Climate Sense

Managing climate related health risks

S.J. Connor, International Research Institute for Climate and Society

ood health status is one of the primary aspirations of human

social development. Consequently, health indicators are key

components of human development indices – for example,

the Millennium Development Goals (MDGs), by which we measure

progress toward sustainable development.

Certain diseases and ill

health are associated with particular environmental, seasonal and

climatic conditions. This was recognized by the ancient writers of

Vedic literature, and by Hippocrates, but largely overlooked during

the development of modern medicine. However, community and

public health services are showing increased awareness of these

associations, and climate and health interactions are the focus of

considerable research today. During 2008, many high-level policy

recommendations were made on the importance of climate and envi-

ronmental change and its potential impacts on health. Climate and

healthwas the topic ofWorldHealthDay and a special resolution on

climate and health was passed by the 61st World Health Assembly.

Climate impacts on health through a number of mechanisms. This may

be directly, through cold or heat stress, or indirectly through its impact

on communicable and non-communicable disease. Climate and weather

extremes cause hazards, drought, food insecurity, social disruption and

population displacement – leading to greater exposure to malnutrition,

diseases or accidental death. The World Health Organization (WHO)

recently identified 14 climate sensitive communicable diseases, includ-

ing malaria, meningitis, cholera and dengue. WHO describes these

diseases as being candidates for the development of climate informed

early warning systems. WHO also acknowledges that many non-commu-

nicable coronary and respiratory diseases are climate sensitive.

Using

research evidence to guide the creation of effective health policy has been

strongly promoted in recent years through, for example, the Cochrane

systematic reviews.

Before using climate information in routine decision making, health

policy advisors and decisionmakers should ask for evidence of the impact

of climate variability on their specific outcome of interest. They should

also investigate whether using climate information is a cost-effective and

practical means to improve health outcomes.

This demand asserts the importance of evidence in effective policy

making while placing climate in a broader context as one amongst several

imperatives. If evidence is to have a greater impact on policy and practice,

four key requirements are necessary:

• Agreement on the nature of acceptable evidence

• A strategic approach to evidence creation, together with the

development of a cumulative knowledge base

• Effective dissemination and access to knowledge

• Initiatives to increase the uptake of evidence in both policy and practice.

Improving routine health surveillance is clearly one essential

component of this strategic approach, but more effective partner-

ships need to be developed to integrate the climate factor effectively.

The following examples, both from the more developed

and less developed countries, illustrate this.

Respiratory disease and heat stress in the

temperate zones

There are numerous studies linking atmospheric air quality

and airborne particulate matter (airborne PM: particulate

matter less than 10 micrometres in size) to aggravated

cardiac and respiratory diseases (such as asthma, bronchi-

tis and emphysema) and various forms of heart disease. A

strong correlation exists between high levels of airborne PM

and increases in emergency roomvisits, hospital admissions

and fatalities. Children, the elderly and people with respira-

tory disorders are particularly susceptible. Meteorological

services are able to provide routine information to help

mitigate this problem.

For example, the Canadian Meteorological Service

produces a daily air quality forecast. Air quality is expressed

using anAir Quality Index. Air Quality Advisories are issued

when the air pollution levels exceed national standards.

They are issued in partnership with provincial and munici-

pal environment and health authorities, and contain advice

on action that can be taken to protect health and the envi-

ronment. A cornerstone of this process is the development

of relevant and timely healthmessages that allowCanadians

to safeguard their own health, as well as the health of those

in their care, and to motivate change in improving air

quality in their communities over the medium- to longer-

term. Similar activities are taking place across the border in

the United States, as well as in Europe.

The European heat wave during the summer of 2003

was associated with an estimated 45,000 excess deaths,

with more than 15,000 of these occurring in France alone.

Following this event, the European Office of WHO, with

funding from the European Union (via Euro-Heat), joined

research institutions, health care providers andmany of the

National Meteorological Services in studies to establish the

factors and mechanisms responsible. This information was

then used to set up early warning systems to increase public

awareness and to reduce vulnerability and associated risk.

The socioeconomic factors related to heightened risk

and vulnerability are complex but include age, existing

medical conditions, poor levels of physical fitness, urban

residence, air quality and poor ventilation. The climatic

factors involved focus largely on the stability and persist-

ence of elevated temperatures, relative humidity and cloud

cover – where these create a high local heat stress index.

Météo France, a Euro-Heat partner, declared July 2006 as

the warmest on record. Yet figures suggest that heat related

mpacts

and

mplications

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hange

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ariability

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