Health Impacts of Disasters and Climate Change: Challenges to Hospitals and Public Health Systems Dr John Juliard Go Third Global Congress of Women in Politics and Governance 21 October 2008
Disasters - threats to life & health 2 billion people affected with 600,000 fatalities globally (1990-1999) More than 2/3 of deaths occurred in Asia 127 major disasters, 23% of all disasters worldwide, occurred in WPR in the past 10 years Philippines is considered the most disaster-prone with its active volcanoes and an average of 20 typhoons a year. Loss of loved ones, homes, livelihood
Hospital damaged in disasters
~ Globally, hundreds of hospitals/health facilities destroyed or damaged during disasters each year ~ Millions of people are left without emergency care during and after disasters when hospitals and health facilities fail to function. ~ Millions more without public health and clinical services when operations are disrupted due to damage to facility
Climate change is Unequivocal Rising atmospheric temperature Rising sea level Reductions in North Hemisphere snow cover
Climate change is here!
The health effects of climate change Some expected impacts will be beneficial but most will be adverse. Expectations are mainly for changes in frequency or severity of familiar health risks Health effects CLIMATE CHANGE Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement Based on Patz et al, 2000
Climate, a health determinant European temperatures, Summer 2003 Deaths During Summer Heatwave. Paris Funeral Services (2003)
Many of the major killers are climate sensitive - Each year: - Undernutrition kills 3.7 million - Diarrhoea kills 1.8 million - Malaria kills 1.1 million
Climate Change and Dengue Climate change is expected to increase the proportion of the global population exposed to dengue from about 35% (upper figure), to 50-60% (lower figure), by 2085. Hales et al, Lancet 2002
How sensitive is health to climate? Diarrhoea Diarrhoea admissions Temperature Daily measurements Jan 1993 Dec 1998 Incidence of diarrhoeal disease is strongly related to climate variables. In Lima, Peru, diarrhoea increased 8% for every 1 0 C temperature increase. (Checkley et al, Lancet, 2000)
Temperature and Mortality in Shanghai in the summer of 1998
Temperature and heat-related victims in the summer of 2004 in Tokyo Tokyo metropolis 40 50 35 40 Maximum temperture ( ) 30 25 20 30 20 10 Num ber of patients (person) 15 501 508 515 522 529 605 612 619 626 703 710 717 724 731 807 814 821 828 904 911 918 925 0 date (5/1/2004-9/30/2004)
Dengue Fever/DHF Cases & Temperature, Singapore, 1977-1999 6000 5000 4000 DF/DHF CASES & TEMPERATURE, SINGAPORE, 1977-1999 DF/DHF Cases 5258 Mean Temperature 4300 28.5 28 27.5 NO. OF CAS 3000 r= 0.85 2000 1000 944 1733 2179 2878 1239 946 2008 3128 1355 27 26.5 26 DEG. CELCI 0 384 92 156 253 136 216 205 86 126 354 436 245 25.5 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 YEAR (e-wk 25)
Health risks are significant, and concentrated on the poor WHO comparative risk assessment estimated that by 2000, climate change that had occurred since the 1970s was causing over 150,000 additional deaths per year (WHO, 2002)
Observed Mean Annual Mean Temperature Anomalies in the Philippines Period: 1951-2006 (departures from the 1961-1990 normal values) 1.5 1 Anomaly 5 year running mean Linear (5 year running mean) Temperature Anomaly ( C) 0.5 0-0.5-1 y = 0.0109x - 0.2423-1.5 51 56 61 66 71 76 81 86 91 96 01 06 Year An increase of 0.6104 C from 1951-2006
Dengue Fever Cases Philippines, 1992-2005 40 35 30 25 20 15 10 5 0 No. of Cases (Thousands) Temperature Increase (C) 35.6 14.6 12.8 9.2 8.6 5.7 5.6 5.2 4 29.9 25 22.8 16.7 14.7 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Y e a r 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
Cholera Cases Philippines, 1995-2005 1,200 1,000 No. of Cases 1,032 Temperature Increase (C) 1 0.9 0.8 800 600 831 605 738 636 0.7 0.6 0.5 400 200 0 330 331 173 Y e a r 202 257 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 139 0.4 0.3 0.2 0.1 0
Malaria Cases Philippines, 1995-2005 2,500 No. of Cases 2,466 Temperature Increase (C) 2,273 1.4 2,000 1,500 1,883 1,675 1,483 1,624 1,378 1,772 1,501 1,589 1,769 1.2 1 0.8 1,000 0.6 500 0 Y e a r 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 0.4 0.2 0
Typhoid Fever Cases Philippines, 1995-2005 1,000 800 600 400 200 0 No. of Cases Temperature Increase (C) 778 715 663 614 575 523 475 460 340 300 274 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Y e a r 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
Other Implications on Communities More disasters More floods and landslides Permanent loss of land Severe drought Implications on food production Implications on poverty Implications on social cohesion Risk of armed conflicts
Implications to Healthcare Facilities Health care services will inevitably be subject to increased demands from the community, thus overburdening existing facilities and the health care system in general. Adaptive strategies for healthcare facilities are necessary to ensure continuity of service delivery to the population in catastrophic weather events such as heat waves, floods, storm surges and cyclones.. Adaptation strategies should include an allowance for an increase in the likelihood of these diseases occurring. - Carthey and Chandra, 2007
Health and Facility Impacts of Heat waves The Sydney 2005 heat waves were reported as the cause of a considerable increase in hospital admissions, placing pressures on the healthcare system. Such events require the employment of additional staff, increased demand for medical supplies plus greater need for equipment suitable for use with overweight and older people, in addition to potentially resulting in the overcrowding iof healthcare facilities.
Health and Facility Impacts of Heat waves Öne hospital was swamped by people not needing medical equipment - simply looking to take advantage of its spacious air conditioned reception area. Can cause hospital computers to overheat and fail (1997) Increased use of fans and air conditioners may cause overheating in electricity supply cables and other electrical appliances, posing a risk of fire. Water shortages and water supply failures may also become a problem during prolonged heat waves as demand for water may increase dramatically. Transport systems may also suffer from problems and interruptions, complicating the situation.
Health and Facility Impacts of Floods The flooding of the River Elbe in 2002 in Saxony/Germany required immediate public health action/ proper public hygiene response. Floods result in degradation of human health and loss of life, high financial cost, trauma, and human misery. When healthcare facilities are flooded, electrical power outages may be unavoidable, so evacuation for oxygendependent patients and emergency patients may be needed. Flooding may create access problems for physicians and other staff travelling to and from hospital
Health and Facility Impacts of Storm Surges As a result of Hurricane Katrina (USA) in 2005, some hospitals were submerged in water, contaminated with sewage and chemicals (19 hospitals evacuated and 18 closed) Storms may potentially knock down health care facilities and wash away roads.
Possible Infrastructural Responses to Extreme Weather Events: Immediate Increased public awareness Warning procedures for the community, esp those at highest risk Thermal control Environmental control Emergency fire fighting response Evacuation of those in immediate danger to safer facilities, surge hospitals, etc
Possible Infrastructural Responses to Extreme Weather Events: Long-Term Urban Planning Health System Responses Facility Management
WHO programme- From describing risks, to highlighting vulnerabilities, to proposing responses
Six focus areas for WHO, public health, and climate change 1. Health security 2. Strengthening health systems 3. Health development 4. Evidence and information 5. Delivery 6. Partnerships
Protect health from climate change.
Let s leave our children a living planet.
Thank you