Climate Change and Health: Framing the issue

Climate Change and Health: Framing the Issue

Contents 

Foreword ......................................................05 

Executive Summary ......................................06 

Introduction ..................................................08 

1. What does the science say about 

climate change? .......................................09 

2. What does the science say about the 

impact of climate change on health?.........11 

3. Where will the impacts be most felt? .........22 

4. What are the societal and economic 

benefits of addressing climate change 

related health impacts? .............................29 

5. What are the impacts and implications 

for the pharmaceutical industry? ...............31 

Conclusion ...................................................35 

Acknowledgements ......................................36 

Appendix 1 ...................................................37 

End Notes ....................................................38

Foreword 

Andrew Witty 

Chief Executive Officer 

GlaxoSmithKline 

Scientific research suggests that climate change will 

exacerbate existing health issues, most notably in the 

developing world. At GSK, we are actively seeking new 

partnerships, and new ways of acting as a catalyst for 

change. We are already making huge strides in tackling 

some of the key diseases that are likely to be most impacted 

by climate change. Current knowledge has only begun to 

scratch the surface of what these impacts could be. 

My ambition is to see GSK and the pharmaceutical industry 

come together to make a progressive industry response 

to climate change and health. There is an opportunity for 

us to work closely with other key stakeholders, to initiate a 

dialogue around the actions we can collectively take, and 

to stimulate innovation and research in the area. As good 

corporate citizens, we all need to ensure that the impact of 

climate change on health is better understood so that we can 

form an appropriate response. 

This paper, developed jointly with Accenture and the Smith 

School of Enterprise and the Environment at the University 

of Oxford, is just the starting point of what I hope will be 

an inspirational journey. Many of the things we need to do 

require transformational change that could take many years, 

but we absolutely must start this journey today. The potential 

of what we can achieve by working in partnership is huge. 

Sir David King 

Director, Smith School of 

Enterprise and the Environment 

University of Oxford 

Climate change is now considered in many quarters to 

be one of the greatest new threats to health in the 21st 

century. Available research suggests that the health impact of 

climate change will be wide ranging including more frequent 

extreme weather events, increase in epidemics, and food 

and water scarcity. Although there are still important gaps 

in scientific knowledge, there is little doubt that the greatest 

health impact of climate change will be borne by developing 

countries already struggling from poverty and a host of other 

socioeconomic and health problems. 

As responsible stakeholders, the healthcare industry has an 

important role to play in helping the global community better 

understand the impact of climate change on healthcare and 

what could be done to mitigate these impacts. On the other 

hand the global community has a right to know the industry’s 

own contribution to climate change and the range of steps 

it is taking to reduce its carbon footprint. Recent history 

suggests that businesses that take the lead in responding 

to climate change will ultimately put themselves ahead of 

the curve. 

The Smith School of Enterprise and the Environment is 

pleased to be collaborating with GlaxoSmithkline (GSK) and 

Accenture on this project which seeks to highlight the impact 

of climate change on health. 

It is my hope that this report will instigate more research and 

wider discussion on this extremely important topic. 

Climate Change and Health: Framing the Issue 

Peter Lacy 

Managing Director 

Accenture Sustainability 

Services, EALA 

In my discussions with executives around the world, it is 

clear that climate change is now a concern across industries 

and markets. The Health sector sits at the interface where 

climate change impacts society and stakeholders in their 

daily lives. However, despite much good work by a number 

of academics and international organisations, significant gaps 

still exist in our understanding of these health impacts. 

It is in this context that the authors of this paper have 

partnered to help frame the debate, with support from an 

inter-disciplinary team of experts. The research findings 

suggest that there is opportunity for industry to better 

understand the issues and implications and develop an 

appropriate response. Through planning for the longer term 

– engaging stakeholders, building resilience, driving science 

and innovation – companies can integrate climate change 

and health into future strategies and be prepared to respond 

and adapt. 

There are economic rewards at stake; up to 2030 the 

benefits of tackling the health impacts of climate change may 

be as much as 0.6 - 1.0 per cent of current gross domestic 

product (GDP) for sub-Saharan Africa and South-East Asia. 

This paper is very much a humble first step by the partners 

to engage a broader set of stakeholders to frame the issues 

and explore solutions. But I believe that first step is an 

important one. 

Foreword 

05


Executive Summary 

The Earth’s climate is changing 

Average world temperatures have risen over the past 

fifty years and are predicted to rise between 1.1 and 

6.4°C (2.0 and 11.5°F) during the 21st century. Prevailing 

scientific opinion is that the greater the increase in 

temperature, the more severe and variable the effects 

of climate change will be. Further and more frequent 

warm spells, heatwaves, changes to the Earth’s humidity 

and rainfall patterns are anticipated. Meanwhile extreme 

weather events (EWEs) including drought, floods, hurricanes 

and acute high tides have become increasingly likely. 

Climate change will impact health 

Changes in temperature may bring some marginal 

improvements to health, such as the contraction of malarial 

zones in parts of Africa and fewer cold weather deaths in 

temperate regions such as the UK. However, the overall 

impact of climate change on health will be negative. 

In fact, climate change has been cited by some as 

the biggest global health threat of the 21st century, 

jeopardising the lives and wellbeing of billions of people. 1 

Extreme weather and heatwaves will have a direct impact 

on morbidity and mortality. Meanwhile an indirect effect 

of climate change on health will be the growing difficulty 

for many regions in accessing sufficient food, clean water 

and sanitation. Issues such as climate-induced migration 

will further add to the health burden. 2 

The pharmaceutical industry has a role to play. 

Understanding the impact that climate change could 

have on human health is important for future disease 

06 Executive Summary 

control and health infrastructure planning. It will also help 

to ensure that industries and governments are prepared 

to effectively respond and adapt. GlaxoSmithKline (GSK) 

recognises that climate change may adversely impact 

health, and that the pharmaceutical industry should 

prepare to respond. GSK has partnered with Accenture 

and the Smith School of Enterprise and the Environment 

at the University of Oxford to examine the science on 

climate change and health, increase collaboration around 

the issue and understanding of it, as well as inform future 

business strategies. This involved a review of over 200 

academic articles and reports, as well as interviews with 

leading experts and academics in the field. 

Uncertainties 

To date, although growing, debate and dialogue on the 

issue of climate change and health have been limited. 

The ability to understand the issues is clouded by 

uncertainty and significant knowledge gaps. Furthermore, 

it is difficult to isolate the impact of climate change on 

health from other influencing and interrelating socioeconomic 

factors that further complicate the relationship. 

These challenges raise three questions: 

• What do we know about the impacts of climate change 

on health? 

• Where are the gaps in our current knowledge? 

• What are the implications for the pharmaceutical 

industry? 

What we know 

Although the current evidence base does not accurately 

predict the scale of the impacts, it does point to the fact 

that the effects of climate change on health are likely to 

increase. Rising temperatures, more extreme weather 

events and changes in air quality are highly likely to 

have a negative impact on six existing health concerns, 

particularly in developing countries: 

• Health effects related to EWEs 

• Cardio-respiratory diseases 

• Temperature-related health effects 

• Malnutrition 

• Vector-borne diseases 

• Waterborne diseases 

Eight infectious diseases have been identified as 

particularly sensitive to climate change. The epidemiology 

of malaria and cholera is particularly susceptible to 

changes in climate, with epidemics highly correlated to 

periods of increased rain and temperature. 

Many of the most serious public health consequences of 

climate change will be experienced by the world’s poorest 

nations, increasing global health inequities. 3 For example, 

malnutrition affects one in three people worldwide 

and is one of the most serious global health problems 

according to the World Health Organization (WHO). 4 This 

is set to worsen in the face of climate change. Changing 

temperature, precipitation, humidity, rainfall and EWEs

will exacerbate food insecurity in many regions, 5 and per 

capita calorie intake could drop by 5.7 per cent by 2050 

in developing countries. 6 

Meanwhile, neglected tropical diseases (NTDs) – the 

most common infections in the 2.7 billion people living on 

less than $2 a day 7 – are likely to be the most sensitive 

to climate change.This would exacerbate the cycle of 

poverty, vulnerability and mortality in the developing 

world. South-East Asia and sub-Saharan Africa are the 

regions of the world most susceptible to climate change 

and its health effects. According to the WHO, in 2000 

these two regions accounted for over three-quarters of 

the estimated global disability-adjusted life years (DALYs) 

lost because of climate change 8 – a DALY represents 

one year of ‘healthy’ life. 

Tackling the impacts of climate change on malaria, 

malnutrition and diarrhoeal disease could result in 

significant economic benefits; up to 2030 this could be 

as much as 0.6 per cent to 1.0 per cent of current gross 

domestic product (GDP) for sub-Saharan Africa and 

South-East Asia. Dealing with the impacts of climate 

change on specific diseases will deliver substantial 

economic benefits. For example, managing climate 

change related cases of malaria in Africa corresponds to 

a net economic benefit of approximately US$14 billion. 9 

What we don’t know 

Current knowledge has only begun to scratch the surface 

of what the impacts of climate change on health could 

be. Significant gaps still exist in our understanding of 

the timing, severity and geographical range of the health 

impacts of climate change. Limitations in the modelling 

of climate change and uncertainties in relation to the local 

and regional effects remain key gaps in our knowledge. 

There are also doubts regarding specific health and 

disease impacts, a lack of long-term health data, and 

difficulties in predicting how humans will mitigate 

and adapt. 

Finally, there remains a need for continuing and 

expanding existing research to better understand the 

relationship between climate and health, the influence of 

modulating factors and profiles of vulnerable individuals 

and populations. 

Implications 

The impact of climate change on health may alter the 

pharmaceutical industry in the long term, but is less 

likely to dramatically alter business or operating models 

in the immediate future. Policy responses will have to be 

formulated under conditions of uncertainty. 10 

Companies within the industry will need to understand 

the issues involved and be prepared to respond and 

adapt to changing demands. Through planning for the 

longer term – engaging stakeholders, building resilience, 

driving science and innovation – the industry can 

integrate climate change and health into future strategies. 

