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 Table of Contents  
REVIEW
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 8-19

Impact of climate change on health and strategies for mitigation and adaptation


National Institute of Cholera and Enteric Diseases, Kolkata, India

Date of Web Publication24-May-2017

Correspondence Address:
Alok K Deb
National Institute of Cholera and Enteric Diseases, Kolkata
India
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DOI: 10.4103/2224-3151.206918

PMID: 28612774

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  Abstract 


Climate change and its negative impacts on health are now globally recognized. A wide variety of diseases and health conditions – ranging from heat and radiation-related illnesses to water and vector-borne diseases, under-nutrition, respiratory and cardiac problems, drowning, injuries and mental stress arising from extreme and sudden weather events and their resultant population displacements – all have been associated with various components of changing climate. However, the exact nature and extent of such impacts are yet to be firmly established since many other non-climate factors also produce or affect similar outcomes. This calls for more research specially from the underdeveloped countries, where such impacts are disproportionately more but reliable data are remarkably less. Recognizing the importance of human influences on global warming, almost all countries in the world have undertaken some kind of policies and measures to mitigate adverse climatic changes. Unfortunately, even without further addition of greenhouse gases (GHGs) in our climate, the amount of GHGs already released has the potential to continue the damages for many more decades to come. Thus, all countries should also place priorities in assessing their own vulnerabilities from climate change and take adaptive measures accordingly. As climate change exerts its impact simultaneously in many non-health sectors as well, this would require strong intersectoral cooperation at various levels.

Keywords: Climate, health impact, adaptation, mitigation, strategies.


How to cite this article:
Deb AK, Kanungo S, Deb M, Nair GB. Impact of climate change on health and strategies for mitigation and adaptation. WHO South-East Asia J Public Health 2012;1:8-19

How to cite this URL:
Deb AK, Kanungo S, Deb M, Nair GB. Impact of climate change on health and strategies for mitigation and adaptation. WHO South-East Asia J Public Health [serial online] 2012 [cited 2021 Feb 28];1:8-19. Available from: http://www.who-seajph.org/text.asp?2012/1/1/8/206918




  Introduction Top


Climate change is one of the major challenges of our time. It adds considerable stress to our societies and to the environment. From shifting weather patterns that threaten food production, to rising sea levels that increase the risk of catastrophic flooding and coastal storm surges, the impacts of climate change are global in scope and unprecedented in scale. As the United Nations Secretary General has said, it is the major, overriding environmental issue of our time, and the single greatest challenge facing environmental regulators. It is a growing crisis with economic, health and safety, food production, security and other dimensions. Without drastic action today, adapting to these impacts in the future will be more difficult and costly.




  Causes of climate change Top


Factors that can shape climate are called climate forcings that include variations in processes such as solar radiation, earth’s orbit and positioning, oceanic currents, volcanic eruptions, mountain-building and continental drift, and greenhouse gas concentrations. The scientific consensus on climate change is that the changes in our climate are largely caused by human activities (anthropogenic)[2] rather than solar and other influences,[3] and that they are largely irreversible.[4]

The most important of these anthropogenic factors is the increase in “greenhouse gases” (GHGs) that primarily include water vapour, carbon dioxide, methane, nitrous oxide, and ozone [Table 1]. They are naturally present at low concentrations in the lower atmosphere to keep the earth’s mean surface temperature at around 15°C. Without this trapping of heat the mean air temperature would be −18°C and the earth would freeze. However, the atmospheric concentrations of GHGs have been increasing alarmingly since the early industrial revolution, owing principally to rapidly increasing combustion of fossil fuels along with increase in deforestation, irrigated agriculture, animal husbandry and manufacturing processes involved in production of lime, cement, steel, fertilizers, chemicals and several other products.[6],[7],[8] This has led the global mean surface temperature to increase by 0.4°C in the past 25 years, and it is projected to rise by about 1-3.5°C by 2100,[9] along with increased temperature variability across the globe.[10]
Table 1: The main greenhouse gases and their potential contributions in global warming[5]

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  Signals of climate change Top


The evidence for climatic change is taken from a variety of sources. Reasonably complete global records of surface temperature are available since the mid-late 19th century. For earlier periods, most of the evidence is indirect—climatic changes are inferred from changes in proxies, such as vegetation, ice cores, dendrochronology, sea level change, and glacial geology.

Besides ambient temperature, global warming is also projected to increase rainfall at high latitudes and high elevations. The migration of plants to higher altitudes has been documented on numerous peaks in the European Alps, Alaska, the Sierra Nevada and New Zealand.[11] These botanical trends, indicative of warming, have accompanied other physical changes such as the retreat of mountain glaciers across the globe.[12]


  Health impacts of climate change Top


A change in world climate would have wide-ranging, mostly adverse, consequences for human health.[13],[14] Most anticipated health impacts would entail increased rates of illnesses and death from familiar causes. About 2500 years ago, Hippocrates noted his observations about the influence of climate on public health, especially on the incidence and severity of various infectious diseases.[15] However, the future health outcomes may result from yet unknown climatic conditions, which in conjunction with other environmental changes, may also increase the likelihood of unfamiliar health outcomes, including the emergence of “new” infectious disease agents.[16]

In general, changes in climatic conditions can lead to three kinds of health impacts [Figure 1]: (i) direct impacts, usually caused by weather extremes; (ii) those due to various processes of environmental changes and ecological disruptions; and (iii) health consequences of population displacements and disruptions as a result of climate-induced economic dislocation, environmental decline, and conflict situations.
Figure 1: Direct and indirect health impacts of climate change and measures to prevent or reduce such impacts

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The consequences of indirect effects pose a greater challenge because they typically result from changes in complex processes. They include changes in the transmission of vector-borne diseases, types and quantity of air pollutants,[17] water quality and quantity, and productivity of agro-ecosystems,[18],[19] with the potential for displacement of vulnerable populations as a result of declines in food supply, disruptions in food chain due to oceanic acidification following increased atmospheric carbon dioxide[20] or sea-level rise.[9],[19] The El Niño phenomenon, which has raised awareness of the potential effects of climate variability on health and disease transmission,[13],[16] has been linked to outbreaks of malaria,[21],[22] cholera,[23] dengue fever,[24],[25] and other emerging infectious diseases.[26] The major types of health impacts potentially due to climate changes are summarized below.

Extreme weather-related health effects

The term “weather extremes” signifies individual weather events that are unusual in their occurrence or have destructive potential, such as hurricanes and tornadoes. The term “climate extremes” is used to represent the same type of event, but viewed over seasons (e.g. droughts), or longer periods. The global climate models predict that with increasing global warming the extreme weather events such as drought, floods and storms may become more frequent and intense in the future. Indeed, with warming of ocean surfaces[27] and increases in atmospheric water vapour due to increasing temperature, the resulting intensification of the hydrological cycle corresponds to evidence in the United States and other nations of an increase in heavy rain events and prolonged droughts in the 20th century.[10] There is evidence that El Niño events have increased in magnitude since the mid-1970s,[28] and climate change may alter the frequency and magnitude of the El Niño Southern Oscillation (ENSO) cycle.[29]

The number of people killed by climatic, hydrological and meteorological disasters in 2008 was the highest of the last decade, with 147 722 deaths reported worldwide.[30] Such extreme events also take a toll on mental health. Although not related to climate change, following the 2004 tsunami disaster, 14–39% of children in coastal communities in Sri Lanka suffered from post-traumatic stress disorder. Extreme weather events associated with climate change may have similar impacts.

Heat-related illnesses and deaths

Global warming is projected to increase the frequency of heat waves and decrease the frequency of winter cold spells. Rapid urbanization is an important cause of increasing temperature – producing “urban heat island” effects; as 60% of the global populations are projected to live in cities by 2030. This will increase the total population exposed to extreme heat.[31]

Heat exposure has a range of health effects, from mild heat rashes to deadly heat stroke; it also aggravates several chronic diseases, including cardiovascular and respiratory disease. The 2006 United States heat wave killed 139 humans in California. Also, heat-related deaths were reported from Chicago earlier. A study of 10 Canadian cities suggested that in Montreal for example, heat- related deaths would increase from 70 per annum to 240–1140 in an “average” summer in 2050 without acclimatization.[32] Past human influence on climate could be responsible for at least half the risk of the 2003 European heat-wave that caused 22 000-35 000 excess deaths.[33] The 2010 intense heat wave in western Russia was the most extreme in the instrumental record since 1880 for that region[34] and an increase of heat waves in the future has been predicted.[35]

The relationship between increased mortality and low temperatures is more complex than that with high temperatures. Thus, the degree to which cold-related deaths in temperate countries may decline with global warming is unresolved.

Water- and food-borne illnesses

Water-borne infectious diseases are also heavily affected by climate change. Both flooding and shortages of water can derange the sanitation system and quality and quantity of available water, especially in poor areas. In Bangladesh, cholera cases[36] increased by both high and low rainfalls which, along with higher temperature, also increased non-cholera cases.[37] Studies from India also showed a relationship between number of cholera cases and rainfall anomalies.[38] In Fiji, diarrhoea reports among infants increased by 2% per unit increase in rainfall and by 8% per unit decrease in rainfall. When the temperature variable was lagged by 1 month, there was approximately a 3% increase in diarrhoea cases per degree increase in temperature in the previous month.[39] Similar associations have been observed in many other developing country settings.

Several recent papers discussed the effects of El Niño on diarrhoeal diseases.[40],[41] A marked increase in the number of cases of diarrhoea and dehydration in infants and young children was observed in Lima, Peru, during an El Niño event; others also described increased hospitalizations due to childhood diarrhoea during such events.[40]

Climate change may have both direct and indirect impacts on the occurrence of food safety hazards at various stages of the food chain. Climate change affects the microbial population of the macro-environment (soil, air and water) and the population of pests or other vectors, thereby contributing to the occurrence of diseases attributable to fungi, bacteria, viruses and insects. Factors such as nutrient deficiencies, air pollutants and temperature/moisture extremes also affect plant health and productivity. Evidence of the impact of climate change on the transmission of food and water-borne diseases comes from a number of sources, e.g. the seasonality of food-borne and diarrhoeal diseases, changes in disease patterns (e.g. salmonellosis and campylobacteriosis) that occur as a consequence of temperature,[42] and associations between increased incidence of food- and water-borne illness and severe weather events.[43]

Vector- and rodent-borne diseases

Climate change is expected to have a pronounced effect on vector-borne diseases such as malaria or dengue fever, with visible effects in areas where the diseases are newly introduced and people have little resistance built up. Global warming will extend favourable zones for vectors. For example, in Africa, this will often be at higher elevations that were formerly too cold to support these diseases. A warmer environment boosts the reproduction rate of mosquitoes and the number of blood meals they take, prolongs their breeding season, and shortens the maturation period for the microbes they disperse. In poorer countries, this may simply lead to higher incidence of such diseases. Populations living at the present margins of malaria and dengue, without effective primary health care, will be the most susceptible if these diseases expand their geographic range in a warmer world.

Rough models of the spread of malaria affected by global warming show that malaria prevalence may increase by 50 million to 80 million cases per year with an associated 3°C rise in average global temperature by the year 2100. In India, studies indicated that in the 2050s, malaria is likely to persist in eastern India, while it may shift from the central Indian region to the south western coastal states.[44] Also the northern states may become malaria prone in the future climate change regime. Similarly, increases in the incidence of malaria and/or a shift to newer areas will also occur in many countries in the African region,[13] where malaria accounts for about 10% of the total disease burden.[45]

Changes in temperature also affect breeding and dwelling habits of other vectors such as flies and ticks, while changes in precipitation affect the range and distribution of these vectors. Thus, other vector-borne diseases such as schistosomiasis, Chagas disease, sleeping sickness, river blindness, and encephalitis all could change their ranges and patterns of infection in the course of climate change.[46] For example, recent modelling of the response of schistosomiasis to current global warming trends suggests that an additional five million cases will appear per year by 2050.[13]

Air pollution-related health effects

Usually, air pollution is differentiated into three broad categories: ambient, indoor and trans- boundary. All three types are strongly affected by climate—precipitation, wind, temperature, radiation—and thus by changes in climate. At the same time, air pollution is thought to be one of the major contributors to the present situation of “climate change”. Worldwide, the World Health Organization (WHO) estimates that as many as 1.4 billion urban residents breathe air with pollutant concentrations exceeding the WHO air guideline values.

