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Human Health: Impacts

,
11 Adaptation, and Co-Benefits

Coordinating Lead Authors:
Kirk R. Smith (USA), Alistair Woodward (New Zealand)

Lead Authors:
Diarmid Campbell-Lendrum (WHO), Dave D. Chadee (Trinidad and Tobago), Yasushi Honda
(Japan), Qiyong Liu (China), Jane M. Olwoch (South Africa), Boris Revich (Russian Federation),
Rainer Sauerborn (Sweden)

Contributing Authors:
Clara Aranda (Mexico), Helen Berry (Australia), Colin Butler (Australia), Zoë Chafe (USA),
Lara Cushing (USA), Kristie L. Ebi (USA), Tord Kjellstrom (New Zealand), Sari Kovats (UK),
Graeme Lindsay (New Zealand), Erin Lipp (USA), Tony McMichael (Australia), Virginia Murray
(UK), Osman Sankoh (Sierra Leone), Marie O’Neill (USA), Seth B. Shonkoff (USA),
Joan Sutherland (Trinidad and Tobago), Shelby Yamamoto (Germany)

Review Editors:
Ulisses Confalonieri (Brazil), Andrew Haines (UK)

Volunteer Chapter Scientists:
Zoë Chafe (USA), Joacim Rocklov (Sweden)

This chapter should be cited as:
Smith, K.R., A. Woodward, D. Campbell-Lendrum, D.D. Chadee, Y. Honda, Q. Liu, J.M. Olwoch, B. Revich, and
R. Sauerborn, 2014: Human health: impacts, adaptation, and co-benefits. In: Climate Change 2014: Impacts,
Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the
Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Field, C.B., V.R. Barros,
D.J. Dokken, K.J. Mach, M.D. Mastrandrea, T.E. Bilir, M. Chatterjee, K.L. Ebi, Y.O. Estrada, R.C. Genova,
B. Girma, E.S. Kissel, A.N. Levy, S. MacCracken, P.R. Mastrandrea, and L.L. White (eds.)]. Cambridge University
Press, Cambridge, United Kingdom and New York, NY, USA, pp. 709-754.
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Table of Contents

Executive Summary ........................................................................................................................................................... 713

11.1. Introduction ............................................................................................................................................................ 715
11.1.1. Present State of Global Health ......................................................................................................................................................... 715
11.1.2. Developments Since AR4 .................................................................................................................................................................. 715
Box 11-1. Weather, Climate, and Health: A Long-Term Observational Study in African and Asian Populations .......................... 715
11.1.3. Non-Climate Health Effects of Climate-Altering Pollutants ............................................................................................................... 716

11.2. How Climate Change Affects Health ....................................................................................................................... 716

11.3. Vulnerability to Disease and Injury Due to Climate Variability and Climate Change ............................................. 717
11.3.1. Geographic Causes of Vulnerability .................................................................................................................................................. 717
11.3.2. Current Health Status ....................................................................................................................................................................... 717
11.3.3. Age and Gender ............................................................................................................................................................................... 717
11.3.4. Socioeconomic Status ....................................................................................................................................................................... 718
11.3.5. Public Health and Other Infrastructure ............................................................................................................................................. 718
11.3.6. Projections for Vulnerability .............................................................................................................................................................. 718

11.4. Direct Impacts of Climate and Weather on Health ................................................................................................. 720
11.4.1. Heat- and Cold-Related Impacts ....................................................................................................................................................... 720

11 11.4.1.1. Mechanisms ...................................................................................................................................................................... 720
11.4.1.2. Near-Term Future .............................................................................................................................................................. 721
11.4.2. Floods and Storms ............................................................................................................................................................................ 721
11.4.2.1. Mechanisms ...................................................................................................................................................................... 722
11.4.2.2. Near-Term Future ............................................................................................................................................................... 722
11.4.3. Ultraviolet Radiation ......................................................................................................................................................................... 722

11.5. Ecosystem-Mediated Impacts of Climate Change on Health Outcomes ................................................................. 722
11.5.1. Vector-Borne and Other Infectious Diseases ..................................................................................................................................... 722
11.5.1.1. Malaria .............................................................................................................................................................................. 722
11.5.1.2. Dengue Fever .................................................................................................................................................................... 723
Box 11-2. Case Study: An Intervention to Control Dengue Fever .................................................................................... 724
11.5.1.3. Tick-Borne Diseases ........................................................................................................................................................... 725
11.5.1.4. Other Vector-Borne Diseases ............................................................................................................................................. 725
11.5.1.5. Near-Term Future ............................................................................................................................................................... 725
11.5.2. Food- and Water-Borne Infections .................................................................................................................................................... 726
11.5.2.1. Vibrios ............................................................................................................................................................................... 726
11.5.2.2. Other Parasites, Bacteria, and Viruses ................................................................................................................................ 726
11.5.2.3. Near-Term Future ............................................................................................................................................................... 727

710

Human Health: Impacts, Adaptation, and Co-Benefits Chapter 11

11.5.3. Air Quality ........................................................................................................................................................................................ 727
Box 11-3. Health and Economic Impacts of Climate-Altering Pollutants Other than CO2 ........................................................... 728
11.5.3.1. Long-Term Outdoor Ozone Exposures ............................................................................................................................... 728
11.5.3.2. Acute Air Pollution Episodes .............................................................................................................................................. 729
11.5.3.3. Aeroallergens .................................................................................................................................................................... 729
11.5.3.4. Near-Term Future ............................................................................................................................................................... 729

11.6. Health Impacts Heavily Mediated through Human Institutions ............................................................................. 730
11.6.1. Nutrition ........................................................................................................................................................................................... 730
11.6.1.1. Mechanisms ...................................................................................................................................................................... 730
11.6.1.2. Near-Term Future ............................................................................................................................................................... 730
11.6.2. Occupational Health ......................................................................................................................................................................... 731
11.6.2.1. Heat Strain and Heat Stroke .............................................................................................................................................. 731
11.6.2.2. Heat Exhaustion and Work Capacity Loss .......................................................................................................................... 731
11.6.2.3. Other Occupational Health Concerns ................................................................................................................................ 731
11.6.2.4. Near-Term Future ............................................................................................................................................................... 732
11.6.3. Mental Health ................................................................................................................................................................................... 732
11.6.4. Violence and Conflict ........................................................................................................................................................................ 732

11.7. Adaptation to Protect Health ................................................................................................................................. 733
11.7.1. Improving Basic Public Health and Health Care Services .................................................................................................................. 733 11
11.7.2. Health Adaptation Policies and Measures ......................................................................................................................................... 733
11.7.3. Early Warning Systems ...................................................................................................................................................................... 734
11.7.4. Role of Other Sectors in Health Adaptation ...................................................................................................................................... 734

11.8. Adaptation Limits Under High Levels of Warming .................................................................................................. 735
11.8.1. Physiological Limits to Human Heat Tolerance .................................................................................................................................. 736
11.8.2. Limits to Food Production and Human Nutrition .............................................................................................................................. 736
11.8.3. Thermal Tolerance of Disease Vectors ............................................................................................................................................... 736
11.8.4. Displacement and Migration Under Extreme Warming ..................................................................................................................... 736
11.8.5. Reliance on Infrastructure ................................................................................................................................................................. 736

11.9. Co-Benefits ............................................................................................................................................................. 737
11.9.1. Reduction of Co-Pollutants ............................................................................................................................................................... 737
11.9.1.1. Outdoor Sources ................................................................................................................................................................ 738
11.9.1.2. Household Sources ............................................................................................................................................................ 738
11.9.1.3. Primary Co-Pollutants ........................................................................................................................................................ 739
11.9.1.4. Secondary Co-Pollutants .................................................................................................................................................... 739
11.9.1.5. Case Studies of Co-Benefits of Air Pollution Reductions .................................................................................................... 740

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Chapter 11 Human Health: Impacts, Adaptation, and Co-Benefits

11.9.2. Access to Reproductive Health Services ............................................................................................................................................ 740
11.9.2.1. Birth and Pregnancy Intervals ............................................................................................................................................ 740
11.9.2.2. Maternal Age at Birth ........................................................................................................................................................ 741

11.10. Key Uncertainties and Knowledge Gaps ................................................................................................................ 741

References ......................................................................................................................................................................... 743

Frequently Asked Questions
11.1: How does climate change affect human health? .............................................................................................................................. 741
11.2: Will climate change have benefits for health? .................................................................................................................................. 742
11.3: Who is most affected by climate change? ........................................................................................................................................ 742
11.4: What is the most important adaptation strategy to reduce the health impacts of climate change? ................................................. 742
11.5: What are health “co-benefits” of climate change mitigation measures? ......................................................................................... 742

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essentially all the important climate-altering pollutants (CAPs) other than carbon dioxide (CO2) have near-term health implications (very high confidence). by the magnitude and severity of the negative effects of climate change (high confidence).g.4} Biological and social adaptation is more difficult in a highly variable climate than one that is more stable. {11. due to changes in temperature and precipitation and occurrence of heat waves. {Box 11-4} Some parts of the world already exceed the international standard for safe work activity during the hottest months of the year. and death due to more intense heat waves and fires (very high confidence) {11. droughts.6} • Increased risks of food.5. shifting patterns of disease vectors). in populations that benefit from rapid social and economic development (high confidence).Human Health: Impacts. worldwide.4-6} Impacts on health will be reduced. or social responses to climate change (such as displacement of populations following prolonged drought). over and above the influence of average temperatures on heat-related deaths. But the largest risks will apply in populations that are currently most affected by climate- related diseases. and reduced capacity of disease-carrying vectors due to exceedance of thermal thresholds (medium confidence). including growing food or working outdoors in some areas for parts of the year (high confidence). In 2010. These positive effects will be increasingly outweighed. Adaptation. floods. {11.7} Until mid-century climate change will act mainly by exacerbating health problems that already exist (very high confidence). particularly during manual labor. the combination of high temperatures and high humidity will compromise normal human activities.and water-borne diseases (very high confidence) and vector-borne diseases (medium confidence) {11. In addition to their implications for climate change.4.4} Local changes in temperature and rainfall have altered distribution of some water-borne illnesses and disease vectors.7). by 2100 some of the world’s land area will be experiencing 4°C to 7°C higher temperatures due to anthropogenic climate change (WGI AR5 Figure SPM. it is expected that health losses due to climate change-induced undernutrition will occur mainly in areas that are already food-insecure. {11.8} 713 . and reduced food production for some vulnerable populations (medium confidence). Thus.5-6} If climate change continues as projected across the Representative Concentration Pathway (RCP) scenarios.5} • Modest reductions in cold-related mortality and morbidity in some areas due to fewer cold extremes (low confidence). but not eliminated. disease. 11. and Co-Benefits Chapter 11 Executive Summary The health of human populations is sensitive to shifts in weather patterns and other aspects of climate change (very high confidence). for example. RCP8. {11. {11.3} In recent decades. {11. the health effects of climate change will be exacerbated. more than 7% of the global burden of disease was due to inhalation of these air pollutants (high confidence).. food-borne infections) may extend their range into areas that are presently unaffected (high confidence). Variability in temperatures is a risk factor in its own right. Indirectly.6-7} Climate change is an impediment to continued health improvements in many parts of the world. These effects occur directly. and existing diseases (e. {11. health may be damaged by ecological disruptions brought on by climate change (crop failures. particularly among the poorest and least healthy groups (very high confidence). in parts of the world during this century.6} • Consequences for health of lost work capacity and reduced labor productivity in vulnerable populations (high confidence) {11. New conditions may emerge under climate change (low confidence).4} • Increased risk of undernutrition resulting from diminished food production in poor regions (high confidence) {11. In the highest Representative Concentration Pathway. If economic growth does not benefit the poor. climate change has contributed to levels of ill health (likely) though the present worldwide burden of ill health from climate change is relatively small compared with other stressors on health and is not well quantified. and fires. If this occurs. The capacity of the human body to thermoregulate may be exceeded on a regular basis. geographical shifts 11 in food production. {11. the major changes in ill health compared to no climate change will occur through: • Greater risk of injury. Rising temperatures have increased the risk of heat-related death and illness (likely).

and alleviate poverty (very high confidence). Among others. particularly in low-income countries. including enhanced surveillance and early warning systems. and consequent CAP emissions over time (medium confidence) {11. and a shift to cleaner energy sources (very high confidence) {11. these include: • Reducing local emissions of health-damaging and climate-altering air pollutants from energy systems. Chapter 11 Human Health: Impacts.9} • Shifting consumption away from animal products. 11 714 .7} There are opportunities to achieve co-benefits from actions that reduce emissions of warming CAPs and at the same time improve health.7} In addition. and Co-Benefits The most effective measures to reduce vulnerability in the near term are programs that implement and improve basic public health measures such as provision of clean water and sanitation.9} There are important research gaps regarding the health consequences of climate change and co-benefits actions. {11.9} • Providing access to reproductive health services (including modern family planning) to improve child and maternal health through birth spacing and reduce population growth. Another gap concerns the scientific evaluation of the health implications of adaptation measures at community and national levels. there has been progress since AR4 in targeted and climate-specific measures to protect health. There are now opportunities to use existing longitudinal data on population health to investigate how climate change affects the most vulnerable populations. secure essential health care including vaccination and child health services. leading to lower emissions of CAPs and better health through improved air quality and greater physical activity (high confidence). especially from ruminant sources. A further challenge is to improve understanding of the extent to which taking health co-benefits into account can offset the costs of greenhouse gas mitigation strategies. increase capacity for disaster preparedness and response. energy use. through improved energy efficiency. Adaptation. {11.9} • Designing transport systems that promote active transport and reduce use of motorized vehicles. in high-meat-consumption societies toward less CAP- intensive healthy diets (medium confidence) {11. {11.

the has dominated global averages.1. 2010) and This is a scientific assessment based on best available evidence according the 2011 UN Habitat report on cities and climate change (UN-HABITAT.and middle- income countries. The underlying causes of global varied by age and gender. and climate. and B1 education. standardized health and demographic surveillance systems.g. and health outcomes. Hajat et al. particularly sub-Saharan Africa and South Asia (Hughes et al. health of all the populations would be challenged by the 2010). comprehensive. change on human health and.. These include more sophisticated 2007. Introduction infectious diseases of adults and children will remain important in some regions. In selecting citations A Long-Term Observational Study for the chapter. Nelson et al. Adaptation. Developments Since AR4 climate. and susceptibility to heat compared with 2004 (WHO. Stanke et al. there have been many reviews. McMichael.1. but most countries have benefited from authors obtained daily meteorological data for 12 INDEPTH substantial reductions in mortality. it is expected that mortality rates will continue to fall in most countries. member sites have collected up to 45 years of information 11. official statistics are so patchy in quality and coverage scenarios (Hondula et al. nevertheless.Human Health: Impacts. 2012). the World Development Report 2010 (World Bank. 2011. work linking climate change. Present State of Global Health on births. the World Health mortality data in Burkina Faso. 2013b. to the judgment of the authors. Rapid progress in a few countries (especially China) To study relationships between weather and health. the major driving Saharan Africa and Asia. and deaths.. 2010. there have been improvements in the methods applied literature up to August 2013. 2012). 2010) and new methods Campbell-Lendrum. Box 11-1 | Weather. There remain sizable and avoidable populations between 2000 and 2009. we report on a project that spans sub- We begin with an outline of measures of human health. another study from the Network. and this trend has continued through the first decade of the 21st century (Wang et al. We searched the English-language 2011). in life expectancy in most parts of the world in the 20th century. poor health are expected to change substantially. health that arise from interventions to reduce emissions of those CAPs reports. we gave priority to publications that were recent (since in African and Asian Populations AR4).. and international assessments that do not appear in listings that warm the planet or vice versa. see Glossary) on health. between weather/climate and health in low. and ethnicity (Beaglehole and Bonita. Years lived with disability have tended to increase in most new climatic conditions.. Using health projections for the remainder of the 21st century. many high-income settings.. Literature was identified using a published protocol (Hosking and food security. (2012) examined the relation between weather and all-cause If economic development continues as forecast. Relations between daily Organization (WHO) estimates the global burden of disease (measured temperature and mortality were similar to those reported in in disability adjusted life years per capita) will decrease by 30% by 2030. A3. 2012). 2008) and in some countries. We drew primarily (but not exclusively) on peer-reviewed journals.. the major 715 . especially later in the century. Huang et al. and Health: 2013) to check for any omissions of important work. for instance. such as MEDLINE but include important information nevertheless. The INDEPTH Network currently forces that act on health worldwide. The chapter also includes a section change and health doubled between 2007 and 2009 (Hosking and on health “co-benefits. the annual number of MEDLINE citations on climate of climate change on human health. The Fourth Assessment Report (AR4) pointed to dramatic improvement 2012). and included areas or population groups that have not previously been well described or were judged to be particularly policy relevant in other Given the dearth of scientific evidence of the relationship respects. This chapter examines what is known about the effects of climate 2011). migrations. and describe steps that may be taken to reduce the impacts For instance. and Co-Benefits Chapter 11 11. In countries (Salomon et al. added significant new findings to the literature. We examine the factors that influence the susceptibility of populations and individuals to ill health due to variations in weather The relevant literature has grown considerably since publication of AR4. In addition.2.1.. and 11 includes 43 surveillance sites in 20 countries. including extensive consultation with technical experts in the field.” Co-benefits are positive effects on human Campbell-Lendrum. 2010. focusing primarily on publications since to investigate climate change and health. Gosling et al. briefly..1. 2012).. with much greater prominence of chronic diseases and injury. and projected future inequalities in life expectancy within and between nations in terms of climate changes to 2100 under the SRES A1B.. Since AR4. recent trends in health status. The authors concluded the that it is difficult to draw firm conclusions about health trends (Byass. 2012) and other approaches. Diboulo et al. 2009. We examined recent substantial reviews (e. income.g. Climate.. Bassil and Cole. modeling of possible future impacts (e. the more direct impacts of climate- altering pollutants (CAPs. 2008a). there are about 3.2 million people under surveillance (Sankoh and Byass. We review diseases and other aspects of poor health that are sensitive to weather and 11. Currently.

