Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 15
Conference on Human Health and Global Climate Change: Summary of the Proceedings tropical and coastal areas and into cooler wilderness areas where they will be exposed to new and unfamiliar health threats. FIGURE 3. Ways in which global climate change may affect human health. (Adapted from IPCC, 1995) From another point of view, the difficulty of responding to global climate change lies in the rapid pace of the change—the projected rate of change is greater than has occurred on earth in the past 10,000 years. Although it appears that some of the global climate changes may be dealt with by the industrial world, adaptation will be more difficult in the developing world. The pace of global climate change may be complicated by an inadequate pace of institutional change. POLICY IMPLICATIONS At the end of the first day of the conference, presentations were made on potential policy implications for health surveillance, disease prevention, and health professional education. In addition, a special address was made by Brian Atwood, administrator of the Agency for International Development, on “Implications for International Cooperation ” (see Box 4). These presentations served as background and introduction for the breakout and working group panel discussions that occurred on the second day; information from those presentations has been integrated into the panel reports that follow. Panel Reports The second day of the conference was organized around six concurrent breakout and working group panels that considered the policy implications of global climate change and human health. The six panels were: (1) Global Surveillance and Response, (2) Disease Prevention, (3) Education for the Medical and Public Health Communities, (4) International Cooperation, (5) Research and Development Needs, and (6) Public Outreach and Risk Communication. These panels were asked to work from the assumption that global climate change would occur, and that its impacts on human health would be more or less as described in the foregoing discussion. Working from that assumption, the panels were charged with addressing the question, “What do we do about it?” That is, what strategic actions could, and should, be taken to anticipate adverse health effects before they occur and to reduce or mitigate those effects when they do occur? In addition, the panels were asked to identify both short-term (1 to 5 years) and long-term (5 to 25 years) strategies. The following summaries reflect the individual group chairs' sense of the participants' discussion in their respective working groups, further illuminated by the material presented in plenary sessions on the preceding day.
OCR for page 16
Conference on Human Health and Global Climate Change: Summary of the Proceedings Global Surveillance and Response3 The emergence of new diseases and the reemergence of familiar diseases represent a serious threat to many regions and, indeed, in a shrinking world, to the entire human species. In the future, therefore, it will be critical to have in place an integrated, worldwide surveillance and response mechanism for emerging infectious diseases. The purpose of such a system would be to shorten the time between the detection of the first case and the implementation of effective measures for treatment, prevention, and control. To the degree possible, therefore, it should also include surveillance for the various changes in climate and environment that may provide early warning signs of the possible outbreak of disease. The vital elements of such a system are (a) a rapid and comprehensive communications network; (b) accurate, reliable, laboratory-based diagnosis capabilities in host countries or regional centers; and (c) a mechanism for rapid response. The functioning of this system would also be aided by heightened cooperation among national and international health organizations. In the end, the creation of an integrated, worldwide system to monitor the occurrence and emergence of disease could become the most important international health policy initiative of the twenty-first century. The breakout panel reported that the most important problem in this area is the creation and maintenance of a critical mass of multidisciplinary expertise. Short-term strategies to address this problem include personnel exchanges, cross-training, and the establishment of a Vice Presidential Fellowship Program. Long-Term strategies include the encouragement of multidisciplinary training at all levels of relevant fields. The panel also endorsed earlier reports calling for the creation of an international consortium to address climate-related issues. One difficulty in doing this is the need for political will and interagency and global coordination. A short-term strategy would be to compile an inventory of existing resources and facilities that might become part of the effort, including sites and projects studying the environment and climate that could provide remote-sensing data and other indicators for health surveillance. There was no consensus on which agency should serve as the focal point for this coordination within the United States, although the Centers for Disease Control and Prevention, the NAS, the IOM, and the interagency Committee on International Science Engineering and Technology (part of NSTC) were offered as candidates. There was agreement, however, that the United States could not carry out this mission alone; it will be necessary to work with the resources, facilities, and institutions of other countries and international organizations. Finally, the importance of global surveillance and response was discussed as being critical to national security because military forces might need to be deployed to virtually any area of the world on short notice. Knowledge of emerging diseases and their potential impact on military operations is of great importance in the preparation of countermeasures to avoid such threats, reduce their impact, and provide a rapid response to outbreaks. 3 Dr. Ruth Berkelman, deputy director, National Center for Infectious Diseases, Centers for Disease Control and Prevention, cochaired this panel and summarized their discussion and findings.
