Search

Climate change will increase extreme heat related health risks. To quantify the health impacts of mid-century climate change, we assess heat-related excess mortality across the eastern United States. Health risks are estimated using the US Environmental Protection Agency’s Environmental Benefits Mapping and Analysis Program (BenMAP). Mid-century temperature estimates, downscaled using the Weather Research and Forecasting model, are compared to 2007 temperatures at 36 km and 12 km resolutions. Models indicate the average apparent and actual summer temperatures rise by 4.5° and 3.3 °C, respectively. Warmer average apparent temperatures could cause 11,562 additional annual deaths (95% Confidence Interval, CI: 2,641–20,095) due to cardiovascular stress in the population aged 65 years and above, while higher minimum temperatures could cause 8,767 (95% CI: 5,030–12,475) additional deaths each year. Modeled future climate data available at both coarse (36 km) and fine (12 km) resolutions predict significant human health impacts from warmer climates. The findings suggest that currently available information on future climates is sufficient to guide regional planning for the protection of public health. Higher resolution climate and demographic data are still needed to inform more targeted interventions.

Climate change, as an environmental hazard operating at the global scale, poses a unique and “involuntary exposure” to many societies, and therefore represents possibly the largest health inequity of our time. According to statistics from the World Health Organization (WHO), regions or populations already experiencing the most increase in diseases attributable to temperature rise in the past 30 years ironically contain those populations least responsible for causing greenhouse gas warming of the planet. Average global carbon emissions approximate one metric ton per year (tC/yr) per person. In 2004, United States per capita emissions neared 6 tC/yr (with Canada and Australia not far behind), and Japan and Western European countries range from 2 to 5 tC/yr per capita. Yet developing countries’ per capita emissions approximate 0.6 tC/yr, and more than 50 countries are below 0.2 tC/yr (or 30-fold less than an average American). This imbalance between populations suffering from an increase in climate-sensitive diseases versus those nations producing greenhouse gases that cause global warming can be quantified using a “natural debt” index, which is the cumulative depleted CO2 emissions per capita. This is a better representation of the responsibility for current warming than a single year’s emissions. By this measure, for example, the relative responsibilities of the U.S. in relation to those of India or China is nearly double that using an index of current emissions, although it does not greatly change the relationship between India and China. Rich countries like the U.S. have caused much more of today’s warming than poor ones, which have not been emitting at significant levels for many years yet, no matter what current emissions indicate. Along with taking necessary measures to reduce the extent of global warming and the associated impacts, society also needs to pursue equitable solutions that first protect the most vulnerable population groups; be they defined by demographics, income, or location. For example, according to the WHO, 88% of the disease burden attributable to climate change afflicts children under age 5 (obviously an innocent and “nonconsenting” segment of the population), presenting another major axis of inequity. Not only is the health burden from climate change itself greatest among the world’s poor, but some of the major mitigation approaches to reduce the degree of warming may produce negative side effects disproportionately among the poor, for example, competition for land from biofuels creating pressure on food prices. Of course, in today’s globalized world, eventually all nations will share some risk, but underserved populations will suffer first and most strongly from climate change. Moreover, growing recognition that society faces a nonlinear and potentially irreversible threat has deep ethical implications about humanity’s stewardship of the planet that affect both rich and poor.

Nonsustainable depletion of our natural resources threatens ecosystems, wildlife populations, and ultimately human/societal health and well-being. Our understanding of these linkages rapidly is becoming clear, as documented in international assessments such as the Millennium Ecosystem Assessment and the United Nations Intergovernmental Panel on Climate Change (IPCC). There is a subsequent need to establish a nexus for the cross-sectoral and interdisciplinary efforts examining these ecology/health relationships. I am pleased to formally announce the establishment of a revitalized and expanded international association to do just that! The International Association for Ecology and Health was launched at the EcoHealth ONE Conference that took place October 6–9, 2006, in Madison, Wisconsin. Nearly 400 attendees, including over 250 presenters from 30 countries around the world, and from several scientific disciplines, participated in the event. Most importantly, the Conference attracted over 30 new student members, and there is a vibrant student organization within the Association. This new Association incorporates ongoing work from organizations such as the expanding Consortium for Conservation Medicine, governmental agencies such as the Canadian International Development Research Centre (IDRC), and past efforts of organizations such as the Society for Ecosystem Health, just as a few examples of spheres of science and policy coming together under this expanded and well-networked international organization. The new Association builds on and combines member scientists, academics, and practitioners. The International Association for Ecology and Health (‘‘EcoHealth,’’ serving as the official simple ‘‘acronym’’) Figure 1. International Association for Ecology and Health President Elect, Jonathan Patz, MD, MPH.

