CRICOS #00212KOctober 12, 2015

Prof Colin D Butler Climate change and health

ANU Medical SchoolOct 12, 2015

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Tony McMichael, 2014

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June, 2015

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“Tackling climate change could be the greatest global health opportunity of the 21st century”

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“The expense may be considerable, but the cost of doing nothing is incalculable”

Health in the Greenhouse

Editorial (Lancet, 1989)

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Outline

Basic science of climate change

Health effects – 3 levels of effect

Next week: what doctors can do

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“…slight change in [the atmosphere’s] constituents….”

John Tyndall, 1859

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Climate change: an old science

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John Tyndall

water vapour, carbon dioxide, methane reduce heat loss, oxygen, nitrogen virtually transparent to heat.

without these, Earth's surface would be "held fast in the iron grip of frost."

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Earth’s Temperature Chart, since Dinosaur Extinction 65m yrs ago

West Antarctic ice sheet begins

Arctic ice sheets appear

East Antarctic ice sheet begins

60myr 50myr 40myr 30myr 20myr 10myr Now

1961-90 av temp

Millions of Years Before Present

12

8

4

0

-4

Temp oC *

(vs. 1961-90)

5oC warmer than 1961-90

?

Paleocene

* Global temperature, measured at deep ocean

3oC warmer than 1961-90

1.5oC warmer

than 1961-90

s

s

Sea level 25-40 metres higher than now

Sea level ~70 metres higher than now

Paleocene-Eocene Catastrophe

Last 2m yr = ice-age

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Last Glaciation

CO2 has not been this high in >half a million years.CO2 from fossil fuels, deforestation, agriculture main cause

Last interglacial

350

300

250

200

Carbon Dioxide Concentration (ppmv)

600 500 400 300 200 100 0

Thousands of Years Before Present

[Adapted from Figure 6.3, ©IPCC 2007: WG1-AR4]

Carbon Dioxide Concentration in Atmosphere over past 650,000 years

280 ppm (‘pre-industrial’) Modern Homo sapiens

Agriculture begins, 10K BP

Holocene

400 ppm CO2

(2013)

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CO2

CH4

N2O

2005

CO2 now

CO2 ppm

N2O ppb

CH4 ppb

Year

Carbon Dioxide (CO2)

Nitrous Oxide (N2O)

Methane (CH4)

“Anthropocene”

Concentrations of main greenhouse gases - other than H2O - over past 2,000 years (IPCC 2007)

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Number of Years Before Present (quasi-log scale)

-2

-3

-4

-5

3

2

1

0

Agriculture emerges

Mesopotamiaflourishes

End oflastice ageglaciation Younger

Dryas event (rapid re-cooling)

Little Ice Age in Europe(14th-19thcenturies)

HoloceneOptimum

Global Temperature: Past 20,000 Years; Next 100 Years

Temp. change (ºC)

10,000 2,000 1,000 300 100 Now +10020,000

MedievalWarm in Europe (& drying in Central America)

Av. temp. over past 10,000 yrs =15 ºC

1940

-6

Dark Ages in Europe

White wine grown in Sth England

4

Vikings in

Greenland

Rome ascendant

1975

Most radiation absorbed byEarth, warming it

Most radiation absorbed byEarth, warming it

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Some energy is radiated back into space as infrared

waves

Some energy is radiated back into space as infrared

waves

The strength of the sun varies a littleThe strength of the sun varies a little

Aerosols: net cooling effect

Aerosols: net cooling effect

Feedback - additional GHGs

Some outgoing infrared radiation trapped by atmosphere, warming it

Some outgoing infrared radiation trapped by atmosphere, warming it

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CH4 CO2

Green house gases

N2O

Sulfate particles

Radiative forcing

NO2

CH4

O3

CH4

CH4

CO2

Slide adapted from one courtesy Prof Steffen Loft, University of Copenhagen,

Denmark

wetlands, rice, tundra, biomass burning,

deforestation

CO2 CH4, black carbon

CO2

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IPCC, Wkg Gp 1 Report, Fourth Assessment Report, 2007, p. 703

anthropogenic forcings

How valid are Global Climate Models (for predicting future change?)

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Physical effects of climate change

Heat

Cold?

Storms

Rainfall changes

Sea level rise

Ocean acidification

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Average global land ocean temp 0.88°C > 20th century average of 15.6°C, hottest August in 136-year record, 0.09°C higher than previous record (2014)

https://www.ncdc.noaa.gov/sotc/global/201508

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July 30, 2015 “heat dome”

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Australia: Getting Hotter from: CSIRO/BoM State of the Climate, March 2010

60

50

40

30

20

10 1960 1970 1980 1990 2000 2010

Year

Data source: Bureau of Meteorology

Average number of record hot days per year, by decade

No. of record hot days [max temperature] at Australian climate reference stations, 1960-2009

No. of record

hot days

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Australia: Getting Less Cold from: CSIRO/BoM State of the Climate, March 2010

No. of record cold days [max daily temperature] at Australian climate reference stations, 1960-2009