OCR for page 17
Conference on Human Health and Global Climate Change: Summary of the Proceedings Strategies (see also Table 3). Short-term strategies: Create and maintain a critical mass of multidisciplinary expertise. Commission the NAS or the IOM to conduct a study of the problem. Long-term strategies: Encourage multidisciplinary training at all levels of relevant fields. Disease Prevention4 The reemergence in the Americas of infectious diseases that had been controlled in the past, such as cholera, plague, and dengue, as well as the emergence of new infectious agents, such as Hanta and Guanarito viruses, E. coli:0:157, and cryptosporidia, have had a direct impact on health policy and prevention efforts. Over the past several years, governmental and nongovernmental organizations have been working closely to modify health policy to place more emphasis on disease prevention. A major concern of these efforts are the changing dynamics of disease transmission, which are influenced by migration, land use, and environmental degradation. Many lines of action are being examined as ways to prevent diseases. One requirement for any response will be flexible management within the health sector closest to the vulnerable population to allow it to adapt to changing patterns of disease. In addition, the wide impact of infectious diseases such as AIDS requires a policy of increased intersectorial cooperation—that is, there must be fluid and open communication and management of health problems among health, environmental, and agricultural sections, supported by competent research that is based on careful policy analysis. Participants believed that policy reform, combined with broad public support gained by effective use of the mass media, will allow us to confront the health problems caused by global climate change and environmental degradation. Policies for disease prevention and control usually involve three responses: (1) removal of the hazardous exposure, (2) early detection (and investigation of the occurrence of diseases), and (3) treatment and control measures, such as prophylactic therapy. Primary prevention might include vaccinating children or draining stagnant pools where mosquitoes breed. In dealing with the health effects of global climate change, however, it would require preventing and even reversing greenhouse warming itself. This kind of “preprimary” or “primordial” prevention would be desirable but was beyond the scope of this conference. Nevertheless, there are still many actions that might be taken to mitigate the health effects of global climate change, especially in terms of anticipating what those effects will be and which populations are most at risk. Secondary prevention involves surveillance and early screening—the collection, analysis, and dissemination of pertinent data—and tertiary prevention involves responses—plans and facilities for rapid diagnosis and effective treatment to keep a disease from progressing. Secondary and tertiary 4 Dr. Jonathan Patz, research associate, Johns Hopkins School of Public Health, cochaired this panel and summarized their discussion and findings.
OCR for page 18
Conference on Human Health and Global Climate Change: Summary of the Proceedings BOX 3. Ecology, Epidemiology and Climate Change* Thomas E. Lovejoy Smithsonian Institution Altered levels of greenhouse gases like CO2 constitute an important environmental change by themselves in addition to those changes driven by the altered levels. Field studies of the effects of elevated CO2 on natural communities are limited at this point. Bert Drake's two-species marsh community at the Smithsonian Environmental Research Center—the longest running field experiment—shows that plants with a C4 photosynthetic pathway (e.g., a sedge) have a definite competitive edge over C3-pathway species (e.g., a grass). Within a group of C4 or C3 plants, however, it is not possible to predict in advance how various species will respond to higher levels of CO2. An initial study of part of a tree subjected to 2 months of elevated CO2 in a Panamanian rainforest led to yellowing of its leaves and reduced photosynthesis. It appears that the excessive accumulation of carbohydrates inhibits photosynthesis, with consequent high irradiation stress, photodamage, and loss of chlorophyll. The rest of the tree seems incapable of drawing off the excess photosynthates. This is, of course, different from a tree experiencing a CO2 increase occurring over years and decades or a tree that grows up in a high-CO2 environment. Of course, climate change will include not only CO2 elevation but also changes in temperature regimes, rainfall, and other hydrological patterns. There are almost no field experiments yet that combine more than a single one of