eBriefing

Human Health in the Face of Climate Change: Science, Medicine, and Adaptation

Human Health in the Face of Climate Change
Reported by
Alan Dove

Posted July 31, 2015

Presented By

Presented by the "la Caixa" FoundationBIOCAT, and the New York Academy of Sciences

Overview

On May 14–15, 2015, the "la Caixa" Foundation, Biocat, and the New York Academy of Sciences held a conference on climate change and health in Barcelona, Spain. At Human Health in the Face of Climate Change: Science, Medicine, and Adaptation, scientists, policy makers, and public health officials heard from over two dozen speakers about the complex interactions that connect climate, culture, economic development, and disease.

Climate change is likely to have multifaceted effects on human health and well-being. The health risks associated with climate change include exposure to extreme weather events; disruption of ecosystems, agriculture, and food production; expansion of infectious diseases; and increased levels of harmful air particulates. Speakers discussed the use of statistics and modeling in efforts to protect vulnerable populations and to predict how government policies could offset climate disruption. They pointed to the need for better data on both climate and health.

The meeting also covered strategies for adapting to the health effects of climate change, which will differ widely and lead to particularly severe outcomes in some areas. Disparities in food production and nutritional outcomes, in the distribution of extreme weather, and in the effects on infectious disease vectors and spread make the task of predicting health implications difficult. Speakers presented case studies of diseases affected by climate change and proposed ideas for explaining scientific results to policy makers and the public.

Use the tabs above to find a meeting report and multimedia from this event.

Presentations available from:
Robert P. Anderson, PhD (City College of New York)
Cassandra De Young, PhD (UN Food and Agricultural Organization)
Peter J. Diggle, PhD, MSc (Lancaster University, UK)
Andrew Dobson, DPhil (Princeton University)
Christopher Dye, DPhil (World Health Organization)
Kristie L. Ebi, PhD, MPH (University of Washington)
Andrew Haines, MBBS, MD (London School of Hygiene & Tropical Medicine, UK)
Deirdre Hollingsworth PhD, MSc (University of Warwick, UK)
Elisabet Lindgren, MD, PhD (Stockholm University, Sweden)
Rachel Lowe, PhD (Institut Català de Ciències del Clima – IC3, Spain)
Mercedes Pascual, PhD (University of Chicago)
Richard E. Paul, DPhil, MSc (Institut Pasteur, France)
A. Townsend Peterson, PhD (University of Kansas)
Xavier Rodó, PhD (ICREA; Institut Català de Ciències del Clima – IC3, Spain)
Madeleine C. Thomson, PhD (Columbia University)


Presented by

  • la Caixa Foundation
  • Biocat
  • The New York Academy of Sciences

How to cite this eBriefing

The New York Academy of Sciences. Human Health in the Face of Climate Change: Science, Medicine, and Adaptation. Academy eBriefings. 2015. Available at: www.nyas.org/ClimateandHealth-eB

Protecting Human Health in a Warmer World


Christopher Dye (World Health Organization)
  • 00:01
    1. Introduction; Facts about climate change
  • 06:30
    2. How climate affects health
  • 10:32
    3. Obstacles to action
  • 21:25
    4. Science into policy; Conclusio

Understanding the Relationship Between Climate and Health: What Can Statistics Contribute?


Peter J. Diggle (Lancaster University, UK)
  • 00:01
    1. Introduction; Statistical modeling principles
  • 04:56
    2. Statistical challenges
  • 10:38
    3. Case studies
  • 19:11
    4. Statistics and scientific method; Conclusio

Latitudinal Gradients in Climate Impact: A View from the Arctic


Andrew Dobson (Princeton University)
  • 00:01
    1. Introduction and outline
  • 04:01
    2. Climate change versus land use change
  • 09:06
    3. Looking at the Arctic; Metabolic theory of climate change
  • 16:42
    4. A seasonal perspective; Application to other systems; Muskox die-off
  • 22:12
    5. Summary, acknowledgements, and conclusio

Abiotic Factors Determining the Seasonal Transmission of Vector-borne Diseases


Richard E. Paul (Institut Pasteur, France)
  • 00:01
    1. Introduction
  • 02:35
    2. Looking at ticks; Modeling seasonality
  • 11:57
    3. Mosquitos and dengue epidemiology
  • 20:27
    4. Aedes aegypti conclusions; Conclusio

Crossing Scales in Biodiversity Prediction for Human Health Applications


Robert P. Anderson (City College of New York)
  • 00:01
    1. Introduction; Conceptual framework
  • 08:22
    2. Models of environmental suitability
  • 14:00
    3. Linking to dispersal/demographic simulations; Including biotic interactors
  • 21:16
    4. Resources and future directions; Conclusio

Adapting to the Health Impacts of Climate Change


Elisabet Lindgren (Stockholm University, Sweden)
  • 00:01
    1. Introduction
  • 03:20
    2. The impact of urbanization; Complex pathways; Local burden of disease
  • 07:36
    3. Nature-based solutions; Countering the urban heat island effect; Wetlands
  • 13:40
    4. Countering negative side effects; Reforestration and agroforestry; Restoring ecosystems
  • 17:00
    5. Challenges and opportunities; Conclusio

Fisheries and Aquaculture Food and Nutrition Security in a Changing Climate


Cassandra De Young (UN Food and Agricultural Organization)
  • 00:01
    1. Introduction; Food and nutrition perspective
  • 04:20
    2. Benefits from seafood; Climate change impact pathways
  • 10:30
    3. Findings from IPCC AR 5; Impacts in developing countries
  • 16:20
    4. Adaptation options; Conclusio

Wind-borne Dispersion of Potential Human Pathogens and Toxins: Recent Lessons from the Kawasaki Disease


Xavier Rodó (ICREA; Institut Català de Ciències del Clima – IC3, Spain)
  • 00:01
    1. Introduction; Particulars of Kawasaki Disease
  • 03:43
    2. Worldwide distribution; Epidemiology; Winds and seasonality
  • 11:14
    3. An opportunity for prediction; Source of the disease agent; Synchrony
  • 16:50
    4. Procedure and modeling; A theory for the source
  • 20:05
    5. Aircraft monitoring; Particle identification
  • 27:51
    6. Studies of interest; Conclusio