The increasing burden of emerging infectious diseases worldwide confronts us with numerous chal- lenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on ''transdisciplinary approaches'' to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases. We describe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social-ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them.

Professor Emeritus Anthony J. (Tony) McMichael, MBBS, PhD, who passed away on September 26, 2014 was a hugely influential pioneer of global environmental health and a giant in the field of environmental epidemiology. He could be regarded along with other legendary names like Rene Dubos and Rachel Carson, who during their lives, challenged conventional assumptions and majorly advanced our understanding of the links between our environment and our health in the twentieth century; Tony Michael’s discoveries and teachings are foundational for the global challenges facing us today in the twenty-first century. McMichael’s exemplary and impactful career includes some of the most important advancements to date in the field of environmental and occupational health. For example, McMichael was the epidemiologist and co-author for the 15-year prospective study on children’s IQ and lead exposure: the Port Pirie study. Tony therefore was among the first health scientists to provide robust quantitative evidence of the link between lead and brain function. Tony McMichael’s next major discovery applied to occupational health. Hazardous exposures in the workplace were common in our industrializing era, with subsequent morbidity and mortality among workers. Eventually, guidelines were made establishing ‘‘safe’’ levels of exposures to workers. But why did workers continue to get sick? It was Professor McMichael who first described ‘‘The Healthy Worker Effect’’—whereby very sick individuals who were no longer in the workforce were left out of risk calculations. This discovery led to lowering the exposure thresholds across numerous occupational settings. I first met Tony at the World Health Organization in 1993. At that time, WHO had just been approached by the United Nations Intergovernmental Panel on Climate Change (IPCC) to contribute a health chapter for their 2nd Assessment Report—the subject of health was missing in IPCC’s first report. Naturally, it was Professor Tony McMichael who was invited to serve as ‘‘Convening Lead Author, a role for which he graciously undertook across many IPCC Assessment Reports. He also served as the lead on many other high-level international initiatives addressing global environmental health challenges. McMichael produced over 300 peer-reviewed papers and three major books, including his 1993 book Planetary Published online: November 19, 2014

Repeatedly these days, we read about newly emergent diseases or public health catastrophes, from severe acute respiratory syndrome (SARS) and avian influenza to the 2003 European heatwave and 2005 Hurricane Katrina. New diseases have always cropped up throughout history, especially since the age of modern agriculture, which brought about a major shift in our societal practices and personal behaviors. Thus, in some ways, these new health threats are not new; but are they occurring at an accelerating frequency? Many would argue that indeed they are, and this begs the question, why? Could it be that our rapid rate of ecological and earth systems change is shifting the balance in a way that enhances disease risk? Intact ecosystems play an important role in regulating the transmission of many infectious diseases, according to the Millennium Ecosystem Assessment (an international assessment of the links between ecological conditions and human well-being (www.millenniumassessment.org)). Biological mechanisms that have altered the incidence of many infectious diseases include altered habitat (leading to changes in the number of vector breeding sites or reservoir host distribution), niche invasions or interspecies host transfers, changes in biodiversity (including loss of predator species and changes in host population density), human-induced genetic changes of disease vectors or pathogens (such as mosquito resistance to pesticides or the emergence of antibiotic-resistant bacteria), and environmental contamination of infectious disease agents. Unhealthy landscape changes are well known in the literature. New water projects may provide increased food crops, but they also provide ideal habitat for snails that serve as the intermediate reservoir host species for schistosomiasis; irrigated rice fields increase the extent of mosquito breeding areas, leading to greater transmission of mosquito-borne malaria, lymphatic filariasis, Japanese encephalitis, and Rift Valley fever. Deforestation alters malaria risk, depending on the region of the world, by favoring the proliferation of Anopheles gambiae and A. darlingi in Africa and South America, respectively. Noninfectious diseases also have their roots in environmental and ecological degradation. Unplanned urbanization and sprawl contribute to numerous health conditions in the ‘‘built’’ environment: obesity, heart disease, and diabetes are exacerbated by sedentary lifestyles from our overdependence on automobiles; heat-related mortality and respiratory illness are exacerbated by the urban ‘‘heat island’’ effect; and depression and social isolation are exacerbated by a reduction in social capital and other stresses of urbanized living. In recognition of the inextricable links between ecosystems, earth systems, and human and wildlife health, the first conference of the International EcoHealth Association (‘‘EcoHealth ONE’’) will convene in Madison, Wisconsin, October 7–10, 2006. International experts from the fields of Published online: January 21, 2006 Correspondence to: Jonathan A. Patz, e-mail: patz@wisc.edu EcoHealth 3, 66–67, 2006 DOI: 10.1007/s10393-005-0011-7