or vice versa. undernutrition. leading to so. Adaptation. positive or negative.. negative effects on human health (Wang gas (GHG) emissions may affect health.. disease CAPs affect health in other ways than through climate change. and health—for example. socioeconomic within the range that all of humanity would experience in some extreme conditions. in low-income settings (e. so far. and air pollution (Section 11. between health and ocean acidification have not been closely studied (Kite-Powell et al. drought. one study has reported a reduction in mental performance at 1000 ppm and above.3. The examples are indicative. Non-Climate Health Effects of extreme weather including heat. 2011). Mediating factors 11 Environmental Social infrastructure Public health capability conditions and adaptation Direct exposures • Geography • Warning systems • Baseline weather • Flood damage • Socioeconomic status • Soil/dust • Storm vulnerability • Health and nutrition status • Vegetation • Heat stress • Primary health care CLIMATE CHANGE • Baseline air/water HEALTH IMPACTS quality • Precipitation Indirect exposures • Undernutrition • Heat Mediated through natural systems: • Drowning • Floods • Allergens • Heart disease • Storms • Disease vectors • Malaria • Increased water/air pollution Via economic and social disruption • Food production/distribution • Mental stress Figure 11-1 | Conceptual diagram showing three primary exposure pathways by which climate change affects health: directly through weather variables such as heat and storms. for example.6). studies of the ways in which policies to reduce greenhouse ozone have substantial. et al. 2009b) and malaria (e.. Chapter 11 Human Health: Impacts.3 and Box 11-3). have multiplied (Haines et al. The green box indicates the moderating influences of local environmental conditions on how climate change exposure pathways are manifest in a particular population. but. How Climate Change Affects Health interaction of large-scale food insecurity. thus reducing the extent and/or pace of climate change as well as improving local health (courtesy of E. for example. The green arrows at the bottom indicate that there may be feedback mechanisms. There is also growing appreciation of the social upheaval and damage to population health that may arise from the 11.. There quality. some measures to improve health also reduce emissions of climate-altering pollutants. direct. and heavy rain (Section of Climate-Altering Pollutants 11. for example. outside particular occupational and health-care settings.. longitudinal mortality data sets with down-scaled meteorological are potential implications for human health. CAPs such as black carbon and tropospheric Since AR4. which relate primarily to changes in the frequency 11. related to occupational heat climate scenarios by 2100 (Satish et al. see Section 11. There are three basic pathways by which climate change affects health (Figure 11-1). 2009b). and pathways heavily mediated through human systems such as undernutrition.. population dislocation.5. exposure (Kjellstrom et al.g. Much has been written on links between climate. and mental stress (Section 11. see coastal populations that depend on local fish stocks.2. occupational acidification.. As discussed later in the chapter. links Box 11-1). just vectors. The gray box indicates that the extent to which the three categories of exposure translate to actual health burden is moderated by such factors as background public health and socioeconomic conditions. 2013. public health. water-borne diseases. between societal infrastructure. 2012). Although CO2 is not called “co-benefits” in the case of positive outcomes for either climate considered a health-damaging air pollutant at levels experienced or health. and adaptation measures and climate change itself. defined than they were at the time of the AR4 (see Chapter 30). Other developments include coupling of high. and Co-Benefits to model the effects of heat on work capacity and labor productivity are well documented and the risks for coral reefs are now more closely (Kjellstrom et al. 716 . such as undernutrition in data.4) • Effects mediated through natural systems. 2008).5) as carbon dioxide (CO2) creates non-climate effects such as ocean • Effects heavily mediated by human systems. Garcia. The effects of rising CO2 levels on calcifying marine species impacts. and adaptation measures. and these provide the organization for the chapter: • Direct impacts.. Gething et al. 2009). through the INDEPTH Network... indirectly through natural systems such as disease vectors. 2010. UC Berkeley).1.g. and conflict (see Chapter 12). Béguin et al.

all of which may have important and injury. food handling problems may be most important elsewhere 11..3.3. Living in rural and remote areas may confer increased risk of ill health because of limited In the IPCC assessments. effects on health (Nunn. The inhabitants of low-lying coral atolls are change. and salination of soil. such as access to markets and Climate Variability and Climate Change irrigation facilities (Acosta-Michlik et al. and the elderly are at increased risk of climate- The 2010 World Development Report concluded that all developing related injury and illness (Perera. causes combine. The background climate-related disease diseases.. the high prevalence of HIV infection in many populations the most relevant adaptation capacities. disadvantage (Smith. The consequences of large magnitude climate change beyond caused by climate change (Samson et al.g. 2010. vary greatly from one setting in sub-Saharan Africa will tend to multiply the health risks of climate to another.. young people. Adaptation. In the USA. psychological distress—but only for those residing in rural and remote extreme weather events. health status. Those working outdoors 2050. sparse infrastructure. Geographic Causes of Vulnerability improved health services. 2008. Lozano-Fuentes et al. 2011).. and elsewhere in the chapter. Chronic diseases such as diabetes and ischemic heart disease and increased incidence of salmonella food poisoning has been magnify the risk of death or severe illness associated with high ambient demonstrated in many places (e. including changes in the range of transmission as a result of rising temperatures individual and population characteristics and factors in the physical and altered patterns of rainfall. Zhang et al. income. and undernutrition are presently concentrated among climate change—but for different reasons (World Bank. Maternal antibodies Pacific. but the lag temperatures (Basu and Ostro. before pursuing the three pathways in Figure 11-1. Vulnerability to Disease and Injury Due to be modified strongly by local factors. There are some factors (such as education. and the vulnerability of populations to these diseases will rate of a population is often the best single indicator of vulnerability to depend on the baseline levels of pathogens and their vectors. but parts of the region under climate change. 2009). due to the interactions between chronic ill health. Current Health Status the quality of governance—how decisions are made and put into practice—affects a community’s response to threats of all kinds (Bowen Climate extremes may promote the transmission of certain infectious et al. those who live on urban heat islands are at greater risk of ill health due to We have outlined the causes of vulnerability separately.. Thus. 2008).. often in a complex and place-specific manner. and responsiveness of government) that act as generic causes of vulnerability. especially when disease control systems environment. although this vulnerability may 11. but in practice extreme heat events (Stone et al. see Chapter 12). for example. Populations that are close to the present In this section. areas (Berry et al. are the current climate In principle. 2013).). Deficiencies in food storage may be the critical link in some places.1. In cities. and undernutrition (Ramin and McMichael. 2008)..Human Health: Impacts. 2010). we very sensitive to flooding. 2008. arboviral diseases such as dengue are rarely seen after 11 has much less absolute impact than doubling of the disease when the flooding. For example. suggesting that the mechanisms differ.. on the other hand. 2010). For example. The explanation lies in the scarcity of dengue (and other pathogenic we treat “risk” in the epidemiological sense: the probability that an viruses) circulating in the population. 2008).3. vulnerability is defined as the propensity or access to services and generally higher levels of social and economic predisposition to be adversely affected (see Chapter 19 and Glossary). and therefore the other hand. 2004).3.3. Children. we consider causes of vulnerability to ill health limits of transmission of vector-borne diseases are most vulnerable to associated with climate change and climate variability. adverse effects of regions are vulnerable to economic and social damage resulting from malaria. On event will occur. (Note that here. 2012. 2010). critical factors for sub-Saharan Africa.) But the precise causes of vulnerability. 11. 2008). provoke the severe hemorrhagic form of illness (Ranjit and Kissoon. background rate is high. Rural populations that rely on subsistence farming in low rainfall areas are at high risk of undernutrition and water-related diseases if drought occurs. compared with the experience in other parts of the Americas. are distinguished by the very large number acquired in utero provide some protection against dengue fever in the of people living in low-lying areas prone to flooding (see Chapters 24 first year of life. would be much more difficult to deal with (Section in countries where temperatures in the hottest time of the year are 11. before the flooding (Keim. Uejio et al. The link between high ambient temperatures 2009).. owing to their small body mass to surface area ratio. 2008).7). and poverty alleviation. and Co-Benefits Chapter 11 The negative effects of climate change on health may be reduced by 11. The children... Although there are exceptions. varies from one country to another. 2008. climate change—doubling of risk of disease in a low disease population as one example. poverty. Age and Gender (Kovats et al. Asia and the (Basu and Ostro. children are thought to be more vulnerable to heat-related stresses (in particular. Kovats and Hajat.. although the cost and effort may be considerable (Section Location has an important influence on the potential for health losses 11.. but if infection does occur in infants it is more likely to and 29). better disaster management. droughts and floods) that may be amplified in illnesses. severe drought in Australia has been linked to change. and evidence of excess heat-related mortality in this age group is mixed high dependence on natural resources (see Chapter 22).8).. however. 2011). diarrhea. contamination of freshwater reservoirs due summarize what is known about vulnerability to climate-induced illness to sea level rise. by acting on severely affected by further warming than workers in cooler countries the underlying vulnerabilities that lead to ill health even without climate (Kjellstrom et al. For example. Sokolnicki et al. 717 . 2012. to a first approximation climate already at the limits of thermal tolerance for part of the year will be more change acts to exacerbate existing patterns of ill health. 2007). are weak (Zhou et al. for reasons of physiological susceptibility (Michon et al. 2009).2.

Under a “business as usual” scenario 718 . excess mortality was greater among females overall. 2009). Studies of the Inuit people. severely affected by flooding. Chapter 11 Human Health: Impacts. 2005).. 2010). 2012). as shown by the deaths resulting from bushfires in Australia in 2009 (Teague et al. followed by a resurgence of 11 damaging for girls than boys (Cook and Frank. In New York. 2011). mostly in large. A study of the health climate is changing quickly. and levels of poverty (Peduzzi et affected by chronic water shortages and by 2050.. floods. for example. due in part to the lack of a constant supply of drinking water in many neighborhoods (leading to people storing water in 11.6.. 2009). 2008). including droughts. Children are generally at greater risk when food supplies are 2008). 2007). Worldwide. females Populations that do not have access to good quality health care and are more affected than males by a range of climate hazards. 2006). and storms. foodborne infections.3. changes in Tibet Autonomous Region. 2013).. In Bangladesh.. 2012) and power. or community- mortality due to natural disasters.. unless there are rapid al. a country with a well-developed (Van Kerkhove et al. and exposure to by climate variability and climate change (Frumkin and McMichael. race and ethnicity are powerful markers of health avoid hazardous situations and also because they are more likely to live status and social disadvantage. 2011). to the effects of diminished food supplies (Pearce et al. water-logged environments (Neelormi et al. Socioeconomic Status containers that are suitable breeding sites for the disease vector Aedes aegypti. A study of the impacts of flooding in Bangladesh found that restricted: households with children tend to have lower than average household risk reduced with increases in both average income and incomes. Adaptation. there is networks (Browning et al..4. of chronic conditions such as overweight and diabetes (Lutsey et al. Ostro et al. but they also took preventive action less often and received assistance after flooding less frequently than did Older people are at greater risk from storms. infectious diseases such as malaria. Public Health and Other Infrastructure age span (25 to 64) possibly due to differential exposures to heat in occupational settings (Fouillet et al. Older people are also more likely to suffer from be more vulnerable to heat-related deaths than other racial groups in health conditions that limit the body’s ability to respond to stressors the USA (Basu and Ostro.. daily mortality spiked after a The poorest countries and regions are generally most susceptible to city-wide power failure in August 2003. For instance.. 2011). rapid economic development may increase the risks of climate.. to air conditioning during heat-waves. the number will rise to almost a tend to be those with relatively low socioeconomic status (Friel et al. waste management. a mosquito capable of transmitting the West resource poor and are affected by climate risks will magnify harmful Nile virus (Liu et al. increasing numbers of people in locations that are already in Lhasa of Culex pipiens.3. 2010). quality of governance.. public health system. also found an excess of losses and poor health. dengue fever has been a persistent problem in the larger cities.. and more affluent households (Brouwer et al.g. see Chapter 8). while females may be more vulnerable well-being (Ford. 2006). and influenza and sanitation.. undernutrition. 2008).. About 150 million people currently live in cities storm intensity. Individuals and households most vulnerable to climate hazards improvements in urban environments.. Virtually all the projected growth in populations will occur in urban agglomerations. However. due in part to increased exposure damage caused by climate extremes and climate variability (Malik et to heat (Anderson and Bell.3. and live in parts of the world where the following flooding (Jonkman and Kelman. Projections for Vulnerability related health issues.. including new roads and substantial in-migration may explain Population growth is linked to climate change vulnerability. floods. The condition of the physical infrastructure that supports Pregnancy is a period of increased vulnerability to a wide range of human settlements also influences health risks (this includes supply of environmental hazards.. 2006). males are at greater risk of death heavily on local resources. If nothing (along with above-average warming) the appearance and establishment else changes. 11. Bulto et al. In the USA. China. 2012). In Cuba. including extreme heat (Strand et al. In the Paris 2003 heat wave. Poorer households were not only more health outcomes among young children (Cook and Frank. are generally at greater risk of economic effects of flooding in Hunan province. financial circumstances (e. 2008). level characteristics such as higher local crime rates or disrupted social is higher among women than men (WHO. billion (McDonald et al. The effect of food 2008). Also. 2011). In Canada’s Inuit population males are exposed to dangers many other day-to-day activities.. Indigenous peoples who depend variation regionally. 2013b). and food insecurity is associated with a range of adverse number of income sources. due to essential public health services are more likely to be adversely affected differences in prevalence of poverty. show flood deaths among males. 2012). often related to rural farming (Abuaku et that rapid warming of the Canadian Arctic is jeopardizing hunting and al. heat waves. 2008).. in part because they tend to be less mobile than younger adults and so find it more difficult to In many countries. 2010). 2009).. 2013). low latitude hot countries in A review of global trends in tropical cyclones 1970–2009 found that which a high proportion of the workforce is deployed outdoors with little mortality risk at country-level depended most strongly on three factors: protection from heat. provision of water for drinking and washing. Black Americans have been reported to alone in some cultures. but wealthy countries are not immune.. and Co-Benefits 2011). lower incomes may restrict access The relationship between gender and vulnerability is complex. climate-sensitive infectious diseases including malaria (Karanikolos et al. al. with implications for livelihoods and associated with insecure sea ice.5. China. but there were more excess deaths among men in the working 11. Harsh economic conditions in Europe since 2008 led to cutbacks insecurity on growth and development in childhood may be more in health services in some countries. other extreme events (Brunkard et al. This may be due to a higher prevalence such as heat and air pollution (Gamble et al. impacts.

2012). Central Europe North Europe 16 North Asia 16 Alaska/Northwest Canada East Canada/Greenland/Iceland 4 16 4 16 16 1 4 1 4 4 1 1 1 Central North America Central Asia Tibetan Plateau East Asia West North America 16 East North America South Europe/ 16 16 16 16 4 16 Mediterranean 16 4 4 4 4 1 4 1 1 1 1 1 4 1 Sahara 16 Central America/Mexico South Asia 4 16 16 Southeast Asia 1 Human Health: Impacts.99 16 1 South Australia/New Zealand 4 4 7 to 9. Colored boxes show the range in which 50% of the model projections are contained.99 West Coast South America South Africa 16 4 5 to 6.99 Southeast South America 16 1 1 16 >10 4 4 Mid-21st century projection 1 Data not available 1 Lower frequency Not applicable Minimum projection Higher frequency Maximum projections 50% of model SRES Scenario projection Full model range Scenarios: B1 A1B A2 Figure 11-2 | Increasingly frequent heat extremes will combine with rapidly growing numbers of older people living in cities—who are particularly vulnerable to extreme heat. and Co-Benefits 4 4 16 1 Amazon 1 4 16 1 4 West Africa East Africa Population increase factor Northeast Brazil West Asia 1 16 16 (2010 to 2050) 16 16 4 4 4 1 4 North Australia 1 to 2.99 1 1 1 16 3 to 4. Chapter 11 719 11 . with lower numbers indicating more frequent events. and whiskers show the maximum and minimum projections from all models (WHO and WMO. and based on 12 global climate models participating in the third phase of the Coupled Model Intercomparison Project (CMIP3). as described in the IPCC Special Report on Emissions Scenarios. Countries are shaded according to the expected proportional increase in urban populations aged over 65 by the year 2050. Bar graphs show how frequently the maximum daily temperature that would have occurred only once in 20 years in the late 20th century is expected to occur in the mid-21st century. Results are shown for three different Special Report on Emission Scenarios (SRES) scenarios (blue = B1. Adaptation. red = A2). green = A1B.