Although the causes and consequences of air pollution are often localized, transboundary movement of air pollutants has regional as well as global implications. Acid deposition, global climate change, and stratospheric ozone depletion are among the emerging issues that transcend political boundaries.

Air pollution results from the combination of high emissions and unfavourable weather. The two air pollutants of most concern for public health are surface ozone and particulate matter. Transport is one of the main sources of air pollution, for which evidence on direct effects on mortality as well as on respiratory and cardiovascular disease is firmly established. The combustion of fossil fuel leads to emissions of greenhouse gases (GHGs), particularly carbon dioxide, in addition to conventional air pollutants like carbon monoxide, volatile organic compounds, carbonaceous aerosols (“soot”), nitrogen oxides and sulphur dioxide. Some of these compounds react in the atmosphere to form secondary pollutants such as ozone, particulate sulphate, nitrate and organic matter, producing impacts on ecosystems and human health.

Allergic disorders

Climate change will affect air quality, including production and allergenicity of aeroallergens such as pollen and mold spores, and increases in regional ambient concentrations of ozone, fine particles and dust. Some of these pollutants can directly cause or exacerbate respiratory disease in susceptible individuals. Precipitation-affected aeroallergens such as mold spores may cause respiratory allergic airway symptoms in 5% individuals over their lifetime.[47]

Storm surge-related drowning and injuries

Atlantic tropical storm and hurricane destructive potential as measured by the Power Dissipation Index (which combines storm intensity, duration and frequency) has increased substantially over the past 50 years in association with warming Atlantic sea surface temperatures.[48] It is very likely that human-induced increase in greenhouse gases has contributed to the increase in sea surface temperatures in the hurricane formation regions. Analyses of model simulations suggest that for each 1°C increase in tropical sea surface temperatures, the core rainfall rates will increase by 6-18% and the surface wind speeds of the strongest hurricanes will increase by about 1-8%. This may result in huge loss of lives and serious injuries among people along with damages to infrastructure in affected areas.

Effects on nutrition

Food-borne illness and food insecurity, both likely outcomes of climate change, may lead to malnutrition. While adult humans exposed to mild famine usually recover quite well when food again becomes plentiful, nutritional reductions to a fetus in the womb appear to have lasting effects throughout life. Malnutrition and under-nutrition in pregnant women are a global cause of low birthweight and other poor birth outcomes that are associated with later developmental deficits.

Drought has been shown to encourage crop pests such as aphids, locusts and whiteflies, as well as the spread of the mold Aspergillus flavus that produces aflatoxin, a substance that may contribute to the development of liver cancer in people who eat contaminated corn and nuts.[49] The spread of agricultural pests and weeds may lead to the need for greater use of some toxic chemical herbicides, fungicides and insecticides, resulting in potential immediate hazards to farm workers and their families, as well as longer-term hazards to consumers, particularly children.

Health problems of displaced populations

It is also highly likely that the long-term effects of climate change will displace significant numbers of people, many of whom are already vulnerable members of society. Extreme weather events, sea-level rise, destruction of local economies, resource scarcity, and associated conflict due to climate change are predicted to displace millions of people worldwide over the coming century. By 2050, 200 million people may suffer from climate change-related displacements;[50] in 2008, Asia was the most affected continent with more than 30 million people displaced due to natural disasters.[51] In addition, people will continue to experience place-based distress caused by the effects of climate change due to involuntary migration or the loss of connection to one’s home environment, a phenomenon called “Solastalgia”.