GSK, Accenture and the Smith School of Enterprise and 

the Environment at the University of Oxford welcome 

partnership on this issue, particularly to examine the 

existing knowledge gaps and to begin to answer some 

of the questions that remain. Most importantly, we invite 

stakeholders to work with us to use this as a starting 

point for action and collaboration. 


We welcome 

partnership on this 

issue, particularly to 

examine the existing 

knowledge gaps and 

to begin to answer 

some of the questions 

that remain. 

Executive Summary 

07


Introduction 

Awareness of the links between climate change and 

public health has grown steadily over the last decade. 

Scientific reports indicate potential trends and healthrelated 

challenges that society may face as a result 

of the changing climate. However, they also point to 

the complexity of the relationship between climate 

change and health, as well as to significant gaps and 

uncertainties in current knowledge. 

GlaxoSmithKline (GSK), together with Accenture and the 

Smith School of Enterprise and the Environment at the 

University of Oxford, aims to frame the discussion around 

climate change and health – what we know, what we don’t 

know and what the impacts and implications might be. 

Rather than provide all the answers, we aim to increase 

awareness of existing knowledge. We are committed to 

initiating a process of multi-stakeholder dialogue on this 

issue with, amongst others, the pharmaceutical industry, 

healthcare professionals, governments and civil society. 

08 Introduction 

The following chapters aim to provide a perspective on 

the following five questions: 

• What does the science say about climate change? 

• What does the science say about the impact of climate 

change on health? 

• Where will the impacts be most felt? 

• What are the societal and economic benefits of 

addressing climate change related health impacts? 

• What are the impacts and implications for the 

pharmaceutical industry? 

Background: 

Chapters 1 and 2 in this report 

are based on an academic paper 

developed by Oxford University’s 

Smith School of Enterprise and the 

Environment, GSK and Accenture. 

This academic paper examined 

over 200 articles and papers 

to understand the current literature 

and science on climate change and 

health and was reviewed by 

a panel of leading academics from 

the Australian National University, 

Harvard University, Jawaharlal 

Nehru University, New Delhi, the 

London School of Hygiene and 

Tropical Medicine and University 

College London. 

This report was also informed 

by interviews, conducted 

by Accenture, with over 20 

leading experts from business, 

academia and non-governmental 

organisations (NGOs).

1. What does the science say 

about climate change? 

World temperatures have risen over the past fifty 

years. The rise in global average temperature is thought 

to be a direct result of the build-up of human-generated 

greenhouse gases (GHGs) – primarily carbon dioxide 

(CO 2 ). 11 Further average global temperature rises are 

predicted to take place during the 21st century – 

between 1.1 and 6.4°C (2.0 and 11.5°F) depending 

on future GHG emissions and the Earth’s response 

to changing conditions 12 (see Figure 1.1). The 

Intergovernmental Panel on Climate Change (IPCC) 

is 90 per cent confident that as a result of rising 

temperatures, the world will see more frequent warm 

spells, heatwaves, humidity and heavy rainfall. This is 

anticipated to lead to an increase in extreme weather 

events (EWEs) including droughts, desertification, tropical 

cyclones, floods, hurricanes and extreme high tides.13 

Experts predict a variety of environmental health impacts 

as average global surface temperature rises (see Figure 

1.2). Ecosystem services (benefits to humans supplied 

by natural ecosystems) such as plant pollination, food 

Box 1.1: The Intergovernmental Panel on Climate 

Change (IPCC) 

The IPCC is a scientific intergovernmental body that evaluates 

the risk of climate change and its potential environmental and 

socio-economic consequences. The IPCC issued comprehensive 

assessments in 1990, 1996, 2001 and most recently the Fourth 

Assessment Report (AR4), released in 2007. A Fifth Assessment is 

due for release in 2014. 

yields, oxygen production and the provision of clean 

water will be impacted, as well as biodiversity. Hundreds 

of millions of people in mid-latitudes and semi-arid 

low latitudes will become exposed to increased water 

and food stress as a consequence of the dramatic 

decrease in water availability and the resulting reduction 

in cereal productivity. Meanwhile, many coastal areas will 

experience increased damage from floods, storms and 

rising sea levels. 

Scientists also suggest certain thresholds or ‘tipping 

points’ could be triggered during this century. This 

would put polar sea ice and ice sheets at risk, causing 

potential changes in weather systems such as Atlantic 

thermohaline circulation, the El Niño southern oscillation, 

and the Indian summer monsoon. 

Note: These scenarios are described in the IPCC Special Report on Emissions 

Scenarios (SRES, 2000). The SRES scenarios are grouped into four scenario 

families (A1, A2, B1 and B2) that explore alternative development pathways, 

covering a wide range of demographic, economic and technological driving 

forces and resulting GHG emissions. 

A1 assumes a world of very rapid economic growth, a global population 

that peaks in mid-century and rapid introduction of new and more efficient 

technologies. A1 is divided into three groups that describe alternative directions 

AR4 is the most comprehensive synthesis of climate change 

science to date. Experts from more than 130 countries contributed 

to the assessment. More than 450 lead authors received input 

from around 800 contributing authors, and an additional 2,500 

experts reviewed draft documents. 

Despite events in 2010 the IPCC remains the most cited and 

respected source of information on climate change. Basing its 

Global surface warming ( o C) 

6.0 

5.0 

4.0 

3.0 

2.0 

1.0 

0 

-1.0 


Figure 1.1 

Global temperatures are anticipated 

to increase 

Scenarios for surface temperature projections 

Low (B1) 

Central (A1B) 

High (A2) 

Year 2000 constant 

concentrations 

20th century 

1900 

Source: IPCC (2007) 

2000 

Year 

2100 

of technological change: fossil intensive (A1FI), non-fossil energy resources (A1T) 

and a balance across all sources (A1B). 

B1 describes a convergent world, with the same global population as A1, 

but with more rapid changes in economic structures toward a service and 

information economy. 

A2 describes a very heterogeneous world with high population growth, slow 

economic development and slow technological change. 

No likelihood has been attached to any of the SRES scenarios 

assessment mainly on peer reviewed and published scientific 

literature, the Panel is seen as an authoritative source; IPCC 

reports are widely cited in most debates related to climate change. 

From a health perspective, organisations that endorse the IPCC 

view include the American College of Preventative Medicine, 

the American Public Health Association, the Australian Medical 

Association, the World Federation of Public Health Associations, 

and the World Health Organization (WHO). 14 

What does the science say about climate change? 09

Climate Change and Health Health: Framing Paper the Issue 

“ Warming of the 

climate system is 

unequivocal, as is 

now evident from 

observations of 

increases in global 

average air and 

ocean temperatures, 

widespread melting 

of snow and ice, 

and rising global 

average sea level.” 

(IPCC 2007) 

010Introduction 

10 What does the science say about climate change? 

Figure 1.2 

Experts predict a variety of environmental and health impacts 

as global average surface temperatures rise 

Selected impacts of global average annual temperature change relative to 1980–1999 (ºC) 

Food and Water 

Ecosystem 

Coast 

Health 

Increase in 

Temperature 

* Significant is defined as more than 40% 

Source: Adapted from IPCC (2007) 

0 1 2 3 4 5 o C 

Increased water availability in moist tropics and high latitudes 

Decreasing water availability and increasing drought in mid-latitudes and semi-arid low latitudes 

Hundreds of millions of people exposed to increased water stress 

Increased damage from floods and storms 

Tendencies for cereal productivity 

to decrease in low latitudes 

Up to 30% of species at 

increasing risk of extinction 

Increased morbidity and mortality from heat waves, floods and droughts 

Changed distribution of some disease vectors 

Millions more people could experience 

coastal flooding each year 

Productivity of all cereals 

decreases in low latitudes 

About 40% of global 

coastal wetlands lost 

Increasing burden from malnutrition, diarrhoeal, cardio-respiratory and infectious diseases 

Significant* extinction 

around the globe 

Substantial burden on health services 

0 1 2 3 4 5 o C


2. What does the science say about the 

impact of climate change on health? 

The health of a population – if it is to be sustained – 

requires clean air, safe water, adequate food, tolerable 

temperatures, protection from the elements and high 

levels of biodiversity. Climate change is expected to alter 

these conditions in various ways and to varying degrees 

throughout the world, with significant – and mostly 

adverse – health consequences. In both developed and 

developing countries the overall tendency will be for 

existing health inequalities to be magnified by changing 

climates. This will result in the most vulnerable being 

disproportionately affected. 15 

Box 2.1: Overarching uncertainties 

• The extent to which the climate will change 

• What the local and regional impacts of climate change 

on health will be 

• What the interplay is between climate, health and other 

modulating factors 

• How humans will mitigate impacts and/or adapt 

Despite overarching uncertainties (see Box 2.1), we know 

that climate change is likely to have a negative impact on 

six existing health concerns: 

• Health effects related to EWEs 

• Cardio-respiratory diseases 

• Temperature-related health effects 

• Malnutrition 

• Vector-borne diseases 

• Waterborne diseases 

We know that 

climate change 

is likely to have a 

negative impact on 

six existing health 

concerns. 

What does the science say about the impact of climate change on health? 

11


Overview 2.1 Health effects related to extreme weather events (EWEs) 

Likely overall impact of climate change on health High negative 

IPCC level of confidence that changes will occur 80 per cent 

Timing of marginal impact Short term 

Headlines • EWEs are expected to continue increasing in 

frequency and severity. Developing countries are 

particularly vulnerable 

• EWEs increase mortality levels and exacerbate 

disease transmission. Uncertainties remain around 

the timing, frequency and magnitude of EWEs, 

particularly at a local level 

What we know 

The IPCC predicts an 80 per cent chance that there will 

be an increase in mortality and morbidity due to climate 

change related EWEs. In 2007, 95 per cent of the 16,000 

global fatalities from EWEs could be directly attributed 

to climate change. 16 As climate has altered patterns of 

temperature, precipitation, winds and sea levels, EWEs 

have changed in frequency and intensity. 