Integrating Climate Information into Surveillance Systems for Infectious Diseases


Madeleine C. Thomson (Columbia University)
  • 00:01
    1. Introduction
  • 03:20
    2. Improving evidence use in policy and practice; Measurement
  • 08:35
    3. Ground observation data; Creating and using information
  • 14:47
    4. Initiatives; Conclusio

Mapping Disease Transmission Risk from Biogeographic and Ecological Perspectives


A. Townsend Peterson (University of Kansas)
  • 00:01
    1. Introduction; Purpose of transmission risk mapping
  • 04:54
    2. Risk map development and workflow
  • 09:40
    3. Climate change effects on disease-relevant organisms
  • 13:27
    4. Not all climate change effects will be negative; Significance of global patterns
  • 18:12
    5. Major tasks remaining; Gaps and impediments; Conclusio

Climate Forcing and Malaria Dynamics in Low-transmission Regions: Implications for the Future


Mercedes Pascual (University of Chicago)
  • 00:01
    1. Introduction; Climate forcing
  • 04:45
    2. Highland malaria and climate change
  • 15:35
    3. Highland findings; Endemic cholera and other disease in and around cities
  • 23:51
    4. General points; Rainfall variability and drug treatment; Acknowledgements and conclusio

Neglected Tropical Diseases, Weather, and Climate


Deirdre Hollingsworth (University of Warwick, UK)
  • 00:01
    1. Introduction and overview
  • 03:35
    2. Locations of neglected tropical diseases; At risk populations; Current policy
  • 07:22
    3. Impact of weather and climate; Mass drug administration
  • 14:58
    4. Modeling infection and program efficacy
  • 19:19
    5. Summary, acknowledgements, and conclusio

Lessons Learned in Health Adaptation


Kristie L. Ebi (University of Washington)
  • 00:01
    1. Introduction and background
  • 03:30
    2. New parallel/reverse scenario process; Representative concentration pathways
  • 10:41
    3. A matrix approach; Shared socieconomic pathways; Conclusio

Health Co-benefits of the 'Low Carbon' Economy


Andrew Haines (London School of Hygiene & Tropical Medicine, UK)
  • 00:01
    1. Introduction
  • 04:11
    2. Estimates of air pollution deaths; New technologies; Methane and black carbon reduction
  • 09:49
    3. Active travel and low emission vehicles; Healthy cities
  • 13:28
    4. Household energy; Food and agriculture; Healthy diets; The health system
  • 18:32
    5. Moving to a low-carbon economy; Summary and conclusio

Evaluation of a Climate-driven Dengue Early Warning System


Rachel Lowe (Institut Catalè de Ciències del Clima – IC3, Spain)

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Christopher Dye

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Andrew Haines

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Deirdre Hollingsworth

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Sari Kovats

Caminade C, Kovats S, Rocklov J, et al. Impact of climate change on global malaria distribution. Proc Natl Acad Sci U S A. 2014;111(9):3286-91.

Fowler T, Southgate RJ, Waite T, et al. Excess winter deaths in Europe: a multi-country descriptive analysis. Eur J Public Health. 2015;25(2):339-5.

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Andrew Larkin

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Elisabet Lindgren

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Rachel Lowe

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George Luber

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Sabrina McCormick

Years Of Living Dangerously

Jane M. Olwoch

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Organizers

Robert P. Anderson, PhD

City College of New York
website | publications

Robert P. Anderson is a professor in the Department of Biology at the City College of New York, City University of New York. He holds a PhD in systematics and ecology from the University of Kansas and completed a postdoctoral fellowship in mammalogy at the American Museum of Natural History. His lab conducts biogeographic research at the interface of ecology and evolution. The research focuses on characterizing the spatial configuration of environmental suitability for species, and then studying its ecological and evolutionary consequences by developing GIS-based methods for modeling species niches and distributions. The lab's current projects focus on the small mammals of the northern Neotropics and Madagascar.

Andrew Dobson, PhD

Princeton University
website | publications

Andrew Dobson is a professor of ecology and evolutionary biology at Princeton University. His research is concerned with the population ecology of infectious diseases, the conservation of endangered and threatened species, and the interaction between climate variability and the transmission of malaria and cholera in India and Bangladesh. He also does conservation work in the Serengeti region of Tanzania. Dobson is interested in the ecology and economics of land-use change, wildlife–human interactions, and ecotourism. He is a partner in the Serengeti BioComplexity Project, a forum for people working in the Serengeti to interact and develop ideas for the conservation of East African grasslands. He holds a PhD from Oxford University and conducted postdoctoral research at Imperial College London and Princeton University.

Christopher Dye, DPhil

World Health Organization
website | publications


Andrew Haines, MBBS, MD

London School of Hygiene & Tropical Medicine, UK
website | publications

Andrew Haines is a professor of public health and primary care with a joint appointment in the Department of Social and Environmental Health Research and the Department of Population Health. He was director (originally dean) of the London School of Hygiene and Tropical Medicine for nearly 10 years, until October 2010, and previously a professor of primary health care at University College London. He also worked part-time as a general practitioner in North London. He has served as director of research and development at the National Health Service (NHS) Executive, North Thames, and as a consultant epidemiologist at the MRC Epidemiology and Medical Care Unit. He has also worked internationally in Nepal, Jamaica, Canada, and the U.S.

Xavier Rodó i López, PhD

ICREA; Institut Català de Ciències del Clima – IC3, Spain
website | publications

Xavier Rodó is an ICREA research professor and the IC3 founding director. He received his PhD at the Barcelona University (UB) in Spain, studying the simulation of extreme ecosystems under climate forcing. He was previously a visiting fellow at Princeton University and is an associated visiting scientist at COLA Laboratory. He has taught at UB and at the Polytechnic University of Catalonia (UPC). Rodó is interested in Mediterranean climate, tropical teleconnections, seasonal forecasting, biogeochemistry, and ENSO dynamics. He also studies the role of climate variability in the global carbon cycle, the detection and simulation of climate impacts, and the development of statistical techniques for improving climate diagnostics.

