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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, National Science Foundation, National Aeronautics and Space Administration, National Oceanic and Atmospheric Administration, U.S. Geological Survey, U.S. Global Change Research Program, and the Electric Power Research Institute. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsors.
Library of Congress Cataloging-in-Publication Data
Under the weather : climate, ecosystems, and infectious disease / National Research Council Division on Earth and Life Studies Board on Atmospheric Sciences and Climate Committee on Climate, Ecosystems, Infectious Disease, and Human Health.
Includes bibliographical references and index.
1. Medical climatology. 2. Epidemiology. 3. Communicable diseases.
I. National Research Council (U.S.). Committee on Climate, Ecosystems, Infectious Disease, and Human Health.
RA793 .U53 2001
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THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
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COMMITTEE ON CLIMATE, ECOSYSTEMS, INFECTIOUS DISEASE, AND HUMAN HEALTH
DONALD BURKE (Chair), Johns Hopkins University, Baltimore, Maryland
ANN CARMICHAEL, Indiana University, Bloomington
DANA FOCKS, U.S. Department of Agriculture, Gainesville, Florida
DARRELL JAY GRIMES, University of Southern Mississippi, Ocean Springs
JOHN HARTE, University of California, Berkeley
SUBHASH LELE, University of Alberta, Canada
PIM MARTENS, Maastricht University, Netherlands
JONATHAN MAYER, University of Washington, Seattle
LINDA MEARNS, National Center for Atmospheric Research, Boulder, Colorado
ROGER PULWARTY, University of Colorado, Boulder
LESLIE REAL, Emory University, Atlanta, Georgia
CHESTER ROPELEWSKI, International Research Institute for Climate Prediction, Palisades, New York
JOAN ROSE, University of South Florida, St. Petersburg
ROBERT SHOPE, University of Texas Medical Branch, Galveston
JOANNE SIMPSON, NASA Goddard Space Flight Center, Greenbelt, Maryland
MARK WILSON, University of Michigan, Ann Arbor
LAURIE GELLER, Study Director
SUSAN ROBERTS, Program Officer
JONATHAN DAVIS, Program Officer
TENECIA BROWN, Senior Program Assistant
BOARD ON ATMOSPHERIC SCIENCES AND CLIMATE
The Board on Atmospheric Sciences and Climate (BASC) was established by the NRC to advance understanding of the earth's atmosphere and climate, to help apply this knowledge to benefit the public, and to advise the federal government on problems and programs within the Board's areas of expertise. The BASC assisted in the development and oversight of the CEIDH study.
ERIC J. BARRON (Chair), Pennsylvania State University, University Park
SUSAN K. AVERY, Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder
HOWARD B. BLUESTEIN, University of Oklahoma, Norman
STEVEN F. CLIFFORD, National Oceanic and Atmospheric Administration, Boulder, Colorado
GEORGE L. FREDERICK, Radian Electronic Systems, Austin, Texas
MARVIN A. GELLER, State University of New York, Stony Brook
CHARLES E. KOLB, Aerodyne Research, Inc., Billerica, Massachusetts
JUDITH L. LEAN, Naval Research Laboratory, Washington, D.C.
ROGER A. PIELKE, JR., National Center for Atmospheric Research, Boulder, Colorado
MICHAEL J. PRATHER, University of California, Irvine
ROBERT T. RYAN, WRC-TV, Washington, D.C.