The IPCC predicts that over most land areas the 

frequency of heatwaves, propensity of drought and 

intensity of tropical cyclone activity is very likely to 

increase. At some level, the perceived increase in the 

number of EWEs could be in part a consequence of 

improved data collection and reporting, however there is 

a marked upward trend. 

Over the past 50 years, severe drought has increased 

by around one to three per cent around the globe. By 

2050 it is anticipated to increase to 12 per cent if global 

temperatures rise by 2°C above pre-industrial values. 17 

An increase in the frequency and intensity of hurricanes 


12 What does the science say about the impact of climate change on health? 

has already been predicted for this century. 18 The number 

of people at risk from coastal flooding by storm surges 

is projected to increase from 75 million at the start of the 

21st century to 200 million in the 2080s in a scenario of 

mid-range climate changes. 19 

EWEs not only result in increased mortality, they also 

exacerbate disease transmission and place strain on 

healthcare systems. Inland and coastal floods are 

already common; they particularly impact South Asia and 

Latin America, where poor drainage and storm water 

management increases the rate of infectious disease 

transmission. Extreme flooding in Brazil, for example, has 

been linked to an epidemic of rodent-borne leptospirosis 

as rodents sought refuge in houses when floods washed 

out their natural environment. 20 Meanwhile droughts 

increase communicable diseases: outbreaks of cholera 

are associated with the dry season in the Amazon when 

access to potable water is scarce. 21 Epidemic meningitis 

appears to be linked with the occurrence of droughts, as 

reflected by the recent spread of the disease into West 

Africa. 22 EWEs can also cause variation in the patterns of 

vector-borne diseases (diseases transmitted to humans 

by vectors such as mosquitoes) by creating or destroying 

favourable environments for vectors or by increasing 

human–vector contact. 

Secondary issues and longer-term impacts include a loss 

of infrastructure and territory, and environmentally induced 

migration, as well as the potential to cause conflict over 

water, energy and other resources. 23 The Stern Review 

on the Economics of Climate Change, for example, 

suggests that drought and other climate-related shocks 

could cause conflict and violence. West Africa and the 

Nile Basin are particularly vulnerable given their high 

water interdependence. 24 The spread of disease is also 

a common problem after EWEs. Survivors of EWEs 

often have an increased risk of contracting respiratory, 

diarrhoeal and waterborne diseases in the aftermath of an 

extreme event. This is due to population overcrowding, 

limited or no access to potable water and food, and 

exposure to chemicals, pathogens and waste. 25 There 

is also evidence of increased mental stress post-EWE. 

One long-term study found that 15–20 per cent of people 

affected by a natural disaster reported symptoms of 

post-traumatic stress disorder. 26 


• The extent of the localised and specific 

relationships between temperature extremes, 

EWEs and health outcomes 

• The timing, frequency, geographical scope and 

severity of future events 

• How to implement effective climate modelling and 

warning systems 

*

Overview 2.2 Cardio-respiratory diseases 



Timing of marginal impact Short term 

Headlines • Climate change will impact air quality and increase 

ground-level ozone, particularly in urban areas, 

leading to an increase in cardiorespiratory disease 

and cancer 

• Young children, the elderly and those with preexisting 

health conditions are especially vulnerable 

• Uncertainties remain around the exact link between 

climate change and individual cardio-respiratory 

What we know 

Climate change will impact air quality, especially in cities, 

potentially exacerbating the urban heat-island effect 27 and 

increasing the prevalence of ground-level ozone (smog). 

Poor air quality is known to cause respiratory health 

problems. The IPCC is highly confident (80 per cent 

confidence) that there will be an increase in cardiorespiratory 

morbidity and mortality associated with 

ground-level ozone. 

Ground-level ozone can damage lung tissue, and is 

especially harmful for those with asthma and other 

chronic lung diseases. Sunlight and high temperatures, 

combined with other pollutants such as nitrogen oxide 

and volatile organic compounds, can cause ground-level 

ozone to increase. The World Health Organization (WHO) 

estimated that poor air quality caused by climate change 

was responsible for over 2.4 million premature deaths in 

2000 alone – one third by outdoor air and another third 

by indoor air – and accounts for approximately two per 

cent of the global cardiopulmonary disease burden. 28 

Particulate matter, nitrogen oxides and sulphur oxides 

can also have a negative impact on health. These 

effects, which are associated more with air pollution 

but potentially exacerbated by climate change, include 

aggravation of chronic respiratory and cardiovascular 

diseases, reduced work capacity, and effects on 

pulmonary function. 29 

Although climate change may increase the concentration 

of ground-level ozone, the magnitude of the effect 

remains uncertain. The effects of climate change and 

weather on the behaviours of other pollutants are less 

well studied, and results vary by region. 30 

The populations most at risk of increased respiratory 

disease include children, pregnant women, people of low 

socio-economic status and those in congested urban 

areas. People living near to forests prone to fire are also 


at high risk; a combination of human actions and climate 

change is likely to increase the extent and intensity of 

forest fires, leading to severe air pollution. 31 

Climate change can also expose patients with existing 

conditions (such as the elderly and overweight) to 

dangerous temperature extremes, placing additional 

stress on their cardiovascular systems. In Italy the summer 

of 2003 saw those aged over 65 years experience 

a 34 per cent greater risk of dying during hot days, with 

a significantly higher risk of respiratory disease. 32 

Climate change could also cause more allergy symptoms 

due to increases in atmospheric carbon dioxide 

concentration and temperature. A warmer climate is 

expected to promote the growth of moulds, weeds, 

grasses, and trees that cause allergic reactions in some 

people. For example, climate change has already caused 

the spring pollen season to begin earlier in North America. 33 


• The magnitude of the effect of climate change on 

pollen concentrations, particulates, ground-level 

ozone and other pollutants and the best means of 

adaptation 

• The effects of climate change on individual 

cardio-respiratory diseases 

• The isolated effects of climate change on 

cardio-respiratory diseases in comparison with 

other variables such as moving to lower-carbon 

living and other lifestyle choices 


* 

13


Overview 2.3 Temperature-related health effects 

Likely overall impact of climate change on health Moderate negative 

IPCC level of confidence that changes will occur 50-80 per cent 

Timing of marginal impact Short/Medium term 

Headlines • Although climate change will bring some benefits 

– including fewer deaths from cold weather – the 

overall burden of rising temperatures will be negative 

• The negative effects will particularly be felt in 

developing countries where heat-related mortality 

and the potential secondary impact on subsistence 

and agriculture could be high 

• Uncertainties remain around our understanding of 

the impact in current high-temperature regions and 

the link between climate change, ozone depletion 

and skin cancer 

What we know 

Increases in average temperature will bring a small 

improvement in health, particularly in temperate regions. 

In Britain, for example, warmer winters might reduce cold 

weather related mortalities. Estimates suggest that 9,000 

deaths per year could be avoided by 2025 in England 

and Wales with a 2.5°C increase in average winter 

temperature. 34 Overall, however, the impact of changing 

temperatures is likely to be negative. The IPCC is 50 per 

cent certain that climate change has increased heatwaverelated 

deaths, and expresses an 80 per cent level of 

certainty that increasing temperatures will have a negative 

impact on health. For each 1°C rise in temperature above 

a specified ceiling (which varies by region) death rates 

are predicted to rise by between one per cent and four 

per cent. 35 Hunger, malaria, flooding and water shortages 



will threaten millions if global average temperatures 

rise by 2°C. 36 

The propensity for developed countries to experience 

heatwaves is increasing, with consequent impacts 

on levels of morbidity and mortality. Those with heart 

problems, asthma, the elderly and the young, and those 

without proper protection from excess heat (such as 

the homeless) can be especially vulnerable. In 2003, 

European temperatures rose 10–12°C higher than 

average during a heatwave, causing between 22,000 and 

35,000 deaths. 37 In Chicago, a heatwave in July caused 

at least 700 additional deaths. Analysis of American 

and European heatwave data suggests that by 2009 

heatwaves in these regions will be 25 per cent and 31 

per cent more frequent respectively. 38 

Although average temperatures are predicted to increase 

more dramatically in the northern hemisphere, the 

changes in developing regions may be more significant. 

This is due to the reliance of these areas on small-scale 

farming, a fragile infrastructure and limited capacity to 

respond to emergencies. Many African communities 

will be at risk, particularly subsistence farmers with low 

incomes in sub-Saharan Africa. Increased temperatures 

leading to droughts may be exacerbating poverty levels 

and increasing vulnerability for small-scale farmers. United 

Nations (UN) scientists warned in 2005 that one in six 

countries are facing food shortages because of severe 

droughts that could become semi permanent. 39 

National communications report that climate change will 

cause a general decline in many subsistence crops, for 

example sorghum in Sudan, Ethiopia, Eritrea and Zambia; 

maize in Ghana; millet in Sudan; and groundnuts in 

Gambia. 40 Africa already accounts for a large proportion 

of the total additional people at risk of hunger as a result 

of climate change; by the 2080s it may account for 

the majority. 41 


• What the precise impact of heatwaves will be in 

current high temperature regions such as Asia, 

Africa and the Middle East 

• The frequency and intensity of heatwaves across 

various timescales 

*

Overview 2.4 Malnutrition 




Headlines • Malnutrition will be one of the biggest health impacts 

associated with climate change 

• Food security will be threatened by changing 

temperature, precipitation humidity, rainfall and 

EWEs – leading to an increase in malnutrition. 

• The developing world will be worst affected, 

particularly sub-Saharan Africa 

• Uncertainties remain around how disease patterns 

will change in the context of climate change induced 

malnutrition 

What we know 

The Food and Agricultural Organization (FAO) and World 

Health Organization (WHO) maintain that malnutrition is 

the most serious health problem worldwide. Currently 

malnutrition accounts for an estimated 15 per cent of 

disease in DALYs. 42 

About 178 million children globally are stunted and 

1.5 million die annually from wasting, both important 

indicators of malnutrition. 43 Climate change could 

exacerbate this situation. The IPCC predicts an 80 per 

cent chance that climate change will increase malnutrition 

and consequent disorders, including those related to 

child growth and development. 

