RAINER SAUERBORN Heidelberg University, Germany 2008 GLOBAL
MINISTERIAL FORUM ON RESEARCH FOR HEALTH BAMAKO, NOVEMBER 16-19,
2008 Climate change destabilizes infectious diseases: challenges
for research and policy #1 Increasing instability of infectious
diseases #2 Improving the scientific basis for predictive modelling
#3 Adaptation policies now, while evidence improves #4 Bringing
health to the mitigation policy debate Key points: Slide 2
http://www.who.int/infectious-disease-report/pages/graph30.html
(Re-)emerging diseases 1994-99 #1 Instability of infectious
diseases (re-)emerging diseases 1994-1999 #1 Instability of
infectious diseases (re-)emerging diseases 1994-1999 Slide 3
Simultaneous influences on infectious diseases Malnutrition Vector
ecology Dysfuntional health services, Low uptake of control
measures by population Resistance development, new drugs/vaccines
Mobility of people, vectors, microbes Land use change, irrigation,
urbanization Climate change Slide 4 The convergence model for
infectious diseases (IOM, 2008) Slide 5 Understanding the
interactions between climate change and infectious diseases:
process-based modelling - Plausible biological assumption -
Mathematical process based models - Decade-long data sets
Prediction modelling for better early warning and intervention
design There is no treatment without diagnosis. Hippocrates # 2
Improving the scientific basis for predictive modelling - Using
climate to predict disease - Using ecological changes - Using
animal diseases - Using human cases Slide 6 Future Present Learn
Detect Forecasting, modelling Three Main Types of Research
Empirical studies McMichael 2007 2050 Slide 7 INDEPTH Network
Currently 37 sites in 19 countries 26 sites in Africa 9 sites in
Asia 1 site in Oceania,1 site in Latin America Geo-referenced,
individual data on death by cause, age, sex and socio-economic
indicators International Network of Developing Countries with
continous longitudinal health surveillanceINDEPTH International
Network of Developing Countries with continous longitudinal health
surveillanceINDEPTH Over 2,000,000 people under health surveillance
Slide 8 INDEPTH Network Health data from over 45 years 1962 2006
Slide 9 Meteo stations Health Surveillance: 47 villages, 73 000
people Satellite imagery Linking health and environmental
monitoring: Nouna district, Burkina Faso Slide 10 # 3 Adaptation
policies now, while evidence improves precautionary principle
1.Early warning systems for climate-sensitive infectious diseases:
malaria, cryptosporidiosis, leishmaniasis, dengue, Hanta,
Chikungunya, RVF, TBE, MBE, WNF leptospirosis, plague, cholera,
Lyme, Ebola and more 2.No regrets strategies top priority:
strengthen health systems Risk pooling strategies (health
insurance) Invest in water and sanitation Food security Priority
for existing control of climate-sensitive infectious diseases Slide
11 Protecting health is the central motivation for most people
everywhere Mitigation has important health co-benefits, reducing:
800,000 deaths to outdoor air-pollution 1,200,000 deaths to
injuries 1,900,000 deaths to physical inactivity Mitigation and
adaptation are poverty reduction strategies # 4 Put the health
argument into the mitigation debate Slide 12 GHG Emissions
Adaptation GHG concentrations Warming and variabilty Health impact
Disease Death, Disab. From emissions to Health Vulnerability
Mitigation: emission control carbon sinks, sequestration Exposure
Climate sensitivity Health sensitivity Vulnerability + Population *
GDP/Person * energy/GDP * GHG emissions/energy Kaya identy = Slide
13 Climate and climate impact: health matters (Stern 2007) Stern,
2007 Notes: Baseline climate: CC as assumed by TAR IPCC High
climate: Incorporating 2 types of feedback: 1. thawing of
permafrost areas 2. weakened carbon sinks Climate Impacts Slide 14
Annual losses of GDP/capita due to climate change -projections
until 2200- Stern, 2007 Slide 15 INDEPTH Network Slide 16
DISCUSSION SLIDES Slide 17 So what? Assume valid &
generalizable malaria risk maps Regardless of whether climate will
change the malaria burden: Need to improve and target interventions
Regrets or no regrets? Slide 18 Gefahr einer Zunahme tropischer
Infektionskrankheiten Rainer Sauerborn Universitt Heidelberg
WARNSIGNAL KLIMA. ffentliches Symposion, Hamburg, 26.-28.2008 Slide
19 Emissions of greenhouse gases Density equalling cartogram.
Countries scaled according to cumulative emissions in billion
tonnes carbon equivalent in 2002. Gibbs et al, in prep. Slide 20
Health impacts of climate change Density equalling cartogram. WHO
regions scaled according to estimated mortality (per million
people) in the year 2000, attributable to the climate change that
occurred from 1970s to 2000. Gibbs et al, in prep. Slide 21
Mitigating and adapting to climate change is inherently pro-poor
Slide 22 Stellschrauben der Adaptation: Malaria Biological Adaptive
Behavioral Useof bednets Biological Adaptive immunity Social
Surveillance Hlthsystems Social Surveillance Hlthsystems Behavioral
Useof bednets Mode intervention National Level of intervention
Community or group Individual Biological Adaptive Behavioral Useof
bednets Biological Adaptive immunity Social Surveillance
Hlthsystems Social Surveillance Hlthsystems Social Surveillance
Hlthsystems Social Surveillance Hlthsystems Behavioral Useof
bednets National Level of intervention Community or group
Individual Other institutions intervention ofMode Primary
Vaccination Dams Secondary Early warning Tertiary Early treatment
Primary Vaccination Dams Secondary Early warning Tertiary Early
treatment Stage of intervention Primary Vaccination Dams Secondary
Early warning Tertiary Early treatment Primary Vaccination Dams
Secondary Early warning Tertiary Early treatment Stage of
intervention Global Slide 23 1.8 o C = 3.2 o F 2.8 o C = 5.0 o F
3.4 o C = 6.1 o F ppm CO 2 Eq 850 600 Even if we stop emitting
today 0.6 o C = 1.0 o F IPCC, WG 1 Slide 24 INDEPTH Network
Prospective monitoring of demographic and health events Slide 25
Estimated current health impact of climate change Slide 26 Basis
for mitigation policies: The Kaya identity CO2 = Population x
GDP/Person x kJoule/GDP x CO2 emissions/kJoule Economic growth
Energy efficiency Energy mix Population growth Slide 27 INDEPTH
Network INDEPTH I nternational Network for the Demographic
Evaluation of Populations and Their Health in Developing Countries
Slide 28 Figure SPM.2. Key impacts as a function of increasing
global average temperature change (Impacts will vary by extent of
adaptation, rate of temperature change, and socio-economic pathway)
Slide 29 Applications of definitions in comparative risk assessment
to climate change Slide 30 Europe Africa S.-Asia Latin-A SIS +++++
sea level ++++++ sea level ++++ ++++++ +++ +? + +? + ? -++++++++?
+++ + Based on: McMichael and Kovats, 2000 Slide 31 Healthy
development Environmental health capacity building Integrated
vector management Health action in emergencies Infectious disease
surveillance Safe drinking water Diseases affected by climate Slide
32 Health Co-Benefits from Mitigation Reduced fossil fuel
combustion: Reduce cardio-respiratory deaths/hospitalisations from
local air pollution (esp. fine particulates). Low-emission urban
(public) transport system: Increase physical activity (walking,
cycling) reduce over-weight, improve lipid/endocrine profiles,
increase social contact and wellbeing. Road trauma should decline.
Reduced red (ruminant) meat consumption (livestock-CH4) Reduce
risks of some disease: large bowel cancer, ?breast cancer; also
heart disease (meat fat content). More energy-efficient housing
Reduce thermal/acoustic stresses Slide 33 Economics of mitigation
(Stern, 2007) To avoid worst effects, stabilization of CO2 should
be at least 550 ppm* To achieve 550ppm, CO 2 emissions must be
brought down to 80% of 1990 level Economic costs of climate change,
if we do business as usual: 5% to 20% of GDP Mitigation costs to
achieve stabilization at 550 ppm CO2: 1% of GDP starting now
Current level of CO2: 430ppm, pre-industrial: 270ppm Maximum in
past 600,000 years: 300ppm Slide 34 How sensitive is health to
climate? Diarrhoea How sensitive is health to climate? Diarrhoea
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)