Madeleine C. Thomson, PhD

Columbia University
website | publications

Madeleine C. Thomson is a senior research scientist at the International Research Institute for Climate and Society and a senior scholar at the Mailman School of Public Health at Columbia University. She also directs the IRI/PAHO-WHO Collaborating Centre (US 306) for Early Warning Systems for Malaria and Other Climate Sensitive Diseases. Thomson trained as a field entomologist and has focused on operational research for large-scale health interventions, mostly in Africa. She develops data, methodologies, and tools for climate-sensitive health interventions, particularly for vector-borne diseases and airborne and waterborne infections. Her models also look at challenges associated with food security and disasters. She is a founding member of the Meningitis Environmental Risk Information Technologies (MERIT) consortium, the vice president of the Health and Climate Foundation, and a special adviser at the Wellcome Trust, UK. She holds a Master's degree in applied pest management from Imperial College London and a PhD in ecology from the University of Liverpool.

Siobhán Addie, PhD

The New York Academy of Sciences

Melanie Brickman Stynes, PhD, MSc

The New York Academy of Sciences


Keynote Speakers

Christopher Dye, DPhil

World Health Organization
website | publications

Christopher Dye is the director of Health Information in the Office of HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases at the World Health Organization. He is a visiting professor of zoology at the University of Oxford, and from 2006 to 2009 was the Gresham Professor of Physic in the City of London. An ecologist, he became interested in infectious diseases at Imperial College London and moved to the London School of Hygiene and Tropical Medicine to study public health. He was head of the school's Vector Biology and Epidemiology Unit until 1996, researching leishmaniasis, malaria, rabies, and other infectious and zoonotic diseases in Africa, Asia, and South America. Dye then joined the World Health Organization, where he has developed methods for using national surveillance and survey data to study the large-scale dynamics and control of tuberculosis (TB) and other communicable diseases. He works with governments and other agencies to translate science into health policy. Dye holds a DPhil in zoology from the University of Oxford. He is a member of the Board of Reviewing Editors for Science, a fellow of the Royal Society, and a fellow of the Academy of Medical Sciences.

Elisabet Lindgren, MD, PhD

Stockholm University, Sweden
website | publications

Elisabet Lindgren is a board-certified physician and an associate professor in sustainability science at Stockholm Resilience Centre, Stockholm University (SU), Sweden. She received an MD at Karolinska Institute (KI) and a PhD in natural resources management at SU, and completed postgraduate work in biostatistics and epidemiology at KI. She researches the health effects of global environmental changes, particularly early signs of the effects of climate change, as well as long-term changes in latitudal distribution of disease vectors and variations in incidence of tick-borne diseases in Europe. She was partner in the first EU-financed research program on climate change and human health, impact and adaption (cCASHh). She also studies impact, vulnerability, and adaptation assessments with an emphasis on emerging infectious diseases, as well as climate-related disasters and health, global transitions, ecosystem services, nature-based solutions, sustainable food production, and sustainable cities. Lindgren has been a temporary scientific advisor to the World Health Organization and advised other UN bodies, as well as the European Commission, EU agencies, and ministries in several countries. She chaired the working group on climate and health in the Swedish government Commission on Climate and Vulnerability, 2005–2007, and was member of the Scientific Council on Climate Issues.


Speakers

Matthew Baylis, PhD

University of Liverpool, UK
website | publications

Jose A. Centeno, PhD, MSc

International Medical Geology Association
website | publications

Cassandra De Young, PhD

UN Food and Agricultural Organization
website

Peter J. Diggle, PhD, MSc

Lancaster University, UK
website | publications

Kristie L. Ebi, PhD, MPH

University of Washington
website | publications

Deirdre Hollingsworth, PhD, MSc

University of Warwick, UK
website | publications

Sari Kovats, PhD, MSc

London School of Hygiene & Tropical Medicine, UK
website | publications

George Luber, PhD

U.S. Centers for Disease Control and Prevention
website | publications

Sabrina McCormick, PhD

George Washington University
website

Jane M. Olwoch, PhD, MSc

University of Pretoria, South Africa
website | publications

Mercedes Pascual, PhD

University of Chicago
website | publications

Richard E. Paul, DPhil, MSc

Institut Pasteur, France
website | publications

Carlos Pérez García-Pando, PhD

Columbia University; NASA Goddard Institute for Space Studies
website | publications

A. Townsend Peterson, PhD

University of Kansas
website | publications

Jan C. Semenza, PhD, MPH, MS

European Centre for Disease Prevention and Control
website | publications

Jeffrey Shaman, PhD

Columbia University
website | publications


Hot Topic Presenters

Joan Ballester, PhD

Institut Català de Ciències del Clima – IC3, Spain

Andrew Larkin, PhD

Oregon State University

Rachel Lowe, PhD

Institut Català de Ciències del Clima – IC3, Spain

Marco Springmann, PhD

University of Oxford, UK


Alan Dove

Alan Dove is a science writer and reporter for Nature Medicine, Nature Biotechnology, and Bioscience Technology. He also teaches at the NYU School of Journalism and blogs at http://dovdox.com.

Sponsors

Presented by

  • la Caixa Foundation
  • Biocat
  • The New York Academy of Sciences

Bronze Sponsors

Fundación Ramón Areces

Wellcome Trust

Speakers

Christopher Dye, Keynote Speaker

WHO

Peter J. Diggle

Lancaster University, UK

Sari Kovats

London School of Hygiene & Tropical Medicine, UK

Highlights

As the average global temperature increases, extreme weather events become more likely.

Modeling the health effects of climate change requires tracking multiple variables.

Data on health and climate are often expressed in different scales, or unavailable.