Changing temperature, precipitation, humidity, rainfall 

and EWEs will make food security more complex. 44 

In the short term the amount of farmland suitable for 

cereal crops could increase in North America (40 per 

cent), Northern Europe (16 per cent), the Russian 

Federation (64 per cent), and East Asia (10 per cent), 

as a result of better growing conditions under warming. 45 

But in the long term, daily per capita calorie availability 

will drop between 2.3 per cent and 2.5 per cent by 

2050 in developed countries and up to 5.7 per cent in 

developing countries. 46 In 2009, most of the 960 million 

undernourished people lived in developing countries. 47 

Climate change is likely to increase food insecurity 

amongst many of these populations. Climate change 

will also compound existing food insecurity. According 

to the UN World Food Programme, the number of food 

emergencies every year has increased from an average 

of 15 during the 1980s to more than 30. 48 For example, 

studies in countries such as Mali and Nepal suggest that 

by 2050, 72 per cent of the population could face serious 

food shortages. 49 


According to the UN 

World Food Programme, 

the number of food 

emergencies every year 

has increased from an 

average of 15 during the 

1980s to more than 30. 


• How disease patterns will change in the context of 

climate change induced malnutrition 

• The local effects of climate change on food yields, 

nutritional quality and price 

• How best to improve food security as weather 

patterns change 


* 

15


Overview 2.5 Vector-borne diseases 



Timing of marginal impact Long term 

Headlines • Climate change will exacerbate current vector-borne 

disease through increased infection rate, increased 

geographical coverage and increased rate of 

breeding 

• The increase in temperature will in general expand 

malaria transmission zones, but could also lead to a 

contraction of malarial zones in some parts of Africa 

• Neglected tropical diseases are endemic in Africa, 

Asia and the Americas – but relatively little is known 

about the impact climate change will have on their 

prevalence 

What we know 

A vector is an insect or any living carrier that transmits 

an infectious disease (for example mosquitoes or ticks). 

Changing temperatures, rainfall patterns and EWEs are 

likely to influence the reproductive cycles and behaviours 

of these vectors, leading to a more suitable environment 

for the spread of disease and the potential for the 

emergence of new ones. As temperature increases, the 

extrinsic incubation period (i.e. the period from when a 

vector acquires an infectious agent and is able to transmit 

the agent) becomes less. This in turn increases the 

infection rate of the parasites, elevating the transmission 

levels of the disease. 



The IPCC gives an 80 per cent level of certainty that 

climate change will affect vector-borne diseases. The 

extent of the impact of climate change will depend on 

the region, the carrier (water or vector) and the disease 

itself, as well as mitigation and prevention strategies. 

Many of the diseases that are highly sensitive to climate 

change and also have a significant global impact in 

terms of the loss of DALYs are vector-borne diseases. 

Examples include malaria, dengue, leishmaniasis and 

schistosomiasis (see Figure 2.5). 

The impact of changes in temperature and climate could 

vary depending on the type of vector and parasite. In the 

case of malaria for example, the minimum temperature 

required for development of the Plasmodium vivax 

parasite ranges from 14.5–16.5°C. For Plasmodium 

falciparum - the most deadly cause of malaria - it 

ranges from 16.5–19°C. The optimum conditions 

for development of the malaria parasite, however, are 

20–30°C temperature and 60 per cent relative humidity. 50 

However, the effect on specific parasites remains an area 

that requires further research and understanding. 

The impact of climate change on malaria will also vary 

according to geography. In some places the geographical 

range will contract, elsewhere the geographical range will 

expand and the transmission season may be changed 

(see Figure 2.3). Senegal, for example, has seen a 60 

per cent drop in malaria over the last 30 years owing to 

reduced precipitation. 51 However, with rising temperatures, 

traditionally cool climates and higher latitudes will become 

more suitable reproductive habitats; already warm zones 

may also see an increase in mosquito populations. Malaria 

has returned to central and northern South America, 

much of Asia, some Mediterranean countries and much 

of the former USSR. Analysis of malaria morbidity data

Figure 2.3: Climate Change and Malaria 


Cartographer/Designer: 

Hugo Ahlenius, 

UNEP/GRID-Arendal 


17


The IPCC gives an 80% level of 

certainty that climate change will affect 

vector-borne diseases. 

in Ethiopia indicates that higher minimum temperatures 

correlate with increased instances of malaria outbreaks. 52 

By 2080, 260–320 million more people are likely to be 

affected by malaria as more areas become infested 

with mosquitoes. 53 Scientific models also infer that the 

geographical limits of dengue fever transmission are 

strongly determined by climate. On the assumption that 

other factors affecting dengue fever transmission remain 

the same, the global population at risk of dengue fever is 

anticipated to rise by 2 billion people by the 2080s. 54 

Other neglected tropical diseases (NTDs) such as 

schistosomiasis, lymphatic filariasis, and onchocerciasis 

are endemic in the tropics, primarily in the developing 

regions of Africa, Asia and the Americas. NTDs are the 

most common infections in the 2.7 billion people living on 

less than $2 a day 55 and these diseases are likely to be 

the most sensitive to climate change, exacerbating 

the cycle of poverty, vulnerability and mortality in the 

developing world. 56 

Owing to lack of attention, little is currently known about 

the pattern of the spread of these diseases and their 

potential links to climate change. However, because 

insects tend to breed faster at higher temperatures, it 



is very likely that the prevalence of these diseases will 

increase with climate change. A recent study of the 

schistosomiasis virus in China, for example, concluded 

that temperature increases have altered disease 

transmission and extended the disease northwards into 

currently non-endemic areas. 57 The study suggests that 

by 2050 the disease could cover 8.1 per cent of the 

surface area of China. 58 Increasingly severe floods are also 

exacerbating the disease; flooding in the Yangtze River 

has been found to produce a nearly threefold increase 

in acute cases of schistosomiasis per annum compared 

with years of normal water levels. 59 


* 

• The effect of climate on the full spectrum of vectorborne 

diseases; and the full impact of temperature 

on rate of infection, geographic coverage and rate 

of breeding for specific parasites 

• Sufficient results from monitoring and surveillance 

of disease and mortality in sensitive regions 

(particularly in the developing world) 

• The link between climate change and neglected 

tropical diseases in detail 

Guide to Overviews 2.1 to 2.6 

• Likely impact of climate change on health and timing of marginal 

impact assessments for the six health concerns are based on 

qualitative assessments of the current evidence base and data 

• IPCC defines short, medium and long term as: 

short – 2010–2020; medium – 2020–2030; long – 2030 onwards 60

Overview 2.6 Waterborne diseases 

Likely overall impact of climate change on health Moderate negative 

IPCC level of confidence that changes will occur 50 per cent (for diarrhoeal disease) 


Headlines • Waterborne diseases are likely to increase because 

water sources will be put at risk as a result of EWEs 

• Diarrhoea, cholera and dengue are predicted to 

increase in developing regions 

• Uncertainties remain because of knowledge gaps 

on existing levels of prevalence, the impacts of 

better water management and adaptation on 

water security 

What we know 

Water is critical to human survival and good health. 

Changes in climate will have a direct impact on water 

temperature and precipitation frequency and intensity, 

thereby altering the earth’s water cycle (the movement 

of water above and below the Earth’s surface). As a 

result, the frequency of heavy rainfall, storms, floods 

and droughts will increase which, as well as having 

an immediate effect on mortality, will also affect water 

availability, quality and access. Waterborne diseases 

are particularly likely to increase with temperature and 

frequency of EWEs, as drinking water from natural 

and infrastructural water sources will be put at risk, 

increasing exposure to unsafe water, the contamination 

of wells and boreholes, and a breakdown of infrastructure 

for dealing with sewage. 

The IPCC predicts, with a level of 50 per cent certainty, 

that climate change will, for example, increase the 

burden of diarrhoeal diseases. 

Almost two million young children die annually because 

of poor sanitation or the use of unsafe water. 61 Diarrhoea 

alone accounts for about 40 per cent of all deaths of 

children under five and 80 per cent of those under two. 62 

Infection spreads through contaminated food or 

drinking water. 

Those with access to clean water usually recover 

from diarrhoea within a few days, but in malnourished 

populations it can lead to severe dehydration and death. 63 

In 2000, diarrhoea linked to climate change caused 

47,000 deaths, most in South-East Asia. Estimates for 

the future of diarrhoea-induced mortality in Africa 

predict over 60,000 deaths in 2030. 64 This is a 10 per 

cent increase in risk over what it would be without 

climate change. 65 Diarrhoeal diseases – along with 


other waterborne diseases such as cholera – are climate 

sensitive (see Figure 2.3). Regional epidemics of cholera, 

for example, occur seasonally and are associated with 

periods of excessive rainfall, warm temperatures and 

subsequent increases in aquatic plankton populations. 

Other factors that impact waterborne diseases include 

localised management of watershed and catchments, 

changes in rainfall, sanitation, water availability and 

access to medicine (see Box 2.2). 


• Information on prevalence, distribution and disease 

burden of individual diseases 

• Marginal impact assessment of climate change 

– and the effect of improved water and sanitation 

infrastructure and adaptation 

• The extent to which social, demographic and 

political conditions will exacerbate water scarcity 

• The implications of different forms of local water 

catchment management on health 


* 

19


Figure 2.4: Tropical Diseases 

Disease 

Cholera 

Dengue 

Diarrhoeal diseases 

Influenza 

Leishmaniasis 

Malaria 

Meningococcal Meningitis 

Schistosomiasis 

Adapted from WHO factsheets 2011 http://www.who.int/topics/en/ 



An intestinal infection caused by a bacteria, and is often linked to contaminated supplies of drinking water. It causes 

severe diarrhoea and vomiting that can quickly lead to severe dehydration and death if treatment is not promptly given. 

A virus transmitted by mosquito. It occurs in tropical and sub-tropical areas of the world. Dengue fever symptoms range 

from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. 

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral 

and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a 

result of poor hygiene. 

A viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection is characterized by sudden 

onset of high fever, aching muscles, headache and severe malaise, non-productive cough and sore throat. The virus is 

transmitted easily from person to person via droplets and small particles produced when infected people cough or sneeze. 

