Climate Change and Health:

Toward a Capacity-building Agenda for

Public Health in Asia and the Pacific

The 42nd APACPH Conference

Bali, Indonesia
26 November 2010

Professor Bruce A. Wilcox, Ph.D

Professor of Ecology and Health
Associate Director, APACPH Secretariat
Office of Global Health Studies
University of Hawaii at Manoa
 Purpose and Themes

•Framing the Problem of Climate Change – It’s academic and

historical context

•Describing and differentiating “climate change science” and

“climate change health science”

•A conceptual framework for climate change health science

research and practice

•The need, opportunity and responsibility for Public health to

provide the leadership

•To assert that “climate change health science” is an

emerging field of global health, and global health is part
of public health!
 What is Global Health?
An area for study, research, and practice:
•For improving health and achieving equity in health for all people worldwide.
•That emphasizes transnational health issues, determinants, and solutions
•That involves many disciplines within and beyond the health sciences and
promotes interdisciplinary collaboration
•Is a synthesis of population-based prevention with individual-level clinical
care

•Can be thought of as:

•A notion (the current state of global health)
•An objective (a world of healthy people, a condition of global health)
•A mix of scholarship, research, and practice (with many questions, issues,
skills, and competencies)

(Based on Kolpan et al., Toward a common definition of global health. 2009.

The Lancet, Vol. 373: 293-5)
 Why Public Health?

The need: There are inevitable health impacts are

catastrophically, locally and potentially globally.
 
The opportunity: Public includes most of the requisite disciplines
(environmental health, disaster management, health promotion,
health systems, global health, and many others), approaches
(community-based participatory action research, ecohealth, etc.) –
real-world problem driven (transdisciplinary)
 
 The Challenge to Public Health
(and Medicine)

 Public health (and medicine) need to build it’s own capacity for
research, training and intervention by doing two things:

 1. Articulating the domain of “Climate change health science” ,

i.e., stating the problem and its components.

2. Building CCHS research and training programs addressing all

levels and sectors.
 Some History – Bali 1982: World National
Parks Conference (UNEP, UNESCO, IUCN)
Dasmann (1984) on ecology and development transitions:
ecosystem-biosphere People continuum model:

Ecosystem people - Biosphere people -

live, and whose tied to the global
ancestors have lived economy, and their
and learned, within a livelihoods are not
particular ecosystem dependent on a
and how to do so within particular ecosystem.
ecological limits.

In the context of establishing protected areas, Dasmann observed in the 1970’s that
much of the difficulty encountered in attempting to achieve ecologically sustainable
ways of life associated is with people whose cultures have been disrupted or
destroyed. As a result their means of working with the natural environment to which
their ancestors were adapted is lost, but they have yet achieved a firm foothold in the
global economy. They are in transition along a cultural continuum that can be
defined in terms of ecosystem and biosphere people at the two extremes.
Some History – Bali 1982: World National Parks
Conference (UNEP, UNESCO, IUCN)

Biological diversity - “The variety of life forms, the

ecological roles they play, and the genetic diversity
they contain” (referring to the variation of life forms, at
multiple scales: genetic, organism, population,
species, and ecosystem*). Wilcox (1984).

*Ecosystem - “A natural, human-built, or human-natural

assemblage of interacting biological and physical elements in a
specific location.” – the set of interactions of all living organisms
with their physical environment in a particular area, applicable on
any scale to the level of the biosphere
Environment, Development, and Health:
Where are we now and how did we get here?
• 1950’s –
-Globalization
-Development & International Development
Assistance
-Global environmental limits appear

• 1972 Stockholm Conference (United Nations

Conference on the Human Environment) -
environment & Economic development must be
reconciled.
Millennium Development
• 1992 Rio Earth Summit (United Nations Conference Project - Investing in
on Environment and Development - sustainable Development: A Practical
development articulated, Convention on Climate Plan to Achieve the
Change, Convention on Biological Diversity, etc. Millennium Development
Goals, Prof. Jeffrey Sachs,
• 2005 New York World Summit (United Nations Chair
Millennium Declaration) Millennium Development
Goals - eradicate extreme poverty & disease
reduction.
Environment, Development, and Health:
The Problem

•UN Declarations and Summits have a history of

variable success/failure in achieving goals

•“Development” as conceived and planned by the North

is flawed in theory and practice - Prof. William Easterly
http://blogs.nyu.edu/fas/dri/aidwatch/

•AID has depended on the economic security & stability

of the North - now seriously in doubt
 Climate Change Science
Fundamentals (Definitions)
Climate Change Science - the study of climate
change

Climate change – refers to any change in climate

over time whether due to natural variability or as a
result of human activity. (Framework Convention on
Climate Change definition refers to only the latter
component.)