A global fever

In geological terms, human civilization developed in a brief period when Earth's overall geography and climate remained relatively stable. As a result, the structure of societies, from our architecture to our politics, rests on a presumption of geological and climatological stasis. Scientists have discovered how wrong that idea is, and how much damage may result.

Human populations have expanded into every part of the globe, restructuring entire ecosystems and releasing astonishing quantities of energy and waste from long-buried carbon sources. The ecological effects of this expansion now rank with the global catastrophes that demarcate past epochs in the fossil record, leading many researchers to propose that a new era, the Anthropocene, has begun. Besides endangering thousands of other species, anthropogenic activity—especially resulting in climate change—could threaten our own health. But how much, how soon, and how badly? These questions were the focus of the conference.

Climate extremes: protecting human health in a warmer world

Christopher Dye of the World Health Organization gave the first keynote presentation, beginning with an overview of anthropogenic climate change. Increased fossil fuel use in recent decades has accelerated emissions of heat-trapping gases, particularly CO2, into the atmosphere. These rising emissions correlate with increases in the global average surface temperature. As scientists have now repeatedly found, the correlation is no coincidence.

"On the controversy [over] whether or not global warming is man-made, there's no doubt left in the scientific community," Dye said, citing a meta-analysis that found 97% agreement on the question in the scientific literature.

The effects of global warming are manifold, mostly bad, and already underway. Though climatologists track the phenomenon by measuring increases in the global average surface temperature, local effects vary widely. Indeed, climate forecasters predict greater extremes in local temperatures and more violent weather patterns as the climate changes. The resulting floods, droughts, heat waves, and cold snaps could have disastrous effects on health.

"It's very difficult to attribute individual events to climate change which have an effect on health, but in the broad spectrum of these changes, clearly there is an association," Dye said. Statistical analysis can assign probabilities for particular phenomena; for example, one analysis found the 2010 heat wave in Russia was more likely than not a result of climate change. Scientists estimate that extreme weather events happen with fivefold greater frequency than they would in a hypothetical world without climate change.

Like the environmental effects, the health effects of climate change will not be evenly distributed. According to current projections, climate change will result in about 250 000 excess deaths worldwide by 2030, representing only 4% of the total deaths that year. Besides being relatively few and uncertain, the excess deaths will happen in the future. Policy makers tend to discount the importance of events that will occur long after their administrations have ended and may not be swayed by such predictions.

Measures that would prevent future climate-related deaths may have other benefits, however. Dye pointed to an intervention in which poor people without access to sanitary toilets were given subsidies to build latrines. The result was a drastic improvement in sanitation in the subsidized areas. "Not only [do] the people who get the subsidies [build toilets], but their neighbors and others in the communities take it up as well," he said. Improved sanitation should reduce the transmission of diarrheal diseases immediately, and make the communities more resilient to more frequent and severe flooding as the climate changes. "This is an example of being ready to ... address a health problem, both directly as it exists now and allowing for the future possibilities with respect to climate change," Dye said. Similarly, measures to improve health care and reduce pollution from fossil fuels can bring substantial co-benefits while also mitigating climate change or reducing its effects.

Dye closed with an overview of the ongoing efforts at the World Health Organization to keep health on the global agenda.

Mind the gaps: statistical issues in understanding climate and health

Peter J. Diggle of Lancaster University opened session one, on climate extremes and data, with a brief explanation of statistical model building. Using models, he explained, is like "buying information with assumptions." He cautioned researchers to incorporate statistical modeling into research at the experimental-design stage, rather than building a model after collecting the data. In general, scientists construct models on the basis of known phenomena, identify the variables most likely to influence future events, and then perform simulations to predict outcomes. Identifying the crucial variables at the start of a study will help investigators determine what types of data to collect to run the model.

That strategy creates some challenges for climate studies. "The relationship between climate and health has to be understood through synthesis of information from many different data sources ... often gathered on incommensurable scales," Diggle said. Nonetheless, he and his colleagues have successfully modeled climate effects on several diseases. In one study, for example, the team correlated rainfall and malaria rates, and identified the most effective anti-malaria interventions among several that public health officials had implemented. Another study, focused on leptospirosis, revealed that the locations of open sewers explained highly localized differences in infection rates within a city.

Sari Kovats of the London School of Hygiene and Tropical Medicine explained that incomplete data hamper statistical modeling, even in developed countries. In the UK, one of the first nations to mandate formal climate risk assessments at the national level, she has used government data to model the effects of extreme weather on health outcomes.

During the Europe's record-setting heat wave in 2003, mortality rates in London varied enormously between neighborhoods. It is hard to know exactly why. "We need to know about the housing characteristics [and] we need to know behavior within the household," Kovats said, adding that modeling is "limited by whether we can link our routine health data to these local or individual characteristics. That's something that's very, very hard to do."

There were lower mortality rates during floods than during heat waves, but Kovats cautioned that those data also had gaps. In particular, post-flood mortality rates may be lower because people move out of the flood-prone area and their subsequent illnesses and deaths are recorded in other districts.

Climate change makes extreme weather events more likely. (Image courtesy of Sari Kovats)

Speakers

George Luber

U.S. Centers for Disease Control and Prevention

Jane M. Olwoch

University of Pretoria, South Africa

Jeffrey Shaman

Columbia University

Andrew Dobson

Princeton University

Richard E. Paul

Institut Pasteur, France

Robert P. Anderson

City College of New York

Highlights

Climate change is global, but its effects vary dramatically from one region to another.

Malaria rates are sensitive to climate, but studies disagree on whether temperature or rainfall is the most important variable.

Absolute humidity is a critical variable in the viability of influenza viruses.

Climate change is altering vector-borne animal disease transmission in polar regions.

Small temperature changes can have huge effects on Lyme disease incidence.

All climate is local: improving health preparedness

George Luber of the U.S. Centers for Disease Control and Prevention began session two, on health preparedness, by reiterating the regional disparities in the effects of climate change. "We cannot take a national-level view of this problem, because the impacts vary so significantly by location," he said, adding that "we have to contextualize this in a regional scale, in a subregional scale, and even in an inter-urban scale."

There are common themes between regions, however. As the climate moves toward greater extremes, the result will generally be an increase in health stresses (environmental conditions associated with poor outcomes), with the greatest effects on the most vulnerable populations. To anticipate those stresses, Luber and his colleagues at the CDC have developed a framework called BRACE (Building Resistance Against Climate Effects) to guide state and local adaptation efforts.

As Jane M. Olwoch of the University of Pretoria explained, local changes in climate do not have to be large to have enormous effects on health. Small shifts in rainfall and temperature can produce huge swings in the reproductive rates of mosquitoes and other important disease vectors. Declining biodiversity and changing migration routes among reservoir species can also push diseases into new areas. "This has far-reaching implications on the distribution and transportation of vectors and their diseases," she said.

Olwoch's team analyzed malaria rates and climate change in three provinces of South Africa. The results showed a correlation between temperature and malaria incidence, in contrast to earlier work in Botswana that identified rainfall as the main correlate of malaria. "But these are just simple correlations, which I think should undergo more serious, detailed analysis for us to be able to make conclusions," Olwoch said. She plans to look for data sources that provide more detailed information and to develop models to forecast future fluctuations in vector-borne disease.

Your local flucast

Jeffrey Shaman of Columbia University presented a modeling strategy for a disease linked more to seasons than to climate: influenza. Flu follows a predictable seasonal pattern in high latitudes, peaking in winter and declining in summer. Researchers have proposed several hypotheses to explain this pattern, but evidence for any of them has been hard to find.

After reanalyzing data from previous papers, Shaman's team realized that absolute humidity has a substantial effect on the survival of influenza virus in the air. With a mathematical model based on this phenomenon, the researchers showed that absolute humidity records track well with historical flu mortality rates across several U.S. states. They used the model in conjunction with data-assimilation methods and real-time observations to produce a forecasting tool for the flu season. "We're able to make predictions of what's going on with skill up to 9 weeks into the future," Shaman said.

Speakers from the first two sessions engaged in a lengthy interactive panel discussion with the audience. Topics included the co-benefits of climate change adaptations, which could make policy making more politically palatable, and the challenges of funding highly interdisciplinary climate and health studies.

Low absolute humidity favors influenza transmission. (Image courtesy of Jeffrey Shaman)

Making predictions

Andrew Dobson of Princeton University opened session three, on biodiversity and community health, with the observation that climate change is literally polarizing: Arctic and Antarctic conditions are changing much faster than conditions at lower latitudes. Besides making the poles good places to preview future climate disruptions, these changes add a sense of urgency to climate studies. "We've probably got about 25 years to study the Arctic before it's gone, [and] that's probably optimistic," Dobson said.

By tracking and modeling a nematode parasite of caribou, Dobson and his colleagues have developed a detailed understanding of how the Arctic's drastic climate change affects disease transmission. The researchers are now applying the model to other diseases of Arctic wildlife.

Meanwhile, new pathogens are arriving in the area. Dobson described the rapid spread of a new bacterial infection in musk oxen, resulting in massive die-offs of this already imperiled species.

Richard E. Paul of Institut Pasteur returned to the theme that small changes make big differences. While studying the biology of tick-borne Lyme disease, he built a model that could predict the incidence of the disease 4 months in advance in most years. But it failed spectacularly for two of the years he examined.

"When there was an anomalous warm winter and an anomalous cold summer, it was only 3 degrees' [difference], and the whole relationship of predictability was completely lost," Paul said. The milder winters and summers expected in some areas as the climate changes could shift the dynamics of Lyme disease dramatically. In another analysis, his team found dramatic variation in the distribution of cases of dengue fever across very small distances, and traced the effect to differences in the feeding habits of the mosquito vectors.

Robert P. Anderson of the City College of New York explained the nuances of building disease models that incorporate climate variables, and why the task a particularly difficult for vector-borne diseases. Models are mathematical constructs that allow researchers to make educated predictions; but models only work if the underlying data are sound and the model accurately represents the system's biology. Anderson outlined the principles his team developed for modeling ecological niches of disease vectors on the basis of physical and biological parameters. He illustrated the method using a model of Lyme disease, which includes data on ticks, populations of rodent reservoirs, and environmental factors that allow the disease to exist in an area. The team has produced software tools for researchers to use in other disease models.

Speakers

Andrew Larkin

Oregon State University

Rachel Lowe

Institut Català de Ciències del Clima – IC3, Spain

Marco Springmann

University of Oxford, UK

Joan Ballester

Institut Català de Ciències del Clima – IC3, Spain

Highlights

Climate policies that improve population health in the short term may be more palatable to the public and to policy makers.

Models of Dengue fever virus transmission could predict outbreaks of the disease and improve public health responses.

Climate change is likely to have profound effects on farming and nutrition.

Extreme winters claim more lives in areas unaccustomed to severe cold.

Mapping air pollution and dengue dynamics

Session four featured hot topic presentations selected by conference organizers from the submitted abstracts. Andrew Larkin of Oregon State University presented the first of these short talks, describing his part of a new global project to track chronic health conditions. The Prospective Urban and Rural Epidemiology (PURE) study is collecting data from 200 000 participants in different communities in 21 countries.

The study tracks variables such as social cohesion, neighborhood walkability, cigarette smoking, and environmental pollution. Larkin's team examines air pollution, using environmental data to estimate emissions of different pollutants and then looking for correlations with respiratory and cardiovascular disease rates. Many of the pollutants are also greenhouse gases, highlighting the added benefits of measures to mitigate climate change.

After identifying health outcomes associated with pollutants, the researchers will be able to project the effect of climate change on each outcome. Larkin closed by inviting attendees with expertise in climate science or sociology to contact his group to explore collaboration.

Rachel Lowe of IC3, Spain, described her work on dengue fever in Brazil, which has the highest reported case counts of the disease. Epidemics of dengue fever generally occur between January and May, during the country's wet season. Lowe is developing a predictive model to provide health authorities with an early warning of impending dengue fever epidemics.

The model includes data on climate, demographics, socioeconomic factors, and dengue fever incidence for over 500 micro-regions of Brazil. After building the model to explain past epidemics, her team used it to develop thresholds for making predictions. "The problem that we often have when we're trying to model diseases is a lack of data. We can overcome this problem by introducing extra layers of uncertainty into the model using [a] hierarchical approach," she said. In a hierarchical model, unknown confounding effects, as well as measured covariates such as environmental and socioeconomic factors, can be accounted for.

Lowe and her colleagues tested the system before the World Cup soccer tournament held in Brazil in 2014, and she hopes to continue testing and developing the model to make regular dengue season forecasts.

Protecting community health

Marco Springmann of the University of Oxford turned the focus to nutrition-related health problems and the particularly devastating effects climate change may have on food systems. "Climate change has been called one of the biggest global health threats of the 21st century, and the health impacts related to food security may be indeed [among] the most important," he said. There are "[a] large number of people that might be affected."

The most obvious connection between climate and food is the potential for extreme weather events to cause crop failures and lead to undernutrition. However, poor diet composition causes 7 times more deaths than undernutrition. Unbalanced diet and obesity are now among the leading risk factors for death worldwide.

Projections of its effects on food production suggest climate change could lead to changes in dietary composition and weight status. Fruit and vegetable consumption, for example, may decrease. By 2050 these changes could lead to about 500 000 climate-related deaths relative to a reference scenario without climate change. Springmann argued that interventions to improve dietary quality would immediately improve public health, and also help countries offset the effects of long-term climate change.

Diet- and weight-related diseases could lead to about 500 000 climate-related deaths by 2050. (Image courtesy of Marco Springmann)

Joan Ballester of IC3, Spain, is studying whether a warming climate will decrease the number of deaths caused by cold weather in Europe. The answer depends on where one asks the question.

With data from 200 regions in Europe collected from 1998 to 2005, Ballester calculated the correlation between daily winter temperature and daily winter mortality for each region, finding that the tightness of the correlation varies dramatically from one region to another. Central and northern Europe show low correlations between death and cold temperatures, while the UK and southern Europe have much stronger correlations. "The interpretation is that those countries that have climatological winters that are harsher are those that are less susceptible to [cold] winter temperatures, essentially because they've taken steps toward acclimatization to these types of events," he said.

The data also revealed two types of acclimatization, suggesting that some regions are highly susceptible to daily but not to seasonal variations in temperature. In those areas, an anomalously cold day in a normally warm season could be deadlier than a series of cold days in winter.

A panel discussion featuring speakers from the third and fourth sessions ended the day, stimulating another round of questions and ideas from the audience. Asked about expanding her work, Lowe reported that she and her colleagues are building dengue fever models for different countries and studying malaria in Malawi. Other speakers fielded questions and comments about how to apply Arctic models to phenomena in the tropics, how heat waves may affect mortality, and how increasing fertilizer use may change projections of climate-related crop decline.

Speakers

Elisabet Lindgren, Keynote Speaker 

Stockholm University, Sweden

Casandra De Young

UN Food and Agricultural Organization

Matthew Baylis

University of Liverpool, UK

Highlights

Urbanization is proceeding alongside global warming.

Cities tend to concentrate heat, exacerbating extreme summer temperatures.

Nature-based solutions to adapt to climate change have many co-benefits for health.

The global supply of fish is changing as oceans, lakes, and rivers get warmer.

Climate change can alter the dynamics of vector-borne livestock diseases.

Summer in the city

Elisabet Lindgren of Stockholm University started the second day with a keynote address about adapting to climate change against a backdrop of other societal changes, most notably accelerating urbanization. "More people are living in cities than in rural environments, and this trend is predicted to continue," she said. According to estimates, by the end of the 21st century 80% of the world's population will live in cities.

Lindgren described several nature-based climate adaptations that could yield immediate health benefits. "Many of these nature-based solutions result in multiple benefits for health, but also for the economy, society, and the environment, and therefore they represent more efficient and cost-effective solutions than many of the traditional approaches," she said.

Coastal areas, for example, can be insulated from severe storms and rising sea levels by mangroves and other aquatic vegetation or by barriers that trap sediment and rebuild river deltas. These measures also restore ecosystems destroyed by past development. Similarly, vegetation grown atop buildings can reduce the "urban heat island" effect that worsens extreme summer temperatures in cities. Green roofs and other urban green spaces also provide recreational opportunities and reduce noise pollution. Beneficial effects from urban greenery have been shown to mitigate some of the negative outcomes associated with living in low-income areas of cities, Lindgren noted.

A project called the Great Green Wall of Africa takes the notion of combating climate change with vegetation further. The idea is to restore lost forests along a 15 km-wide belt across the continent, from Senegal to Djibouti. If successful, ecologists predict the reforestation could yield substantial benefits, such as reduced desertification and extensive agricultural and economic opportunities in multiple countries.

Simply salvaging degraded agricultural land is important. Restored farmland could feed more than a quarter of the 2.5 to 2.6 billion additional people the world is expected to have by 2050.

But nature-based solutions can incur costs; building parks in wet climates, for example, may expand mosquito habitats. Lindgren is optimistic that such costs can be mitigated; for example, by introducing biological controls such as natural mosquito predators into new parkland.

Lindgren closed with a plea for interdisciplinary collaboration to explore interactions between climate, health, and society. "If we understand these complexities, and by choosing the right solutions, we can actually not only avoid many of the local possible health effects of climate change, but we can also further decrease the local burden of disease," she said. "That will be very cost-effective for society."

The meat of the matter

Session five, on food and nutrition security, began with a presentation by Cassandra De Young of the UN Food and Agricultural Organization. She discussed the effects of climate change on oceans and fisheries, and the implications for nutrition. Seafood is among the most widely traded food products and is a particularly important source of animal protein in Africa and Asia. Fisheries often also serve as emergency food sources when crops fail. But data on fisheries are often scattered and inconsistent.

Changing ocean currents, rainfall patterns, and lake and ocean thermal structures, and ongoing ocean acidification, are causing major shifts in the global distribution of fish. In some areas, particularly in northern latitudes, fisheries may improve. However, some of the worst fishery declines are expected in many of the tropical regions most dependent on seafood. "Unfortunately the projections are fairly scary," De Young said, adding that in many areas it has proven difficult to implement scientists' recommendations for adapting to these changes.

Fish is a crucial source of high-quality protein. (Image courtesy of Cassandra De Young)

Matthew Baylis of the University of Liverpool began by polling the audience about their eating habits; the overwhelming majority of attendees relied on livestock for at least some of their food. Global data show that one third of human protein consumption comes from livestock and that demand is increasing.

Baylis and his colleagues are building mathematical models to understand how climate change will affect livestock diseases, over half of which are sensitive to climate. In different vector-borne diseases of cattle and sheep, the models show how various control measures would affect the progress of outbreaks. The models helped explain why in sheep bluetongue disease is relatively easy to control through a quarantine strategy, while Schmallenberg virus, carried to sheep by the same vector, spreads much faster. The models also demonstrate that vector-borne diseases can be exquisitely sensitive to small changes in climate.

Speakers

Carlos Pérez García-Pando

Columbia University; NASA Goddard Institute for Space Studies

Jose A. Centeno

International Medical Geology Association

Xavier Rodó

ICREA; Institut Català de Ciències del Clima – IC3, Spain

Madeleine C. Thomson

Columbia University

A. Townsend Peterson

University of Kansas

Mercedes Pascual

University of Chicago

Deirdre Hollingsworth

University of Warwick, UK

Highlights

Dust blown up from deserts can carry toxins and pathogens around the world.

Kawasaki disease in Japan may be caused by a pathogen blown across the sea from China.

Better weather data tracking in Africa should improve predictions of malaria outbreaks.

Climate change is altering the ranges of some pathogens, though not always in bad ways.

Mathematical models could improve the efficiency of interventions during outbreaks of neglected tropical diseases.

The answer is blowing in the wind

In session six, on the effects of wind and dust on airway disease and respiratory illness, Carlos Pérez García-Pando of Columbia University and the NASA Goddard Institute for Space Studies opened with an overview of his work on meningococcal meningitis. This bacterial infection of the brain and spinal cord is particularly prevalent along the so-called meningitis belt, which stretches across Africa from Senegal to Ethiopia. Cycles of meningitis epidemics occur in this region every 8–10 years, generally during the dry season.

Public health authorities react to these epidemics with vaccination campaigns. To improve the efficiency of the campaigns, Pérez García-Pando and his colleagues developed a forecasting model to predict when epidemics would occur. Good predictors of the progress of an epidemic were wind and dust patterns in November and December and early case counts of the disease. Forecasting and tracking these parameters could therefore guide vaccination campaigns, potentially saving thousands of lives.

Jose A. Centeno of the International Medical Geology Association discussed the biology and the toxicology of airborne dust. Most dust carried by winds comes from arid areas, particularly the Gobi and Sahara deserts. "This dust can travel the globe in a matter of days, perhaps weeks, and circle the entire globe," Centeno said.

Dust smaller than 2.5µm is especially important in health, because it can penetrate deep into the alveoli of the lungs. Though silica is the major component of airborne dust worldwide, depending on its origin dust can also carry toxic heavy metals such as arsenic, nickel, and cadmium, as well as pathogens.

Centeno described work linking earthquakes to outbreaks of valley fever, a dust-borne disease caused by Coccidioides immitis fungi endemic to the southwestern U.S. and parts of Mexico and Latin America. Meanwhile, U.S. soldiers returning from Iraq and Afghanistan have complained of a range of respiratory problems that may be linked to dust from that region.

Xavier Rodó of ICREA and IC3 turned the focus to Asia, where his group has studied a mysterious condition called Kawasaki disease. Epidemics of Kawasaki disease have been observed seasonally in Japan since the 1980s, but its causes are unknown. Climatological data revealed that outbreaks correlate closely with northwesterly winds blowing across Japan from mainland China.

Deeper analysis identified a possible source of the causative agent more precisely. "It was striking to see how all results converged to indicate that the potential origin ... came from an area in northeast China which is densely filled with crops," Rodó said. The researchers sampled the air over Japan on days with Kawasaki disease-associated winds, and performed a metagenomic analysis to identify potential pathogens. Numerous species of fungi appeared in the samples, but Rodó emphasized that the evidence linking any of them to the disease is still circumstantial.

Where does Japan's Kawasaki disease agent come from? (Image courtesy of Xavier Rodó)

In a panel discussion with the speakers from sessions five and six, Rodó expanded his discussion of Kawasaki disease, adding that since revealing the possible origin of the condition, he has been unable to get additional data from China. Other speakers discussed their own data collection problems, as well as the changing science of epidemiological modeling.

Accurate disease and climate surveillance

Madeleine C. Thomson of Columbia University began session seven, on climate-induced shifts in infectious diseases, by describing surveillance systems for infectious diseases and climate. An entomologist, Thomson became interested in weather stations while building malaria forecasting models that would account for climate change. She saw large gaps in the available climate data for Africa. Now, starting in Ethiopia, she and her colleagues are working to improve data availability. "The idea is to create high-resolution, high-quality data at the national level that is better than anything you can access elsewhere," she said.

The project deploys an integrated system that combines high-resolution ground station and satellite data, and then makes these data available to national meteorological offices. The researchers have helped build such systems for several countries.

The potential range of Marburg disease extends to Cameroon and Angola. (Image courtesy of A. Townsend Peterson)

A. Townsend Peterson of the University of Kansas talked about the questions underlying his efforts to map disease spread: "For a given disease system, where do we expect it to occur, and where do we expect it not to occur?" The answers are not simple and not always popular.

Peterson cited the example of Marburg virus, for which he and his colleagues built ecological and distribution models in early 2004. The models predicted that the virus could occur well outside its historical range in East Africa, even into northern Angola. "I was ... mocked at a meeting for that northern Angola prediction, because everybody knew that Marburg was an East African disease," Peterson said. But an outbreak of Marburg virus occurred in Angola in October the same year.

