdoor and indoor air pollution, lack of water and sanitation Injuries

18 Trends and challenges

19 New exposures Percentage Mortality exceedance Global warming is a matter of fact 12 August 2003 (Inserm, 2007)

20 Concentrations of Main Greenhouse Gases over Past 2,000 Years (IPCC 2007) 2005 CO 2 now Carbon Dioxide (CO 2 ) Nitrous Oxide (N 2 O) CO 2 ppm N 2 O ppb Methane (CH 4 ) CH 4 ppb CO 2 N 2 O CH 4 Year

21 Projected Global Warming: IPCC Greenhouse gas emission scenarios (see # below) Atmospheric concentrations remain as at 2000 (2007) 2020s A2 2090s Av. surface warming, o C o C A1B o C Year # Future climate scenarios modelled on 3 different emissions projections in 21 st Century: B1 0 o 3.5 o 7.0 o (Temp Rise, o C) A2 relatively high A1B mid-level emissions B1 low INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE, 2007: SYNTHESIS REPORT, p. 46.

22 Climate Change: occurring faster than expected IPCC 2007 Assessment now looks conservative. Recent research shows increases in: Global GH Gas emission rate Ice melt rate (Arctic sea ice, Greenland, Antarctic, alpine glaciers) Sea level rise Saturation of carbon sinks (land and sea) Estimated carbon stored in permafrost

23 Climate Change Impacts Climate Change: Impact Pathways Direct impacts (extreme events, heatwaves, air pollutants, etc.) What is important? Physical systems (river flows, ocean temp, soil moisture) Biological cycles Ecological linkages Human Health: Injuries/deaths Thermal stress Infectious diseases Malnutrition Mental stresses Other disorders Indirect impacts ecologically mediated Economic impacts infrastructure, production, growth Indirect impacts socially mediated

24 Mortality Impacts of Climate Change: Year 2000 Estimated annual deaths due to climate change: malnutrition (~80K), diarrhoea (~50K), malaria (~20K), flooding (~3K) 14 WHO regions scaled according to estimated annual death rates due to the change in climate since c (Patz, Gibbs et al, 2007: based on McMichael, Campbell-Lendrum, et al, 2004)

25 Cumulative Emissions of Greenhouse Gases Countries scaled according to cumulative emissions (billions of tonnes CO 2 -equivalent) up to (Patz, Gibbs, et al, 2007)

26 Heatwave: August 2003 ~50,000 extra deaths over a 2week period