these factors. Nonetheless, it is clear from the above findings that it is a mistake to think of elevated CO2 alone as a benign fertilizing factor for plants. Rather, it is important to recognize that elevated CO2 and associated climate change will instigate a cascade of effects that will ripple through natural communities with hard-to-envision epidemiological consequences. Paleoecological evidence relating to climate change during glacial/interglacial swings indicate rates of dispersal for plant species, especially trees, that are much slower (1/10th) than those projected by climate models. It is simply not known whether species could move faster. In addition, it is well known in North America and Europe, and to a lesser extent in the less studied tropics, that biological communities disassembled during those climate changes and different species moved at different rates and in different directions. Ultimately, species assembled in communities of different composition. The implications for epidemiology are difficult to envision, although worrisome. Climate change, whether human or naturally driven, will take place in landscapes that have been highly modified by human activity. This will dramatically lower opportunities for dispersal and consequently generate considerable extinction of species—that is, a reduction in biological diversity. What are the implications for human health? It is hard to be precise and to provide a lot of detail. Nonetheless, an abundance of changing relationships between species will undoubtedly affect epidemiology. Some changes, of course, may be beneficial, but the balance are likely to be detrimental because weedy species such as white-tailed deer will be favored over nonweedy species. It seems reasonable to anticipate epizootics and epidemics without any precedents. In addition, loss of biodiversity will impoverish the potential of biotechnology to contribute to the wealth of nations and will similarly diminish the potential of the life sciences to contribute to human health, wealth, and well-being. *Excerpts from a special briefing at the Conference on Human Health and Global Climate Change, September 11, 1995.
OCR for page 19
Conference on Human Health and Global Climate Change: Summary of the Proceedings prevention strategies are needed in most if not all nations. However, the creation of a global surveillance and response capability will require unprecedented international collaboration, including a softening of the traditional boundaries between sectors, agencies, and nations. Nongovernmental organizations and the media also have a important role to play in educating the population, without frightening them, and possibly changing some of their more destructive behaviors (see “Public Outreach and Risk Communication,” p. 24). The breakout group recommended that prevention activities focus on anticipatory, rather than reactionary measures. It identified six priority areas that overlap and incorporate those of other breakout groups: targeted, integrated surveillance that focuses on transitional zones and vulnerable populations; changes in medical education that incorporate environmental health into curriculum and board exams; international cooperation through information sharing and surveillance networks; methodological research to evaluate prevention and intervention programs and to identify vulnerable populations, transition areas, and other risk factors; public education and outreach aimed at policymakers as well as vulnerable popu-lations, especially children and the elderly; and public health infrastructure to conduct (a) research and (b) vaccine and exposure reduction programs. Strategies (see also Table 3). Short-term strategies: Compile an inventory of existing resources and facilities to study the environment and climate that could provide remote-sensing data and other indicators for health surveillance. Long-term strategies: Refocus or develop the public health infrastructure. Education for the Medical and Public Health Communities5 Despite increasing evidence that global climate change and ozone depletion may have serious consequences for human health, there is little understanding, both among policymakers and the public, of the extent of this potential threat. Physicians and public health professionals should be central figures in helping to promote an understanding of the health effects associated with climate change, but they are by and large uninformed about the topic, as their education does not, in general, cover the relationship of global environmental change to human health. 5 Dr. Max Lum, director, Office of Health Communications, National Institute of Occupational Safety and Health, cochaired this panel and summarized their discussion and findings.