4.. Christidis et al. and gross social. on mortality (Hajat et al. such as suicide.. but also ventilation. 2008).. there are few studies of the impacts of climate change itself. including extremely long-term data series on climate and disease rates. health agencies epidemiological studies (Anderson et al. as there are few studies of the large developing country populations in the tropics. decrease in the number of cold days and nights. that are sometimes related to high temperature (Page et al. 2012. and these Future trends in social and economic development are critically important point to effects of heat. therefore.1. Chapter 11 Human Health: Impacts. is projected basis it is likely the excess mortality attributed to the heat wave (about to increase from about 10% presently to about 32% by the end of the 15. 2008). displacement of blood to the surface of the body as climate change is defined in decades. The IPCC Special Report on Extreme Events more during heat waves than would be anticipated solely on the basis (SREX) concludes that it is very likely that there has been an overall of the short-term temperature mortality relationship (D’Ippoliti et al. in association with rising annual average temperatures. 2010).. Parsons. impacts on health of more frequent heat extremes greatly outweigh chronic drought. If there has small in some series. The 2003 heat wave was people will be without access to basic sanitation in 2050 (OECD. has increased almost everywhere in the last 20 years. Detailed exposure-response relationships were described long and Weather on Health ago (Wyndham. 2011). are less evident for other causes of death. to winter deaths in Australia increased between 1968 and 2010.. 1969). radiation from walls or ceiling. Overall. high consumption of environmental resources (UNDP. the effects of heat waves “extremely likely (probability greater than 95%)” that anthropogenic are only a fraction of the total impact of heat on health. Potts and Henderson. body temperatures exceed 40°C. countries with a higher Human Development There is also significant uncertainty over the degree of physiological. and heightened vulnerability in (An example: Bennett et al. however. but this has been accompanied by increasing inequalities between and within countries. Anderson and Bell. 2011). risks of organ damage. in our (Gasparrini and Armstrong. which is associated with relatively poor heat tolerance... that the number of heat-related deaths is likely to have also infrequent compared with the total number of days with temperatures increased. and an overall increase 2010. Some studies 720 . to vulnerability. but not cold. For instance.. often sufficiently direct to permit strong inferences about cause and effect (Sauerborn and Ebi. 2011). The prevalence of overweight and obesity. Indoor thermal conditions. the association between Heat waves refer to a run of hot days. Therefore policies that boost health. 2012). and death increase 11. worldwide. 2011). although the added effect is relatively in the number of warm days and nights. humidity. one such record event. (2012) concluded that it is greater than the optimum for that location. Heat.000 deaths in France alone (Fouillet et al. and most evident with prolonged heat waves been an increase in daily maximum temperatures. At high temperatures. and on this (see Figure 11-2).1.. The proportion aged over 60. Most notably. periods. Mechanisms in HDI in the last 30 years. literacy. precisely how many days. biasing long-term analyses.. above 40. 2010). the probability that particular heat The age structure of the population also has implications for vulnerability wave can be attributed to climate change is 75% or more. 2013). Adaptation. If the body temperature rises above 38°C (“heat exhaustion”). 2013). globally. 11. Ebi and Mills. coupled or absence of air conditioning. Kim et al. or technological adaptation to increasing heat over long time domestic product (GDP) per capita—are less affected by the floods. the Organisation for Economic climate change at least quadrupled the risk of extreme summer heat Co-operation and Development (OECD) projects that about 1. education. 2003) and meta-analysis Although there is ample evidence of the effects of weather and climate (Bouchama et al. are defined variously (Kinney et temperature for a specified location) and increases in mortality is very al. and economic development should reduce future vulnerability. 2000. 2008)) was caused by century (Lutz et al. It has been pointed out that in deaths associated with cold spells. 2012). Wherever risks are identified. Robust studies require not only may lead to circulatory collapse.4 billion events in Europe in the decade 1999–2008. there have been substantial improvements 11. loss of consciousness. Nevertheless. 2012). 2012).4. Because heat waves are relatively view. Some investigators have reported that mortality increases robust (Honda et al. 2011). Quantification. 2012. and in many countries the trend The rise in minimum temperatures may have contributed to a decline continues upwards (Finucane et al. but these variables are seldom well-measured in various contributing factors. and governmental instability (Diffenbaugh and Giorgi. anthropogenic climate change. Direct Impacts of Climate sharply. education. Likhvar et al. remains highly uncertain. Biological mechanisms are mandated to intervene immediately. Index (HDI)—a composite of life expectancy. the influence of seasonal the Sahel region of Africa may be particularly vulnerable to climate change factors other than temperature on winter mortality suggests that the because it already suffers so much stress from population pressure. and cyclones that take place (Patt et al. at the global scale. then it follows. and the presence information on other established or potential causative factors. the connection between weather and health impacts is 2011.) The issue is scale.6°C (“heat stroke”).1.. 2007. benefits of fewer cold days (Kinney et al. and hot days (commonly defined in terms of the percentiles of daily maximum how high the temperatures must rise.4. and Co-Benefits with mid-range population growth. but the relationships in different community settings and for different age/sex groups are not yet well established.and Cold-Related Impacts The early studies are supported by more recent experimental and field 11 studies (Ramsey and Bernard.. For example. 2007) that show significant effects of heat stress as on health... (2013) reported that the ratio of summer individuals with preexisting disease. and has come at the cost of The basic processes of human thermoregulation are well understood. physical and cognitive functions are impaired. droughts. are important in determining whether with statistical analysis to apportion changes in health states to the adverse events occur.

. Globally..2). Hanna et al. There is little information on active (e. 11. 2012). showed an deviation of summer temperatures was associated with survival time increase in summer mortality that clearly outweighed a small reduction 11 in a U.. exception. 2011) because mild acclimatization may reduce the impact of added summer heat in the winters may leave a higher proportion of vulnerable people (Stafoggia 2050s by roughly a quarter (Knowlton et al.Human Health: Impacts. In Australia in 2009. 2009). For instance. Chapter 1) in the near-term future.. Patt et al. 2011). 2005).g. 2012. when considered in terms of both number affected (112 respond more quickly to a highly variable climate than do their multi. increasing opportunities for new and resurgent diseases.. extended to 2099.. have reported increases in For reasons given above. 2012). based on hospital admissions or emergency presentations. 2009a. Most studies of heat have been in high-income countries. respiratory. Pudpong and Hajat... and laboratory studies have shown that microbes flood events. increase by ≥2°C and outdoor activity is hazardous. 2009. 2011. but 2013. Questions were raised at the time as to why midway through the 21st century. 2008b. Recent studies have found that when Baccini et al. rapid changes in temperature may 11. 2013).1. caused fires of unprecedented than can be compensated for by mitigation measures (see Chapter 10 intensity and 173 deaths from burns and injury (Teague et al.6. Knowlton et al.4. Bi and Parton... but more variable. broadly speaking. climate (Kinney et al. 2009). with one 2°C (Huang et al. (with SRES A1FI) for non-acclimatized people. cohort study of persons aged older than 65 years with chronic in autumn deaths... is projected to rise suggesting heterogeneity in vulnerability by age groups and socioeconomic from the current 4 to 6 days per year to 33 to 45 days per year by 2070 factors similar to that seen in higher-income settings (Bell et al.. 2011). people. 2007. variability had an effect (increased deaths) over and above what was estimated from the rise in average temperatures (Gosling et al.. it was estimated that increased (Rocklov and Forsberg.. It is still not (see SPM). 2008.5. Adaptation. A study that as the outcome. on fire risk. This has importance for recreational health trends attributable to flooding. Rocklov et al.2... It is uncertain how much acclimatization may mitigate the clear. record high temperatures. In New York.2). influenza season the year before..1. million people) and number of deaths (3140 people) (Guha-Sapir et al. Overall. 2011). except for mortality and there activity outdoors and it is relevant especially to the impacts of climate are large differences in mortality risk between countries (UNISDR. change on occupational health (Kjellstrom et al. 2011). 2009) and the impact Ebi and Mills. Reports from France (Fouillet et al. 2008. especially in tropical developing countries with limited adaptive capacities and large exposed populations (Wilkinson et al. and only slight variations in winter and spring (Doyon disease who were tracked from 1985 to 2006 (Zanobetti et al. see Section 11. Severe damaging floods in Australia in 2010–2011 and 721 .. 2009. Kellenberg Heat also acts on human health through its effects. see also Section 11. 2010). Among acclimatized McMichael et al. 2011. 2007a..5. manual laborers). 2007b). et al. periods. 2008..6. A There is evidence now that both average levels and variability in similar pattern has been projected for temperate zones. based on SRES A2 and B2. Ebi and Mills. Honda et al. 2012.. in conjunction with and Mobarak. Ha et al. it is not clear whether winter mortality will events due to cardiovascular. migration to slums low rainfall. or the era of climate responsibility this event had such a devastating effect (Kosatsky. A study of three temperature are important influences on human health.S. 2007).4. 2011... when core body temperatures may but there has been work recently in low. 6 of the 10 biggest natural disasters were function of mass. et al. cellular hosts (Raffel et al. number of “dangerously hot” days. This may be mortality and morbidity (Analitis et al.. Maloney and Forbes.and middle-income countries. 2008) concluded that most temperatures and an increase in frequency and intensity of heat waves of the extra deaths occurred in elderly people (80% of those who died (Section 2. Near-Term Future The extreme heat wave in Europe in 2003 led to numerous epidemiological The climate change scenarios modeled by WGI AR5 project rising studies. the frequency of river flood events has been increasing. 2011). Relevant to Section 11. Mortality from flooding and storm events is generally declining. 2009. 2011. 2011). in coastal cities may increase population exposure at a greater pace combined with long-term drought. or may result from a large group in the population that is more susceptible to heat early in the season (Rocklov et al. 2010). The standard Quebec cities. In Australia. Australia..3. there is good evidence that mortality risks first increase with economic development before declining (De Haen and Hemrich. related mortality by mid-century will outweigh gains due to fewer cold 2011). 2011. and Co-Benefits Chapter 11 have shown larger effects of heat and heat waves earlier in the hot Smoke from forest fires has been linked elsewhere with increased season (Anderson and Bell. 2011). but one contributing factor may have been the relatively mild effects on human health (Wilkinson et al.. Peng the previous year’s winter mortality is low. Lin and Chan. Numerous studies of temperature-related morbidity.. Floods and Storms also alter the balance between humans and parasites.. defined as roughly were older than 75 years).2. 2012).. the effect of summer heat is et al. testament to the importance of acclimatization and adaptive measures. as well as economic losses. and kidney diseases (Hansen decrease in a warmer. 2008). The speed with which Floods are the most frequently occurring type of natural disaster (Guha- organisms adapt to changes in temperatures is. 2013). In 2011. 2008. due to the expansion of population and Health risks during heat extremes are greater in people who are physically property in flood plains (Chapter 18). on urban risks). we conclude that the increase in heat- has been related to the duration and intensity of heat (Nitschke et al. a Sapir et al. when warming exceeded average temperatures for six cities for 2070–2099 found that. an increase from 1 to 5 days per year to 5 to 14 days per year is expected (Hanna et al. found the gains associated with fewer cold days were modeled separately projected increases in temperature variability and less than the losses caused by more hot days. the et al. Another study in Brisbane.. using years of life lost Greater variability was associated with reduced survival.

. although there is high anxiety. They modeled 1-in-100 year storm-surge events. higher temperatures in countries with temperate climates may individuals (2007 flood in England and Wales. and Central and South America (Plasmodium falciparum. increases in intense tropical cyclones are likely in the Plasmodium ovale. In the 84 developing and pathogen. accounting for sea in temperature.1. In one study in the USA. mid-century. (2009) developed a spatially explicit mortality model for 84 developing countries The influence of temperature on malaria development appears to be and 577 coastal cities. 2012). when the maximum is close to the upper limit for vector level rise and a 10% increase in event intensity. Vector-Borne and Other Infectious Diseases months) effect on mortality in the flooded population. Increased variations and assessed future impacts under climate change. or ticks.000 deaths (Doocy et al. 2011). If this happens. levels at the Earth’s surface will generally return to pre-1980 levels by 2012). of cases of squamous cell carcinoma was 5.2..000 in 2010 (Murray et al. 2009). Plasmodium vivax.. 2008). more evidence has emerged on the influence vitamin D levels (Lucas et al. The attribution of deaths to flood events is complex. Chapter 11 Human Health: Impacts. and basal cell carcinoma was 2. distribution. funestus in Kenya found that abundance. In terms of exposure. but the consequence is uncertain in larger catchments (see Chapter 3). Schnitzler et al. location..1. 2013). hypothermia. No persisting effects were observed in a study in England and Wales (Milojevic et al.. and other factors (such as diet) that Jakubicka et al. Also.1. There is some uncertainty as to whether flood events are associated with a longer-term (6 to 12 11.. These values correspond to an 11. tend to reduce transmission. Table 11-1 summarizes what is known about the influence of weather and climate on selected VBDs.8 billion people were affected by floods million episodes of malaria worldwide. transmission (Paaijmans et al.. 2009). 2006. Malaria frequent. 2012).5. the average 722 .. and may diminish further by 2100. Flooding ozone recovery and climate change project that ultraviolet radiation and storms may have profound effects on peoples’ mental health (Neria.4.. Paranjothy et al. 2007.. 11 Under most climate change scenarios. Ultraviolet Radiation are affected in different ways by precipitation and temperature (Kelly- Hope et al. There are lag times according to the lifecycle of the Ambient ultraviolet (UV) levels and maximum summertime day vector and the parasite: a study in central China reported that malaria temperatures are related to the prevalence of non-melanoma skin incidence was related to the average monthly temperature. while increased variations countries.4..5% higher for every 1°C increment in average temperatures. of Climate Change on Health Outcomes reported (Health Protection Agency. It has been estimated mosquitoes between individuals. with important consequences for health.g.. but longer-term increases in mortality were found in a rural transmitted by the bite of blood-sucking arthropods such as mosquitoes population in Bangladesh (Milojevic et al. intensity of exposure. 2010). In 2010 there were an estimated 216 conservatively that around 2.2. and infectious diseases (e. result in an increase in the time which people spend outdoors (Bélanger In the USA. most reports of flood deaths include only immediate 11.5. Dasgupta et al. 11. 2010).3.4. caused by storms and floods will increase this century if no adaptation 2012). and disease transmission 11. 2010). Studies of stratospheric long-term (months to years) implications of flooding for health. which means that the total mortality burden is under. a follow-up of New Orleans’ residents almost 2 years after Hurricane Katrina (Kessler et al. balance of gains and losses due to increased UV exposures vary with leptospirosis. These are some of the best-studied diseases associated with climate change. 2010). Plasmodium malariae.2. On this basis we conclude it is very likely that health losses malaria deaths was estimated to be 1.. with more than 500. mostly among children younger between 1980 and 2009. and is vector specific (Alonso et al. Bi et al. cholera.1. it is expected that more people will Malaria is mainly caused by five distinct species of plasmodium parasite be exposed to floods in Asia.9% more common with every 1°C increase. Adaptation.238. the number may still be affected (Guha-Sapir et al. Plasmodium knowlesi).5. Vector-borne diseases (VBDs) refer most commonly to infections 2011). diarrheal disease.. However. The number of global 2013). Accordingly the injuries. What is not clear is how much of this projected control in the last 20 years (Feachem et al. Near-Term Future 2008. Halide and Ridd.. Africa. Wu et al. Worldwide. 2011). transmitted by Anopheline late 21st century (WGI AR5 Table SPM. due to their widespread occurrence and sensitivity to climatic factors (Bangs et al.1). 2009) and lead to additional UV-induced adverse effects. signs of hurricane-related mental illness were observed in et al. On the other who reported flood water in the home compared to non-flooded hand. 2008).. Ecosystem-Mediated Impacts traumatic deaths. (Chapter 3)... floods in small catchments will be more 11. 2012).000 km2 of land were of mean daily temperature near the minimum boundary increase projected to be affected by 2100. of vitamin D. 2011). The prevalence of mental health symptoms (psychological distress. Mechanisms increase in the effective UV dose of 2% for each 1°C (van der Leun et al. vector-borne disease. 2013). increase can be attributed to climate change. than 5 years in the African Region (WHO. 2007. there have been significant advances made in malaria measures are taken.. it is expected that more frequent intense rainfall events will occur in most parts of the world in the future (IPCC.. Since AR4. Analysis of environmental factors associated with the malaria vectors Anopheles gambiae and A. and Co-Benefits in the northeastern USA in 2012 indicate that high-income countries cancers and cataracts in the eye.. exposure to the sun has beneficial effects on synthesis Flooding and windstorms adversely affect health through drowning. nonlinear. an additional 52 million people and 30. and depression) was two to five times higher among individuals uncertainty around the projections (Correa et al.

Earnest et Dengue esp. the burden of disease find a clear increase in temperatures accompanying increases in malaria is still high and may actually be on the increase again. But malaria is very sensitive (WHO.1. 2010).. Pham et al. but many other regions are affected also. The incidence of malaria has reduced over Asia-Pacific region. but this 2011). (2011). Ogden et al. (2011) Beebe (2009). economic development and control interventions current month (Zhou et al. China encephalitis Temperate areas of Bennet (2006). locally transmitted malaria has re-emerged over longer periods have confirmed increasing temperatures since 1979 in Greece in association with economic hardship and cutbacks in (Omumbo et al. if conditions are otherwise suitable (Pascual et al.. is associated with climate on spatial (Beebe et al. Alonso et al. 2010) concluded that decadal temperature changes have played a role showing a 30-fold increase in global incidence over the past 50 years in changing malaria incidence in East Africa.5. Although modest warming has More work has been done since AR4 to elucidate the role of local facilitated malaria transmission (Pascual et al.. Kelly-Hope et al. have dominated changes in the extent and endemicity of malaria over the last 100 years (Gething et al.2. The strongly nonlinear response government spending (Danis et al. vivax malaria in moderate and intensity of vector control programs.. Russell et al. About 40. and the generally worldwide. 2012). Asia Pacific About 50 million al.000 in USA America Other vector-borne diseases Hemorrhagic fever Fang et al.. 2011). Adaptation. Descloux (2012) Tick-borne diseases Europe. and Co-Benefits Chapter 11 Table 11-1 | The association between different climatic drivers and the global prevalence and geographic distribution of selected vector-borne diseases observed over the period 2008-2012. 2010). Among the vector-borne diseases shown here. % Astrom et al. (2011). Dengue Fever high temperatures modest warming may reduce the potential of malaria transmission (Lunde et al. 2011.. One review (Chaves and Koenraadt.Human Health: Impacts. The disease et al. Earlier research had failed to climates with low transmission intensity. (2011) locations worldwide Climate drivers Climate driver variables Confidence levels Increase or % decrease > Increased < Decreased High confidence in global effect More Fewer High confidence in local effect Temperature Precipitation Humidity # of cases Footnote Low confidence in effect 1 Effects are specific to Anopheles spp 11 temperature of the previous 2 months.. of which roughly 96 million manifest with symptoms (Bhatt more conducive climate conditions have been offset by more effective et al.. Russian Fed. 2012)... Andriopoulos et al.000 Mongolia. 2012). Dengue is the most rapidly spreading mosquito-borne viral disease. 2006. On the other hand. (2012). For instance. 2011). but new studies with aggregated meteorological data (WHO.. largely due to control of P. 1 1 Omumbo et al. at relatively 11. (2006). (2012). 2013)..15–0. and the average rainfall of the At the global level. SE Asia About 220 million % (2009).. 2009. 723 . Xu et al. (2008) Europe. while malaria and hemorrhagic fever with renal syndrome showed a positive association at the local level (high confidence). Climate sensitivity and Disease Area Cases per year Key references confidence in climate effect Mosquito-borne diseases WHO (2008). North % Lyme About 20. The first much of East Africa (Stern et al. Three quarters of the people exposed to dengue are in the disease control activities.. only dengue fever was associated with climate variables at both the global and local levels (high confidence). Alonso et al. 2011.000 (2010). Stern et al. Asia.. although increased variability sustained transmission of dengue in Europe since the 1920s was in disease rates has been observed in some high-altitude areas (Chaves reported in 2012 in Madeira. Malaria Mainly Africa. Each year there occur about 390 million dengue infections also to socioeconomic factors and health interventions.. (2010) with renal Global 0. 2013). the proportion of the world’s population affected by the disease is hampered by the lack of time series data on levels of drug resistance has been reduced. warming on malaria transmission in the East African highlands. (2011) Tick-borne About 10. Ari et al. 2013). 2011).. 100 countries. Portugal (Sousa et al. 2006..2 million % syndrome (HFRS) Plague Endemic in many Stenseth et al. However. Tokarevich et al. to temperature means that even modest warming may drive large increases in transmission of malaria. Alonso et al. in some locations transmission. 2013).