Influenza tends to spread rapidly in seasonal epidemics. 

Caused by the Leishmania parasite which can be transmitted to humans when a sandfly infected with the parasite bites 

them. The most severe form of the disease attacks the internal organs and is usually fatal within two years if left untreated. 

An estimated 12 million people are infected by leishmaniasis and around 2 million infections occur each year. 

Caused by a parasite which is transmitted via the bites of infected mosquitoes. Symptoms of malaria include fever, 

headache, and vomiting. If not treated, malaria can quickly become life-threatening. The majority of 1.5-2.5 million 

estimated annual deaths occur in sub-Saharan Africa. 

An inflammation of the lining of the brain and spinal cord, caused by bacterial infection. It can cause severe brain damage 

and is fatal in 50% of cases if untreated. The bacteria are transmitted from person to person through droplets of respiratory 

or throat secretions. The highest burden of meningococcal disease occurs in the region of sub-Saharan Africa known as 

the “Meningitis Belt” which stretches from Senegal east to Ethiopia 

A parasitic disease caused by flatworms which results in urinary or intestinal disease. Fresh water snails release a larval 

form of parasite that penetrates the skin of people exposed to contaminated water. Mortality, while generally low, may 

occur in advanced cases usually due to bladder cancer. 80% of infected people live in sub-Saharan Africa.

Box 2.2 Water security 

The array of complex factors that determine access to clean 

water – encompassing social, political and environmental 

issues – means that the impacts on health have often not been 

well addressed. 66 The localised nature of water challenges 

and watershed management issues add further complexity. 

In some parts of the world there will not be enough water; in 

others there will be too much. For example, predictions suggest 

that by 2025 climate change could lead to deficits in the water 

available from the Nile river basin, which covers three million 

square kilometres and ten Northern African countries including 

Egypt, Sudan and Ethiopia. 67 Meanwhile many other parts of 

the world such as Bangladesh are at risk from rising sea levels. 

Today one in three people are already facing water shortages. 

Over the next twenty years global water demand will outpace 

supply by 40 per cent. Under the pressure of potential effects 

of climate change, the stakes become even higher. Increased 

water temperatures and changes in extreme weather, including 

floods and droughts, are expected to affect water quality and 

exacerbate water pollution. 68 This will hinder the use of water 

for hygiene purposes and affect food security. Increasing 

temperature also promotes the proliferation of microorganisms 

in contaminated food and drinking water. 

Projections for 2050 suggest that 38 per cent of the world 

population across 149 countries will live in water-scarce areas. 

The subtropics and mid latitudes, where much of the world’s 

poorest populations live, are expected to become substantially 

drier, resulting in heightened water scarcity. This will exacerbate 

the problem of malnutrition and lead to the increase of many 

waterborne diseases. Meanwhile, most existing water treatment 

plants and distribution systems were not built to withstand 

changes now expected in precipitation and frequency of severe 

weather, 69 leaving the current infrastructure without the capacity 

to fully capture large volumes of water, or to meet water 

demands in times of sustained drought. 


Figure 2.5: Eight infectious diseases that are sensitive to climate change 

Diseases 

Malaria 

Cholera 

Dengue 

Meningitis 

Leishmaniasis 

Influenza 

Diarrhoeal 

diseases 

Schistosomiasis 

Significance of climate 

change as a factor in 

determining future 

epidemics 1 

Primary 

Primary 

Important 

Important 

Important 

Significant 

Significant 

Significant 

Existing Global Burden 2 

(millions of DALYs lost) 

0.67 

33.98 

Pandemic 

potential 

1.43 

1.97 

Pandemic 

potential 

1.71 

72.78 

Countries affected 

Tropics, Sub-tropics 

Africa, Asia, Russia 

South America 

Africa, Europe, South 

America, South East Asia 

Worldwide 

Africa, Asia, Europe 

India, South America 

Worldwide 

Worldwide 

Africa, East Asia 

South America 

Source: 1.World Health Organization (WHO), 2005; Smith School Academic Review, 2. WHO, Global Health Observatory, Global Burden of Disease, 2004 (NB the Global Burden of Disease is an overall figure - not specific 

to climate change) 

The majority of infectious diseases that are most climate sensitive fall into the Neglected Tropical Disease (NTDs) category. Over 1 billion people are infected with one of the 14 diseases defined by the World Health 

Organization (WHO) as NTDs – the world’s sixth leading cause of DALY loss. Although much attention in the past decade has focused on combating the ‘Big Three’ neglected diseases – HIV/AIDS, malaria, and tuberculosis 

– many of NTDs are often insufficiently funded from a Research and Development (R&D) perspective. In 2007, less than 5 per cent of US$2.5 billion in total funding for neglected diseases R&D went to NTDs. There are 

growing signs that the pharmaceutical industry is devoting more of their research and development efforts to NTDs by developing new products and supporting community initiatives. However, the extent to which these 

responses factor in the diseases’ sensitivity to climate change remains uncertain. The World Health Organisation report assessed the significance of climate change as a factor in determining epidemics by looking at 

whether the climate-epidemic relationship has been successfully quantified. In the case of Malaria and Cholera, climate is the primary factor in determining at least some epidemics, and the strength of the association 

between climate and disease outbreaks has been assessed on the basis of published quantitative (statistical) rather than anecdotal evidence. 


21


3. Where will the impacts be most felt? 

The impacts of climate change on health will be felt most 

acutely in countries with low levels of gross domestic 

product (GDP) and low investment in health per capita. 

The countries that are most likely to be impacted by 

climate change are also the countries that suffer the 

greatest health burden. South-East Asia and sub-Saharan 

Africa are most vulnerable to climate change and its 

health impacts. 

Developing countries 70 will suffer the most serious health 

impacts of climate change. Many of these countries have 

climates that are among the most variable in the world 

and are susceptible to EWEs. Between 1990 and 1998, 

Regions most vulnerable to climate change 

The geographical regions of the world most vulnerable to climate 

change – namely South-East Asia and sub-Saharan Africa – are 

also likely to bear the largest health burden associated with it 


22 Where will the impacts be most felt? 

94 per cent of the world’s 568 major natural disasters 

and more than 97 per cent of all natural disaster related 

deaths were in developing countries. 71 

The Maplecroft Climate Change Vulnerability Index rates 

166 countries according to six vulnerability factors: 

economy; national resource scarcity; ecosystems; 

poverty, development and health; population, settlement 

and infrastructure; institutions, governance and social 

capital. The Index found that Bangladesh, Burundi, 

Comoros, Rwanda, Haiti, Ethiopia, India, Afghanistan, 

Sierra Leone, and Pakistan are the ten countries currently 

most vulnerable to climate change. Africa has five of 

these ten countries and seventy percent of the 20 most 

vulnerable (see Figure 3.1). 72 

94% of the world’s 568 natural 

disasters and more than 97 per cent of 

all natural disaster related deaths were in 

developing countries. 

(see Figure 3.2). In 2000 these two regions accounted for over 

three quarters of the estimated global DALYs lost because 

of climate change. South-East Asia experienced the highest 

impact, with over 2.5 million DALYs lost, while Africa lost around 

1.8 million. This compares starkly with the 8,000 DALYs lost in 

developed countries.

Figure 3.1: Africa hosts 8 out of the 10 countries most vulnerable to climate change 

Maplecroft Climate Change Vulnerability Index (2010) 

Key 

Extreme 

High 

Medium 

Low 

Figure 3.2: South-East Asia and sub-Saharan Africa will bear the largest health burden 

Estimated impacts of climate change in 2000 by DALYs and WHO region, WHO (2003) 

Dev’d countries (8) 

Lat Am & Carrib (92) 

W.Pacific (169) 

E.Med (768) 

Africa Region (1984) 

S.E Asia (2572) 

(DALYs ‘000s) 


Where will the impacts be most felt? 

23


Figure 3.3 Low GDP and investment in health 

correlate to climate change vulnerability 

Climate Change Score 

Netherlands 

United Kingdom 

United States 

Norway 

Ireland 



High HD, High CCV Low HD, High CCV 

Cyprus 

Finland 

Bahrain 

Saudi Arabia 

Kuwait 

Russia 

Romania 

Lebanon 

South Africa 

Ecuador 

Legend - Regions (WHO) 

European Region 

Western Pacific Region 

South East Asia Region 

African Region 

Americas Region 

Eastern Mediterranean Region 

Size of bubble is proportional to the country’s GDP per Capita 

High HD, Low CCV Low HD, Low CCV 

Health Score 

China 

Philippines 

Indonesia 

Nigeria 

Gambia 

India 

Kenya 

Bangladesh 

Sources and approach: Climate Change Vulnerability Score ascertained through weighted averages of Climate Change Vulnerability Index (Maplecroft, 2011) 

and Climate Risk Index (Germanwatch, 2009). Health Expenditure per capita in 2007 (Government expenditure on health per capita, Purchasing Power Parity 

(PPP) international $, World Health Statistics 2010); GDP per capita (US$, ‘000s, World Bank, 2008) 

Pakistan 

Vulnerable countries typically have low 

levels of GDP and low investment in 

health per capita (see Figure 3.3). 

Four countries amongst this group – 

India, Bangladesh, Kenya and Angola 

– have been selected as case studies. 

These countries are amongst those 

that are vulnerable to climate change; 

they have limited financial resources to 

deal with the health impacts of climate 

change and also have an increasing 

need for health care. Two countries 

each have been selected from different 

parts of South-East Asia and sub- 

Saharan Africa as these are the 

regions that are at most risk.

