Global Climate Change and Extreme Weather Events Understanding the Contributions to Infectious Disease Emergence: Workshop Summary (2008) / Chapter Skim
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4 Policy Implications of the Health Effects of Climate Change and Extreme Weather Events
4 Policy Implications of the Health Effects of Climate Change and Extreme Weather Events
Pages 219-244
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The authors discuss the burgeoning influence of human mobility and migration on infectious disease emergence and describe a variety of ways in which interactions between climate and human behavior shape infectious disease dynamics, from the cataclysmic repercussions of extreme weather events to the slowly evolving impacts of increasing temperatures, sea level rise, and decreasing freshwater availability. If, as expected, climate change drives the simultaneous emergence of multiple infectious diseases along many possible pathways, the authors observe, preventing the global spread of individual pathogens is unlikely to be feasible.
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This is the position taken by WHO, which has evolved from assessing the health risks associated with climate change to an increasingly operational role in addressing these risks; Campbell-Lendrum discusses the organization's primary objectives in this area, which include raising public and political awareness of climate change, promoting health through climate change mitigation, and strengthening health systems to manage the additional burden imposed by climate change. Due in large part to its predicted far-reaching effects on health, climate change is viewed as a potentially powerful agent of geopolitical upheaval.
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Experts advising the NIC have predicted that climate change will produce water issues and damaging weather extremes, such as the flooding of major coastal cities, in North America and Asia; stress on marine ecosystems in Asia and Australia; flooding and heat waves in Europe; both flooding and drought in South America; intensification of drought in Australia; and increasingly extreme environmental changes at the world's poles. In addition to these climate change scenarios, which Engel characterized as "middle of the road," the NIC is considering the implications of unlikely but disastrous "threshold" events, such as the collapse of major ice sheets in Antarctica and Greenland or the stopping, slowing, or reversal of patterns of circulation in the North Atlantic current of the Gulf Stream, which provides warmth to Europe.
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The infectious diseases we carried and the new microbial agents that were encountered during this primordial migration have very much contributed to the evolutionary development of the human race. The slow and evolutionary process of population mobility driven by expedient "push" forces of available food and water supply, environmental events, physical hazards, and predation, were combined with corresponding "pull" factors of exploration, conquest, environmental suitability, and human curiosity.
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The association of human population mobility with global climate change and adaptation can be viewed through two lenses. The first is related to the total population number and spatial density of human beings on the planet and the associated energy requirements necessary for individual-to-communal growth and development.
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At the same time, those three factors also generate secondary influences on the distribution and epidemiology of infections through ecological change, contiguous extension of microbial and vector geographic patterns, and the incidental introduction of infectious diseases as a consequence of the movement of goods, conveyances, and people. The second lens through which to view global climate change and population mobility is provided by examination of the changing physical environment and the potential for extreme weather events to provoke or generate secondary adaptive population movements.
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Relationships Between Population Mobility and Global Infectious Disease Epidemiology Human population mobility can affect the global distribution of infections through either chronic, sustained, or acute short-term processes. Either of these situations allows for or supports the establishment of new, noncontiguous prevalence zones of infectious diseases -- what in this paper are called "skip" patterns of disease extension.
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. Additionally, greater attention is paid to the broader global epidemiological implications of population mobility and infectious diseases of importance to the health of the public.
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As noted above, tourism and other voluntary and usually temporary population movements, all associated with economic capacity, have the potential to bring individuals from low-risk regions into diverse environments that may also represent greatly enhanced risks for acquired infectious diseases (Fenner et al., 2007; Pistone et al., 2007; Sejvar et al., 2003)
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Policy Implications Related to Population Mobility, Climate Change, and Infectious Diseases Recognizing the relevant linkages between population mobility, climate change, and infectious diseases, and being able to address them at a programmatic level, require policy responses that are informed, robust, and feasible and extend across a spectrum from local to international scope. Existing methodologies used by some nations, such as the medical screening
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For example, climatic events precipitating large population movements may themselves be of magnitudes that exceed the capacity to mitigate or prevent the introduction of infectious diseases. Very large movements, such as seen in the Americas during school winter breaks, when thousands of people move to warmer regions for vacations, may overwhelm the existing local public health detection systems originally designed for the host population.
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Global climate change, extreme weather events, and infectious diseases are a complicated and complex interface involving several factors. Humans contribute to the issue, experience both the benefits and the deleterious consequences, and are the potential stewards of this dynamic interaction.
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, the empirical evidence that gradual climate change is already affecting health is limited to a few specific examples, but at the same time, the evidence that important diseases are climate sensitive, and therefore likely to be affected either now or in the future, is overwhelmingly strong. Related to this, much of the effort of the health sector is applied to addressing individual diseases with specific, often curative, interventions. This tends to lead to a focus on identifying single technological tools to address new risks, with a relative hesitancy to work across sectors to address the root causes of multiple health exposures, including environmental and social determinants (Commission on Social Determinants of Health, 2007; McMichael et al., 2008)
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Placing Climatic Influences on Infectious Diseases in Context The focus of this particular meeting of the Forum on Microbial Threats is on the potential effect of climate change on the emergence, reemergence, and spread of infectious disease. Such processes, bringing infections to new populations, have important public health implications.
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For these reasons, separating the effects of climate variability and change from the context of other determinants, or assessing the influence of climate versus other factors as a mutually exclusive "either/or" debate, is unproductive. Instead, considering climate as one important determinant of health risks, mediated by other contextual determinants, is more likely to lead to sound health policy.
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promoting health through climate change mitigation, and (3) strengthening health systems to address the additional health risks from climate change.
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3. Developing capacity to assess the risks from climate change for human health and to implement effective response measures, through further research and pilot projects, including on • the scale and nature of health vulnerability to climate change; • assessment of protection strategies and measures; • the health impacts of potential adaptation and mitigation measures in other sectors such as water resources, land use, and transport; • decision support and other tools, such as surveillance and monitoring, for assessing vulnerability and targeting protection measures appropriately; and • assessment of the likely financial costs and other resources necessary for health protection from climate change.
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The most obvious and immediate area of engagement, however, is in strengthening public health systems to protect populations against emerging health risks. In climate change policy, this corresponds to "adaptation" (i.e., minimizing the damages caused by climate change that is now inevitable)
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Most importantly at the global level, the newly revised International Health Regulations define operating procedures for detection, notification, and control of disease risks, including but not restricted to preventing the spread of infections across international borders (WHO, 2007)
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Morbidity and Mortality Weekly Report 55(9)
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2000. Population mobility and infectious diseases: the diminishing impact of classical infectious diseases and new approaches for the 21st century.
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Emerging Infectious Diseases 9(6)
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Clinical Infectious Diseases 44(8)
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2004. Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors.
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In Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors, edited by M Ezzati, A
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