2009). Trinidad (2002–2004) 50 Breteau index 1600 Number of dengue cases/ Rainfall (mm) 45 1400 40 1200 35 1000 Dengue cases 30 25 Rainfall (mm) 800 20 Breteau 600 15 11 400 10 200 5 0 0 ch ly pt v ch ly pt v ch ly pt v No No No Ju Ju Ju Se Se Se ar ar ar M M M (b) Efficacy of pre-seasonal treatment with temephos on Aedes aegypti ovitrap egg counts in Curepe (treatment) and St. Breteau index. 2011). 2011). Joseph (control)... Evidence of the efficacy of the pre-seasonal larval control through focal treatment of Ae. 724 . aegypti populations and therefore suppress the onset of dengue transmission (Chadee. 1956). This led to a control program that concentrated on reducing the mosquito population before the onset of the rains. and Co-Benefits Box 11-2 | Case Study: An Intervention to Control Dengue Fever Seasonality in dengue transmission is well established in many parts of the world. Trinidad (2002–2004). Adaptation. In these scenarios. with the northern Caribbean region receiving more rainfall than in the southern Caribbean (Campbell et al. Joseph (control). and dengue fever cases. aegypti in the Caribbean. albopictus. by application of insecticides (temephos) into the water drums that serve as primary breeding sites of Ae. aegypti population and dengue fever incidence. Chadee et al. there is greater variability in rainfall patterns during November to January. and Dengue cases.. Trinidad (2003). a period when the Ae. both of which affect the breeding habitats of Ae. and flooding after episodes of heavy rainfall. Trinidad (2003) Number of eggs 2000 1500 Control 1000 Treatment 500 0 1 3 5 7 9 11 13 15 17 19 21 Rains start Weeks Figure 11-3 | (a) Rainfall. There may be water shortages during drought periods. The one-off treatment effectively controlled the mosquito populations for almost 12 weeks after which the numbers reverted to levels observed in the untreated control areas. aegypti larvae per 100 houses). aegypti population is provided. Treatment at the onset of the rainy season can effectively prevent the rapid increase in Ae. Vector control strategies will need to be planned and managed astutely to systematically reduce mosquito populations. aegypti and Ae. Climate scenarios that extend to 2071–2100 project changes in the intensity and frequency of rainfall events in the Caribbean (Campbell et al. Breteau index (number of water containers with Ae.. and transmission occurs mostly during the wettest months of the year (Gubler and Kuno. aegypti mosquito population density was four to nine times higher than the dengue transmission threshold (Macdonald. Rainfall was found to be significantly correlated with an increase in the Ae. 2007). 1997. (a) Rainfall. b) Efficacy of pre-seasonal treatment with temephos on Ae. 2007). with a clearly defined “dengue season” between June and November over two years of the study (Chadee et al. Chapter 11 Human Health: Impacts. Figure 11-3 shows that about 80% of dengue fever cases in Trinidad were recorded during the wet season. aegypti ovitrap egg counts in Curepe (treatment) and St.

Tick-Borne Diseases climate constant. reported to within-season variability in rainfall (Caminade et al. 2009.. 2012. especially during the warmer months of the dengue fever (Hsieh and Chen. With GDP per capita held constant at 2010 values.5. Assuming high GDP illness rates across the region demonstrate that climate change alone growth that benefits all populations. increased rates of admissions to hospital due to dengue with both high and low river levels (Hashizume and Dewan. and rainfall are transmitted viral disease (Anyamba et al. and may generate acute viral disease affecting humans and domestic animals.5. Aedes aegypti and Ae. first identified in Africa. albopictus. 2008). Lai. Liu et al.. 2011. temporal (Hii et al. Over the last 2 decades. 2009. Several studies in Taiwan reported that encephalitis. The study was based on routine signs of lengthening transmission season and higher altitudinal range disease reports. Gharbi et al. However variations in growth. 2009.2 billion people at risk in 2050. another mosquito-borne viral disease. precipitation. Earnest et al. climate conditions have Fang et al. A study in Dhaka.. out of a predicted global population of 8. Borrelia is is 200 million more than if disease control efforts were not opposed by transmitted to humans by the bite of infected ticks belonging to a few higher temperatures and shifts in rainfall patterns. 2010.. an extreme rainfall. to North America or Europe.000 hospitalized cases each year. However. in northwestern China is highly correlated with annual temperature and MacMillan et al. Temperature. 2011). and the A1B scenario for climate change. is good evidence of northward expansion of the distribution of the tick and recent experience in southern Europe demonstrates how rapidly vector (Ixodes scapularis) in the period 1996–2004 based on an analysis the disease may reappear if health services falter (Bonovas and of active and passive surveillance data (Ogden et al.5. that is. there suitable vectors for P. persists in many parts of the world.. Tokarevich et al. vivax malaria abound in these parts of the world. For the impact on disease incidence. 2011).. Lyme disease is Factoring in climate change would increase the “best case” estimate an acute infectious disease caused by the spirochaete bacteria Borrelia of the number of people at risk of malaria in 2050 to 1. in the Czech Republic. Nakazawa et al. In West Africa.. where it was once prevalent. 2012). 2006.. 2009. the adverse effects of climate change in agriculture and recreational activities) have affected patterns of disease are balanced by the beneficial outcomes of development.. outbreaks of Rift Valley Fever. the USA.46 billion. 2012. Lukan et al. 2008. Typhoons result in year (Bai et al. 2010). 2012). 2011). but it was not possible to project late 1980s. 11. Bangladesh. In North America.. 2010).Human Health: Impacts.4. the population at risk of malaria to 2030 and 2050. 2012. China. and Co-Benefits Chapter 11 2009. Other Vector-Borne Diseases Herrera-Martinez and Rodriguez-Morales.. Hsieh and Chen. climate sensitive. and the disease has recently emerged in parts wind velocity is inversely associated with rates of the disease (Lu and of Europe (Angelini et al. and relative humidity (Pettersson et al. species of the genus Ixodes (“hard ticks”).. The incidence of this disease has been associated with The principal vectors for dengue. one of the oldest diseases become more suitable for albopictus in some areas (e. Keeping 11. the Hanta virus. This study in Europe (Sumilo et al. and leads to approximately 200. A systematic review of research on the distribution of dengue and possible influence of climate change (Van Kleef et al. and water pooling. 2011. 2011. and is endemic in temperate regions of Europe and Asia. 2011).. and now present also in Asia.. 2011). 725 . 2010).1. 2009). 2010.g. Lai. The incidence in China of Japanese Lin. 2009. estimates of GDP in association with warming (Kriz et al.. it is apparent that heavy precipitation favors the spread 11. Holt et al. people at risk (approximately half the present number at risk) in 2050. There are no recent studies that project the return of established malaria 2006.. Li et al..g. The complex ecology considered only the margins of the geographic distribution of dengue of tick-borne diseases such as Lyme disease and TBE make it difficult to (where economic development has its strongest effect) and did not attribute particular changes in disease frequency and distribution to examine changes in intensity of transmission in areas where the disease specific environmental factors such as climate (Gray et al.. 2010) concluded There was a marked rise in TBE cases from the 1970s in central and that the area of the planet that was climatically suitable for dengue Eastern Europe. which 11 burgdorferi and is reported in Europe. Andreassen et al. 2012)... (2011) projected (Beebe et al. the model projected 1. Estrada-Peña et al. and Canada. the number exposed to dengue in cannot explain the increase. 2013). Jaenson et al. between 1970 and 2008. 2008. there is no evidence so far of any associated changes in the distribution in North America of human cases of tick-borne diseases.. 2012). Chikungunya fever is a climate-sensitive mosquito- precipitation (Wu et al. are linked fresh mosquito breeding sites..74 billion Tick-borne encephalitis (TBE) is caused by tick-borne encephalitis virus. 2011) scales. 2012). over known to humanity. the model projected 5. 2010. Socioeconomic changes (including changes 2050 falls to 4. Spring-time daily maximum temperatures rose in the would increase under most scenarios. Many studies have reported associations between climate and tick-borne diseases (Okuthe and Buyu. and assuming strong economic growth allied with social development (“best case”). Åström et al. albopictus et al. sufficient to encourage transmission of the TBE virus.1. is already established. In some circumstances. Li et al. high humidity. Plague... population projections. 2011). positively associated with dengue incidence in Guangzhou.. humidity.. 2012).. Near-Term Future of dengue fever. 2009. over been linked to seasonal and interannual variability in climate (Stenseth southern Spain) (Caminade et al. 2012) and spatiotemporal Hemorrhagic fever with renal syndrome (HFRS) is a zoonosis caused by (Chowell et al. Distribution of Ae. 2012). but drought can also be a cause if households store water in containers that provide suitable mosquito breeding sites Using the A1B climate change scenario..3. 2007...95 billion.. surveys. Pham et al.. is correlated with typhoons remain an important factor affecting vector population and temperature and rainfall. Nikolopoulos. Béguin et al. 2008. there were population at risk out to the year 2050.1. Descloux et al. 2011.5 billion.. Xu et al.5. are temperature. Adaptation... (2012) estimated the instance. Padmanabha et al. However. 2011. Outbreaks have central northwestern Europe) but less suitable elsewhere (e.. Randolph.

there appears to be a robust relationship between al. 2011). with a rapid rise in by direct contact with eyes.. addition.. direct contact or via seafood). explain seasonal and latitudinal indirect pathway. incidental ingestion during swimming.. Bompangue et al. 2011). Reyburn et al.. and skin diseases. There are seasonal affect the spatial and temporal range of the organism and also influence peaks in the number of cases in temperate and subtropical regions but exposure routes (e.and water-borne bacterial up to 1 month longer than at present (Moore et al. Other Parasites. outbreaks have been linked to variations in temperature and rainfall. 2011). it is not clear what the underlying driver is and if temperature is or deposited on irrigated food crops.2. addition of Worldwide.000 deaths in children organic carbon or other nutrients. Cholera al.5. persistence. concentrated by bivalve shellfish (e. 2010) have been attributed to there is not secure disposal of fecal waste. digestive. 2009). 2012). He predicted that climate change and higher disease rates at warmer temperatures.. Enterovirus infections in 11. and Human exposure to climate-sensitive pathogens occurs by ingestion of mouth disease (caused by coxsackievirus A16 and enterovirus 71) shows contaminated water or food. indirect influences include climate-related (which is often captured in shallow lagoons) into groundwater. 1990). and Co-Benefits Kearney (2009) used biophysical models to examine the potential pathogens worldwide.. or open wounds. heavy rainfall promotes the transmission of pathogens when time in the same country (Dey et al.. and Indian Ocean Dipole (IOD) and El Niño. Mostly. precipitation. Pathogens of concern include confounded by other seasonal factors. 2006). attached to leafy crops under conditions of both flooding and drought Cholera may be transmitted by drinking water or by environmental (Ge et al. This latter pattern is reflected in patterns of illness exposure in seawater and seafood. 2008)..5. nor the mechanism for the association blooms in Puget Sound using an A1B scenario suggest that by the end with temperature.. Atchison et al. as melt of the permafrost hastens transport of sewage or virulence of pathogens.. 2011). Bacterial pathogens are more likely to grow on produce crops (e. perturbations in local ecosystems or the habitat of species that act as drinking water sources. Increasing temperatures 11. and accompanying changes in salinity due to freshwater runoff.g. neither the specific causes of in lakes in the USA (Davis et al. 2008. 2010. 726 . Pitzer et al. 2011). Among the enteric viruses. 2012). in part. 2009). alginolyticus emerging in importance (Weis.. Variations in the timing of peak outbreaks between countries temperature and the disease (Islam.. 2006. and Viruses promote bloom formation in both freshwater (Paerl et al. While vaccination against rotavirus is expected to reduce the the North Sea has been established by DNA analyses of formalin-fixed total burden of disease. relationship between Vibrio numbers and sea surface temperature in 2011). of the century the “at risk” period may begin 2 months earlier and last among the most common zoonotic food. Climate Temperature is directly linked with risk of enteric disease in Arctic may act directly by influencing growth. rotavirus infections caused about 450. it may also increase seasonal variation (Tate et samples collected over a 44-year period (Vezzulli et al. neurotoxic shellfish poisoning. causing liver. Projections of toxin-producing the diarrheal illness are known. After controlling for seasonality and interannual variations. 2009). 11 Risk of infection is influenced by temperature. An unequivocal positive fluctuations in the number and seasonality of births (Pitzer et al. ears. vulnificus. sea chlorophyll and Harmful algal blooms can be formed by (1) dinoflagellates that cause cyanobacteria contents. foot. 2012)..g. 2009. survival. a potent neurotoxin that is bioaccumulated in shellfish and finfish (Erdner et al. Adaptation.2.2. oysters).g. Higher concentrations of enteric viruses linked to seawater and shellfish. Paz. In countries with less distinct patterns are seen within 10° latitude of the equator (Cook et endemic cholera. 11.. Increasing Rates of diarrhea have been associated with high temperatures (Kolstad temperature favored growth of toxic over non-toxic strains of Microcystis and Johansson.1. between climate (especially temperature) and non-outbreak (“sporadic”) Changes in water storage as a response to a drier climate may be an cases of salmonellosis may. with V. lettuce) in Vibrio is a genus of native marine bacteria that includes a number of simulations of warmer conditions (Liu et al. may be zoonotic in origin. and Southern Oscillation (ENSO) events (de Magny et al.. hand. However. 2009).. thawing may damage drinking water intake systems (for those communities with such infrastructure) (Hess. there are distinct seasonal patterns in infection that can be related indirectly to temperature.. 2009. most notably V.. 2012). transmission. The association would increase habitat suitability throughout much of Australia. 2011). Rinaldo et al. Reyburn et al. 2011. Pathogens in water incidence when the temperature exceeds 32°C (Hii et al.. 2007). ciguatera fish poisoning... or other surface waters (Martin et al. 2008). outbreaks of paralytic shellfish poisoning. Food. communities. 2009.. 2010) and variations with In addition. or changes in pH. Hashizume. enteric organisms that are transmitted by the fecal oral route and also bacteria and protozoa that occur naturally in aquatic systems... through which climate change affects mosquito trends in diarrhea (Lake. following heavy rainfall (Delpla et al.2. Chapter 11 Human Health: Impacts. 2012). neurological. Exceptions include Salmonella and Campylobacter. however.. These include V. (2) cyanobacteria that produce toxins 2008. see Chapter 5)... 2011. or regions (Turcios et al. 2009. and other variables including sea and river levels. In zoonotic reservoirs.. and (3) diatoms that can produce domoic acid. Vibrios Rainfall has also been associated with enteric infections. 2013a).5. 2011) and marine environments (Marques et al. and become human pathogens. These factors all younger than 5 years old in 2008 (Tate et al. or a linear relationship with temperature in Singapore.. cholerae which causes cholera. breeding (Beebe et al. which both show distinct seasonality in infection extension of vector range in Australia. other Vibrio species are solely (Bandyopadhyay et al. parahaemolyticus and have been reported frequently in drinking water and recreational water V.and Water-Borne Infections the USA peak in summer and fall months (Khetsuriani et al.. Bacteria.

