Climate Change and Infectious Disease: Implications for Public Health Policy

Transcription

1 Climate Change and Infectious Disease: Implications for Public Health Policy Institute of Medicine Forum on Microbial Threats Workshop December 2007 Diarmid Campbell-Lendrum 1

2 Outline Some thoughts on policy questions versus scientific questions. WHO and other initiatives on health protection from climate change. Some thoughts on priority issues for research. 2

3 The kinds of questions we get asked Is [health incident X] because of climate change? Will climate change bring [malaria/dengue] to [Europe/USA]? How many people are killed by climate change? Shouldn't you be concentrating on the real issues? What do you want [the Government/ people/me] to do about it Where is the money going to come from? 3

4 Climate change as a new threat VibrIo parahaemolyticus in Alaska Malaria at higher altitudes in the East African highlands Chikungunya in Italy West Nile Virus in the US 4

5 Climate change on top of everyday burdens Each year: - Malaria kills 1.1 million - Diarrhoea kills 1.8 million - Undernutrition kills 3.7 million Each of these is highly sensitive to temperature and precipitation: 5

6 Non (re)emerging, non-spreading diseases are also highly sensitive to climate Diarrhoea admissions Temperature Incidence of diarrhoeal disease is related to variations in temperature and precipitation, over both space and time. In Lima, Peru, diarrhoea increased 8% for every 1 0 C temperature increase. (Checkley et al, Lancet, 2000) Daily measurements Jan 1993 Dec

7 Causes of persistent vulnerability: Example of Afric l Cycle of natural and human-caused disasters l Poverty, armed conflicts, tribalism l Weak internal and external governance l Aid Dependence l Institutional weakness l High burden of climate-sensitive diseases 7

8 WHO programme- From describing risks, to highlighting vulnerabilities, to proposing responses 8

9 Climate as a global health priority "We are now embarking on a new struggle, with profound global implications. It may turn out to be the most ominous struggle of them all. I am referring to climate change." Margaret Chan, WHO Director General. 10/09/

10 Requests from countries United Kingdom delegation requests that "Health Protection from Climate Change" be included on the agenda for the 2008 World Health Assembly. 20/09/07 " It is necessary to launch a strategy jointly with the WHO.. to ensure that the climate change that is now inevitable, has the minimum possible impact on human health". Prime Minister Zapatero of Spain, UN Climate Summit. 24/09/07 10

11 WHO framework on Health Protection from Climate Chang 1. Advocating for climate change as a health security issue 2. Strengthening health systems to cope with climate change 3. Guiding development to promote health 4. Generating Evidence for Health Action 5. Delivery, Monitoring and Evaluation 6. Building Partnerships 11

12 1. Advocating for health security as a central issue in Climate Change A telephone survey.. released today showed that 40 percent of Australia hought that global warming was a greater threat to security than Islamic undamentalism." New York Times, 04/10/07 12 Nobel Peace Prize for 2008 awarded jointly to Al Gore and IPCC. 12/10/0

13 2. Strengthening health systems to cope with climate change 13

14 Identifying and prioritizing the range of health risks 14

15 Health sector actions as climate change adaptations Infectious disease surveillance Integrated vector management Health action in emergencies Safe drinking water Diseases affected by climate Environmenta health capacit building Healthy development 15

16 Who cares what you say is going to happen? "Development of early warning systems should involve active participatio of the system's end users NRC, Under the Weather Teklehaimanot et al., 2004 "Forecasts based entirely on scientific objectives have little impact on polic because there is no stakeholder." Clark et al, Ecological forecasts: an Emerging Imperative, Science,

17 The need for response as well as predictions The published literature to date, however, includes no full descriptions of climate-based early warning systems being used to influence control decisions for infectious disease. (WHO, 2005) there will always be some element of unpredictability in climate variations and infectious disease outbreaks. Therefore, a prudent strategy is to set a high priority on reducing people's overall vulnerability to infectious disease through strong public health measures such as vector control efforts, water treatment systems and vaccination programmes. (NRC,

18 3. Guiding Healthier Development 18

19 Protecting health while reducing Emissions Buildings Indoor air pollution Heat and cold protection Transport Air pollution Traffic injuries Physical inactivity Industry Occupational risks, ining and transport Greenhouse Gas Emissions Energy supply & conversion Occupational risks; Construction and trans Agriculture Nutrition, Water / vector-borne disease Waste Occupational, chemical 19

20 The opportunity for improving health determinants an we reduce: e 800,000 annual deaths from urban air pollution e loss of 1.9 million deaths, and 19 million years of healthy life, from physical inactivity e 1.2 million deaths and over 50 million injuries from road traffic accidents 20

21 Alternative routes to healthier transport Percentage of people walking or cycling to work: l Copenhagen 32 % l Santiago 30 % l Tokyo 22 % l Brasilia 2 % l Atlanta 0.3 % Percentage of urban trips by motorised private transport: l USA 89 % l Western Europe 50 % l High Income Asia 42 % l China 16 % (Kenworthy,

22 Multiple benefits of rethinking transport systems Policy Reducing crashes Reducing air pollution Reducing noise Promoting physical activity Promoting social cohesion Mitigating climate change Reducing transport demand (e.g. telecommunication) Promotion/Investment for safe cycling, walking and public transport Traffic calming and speed reduction in residential areas Environmentally differentiated ees for motorized transport in urban areas / / / unclear leaner fuels and more efficient vehicles / / / / Reducing the power of vehicles / - unclear Safer cars (including fronts protecting pedestrians) / / / / / Adapted from Racioppi, et al,

23 Research for Improved Tools an we accelerate development of tools to control diseases which are increasing rapidly, such as dengue? an we measure better the effectiveness of interventions to address emerging health threats, such as heatwaves? 23

24 Research for Improved Health Systems an we adapt existing surveillance systems, anticipate risks and reduce human health impact? an we improve delivery systems to meet the new challenges of climate change? 24

25 Research for Improved Policies an we assess better the health pacts of major policies related to imate change? an we assess better the costs to alth of (in)action to mitigate and apt to climate change? 25

26 5. Monitoring and evaluation 1. Strategies that are effective in achieving health goals 2. Programmes that are aligned with development and climate objectives 3. Interventions that are efficient and targeted to greatest need 4. Monitoring systems that build on existing functions 26

27 6. Partnerships WHO selects "Health Protection from Climate Change" as the theme for World Health Day /10/2007 Australian breweries lead early running for World Health Day slogan. 27

28 More Information 28