Climate Change and Health: Framing the issue

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Climate Change and Health Health: Framing Paper the Issue 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/ 020Introduction 20 What does the science say about the impact of climate change on health? 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. Climate Change and Health: Framing the Issue 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. What does the science say about the impact of climate change on health? 21
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