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CENTER FOR HEALTH AND THE GLOBAL ENVIRONMENT

HARVARD MEDICAL SCHOOL

Climate Change and Human Health

MITPaul R. Epstein, MD, MPH



Epidemiological Framework

AGENT

HOST ENVIRON-MENT

DISEASE

Ecological-Epidemiological Framework

SOCIAL

ECO-SYSTEMS

GLOBAL

EPIDEMICS



United Nations Intergovernmental United Nations Intergovernmental Panel on Climate Change Panel on Climate Change

Third Assessment Report 2001Third Assessment Report 2001

1. Climate is changing2. Human activities are contributing3. Biological systems are being affected

on all continents4. Weather is becoming more extreme

All weather = All weather = f f (CC + NV)(CC + NV)



379ppm

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.



Deep Ocean Warming

Oceans: 14.2 x 1022 JAtmosphere: 6.6 x 1021 J

Levitus et al. Science 2000; 287:2225

Parrilla et al. Nature 1994;369:48



The Changing Shape of the Curve(A) INCREASE IN MEAN

More hotweather

More record hot

weatherLess cold weather

Cold

Prob

abili

ty o

f occ

urre

nce

Average Hot

P

revi

ous C

limat

e

New

Clim

ate

More record hot

weather

More record hot

weather

More record cold

weather

More hotweather

Much more hotweather

More coldweather

Less change for cold weather

(B) INCREASE IN VARIANCE

Cold Average Hot

(C) INCREASE IN MEAN AND VARIANCE

Cold Average Hot

New

Clim

ate

Previous Clim

ate

P

revi

ous C

limat

e

N

ew C

limate

Prob

abili

ty o

f occ

urre

nce

Prob

abili

ty o

f occ

urre

nce

Figure by MIT OCW.

http://www.grida.no/climate/ipcc_tar/wg1/fig2-32.htm



Assessing Climate Stability

• Rates of Change• Variability

• Gradients• Number of

Components Changing



Model Projections: Heat Waves

Atlanta

AVERAGE SUMMER MORTALITY RATES

Estimates for 2020 and 2050 are based on the Max Planck GCM results (IPCC 1994)

Chicago Los Angeles Minneapolis New York St. Louis

1964-1991

0

12

3

4

5

6

7

8

9

Mor

talit

y pe

r 100

,000 2020

2050

Attributed to hot weather episodes.

Figure by MIT OCW.



Summer 2003 Heat WaveFrance, Germany, Italy, Spain, Portugal 21-35, 000 Deaths

2003 Summer Temperatures 10oC (18oF) >30year averageSource: NASASource: NASA



INDIAJune 2003 T 122•F >1400 deaths

July Floods

Japanese B encephalitis



Air Pollution and Climate Change

Indoor pollutants Socio/economic/emotional factors

Ground-level Ozone& Heat Waves

Droughts & Fires

ASTHMA2-3x

Since 1980s

Diesel ParticlesMold & PollenPollen & CO2

Floods & Fungi



Ground-level Ozone And Temperature



RAGWEED POLLEN PRODUCTIONand CO2

0CO2 350 ppm

Height

Biomass

CO2 700 ppm p = 0.005

10

20

30

40

50

60

70

Seed Mass

Pollen

Figure by MIT OCW.



92 oF

29.3 oC

33.3 oC

Rural

CO2 Dome

Late

afte

rnoo

n te

mpe

ratu

re

Commercial

SKETCH OF AN URBAN HEAT-ISLAND PROFILE

Urban Residential

SuburbanResidential

Suburban Residential

Downtown Park RuralFarmland

85 oF

Figure by MIT OCW.



Emerging Infectious Diseases

30 “NEW” TO MEDICINE SINCE 1976HIV/AIDS Legionnaires’

E. coli O157:H7 MDRTB & others

SARS nvCJD

HPS Vibrio cholerae O139

Nipah virus EbolaArenaviruses Lyme disease

RESURGENT & REDISTRIBUTING

Malaria, DF, WNV, Leptospirosis,

Cholera, Avian Flu

VECTORSMosquitoes

TicksRodents

BatsTsetse Flies

FleasLice

SnailsAlgae



Infectious Disease: A Driving Force In History

The “Good” NewsThe Bad News:

PLAGUE

541 AD

1346 AD

Deaths from IDs in London Cholera, TB, Smallpox

1/50

40

50

60

70

80

1800Year

Perc

ent o

f all

deat

hs

1850 1900

Figure by MIT OCW.



Figure by MIT OCW.