Country profiles 

INDIA 

Climate-change vulnerability HIGH 

Health expenditure per capita (Int. $ at PPP*) 29 

GDP per capita (US$) 1,017 

Climate-related health risks include: EWEs, vector-borne diseases such as malaria, water 

scarcity and malnutrition 

EWEs 

• India is at ‘extreme risk’ from natural disasters. 73 Natural disasters have caused nearly 150,000 deaths since 

1980 – with an average annual death toll of 3,255. 74 

• Heavy rainfall and flooding impacts health – particularly in urban areas. In July 2005, Mumbai had 944 

millimetres of rainfall in a 24-hour period (compared with the annual average of 21.7 centimetres of rainfall). 75 

The flooding was exacerbated by blocked canals and drains, causing an outbreak of infectious disease, 

such as cholera and typhoid fever, 76 with the prevalence of the vector-borne leptospirosis increasing eightfold. 77 

Disease 

• Malaria zones are predicted to spread to elevations above 1800m by 2080 owing to rising temperatures. 78 

• Access to clean water and water scarcity is an issue exacerbated by climate change – by 2050 there could be 

an estimated 38 per cent potential drop in per capita water availability. 79 


Natural disasters 

have caused nearly 

150,000 

deaths since 1980 

Health Expenditure per capita in 2007 - Government expenditure on health per capita, Purchasing Power Parity (PPP)* international $ (World Health Statistics, 2010); GDP per capita at current prices (US$), 

World Bank World Development Indicators 2008. 

* PPP (Purchasing Power Parity) is the exchange rate that equates the price of a basket of identical traded goods and services in two countries. 


25


BANGLADESH 



GDP per capita (US$) 497 

Climate-related health risks include: EWEs, TB, malnutrition, dengue fever, diarrhoea 

and Hepatitis A 

EWEs 

• Bangladesh is at extreme risk from rising sea levels and flooding – and forced migration is likely to exacerbate 

communicable diseases. 

• Bangladesh suffered eight major floods between 1974 and 2004, the 1998 flood alone affecting 30 million 

people and inflicting losses of US$3 billion. 80 

• The direct annual cost of natural disasters over the last 10 years is estimated to be between 0.5% and 1% of 

Bangladesh’s GDP. 81 

Disease 

• Food or waterborne diseases are common in Bangladesh - bacterial and protozoal diarrhoea, hepatitis A and E, 

and typhoid fever are especially common. 

• Vector-borne diseases – especially dengue fever and malaria – are high risks in some locations. Out of 64 

districts in Bangladesh, 13 are classified as being in a high-risk malarial zone. A total of 14.7 million people in 

Bangladesh are classified as high-risk in terms of catching malaria. 82 

Major floods in 1998 affected 30 million people 


26 Where will the impacts be most felt?

KENYA 



GDP per capita (US$) 783 

Climate-related health risks include: Malaria, NTDs and water scarcity 

EWEs 

• Kenya is susceptible to a number of natural hazards, including floods, droughts, landslides and wild fires. 83 

• Drought is the most common natural hazard; almost 70 per cent of Kenya’s land mass is affected by drought. 84 

In the areas of Kenya most affected by drought in the arid north of the country up to 30 per cent of children 

are malnourished. 85 

• Floods seasonally affect various parts of the country. 86 The most severe floods in 1997–98 affected 

1.5 million people. 87 

Disease 

• Kenya has a high degree of risk from climate-sensitive infectious diseases such as food or waterborne diseases 

like diarrhoea, hepatitis A, and typhoid fever. Vector-borne diseases such as malaria, dengue fever, and Rift 

Valley Fever are also common. 88 

• High temperatures and intense rainfall events are known to be critical factors in initiating malaria epidemics in 

East Africa. 89 Malaria affects 20 million individuals annually in Kenya and costs an overall production loss of two 

to six per cent of GDP. 

• In the 1997 and 2006 El Niño seasons, Rift Valley Fever (RVF) caused major outbreaks in livestock and human 

populations. From 30 November 2006 to 12 March 2007 a total of 684 cases of RVF, including 155 deaths, 

were reported in Kenya; a case-fatality ratio of 23 per cent. 90 


Almost 70% of 

Kenya’s land mass is 

affected by drought 


27


ANGOLA 



GDP per capita (US$) 4,714 

Climate-related health risks include: EWEs, diarrhoea, hepatitis A, malaria, 

and schistosomiasis 

EWEs 

• There has been an increase in the number of warm spells over Southern Africa and a decrease in the number 

of extremely cold days. In some parts of Southern Africa, including Angola, a significant increase in heavy 

rainfall events has been observed along with evidence for changes in seasonality and extremes. 91 

• Locally heavy rainfall causes periodic flooding on Angola’s interior plateau. 92 In 2009, about 80,000 people were 

displaced from their homes and 220,000 people were affected by floods in the southern Angolan province of 

Cunene. 93 

Disease 

• The entire population of Angola is considered at risk of malaria. 94 

• Angola has a ‘very high’ risk rating for a number of other major climate-sensitive infectious diseases: food or 

waterborne diseases such as bacterial and protozoal diarrhoea, hepatitis A, typhoid fever; vector-borne diseases 

such as African trypanosomiasis (sleeping sickness); and water contact diseases such as schistosomiasis. 95 

• Cholera and respiratory infections also increased dramatically after recent floods. 96 



In 2009, about 

80,000 people 

were displaced 

from their homes.


4. What are the societal and economic 

benefits of addressing climate change 

related health impacts? 

Tackling the health impacts of climate change will have a 

positive impact on society, but also on the economy. 

• Societal benefits: Most importantly, tackling the impacts 

of climate change on health will alleviate the human 

costs of pain and suffering, allow resources to be 

allocated to education, and support development. 

• Economic benefits: Although the impact on disease 

and human health is the most important benefit, there 

are also economic rewards at stake. The net economic 

benefits of managing climate change related incidents 

of malaria, malnutrition and diarrhoeal disease in 

sub-Saharan Africa and South-East Asian economies 

could range from US$33–US$54 billion between 

2010 and 2030. 97 

Even if global emissions of GHGs are drastically reduced 

in the coming years, temperatures are nonetheless 

expected to rise. The health impacts of climate change 

will need to be addressed through prevention, treatment 

and adaptation. 

Tackling the health impacts of climate change will have 

a positive impact both on society and on the economy. 

Health interventions will alleviate some of the human 

suffering involved, including loss, pain and bereavement. 

It is impossible to quantify this benefit, but it nonetheless 

remains the primary consideration in the fight against disease. 

In considering the benefits of addressing the health 

impacts of climate change it is also important to bear in 

mind the alleviation of strain for individuals and countries. 

At a national level, developing countries with already 

limited resources are further stretched by the pressures 

on public health systems. 

Meanwhile at the household level, families will often divert 

spending towards medicine at the expense of other 

basic needs. Reducing the disease burden would allow 

resources to be directed to other activities – for example 

education – that can improve both quality of life and 

future earning prospects. 

Benefits also extend to the wider international health 

and development agenda. Four of the United Nations’ 

Millennium Development Goals (MDGs) – although 

underpinned by wider economic factors – relate 

specifically to health and/or climate change. The goals to 

eradicate extreme poverty and hunger (goal 1), reduce 

child mortality rate (goal 4), combat HIV/AIDS, malaria 

and other diseases (goal 6) and ensure environmental 

sustainability (goal 7) could all be impacted by the health 

effects of climate change. Limiting GHGs and ensuring 

that any additional health impacts from climate change 

are addressed will contribute significantly to furthering 

the MDGs. 

The net economic benefits of managing the 

additional health effects of climate change will 

also be significant. 

What are the societal and economic benefits of addressing climate change related health impacts? 

29


Disease can lead to death or disability, preventing an 

individual from taking part in productive economic activity. 

Therefore each life saved – or each individual restored 

to health through a health intervention – represents a 

benefit to the economy. It opens up the possibility that 

the individual will remain in (or enter) the labour force and 

contribute to economic output. 

Initial analysis, albeit based on limited data, indicates that 

the net economic benefits of managing the climate change 

related incidence of malaria, malnutrition and diarrhoeal 

disease in the sub-Saharan African and South-East Asian 

economies are expected to range from US$33–US$54 

billion from 2010 to 2030 (Figure 4.1). This represents 

between 0.6 per cent and 1.0 per cent of current GDP for 

these regions; a significant benefit, particularly in light of 

the prevalent poverty in many of these countries. The total 

annual benefit is based on the additional economic output 

that is gained from managing the diseases. 

From this indicative analysis, South-East Asian economies 

are estimated to yield the greatest net benefit in absolute 

terms. However, Sub-Saharan African economies will feel 

the benefit of tackling these issues the most owing to 

their current low levels of GDP. Benefits vary by disease 

and by climate change scenario. If a medium climate 

change scenario is taken as the most likely outcome, 

tackling climate change related malaria incidents across 

these two regions could yield a net economic benefit of 

approximately US$14 billion, with most of this benefit 

arising in sub-Saharan Africa. For diarrhoeal diseases the 

net benefit across these two regions would be around 

US$6 billion and for malnutrition it would be US$23 billion. 

The analysis, although dealing with the marginal impact 

of climate change, points to the benefits that would arise 

from treating the wider pool of disease (see Appendix 1 

for more detail). 


30 What are the societal and economic benefits of addressing climate change related health impacts? 

Figure 4.1: The cumulative economic benefit of tackling the impacts of climate 

change on health could be significant 

Net positive economic benefit of tackling the health impacts of climate change on malaria, malnutrition 

and diarrhoeal disease by 2030 

Source: Accenture Analysis (for a breakdown of the methodology, countries covered in the analysis, 

and other variables, please see Appendix 1) 

Malaria 

Malnutrition 

Diarrhoeal 

diseases 

Climate change scenario 

Impact on GDP$bn 

Sub-Saharan 

Africa 

South East Asia 

Sub-Saharan 

Africa 


Sub-Saharan 

Africa 


Low Medium High 

12 

Summary of total Net Benefit 

Note: Climate change scenarios are adapted from the three alternative emissions scenarios used by the World Health 

Organization Global Burden of Disease Study (2003). Additional incidence of disease taken from Ebi (2008). 98 

14 

– Negligible Negligible 

2 3 1 

15 

24 

20 20 

4 6 7 

0.5 0.6 0.7 

Total GDP Impact 

The net bene�t to these regions of 

managing the additional climate 

change related cases of Malaria could 

correspond to 0.2-0.4% of GDP 


The net bene�t to these regions 

of managing the additional climate 

change related cases of Malnutrition 

could correspond to 0.3-0.4% of GDP 


The net bene�t to these regions of 

managing the additional climate change 

related cases of Diarrhoeal disease 

could correspond to 0.1% of GDP


5. What are the impacts and implications 

for the pharmaceutical industry? 

