Climate Change and Human Health
MIT
Paul R. Epstein, MD, MPH
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Epidemiological
Framework
Ecological-Epidemiological
Framework
SOCIAL
AGENT
HOST
ENVIRONMENT
DISEASE
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ECOSYSTEMS
EPIDEMICS
GLOBAL
United Nations Intergovernmental
Panel on Climate Change
Third Assessment Report 2001
1. Climate is changing
2. Human activities are contributing
3. Biological systems are being affected
on all continents
4. Weather is becoming more extreme
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All weather = f (CC + NV)
379ppm
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Vostok Ice Core
Since 2001, studies show:
• CO2 rise is accelerating, 3ppm/yr, up from 1.8
• Tropical oceans are warmer and saltier, surface
waters near the poles are cooler and fresher
• Polar and mountain glacial ice is
diminishing at surprising rates
• Winds around both poles are
becoming more forceful.
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Deep Ocean Warming
Oceans: 14.2 x 1022 J
Atmosphere: 6.6 x 1021 J
Levitus et al. Science 2000; 287:2225
Parrilla et al. Nature 1994;369:48
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The Changing Shape of the Curve
Probability of occurrence
a
im
Cl
Average
us C
lim
ate
Much more hot
weather
More
record hot
weather
te
ew
Cl
im
a
vio
Less change for
cold weather
N
Cold
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ew
Cold
Pre
Probability of occurrence
Hot
te
N
lim
wC
Ne
vio
Pre
(C) INCREASE IN MEAN
AND VARIANCE
More
record cold
weather
Average
More
record hot
weather
at e
Average
More hot
weather
lim
Cold
More
record hot
weather
More cold
weather
us C
us C
ate
lim
ate
More hot
weather
vio
Less
cold weather
(B) INCREASE IN VARIANCE
Pre
Probability of occurrence
(A) INCREASE IN MEAN
Hot
Figure by MIT OCW.
Hot
Assessing Climate Stability
• Rates of Change
• Variability
• Gradients
• Number of
Components
Changing
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Model Projections: Heat Waves
AVERAGE SUMMER MORTALITY RATES
Attributed to hot weather episodes.
Mortality per 100,000
9
8
1964-1991
7
2020
6
2050
5
4
3
2
1
0
Atlanta
Chicago
Los Angeles Minneapolis
New York
St. Louis
Estimates for 2020 and 2050 are based on the Max Planck GCM results (IPCC 1994)
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Figure by MIT OCW.
Summer 2003 Heat Wave
France, Germany, Italy, Spain, Portugal 21-35, 000 Deaths
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Source: NASA
2003 Summer Temperatures
10oC (18oF) >30year average
INDIA
June 2003
T 122•F
>1400 deaths
July Floods
Japanese B encephalitis
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Air Pollution and Climate Change
Socio/economic/emotional factors
Indoor pollutants
Pollen & CO2
ASTHMA
2-3x
Diesel Particles
Mold & Pollen
Since 1980s
Ground-level Ozone
& Heat Waves
Floods & Fungi
Droughts & Fires
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Ground-level Ozone And Temperature
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RAGWEED POLLEN PRODUCTION
and CO2
70
60
Biomass
50
Pollen
40
30
Seed Mass
20
10
Height
0
CO2 350 ppm
CO2 700 ppm
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p = 0.005
Figure by MIT OCW.
SKETCH OF AN URBAN HEAT-ISLAND PROFILE
Late afternoon temperature
92 oF
33.3 oC
CO2 Dome
85 oF
29.3 oC
Rural
Suburban
Commercial
Residential
Downtown
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Urban
Residential
Park
Suburban
Rural
Residential Farmland
Figure by MIT OCW.
Emerging Infectious Diseases
30 “NEW” TO MEDICINE SINCE 1976
HIV/AIDS
Legionnaires’
E. coli O157:H7
MDRTB & others
SARS
nvCJD
HPS
Vibrio cholerae O139
Nipah virus
Ebola
Arenaviruses Lyme disease
RESURGENT & REDISTRIBUTING
Malaria, DF, WNV, Leptospirosis,
Cholera, Avian Flu
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VECTORS
Mosquitoes
Ticks
Rodents
Bats
Tsetse Flies
Fleas
Lice
Snails
Algae
Infectious Disease: A Driving Force In History
The “Good” News
The Bad News:
PLAGUE
80
541 AD
1346 AD
Percent of all deaths
70
60
50
40
1/50
Figure by MIT OCW.
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1800
1850
1900
Year
Deaths from IDs in London
Cholera, TB, Smallpox
Figure by MIT OCW.