Average number of record cold days per year, by decade

1960 1970 1980 1990 2000 2010

Year

40

30

20

10

Data source: Bureau of Meteorology

No. of record

cold days

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1. Thermal expansion2. Melting land ice – Greenland, Antarctica3. Other glaciers (eg Alaska, Himalayas)4. Partly offset by dams

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Global mean sea level (mm)

Hay et al, Nature, 2015

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Observed global mean sea level and derived instantaneous sea level riseGlobal Environmental Outlook – not peer reviewed

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Outline

Health effects – 3 levels of effect

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“Secondary”

“Tertiary”

“Primary”

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Prof Colin D Butler Climate change and health (2/2)

ANU Medical School Oct 19, 2015

Super Typhoon Haiyan approaching the Philippines on Nov 7, 2013. Credit: EUMETSAT (Wide-angle satellite image)

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Typhoon Haiyan, Tacloban, The PhilippinesStrongest recorded storm to make landfallDirect death toll: >5,000Displaced: >4 millionTotal Burden of Disease?Fraction attributable to climate change?

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A year on, typhoon-devastated Philippine city fails to rebuild homes Date: 29-Oct-14Country: PHILIPPINES

Tacloban Mayor: <100 of 14,500 promised permanent homes built, (7m storm surges destroyed around 90% of city)

“The nephew of Imelda Marcos did not mention graft as factor in one of Asia's most corrupt countries”

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A woman, who survived the typhoon by climbing up a steep hill, stands beside her temporary home. “I’m scared living here. When the tide comes up here, I’m very nervous that my house will be destroyed,” she said. Photograph: Eleanor Farmer/Oxfam

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http://www.tropicalstormrisk.com/ Tyhhoon Koppu, The Philippines, 18/10/2015

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Interaction, warm air helps trap Koppu for a number of days ... 1 metre rain forecast

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“surges exceeding 11m in Tampa and 7m in Dubai .. non-negligible probabilities, especially towards end of century.”

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Heat waves, fewer cold waves, injuries, floods, fires

Infectious diseases, especially vector borne, allergies, air pollutants, infrastructure

secondary

primary

tertiary

Health effects of eco-climate-social stress

famine, conflict, pop’n displacement, refugees, development failure

3737

Men

tal h

ealth

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Miami: especially vulnerable to sea level rise

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Paris, Heatwave (2003): Daily Mean Temps and Deaths

30Mean daily temp, 2003

Mean daily temp 1999-2002

~12 oC above season norm

25

15 oC

20

35 oC

~900 extra deaths during heatwave

350

300

250

200

150

100

0

Daily deaths

50

van den Torren, 2004

+8 oC

+12 oC

Daily deaths: 2003 1999-2002

~100 extra deaths

June …..……………… July …………………. ………… August ……….

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Ambulance attendances: heat-related illnesses Metropolitan Melbourne heatwave, 2009

Victorian Dept of Health

Elderly at most risk: vulnerable to exacerbation of chronic illness?

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Night-time

Day-time‘Heat Island” Effect: Melbourne, Australia

Heatwave, Jan 2009

From: M Loughnan, Monash University

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Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave

(Azhar et al, 2014) (adapted)

May 1-31

Max temp 2010

Max temp 2009-and 2011

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Daily deaths 2009 & 2011, 2010

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Infectious diseases, especially vector borne, allergies, air pollutants, infrastructure

secondary

Health effects of eco-climate-social stress

4444

Men

tal h

ealth

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3650m (13,000 feet)

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Baseline 2000 2025 2050

Ebi et al., 2005

Climate Change and Malaria Potential transmission in Zimbabwe

Bulawayo

Climate suitability: red = high; blue/green = low

High probability

Medium probability

Low probability

Harare

Highlands

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Bulawayo

Harare

Baseline 2000 2025 2050

Climate Change and Malaria Potential transmission in Zimbabwe

Climate suitability: red = high; blue/green = low

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Bulawayo

Harare

Baseline 2000 2025 2050

Climate Change and Malaria Potential transmission in Zimbabwe

Climate suitability: red = high; blue/green = low

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Malaria in Papua New Guinea

Old location

New location

courtesy Prof Ivo Mueller:

Institute of Medical Research, PNG

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Dengue’s principal vector: Aedes aegypti

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Effects of Temperature Rise on Dengue Transmission

Faster viral incubation in mosquito

Shorter mosquito breeding cycle

Increased mosquito feeding frequency

More efficient transmission of dengue virus from mosquito to human

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Map-projection of changes to rainfall across Australia to 2100 under ‘dry’ and ‘wet’ scenarios.

Using evidence from published literature, modelled how these changes would affect dengue distribution over space and time.

Areas suitable for dengue transmission in 2100 under 4 climate change scenarios (grey = ≥50% likelihood of transmission)

Bambrick et al., 2009, Global Hlth Action

4. Warm (strong mitigation)3. Hot & Wet

2. Hot, Median humidity1. Hot & Dry

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1998 line of northern limit has moved north during ensuing 8 years. 1950 line from surveillance by U.S. occupation army.