5. falling sharply changes in economic growth and social development. compared with 2000 (adapted from Zhou et al. The authors attribute this to the increasing down-scaled climate change models showed that overflows of sewage mortality of both the snails and the water-borne intermediate forms of into Chicago’s watersheds would increase by 50 to 120% by 2100.. They concluded that an additional 784. using the A1B scenario and 19 coupled atmosphere-ocean cycle of another species. The blue area shows the additional area suitable for disease transmission in 2050. 2013). (2008) constructed a mechanistic model of the transmission change. S. the same analysis projected that incidence of diarrheal disease in the wet season would decline. 727 . japonicum in China. the present dry season peak in diarrheal disease may be amplified (Alexander et 11.Human Health: Impacts. like the ocean acidification 11 Range of schistosomiasis in China in 2000 Additional area suitable for disease transmission in 2050 N 0 250 500 1000 km Figure 11-4 | Effect of rising temperatures on the area in which transmission of Schistosomiasis japonica may occur.3. However. as the parasite. and Co-Benefits Chapter 11 11.5. as projected by down-scaled climate scenarios. Zhou et al..000 km2 secondary pollutants in the atmosphere. Adaptation. either directly or by contributing to S. Near-Term Future would become suitable for schistosomiasis transmission in China by 2050. Green area denotes the range of schistosomiasis in China in 2000. This study did not account for future burden in humans at an ambient temperature of 30°C.3.. if hot. dry conditions begin earlier in the year. Based on a biology-driven model including parasite (Schistosoma japonicum) and snail intermediate host (Oncomelania hupensis) and assuming average temperatures in China in mid-winter (January) increase by 1. and are prolonged. 2008).2. and reported a peak in the worm climate models from CMIP3. and noted that worm burden is not directly linked to the a result of more frequent and intense rainfall (Patz et al. Thus. Botswana. mansoni. as the mid-winter freezing line moves northward (Figure 11-4). Air Quality al. Kolstad and Johansson (2011) projected an increase of 8 to 11% in the risk of diarrhea in the tropics and subtropics in 2039 due to climate Mangal et al. 2008).6°C in 2050. Application of as temperature rises to 35°C. In prevalence of schistosomiasis. (2008) Nearly all the non-CO2 climate-altering pollutants (see WGI AR5 Chapters studied the effect of climate on transmission of schistosomiasis due to 7 and 8) are health damaging.

per se.7% of the global economy (approximately US$70 trillion in 2010). coming from the contribution to general ambient pollution of household fuels.3. however.5 and Annex II). Put into terms of disability-adjusted life years (DALYs).1. All particles are dangerous for health. not reviewed in detail in this assessment. 2012). Although (WGI AR5 TS. the climate impacts will become more prominent. see WGIII AR5 Chapter 3 for more discussion. UNEP.9. far higher than any other environmental risk and rivaling or exceeding all of the five dozen risk factors examined. Here. particularly on health. Therefore. the most comprehensive was the Comparative Risk Assessment carried out as part of the 2010 Global Burden of Disease Project (Lim et al. was about 6.8). and some warming. which are found by WGI to be elevated temperatures (WGI AR5 Chapter 8). It also found that about 150. This burden puts particle air pollution among the largest risk factors globally. there are nevertheless specific actions that will work toward both goals. As discussed in Section 11.4. in a consistent way (WGI AR5 Section 11. such as sulfates. See Box 11-3. The quite different time scales for the two types of impacts make comparisons difficult. The economic impact of this burden is difficult to assess as evaluation methods vary dramatically in the literature. a major success for health.9 trillion. however. This would imply that the total lost economic value from global climate-altering pollutants in the form of particles is roughly US$1. plus general ambient pollution..000 premature deaths could be attributed to ambient ozone pollution. we will use the mean global income per capita (approximately US$10.6% of all DALYs lost. the health impacts of non- CO2 CAPs are substantial globally. in the sense that the world ought to be willing to pay this much to reduce it..8 million premature deaths annually.5. methane (CH4). Most in the health field prefer to consider some version of a lost healthy life year as the best metric although the economics literature often uses willingness to pay for avoiding a lost life (Jamison et al. 2006). Long-Term Outdoor Ozone Exposures Although there is a large body of literature on the health effects of particulate air pollution (see Box 11-3). It found that the combined health impact of the household exposures to particle air pollution from poor combustion of solid cooking fuels. and alcohol.. 2009). carbon monoxide (CO). but some are cooling. Chapter 11 Human Health: Impacts. scenarios of future climate change have non-climate-mediated impacts. that is. or about 7. 2009a). and ecosystem/agriculture fertilization impacts of CO2. smoking. Thus. including malnutrition. will affect long-term particle levels involve nitrogen oxides (NOx). This is about 2. high blood pressure. this shows that global atmospheric pollution already has a major impact on the health and economic well-being of humanity today. such as black carbon (Smith et al. Adaptation. If CO2 is not controlled and climate change continues to intensify while air pollutant controls become more stringent. particle air pollution was responsible for about 190 million lost DALYs in 2010..000 in 2010) to scope out the scale of the impact globally without attempting to be specific by country or region. would have only a minor net impact on climate (WGI AR5 Figure TS-6). Indeed elimination of all anthropogenic particles in the atmosphere.5. Another difficulty is that any valuation technique that weights the economic loss according to local incomes per capita will value health effects in rich countries more than in poor countries. which would seem to violate some of the premises of a global assessment. if temperatures 728 . WGI indicates that there is little Tropospheric ozone is formed through photochemical reactions that evidence that climate change. Air pollution reductions do not always promote the twin goals of protecting health and climate but can pose trade-offs. we and volatile organic compounds (VOCs) in the presence of sunlight and focus here on chronic ozone exposures.3.g. for example. and Co-Benefits Box 11-3 | Health and Economic Impacts of Climate-Altering Pollutants Other than CO2 Although other estimates of the global health impacts of human exposures to particle and ozone pollution have been published in recent years (e. 2011). with about 5% overlapping. 11 On the one hand. The WHO CHOICE approach for evaluating what should be spent on health interventions indicates that one annual per capita income per DALY is a reasonable upper bound (WHO. due mainly to the direct effects rather than those mediated through climate. 11. but not all. the other CAPs enhanced in some.

based change on air pollution-related morbidity and mortality have focused on measurements since 1885. ozone. During a fire near Denver (USA) in June 2009. as well as effects on conjunctivitis and dermatitis ozone may affect health (Bell et al.. Ebi and McGregor. 2009).5. 2011. 2012).. Wilkinson et high levels of PM10 were observed in Moscow due to forest fires caused al. to ozone during the European summer heat wave of 2003 and found 2008.. 2009). all-cause mortality related to ozone is There may be an interaction of tropospheric ozone and heat waves. Chang et al...08 ppm over 8 hours) were amplified if higher CO2 levels stimulate plant growth.. there will be consequences for human 2006). Near-Term Future 11 1-hour concentrations of particulate matter with aerodynamic diameter <10 μm (PM10) and particulate matter with aerodynamic diameter <2. 2007.. 2012). Under a scenario in 729 . West et al.. and transport these allergens to new and McGregor. One study of et al. 2008. concentrations reached 91 µg m–3 and 44 µg m–3 (Vedal and Dutton. 2006).5. fine particles (PM2. Increased release of allergens may be meet the USEPA 8-hour regulation (0. Aeroallergens (TS. Daily mean temperatures in Moscow exceeded the respective long-term averages by 5°C or more for 45 days. WHO AQGs of 7 mg m–3. there may be an effect on asthma and other allergic respiratory diseases Even small increases in atmospheric concentrations of ground-level such as allergic rhinitis. The highest 24-hour pollution 2009. Children are particularly susceptible to most allergic Jerrett et al. Ebi which contain pollen and spores.Human Health: Impacts.. Droughts and high concentrations (from 0 to ~10 ppb) but the association becomes positive winds may produce windborne dust and other atmospheric materials. A cross-sectional study in the three climatic regions of Spain documented 11. 2012.000) (Johnston et al.. 2008.. Enhanced temperature also accelerates destruction of ozone. 2008). with much less certainty. Tagaris et al. Jackson et al. and approximately linear at higher concentrations (Bell et al.S.. 2007).000 deaths per year (range 260. many air pollution models (Ebi and McGregor. Visual monitoring associated with increased risk of premature mortality. 2006. Jackson et al. and 24-hour average including levels of photochemical oxidants and.. Tsai et al. cities regions. expected to increase in the USA and Canada (Bell et al. prevented dispersion of air pollutants. Warmer show that local variations can have a different sign to the global one conditions generally favor the production and release of airborne (Selin et al. development in the absence of emission controls could also lead to Saharan Africa and Southeast Asia (Johnston et al. Dong et al. but occasionally reached 1500 µg m–3. 2010). 2010). μm (PM2. Tagaris et Dear et al.. If this occurs. 2009). consequently. Jerrett et al. which occur more commonly following heat waves and the number of sunshine hours (Suarez-Varela et al.3.. 2008.5.8). Polvani et al. 2008. Projections are rare for other areas of the levels recorded in Moscow during these conditions were between 430 world. indicate tropospheric ozone may rise from additional CH4 emissions stimulated by climate change.. although estimates of the size of this effect vary (Ren et al.. benzene. Acute Air Pollution Episodes a positive correlation between the rate of child eczema and humidity. For instance. and negative correlation between child eczema and air temperature or Wildfires. respectively. fires estimated there were 339. Cheng et al... and Canada (Bell et al. and the net direct impact of climate change on ozone concentrations worldwide is thought to be a reduction (WGI AR5 TS. drought. and an anti-cyclone in the Moscow region on ozone in Europe. Bell et al. Ten new Most post-2006 studies on the projected impacts of future climate temperature records were established in July and nine in August... and Co-Benefits Chapter 11 rise.2. compared to the 24-hour WHO Air Quality Guidelines (AQGs) for health (Bell et al.5) reached 370 µg m–3 and 200 µg m–3. 2013)..” 2010). 2011). with 18 years of follow-up (1982–2000). 2012. tropospheric ozone levels were found to be significantly associated with cardiopulmonary mortality Studies have shown that increasing concentrations of grass pollen lead (Smith et al. by a heat wave in 2010. 2009).5 It is projected by WGI that climate change could affect future air quality. notably the developing countries where air pollution is presently and 900 µg m–3 PM10 most days. Selin et al. toluene. the USA. with a time data from developing countries (WHO.3..4. 2012. al. which includes to more frequent ambulance calls due to asthma symptoms. and the levels of formaldehyde. 2010. 2006)..5). 2009). 2009. Models also Allergic diseases are common and some are climate sensitive. Increasing urbanization. and industrial 600. a serious problem and is expected to worsen unless controls are The highest 24-hour CO concentration was 30 mg m–3 compared to the strengthened. 2009. 2011) project increased ozone that possibly 50% of the deaths could have been associated with ozone production especially within and surrounding urban areas (Hesterberg et exposure rather than the heat itself. Jackson et al. There is a lack of and experiments have shown that increases in air temperature cause association between ozone and premature mortality only at very low earlier flowering of prairie tallgrass (Sherry et al.. In an analysis of 66 U. 2012).5.... (2005) modeled the daily mortality due to heat and exposure al. Lepeule these pollutants of 50 µg m–3 and 25 µg m–3. 2008). 2006.000 to 2010). 2009). 2012.. See also the global review by WHO. 2008. release particulate matter and other toxic substances that may affect large numbers of people for days to months (Finlay et al. Extremely increases in ozone chemical precursors (Selin et al. The regions most affected are sub.3.4. lag of 3 to 5 days (Heguy et al. Adaptation. Some WGI 11... Meister et al.5. and styrene were also increased (State Environmental Higher temperatures may magnify the effects of air pollutants like Institution “Mosecomonitoring.. (Beggs. 2009). Handmer et al. ethyl benzene. Pollen levels have also been linked to hospital visits with rhinitis symptoms (Breton et al. 2010. In general.3..4. (2006) found that levels that diseases (Schmier and Ebi.8) scenarios. 2009). allergens (such as fungal spores and plant pollen) and.. Chang et al. 11. High temperatures worldwide premature mortality attributable to air pollution from forest may also magnify the effects of ozone (Ren et al. however.. use of solid biomass fuels... 2007. 2007.

the global food price fluctuates. (2011b) showed health impacts across regions. HIV deaths and malaria deaths. are not expected to increase from air conditions.9). 2009). leading to Industrial Research Organisation (CSIRO) and relative to a “no climate wasting (low weight for height). On the basis of the relation of asthma to air amount of food fed to livestock. which are prominent in 1% under optimal rainfall conditions and by 1. higher prices through Human Institutions increase the number of malnourished people. 2011).. such as food prices and access. there is growing evidence (Auffhammer.1.g.8 4.1.” as it includes overnutrition.3% increase in summer ozone-related asthma emergency et al. and no CO2 fertilization benefits. and East Asia. and model (DSSAT) and a global agricultural trade model (IMPACT 2009) to undernourishment. calorie for human consumption. Adaptation.1. leading to stunting (low height for age).7 5.5 3. the ozone (Cheng et al. amplified by speculation (Piesse and Thirtle. 2011).. Under a maximum feasible CO2 reduction scenario related to The processes through which climate change can affect human nutrition A2.7 % under drought sub-Saharan Africa. a threat to crop productivity in areas that are already food insecure.1 14. droughts (Williams and Funk.4 2. Health Impacts Heavily Mediated may have contributed to higher prices.5 (Tagaris agricultural production due to increasing temperatures and changes in et al. 11.2. would decline in developing countries by 2050.6. Since AR4 at least four studies have been published which project the nutrient absorption. The first study population receiving “insufficient” calories. socioeconomic factors. “malnutrition..” Rising temperatures may also affect food security through the impact A study that investigated regional air quality in the USA in 2050.7 147. which reflects national (post-trade) calories available estimate crop production (with and without CO2 enrichment). 2011).6.3 10. South Asia.5 32.1 7. using of heat on productivity of farmers (see Section 11. Lloyd et al.2 138. 2007a). (2012) drew the conclusion that “climate change is disease that dominate other regions. (2009. Results assume no effect of heat on farmers’ productivity. Global Climate Model). While the main driver is higher the 2020s compared to the 1990s. From their systematic review of more than a thousand pollution exposures in the same way as deaths from cardiovascular studies.. 2009) was carried out under the A2 emission scenario. and heat waves. Lobell et al.000 premature ozone-related deaths could are complex (see Section 7. mostly in South Asia (West et al.. Chapter 11 Human Health: Impacts. consumed beyond quality in the last decade (1999–2010).. it is projected that 460. All-cause precipitation may reduce both the quantity and quality of food mortality.1 2. 2009)..6. given that background disease conditions for African maize that for each degree above 30°C. for example. 2009). (Adapted from Nelson et al. however. 2013).0 1. is not the best metric for comparing air pollution harvested (e.2).1 41... Knox et al. and therefore on health (Green a median 7. All three may be influenced by climate but only agricultural production has been modeled in a climate impacts framework.9 No climate change 52.7 3. Higher temperatures and changes in be avoided in 2030.6.2. energy costs. All else being equal.2). Battisti and Naylor. 2008. Near-Term Future wastes and storage losses). We do not use the term (Nelson et al. especially those that affect appetite. projected negative effects on food consumption. especially floods. Nutrition 11 Nutrition is a function of agricultural production (net of post-harvest 11. used for biofuels. effect of climate change on undernourishment and undernutrition. (2011). concluded there would be about 4000 additional The magnitude of detected and predicted decline in land-based annual premature deaths due to increased exposures to PM2. Here Nelson et al. child underweight. 2010) conducted two studies using a crop simulation we use the terms undernutrition. (2012) anticipate baseline needs by the overnourished.6 23. Mechanisms deaths due to ozone would be wound back in Africa. Undernutrition can be Atmospheric Research (NCAR) and Commonwealth Scientific and chronic. and Co-Benefits which present air quality legislation is rolled out everywhere. yields decreased by vary so widely. Air pollutant-related mortality increases are also projected rainfall must be put in perspective to other changes. applying the SRES A2 scenario.. The authors found that yields of most important crops combination of chronic and acute undernutrition. underweight (low weight for age) is a change” future. that per capita calorie Table 11-2 | Number of undernourished children younger than 5 years of age (in millions) in 2000 and 2050. and is expressed as estimated percent of the availability. There is good evidence that local food price increases have by 2050. or acute. 2009). and catabolism (Black et al.5 730 .1. Against this background. Thompson et al. premature 11. 2011) that extreme weather events. Sheffield et al.7 113. such as increase for Canada. and human diseases. a down-scaled climate model (Goddard Institute for Space Studies. and adaptation costs.1 52. Europe and Latin America Middle East / Sub-Saharan All developing Scenario South Asia East Asia / Pacific Central Asia and Caribbean North Africa Africa countries 2000 75.7 6.3 2050 Climate change 59. which is a health outcome. department visits for children (0 to 17 years) across New York City by though with a recently rising trend.6. using the National Center for Atmospheric Research (NCAR) climate model (and the A2 scenario from AR4). which is not considered using two General Circulation Models (GCMs): National Center for here (except under co-benefits in Section 11. 11. or wasted in other ways (Foley et that the prevalence of asthma in South Africa will increase substantially al. but in this case they are largely driven by the effects of in harvests due to improved farming knowledge and technology. 2011). See Chapter 7 for a more detailed discussion of the impact of climate change on food production.

about 25 million children Since AR4.. Kjellstrom et al.6. That is. Exposure to heat affects psychomotor.e. food production and availability. 2011). and the economic impacts of reduced work capacity may be sufficient to jeopardize livelihoods (Lecocq and Shalizi. hourly distribution. However. (2) childhood at higher temperatures (Bennett and McMichael. which may in turn undermine health protection for the wider population (WHO. Parsons. 11 after accounting for the potential benefits of economic growth. and (3) on undernutrition-related temperatures reducing sea ice and increasing risk of drowning in those child deaths and DALYs lost in developing countries (high confidence).2. 30% faster growth in animal numbers. and favor mosquito breeding and biting (Bennett and McMichael. 2010).6. “heat exhaustion”) and heat stroke. under A2 emissions with productivity goes down (Sahu et al. and climate lead to more work during dawn and dusk when some of the vectors and stunting. are common. 2009a. “food. (temperature and precipitation). Schulte between 2000 and 2050. particularly stunting. livelihood. see Figure food-related” causes of stunting). the authors projected impacts are biting humans more actively... 2008. mainly in agriculture and construction (IFAD. ISO.2. 2010. Heat Exhaustion and Work Capacity Loss It should be noted here that severe stunting carries three to four times the mortality risk of moderate stunting. 2009a. ILO. Applying the model to Mali. and Co-Benefits Chapter 11 availability would drop below levels that applied in the year 2000. The authors concluded that climate change will increase the proportion of stunted children in countries 11. as well as child stunting in Kenya. even the hot season. the underweight estimates people (Kjellstrom et al. people working in fields without effective protection may experience a higher incidence of these diseases when climatic conditions Similarly. 2007) and undernutrition due to changes in climate. increases risk of injuries (Ramsey. 2010) and rising undernutrition. at higher temperatures there is potential conflict availability estimates from Nelson et al. 2008). and 11. we conclude that climate change will have a substantial occupational exposures to toxic chemical solvents that evaporate faster negative impact on (1) per capita calorie availability. 1995). 2003) for conclude that climate change would hold back efforts to reduce child both acclimatized and non-acclimatized people. at least in Asia and Africa.. engaged in traditional hunting and fishing in the Arctic (Ford et al. improvements would be necessary to counteract the effects of climate change. health workers.67. such as investment in education and In areas where vector-borne diseases.2. health variables (stunting and underweight). are at heightened risk of heat strain approximately 10% higher with climate change compared to a future (ICD code T. 731 .. Other Occupational Health Concerns such as Kenya that are dependent on rain-fed agriculture. large proportions of the workforce are affected by heat. Kjellstrom and Crow (2011) and climate change on undernutrition have also been carried out since AR4. The second study by Nelson et al. income countries such as the USA (Luginbuhl et al. agricultural technology..1. 11. The authors identified a Increasing heat exposure in farm fields during the middle of the day may link between type of livelihood and risk of undernutrition. per capita projections and estimates of the Gini index for income 2011): as workers take longer rests to prevent heat stress. 2013). Extreme weather events and three-quarter to one million of this number will be children younger climate-sensitive infectious diseases also pose occupational risks to than five. In a future without climate There are international standards of maximum recommended workplace change.. 2013). unless there are substantial adaptation efforts. livelihood. Moreover. (2012) modeled the relationship between climate variables and wettest seasons has already occurred. much has been written on the effects of heat on working would be affected (see Table 11-2). that are not temperature-controlled.g. Occupational Health that child underweight would be approximately 20% higher (in the absence of carbon enrichment effects). They estimated that by 2050. Lloyd et al. Agricultural and construction workers in tropical developing countries are therefore among the most exposed. Dunne et al. Other mechanisms include elevated In summary. moderate to high economic growth and compared to a future without climate change. Of note. Heat Strain and Heat Stroke the rate of expansion of irrigated areas. (2013) report that loss of work productivity during the hottest Grace et al.6. These included a 60% increase in yield growth (all crops) over baseline. and even for some workers in high- related” causes of stunting) and socioeconomic conditions (i.. leading the authors to heat exposure and hourly rest time (e. or sufficient water.e. 2009b).. “non. In addition to global studies.6. Kjellstrom and Crowe. and the latter on GDP between health protection and economic productivity (Kjellstrom et al. to 2025 and estimated that nearly 6 million people may experience perceptual. and a 25% increase in 11. (2009). 2013) and on other climate- do not account for possible improvements in socioeconomic conditions related occupational health risks (Bennett and McMichael. In hot countries during undernutrition in the most severely affected parts of the world. with the level of physical exertion. and cognitive performance (Hancock et al. 2009). regional projections of the impacts of 2011.Human Health: Impacts. Dunne et al. such as malaria and dengue fever.3. 2007. (2012) included climate. there may be a relative increase of severe stunting of 31 to 55% across regions of sub-Saharan Africa and 61% in South Asia. Jankowska et al. used a wider range of socioeconomic and climate scenarios but Worldwide. it was estimated that substantial and Chun. The former were based on calorie 11-5).. Estimates of improved outdoors. 2010. 1989. socioeconomic conditions were insufficient to fully offset the potential Individuals who are obliged to work outside in hot conditions. (2011) built a model for estimating future stunting driven but heat stress is also an issue for those working indoors in environments by two principal inputs: estimates of undernourishment (i. undernutrition was projected to decline. Health risks increase without climate change. without impacts of climate change: child underweight was estimated to be access to shade.2..2. and demography. Adaptation. more than half of all non-household labor-hours occur health impacts were similar to the first study.