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Upward Plant Migration
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Changes in the Cryosphere
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Geographic Shifts of Disease Vectors
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Changes in Permafrost
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Extreme Weather Events &
Disease Clusters
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Precipitation Extremes
Past century average
precipitation:
7%
annual
“Heavy rain events" (>2”/day):
14%
“Very
heavy
rain
(>4”/day):
20%
events"
Western drought – worst in 500
years. Devastating rains 2005
Groisman et al. 2004
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Hurricane Mitch
Impacts On Health and Development
DISEASE CLUSTER
-- Malaria (>30,000 cases)
-- Dengue fever (>1,000)
-- Cholera (>30,000)
-- Leptospirosis
Source: Juan Almendares
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WNV: Meteorological Factors
(Factor - 1)
(Factor - 2)
MILD WINTER
More mosquitoes than usual survived
the winter in sewers, damp basements
and other sources of still water
DRY SPRING AND SUMMER
Many birds congregated at
dwindling water sources
Lack of rain killed predators of mosquitoes
(frogs, lacewings, ladybugs)
As water in breeding sites evaporated,
organic compounds became concentrated,
nourishing mosquito larvae
Mosquito population flourished in spring
and summer
(Factor - 3)
MOSQUITO POPULATION
GREW LARGE
JULY HEAT WAVE
DRENCHING AUGUST RAINS
Downpours formed new breeding
sites for mosquitoes, yielding a new
crop of the insects
(Factor - 4)
Once mosquitoes infected with the
West Nile virus appeared, the heat caused
the virus to proliferate rapidly inside them
VICIOUS CYCLE BEGAN
Infected mosquitoes transmitted
the virus to initially uninfected birds
INFECTION SPREAD TO PEOPLE
As more and more mosquitoes became
infected, they spread the virus to still
more birds and ultimately to people
Initially uninfected mosquitoes picked
up the virus from infected birds
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Figure by MIT OCW.
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
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Ecological Ripples
Infectious Diseases As Forces Of Global Change
Raptors
Rodents
Lyme disease
Hantaviruses
Arenaviruses
Leptospirosis
Toxoplasmosis
Plague
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Weather Anomalies, Travel Hazards
And Trauma
•
Fog, Ice Storms & Road Travel
•
Floods & Mudslides
•
Ice Instability, Heavy Precipitation
& Avalanches
•
Infrastructure Damage and Water
Q&Q
HEALTH & ECONOMIC
IMPACTS
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Range Expansion of Soybean Rust
Figure by MIT OCW.
Crop Pests:
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Generations/Year
Drought, Bark Beetles & Fires
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Coral Bleaching:
Warming and Microbes
Vibrio coralyticus
• lysis at 29ºC
• release of zooxanthellae
• infection and immunity
Kushmaro et al., Int J Syst Evol Microbiol 2001; 51:1383
Ray Hayes
Coral diseases
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-Patterson et al., PNAS 2002;99:872
Costs of Emerging Infectious Diseases
SARS
China, Singapore, Canada.....
$50 bn +
$50
Estimated costs (billion)
$40
Foot & Mouth UK
$20-30 bn
$30
BSE, UK
$10-13 bn
Foot & Mouth
Taiwan, $5 bn
$20
$10
Nipah, Malaysia
$350-400m
Cholera, Peru
$775 m
West Nile, U.S.
$300-500 m
Lyme Disease, U.S.
$2.5 bn
1991
1992
1993
1994
1995
Avian flu
Europe, $200 m
BSE (Mad Cow)
Canada, $200 m
Exotic Newcastle
Disease, $100 m
1996
1997
1998
1999
2000
2001
2002 2003
Figures are estimates and are presented as relative size.
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Figure by MIT OCW.
Uncertainty: Physical
Financial
GLOBAL INSURED DISASTER LOSSES ON THE RISE
Increasing Variability (σ)
50
Est.
10
“Catastrophe insurers
can't simply extrapolate
past experience.”
- Warren Buffett (1992)
2003 US$ Billion
40
2003 US$
Billion 5
0
1970 74 78 82 86 1990 94 98 02
30
"9/11"
100%
20
50%
0%
1970 74 78 82 86 1990 94 98 02
10
Note: plot shows only large
events and excludes
health/life losses. Including
small-scale events would
double these numbers; healthrelated losses unknown
0
1970 72
74
76
78
82 84
Natural catastrophes
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80
86 88
90
92 94
96
98 2000 02
04
Man-made catastrophes
Figure by MIT OCW.
Harmonizing Adaptation with Mitigation
Distributed Generation
Water:
Purification
Pumping
Irrigation
Desalinization
Clinics
Homes
Schools
Computers
Cooking
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Enabling Financial Architecture For
Sustainable Development
REGULATORY
FUNDS,
SUBSIDIES,
TAX
INCENTIVES
•
•
•
•
•
INSTITUTIONAL
EE, RE and DG
“Green Buildings” & Smart Growth
Rationalized Transport & Transit
Retrofitting Infrastructure
Ecological Reconstruction
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THE ENGINE OF
GROWTH
for the
21st CENTURY