　 Confirmed city

Non-confirmed

19982000

100 Km 1950

2006

Northern range of Ae. albopictus in Tohoku district, Japan

Tokyo

Courtesy of: Dr Mutsuo Kobayashi

N2003

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1980s 1990s

Based on: Lindgren, et. al. 2000

Sweden: Tick-Borne encephalitis Spread of Ixodes ricinus

tick to higher latitudes (and altitudes)

Warmer winters

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Bats (pteropid species) colonising urban environments Habitat loss, new-habitat attraction, climate changePotential source of many new viruses

Nipah, Ebola, Hendra, …

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tertiary

Health effects of eco-climate-social stress

famine, conflict, pop’n displacement, refugees, development failure

5656

Men

tal h

ealth

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Prevalence of Stunting in Children Under 5 years (2005)

Black et al, Lancet 200857

Stunted children

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Photo-synthetic

activity

20o C 30o C 40o C

Food Yields: General Relationship of Temperature and Photosynthesis

0%

100%

e.g.: Field & Lobell. Environ Res Lett, 2007:

Globally averaged estimate: +0.5oC reduces crop yields by 3-5%.

+2oC

+2oCPlus:• Flood/storm/fire damage• Droughts – range, severity• Pests (climate-sensitive)• Diseases (ditto)

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Climate change will impair farm production in many poor countries and regions

Modelled % change in agricultural production due to climate change, 2080

Source: Cline WR, 2007: Global warming and agriculture: Impact estimates by country. Washington, D.C.: Center for Global Development, Peterson Institute for International Economics (cited in von Braun J (IFPRI), 2007

< -25%

> + 25%

0 to 5%

NA

-15 to -5%LESS

MORE

- 5 to 0%

5 to 15%

15 to 25%

-25 to -15%

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decline in price due to Green Revolution

oil, speculation, rice panic

extreme events

World food price index (deflated) (1961-2015) (data FAO)

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Climate change will 'lead to battles for food', says head of World Bank (April 2014)Jim Yong Kim urges campaigners and scientists to work together to form a coherent plan in the fight against climate change

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1989: Lancet editorial: foreshadows conflict

2011: Jarvis et al: "Climate change, ill health, and conflict." BMJ 342: 777-778.

2014: Stern, N. “Climate change is here now and it could lead to global conflict.” The Guardian

Conflict and climate change

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“a risk multiplier”

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Waterscarcity

Regions afflicted by problems due to environmental stresses: • population pressure • water shortage• climate change affecting crops • sea level rise • pre-existing hunger• armed conflict, current/recent

From UK Ministry of Defence

[May RM, 2007 Lowy Institute Lecture]

Climate Change: Multiplier of Conflicts and Regional Tensions

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Damascus, 2014. Line for food aid from UN Relief and Works Agency in a great city - large parts of which have been destroyed by civil war, along with basic food supply infrastructure

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Burden of Disease (proportion)

Year widely accepted

now 2050?

PRIMARY (eg heat, injury, productivity)

SECONDARY (e.g. vector-borne diseases, air pollution, allergies)

TERTIARY: (a “systemic multiplier”) famine, conflict, large-

scale migration, economic collapse

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Attribution

For want of a nail the shoe was lostFor want of a shoe the horse was lostFor want of a horse the rider was lostFor want of a rider the battle was lost

For want of a battle the kingdom was lostAnd all for the want of a horseshoe nail

1390 C.E.

“Prisoners of the Proximate: Loosening the Constraints on Epidemiology in an Age of Change”

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Trenberth, 2011:

Climate change attribution - null hypothesis: no human role

“science community much too conservative .. too many authors make Type II errors” (accept the null hypothesis in error) – ie conclude any particular extreme event has no anthropogenic (human) component”

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“Global warming is contributing to a changing incidence of extreme weather because the environment in which all storms form has changed from human activities”

WIREs Clim Change 2011, 2:925–9 30. doi: 10.1002/wcc.142

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Oreskes & Conway (2013):

“Western scientists built an intellectual culture based on the premise that it was worse to fool oneself into believing in something that did not exist than not to believe in something that did. Scientists referred to these positions as “type I” and “type II” errors, and established protocols designed to avoid type I errors at almost all costs”.

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Type 1 error spectrum Type 2

conservative?risky?precautionary? risky?

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Toxicity

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Placebo

Vaccine spectrum

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Panic, despair, or indifference

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“Polyanna”

“Social vaccine” spectrum

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“Peak health”

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“Peak health”

President Royal Society 2005-2010

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“The dangerous impacts of climate change can only be

discussed in terms of nonlinear behavior.’’

Hans Joachim Schellnhuber

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“Coal is good for humanity”

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very dangerous

catastrophic

IPCC 2013

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me

my nephew

a baby

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This changes everything – Naomi Klein

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Crisis = opportunity81

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Ingenuity in the Year without a summer (1816)82

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Rod Simpson

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86

86

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Solar Power Will Become Cheaper Than Coal By 2017HuffPost India | By Anirvan Ghosh Posted: 14/05/2015 16:12 IST Updated: 21/05/2015 14:45 IST

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He Had a dream

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http://www.saskwind.ca/blogbackend/2014/9/17/wind-solar-cost-declines-renewables-growth

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Vatican official calls for moral awakening on global warmingApril 28, 2015