OCR for page 20
Conference on Human Health and Global Climate Change: Summary of the Proceedings Physicians, nurses, and other health professionals have a vital role to play in responding to the health effects of global climate change. At present, however, physicians do not receive adequate training in occupational and environmental medicine, much less in the medical problems arising from global climate change, such as tropical diseases appearing in temperature zones. In the United States, for example, although two-thirds of medical schools include occupational and environmental health in their curricula, the average student receives only 6 hours of exposure to these subjects over 4 years of study. The situation is somewhat better in schools of public health. Yet for both medical and public health students in the United States there is essentially no time available in the curriculum to address the potential human health consequences of global climate change. For most professionals their principal source of information on global environmental health are articles in the scientific literature and conferences sponsored by nonprofit organizations. The breakout group agreed that health professionals should play a critical role in addressing the health effects of global climate change. The central questions panelists posed were (a) what do health professionals already know, (b) what do they want to know, and (c) what should they know. As a short-term strategy, the group recommended that the IOM and NAS conduct a study to identify core competencies and training mechanisms in the area of human health effects of global climate change, similar to a recent IOM study of environmental medicine (1995). Global climate and health issues should be incorporated into medical board exams, reflecting the importance of this subject for the training of physicians. The IOM and NAS might also broker efforts to promote faculty development in this area and to create centers of excellence in medical schools that would develop curricula in human health and global climate change. The group also recommended conducting a study to identify existing government and industry programs that protect workers from the effects of ultraviolet exposure. Such an activity could also increase awareness of the hazards of stratospheric ozone depletion. These efforts should be coordinated with those of professional, educational, and public service organizations. Health professionals should also help in developing educational materials and in presenting information to policymakers and the general public to help increase understanding of the health implications of environmental policies. These efforts should include the special needs of populations such as migrant workers and minorities that might not have adequate access to health care information. In the long term, it will be important to monitor the effectiveness of these and other programs and, more importantly, to disseminate their results. Strategies (see also Table 3). Short-term strategies: Have the IOM or NAS conduct a study to identify core competencies and training mechanisms in the area of global environmental health, similar to a recent IOM study of environmental medicine. Identify and study existing government and industry programs designed to protect workers from the effects of exposure to the sun.
OCR for page 21
Conference on Human Health and Global Climate Change: Summary of the Proceedings BOX 4. Implications for International Cooperation* Brian Atwood U.S. Agency for International Development By working closely with our developing country partners, the U.S. Agency for International Development is able to facilitate the subtle but critically important changes that raise awareness of the threats of climate change and help to shape preventative and responsive measures. Our work has informed other donors and encouraged them to invest in solutions we need. Developing countries in particular are on the precipice of global environmental change. They soon will be the leading source of greenhouse gas emissions, and the resulting climate change will take a heavy toll on their crowded coastal areas and fragile ecosystems. The extraordinary biological wealth of these countries is already threatened by poorly planned development that undercuts the natural capital they and we need for the future. Energy consumption and one of its unwelcome by-products, pollution in the form of carbon emissions, are growing fastest in developing countries and in countries whose economies are in transition. Developing countries are also experiencing rapid rates of deforestation and ecosystem degradation, which eliminates a primary sink for greenhouse gases. For example, over the last decade, 154 million hectares of tropical forests, equivalent to more than three times the land area of France, have been lost to other uses. The rate of that loss of biomass, especially in developing countries, is alarming. The resulting environmental degradations and misuse of natural resources create opportunities for new diseases, or old ones, to take hold. We use the phrase “emerging diseases,” yet for millions of people the new viruses have already emerged, and they have already claimed the lives of loved ones. The word “emerging” simply does not convey the urgency we sense. Only yesterday we were convinced that science had overcome the assault of these infectious diseases. Advances in antibiotic drugs, vaccines against childhood diseases, and improved sanitation technology all seemed to be winning the day. The incidence of polio, whooping cough, and diphtheria were declining. Fast-acting antibiotics reduced the threat of meningitis and bacterial pneumonia. But we now know that our euphoria was premature. We did not take into account the extraordinary resilience of infectious microbes, which have a remarkable ability to evolve, adapt, and develop resistance to drugs. Thus, diseases that were once thought to be under control have reemerged. There are many of these reemerging diseases, and they just do not appear only in the developing world nowadays. We find them in New Mexico, in Minnesota, in Virginia, and in New York. Around the world there is a resurgence of cholera, malaria, and yellow fever, often in drug-resistant forms. And of course, there is HIV and AIDS. We believe that global problems must be resolved at the local level. We know that these efforts must be aided by new breakthroughs in science and technology. Investment in research is essential if we are to keep up with the effects of ecological change. The battles we must fight against new microbes, new forms of crop blight, the spread of desertification, new forms of pestilence, and the rapid population growth make research more important than ever. We face a dynamic, rapidly accelerating set of new challenges, yet we are at risk of falling desperately behind the curve, as the changes we advertently and inadvertently introduce run far ahead of our resources and our knowledge base. Research is not like tap water. It cannot be turned off and on again without serious consequences. To be successful in these efforts, *Excerpts from remarks at the Conference on Human Health and Global Climate Change, September 11, 1995.
