Global Environmental Change

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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
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The loss of forests, freshwater and biodiversity,
inadequate and inefficient use of energy, and the
explosive growth in the worlds 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 countrys 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)
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Traditional Epidemiological Framework
Ecological Epidemiological Framework
Agent
Social
SYSTEMS
Environment
Ecological
Global
Host
Epidemics
Disease
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Global Temperature the Past 20,000 Years, the
Next 100 Years
IPCC (2001) forecast 1.4-5.8oC, with band of
uncertainty

Black Death
Holocene Optimum
21st century rapid rise
Medieval Warm
1940
Little Ice Age in Europe (15th-18th centuries)
-2
-3
-4
Younger Dryas
-5
10,000
2,000
1,000
300
100
Now
100
20,000
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370 ppm
VOSTOK ICE CORE
280 ppm
CO2 T
180 ppm
420 kya Present
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Observed vs. modeled temperature rise since 1860
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Deep OceanWarming
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SST Anomalies May 2003
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Health Impacts of Climate Change
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HEATWAVES
May 2003 Andhra Pradesh T 122F gt400 deaths
HUMIDITY HEAT INDICES TMINS
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AIR POLLUTION AND CLIMATE CHANGE
Indoor pollutants
SES/emotional factors
Diesel ( pollen)
  ASTHMA 2-3x Since 1980s

• Pollen

Floods Mold
Ground-level Ozone (T-dependant)
Droughts Fires
 
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• IPCC 2001 New Findings
• Extreme Weather Events
• Heatwaves, Droughts Floods
• Intensity Frequency
• (rains gt2/d)
• Biological Systems are Responding
• Plant migrations
• Insects butterflies
• Bird egglaying
• Marine species

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Emerging Infectious Diseases
30 DISEASES NEW TO MEDICINE SINCE 1976
HIV/AIDS Ebola Legionnaires E. coli
O157H7 SARS Antibiotic-Resistant
Agents Hantavirus Pulmonary Syndrome Lyme
Disease Nipah Virus Vibrio
cholerae O139 Arenaviruses RESURGENT
REDISTRIBUTING Malaria, Dengue Fever, West Nile
Virus, Cholera
VECTORS Mosquitoes Ticks Rodents Bats Tsetse
Flies Fleas Lice Snails Algae
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INFECTIOUS DISEASE A DRIVING FORCE IN HISTORY
The Bad News PLAGUE 541
AD 1346 AD
The Good News
Cholera, TB, Smallpox
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Climate Models and Potential Malaria Distribution
T
Average
1ºC/C
T MINIMUMS
2ºC/C
1950 2000
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THE CRYOSPHERE
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PLANT COMMUNITIES
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Changes in the Cryosphere
Geographic Shifts of Mosquitoes
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450 ft. 2F warming 1970-1990
Diaz Graham, Science 19967
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LYME DISEASE
WARMER WINTERS
PREDATORS OF DEER
1980s
1990s
TICK DISTRIBUTION IN SWEDEN
Lindgren Gustafson. Lancet 200135816
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HURRICANE MITCH 1998
HURRICANE MITCH
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HURRICANE MITCH IMPACTS ON HEALTH AND
DEVELOPMENT
DISEASE CLUSTER
-- Malaria (gt30,000 cases) -- Dengue
fever (gt1,000) -- Cholera (gt30,000) --
Leptospirosis

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4161 cases 284 deaths

WNV HUMAN CASES DEATHS
62 66
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BLOOD ORGAN TRANS IN-UTERO ? BREAST
MILK POLIO-LIKE PRESENTATION NEURO
SEQUELAE

• 2000 2001 2002

Science 20022971988
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• 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
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• INFECTIOUS DISEASES FORCES OF GLOBAL CHANGE
• SPECIES LOSS VECTOR DISEASES
• Raptors Rodents
• Lyme, Hantaviruses,
• Leptospirosis, Plague
• Vulture die off
• India
• Feral Dogs Rabies

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Hantavirus Pulmonary Syndrome
1993 Drought, Then Early Rains 10X Explosion
of Mice Populations
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Range Expansion of Soybean Cyst Nematode in North
America
Crop Pests Generations/Year
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DISEASES OF TREES

• US
• 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.

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Coral Diseases
Color Variants on M. cavernosa Photo Raymond
Hayes
Red Band Disease on M. annularis Photo Laurie
Richardson
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SARS Severe Acute Respiratory
Syndrome CORONAVIRUS

• Species X-over
• Genetic reshuffling
• Farming practices
• food handling

50-100 BILLION TRADE, TRAVEL, TOURISM Bio
Economic Research Associates, Cambridge, MA
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HIV/AIDS SOCIAL AND ENVIRONMENTAL DETERMINANTS
Transmission Informal sector, Mining, Conflict
Viral Evolution Coxsackie virus Levander
Beck. Selenium and viral virulence. Br Med Bul
199955528 Malnutrition disease burden
Chandra RK. Nutrition and immunoregulation. J
Nutr 1992122754 Stress proteins
mutations Immune surveillance system
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Costs of Extreme Weather Events
Insurance Reinsurance, FEMA, OFDA, NGOs, Nation
States, Companies
UNEP 150b/y w/in this decade
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Levels of Solutions

• Surveillance and Response Capacity
• Health Early Warning Systems
• Environmental, Energy Economic Policies

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• CHALLENGES
• CLEAN ENERGY HARMONIZING ADAPTATION
  MITIGATION
• MDGs HEALTH, NUTRITION, POVERTY
• AGENDA 21 FISHERIES, FORESTS, POPs
• 0

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

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• CLEAN DEVELOPMENT

Framework
Reg
THE ENGINE OF GROWTH for the 21st CENTURY
Funds
Inst

• EE and RE
• Green Buildings Smart Growth
• Rationalized Transport Transit
• Retrofitting Infrastructure
• Ecological Reconstruction

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FOR Q A
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CLIMATE STABILITY
Changing weather patterns Volatility
Wider swings from norms Security of
investments Economic stability

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TEMPERATURE PRESSURE WIND WEATHER
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TRENDS IN VARIANCE
Prolonged droughts Rains gt 2/day
Wide swings in weather Timing, intensity and
location of precipitation
STABILITY RATES OF CHANGE VARIANCE
VOLATILITY UNCERTAINTY PREDICTABILITY
ANOMALIES SHIFTING PATTERNS
GRADIENTS WIND SPEEDS
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TRENDS IN VARIANCE
WEATHER Prolonged droughts Rainsgt
2/day Wide swings Timing, intensity
and location of precipitation
T
CLIMATE
1900
1940
1976
2000
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ATMOSPHERIC FORCING FACTORS
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FRESHENING OF THE ARCTIC
Hoerling and Kumar Science 2003 January 31
299 691-694
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• WEATHER ANOMALIES, TRAVEL TRAUMA
• WIDER SWINGS IN WEATHER
• Hurricane Floyd after 99 drought
• Severe winter after milder
• Fog, Ice Storms Road Travel
• Floods Mudslides
• Ice Instability, Heavy Precipitation
  Avalanches
• Infrastructure Damage and Water QQ
• TRADE, TRAVEL,
  TOURISM

STORM OF 2003
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Temperature Dependence of Plasmodium Extrinsic
Incubation Period
Tempmin 16oC
n No. of degree-days required
Temp Tempmin
Number of days, n
a
b/a 0.5
b
c
d/c 0.75
d
2oC
2oC
15
20
25
30
Temperature, oC
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GENETIC SHIFT IN PHOTOPERIODIC RESPONSE
CORRELATED WITH GLOBAL WARMING --Bradshaw
Holzapfel, PNAS 2001
Wyeomyia smithii (pitcher-plant
mosquito) Southern phenotype Shorter
daylengths for diapause Later onset of winter

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The Geographic Distribution of Japanese B
Encephalitis Family
NYC 1999
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WEST NILE VIRUS
-CDC
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Projected Aug 2003
May 2003
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WNV and DROUGHT CASE REPORTS Romania
1996 Neurological disease Hundreds, Fatalities
17 Prolonged drought and heatwave. Bucharest
cases concentrated in blockhouses over aging
sewage system where C. pipiens was breeding in
abundance.   Volgograd 1999 Hospitalized 626,
Meningoencephalitis 84, Fatalities 40 Followed a
drought.   Israel 2000 Serologically confirmed
417, Fatalities 35 Drought across southern Europe
and Middle East. C. pipiens identified as a
vector.   US 1999 Neurological disease 62,
Fatalities 7, Sequelae gt½   Severe spring/summer
drought, mild winter and 3-week July
heatwave.   US 2002 Human cases 3737,
Fatalities 214, 43 US states, DC and 5
Canadian Provinces   Severe drought West and
Midwest. Absence of snowpack in the Rockies.
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ST. LOUIS ENCEPHALITIS1933-2001
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El Niño
Since 1976 El Niño Events Have Increased in
Frequency, Intensity Duration
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REGIME SHIFT
Chavez et al., Science 2003 299 217-221
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The Western Warm Pool and El Niño
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El Niño/La Niña and the Jet Stream
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THE ARCTIC
NADW pump 20
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ASIAN DROUGHT FIRES 1998
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• COASTAL MARINE ECOSYSTEMS
• PRESSURES ON REEFS
• Nutrient overload urban, rural, air-borne
• Loss of wetlands Natures kidneys
• Warming and weather extremes
• Diseases of sea urchins - reef cleaners
• Overfishing reef cleaners

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• HEALTH CONSEQUENCES
• Red Tides PSP, ASP, NSP
• Fisheries nutrition
• Salinization
• Cone snails medicines
• Biophilia mental health

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OIL LIFE CYCLE COSTS
Harm Marine Mammals Shore
birds Fisheries Consumers Livelihoods
Spills Leaks
Exploration Extraction Transport Refining Transpor
t
MERCURY
Air Pollution
Eutrophication NOxs
Acid Rain
Combustion
Warming Oceans Coral Reefs SLR EWEs Melting Polar
Ice
Climate Change
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CLIMATE CHANGE ENVIRONMENTAL JUSTICE
Oil-related Extraction Nigeria, Ecuador,
Mexico Refining benzene locations and
communities Air pollution inner city truck
routes Extreme Weather Events Economic
inequities Vulnerabilities coping, adaptation,
restoration, prevention, public health
infrastructure But no nation is immune
Mozambique
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ECOLGICAL AND HEALTH CONSEQUENCES OF INFECTIOUS
DISEASES Predators WNV Raptors Rodents
Lyme, Hantaviruses, Leptospirosis Scavenger
s, Decomposers Vulture die off in
India Dogs Rabies Forest Pests and
Pathogens Water Q and Q, Vulnerability to
Fires Coral Bleaching and Diseases Salinizati
on, Fisheries Nutrition
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ECOLOGICAL DYNAMICS DISEASE FUNCTIONAL GROUPS
diversity and redundancyof predators, prey,
competitors, recyclers, N fixers r-strategists w
eeds, insects, rodents, fungi, bacteria, viruses
- opportunistic, pioneering species. Huge
broods, rapid generation times, good
dispersal mechanisms, good colonizers of
disturbed environments. Generalists.
K-strategists predators - large bodies,
small broods, reproduce later in life. Many
are specialists and good competitors in stable
environments.
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Coral Bleaching Warming and Microbes
Vibrio shiloi V. coralyticus -infection and
immunity are temperature-dependent -optima
l infection and lysis at 29ºC release of
zooxanthellae
ENSO
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Regime Shifts
THE PACIFIC Warm West, Cold East
Hoerling and Kumar Science 2003 299 691
Chavez et al., Science 2003 January 10 299 217
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GENETIC SHIFT IN PHOTPERIODIC RESPONSE CORRELATED
WITH GLOBAL WARMING --Bradshaw Holzapfel, PNAS
2001
Wyeomyia smithii (pitcher-plant mosquito)
has shifted toward southern phenotype --
Shorter daylengths (southern) to cue for
diapause, with delayed onset of winters --
Fastest evolutionary response has occurred
in northern populations (reflecting TMINs
in Boreal latitudes)
Red squirrels give birth 3 weeks earlier,
corresponding to the earlier arrival of spring. 
Change genetic in origin squirrels that breed
earlier benefit from better access to food and
territory, then pass on their early-breeding
preferences to the next generation.  --
Proceedings of the Royal Society of London B.
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Average T 1ºC/C WINTER NIGHTTIME TEMPS
2ºC/C Since 1950
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EXTREME WEATHER EVENTS DISEASE CLUSTERS
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PACIFIC ANOMALIES
ASIA
AFRICA
AMERICAS
AUS
WARM WEST COLD EAST
Hoerling and Kumar Science 2003 299 691
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ABRUPT PHASE-STATE CHANGE