By 2100.1989) for heat stress in the workplace that leads to recommendations for increased rest time per hour to avoid heat exhaustion at different work levels. and other factors into a single index of the impact on work capacity and threat of heat exhaustion. Temperature and have indirect effects on those with mental illness. under RCP4.. disorders are more common (Berry. leading to more parts of the world being restricted for more of the year. 2011. and major floods may also have activity.. 2012). The (Berry et al. the mentally ill may be at risk: half the afternoon work hours will be lost due to the need for rest cities often feature zones of concentrated disadvantage where mental breaks (Kjellstrom et al. however. with climate change. through the impacts on humidity were both included. fishing. 2013).6. changes in the workforce distribution relating to the need for physical Disasters such as cyclones. Dunne et al. 2012)..5.9°C. and other economic activities. heat exhaustion.6. In Southeast Asia. forestry. which combines temperature. 2010).4.4. The insert shows the International Organization for Standardization standard (ISO.. Here again. 2005. 11 11. concludes that factors associated with risk of violent conflict. Chapter 11 Human Health: Impacts. depression.g.. Sahu et al. impacts include chronic psychological distress and increased incidence of suicide (Alston Projections have been made of the future effects of heat on work and Kent. In general. and Soil degradation. droughts.2. aggression. and Co-Benefits Job exertion required (Watts) 0 0 0 0 50 40 30 20 Percent of full working capacity 100 80 e. 2009a.. as many factors influence include severe anxiety reactions (such as post-traumatic stress) and conflict and violence. The topic is reviewed closely in Chapter 12. 2007) and there is also higher risk (2013) project up to a 20% loss of productivity globally. for every 1°C that Tmax goes up. Mental Health 11. 2013). are sensitive to climate variability. measured in web bulb globe temperature (WBGT).. 2007) and they lose amenity and opportunity. Ronan et al. there may be a distressing sense of loss. Violence and Conflict Harsher weather conditions such as floods. 2008.. Dunne et al. Hanigan et al. which creates risks for poor and disenfranchised laborers working under In addition to effects of extreme weather events on mental health via difficult working conditions and inflexible rules (Kjellstrom et al. Near-Term Future For slow-developing events such as prolonged droughts. Note that some parts of the world already exceed the level for safe work activity during the hottest month. the WBGT goes up by about 0. 2009b. unfortunate trade-off between health impact and productivity. Adaptation. heat waves. This is based on studies of healthy young workers and includes a margin of safety.. 732 . the model indicates that more than destructive effects in cities. humidity. and heat waves tend to increase the stress on all those who are already mentally ill. and need for air conditioning to protect health (Lemke and Kjellstrom. and the modeling took into account the agricultural productivity. which longer-term impacts such as generalized anxiety.6. 2008). 2013). Manifestations of disaster-related psychiatric trauma relationships are not straightforward.. in 2050. population pressures.” that people experience when their land is damaged (Albrecht et al. known as “solastalgia. poverty and impaired state institutions. freshwater scarcity. There is an of natural disasters (such as flooding). Extreme weather conditions may capacity (Kjellstrom et al. and other may create sufficient stress for some who are not yet ill to become so forces that are related to climate are all potential causes of conflict. such as and complex psychopathology (Ahern et al.3. the risk/disadvantage cycle. 11. 2˚C rise approximately 60 halves work output 40 Heat exposure WBGT °C 20 Low risk Moderate risk High risk 0 <20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 >35 25˚C 30˚C 35˚C 40˚C Wet bulb globe temperature (WBGT) Figure 11-5 | The 1980–2009 average of the hottest months globally. with consequent impacts on productivity.

Health Adaptation Policies and Measures organizations and local communities (Khan. 2011). a cyclone of similar severity caused about level rise and flooding is expanded health insurance arrangements. This is important Climate change may threaten the progress that has been made in because the present health status of a population may be the single reducing the burden of climate-related disease and injury.. Reid et al.. 2009). Transitional adaptation moves beyond focusing on reducing the current Alongside improving general disaster education (greatly assisted by adaptation deficit to considerations of how a changing climate could rising literacy rates. A review by the World Health Organization in 2012 diminished in magnitude (Tate et al.7. In 1991. For example. than 30 million in the intervening period (Mallick et al. such as enhancing disease of where. and improved methods to detect pathogens and contaminants in food (Tirado et al.. one measure proposed as part of the national response to sea 1970 (Khan. and how the health burden could change with climate surveillance. Improving Basic Public Health Also. 2007). 2013).000 deaths. 2008). disasters associated with extreme weather and climate events. monitoring environmental exposures.Human Health: Impacts. Early al.. and Co-Benefits Chapter 11 but evidence of an effect of climate change on violence is contested. were delayed and growing less rapidly. transitional. For conditions.1. an assessment of actions to improve the amount to less than 1% of the annual health costs attributable to resilience of vulnerable populations to heat waves recommended staff climate change in 2030 (WHO Regional Office for Europe. there is 11. has yet to be implemented in the current and possible future risks related to climate change. when. of diseases (Woodward et al.2. 2008). For example. it is noted that populations affected by violence are particularly and Health Care Services vulnerable to the impacts of climate change on health and social well- being. after which seasonal outbreaks of include health. would increase example. and there are many more national adaptation plans that of vaccination programs in the USA. and political context for intervention (Ebi et al. (2009) mapped community determinants of heat vulnerability 733 . Adaptation to Protect Health abundant evidence of steps that may be taken to improve relevant public health functions (Woodward et al. For example. 2009). In (category 3 in severity) hit East Pakistan (present day Bangladesh) in Benin. 2008). 2006). 2012). other sectors to deal with shifts in the incidence and geographic range economic. public health and health care services for climate-related health providing support to those in need (Frumkin et al. 2010). Incremental adaptation includes improving be more successful in disseminating health and related messages.000 people died when Cyclone Bhola the ability of communities to manage large-scale floods and storms.7. In November 2007. integrated warning messages by bicycle. Efforts to adapt to the health impacts of climate change can be Indicators of community functioning and connectedness also are categorized as incremental. 2008).2. and the social. which requires Vulnerability mapping is being increasingly used to better understand fundamental changes in systems. leading to initiatives such as vulnerability mapping and 11. monitoring of food-borne and animal diseases. especially among women). 11. and transformational actions relevant because communities with high levels of social capital tend to (O’Brien et al. Bangladesh achieved this remarkable reduction in mortality through effective collaborations between governmental and non-governmental 11. the feasibility of implementing additional programs. Transformational adaptation (see Chapter 16). without necessarily considering the possible impacts of climate change. Transitional adaptation means shifts in attitudes and perceptions. the country deployed alter health burdens and the effectiveness of interventions (Frumkin et early warning systems and built a network of cyclone shelters.7. The scientific literature on adaptation to climate change has expanded Examples of incremental health care interventions include introduction since AR4. the effectiveness of current interventions. and monitoring of those in the The value of adaptation is demonstrated by the health impacts of recent highest risk population groups (WHO Regional Office for Europe. improving disaster change.. maintaining and improving food safety in the warning systems included high-technology information systems and face of rising temperatures and rainfall extremes depends on effective relatively simple measures such as training volunteers to distribute interactions between human health and veterinary authorities. The degree most important predictor of both the future health impacts of climate to which programs and measures will need modification to address change and the costs of adaptation (Pandey.. Post-disaster initiatives also estimated that commitments to health adaptation internationally are important. cooling of health care facilities. although Ensuring essential medical supplies for care of individuals with chronic not necessarily attributed with confidence to climate change itself. 2011).1.. Vulnerability Mapping improved surveillance systems that specifically integrate environmental factors. so 11 140. The population had grown by more promptly and effectively (Dossou and Glehouenou-Dossou.. approximately 500. including effective post-disaster distribution. training of staff to recognize and treat heat strain. Although the short time period since health adaptation options have been implemented means evidence of effectiveness in specifically reducing climate change-related impacts is currently lacking.7. 2010). Most health additional pressures from climate change will depend on the current adaptation focuses on improvements in public health functions to burden of ill health. planning over the summer period. Cyclone Sidr (category 4) resulted that diseases such as malaria and enteric infections can be treated in approximately 3400 deaths. 2005). outcomes. a common climate-sensitive pathogen. other risk management.. and facilitating coordination between health and stressors that could increase or decrease resilience. health sector. Adaptation. but investment in specific health protection activities is rotavirus. projections reduce the current adaptation deficit.

A study examining well-established interventions negative health impacts through alerting public health authorities and to reduce the urban heat island effect (replacing bitumen and concrete the general public about climate-related health risks. weather conditions associated with increased morbidity or mortality. infrastructure. (2012) was inconclusive. and Co-Benefits in the USA. and alerting associated with the forecasts (Thomson et al. Chapter 11 Human Health: Impacts.. In Botswana. more complete picture of vulnerability. This was more than 4000 fewer deaths than example. For example.. but more favorable in the center and northern parts of the 11. (Thornton et al.. spatial epidemics 13 months ahead of the peak in new cases. mapping exercises also could agriculture. improve air quality. re-vegetation of watersheds to improve water evaluations of the effectiveness of these systems is urgently needed to quality). 2008. to reduce the harmful effects of climate extremes on health include A national assessment attributed the lower than expected death toll to savings schemes. communicating London. 2008). Weisskopf flexible financing and the capacity to rapidly scale up depending on et al. 2006). local control and greater public awareness of the health risks of heat. Role of Other Sectors in Health Adaptation country (Casimiro et al. modeling of Lyme disease indicates that future conditions will be less favorable for disease transmission in the south. exacerbate health risks (e. Of seven studies of the effectiveness of heat wave early warning systems or heat prevention activities to A review of food aid programs indicates that a rapid response to the reduce heat-related mortality.... for about 2000 excess deaths. and neighborhood level solid waste care facilities. A study in timely response plans that target vulnerable populations. and introducing more green spaces warning systems take into consideration the range of factors that can to the city) estimated these would reduce heat-related emergency 11 drive risk and are developed in collaboration with end users.. energy and transportation. In Portugal. indicating where city greening probability distributions of disease risk and measures of the uncertainty and other urban cooling measures could be most effective. improved health maintenance of water supplies. It is important to note system (Fouillet et al. Early Warning Systems building design. Tan et al. This information can be used to modify surveillance programs before disease outbreaks occur.7. Ebi et al. For example. In the Philippines. Mapping at regional and larger scales may be useful to guide to 80%) (Weisent et al. France experienced high temperatures with adaptation. 2012). identifying triggers of effective and wave-related morbidity and mortality depend on location. and others—play an important part in determining the done in an assessment of climate change and risk of poverty in Africa risks of disease and injury resulting from climate change. land use consider climate sensitivity and adaptation capacity. used to identify characteristics of domestic malaria transmission in 2012). six reported fewer deaths during heat risk of child undernutrition. with waves after implementation of the system (Palecki et al. 2010)... 2011). 2010). In another example. A review of the heat wave early warning that climate change adaptation in other sectors may influence health systems in the 12 European countries with such plans concluded that in a positive manner (e. developed in Singapore. 2001. and the introduction in 2004 of a heat wave early warning management strategies (Dodman et al. 2007. 2010). predicted heat waves (Luber and McGeehin. wave early warning systems are being increasingly implemented. the extent to which changes in these factors reduce heat predicting possible health outcomes. found that built form and other dwelling characteristics risks and prevention responses. food-borne infections. 2010). 2011).. 2008). Effective early with more heat-reflective surfaces. Urban green spaces lower ambient temperatures. hygiene education. targeted to those in greatest need. Adaptation.. primarily in high-income countries. adaptation actions. these interannual and seasonal variations in climate are associated with technologies can be used to map surface temperatures and urban heat outbreaks of malaria in this part of Africa. Model outputs include island effects at the neighborhood scale. 2011). an early warning system forecasts who were elderly or diabetic.. Heat than did the urban health island effect (Oikonomou and Wilkinson. provide Components of effective early warning systems include forecasting shade.. To capture a Other sectors—including ecosystems. sufficiently fine-grained to map local vulnerability. The four factors explaining most of the variance were a Early warning systems have been developed also for vector-borne and combination of social and environmental factors. social isolation. which gave the modeling of geo-referenced climate and environmental information was national control program time to increase control measures (Hii et al. such as was management.. interventions in low-income urban settings with the potential was anticipated on the basis of what occurred in the 2003 heat wave. and urban land use as important elements of national and municipal heat wave and health action plans (WHO Regional Office Early warning systems have been developed in many areas to prevent for Europe. (Medlock and Vaux. and evaluating and revising the system more strongly influenced indoor temperatures during heat waves to increase effectiveness in a changing climate (Lowe et al. including disaster risk management.. only Morabito et al.. A weather-based public health authorities to populations that may be at greatest risk of forecasting model for dengue.. 2008). and may be good for mental health (van den Berg et al. monthly disease risk with a very good fit in validation data sets (R2 up 2013).. 2009)..g.3.g. UK. However. Fouillet et al. to guide malaria control efforts (Sudre et al. A study of campylobacteriosis in the USA developed models of 2009–2012 in Greece. 2004. may reduce damaging health consequences (Alderman. 2006).7. urban wetlands inform good practices. a review of public health responses to extreme heat in Europe identified transport policies.4. or on occasion. Community-based programs designed for other purposes can facilitate in the summer of 2006. particularly understanding which actions increase designed primarily for flood control may promote mosquito breeding) resilience (Lowe et al. 2002. and the proportion of the population disease burdens is limited. Within the context of the EuroHEAT project. 11. 2009). 734 .. small-scale loans. Remote-sensing technologies are now malaria incidence up to 4 months in advance based on observed rainfall. water supply and sanitation. although evidence of their effectiveness in reducing prevalence of air conditioning. et al. calls for medical assistance by almost 50% (Silva et al. Chau need. 2010).

Impacts are identified in eight health-related sectors based on assessment of the literature and expert judgments by authors of Chapter 11. that the health consequences of important to examine the likely health consequences of warming beyond a 4°C temperature increase will be more than twice those of a +2°C 2°C.. 2011. Adaptation Limits this nature are limited by uncertainty about climatic as well as key. for example. including extreme warming of 4°C to 6°C or higher. Impact levels are presented for the near-term “era of committed climate change” (2030–2040).4. but the net impact is expected to be negative. health and wellbeing (Section 16. we instead focus primarily on physiological or Most attempts to quantify health burdens associated with future climate ecological limits that constrain our ability to adapt and protect human change consider modest increases in global average temperature. that is. research published since AR4 raises doubt over whether it will be possible to limit global warming to 2°C It can be assumed that the increase in many important climate-related above preindustrial temperatures (Rogelj et al. Estimated impacts are also presented for the longer-term “era of climate options” (2080–2100). For some sectors.and health water-borne Vector-borne infections diseases Mental health Heat and violence Extreme weather Air quality events Occupational Food.and health Risk level with water-borne current adaptation infections Potential for Mental health adaptation to Risk level with reduce risk Extreme and violence high adaptation 11 weather Air quality events Figure 11-6 | Conceptual presentation of the health impacts from climate change and the potential for impact reduction through adaptation. which could potentially be avoided by vigorous mitigation efforts taken soon. However. in which projected levels of global mean temperature increases do not diverge substantially across emissions scenarios. Nonlinear and threshold effects have been 735 .8. It is therefore increasingly than simple linear increments. heat/cold stress. vector-borne diseases. and Co-Benefits Chapter 11 Present Undernutrition Vector-borne diseases Heat 2030–2040 "Era of committed climate change" + 1. The width of the slices indicates in a qualitative way the relative importance in terms of burden of ill health globally at present and should not be considered completely independent. Adaptation. impact levels are estimated for the current state of adaptation and for a hypothetical highly adapted state. typically less than 2°C. 2009. there may be benefits to health in some areas. PriceWaterhouseCoopers. for global mean temperature increase of 4°C above preindustrial levels. Predictions of world (see Figure 11-6). Anderson and health impacts at increasingly higher levels of warming will be greater Bows.5°C Undernutrition Occupational Food. and agricultural production and undernutrition. 11. non- Under High Levels of Warming climatic determinants of health including the nature and degree of adaptation.Human Health: Impacts.1). For each timeframe. 2012).and 2080–2100 water-borne health "Era of climate options" infections Mental health + 4°C Undernutrition and violence Extreme weather Air quality events Vector-borne diseases Heat Risk and potential for adaptation Occupational Food. Here. indicated by different colors.