Global warming – the increase in the average

temperature of the Earth’s near-surface air and
oceans
Climate Change Science Fundamentals

Greenhouse effect – is a process by which thermal

radiation from a planetary surface is absorbed by
atmospheric greenhouse gases, and is re-radiated in
all directions.

Greenhouse gases – gases in Earth’s atmosphere

that absort and emit radiation with the thermal infrared
range of (the major GHGs by their contribution are:
water vapor, 36–70%; carbon dioxide, 9–26%;
methane, 4–9%, ozone, 3–7%)
Climate Change Science Fundamentals

Climate change mitigation – efforts to stabilize or

reduce the production of greenhouse gases.
 
Climate change adaptation – efforts to reduce public
health impact to climate change.
 Climate Change and Health Science
Climate change and health – refers to the direct and
indirect risks or impacts to public health due to climate
change.
 
It is fair to say it is an ad hoc component of climate
science only more recently added – and not yet a
mature science, thus climate change adaptation as it
relates to health risks and impacts is in its infancy as
field or research and practise.

“Climate change health science” remains to be

defined.
Earth’s Energy Budget and the Greenhouse Effect

Contemporary elaboration of
what Svante Arrhenius and others
discovered over 100 years ago:

30% incoming energy is reflected

back to space 70% is absorbed
by earth’s surface, clouds or
atmosphere. Some of this
absorbed by water vapor, carbon
dioxide, and other gases in the
atmosphere (called greenhouse
gases because of their heat-
trapping capacity) and is then re-
radiated back toward the Earth’s
surface.

From G. Tyler Miller, Jr., Living In The Environment, 12th edition, 2002, Wadsworth
Group.
The “Keeling Curve” for Atmospheric CO2 Directly
Measured at Mauna Loa, Hawaii

Keeling Curve
Global Surface Temperature Variation: Past 140 & 1000 yrs

Source: Dr. Warren Washington, NCAR

Global Warming (increased heat energy captured by
the Earth) does not lead to a globally uniform
The average 1°F or ~ 0.5°C increase that already occurred represents as
high as 3°- 5°F and increased and temperature in some places and and
decreased temperature in others – predicted by models and observed

This is explained empirically

by high and low pressure
zones, wind patterns and
other phenomena – and
reasonably predicted by
general circulation models
The Land and Oceans Have Warmed (and cooled)
 Sea Level Rise

•Sea Level rise occurs due to thermal expansion of ocean water and glaciers melting.
There has been an upward trend in the past 100 years.
•Relatively small vertical changes (>1 meter) translate into kilometer scale horizontal
impacts on low lying coastal regions.
•An estimated 634 million people live in coastal areas within 30 feet (9.1 m) of sea level.
The study also reported that about two thirds of the world's cities with over five million
people are located in these low-lying coastal areas. Environment and Urbanization, April,
2007.
Public Health Impacts of Climate Change
Main findings of the IPCC TAR (McMichael et al., 2001)

• An increase in the frequency or intensity of heatwaves will increase the risk

of mortality and morbidity, principally in older age groups and among the
urban poor.

• Any regional increases in climate extremes (e.g., storms, floods, cyclones,

droughts) associated with climate change would cause deaths and injuries,
population displacement, and adverse effects on food production, freshwater
availability and quality, and would increase the risks of infectious disease,
particularly in low-income countries.

• In some settings, the impacts of climate change may cause social

disruption, economic decline, and displacement of populations. The health
impacts associated with such socioeconomic dislocation and population
displacement are substantial.
 Public Health Impacts of Climate Change
Main findings of the IPCC TAR (McMichael et al., 2001)

• Changes in climate, including changes in climate variability, would affect

many vector-borne infections. Populations at the margins of the
current distribution of diseases might be particularly affected.