OCR for page 22
Conference on Human Health and Global Climate Change: Summary of the Proceedings governments must continue their support of the scientific community. This will require considerable efforts by federal agencies, by our university partners, and by nongovernmental organizations. The private sector is our natural partner. However, it does not cover the entire spectrum of research. It is dangerous to assume that the unfettered hand of Adam Smith will lead to the investments we need to deal with international health and environmental threats to the United States. That will require a coherent and cost-effective foreign assistance program backed by sound policies and global cooperation. We are uniquely placed as a nation to help the rest of the world meet these challenges. Our quality of life in the next century will be determined in large measure by how we meet the global challenges of today. Science and technology give us the tools we will need to meet the challenges of tomorrow. Long-term strategies: Monitor the effectiveness of these and other programs and, more importantly, disseminate their results. Incorporate questions about climate-related health issues on medical board examinations. International Cooperation6 Global climate change is believed to cause a wide variety of deleterious effects including desertification, changes in agricultural patterns, and disease. These effects are both direct and indirect, and the causes may be either natural or manmade. To the extent that global climate change and its impacts are influenced by human activity, methods must be found to mitigate, adapt to, or respond to them. The U.S. government is obligated to exercise leadership at home and abroad to ensure that responses are appropriate and timely. Every human being is vulnerable to the effects of global climate change, but the citizens of developing countries and regions face the most immediate dangers. In those areas, both climatic change and the need for responses to it may be greatest, but the available resources for addressing them is most limited. Clearly, the preventive and responsive measures we use to deal with global climate change and its effects must involve every affected person and operate society-wide. The breakout panel reported that many of the necessary systems and networks for international cooperation are already in place—the United Nations Environmental Programme, the World Health Organization, UNICEF, and networks of collaborating centers. What is required is improved coordination among existing systems to place the health effects of global climate change on their respective agendas and to ensure a two-way flow of information among them. The panel found a particular need to improve the links between agencies and organizations that conduct climate forecasting, health planning, health surveillance, and the implementation of health programs. 6 Dr. Rudi Slooff, Division of Environmental Health, World Health Organization, cochaired this panel and summarized their discussion and findings.
OCR for page 23
Conference on Human Health and Global Climate Change: Summary of the Proceedings One short-term strategy would be to incorporate health effects monitoring and reporting into existing global climate change activities, such as the Framework Convention on Climate Change program and the United Nations-sponsored “Climate Agenda.” Another strategy would be to look for the health effects of global climate change in the information already gathered for the ongoing U.S. Country Study Program. These efforts will be ineffective, however, unless they are accompanied by increased efforts to provide relevant information to national and international policymakers. In the long term, the panel recommended that global climate change and health issues be incorporated into sustainable development planning, not only by individual nations, but also by the World Bank, the United Nations Development Program, the Food and Agriculture Organization, and similar organizations. By the same token, health and climate planning should be broadened to include related environmental issues such as biodiversity. This, in turn, requires that stakeholders have better access to the information gathered, analyzed, and disseminated by the global surveillance system discussed by other breakout panels. Strategies (see also Table 3). Short-term strategies: Incorporate health effects monitoring and reporting into existing global climate change programs. Look for the health effects of global climate change in the information already gathered for other programs. Long-term strategies: Incorporate global climate change and health issues into sustainable development planning, not only by individual nations, but also by the World Bank, the United Nations Development Program, the Food and Agriculture Organization, and similar organizations. Broaden health and climate planning to include environmental issues such as biodiversity. Research and Development Needs7 Rather than enumerate the many specific research topics that need to be addressed, the breakout panel emphasized the need for an integrated, interdisciplinary R&D program that will encourage collaboration among experts and organizations from a wide range of fields and disciplines. Achieving this will probably require a concerted effort to overcome the boundaries that currently separate scientific disciplines, research institutions, budgetary programs, funding agencies, and international sponsors. In the United States, for example, funding would probably come from a consortium of federal agencies rather than from a series of small, fragmented programs. The research problems addressed by this program should include climatic variations that already pose health risks, as well as future effects of global climate change. 7 Dr. David Rall, foreign secretary, Institute of Medicine, cochaired this panel and summarized their discussion and findings.