The current understanding of the impact of climate 

change on health suggests that this issue is unlikely 

to lead to fundamental changes in the pharmaceutical 

business model – at least in the short term. 

However, there are a number of factors which will 

influence the pharmaceutical industry in the more 

immediate future. These include increasing demand 

for healthcare products within emerging markets, 

improving access to medicine in the developing world, 

an increasingly stringent regulatory and operating 

environment, and a drop in innovation and R&D 

productivity, as well as the growing need for research 

and development on NTDs. Improvements in healthcare 

information technology and an increase in targeted 

treatment solutions are also likely to be more important 

areas of focus for the industry. 

5.1 Impacts 

Despite other immediate – and seemingly more pressing 

– issues, it is imperative that we start to frame the debate 

around what the potential impacts and implications of 

climate change are for the pharmaceutical industry over 

the longer term. Doing this makes successful mitigation, 

response and adaptation to risks more likely. The following 

section highlights potential impacts identified to date in 

relation to four key areas: 

• Stakeholder relations: The breadth of stakeholders 

the industry needs to interact with on this issue 

will increase 

• Strategic planning: Current uncertainty will continue 

to make strategic choices and planning on this 

issue difficult 

• Skills: New skills may be required to respond to 

climate change impacts 

• Supply chains: Pharmaceutical supply chains could 

be affected 

Stakeholder relations 

Building trust and reputation is a key priority for the 

pharmaceutical industry. The breadth of issues and 

stakeholder groups with which pharmaceutical 

organisations may wish to interact and develop a 

trusted relationship is likely to increase in coming years 

as climate change starts to impact health. These issues 

could range from intellectual property rights to the R&D 

agenda, as well as the contribution pharma is making to 

climate change adaptation. Pharmaceutical companies 

may need to develop closer partnerships with NGOs, 

government agencies and other stakeholders. This move 

away from traditional stakeholders is a general industry 

trend as the role of pharmacists, payers and patients 

increases. The impact of climate change on health could 

accelerate this trend. 

There is increasing stakeholder demand for 

pharmaceutical companies to quantify the benefits 

they have on the bottom line, as well as to society 

more broadly. This may mean that a more focused and 

proactive approach to tackling climate change impacts 

on health is required. As a result, some existing activities 

will increase in importance and come under more intense 

stakeholder scrutiny; for example building trust and 

reputation, examining intellectual property, access to 

medicines and preferential pricing schemes. 

What are the impacts and implications for the pharmaceutical industry? 

31


Strategic planning 

Uncertainty and lack of granularity in the data around 

climate change and health might present strategic 

difficulties for organisations and for the pharmaceutical 

industry as a whole. Particular challenges include the 

ability to: 

• Make strategic choices based on climate change 

and health 

• Undertake informed choices on future R&D priorities 

and plans 

• Model the impact of climate change on disease 

epidemiology and the cost-effectiveness of products 

• Develop appropriate pricing and marketing approaches 

• Plan appropriate supply and distribution; how much is 

required, where and when 

The limitations presented by uncertainty and the lack of 

specificity in research on climate change and health are 

probably the biggest risks of all at present. 

Skills 

Climate change is unlikely to have a significant impact 

on the individual skills required within the majority of 

pharmaceutical company functions. There may be 

increased demand for infectious disease specialists 

(scientists, researchers, medics, statisticians, etc), but 

the degree of change is likely to be minimal and over a 

prolonged period; other portfolio changes are likely to 

have a greater, and more immediate, impact on the mix 

of specialism required. 

The more likely scenario is that a new blend of skills 

will be required across the organisation, for example 

partnering and interdisciplinary cooperation with various 

stakeholders involved in the climate change and health 


32 What are the impacts and implications for the pharmaceutical industry? 

debate. This is likely to include healthcare professionals, 

climate experts, biologists and social scientists, as well 

as governmental and multilateral organisations, NGOs, 

community groups, etc. 

Supply chains 

Finally, although the evidence is limited, it is conceivable 

that climate change could present a risk to the supply 

chain. One risk is the potential for disruption in the 

availability of raw materials; decreased biodiversity as a 

consequence of climate change will have an impact on 

current and new drug development. Another instance 

is the potential impact on distribution networks for the 

onward delivery of finished product. Product supply could 

also possibly be compromised during climate induced 

crises or sudden disease spread. The potential risks and 

impacts, however, are not well understood. 

5.2 Developing a response 

Pharmaceutical executives might consider the following 

critical questions as they address the implications of 

climate change and health for their organisation: 

• Which stakeholders does the industry need to engage 

with around climate change and health? What is the 

most appropriate forum for collaboration? 

• What tools and methods can be used to factor 

uncertainties into corporate planning? How can climate 

change be added as a variable to ensure adequate 

preparation for both acute and sudden impacts? 

• What research methods and data already exist that 

can be used to model the impact of different climate 

scenarios on specific diseases? 

• What is the best means of gathering new data on 

disease burden and unmet needs? 

By embedding 

vigilance, flexibility 

and adaptability into 

business models, 

organisations will be 

better placed to meet 

customer needs in the 

face of the changing 

environment. 

• How can R&D be geared towards lessening the health 

impacts of climate change as well as addressing patient 

needs? 

• How can organisations most effectively work with 

governments, regulatory bodies and other agencies to 

create a common language and understanding around 

the issues and possible solutions? 

• How will climate change affect the sales of different 

products and services? What changes, if any, are 

required to the sales and marketing function to meet 

this demand and address patient needs? 

• Which manufacturing sites/supply chains/distribution 

networks are dependent on parts of the world that are 

susceptible to both the impacts of climate change and 

its associated health effects? How can they be made 

more resilient?

5.3 Implications 

Given the gaps in our knowledge and many of the 

remaining uncertainties, we see the response of the 

industry covering four key areas: 

• Engaging stakeholders: Working together with multiple 

stakeholders to increase awareness and understanding 

around the issue of climate change and health 

• Building resilience: Partnering with the broader health 

community to integrate climate change resilience into 

existing activities 

• Driving science and innovation: Contributing to the 

global research agenda around climate change 


• Being prepared to respond: Integrating climate change 

and health as an additional consideration in future 

planning 

Engaging stakeholders: Stakeholder interest on climate 

change and health already exists and is growing. For 

example the number of articles on climate change and 

health (still an emerging area of research) has increased 

significantly in the past decade (see Figure 5.1). 

There will be a good opportunity for the pharmaceutical 

industry, healthcare professionals, policy makers and 

wider society to come together to discuss the challenges 

and opportunities presented by climate change and 

health. At the very least, this will help to build trust and 

communication. At best it will lead to innovative solutions, 

shared benefits, and collective awareness regarding an 

uncertain future. 

Figure 5.1: Academic interest in climate 

change and health is growing 

Number of academic articles with ‘climate change’ 

and ‘human health’ in the article title, abstract or 

body text 

Climate change and health article count 

250 

200 

150 

100 

50 

0 

1980 1995 2010 

Year 

Source: Scopus article search (as of May 2011) 


Practical steps to engage with stakeholders 

could involve: 

• Initiating or co-developing a forum of key stakeholders 

to discuss the implications of climate change on health 

for a broad range of health-related sectors. Policy 

makers, NGOs, multilateral organisations, local health 

and environmental agencies as well as the private 

sector will be critical to the success of any such 

dialogue 

• Engaging in open dialogue with a wider audience 

through public engagement and advocacy 

• Developing communication and education materials. 

These could outline the key issues and explain actions 

being taken by the industry to understand and tackle 

the impact of climate change on health 

Building resilience: The impacts of climate change 

and health will be both gradual and sudden. For some 

health impacts it could be decades before the impact of 

climate change is felt. For others such as EWEs or new 

emerging diseases the effect could be sudden and come 

without warning. 

Ensuring health systems have the capacity to deal 

with change and continue to function in this context 

becomes essential. This is a particular consideration 

for, but not isolated to, many emerging and developing 

countries where weak healthcare infrastructure is already 

strained. Integrating climate change resilience into 

the development of healthcare systems will improve 

accessibility and availability of services when they are 

needed the most. Although this is not the primary 

responsibility of the pharmaceutical industry, there is 

a role for the industry to play as part of the broader 

community engaged in supporting public health systems. 

What are the impacts and implications for the pharmaceutical industry? 

33


Building capacity to ‘bounce back’, for example to 

respond efficiently and quickly after EWEs, is also relevant 

for organisations in the health and pharmaceutical 

sector, where continuity is essential for saving lives. 

By embedding vigilance, flexibility and adaptability into 

business models, organisations will be better placed 

to meet customer needs in the face of the changing 

environment. 

Practical steps to build resilience could involve: 

• Helping to ensure climate change is embedded into 

existing financial and/or technical support for capacity 

building and infrastructure development in emerging 

and developing markets 

• Assisting in the development of disaster contingency 

plans for healthcare systems in both the developed and 

developing world 

• Adding climate change as an additional consideration 

in strategic planning and operating models to allow 

continual adaptation to the evolving environment 

• Creating a climate change resilient supply chain to 

provide surety of supply for consumers 

Driving science and innovation: Lack of data is one of 

the biggest barriers to decision-making around climate 

change and health. The pharmaceutical industry could 

contribute to furthering the knowledge base by engaging 

in the global research agenda on this issue. Addressing 

some of the gaps in the existing body of knowledge 

will not only increase levels of understanding, it will also 

enable its resources and public policies to be targeted 

appropriately. 


34 What are the impacts and implications for the pharmaceutical industry? 

National and community-based monitoring and surveillance 

in particular will increase the knowledge of how climate 

change is affecting human health, now and in the future. 

This is no simple undertaking; it is likely to require a range 

of efforts, insights, expertise and finance from the private 

and public sector, academia and civil society. 