2012). societies may be able to protect themselves relations. 2009.5 scenario in which global mean temperatures rise 3. Chapter 11 Human Health: Impacts. 2009..8. and Co-Benefits observed in the mortality response to extreme heat (Anderson and Bell... On the other hand. also RCP8. 736 . Adaptation. Dunne et al. An increase of 11°C to 12°C 2001. 2009). diseases related to thus suggest that there may be a threshold of global warming beyond overcrowding such as measles. 2012).1.4. adults of two malaria-transmitting the wet-bulb globe temperature (WBGT) exceeds 32°C (Willett and mosquito species are unable to survive temperatures much above 40°C Sherwood.. for infectious diseases that exist at present close to their upper tolerable example.1 One malaria parasite within the mosquito is impaired at lesser raised estimate suggests global labor productivity will be reduced during the temperatures (Paaijmans et al. Health grain-filling.. first for their most vulnerable 1 WBGT is a heat index closely related to the wet-bulb temperature that also incorporates measures of radiant heat from the sun and evaporative cooling due to wind. However.5). and seed set have maximum temperature thresholds near studies of refugees. For example. It is projected that tropical and mid-latitude regions including India. Porter and Gawith. and infectious diseases (Altizer et al.8. 2009a).8. Larval development of Aedes hottest months to 60% in 2100 and less than 40% in 2200 under the albopictus. 2013).. as key determinants plant diseases.1 will become much more severe..1. and climatic thresholds for other influences such as infestations and 2011.2)..3. These are also briefly elaborated here. increased maternal mortality. 11. is likely to lead to more adverse health Semenov. Lobell et al. as already evidenced by the northward conclude that a global mean warming of roughly 7°C above current extensions in Canada and Scandinavia of tick populations. The health risks associated with forced displacement include (Brázdil et al. 2013a). Physiological Limits to Human Heat Tolerance 11. 2009). while key phenological stages such as sowing to emergence. for of 4°C to 6°C or higher in global mean temperature (medium evidence. and soybean is generally assumed to the nature of human migration in response to 4°C of warming relative face an absolute temperature limit in the range of 40°C to 45°C (Teixeira to 2°C would be to remove many people’s ability to choose whether to et al. Sherwood and Huber (2010) temperature boundaries. agricultural crop yields. Thermal Tolerance of Disease Vectors In standard (or typical) conditions.8. dissipation would become impossible. suspends all physical training and strenuous exercise when temperature limits.2. rice. the vectors temperatures would create small land areas where metabolic heat for Lyme disease and tick-borne encephalitis (Lindgren and Gustafson.and water-borne illnesses. the emergence of new would enlarge these zones to encompass most of the areas occupied temperature regimes that exceed optimal conditions for vector and host by today’s human population.. and the southeastern USA will be particularly badly affected 11. high agreement) (Chapter 7.4.5. 2011. meningitis. stay or leave when confronted with environmental changes. current models to estimate the human health consequences of climate- impaired food yields at higher global temperatures generally incorporate 11.6. Reliance on Infrastructure neither critical thresholds nor nonlinear response functions (Lloyd et al. by enclosing places for living and working. the scale and feasibility of adaptation. Schlenker and Roberts. Executive Summary). sexually transmitted diseases.S. estimate of an absolute limit to human heat tolerance because working with high enough temperature rise. 2012..... an Asian mosquito vector of dengue and chikungunya. 2011b) undernutrition. although in the external acclimatized individuals spend doing low intensity labor such as office world they may seek out tolerable microclimates. Northern Australia. Porter and that forced displacement. Extrapolation from current models nevertheless suggests of childhood nutrition and development (Schlenker and Roberts. in turn. The existence of critical climatic thresholds and evidence impacts than voluntary migration or planned resettlement (McMichael of nonlinear responses of staple crop yields to temperature and rainfall et al. and 6. and the impacts on malnourishment and undernutrition and mental health disorders (McMichael et al.8. 1981.2°C by 2200 relative to 1861–1960 (Dunne et al. reflecting uncertainties about exposure-response Under severe climate regimes. core body temperatures will reach Substantial warming in higher-latitude regions will open up new lethal levels under sustained periods of wet-bulb temperatures above terrain for some infectious diseases that are limited at present by low about 35°C (Sherwood and Huber. migrants. food.. This trend is expected to Agricultural crops and livestock similarly have physiological limitations be more pronounced under extreme levels of warming (Section 16. 2013). and acute respiratory which current agricultural practices can no longer support large human infections. 2012). Lake et al. 2005 ). 2010). The U. 2011a). 2012). production of the Gemenne (2011) argues that the most significant difference between staple crops maize. 2012) while international labor standards suggest the time in laboratory experiments (Lyons et al.. in terms of thermal and water stress. For example. 1999.4°C by 2100 does not occur at or above 40°C (Delatte et al. civilizations. 2006). 2006). McMichael. This analysis is likely a conservative species will reduce the potential for infectious disease transmission and. may eventually eliminate some conditions are hazardous at lower thresholds. that the global risk to food security becomes very severe under an increase Lobell et al. Displacement and Migration (Willett and Sherwood. Limits to Food Production and Human Nutrition level rise lead to both more people displaced and increase in populations that are effectively trapped (Section 12. military. 2009. future extreme events. example. Ogden et al. 2011). Under Extreme Warming 11 Weather extremes and longer term environmental change including sea 11. Reproduction of the work be halved under such conditions (Kjellstrom et al.. and people in resettlement schemes suggest or below 35°C (Yoshida et al. wheat.. described in Section 11.

.. This figure evaluates only a small subset of all co-benefits opportunities. 737 . we summarize DALYs avoided what is known about the main categories of co-benefits.. energy efficiency. Note that even with the log-log scaling. and the energy is derived from combustion average world gross domestic product (PPP) per capita in 2000). 2009. to both accidental and disease-related deaths in temperate climates (Anderson and Bell. 2012). Reduction of Co-Pollutants Figure 11-7 | Illustrative co-benefits comparison of the health and climate Most of the publications related to CAPs and health-damaging cost-effectiveness of selected household.1). or control of landfills United States: • Increase access to reproductive health services hybrid vehicles • Decrease meat consumption (especially from ruminants) and substitute low-carbon healthy alternatives India: improved • Increase active transport particularly in urban areas 10 biomass stoves • Increase urban green space. For other figures products of incomplete combustion are climate altering and nearly all are comparing the climate and health benefits of co-benefits actions including those in damaging to health (Smith and Balakrishnan. 2012).. These include: household coal to propane/LPG stoves • Reduce emissions of health-damaging pollutants.. United States: wind 11 China: nuclear In addition. In many 11. household fuels (poorly combusted biomass and coal) are responsible for a substantial percent of primary outdoor fine particle pollution as well. there are big differences among them. This indicates that reductions in emissions from household even fewer strongly to both.1.. Adaptation. 2009. 2009). and details of the calculations in this figure (Smith and Haigler. and carbon taxes that are potentially deleterious for human gasifier stoves health (Tilman et al.. efficiency and/or fuel itself is renewable.9. wave. Shindell et al. 0.0 0 0 . would reduce emissions of warming CAPs and mean increased vulnerability to infrastructure failure and unreliable health damaging air pollutants. 2007. ill. 0 00 00 00 00 0 0 10 0 0 0 . either primary or United States: precursors to other pollutants in association with changes in energy nuclear China: wind production. It does illustrate. 0. UNEP. biofuel China: household coal to biomass tCO2-eq offset expansion. In Table 11-3.0 1. transport. however. Apsimon China: solar PV et al. Large-scale sources that produce outdoor air pollution (Bell et al. These so-called co-benefits include health gains from strategies that are directed Carbon cost effectiveness ($Int/tCO2-eq) primarily at climate change. 10 00 00 10 00 . and power sector interventions pollutants refer to fuel combustion and fall into three major categories: (Smith and Haigler.6.. and Co-Benefits Chapter 11 members: the young. we only provide additional detail for two of them 1 below.0 . perhaps a quarter in India for example (Lim et al. In many parts of the world. either directly or shows the range of the cut offs for cost-effective (solid lines) and very cost-effective (dashed lines) health interventions in India (red lines) and China (purple lines) using through the electric power system. 2009. This strategy will geothermal energy. such as geoengineering. providing benefits for climate and energy and water supplies. United States: solar PV 2012). and manual laborers. and both climate and health benefits. (2) increases of combustion efficiency the WHO CHOICE (CHOosing Interventions that are Cost-Effective) criteria (WHO. 2009). Co-Benefits parts of the world. old. The literature on health co-benefits associated with climate change mitigation strategies falls into several categories (Smith and 100 China: Balakrishnan. Smith and Balakrishnan. because a number of the the kind of comparisons that can help distinguish and prioritize options. would therefore pose a serious health risk. and mitigation of climate change from well. such as wind. but not all are strongly linked to either and et al. Here we focus on measures to mitigate sources will yield co-benefits through the outdoor pollution pathway. but because of space limitation. see Haines et al. See the original reference for use of non-combustion sources. Smith et al. 2013). (decreasing emission of incomplete combustion products) will have 2003). 10 0 10 Health cost effectiveness (Int$/DALY) 11. Area of each circle denotes the total social benefit in international dollars (Int$) from the combined value of carbon offsets (valued at (1) improvement in energy efficiency will reduce emissions of CO2 and 10$/tCO2-eq (tons of carbon dioxide equivalent)) and averted disability-adjusted life health-damaging pollutants. providing these gains are not outpaced by years (DALYs. 300 chosen policies for health advancement (Haines et al. solar.. and (3) increased food supply and urban design. 2011. 2008). even if there is no change in energy thus should not be considered either current or complete. 2009.9. see Chapter 19). (2009). tidal. 2008). and failures in power supplies are more likely Studies of the health co-benefits of reduction in air pollutants include to occur during extreme weather events (Section 19.0 1. there are potential health side effects of mitigation measures.0 .Human Health: Impacts. which is representative of valuing each DALY at the increases in energy demand. household fuel (poorly combusted biomass and coal) is responsible for much fine particle outdoor air pollution and may Essentially every human activity affects (and is affected by) climate and contribute to long-range transport of hazardous air pollutants (Anenberg health status in some way. 2008a) and reliance on air conditioning under a significantly hotter climate regime household sources (Po et al.2. Electrical power outages have been linked health (Jacobson et al.. The vertical lines of fossil fuels or non-renewable biomass fuels. although not discussed here. the atmospheric concentration of warming climate-altering pollutants that also hold the potential to significantly benefit human health. 2011). 2013). $7450/DALY.

see also declines in production or competitiveness in rural deforestation and degradation Sections 20.1. The burden of disease from outdoor exposures in a country may often be Smith et al. Po et al. Jacobson low carbon alternatives (Section 27. O’Neill et al.9. (2007). colorectal cancer (2012). associated co-pollutants from industrial emissions would decrease exposures to outdoor air carbon. Friel et al. Reductions of CAP emissions Babey et al. (2007). (2012). (2012). (2010). and preterm birth.. better self-perceived health status (2010). (2010). stroke.3. sources.9. Gribble et al.2. lung cancer. (2009). (2008). settlements (see also Sections 24. Reed and Ainsworth pollution due to modifications to the built reduced non-communicable disease burden. black carbon. (2011). Wilkinson et al. Jakszyn et al. Pan et al. Jensen et al. low birth weight and including CO2.4. Jarrett et al. 2013).5. (2009) may sometimes be less than anticipated emissions of CAPs associated with fuel combustion to decreases in fuel consumption because part of the efficiency benefit is taken and subsequent exposures to pollutants that are as more service. improved mental health. (2009). Venkataraman et al. access to essential services. (2009). (2009). greater in populations with low socioeconomic status. Ezzine-de-Blas et al. Outdoor Sources Globally. which can have beneficial effects on a range (particularly from ruminants) and replacement by from energy-intensive livestock Sinha et al.. (2013) Healthy low greenhouse gas emission diets. (2012) Reduction of greenhouse gases and Reductions in health-damaging co-pollutant Reductions in emissions of CO2. Chapter 11 Human Health: Impacts. the approximate are formed downwind from the combustion source via atmospheric 41% of all world households using solid fuels for cooking are all among 738 . environment. (2012). (2009). Lefohn et al. very few families who can afford to do so. (2011) reducing emissions from deforestation and through sale of Clean Development Mechanism promotes carbon sequestration degradation. both because of living in areas with higher exposures and because these populations often Another category of air pollution co-benefits comes from controls on have worse health and are subjected to multiple additional negative methane emissions that both reduce radiative forcing and potentially environmental and social exposures (Morello-Frosch et al. such as particulate matter (PM) and carbon use of biomass for cooking is distributed nearly inversely with income. Woodcock et al.1 and 26. Chapters 7 to 10) illnesses. such as power plants and landfills. public transport and higher density of urban reduced exposure to air pollution. known to be health damaging. Maas et al. (2007). (2009). 24. do not. Poverty alleviation and livelihood / job generation Reduces emissions of CAPs and Holmes (2010). Shindell et al. (2008). (2013) Energy efficiency. the largest exposures from the pollutants from poor fuel combustion occur in the poorest populations. and carbon offset sales (see and voluntary market credits. Anenberg et al. Apsimon et al. Reduced dietary saturated fat in some populations Reductions in CO2 and CH4 emissions McMichael et al.7. and Co-Benefits Table 11-3 | Examples of recent (post-AR4) research studies on co-benefits of climate change mitigation and public health policies. van Dillen et al. black Bell et al. World Health stillbirths.2) lung cancer. (2012). (2009).3) plant sources associated with decreased risk of systems (2009). Household Sources 11. Actual energy reduction Reductions in fuel demand potentially can reduce Reductions in emission of CAPs due Markandya et al. (2009). (2007). Grabow et al. Potts and Henderson (2012).7. (CAP = climate-altering pollutant. Kozuki et al. (2009). van den Berg et al.8. (ischemic) heart disease. 11 reduced noise. Xu et al. while Essentially. Diamond-Smith emissions. no poor family can afford gas or electricity for cooking and secondary co-pollutants.8) enhanced safety McCormack and Shiell (2011). 2011). more efficient generation or substitution of disease. replacing existing vehicles with lower Casagrande et al. with disease. Increases in active travel and reductions in Increased physical activity. by pollution and could reduce risks of cardiovascular (2009). West et al. (2010). (2010). West et al. (2008). 24. monoxide (CO) are those released at the point of combustion.4. Smith et al. 2012. change. For recent estimates of the global and regional burden of disease from the various risk factors involved. such as tropospheric ozone and sulfate particles.4.4. health associated with vehicle transport. This is because household Primary co-pollutants. pollution emissions. etc. Nemet et al. chronic and acute respiratory with household solid fuel use Wilkinson et al. (2011) Carbon sequestration in forest plantations. Reduces atmospheric CO2 via carbon Mitchell and Popham (2007). enhanced safety. benefits. CO. Durand et al. Kaczynski and Henderson (2008). and possibly tuberculosis and CH4 Organization Regional Office for Europe (2010). Babey et al.3.1. Hooper et al.. reduce human exposures to ambient ozone. (2009). (2013). reduced obesity. 26. (2010). Shonkoff et al. 2009) and can be transported long of other potential health benefits beyond reduction of particulate air distances. Ameliorate through reducing emissions from Chapter 13 and Section 15. solid fuel combustion (see also WGIII AR5. (2012) (processed meat consumption). Prata birth intervals and shifts in maternal age consumption and related CAP (2009). less impact on land use and Potts (2011). (2011). see Lim et al. including better access to service costs averted. (2009). Smith and Balakrishnan of health outcomes (see also Table 11. (2010). Increased fruit and vegetable consumption can reduce risk of chronic diseases. there are a range chemical interactions (Jerrett et al.3) communities If interventions result in reductions in coal combustion. 11. (2011). (2013) Increases in urban green space (Table 25-5) Reduced temperatures and heat island effects. pollution.) Co-benefit category Benefits for health Benefits for climate References Reduction of co-pollutants from household Potentially reduce exposures that are associated Reduces CAP emissions associated Bell et al. and other CAPs Jacobson (2009).1. Rive and Aunan (2010). Greater access to reproductive health services Lower child and maternal mortality from increased Potentially slower growth of energy Tsui et al. increased local emission vehicles could reduce air Rundle et al. chronic and acute respiratory illnesses. Puppim de Oliveira et al.6. psychological sequestration in plant tissue and soil (2008). Tollefsen et al. Adaptation. Smith et al. Dennekamp et al. (2011). CH4. 24. including food stores. (2011). (2009). Reduced CH4 emissions due to a decreased demand for ruminant meat products would reduce tropospheric ozone. for which methane is a precursor. (2009). including reducing other types of health-damaging emissions and the human impacts from coal mining (Lockwood. CO. Woodcock et al. Thus.