Upward Plant Migration



Changes in the Cryosphere



Geographic Shifts of Disease Vectors



Changes in Permafrost



Extreme Weather Events & Disease Clusters



Precipitation Extremes

Past century average annual precipitation: 7%

“Heavy rain events" (>2”/day): 14%

“Very heavy rain events" (>4”/day): 20%

Western drought – worst in 500 years. Devastating rains 2005

Groisman et al. 2004



Hurricane MitchImpacts On Health and Development

DISEASE CLUSTER

-- Malaria (>30,000 cases)-- Dengue fever (>1,000)-- Cholera (>30,000)-- Leptospirosis

Source: Juan Almendares



WNV: Meteorological Factors

More mosquitoes than usual survivedthe winter in sewers, damp basementsand other sources of still water Lack of rain killed predators of mosquitoes

(frogs, lacewings, ladybugs)

Many birds congregated atdwindling water sources

Once mosquitoes infected with the West Nile virus appeared, the heat caused the virus to proliferate rapidly inside them

Infected mosquitoes transmittedthe virus to initially uninfected birds

Initially uninfected mosquitoes picked up the virus from infected birds

INFECTION SPREAD TO PEOPLEAs more and more mosquitoes becameinfected, they spread the virus to stillmore birds and ultimately to people

DRENCHING AUGUST RAINSDownpours formed new breedingsites for mosquitoes, yielding a newcrop of the insects

Mosquito population flourished in spring and summer

As water in breeding sites evaporated, organic compounds became concentrated, nourishing mosquito larvae

MILD WINTER DRY SPRING AND SUMMER

JULY HEAT WAVE

VICIOUS CYCLE BEGAN

MOSQUITO POPULATIONGREW LARGE

(Factor - 1)

(Factor - 3)

(Factor - 4)

(Factor - 2)

Figure by MIT OCW.



WNV: A Disease Of Wildlife230 SPECIES 44 STATES, DC, 5 CANADIAN PROVINCES

• 138 Bird spp., RAPTORS

- 37 spp. of mosquitoes

• HORSES

• ZOO animals

• REPTILES



Infectious Diseases As Forces Of Global Change

Raptors Rodents

Ecological Ripples

Lyme disease HantavirusesArenavirusesLeptospirosisToxoplasmosisPlague



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



Range Expansion of Soybean Rust

Crop Pests: Generations/Year

Figure by MIT OCW.



Drought, Bark Beetles & Fires



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-Patterson et al., PNAS 2002;99:872



Costs of Emerging Infectious Diseases

1991

$10

Estim

ated

cos

ts (b

illio

n)

$20

$30

$40

$50

1992 1993 1994 1995

BSE, UK$10-13 bn

Lyme Disease, U.S. $2.5 bn

Cholera, Peru$775 m

Foot & MouthTaiwan, $5 bn

Nipah, Malaysia$350-400m

Exotic NewcastleDisease, $100 m

Avian fluEurope, $200 m

BSE (Mad Cow)Canada, $200 mWest Nile, U.S.

$300-500 m

Foot & Mouth UK$20-30 bn

Figures are estimates and are presented as relative size.

SARSChina, Singapore, Canada.....

$50 bn +

1996 1997 1998 1999 2000 2001 2002 2003

Figure by MIT OCW.



Uncertainty: Physical Financial

“Catastrophe insurers can't simply extrapolate past experience.”

- Warren Buffett (1992)

Note: plot shows only large events and excludes health/life losses. Including small-scale events would double these numbers; health-related losses unknown

19700

10

20

30

40

50

2003

US$

Bill

ion

72 74 76

19700%

0

50%

5

102003 US$

Billion

100%

74 78 82 86 1990 94 98 02

1970

Increasing Variability (σ)

Est.

"9/11"

GLOBAL INSURED DISASTER LOSSES ON THE RISE

Natural catastrophes Man-made catastrophes

74 78 82 86 1990 94 98 02

78 82 84 86 88 92 94 96 98 02 0420009080

Figure by MIT OCW.



Harmonizing Adaptation with Mitigation

Distributed GenerationWater:

PurificationPumpingIrrigationDesalinization

ClinicsHomesSchoolsComputersCooking



Enabling Financial Architecture For Sustainable Development

THE ENGINE OF GROWTH

for the21st CENTURY• EE, RE and DG

• “Green Buildings” & Smart Growth• Rationalized Transport & Transit• Retrofitting Infrastructure• Ecological Reconstruction

REGULATORY

FUNDS, SUBSIDIES,

TAX INCENTIVES

INSTITUTIONAL

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