Strategies to reduce/prevent health impacts of climate change

The health risks associated with climate change call for a broad spectrum of policy responses and strategies at local, regional, national and global levels. According to the United Nations Framework Convention on Climate Change (UNFCCC), the two fundamental response strategies include mitigation and adaptation. The mitigation processes intend to limit climate change by reducing the emissions of GHGs whereas adaptation aims to alleviate the adverse impacts through a wide range of actions.

Mitigation strategies

In general, mitigation policies are developed in response to a perceived risk of climate change impacts. However, deciding on a proper response involves a lot of uncertainties due to lack of complete and reliable data on specific risks.[52] The mitigation strategies mostly involve identification and selection of actions to reduce GHG emissions. Since these emissions are strongly tied to human activities that support life systems, it is necessary that such strategies should promote sustainable and equitable development while reducing the concentration of GHGs. This is a major challenge because of diversities in responsibility and obligations and developmental needs of countries around the world. For example, industrialized countries have only 25% of the world’s population but are responsible for most of the current and past global GHG emissions including 75% of carbon dioxide emissions.[53] However, a large number of tools and techniques are available that can assist countries and regions to determine the appropriate strategies. Of course they will need to be continuously adapted so as to overcome the numerous barriers and threats that remain in implementing actions to mitigate the negative effects of climate change.

Limiting carbon dioxide emissions is central in reducing GHG emissions. Carbon dioxide is emitted to the atmosphere by three main sources – energy production and use (contributes over 70% of the total), industrial activities and land use changes. Current trends show that energy demand will continue to increase for most countries of the world in the future. In developing countries it is due to the need to overcome poverty and cope with high population growth, while in newly industrialized countries it is due to the tendency to replicate past energy use patterns of industrialized countries. The Inter-government Panel on Climate Change (IPCC)‘s Special Report on Renewable Energy Sources and Climate Change Mitigation (SRREN) noted the significant potential of renewable energy to mitigate climate change and to provide wider benefits. Several studies assessed how greenhouse gas mitigation measures in the electricity generation sector can benefit health due to changes in particle air pollution emissions. It was observed that health benefits greatly offset costs of GHG mitigation, especially in India where pollution is high and costs of mitigation are low.[54] As mentioned previously, the threat of climate instability will have impacts that no single country alone can solve.

Adaptation strategies

Adaptation to the adverse effects of climate change is vital in order to reduce the impacts of climate change that are happening now and to increase resilience to future impacts.[55] Proper adaptation requires natural resource management, enhancing food security, development of social and human capital and strengthening of institutional systems. Such processes, besides building the resilience of communities, regions and countries to adverse climatic impacts, are good development practice in themselves.

Successful adaptation not only depends on governments but also on the active and sustained engagement of different stakeholders. Adaptation strategies that are community-based can greatly benefit from knowledge of local coping strategies. For instance, the National Adaptation Programmes of Action (NAPAs), which are based upon existing information and community-level inputs, provide an important way to prioritize urgent and immediate adaptation needs for the least developed countries. However, to take adaptive measures, most of these countries would require international assistance in terms of funding, technology transfer and capacity building.

Since health care is a major economic sector worldwide[56] and major health organizations, including WHO, hold that climate change is a major public health concern, the health sector has to take a leadership role to address mitigation and adaptive issues. The adaptive measures include public health response to changing patterns of disease transmission and natural disasters, such as setting up effective surveillance and response systems, formulating integrated measures for rapid response after natural disasters, and strengthening institutional capacity including procurement of necessary and sufficient supplies. The mitigation measures, on the other hand, may include activities like building energy-efficient facilities, use of natural ventilation and daylight, on-site rainwater capture and treatment, appropriate waste/ sewage treatment, improving access to health care by mass transport and expanded use of tele-health. For example, rainwater harvesting is one conservative measure widely promoted in the WHO South-East Asia Region.[57]

Some of the most effective actions by health professionals will nevertheless involve supporting other sectors’ efforts to mitigate and adapt to climate change. The ultimate goal of the public health community, however, should go beyond reacting to a changing climate. A true preventive strategy needs to ensure the maintenance and development of healthy environments, since in the long term sustainable development and protection of ecosystem are fundamentally necessary for human health.



 
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