concluded that the net impact of BC emissions reductions the reduction of impacts from these fuels.. whether net warming or cooling. CH4 emissions are generally associated with combustion products in households burning biomass accepted as the primary anthropogenic source of tropospheric ozone and/or coal for cooking and heating. potential and WHO reviews of health impacts (WHO.. 2013). in 2010 or 4. 2010). (2010) found that 1-hour and 8-hour ambient ozone averages have 4. Bond et al.4. like CH4. non-methane hydrocarbons. Although health 739 . work and CO. 2010. however.5).. has not been found overall is not certain as to sign. especially to particles with diameters less than 2. 2012).8). This is consistent with for child pneumonia (Smith et al. 2008.. probably the greatest health and largest Reviews have concluded that abatement of particle emissions including climate impacts per household result from use of coal. Carmichael.e. On the other hand.1. and ecosystems Assessment (CRA) for outdoor air pollution done as part of the Global (WGI AR5 TS... making a total of about 4 million through regulatory tools that reduce the emissions of ozone precursors. either decreased or failed to increase due to successful regulations of there are also studies showing health benefits of household interventions. there would be co-benefits in circumstances where BC is to date and may require moving to clean fuels (Bruce et al. 2012). These results half a million premature deaths are attributed to household cookfuel’s point to the effectiveness of reducing ambient ozone concentrations contribution to outdoor air pollution.5. come in part from potential reduction of net warming by reducing emissions of aerosols (including black carbon). reductions in CH4 could lead to reductions in Burden of Disease (GBD) 2010 Project found approximately 3. WHO Regional Office for Europe. methane is also a significant and cerebrovascular disease... Baumgartner et al. in addition to the diseases noted concentrations above other human-caused emissions of ozone precursors above. adult chronic and child acute respiratory precursor to regional anthropogenic tropospheric ozone production. (Edwards et al. i. 2012).5 million premature deaths In an analysis of ozone trends from 1998–2008 in the USA.. globally—sufficient to prevent 30. and stillbirth have been associated (West et al. Although and the largest cohort study to date of the health effects of BC found biomass makes up the bulk of this fuel and creates substantial health that there were probably stronger effects on mortality from exposure impacts from products of incomplete combustion when burned in simple to BC than for undifferentiated fine particles (PM2. 2012). 2010) in adults and cognitive effects in children (Dix-Cooper et al. al.. reductions forcing.Human Health: Impacts. 11. health-damaging co-pollutants of from reduction of CH4 and other CAPs that are produced by incomplete CO2 from fuel use are carbon monoxide. 2005). such as PM reductions are epidemiologically significant. See WGI for more on climate (WGI AR5 Section 8. Shindell et al. meta-analysis.. 2011).9.. Primary Co-Pollutants 11. and emissions of nitrogen oxides and volatile organic compounds fell by chronic obstructive pulmonary disease (Chapman et al.5 µm (PM2.5. indicating a more conservative There is also growing evidence of exacerbation of tuberculosis (Pokhrel interpretation of the evidence for mortality from ozone (Lim et al. which can also BC represents an opportunity to achieve both climate mitigation and be contaminated with sulfur and a range of toxic elements as well health benefits (UNEP. in ambient PM concentrations have also been shown to decrease morbidity and premature mortality (Boldo et al. ozone exposures globally in 2010... 2011. Thus. respectively (Lefohn et al. 2013). 2006. Secondary Co-Pollutants Outdoor exposure to PM. and possibly other diseases. which in turn could result premature deaths globally from ambient particle pollution or about 3% in reductions in population morbidity and premature mortality and climate of the global burden of disease (Lim et al.4% of the global burden of disease (Lim et al. 2011) . is both Not every CAP emitted from fuel combustion is warming. 2010). The CRA of the GBD-2010 found 3. EPA. crops. 8-hour surface ozone by 1 ppb by volume. A significant One study found that a reduction of global anthropogenic CH4 emissions portion of ambient particle pollution derives from fuel combustion. to be easily accomplished with biomass/coal stove programs implemented Nevertheless. In addition to being a strong GHG. The most a strong CAP and health-damaging (IPCC.3... 2009).2 million ambient tropospheric ozone concentrations. 2012).9. Thus. 2004. The Comparative Risk itself is both a GHG and damaging to health. Ramanathan and prominent example is sulfur dioxide emitted from fossil fuel combustion..000 premature all-cause mortalities globally in 2030. but more confidently Other examples of climate forcing.5) (Smith et al. some of which. which illnesses. 2007.. a primary product of incomplete combustion. Lefohn et annually from household air pollution derived from cooking fuels or al.1. Importantly. CO has impacts on unborn children in utero through exposures done for the GBD-2010 estimated 150. 2007b). 2012). WGI AR5 (Box TS-6). and 370. 2010). are GHGs. Adaptation. blood pressure (McCracken et the EPA (2013) conclusion that in the USA.000 Because of higher exposures. 2007.. Another 59% and 57%. Black carbon (BC). and thus the indirect health co-benefits of CH4 strongly with exposures to incomplete combustion products.. ozone precursors. predominantly NOx and CH4. 2012)... and Co-Benefits Chapter 11 the poor in developing countries (Bonjour et al. 2013). which changes to particle sulfate in the atmosphere. 2012). an additional set of diseases has also been between 2010 and 2030 (West et al. low birth weight. contributes significantly to ill health including cardio. 2013). lung cancer.. combustion..4. stoves (Lim et al.3). Successfully accelerating however. as with diesel and climate benefits from improving household biomass fuel combustion kerosene combustion (Lam et al. cataracts. Each co-pollutant poses risks as well as are applied in areas relying on non-renewably harvested wood fuel being climate altering in different ways.9% of the global burden of disease (Lim et al. 2007). 2002). A systematic review. 2012). 2012). for the period 1980–2012. as well as reductions in net CO2 emissions if interventions and sulfur and nitrogen oxides. The emitted without many other cooling aerosols.000 premature deaths from all to their pregnant mothers (WHO Regional Office for Europe. Importantly. Zhang and Smith. lung cancer (Lan et al. by 20% beginning in 2010 could decrease the average daily maximum 11 perhaps 80% globally (GEA. et al.

Current evidence supports.. infant. CO2-eq (Wilkinson et al. One study showed that CO2 emissions could be lower were implemented on a global scale. 2009). The analysis also found that if the health the world (Rutstein. especially in protection. one-third of national BC emissions.9.2. 740 . that short birth intervals (defined as birth intervals ≤24 months and inter-pregnancy In their estimation of effects of hypothetical physical and behavioral intervals <6 months) are associated with increased risks of uterine modifications in UK housing.9. 2009). as A study of the benefits of a hypothetical 10-year program to introduce might be achieved by increasing access to family planning. and 4% of all national GHG emissions by hypothetical 11.3 million premature deaths by 2050 with avoided costs of premature because of income rise in developing countries and concurrent reduction mortality many times those of the estimated cost of abatement (West of greenhouse emissions in developed countries.35 to 4.. Conde-Agudelo et al. 5..5. Also. could be achieved. and infant mortality after controlling for et al. 2012).9. 11. Birth and Pregnancy Intervals substitution of clean household fuel technologies (Venkataraman et al. 2010). 2009) found that the magnitude and direction of implications for et al. Gribble et al. 2012)..52 million avoided premature that has both high fertility and high vulnerability to climate change deaths.2). changes in modes (Rutstein.3 to 37. sulfate particles have a cooling effect on global radiative benefits were valued similarly to the approach used by the EU for air forcing. 2010).. ventilation of low birth weight (Zhu. 2010). where there is unmet need for reproductive health and including climate change feedback showed potential reductions of services as well as high CO2 emissions per capita (Cohen. it was studies performed in the USA. 2009).1. 2011). reduction of sulfur emissions. per million population in 1 year.2. Thus. 2013).0 billion tons young and old mothers. and a savings of 0. there would be a reduction of 0.5 to 1. with 80% of the estimated health benefits occurring in Asia (Anenberg et al.000 premature deaths a year. 2012). Another study of India found a potential 11 to reduce 570. the estimated benefits to health by 30% by 2100 if access to contraception was provided to those would come predominately from reducing PM2..and World of CAPs (Cohen. Providing the avoided premature deaths. Case Studies of Co-Benefits of Air Pollution Reductions Population growth influences the consumption of resources and emissions A recent United Nations Environment Programme (UNEP). Zhu (2005) found. Access to Reproductive Health Services 11. in a review of three control. The greatest effect was found in India by 20% (approximately 2 million) the current excess child mortality in and the smallest in the EU. preterm birth. China. with medium confidence.. along with behavioral changes. However. does not qualify as a co-benefit activity because it actually the Indian context where emissions are high but costs of implementing acts to unmask more of the warming effect of other CAP emissions the measures are low (Markandya et al. (Smith et al. One study estimated that shifting birth spacing from of production of electricity to reduce CO2 emissions were found to reduce current patterns in the world to a minimum of 24 months would reduce PM2. 2005). 2007). Slowing population growth through lowering fertility... health depended heavily on the details of the intervention.5 and associated mortality. emissions per capita is expected in most scenarios by 2100 (WGI AR5 TS. (2009) assessed the changes in emissions of PM2. if all of 400 proposed BC and CH4 mitigation measures important factor.1. 2005.5 and Although an ecological analysis..04 to 0. would come from reducing PM2. a review across 17 countries shows a subsequent effects on population health that could result from climate strikingly coherent picture of the relationship between birth spacing change mitigation measures aimed to reduce GHG emissions by 50% and reductions in child.5. which is important for health pollution.6 megatonnes of CO2 was found with inter-pregnancy spacing between 18 and 23 months. About 98% of the avoided deaths proceeds (Potts and Henderson.7 to 4. Although population growth rates and total Meteorological Organization (WMO)-led study of BC and tropospheric population size do not alone determine emissions. a convergence in et al. however.6 million women expressing a need for it (O’Neill et al. and Co-Benefits damaging. population size is an ozone found that. the interventions were found to be generally positive for health.4 million avoided years of life lost) unmet need for these services in areas such as the Sahel region of Africa compared to tropospheric ozone (0.. and fuel switching. they offset the cost of GHG emission reductions. 2009). These calculations Another review of five cohort studies found that a birth interval shorter were made by comparing the health of the 2010 population with and than 18 months was significantly associated with increased low without the specified physical and behavioral modifications (Wilkinson birth weight. Wilkinson and colleagues (Wilkinson et rupture and bleeding (placental abruption and placenta previa) (Bujold al. Chapter 11 Human Health: Impacts. 2009).5. but also some rich reduction of PM and ozone exposures due to CAPs emissions controls ones like the USA.7 million avoided years of life lost) based on 2030 can potentially significantly reduce human suffering as climate change population figures (UNEP. Markandya et al. Adaptation. 2002... 2013). with risk of child by 2050 (compared with 1990 emissions) from the electricity generation undernutrition and mortality both increasing with shorter birth intervals sector in the EU. 2005). Another study of the This is important not only in poor countries. 1. In all three regions. that the smallest risk of low birth weight estimated that 850 fewer DALYs. and neonatal mortality. 0.5 (0. confounding factors (Kozuki et al. has been advanced combustion cookstoves in India found that in addition to associated with improved maternal and child health—the co-benefit— reducing premature mortality by about 2 million and DALYs by 55 million in two main ways: increased birth spacing and reducing births by very over that period. In a There is also a correlation between short birth interval and elevated risk strategy of housing modification that included insulation. and India.

vulnerability in low. and these are also the age groups that most often want to A recent scoping review identified quantitative peer-reviewed studies control their fertility (Engelman. it is the highest risk age adaptation assessments that focus on particularly vulnerable populations groups (youngest and oldest women) who reduce their fertility the most. as decisions today about mitigation will determine their likelihood. Ujah et al. (3) health implications of adaptation and mitigation decisions taken in other sectors. impact data and provide a basis for early warning systems as well as development of future scenarios. research will need to make the best use of traditional There is evidence that poverty alleviation. or both of which can lead to long-term physical and mental developmental mental health. quantitative estimation of the In other words. These include the long-term and systems for disasters and epidemics will help to protect health from climate uncertain nature of the exposure and effects on multiple physical and risks. There are also comparatively few studies of preterm delivery. and will be personally of health risks from climate change. family planning has a differential impact on maternal effectiveness of health adaptation measures. obstructed labor. 2009) while simultaneously reducing likely to come from cross-disciplinary studies. 11.9. (2) indirect impacts from environmental and ecosystem changes. example those arising from biofuel policies that compete with food production. expected to be relatively small in the next few decades. children born to women younger than the age of 20 disease pathways.10. such as shifts in patterns of disease- carrying mosquitoes and ticks. and encompass complex causal pathways. In addition. toxemia. and maternal death (Tsui et al. Given the increase globally in life expectancies. and violent conflict caused by population displacement.and middle-income populations. Providing access to family planning saves women’s lives by reducing the total number of births and. national governments. Studies of health co-benefits of climate change mitigation problems (Tsui et al. floods. Campbell-Lendrum. economic losses due to widespread “heat exhaustion” impacts on the workforce. and (3) indirect impacts mediated through societal systems. 2005. mothers. in the following areas: improved vulnerability and when women have access to family planning. and other extreme weather events in which climate change may play a role. and assessment of the health co- benefits of alternative climate mitigation policies. including public health total fertility and subsequent CAP emissions. and damage to health care systems by extreme weather events. Since AR4.. 2011). such as undernutrition and mental illness from altered agricultural production and food insecurity. Studies have found that decision makers.. such as the mortality and morbidity (including “heat exhaustion”) due to extreme heat events. or of more complex 2007). in particular. Potential negative side effects also need to be addressed. mortality reduction through reducing births in the highest risk groups and observational systems that link climate. public health interventions epidemiologic methods. bleeding.1 | How does climate change affect human health? Climate change affects health in three ways: (1) directly. stress. and (5) estimation of resource requirements. but plausible. on zoonotic diseases. Childbearing at later ages (>35 years) is policies also remain rare compared to the size of the potential health associated with increased risk of miscarriage and other adverse health gains. many babies born this have specifically called for increased research on (1) the scale and nature decade will be alive at the end of the century. but otherwise Although difficult.2. through the World Health Assembly. There are low-probability. Adaptation. Frequently Asked Questions FAQ 11. including taking into account the risks posed by climate including high-impact events.2. climate change health effects are scenarios for extreme climate regimes before the end of the century. health. 2007). 741 . Maternal Age at Birth to protect health. monitoring. 2012).. or increases in waterborne diseases due to warmer conditions and increased precipitation and runoff. while also taking into account the specific such as provision of water and sanitation. with the exception of studies on the effectiveness under the age of 20 years are at an increased risk of developing pregnancy or cost-effectiveness of targeted adaptation measures (Hosking and complications such as cephalopelvic disproportion. with the potential for diverse and widespread effects. and sanitation provision and diarrhea rates. change. (2) effectiveness of interventions affected by the climate that is in place in 2100. The key uncertainty is the extent to which society will strengthen biotic systems. and Co-Benefits Chapter 11 11. 2010). through the reduction of Relevant research for health protection in the near term is therefore births in high-risk groups (Prata. 11 these services. it is important to develop robust methods to climate-attributable cases of disease and injury will steadily increase. such as the effect of more extreme weather on water are at increased risk of fetal growth retardation and low birth weight. and early warning and response characteristics of climate change. investigate the health implications of conditions that may apply in 2100. 2005). With a strong response. for outcomes (Cleary-Goldman et al. and economic (Diamond-Smith and Potts. or other environmental stressors.Human Health: Impacts. Women who begin child bearing across all of these areas. (4) improvement in decision support Risk of death during delivery is highest in very young and very old systems and surveillance. surveillance. Key Uncertainties and Knowledge Gaps In the longer term..

Frequently Asked Questions FAQ 11. increasingly so as climate change progresses. Chapter 11 Human Health: Impacts. Priority interventions include improved management 11 of the environmental determinants of health (such as provision of water and sanitation). Programs that encourage “active transport” (walking and cycling) in place of travel by motor vehicle reduce both CAP emissions and offer direct health benefits..3 | Who is most affected by climate change? While the direct health effects of extreme weather events receive great attention. accelerating public health and medical interventions to reduce the present burden of disease. globally. Frequently Asked Questions FAQ 11. For example. Some areas currently prone to flooding may become less so. the diverse and global effects of climate change mean that higher income populations may also be affected by extreme events. Adaptation. the overall impact for nearly all populations and for the world as a whole is expected to be more negative than positive. Reducing consumption of meat and dairy products from these animals may reduce ischemic heart disease (assuming replacement with plant-based polyunsaturates) and some types of cancer. undernutrition. and diarrhea. 742 . increasing combustion efficiency in households cooking with biomass or coal could have climate benefits by reducing CAPs and at the same time bring major health benefits among poor populations. but also reduces emissions of fine particles that cause many premature deaths worldwide as well as reducing other health impacts from the coal fuel cycle. however. infectious disease surveillance. A major share of greenhouse gas emissions from the food and agriculture sector arises from cows. parts of the world may experience temperatures that exceed physiological limits during periods of the year. Frequently Asked Questions FAQ 11. For example some populations in temperate areas may be at less risk from extreme cold.5 | What are health “co-benefits” of climate change mitigation measures? Many mitigation measures that reduce emissions of those climate-altering pollutants (CAPs) that warm the planet have important direct health benefits in addition to reducing the risk of climate change. Energy efficiency and reducing reliance on coal for electricity generation not only reduces emissions of greenhouse gases. at least for moderate degrees of climate change. the latitude range in the world that may benefit from less cold (e. the higher-end projections of warming indicate that before the end of the 21st century. and may benefit from greater agricultural productivity.” For example. is the single most important step that can be taken to reduce the health impacts of climate change. the far north of the Northern Hemisphere) has fewer inhabitants compared with the equatorial latitudes where the burden will be greatest. Thus.2 | Will climate change have benefits for health? Yes. emerging risks. However.4 | What is the most important adaptation strategy to reduce the health impacts of climate change? In the immediate future. and Co-Benefits Frequently Asked Questions FAQ 11. This relationship is called “co-benefits. goats. who are most affected today by such climate-related diseases as malaria. but also will reduce the numbers of child and maternal deaths. the greatest burden will fall on poor countries. Alleviation of poverty is also a necessary condition for successful adaptation. Programs to provide access to reproductive health services for all women will not only lead to slower population growth and its associated energy demands. particularly on poor children. most assessments indicate that poor and disenfranchised groups will bear the most risk and. There are limits to health adaptation. However. and the spread of impacts from more vulnerable populations. particularly diseases in poor countries related to climatic conditions. and with the least capacity to adapt. and sheep—ruminants that create the greenhouse gas methane as part of their digestive process. climate change mainly harms human health by exacerbating existing disease burdens and negative impacts on daily life among those with the weakest health protection systems. and strengthening the resilience of health systems to extreme weather events. In addition. making it impossible to work or carry out other physical activity outside.g.

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