Practical steps to drive science and innovation 


• Using the pharmaceutical industry’s knowledge to 

contribute to the knowledge base on climate change 


• Partnering with academia, local communities and 

government to support a Climate Change and Health 

Observatory, with a specific focus on emerging and 

developing markets. The remit of such an observatory 


• Building monitoring and early-warning systems using 

climate change metrics and thresholds for key diseases 

• Putting in place metric tracking and management 

capabilities 

• Creating a repository or database to collect information 

• Developing climate change guidance for the healthcare 

industry and other interested parties 

• Building skills and knowledge 

• Advocating governments to provide funding for 

research into climate change and its impact on disease 

pathways and epidemiology 

Being prepared to respond: The interplay between 

climate change and health should be added as 

a consideration in the strategic planning and risk 

management activities of the pharmaceutical industry. 

Continued monitoring and exploration will help the 

industry manage the uncertainty associated with climate 

change and health. It will also enable the industry to 

become more aware of potential future events and be 

better prepared to respond to a range of possibilities. 

Practical steps to ensure the industry is prepared to 

respond could include: 

• Adding climate change and health as a consideration in 

strategic planning and risk management activities 

• Using horizon scanning and scenario planning to 

monitor and explore the uncertainty associated with 

climate change and health 

• Ensuring R & D priorities factor in the impact of climate 

change on infectious diseases. This should especially 

include those that are particularly climate sensitive, 

including many neglected tropical diseases 

• Examining how climate change could affect the health 

landscape in emerging and developing markets 

• Understanding where the pharmaceutical industry can 

have the greatest impact and what the industry’s role 

should be on the issue

Conclusion 

Science tells us that change is happening. 

It also suggests that climate change will 

exacerbate existing health issues – most 

notably in the developing world. 

However, current knowledge has only begun to scratch 

the surface of what the impacts of climate change on 

health could be. Gaps remain in our understanding of 

the health impacts of climate change at a local and often 

disease-specific level. 

Most importantly, 

we invite stakeholders 

to work with us to 

use this as a starting 

point for action and 

collaboration. 

Like all big enterprises, companies in the pharmaceutical 

industry need to reduce their GHGs to contribute to the 

global efforts to mitigate against the effects of climate 

change. Additionally, from a health perspective, the 

industry has an important role to play in helping society 

adapt and respond to the changing climate. 

By working with society to reduce knowledge gaps, 

engaging with a wide range of stakeholders, continuing 

to bolster healthcare systems and improving access to 

medicine in the developing world, both society and the 

pharmaceutical industry will be better prepared to adapt 

to an uncertain future. 

GSK, Accenture and the Smith School of Enterprise 

and the Environment welcome partnership on this issue, 

particularly to examine the existing knowledge gaps and 

to begin to answer some of the questions identified. Most 

importantly, we invite stakeholders to work with us to use 

this as a starting point for action and collaboration. 


Conclusion 

35


Acknowledgements 

We would like to thank the following external experts for their contributions to this report. 

Professor Anthony McMichael Australian National University 

Ben Schwartz Care International 

Maryann Delea Care International 

Madeleine Thomson International Research Institute for Climate and Society, 

Columbia University 

Daniel Osgood International Research Institute for Climate and Society, 

Columbia University 

Professor Walter Leal Filho Hamburg University of Applied Sciences 

Professor Paul Epstein Harvard University 

Professor Sir Roy Anderson Imperial College, London 

A.J.M. (Ton) Hoek International Pharmaceutical Federation 

Professor Rais Akhtar Jawaharlal Nehru University, New Delhi 

Professor Andrew Haines London School of Hygiene and Tropical Medicine 

Dr Paul Wilkinson London School of Hygiene and Tropical Medicine 

Professor David Matthews Oxford Centre for Diabetes, Endocrinology and 

Metabolism 

Christopher Elias PATH 

Sophia Tickell Meteos 

Dr Manjinder Sandhu University of Cambridge 

Professor Anthony Costello University College London 

Professor Mark Maslin University College London 

Dr Angela Wilkinson University of Oxford 

36 Acknowledgements 

GSK Study Sponsors 

Andrew Witty, Chief Executive Officer 

Duncan Learmouth, Senior Vice-President 

Developing Countries and Market Access 

Accenture Study Sponsor 

Peter Lacy, Managing Director, Accenture 

Sustainability Services Europe, Africa and 

Latin America 

Smith School of Enterprise and the 

Environment Study Sponsor 

Professor Sir David King, Director

Appendix 1 

Approach for quantifying the economic benefit of addressing the health impacts of climate change 

Background 

Economic analysis for this paper focuses on the climate 

change related additional incidents of malaria, diarrhoeal 

diseases, and stunting and wasting (malnutrition) in 

the following three WHO-classified regions: “Afr-D” 

(predominantly West Africa), “Afr-E” (predominantly 

South and East Africa) and “Sear-D” (predominantly 

South-East Asia). 

The analysis examines benefits across three climate 

change scenarios based on those used by the WHO in 

their Global Burden of Disease Study (2003): 

1. S550 – emissions reductions stabilise CO2 at 550 ppm 

CO2 equivalent in 2170. 

2. S750 – emissions reductions stabilise CO2 at 750 parts 

per million (ppm) in 2210 

3. Unmitigated Emissions (UE) – no action is taken to 

stabilise greenhouse gas emissions 

Objectives were to assess lost economic output and 

derive estimates of net benefit in managing the three 

climate change related diseases. 

Method 

Benefits – Estimates of the additional climate change 

related incidence of disease in 2030 99 are used to 

generate disability-adjusted life years. This is combined 

with output per capita to determine total annual benefit 

gained from managing the diseases. 

Costs – Marginal cost of intervention per case is 

based on existing treatment costs for all cases of 

these diseases adjusted for number of cases where 

intervention takes place. 

Net Benefit – Costs and benefits are spread from 

2010 to 2030, so both are discounted to Net Present 

Value (NPV) using a rate of 3.5 per cent. This discount 

rate is consistent with the UK Treasury’s Green Book 

recommendation for policy appraisal. 

Source: This analysis was carried out by the economics team 

at the Accenture Institute for High Performance: Mark Purdy, 

Athena Peppes, and Matthew Robinson 

Figure A.1: Factors used to derive net benefit 

Net benefit 

Economic 

benefits 

Cost of 

intervention 

DALYs saved 

Output per 

life year 

Cost per 

incident 

Incidents that 

receive intervention 

Findings 


S550 

NPV (US$ bn, PPP) 

S750 UE 

Afr-D 6.41 7.52 11.02 

Afr-E 11.44 14.56 21.39 

Sear-D 15.13 20.51 21.11 

Total 32.97 42.58 53.52 

NPV (% of GDP, 2008) 

S550 S750 UE 

Afr-D 0.7 0.8 1.1 

Afr-E 1.3 1.6 2.4 

Sear-D 0.4 0.6 0.6 

Total 0.6 0.8 1.0 

Success of 

intervention factor 

Recurrence 

factor 

Climate change 

related DALYs 

Output per 

capita 

Output per capita 

growth rate 

Incidents that 

receive intervention 

Climate change 

related incidents 

Ratio of incidents 

to DALYs 

Appendix 1 

37


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natural disaster risk ranking – France, Italy, USA at “high risk” 

http://www.maplecroft.com/about/news/natural_disasters. 

html (Date accessed 10/06/2010) 

74. Harmeling, S. (2009) ‘Briefing Paper: Global Climate Risk 

Index 2010’, Berlin: Germanwatch 

75. Kovats, R. S. & Akhtar, R, (2008) op. cit. 

76. Ibid. 

77. Maskey, M, J. et al. ‘Leptospirosis in Mumbai: post-deluge 

outbreak 2005’ Indian Journal of Medical Microbiology 24(4): 

337–338 

78. Kovats, R. S. & Akhtar, R, (2008) op. cit. 


80. Department for International Development (DFID) (2004) 

http://www.dfid.gov.uk/r4d/PDF/Outputs/consultation/ 

BackgroundEnvironmentalChange.pdf) 


81. United Nations Development Programme Country Evaluation: 

Assessment of Development Results Bangladesh (2005) 

82. Reid, H. and Sims A., 2007. Up in smoke? Asia and the 

Pacific, Up in Smoke Working Group on Climate Change and 

Development. p. 92. 

83. United Nations Development Programme (2010) ‘Kenya 

Disaster Profile’ Nairobi: United Nations Development 

Programme Kenya Office 

84. Ibid. 

85. Merlin (2010) http://www.merlin.org.uk/Where-we-work/ 

Kenya.aspx (Date Accessed 18/06/2010) 

86. United Nations Development Programme (2010) ‘Kenya 

Disaster Profile’ Nairobi: United Nations Development 

Programme, Kenya Office 

87. Ibid. 

88. CIA World Factbook (2010) https://www.cia.gov/library/ 

publications/the-world-factbook/geos/rp.html (Date 

Accessed 18/06/2010) 

89. Barclays Social Intelligence Unit (2010) Storm Shelter: 

Managing Climate Risks in Africa, London: Barclays Bank 

90. WHO (2009) http://www.who.int/csr/don/2007_05_09/en/ 

index.html (Date Accessed 18/06/2010) 



92. CIA World Factbook (2010) https://www.cia.gov/library/ 

publications/the-world-factbook/geos/ao.html (Date 

Accessed 18/05/2011) 

93. British Red Cross (2009) http://www.redcross.org.uk/Aboutus/News/2009/May/Delegates-deployed-to-floods-in-Angola 

94. WHO World Malaria Report 2010 http://www.who.int/ 

malaria/publications/country-profiles/profile_ago_en.pdf 

(Date Accessed 18/05/2011) 



96. International Federation of Red Cross and Red Crescent 

Societies (2009) http://www.ifrc.org/en/news-and-media/ 

news-stories/africa/angola/angola-red-cross-responds-toincreasing-cholera-cases-due-to-floods/ 

97. Ibid. 

97. Accenture Institute of High Performance analysis, 2010 

97. Ebi, K.L., Adaptation costs for climate change-related cases 

of diarrhoeal disease, malnutrition, and malaria in 2030’, 

Globalization and Health, 2008, 4:9 

98. Ibid. 

Endnotes 

39

Climate Change and Health: Framing the issue

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