• Climate change represents an additional pressure on the world’s food

supply system and is expected to increase yields at higher latitudes and
decrease yields at lower latitudes. This would increase the number of
undernourished people in the low-income world, unless there was a major
redistribution of food around the world.

• Assuming that current emission levels continue, air quality in many large
urban areas will deteriorate. Increases in exposure to ozone and other air
pollutants (e.g., particulates) could increase morbidity and mortality.
Geographically Variable Effects: Empirical and
Projected by models
Climate Change: A Recently Added
Dimension of Regional Environmental Change
Regional environmental change as exemplified by urbanization,
agricultural intensification and natural habitat conversion (e.g.,
deforestation) both contributes to global climate change by affecting
radiative forcing and either moderating or amplifying climate change
impacts.

The forest-agro/rural-urban landscape and biodiversity gradient

 Regional Environmental Change
Measured as Land Cover Change
Global land cover as of 2000 (of ~ 130 million km2):
Agriculture
Cropland ~ 15 million km2
Pasture ~ 34 million km2
Urban ~ 5 million km2 (settlements, transportation links, industries,
dams/reservoirs) – megacities will grow to 23 by 2015 (from 4 1975)

Forest (closed canopy) ~ 30 million km2 (50% of “original forest” lost due to
human activity)
Degraded > 5 million km2
Plantation ~ 6.5 million km2

Remainder of landcover (~45 million km2 ) is rock and ice, desert, scrubland, etc.

Humans have converted a significant share of all natural terrestrial biomes to other
uses – and depleted much of the World’s ocean resources including destroying
probably over half of the coral reef ecosystems.
 Climate Change
regional changes in temperature and
rainfall patterns; increased frequency
and intensity of storms, floods, fires,
and droughts; sea-level rise; ocean
acidification
Indirect Direct
Effects Regional Impacts

Ecological
Ecological Social
Social
Resilience
Resilience Resilience
Resilience

Environment Human
stressed water, Well-Being
agriculture, and displacement,
fishery resources; physical and mental
biodiversity loss; health risks,
changing natural security, economic
landscapes and cultural loss

(Downscaling)

Local Context
governments, communities, schools
What does this mean to us?
 Climate Change
regional changes in temperature and
rainfall patterns; increased frequency
and intensity of storms, floods, fires, Climate
and droughts; sea-level rise; ocean
acidification Change
Indirect Direct Science
Effects Regional Impacts

Ecological
Ecological Social
Social
Resilience
Resilience Resilience
Resilience

Environment Human
stressed water, Well-Being
agriculture, and displacement,
fishery resources; physical and mental Climate
biodiversity loss;
changing natural
health risks, Change
security, economic
landscapes and cultural loss Health
Science
(Downscaling)

Local Context
governments, communities, schools

What does this mean to us?

GLOBAL ENVIRONMENTAL CHANGE and HEALTH RISK

DRIVERS OUTCOMES
Global Change Population
Components Health Status

Urbanization

Agricultural Infectious disease

intensification
Chronic Disease
Deforestation
Accidents/Injuries

Mental health

Climate change Nutritional state

Individual & family

Environmental
coping/resilience
variation (Floods,
storms, drought,
heat waves)

Stress Effect
Major Problems Associated with Human
Transformation of the Biosphere

The largest problems now affecting the world are: Acid

Rain, Air Pollution, Global Warming, Loss of Biological
Diversity, Hazardous Waste, Ozone Depletion, Smog,
Water Pollution, Overpopulation, and Tropical Forest
Destruction, Ocean Fishery Collapse, Biological Invasions.

These are all elements of what science calls global

environmental change - changes that result from or result
in global scale alteration of components of the biosphere.
 Regional Environmental Change
(occurring globally)

Global land cover as of 2000 (of ~ 130 million km2):

Agriculture
Cropland ~ 15 million km2
Pasture ~ 34 million km2
Urban ~ 5 million km2 (settlements, transportation links, industries, dams/reservoirs)
– megacities will grow to 23 by 2015 (from 4 1975)

Forest (closed canopy) ~ 30 million km2 (50% of “original forest” lost due to
human activity)
Degraded > 5 million km2
Plantation ~ 6.5 million km2

Remainder of landcover (~45 million km2 is rock and ice, desert, scrubland, etc.
Point: Humans have converted a significant share of all natural terrestrial biomes to
other uses – and depleted much of the World’s ocean resources including destroying
probably over half of the coral reef ecosystems.
 Climate: Variety, Expanse, and Types of Ecosystems

Marine Ecosystems Open Ocean, Continental Shelf Waters, Upwelling Regions, Hydrothermal
Vents, Estuaries
Freshwater Ecosystems Lakes & Ponds, Rivers & Streams, Marshes & Swamps
Terrestrial Ecosystems Tundra, Polar Ice Caps, Coniferous Forests, Deciduous Forests,
Temperate Grassland, Tropical Grassland, Chaparral, Desert, Tropical
Forests
 How many species do these
ecosystems support?

* 287,655 plants, including: Source:http://en.wikipedia.org/wiki/Biodiversity

o 15,000 mosses,
o 13,025 ferns,
o 980 gymnosperms,
o 199,350 dicotyledons, However the total number of species
o 59,300 monocotyledons; for some phyla may be much higher:
* 74,000–120,000 fungi;
* 10,000 lichens; * 10–30 million insects;
* 5–10 million bacteria;
1,250,000 animals, including: * 1.5 million fungi;
* 1,190,200 invertebrates: * ~1 million mites
o 950,000 insects,
o 70,000 mollusks,
o 40,000 crustaceans,
o 130,200 others; ~ 1.5 million higher
* 58,808 vertebrates: plants and animals,
o 29,300 fish, and tens of millions of
o 5,743 amphibians, invertebrates - most
o 8,240 reptiles, are in Tropical forest
o 10,234 birds, (9799 extant as of 2006)
ecosystems
o 5,416 mammals.
 An Ecosystem Approach
Glacier

Forest
Village

City
Town
Crop land

Arid land
Island

Wetlands/
Delta

Ecosystems are “coupled human-natural systems” to which principles

of social ecological systems and resilience theory are applicable.
 GLOBAL ENVIRONMENTAL CHANGE and HEALTH RISK
DRIVERS MEDIATORS OUTCOMES

Global Change Regional & Local Eco-Bio-Social Population

Components Social Ecological Conditions Health Status
Urbanization Systems
Land Natural resources Infectious disease
Agricultural
intensification Oceans Population density Chronic Disease

Deforestation Fresh water Host/vector- Accidents/Injuries

pathogen stability
Biodiversity
Mental health
Crop yields
Agricultural
Climate change production systems Nutritional state
Food security
Human Individual & family
Environmental Infrastructure Economic status coping/resilience
variation (Floods,
storms, drought, Social organization Social capital
heat waves)

Stress System Effect

Adaptability/Resilience
 SOCIAL
SOCIAL RESILIENCE
RESILIENCE LOSS
LOSS of
of NATURAL/ECOLOGICAL
NATURAL/ECOLOGICAL RESILIENCE
RESILIENCE
•• Social
Social capital
capital •• Forest/Upland/Coastal/Mangrove
Forest/Upland/Coastal/Mangrove
•• Health
Health status
status •• Biodiversity
Biodiversity
•• Socio-economic
Socio-economic status
status •• Reefs
Reefs
•• Infrastructure
Infrastructure •• River
River systems
systems

Glacier
EXTREME
EXTREME RAINFALL
RAINFALL
EVENTS
EVENTS MALNUTRITION
MALNUTRITION
Forest
Village INFECTIOUS
INFECTIOUS DISEASE
DISEASE HEAT
HEAT STRESS
STRESS

City
Town
Crop land

GLACIAL
GLACIAL
MELTING
MELTING Arid land
Island
DROUGHT
DROUGHT
Wetlands/
Delta
FLOODING
FLOODING
SEA-LEVEL
SEA-LEVEL RISE
RISE
STORM
STORM SURGE
SURGE
SALT
SALT WATER
WATER INTRUSION
INTRUSION
Thinking of Disease Emergence as a Environmental
Change Process Driven by Global Change:
Population
Technological capacity
Socio-cultural organization

Agricultural Habitat
Urbanization intensification* alteration
* Includes food production

ecosystem continuum

(Based on Wilcox and Gubler 2005)

 REGIONAL ENVIRONMENTAL CHANGE
Population
Technological capacity
Socio-cultural organization

Agricultural N
H Urbanization Habitat
intensification* alteration A
U * Includes food production T
M
U
A
ECOSYSTEM LEVEL OF ORGANIZATION R
N
A
L
E ecosystem continuum
C E
O C
S O
Y S
S Y
T S
E T
M E
(Based on Wilcox and Gubler 2005) M
 REGIONAL ENVIRONMENTAL CHANGE
Population
Technological capacity
Socio-cultural organization

Agricultural N
H Urbanization Habitat
intensification* alteration A
U * Includes food production T
M
U
A
R
N Species’ Ecological-evolutionary Dynamics A
Opportunistic habitat expansion/ecological release L
Vector/Reservoir (domestication) Feral reservoir species
E Wildlife transport Human encroachment
C E
O LANDSCAPE LEVEL OF ORGANIZATION C
S O
Y S
ecosystem continuum
S Y
T S
E T
M (Based on Wilcox and Gubler 2005)
E
M
 REGIONAL ENVIRONMENTAL CHANGE
Population
Technological capacity
Socio-cultural organization

Agricultural N
H Urbanization Habitat
intensification* alteration A
U * Includes food production T
M
U
A
R
N Species’ Ecological-evolutionary Dynamics A
Opportunistic habitat expansion/ecological release L
Vector/Reservoir (domestication) Feral reservoir species
E Wildlife transport Human encroachment
C E
O C
Host-Pathogen Dynamics O
S
Emergence Processes of ‘Host-Parasite Biology’
Y Host switching (host novelty) • Breaching of pathogen persistence thresholds
S
S Transmission amplification and genetic exchange (pathogen novelty) Y
T S
E COMMUNITY LEVEL OF ORGANIZATION T
M (Based on Wilcox and Gubler 2005)
E
M
ecosystem continuum
 REGIONAL ENVIRONMENTAL CHANGE
Population Global
climate
Technological capacity change

Socio-cultural organization

Agricultural N
H Urbanization Habitat
intensification* alteration A
U * Includes food production T
M
U
A
R
N Species’ Ecological-evolutionary Dynamics A
Opportunistic habitat expansion/ecological release L
Vector/Reservoir (domestication) Feral reservoir species
E Wildlife transport Human encroachment
C E
O C
Host-Pathogen Dynamics O
S
Emergence Processes of ‘Host-Parasite Biology’
Y Host switching (host novelty) • Breaching of pathogen persistence thresholds
S
S Transmission amplification and genetic exchange (pathogen novelty) Y
T S
E T
M (Based on Wilcox and Gubler 2005)
Disease Emergence E
M
ecosystem continuum
 REGIONAL ENVIRONMENTAL CHANGE
Population Global
climate
Technological capacity change

Socio-cultural organization

Agricultural N
H Urbanization Habitat
intensification* alteration A
U * Includes food production T
M
U
A
R
N Species’ Ecological-evolutionary Dynamics A
Opportunistic habitat expansion/ecological release L
Vector/Reservoir (domestication) Feral reservoir species
E Wildlife transport Human encroachment
C E
O C
Host-Pathogen Dynamics O
S
Emergence Processes of ‘Host-Parasite Biology’
Y Host switching (host novelty) • Breaching of pathogen persistence thresholds
S
S Transmission amplification and genetic exchange (pathogen novelty) Y
T S
E T
M (Based on Wilcox and Gubler 2005)
Disease Emergence E
M
ecosystem continuum
Environment, Development, and Health:
Toward a New Paradigm I. Prigogine -
complex adaptive
systems
Pivotal Thinkers Conservation Science &
Sustainability in the 20th Century

A. Leopold - A Sand
County Almanac

C.S. Holling - social

ecological
systems & resilience
theory

R. Carson - Silent
Spring
Environment, Development, and Health: Social
Ecological Systems and Resilience Theory
Paradigm Shift: Coupled Human-Natural Systems;
Sustainable Development of the Biosphere

Holling et al’s renewal cycle model - “social ecological

systems and resilience theory”