MARK R. SCHOEBERL, NASA Goddard Space Flight Center, Greenbelt, Maryland
JOANNE SIMPSON, NASA Goddard Space Flight Center, Greenbelt, Maryland
THOMAS F. TASCIONE, Sterling Software, Inc., Bellevue, Nebraska
ROBERT A. WELLER, Woods Hole Oceanographic Institution, Woods Hole, Massachusetts
ERIC F. WOOD, Princeton University, Princeton, New Jersey
Ex Officio Members
DONALD S. BURKE, Johns Hopkins University, Baltimore, Maryland
DARA ENTEKHABI, Massachusetts Institute of Technology, Cambridge
MARIO MOLINA, Massachusetts Institute of Technology, Cambridge
EUGENE M. RASMUSSON, University of Maryland, College Park
EDWARD S. SARACHIK, University of Washington, Seattle
ELBERT W. (JOE) FRIDAY, JR., Director
LAURIE S. GELLER, Program Officer
ALEXANDRA ISERN, Program Officer
PETER A. SCHULTZ, Senior Program Officer
VAUGHAN C. TUREKIAN, Program Officer
DIANE L. GUSTAFSON, Administrative Assistant
ROBIN MORRIS, Financial Associate
TENECIA A. BROWN, Senior Project Assistant
CARTER W. FORD, Project Assistant
Acknowledgment of Reviewers
This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the NRC in making the published report as sound as possible and to ensure that it meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:
William E. Gordon, Rice University, Houston, Texas
Nicholas Graham, Scripps Institution of Oceanography, San Diego, California
Donald A. Henderson, Johns Hopkins University, Baltimore, Maryland
Joshua Lederberg, The Rockefeller University, New York
Simon Levin, Princeton University, Princeton, New Jersey
Mercedes Pascual, University of Michigan, Ann Arbor
Roger Pielke, Jr., National Center for Atmospheric Research, Boulder, Colorado
Arthur Reingold, University of California, Berkeley
Peter B. Rhines, University of Washington, Seattle
David J. Rogers, University of Oxford, England
Mary Wilson, Harvard University, Cambridge, Massachusetts
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Lynn Goldman (Johns Hopkins University) appointed by the Division on Earth and Life Studies, and Gilbert Omenn (University of Michigan) appointed by the NRC's Report Review Committee, who were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Over the past several years, scientists, public health officials, and policy makers have become increasingly interested in understanding how the emergence and spread of infectious diseases could be affected by environmental factors, particularly variations in climate. In September 1995 the Institute of Medicine/ National Academy of Sciences and the National Science and Technology Council held a Conference on Human Health and Global Climate Change. Following this event, an interagency discussion group met several times and decided that a more in-depth exploration of this issue was needed, and thus plans were developed for this study on climate, ecosystems, infectious diseases, and health (CEIDH).
Support for this study was provided by the U.S. Environmental Protection Agency, the Centers for Disease Control and Prevention, the National Science Foundation, the National Aeronautics and Space Administration, the National Oceanic and Atmospheric Administration, the U.S. Geological Survey, U.S. Global Change Research Program, and the Electric Power Research Institute.
The study committee, consisting of 16 people from a broad range of disciplinary backgrounds, was appointed in January 1999; see Appendix A for biographical details on the committee members. Over the course of the next 18 months, six meetings were held, where the committee received briefings from federal agency representatives, talked with experts on a wide variety of topics relevant to the study, and worked on this report. See Appendix B for a detailed list of the discussion topics and speakers at the meetings.
While this study was under way, several other assessment activities related to the issue of climate and health were being carried out, for instance, by the American Academy of Microbiology, the U.S. Global Change Research Pro
gram, and the Intergovernmental Panel on Climate Change. The CEIDH committee has followed the progress of these other activities, and in fact some committee members participated in them. However, the committee's final deliberations, and the recommendations and conclusions contained in this report, were developed independently of these other activities.
As the report title implies, this study explores the linkages among climate, ecosystems, infectious diseases, and human health. This study is global in scope; the committee considered infectious disease threats not only to the United States, but also to populations around the world. The study focuses only on the issue of infectious diseases, but it should be noted that there are many ways that climate and weather can affect human health, including the direct physical impacts of temperature extremes and severe storms, and the respiratory effects of heat-exacerbated air pollution.
An important goal of this report is to help the different groups of researchers involved in climate and infectious disease studies gain a more realistic understanding of the current capabilities and limitations of each other's fields. For instance, climatologists need to understand that epidemiological data from many parts of the world are highly limited or nonexistent, and a great deal of effort will be needed to improve this situation. In turn, epidemiologists and other health professionals need to understand the considerable uncertainties associated with many aspects of climate forecasting. Improving this mutual understanding will help ensure that future research activities are effectively designed, and that all involved have realistic expectations about the feasibility of climate-based disease early warning systems.
The primary intended audiences for this report are the scientists and program managers responsible for planning and carrying out future research on this topic. However, this issue is certainly of interest to a wider audience, and thus the committee attempted to write a report that would be accessible to people from a broad range of educational and professional backgrounds.
|Cholera and other Vibrios,||57|
|5||ANALYTICAL APPROACHES FOR STUDYING CLIMATE/DISEASE LINKAGES||59|
|Observational and Experimental Studies,||59|
|Risk Assessment Frameworks,||68|
|Surveillance/Observational Data Needs,||73|
|6||TEMPORAL AND SPATIAL SCALING: AN ECOLOGICAL PERSPECTIVE||80|
|Biological Effects of Observed Climate Variability,||80|
|Confounding Influences on Ecological Forecasting,||82|
|7||TOWARDS THE DEVELOPMENT OF DISEASE EARLY WARNING SYSTEMS||86|
|Developing Effective Early Warning Systems,||87|
|Examples of the Use of Climate Forecasts,||97|
|8||KEY FINDINGS AND RECOMMENDATIONS||103|
|APPENDIX A:||BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS||127|
|APPENDIX B:||SPEAKERS/PRESENTATIONS AT THE COMMITTEE MEETINGS||132|