OCR for page 24
Conference on Human Health and Global Climate Change: Summary of the Proceedings Strategies (see also Table 3). Short-term strategies. In the short term, the panel proposed that the program undertake pilot projects involving case studies that integrate three sets of variables: infectious diseases (e.g., cholera, dengue, malaria, and Lyme disease); mechanisms of susceptibility (e.g., UV-B and immune suppression, fine particulates, and cardiovascular or pulmonary disease); and global change drivers that might exacerbate or mitigate these problems (e.g., population growth, economic development, and urbanization). Possible models for these case studies are the Technical and Scientific Assessment and the United Nations Intergovernmental Panel on Climate Change. The case studies themselves could be performed by international organizations, by private groups, or by the IOM or NAS. Long-term strategies. The long-term goals of this program would be to identify and address gaps in current knowledge, and to disseminate and apply the lessons learned from the case studies. Public Outreach and Risk Communication8 Despite a wealth of scientific studies and technical information, the general public is not well informed on the relationship between global climate change and human health. Several participants made the analogy to the difficulties of informing the public about the dangers of nuclear war: Such information is highly technical, far removed from the common experience, disconcerting to contemplate, and often undermined by a vocal opposition. As a result, the first step in any outreach campaign would be to assess the information (and disinformation) that is already available to determine what further steps might be appropriate. The breakout panel endorsed the principles of risk communication that are embodied in the 10-step strategy outlined in Table 2. The primary long-term goals of this strategy are (1) involving the public by encouraging awareness and discussion, and (2) building bridges between the medical and environmental communities. In both cases, the panel recommended working through existing networks and infrastructures, initially targeting opinion leaders but making use of the full range of formal and informal intermediaries to reach broader audiences—not only churches and newspaper editors, for example, but also Boy/Girl Scouts and television weathermen, as well as medical associations, senior citizens' associations, and schools. 8 Dr. William Farland, director, National Center for Environmental Assessment, Environmental Protection Agency, cochaired this panel and summarized their discussion and findings.
OCR for page 25
Conference on Human Health and Global Climate Change: Summary of the Proceedings TABLE 2. Developing a Risk Communication Strategy for Global Climate Change Step 1: Review background information. (What messages are already out there?) Step 2: Set communication objectives. (What do we want to accomplish?) Example: Increase public awareness about the public health implications of global climate change. Step 3: Analyze and segment target audiences. (Whom do we want to reach?) Example: Construct communications based on audience attitudes. Step 4: Develop and pretest message concepts. (What do we want to say?) Step 5: Select communication channels. (Where do we want to say it?) Step 6: Create and pretest messages and products. (How do we want to say it?) Step 7: Develop a promotion plan. (How do we get it used?) Step 8: Implement communication strategies and conduct a process evaluation. (Let's do it!) Step 9: Conduct outcome and impact evaluations. (How well did we do?) Step 10: Feedback to improve communication effectiveness. (Where do we go from here?) Strategies (see also Table 3). The panel identified the following short-term action items, which might serve as the foundation for long-term efforts: Identify, contact, and infuse existing networks with health concerns related to global climate change. Use these networks as a feedback mechanism to find out what further information the public wants or needs. Distill the information generated by the present conference for dissemination through journal articles, editorials, op-ed pieces, targeted brochures, public service announcements, informational videos, or a home page on the World Wide Web. Establish a volunteer group or forum to continue the communication activities suggested or actually begun during the present conference. Develop a response capability to counter disinformation.
Representative terms from entire chapter: