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

Abstracts

Keynote Address 1

Protecting Human Health in a Warmer World
Christopher Dye, DPhil, Office of the Director General, World Health Organization, Geneva, Switzerland

From the perspective of health, the diverse risks linked to climate change have three menacing characteristics: climate change is most likely to exacerbate existing health hazards, especially for those people who are already most vulnerable; the threats to health will take many forms – from a more dangerous physical environment to the worsening quality of air and water to the spread of infectious diseases; and there is great uncertainty in the timing, location and magnitude of climate’s harmful effects. Among the responses to climate change, mitigation is critical, particularly in limiting the production of greenhouse gases and fine particulate matter. Mitigation will bring many health benefits, including the reduction of air pollution. But for those who are most concerned with health, the direct challenges are in adaptation – building resilience, not only to the effects of climate but to social and environmental changes of all kinds. Climate’s big health warning is one that is difficult to anticipate – that today’s hard-pressed health services should prepare for a greater number of unpredictable challenges in the future. The threats highlighted by climate change call for a set of actions to safeguard health: (1) strengthen health systems where they are weakest; (2) combine forces across nations and institutions for more effective responses; and (3) reinforce climate science, especially on how climate affects health. Even without more research, we can draw one firm conclusion: concerted action to build resilient systems is a sure investment in health today, and a safe bet against an uncertain future.
 

Session I: Climate Extremes: Utilizing Science to Protect Vulnerable Populations

Statistical Issues in Understanding the Relationship between Climate and Health
Peter John Diggle, MSc, PhD
Lancaster University Medical School, Lancaster, United Kingdom
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom

To understand the relationship between an exposure, X, and an outcome, Y, the ideal is to observe Y over a range of values of X in a controlled experiment. The apotheosis of this simple paradigm is the randomized clinical trial. But we can neither control the climate, nor randomize people’s exposure to different climates. So instead we build models, perhaps the simplest example of which is the linear regression model, Y = α + βX + noise. However, in doing so “we buy information with assumptions’’ (Coombs, 1964)…and we need to be sure we pay a fair price.
 
Models of climate and health need to acknowledge some inherent complexities of the system under investigation: it can only be measured imperfectly and incompletely; it is affected by a mix of natural and social processes, some of which are well understood, others less so; critically, both climate and health vary unpredictably in space and in time. In this talk, I will first illustrate the general principles of statistical method in a simple example, then describe applications of spatio-temporal statistical modelling in environmental epidemiology.
 

What Do We Need to Know to Protect Populations From Extreme Events?
Sari Kovats, MSc, PhD, London School of Hygiene and Tropical Medicine, London, United Kingdom

National and local adaptation plans need to be underpinned by high quality research on the health effects of current climate risks and how these may involve in the future. Adaptation planning requires different approaches to traditional environmental risk assessment, particularly to assess risks beyond 2050, and under high rates of warming. In the near term, effects on health will be through changes in the frequency and intensity of natural hazards – floods and heat waves. Current public health policy focusses on early warnings and emergency planning, and we now have better evidence on how these risks are mediated though features of the built environment, and changes in land cover. Climate change is likely to have a wide range of impacts on health: while some may be beneficial, others will be harmful. This talk will review the current state of knowledge regarding extreme events risks to health and the contribution of environmental epidemiology.
 

Session II: Climate Information For Better Health Preparedness: What Do We Need to Improve?

Building Resilience in the Public Health Sector: The Development of an Evidence-Based Framework for Change Adaptation Planning
George Luber, PhD, Climate and Health Program, National Center for Environmental Health, Centers for Disease Control & Prevention, Atlanta, Georgia, United States

Managing the risks to public health from climate change requires the integration of multiple streams of and sources of information. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information-hallmarks of adaptive management-are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are discussed. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health's established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents.
 

Importance of Temperature as the Main Driver to Malaria Transmission in Limpopo Province, South Africa
Jane Olwoch, PhD²

Malaria in Limpopo Province of South Africa is shifting and now observed in originally non-malaria districts, and it is unclear whether climate change drives this shift. This study examines the distribution of malaria at district level in the province, determines direction and strength of the linear relationship and causality between malaria with the meteorological variables (rainfall and temperature) and ascertains their short- and long-run variations. Spatio-temporal method, Correlation analysis and econometric methods are applied. Time series monthly meteorological data (1998–2007) were obtained from South Africa Weather Services, while clinical malaria data came from Malaria Control Centre in Tzaneen (Limpopo Province) and South African Department of Health. We find that malaria changes and pressures vary in different districts with a strong positive correlation between temperature with malaria, r = 0.5212, and a weak positive relationship for rainfall, r = 0.2810. Results show evidence of strong existence of a long-run relationship between climate variables and malaria, with temperature maintaining very high level of significance than rainfall. Temperature, therefore, is more important in influencing malaria transmission in Limpopo Province.
 
Coauthors: Kibii Komen¹, Hannes Rautenbach PhD¹, Joel Botai PhD¹, and Adetunji Adebayo³
1 Geoinformatics and Meteorology - Center for Environmental Studies, Department of Geography, University of Pretoria, Pretoria, South Africa
2 SANSA Earth Observation, South African National Space Agency (SANSA), Pretoria, South Africa
3 Department of Town and Regional Planning, University of Pretoria, Pretoria, South Africa
 

Forecasting Infectious Disease Outbreaks
Jeffrey Shaman, PhD, Mailman School of Public Health, Columbia University, New York, New York, United States

Dynamic models of infectious disease systems abound and are used to study the epidemiological characteristics of disease outbreaks, the ecological mechanisms affecting transmission, and the suitability of various control and intervention strategies. The dynamics of disease transmission are non-linear and consequently difficult to forecast. Here, I describe the combined model-inference frameworks developed for the prediction of infectious diseases. I show that accurate and reliable predictions of seasonal influenza outbreaks can be made using a mathematical model representing population-level influenza transmission dynamics that has been recursively optimized using ensemble data assimilation techniques and real-time estimates of influenza incidence. Operational real-time forecasts of influenza and Ebola are currently being generated.
 

Session III: Connecting Climate Change, Biodiversity, and Community Health

Influence of Climate Change on Pathogen-Host Dynamics and Different Latitudes
Andy Dobson, DPhil¹

Climate change will have an asymmetrical impact on the planet in the next 100 years – significant climate change is already observed in polar regions, significant effects are observed in Temperate regions and complex interactions are occurring in the Tropics where it will be increasingly hard to disentangle the impact of climate from those of human population expansion and land-use change. This geographic trend in signature of climate change and intensity of confounding factors suggests we will get the clearest signal of the impact of climate change in Arctic systems. This talk will focus on recent work on the impact of climate on the dynamics of parasitic worms and other pathogens on the wildlife species on which Arctic peoples are dependent for food and other products. We will use a mixture of field experiments and physiologically structured mathematical models to illustrate how these host-parasite systems are changing with climate. The mathematical framework can readily be modified to use in regions with different climates and provides important predictive skill. We will then use this as a null model to make projections for what will eventually happen in the Temperate and Tropical regions. We will also illustrate several unexpected consequences of climate change in the Arctic, for which we will only have sudden observational data and no predictive skill. The work illustrates how we can prepare for climate change, but emphasizes that we also need to be prepared to be surprised.
 
Coauthors: Peter K. Molnar, PhD², Susan Kutz, DVM, PhD³
1 EEB, Eno Hall, Princeton University, New Jersey, United States
2 Department of Biological Sciences, University of Toronto Scarborough, Ontario, Canada
3 Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada

Abiotic Factors Determining the Seasonal Transmission of Vector-Borne Diseases
Richard E. Paul, DPhil, Institut Pasteur, Paris, France

The expansion of the geographical distribution of vector-borne diseases is a much emphasized consequence of climate change. However, as, if not more important for public health are the consequences for already endemic areas. Here we focus on two contrasting arthropod vectors, the Aedes aegypti mosquito species and Ixodes spp. ticks and their associated pathogens. The first largely urban with a tropical/sub-tropical distribution and the major vector of dengue. The second a widespread temperate vector responsible for several anthropozoonotic diseases, most notably Lyme borreliosis. Nymphal stages pose the greatest risk of infection for man, but because Ixodes spp. are univoltine, there exists a finite stock that is depleted at a predictable rate dependent upon local temperature and relative humidity. One major question is the extent to which climate change can impact upon the phenology of tick stages, generating multivoltine populations as seen with Rhipicepalus appendiculatus in Africa with consequences for disease risk. By contrast, Ae. aegypti is a domesticated vector, breeding in man-associated habitats, with a rapid life-cycle in a comparatively stable climatic environment. Although excessive rainfall can be deleterious for mosquito populations, variation in temperature, both overall and diurnal, can have significant effects on the development of the dengue virus within the mosquito. However, given that temperature can vary within a city at the same time point by up to 10° and that dengue transmission is highly spatially structured, the impact of climate change on dengue incidence delimited at the scale of the city will be a serious challenge.
 
Coauthor: Marie J. Vassallo, PhD, Institut Pasteur, Paris, France
 

Crossing Scales in Biodiversity Prediction for Human-Health Applications
Robert P. Anderson, PhD, City College of New York, City University of New York, New York, New York, United States

Many human health issues depend on both deterministic factors that influence suitability (the environmental conditions necessary for the disease), and contingent factors (spatially and temporally explicit details related to its spread in a particular landscape). Here, I present current paradigms from basic science for modeling each of these kinds of factors and linking them in order to predict the spatial distribution of a disease (in particular with climate change). I concentrate on relevance for zoonotic diseases (passed to humans by animals) but also extend this general framework to other kinds of diseases. Because biotic interactors (e.g., host, reservoir or vector species) are key for zoonoses, I concentrate on ways to consider their effects. Recent distinctions between what have been termed “Grinnellian” and “Eltonian” niches provide key insight. Grinnellian niches are defined by density-independent factors not affected by the focal species (termed “scenopoetic” variables), which typically are relevant at coarse grains and vary over large geographic extents. In contrast, Eltonian niches include density-dependent feedbacks between the two species (and are usually relevant locally). Some biotic interactors represent scenopoetic variables and can be integrated into Grinnellian models of suitability. Others can be taken into account in post-processing of the output of Grinnellian models. However, some only can be modeled by considering linked feedback with the population level of the focal species (via Eltonian models). Such determinations for a particular disease should promote more effective linking across scales and facilitate spatially explicit estimations of dispersal and demography under climate change.
 

Session IV: Hot Topic Talks

Speakers to Be Selected from Submitted Abstracts

Keynote Address 2

Adapting to the Health Impacts of Climate Change
Elisabet Lindgren, MD, PhD, Stockholm Resilience Centre, Stockholm University, Sweden

Adapting to health impacts of climate change poses challenges to society but also creates opportunities for sustainable cost-effective innovative solutions. Climate change will have both direct and indirect impacts on health. An understanding of the dynamic, systemic causative interactions at the local level is the first step towards sustainable adaptation. Work across scientific disciplines as well as between different sectors of society with stakeholder involvement is needed. Adaptation measures consist of both traditional and innovative approaches. Climate change both aggravates current conditions and creates new health threats, and adaptation measures could range from strengthening existing disaster reduction measures and structures, to increasing disease surveillance to facilitate health system response to emerging threats. Education and information are important adaptation tools if appropriate target groups are chosen. Nature-based solutions will be the new key area for climate change adaptation and mitigation. They may result in multiple co-benefits for health and other sectors and are therefore more cost-effective than traditional approaches. Nature-based solutions can for example be used to reduce impacts of heat waves, reduce the risk of urban flooding and associated health effects, improve resilience of coastal settlements to storm surges and sea level rise, reduce the incidence of vector-borne diseases, increase water availability, and improve food security. More research is needed to explore the full potential for health, including possible negative effects, of nature-based solutions as climate change adaptation.
 

Session V: Impacts of Climate Change on Food and Nutrition Security

Fisheries and Aquaculture Food and Nutrition Security in a Changing Climate
Cassandra De Young, MSc, United Nations Food and Agriculture Organization, Rome, Italy

It is often overlooked that over 500 million people depend, directly or indirectly, on fisheries and aquaculture for their livelihoods. In addition, fish provides essential nutrition for over 4 billion people and at least 50 percent of animal protein and essential minerals to 400 million people in the poorest countries. Trade is also an important characteristic of fisheries and aquaculture: fish products are among the most widely-traded foods, with more than 37 percent by volume of world production traded internationally. At the same time, climate change is bringing an ocean of change to the world’s fisheries and the communities and economies that depend on them. This lecture will focus on the climate change food and nutrition implications for the sector, what we are learning from vulnerability assessments and what adaptation options are  available to help the attain food, nutrition and livelihood objectives for the sector.
 
Coauthors: Doris Soto, PhD¹ and Tarub Bahri, PhD¹ 1 United Nations Food and Agriculture Organization, Rome, Italy
 

Infectious Diseases in Livestock: Should We Care About Climate Change?
Matthew Baylis, DPhil
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom

Livestock products provide one-fifth and one-third of human calorie and protein consumption respectively; with increasing trend. Combined with a growing human population, there needs to be significantly more livestock production in future. Climate change threatens this in many ways, including the enhanced transmission of infectious diseases.
 
Livestock infectious diseases are important for several reasons such as: welfare; livestock provide income, food and clothing and, particularly in Lower Income Countries (LICs), building materials and draught power; and they are a source of human disease – 60-70% of human pathogens originated from animals, especially livestock.
 
The most climate-sensitive diseases of livestock - and hence those most likely to respond to climate change - are vector-borne, water-borne, food-borne or have free-living environmental stages. These transmission routes apply to two-thirds of the livestock diseases with greatest impact on the global poor. Furthermore, vector-borne diseases threaten the developed world, as climate change allows insect and tick vectors, or the diseases they transmit, to spread beyond their normal ranges. The impact of vector-borne diseases of livestock can be economically costly or devastating.
 
Many non-climate disease drivers are changing at the same time as climate and, when a disease emerges, it is usually difficult to attribute the emergence to climate change. This is particularly the case for human diseases, as our disease exposures are changing very rapidly. The disease exposures of livestock are also changing, but less rapidly and, as such, livestock may act as sentinels of the effects of climate change on infectious diseases.
 

Session VI: Effects of Wind and Dust on Airway Disease and Respiratory Illness

Can We Inform Reactive Vaccination Strategies for Meningococcal Meningitis in Sub-Saharan Africa Using Dust and Climate Predictors?
Carlos Pérez García-Pando, PhD
Columbia University, New York, New York, United States
NASA Goddard Institute for Space Studies, New York, New York, United States

Meningococcal meningitis is one of the most feared dry season infectious diseases in sub-Saharan Africa. Response to meningitis epidemics in the region is based on weekly incidence thresholds at the district level. When the number of cases reaches a threshold, vaccinations are ordered for that district. The intensity of meningitis epidemics led to the development of a conjugate vaccine introduced in 2010 that provides long-term immunity for serogroup A. This has highly reduced the threat of epidemics, but other serogroups could be a problem in the future.
 
The threshold strategy depends on timely surveillance, and rapid response, which are difficult to achieve in less-developed countries. The strategy can therefore benefit from improved surveillance and forecasting tools. In the last few years, scientists have linked the seasonality and part of the year-to-year variability of meningitis to climate and environmental factors, and proposed forecast tools. However, delivering apparently simple changes into an epidemic response strategy is complex. During my talk I will review recent research and practice seeking to improve the epidemic response strategy of National Ministries of Health in the Meningitis Belt of Africa, and the challenges ahead.
 

Inhalation of Environmental Dust and Potential Impacts to Human Health
Jose A. Centeno, MSc, PhD, FRSC
International Medical Geology Association
The Joint Pathology Center, Division of Biophysical Toxicology Laboratories, Malcolm Grow Medical Clinic, Maryland, United States

Atmospheric particles originate from a variety of sources, both natural and anthropogenic. While aerosol pollutants such as NOx and SOx are mainly from industrial activities, airborne natural mineral dust has existed as long as there has been loose particles and wind on earth. The total aerosol load in the atmosphere, as well as their metal chemistry and microbiological composition, have been shown to be strongly influenced by presiding climate systems and presence of dry land areas (deserts) and industrialized areas. Hence, natural dust is a form of geologic emission, arising from arid land areas, or from any human activity disturbing the earth’s surface such as mining, agriculture, construction, etc.
 
Health effects from exposure to particulate matter have been widely described in the medical respiratory diseases literature. Direct contact with potentially harmful inhaled particles and the fine, fragile airways contributes to making the respiratory system a major target for dust and toxic agents. But toxic agents carried by dust can also exert adverse effects in other parts of the body as they are dissolved in the lung and absorbed into the blood stream. It is not only the inhalation pathway that needs to be considered, but also the increased exposure from dust deposition on edible crops and in drinking water sources. Thus, in order to set up preventive measures and regulations for dust levels to ensure public health, it is critical to gain knowledge about the potential health effects of environmental dust exposure. Geological information on dust sources, processes that affect mobilization, and transport of dust, as well as toxicological information on the effects and pathways of dust particles through respiratory organs are needed. In addition, careful studies on dust levels, chemical composition, and environmental pathology are required. This presentation will emphasize the global scale of the problem, in terms of its environmental, chemical, and human health implications. Examples will be presented of potential health effects of inhaled environmental dust in deployed military personnel.
 

Wind-Borne Dispersion of Potential Human Pathogens and Toxins: Recent Lessons from Kawasaki Disease
Xavier Rodó, PhD, ICREA & Institut Català de Ciències del Clima - IC3, Barcelona, Spain

Kawasaki disease (KD), an acute self-limited coronary artery vasculitis affecting susceptible children around the world has yet an unexplained epidemiology. Its etiology is unknown more than 40 years after the first case was identified in Japan and its incidence continues to rise in many countries worldwide. Due to the lack of a diagnostic test, many patients are misdiagnosed and severe cardiac sequela, even later at an adult age may lead to aneurysms, cardiac infarction and even death. Though genetic predisposition seems to be a key factor, the temporal and spatial aggregation of synchronic clusters of cases and the year-to-year repeated regional seasonality in occurrences made scientists long ago think of an environmental factor, possibly a virus or bacteria, as the etiologic agent of the disease. Recent results from a suite of different approaches suggest that the cause might be an environmental trigger or preformed toxin being dispersed through the wind and not coursing in the human host as an infectious disease but instead eliciting an idiosynchratic immune response in genetically susceptible children. The trigger, possibly a fungus, due to the abundance of taxa identified in atmospheric samples collected at the times of high incidence of cases in Japan, the country of the world with highest KD incidence, was traced to have the source in intense agricultural areas in NE China. Such an intriguing finding, the confirmation that fungal diseases are on the rise and the fact that animal models in the past were already developed successfully in the lab against one of the suspected candidates for the disease, poses new questions on the role that human activities are having in the binomia environment and health that demand new research avenues and immediate policy action.
 

Session VII: Climate-Induced Shifts in Infectious Diseases

Integrating Climate Information into Surveillance Systems for Infectious Diseases
Madeleine C. Thomson, PhD, International Research Institute for Climate and Society, Earth Institute/Department of Environmental Sciences, Mailman School of Public Health, Columbia University, New York, United States

Many infectious diseases (including those transmitted by insect vectors) are climate sensitive; climate acting as an important driver of spatial and seasonal patterns, year to year variations (including epidemics) and longer term trends. Although climate is only one of the many drivers of infectious diseases public health policymakers and practitioners are increasingly concerned about the potential impact of climate change on the health of populations.
 
The global health system is in a period of rapid change with global health surveillance receiving increasing recognition as a primary source of protection from newly emerging and reemerging threats; infectious diseases, new cycles of pandemics and bioterrorism as well as climate change. These changes impact directly national health systems and services.
 
This presentation will discuss the incorporation of climate information into routine epidemiological surveillance systems for climate-sensitive diseases (focusing on malaria) at the national level in Africa. In it is discussed the changes and improvements in policy, practice, climate services and data required for development and implementation, experience to date and research priorities.
 

Mapping Disease Transmission Risk from Ecological and Biogeographic Perspectives
A. Townsend Peterson, PhD, Biodiversity Institute, University of Kansas, Lawrence, Kansas, United States

Mapping disease transmission risk has long been treated as a spatial challenge—that is, clusters of transmission across regions are detected and mapped, and spatial interpolations are used to fill in gaps in knowledge. This presentation explores a distinct paradigm, which focuses instead on the environmental conditions under which cases or clusters of cases occur, and the geographic distribution of those conditions as regions of potential transmission. The approach thus treats disease transmission more as an ecological and biogeographic phenomenon, and thereby takes advantage of suites of tools developed in the world of biodiversity science. One particular application of this approach has been to mapping potential effects of global climate change on disease transmission risk: as climates warm and reorganize globally, certainly, geographic distributions of species (including pathogens, vectors, and hosts) also will shift and reorganize, creating new and different foci of transmission. I illustrate these ideas with recent analyses of visceral and cutaneous leishmaniasis across the Americas, and of mosquito vectors of dengue and chikungunya.
 

Strong Role of Climate Forcing in Malaria Dynamics in Low Transmission Regions: Implications For the Future
Mercedes Pascual, PhD^1,2

Low transmission regions of high seasonality are of particular relevance to understanding the role of climate forcing in vector-borne infections. For malaria, these regions are found at the edge of its geographic distribution, in highlands and semi-deserts, where the population dynamics of the disease are known as ‘unstable’ and are characterized by seasonal outbreaks whose size varies significantly across years. Besides this interannual variability, incidence patterns show pronounced decadal trends, whose underlying causes have been the subject of debate because of multiple potential drivers, other than climate ones. This talk presents insights from case studies in highlands of East Africa and South America and in semi-arid regions of Northwest India, to show evidence for a clear role of climate forcing in recent decades, and to discuss how this forcing can interact with other drivers of change. ‘Shifts’ created by land-use, intervention efforts, and urban growth will be briefly discussed.
 
Coauthors: Menno J. Bouma, PhD³, Andres Baeza, PhD⁴, Amir Siraj, MSc⁵, Mauricio Santos-Vega, MSc¹
1 University of Chicago, Chicago, Illinois, United States
2 Santa Fe Institute, Santa Fe, New Mexico, United States
3 London School of Hygiene and Tropical Medicine, London, United Kingdom
4 National Socio-Environmental Synthesis Center, Annapolis, Maryland, United States
5 University of Denver, Denver, Colorado, United States
 

Neglected Tropical Disease Transmission, Weather and Climate
Deirdre Hollingsworth, PhD, University of Warwick, Coventry, United Kingdom

Neglected tropical diseases (NTDs) are a group of diseases which affect the poorest populations in the world. They have a variety of routes and modes of transmission, each of which are likely to be differently affected by weather and climate. However, the role of weather and climate on NTD transmission has been very limited, reflecting their ‘neglected’ status. In recent years, there has been a growing international effort and financial investment in controlling these diseases, with commitments extending into the coming decades. Therefore, it is important to assess the role of current climate on their transmission, and study how this may change in the future. Many of these diseases are seasonal and are addressed by yearly or bi-yearly mass drug administrations. Using the particular example of soil-transmitted helminths, we will outline the current evidence base for the role of temperature on transmission, and the likely implications for the timing of interventions. We will also discuss the importance of differences in climate for vector-borne diseases, such as lymphatic filariasis and assess the current state of knowledge on the importance of temperature on their dynamic.
 

Session VIII: Going Global: Pinpointing the Next Steps to Translate Climate Science Into Policy

Lessons Learned in Health Adaptation
Kristie L. Ebi, PhD, MPH, Department of Global Health, University of Washington, Seattle, Washington, United States To address the limited understanding of effective approaches to scaling up health adaptation options to address current and future climate variability and change in low- and middle-income countries, a qualitative review and synthesis of documents was undertaken covering the first five years of implementation (2008-2013) of three multinational health adaptation projects covering fourteen countries (Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Macedonia, Philippines Russia, Tajikistan, and Uzbekistan). Also, qualitative data were collected through a focus group consultation and interviews with 19 key informants purposively selected for their expertise and role in health adaptation.
 
The national projects increased resilience for particular weather-sensitive health outcomes by focusing on incremental improvements in policies and programs to address the current adaptation deficit associated with climate variability, and by beginning to establish enabling environments for additional adaptation. However, no project planned nor considered how to scale up successful community-based activities.
 
The activities undertaken may not be sufficient to address significant increases in climate variability and change. National health plans and budget processes need to move beyond focusing on shorter-term activities to address climate variability to prepare for climate change through better understanding of potential risks, strengthening health systems, ensuring adequate policies and legislation, facilitating institutional support, and public education and awareness programs, including disaster preparedness measures.
 

Health Co-Benefits of the Low Carbon Economy
Andy Haines, MD, F Med Sci, London School of Hygiene and Tropical Medicine

Deep cuts in greenhouse gas emissions are needed to avert dangerous climate change but policymakers are slow to implement appropriate policies because of concerns about cost, impacts on industrial competitiveness and perceived divisions in public opinion.  However a range of collateral benefits (co-benefits) of low GHG emission policies can help offset the costs of implementation.  Strategies to reduce GHG emissions can result in improvements in health through a range of pathways. Reducing the combustion of fossil fuels, particularly coal, can reduce fine particulate air pollution exposure with major benefits to health. Policies directed at reduction of short lived climate pollutants (SLCPs), particularly black carbon and methane, can also lead to substantial reductions in mortality. Improving insulation and ventilation of existing housing stock can reduce exposure to cold and to a number of indoor pollutants. Reducing the use of private cars and increasing active travel through more walking and cycling in urban areas can reduce the adverse health effects of sedentary lifestyle. Changes in diet, including increased consumption of fruit and vegetables, and decreased consumption of animal products (particularly from ruminants) in high consuming economies, can improve health as well as reducing GHG emissions. Taking into account these co-benefits in economic analyses can make policies to reduce emissions more attractive to policy makers.
 

Monitoring Epidemic Precursors of Infectious Diseases in Europe
Jan C. Semenza, PhD, MPH, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

The expansion of infectious diseases is a global public health concern.  A complex web of interacting drivers has been responsible for infectious disease threats in Europe; these drivers can be broadly organized into three categories: 1) Globalization and environmental change, includes climate change, land-use, international travel and tourism, global trade and distribution systems, migration, etc. 2) Social and demographic change, includes social inequalities, lifestyle, etc. 3) Health system capacity, includes health-care delivery, surveillance, reporting, research and development, animal health, food security, etc.  These infectious disease threats are routinely monitored at ECDC as part of epidemic intelligence.  The drivers that contributed to these threats were extracted from scientific papers and epidemiologic reports and subjected to frequency and multiple logistic regression analyses.  Globalization and environment was by far the most important driver category in this analysis, contributing to 61% of all threats. The multiple logistic regression models ranked three globalization and environment drivers in the top five drivers of all threats.  Monitoring and modelling these drivers of globalization and environmental change can help accelerate detection of early cases and provide insights into the timing and patterns of infectious disease outbreaks.  ECDC has explored the utility of such predictive models and has made them available through the E3 Geoportal of the European Environment and Epidemiology (E3) Network.  Selected examples will be presented how ECDC has monitored environmental precursors of infectious diseases in order to help accelerate detection and response.
 

Communicating Climate Science to the Public
Sabrina McCormick, PhD

*To follow.