Peterson's team has since studied the ranges of several other diseases, showing that climate change is already affecting pathogen spread. Not all the changes in distribution will be negative for humans, however.

Mercedes Pascual of the University of Chicago reiterated earlier speakers' contention that while climate change is global, its effects on diseases will vary dramatically between regions and localities. Pascual described her work studying malaria in Ethiopia and Colombia and cholera in Bangladesh.

In Ethiopia and Colombia, Pascual's team found that malaria incidence clusters according to altitude. "As temperature decreases with altitude, we have a decrease in malaria and a change in the dynamics [of the disease]," she said. In warmer years, malaria cases increase at higher altitudes, mimicking what the investigators anticipate will happen with global warming.

Malaria decreases with altitude; cholera increases with urban poverty. In Bangladesh the team found drastically higher rates of cholera in the dense inner-city areas of Dhaka than in the city's periphery. "My prediction would be that we are going to go into worse scenarios in these very large cities that are growing at a very fast pace," she said.

Deirdre Hollingsworth of the University of Warwick ended the session with a discussion of neglected tropical diseases, which affect the "bottom billion" poorest people in the world. Populations at the highest risk for these diseases are often the same ones most vulnerable to rising sea levels and other effects of climate change.

Hollingsworth develops disease models to maximize the efficiency of treatment interventions for these neglected diseases. In one project, her team modeled the epidemiology of the intestinal worm Ascaris lumbricoides to determine the best strategy for distributing antihelminthic drugs. The model suggested that the timing of drug delivery could be critical to the effectiveness of a treatment campaign. But the researchers have limited data on the relationship between egg survival and climate, so she cautioned that using the model to suggest specific policy changes for timing drug delivery is "a long way from where we are at the moment." Although their roles in neglected tropical disease transmission are not fully understood, both weather and climate are likely to influence the long-term success of programs to control disease.

Speakers

Jan C. Semenza

European Centre for Disease Prevention and Control

Andrew Haines

London School of Hygiene & Tropical Medicine, UK

Kristie L. Ebi

University of Washington

Sabrina McCormick

George Washington University

Highlights

Making small lifestyle changes, such as adhering to dietary guidelines, could help mitigate climate change.

Scenarios of different socioeconomic development paths help researchers predict the effects of climate policies.

Researchers seeking to educate the public about climate and health should focus on telling stories in addition to describing data.

Anticipating new health threats

Jan C. Semenza opened the final session, which covered the problem of translating scientific findings into policies. He talked about efforts at the European Centre for Disease Prevention and Control (ECDC) to anticipate the health threats that climate change could bring to Europe. Semenza and his colleagues monitor numerous data and news sources to identify threats that could overwhelm the health system. "We are looking at these events that could potentially have catastrophic impacts on the public health structure in Europe," he said.

The team identifies the biggest dangers using a database of events compiled by the ECDC's threat-tracking system. Their work suggests that climate change will have the largest effect on vector-borne diseases and foodborne and waterborne pathogens. These results helped persuade European officials to implement surveillance for tick-borne encephalitis, which the ECDC identified as a particularly serious threat. Semenza has also used the system to identify the areas at highest risk of West Nile virus, dengue fever, and cholera.

Small steps

Andrew Haines of the London School of Hygiene and Tropical Medicine returned to the topic of climate policies' co-benefits. He gave the example of air pollution, which kills several million people annually. Coal-fired power plants are among the biggest sources of air pollution, and a major driver of climate change. Switching to sustainable energy sources will therefore save lives immediately, making the change easier to justify to policy makers.

Similarly, redesigning urban infrastructure to favor active travel by cycling or walking, rather than passive travel in cars, would reduce air pollution and improve cardiovascular health. Dietary changes could also have broad benefits for both health and climate. "Just adhering to healthy dietary guidelines would reduce emissions by about twenty percent in a country like the UK," because of reduced meat consumption, Haines said.

A fork in the road

Kristie L. Ebi of the University of Washington briefly described a report on climate change adaptation in 14 low- and middle-income countries, released recently by World Health Organization. She also explained a process for assessing the risks of climate variability and change by developing new scenarios of climate and development. The scenarios include five development pathways in worlds with increasing challenges to adaptation and mitigation, including a world aiming for sustainable development and a world with high dependency on fossil fuels. Taking this approach allows researchers to ask new questions, such as whether the world is on track for a specific warming level; what difference development choices make; and, if the world is on a particular development track, what difference the magnitude and pattern of climate change makes. The scenarios will be useful for studying questions about food and agriculture and questions about the changing health risks of climate change.

Global development could follow any of several different scenarios. (Image courtesy of Kristie L. Ebi)

Changing public perceptions

Filmmaker and sociologist Sabrina McCormick of George Washington University gave the meeting's last presentation, describing her work on a television series about climate change that aired in the U.S., where the subject is highly polarizing. "People only really want to do something about climate change if they ... think it's going to be a problem and ... think it's something they can do something about," she said.

With a background studying the sociology of heat waves, McCormick was recruited to work on an episode of the Years of Living Dangerously series. The episode featured Matt Damon, who interviewed experts on the effects of extreme heat and visited a hospital in Los Angeles during a heat wave. McCormick explained that scientists who want to explain climate change to the public can employ similar tactics, focusing on memorable stories to change attitudes and behaviors.

The meeting closed with a final panel discussion, in which speakers from sessions seven and eight joined members of the audience to explore the presentation topics and the group's broader goals. The kinds of political divisions seen in the U.S. on climate change occur elsewhere, though not necessarily along the same ideological lines.

Attendees debated the best strategies for speaking to the public and policy makers. The group broadly agreed that research on climate and health is chronically underfunded, and that projects in the field are often fragmented. Nonetheless, scientists clearly need to discuss the subject with wider audiences. "Don't think that communicating about climate change is something for somebody else to do," McCormick said. "Scientists by default are leaders in making this a social problem."