Roundtable Themes
1. Health Impacts and Costs of Climate Change
There are a number of links between health and climate change, including periods of extreme heat and cold, severe weather events like hurricanes, tornadoes, lightning and floods, and a variety of direct and indirect influences on the occurrence and movement of disease. In many countries, the impact of climate change on food supplies will also have implications for human health.
Looking ahead, atmospheric carbon dioxide (CO2) concentrations can be expected to double over pre-industrial levels by 2060 or 2070, an outcome that would only be delayed by 10 to 20 years by full implementation of the Kyoto Protocol.
Less extreme cold will mean reduced stress for Canadians, but will make it easier for wintering diseases and pests to survive from one summer season to the next. A warming of up to 5·C during the summer will increase the frequency of extreme heat waves, like the one that led to hundreds of deaths in Chicago a couple of years ago. Bad air days in major cities will also be more common.
Climate researchers are concerned that hurricanes, tornadoes, lightning, and winter storms will increase in frequency and intensity. Summer precipitation will decrease over most of North America but increase in the high North, with direct impacts on food production and the frequency of drought and extreme rainfall.
Because climate change has a combined impact on environmental, economic and health systems the issue represents the best opportunity to implement sustainable development. But since the climate is to some extent an open-access resource, international agreements will be needed to support the local mitigation efforts that are needed. Ultimately, a healthier population means more adaptive institutions, greater ecological integrity, more robust infrastructure, and a society that is less vulnerable.
2. Health Implications of Reducing Emissions
Although the economic costs of climate change have been identified as a primary concern, economic costs should not be the only consideration. Avoided premature deaths constitute 75-85% of all estimated benefits resulting from reduced green house gas (GHG) related emissions and improved air quality; it is estimated that 16,000 Canadians die prematurely each year because of air pollution.
Other health co-benefits include the avoidance of cancer mortality, as well as a range of neurological, reproductive, developmental and immunological diseases. The overall magnitude of co-benefits to GHG reduction is greater than previously estimated.
3. Climate Change Scenarios
Adaptations related to human health can occur at different points in the cycle of GHG emissions and climate change, corresponding to primary, secondary and tertiary public health prevention measures. Level one involves tactical/private adaptations, level two calls for strategic/public adaptations, and level three emphasizes sustainable development paths, including changes in lifestyle, values and technology.
To date, the climate change debate has been mitigation-driven, and has neglected public health. Discussions have emphasized biophysical impact, and human health impacts have been seen as concerns for the future. Peaks in health emergencies related to weather suggest that the meteorological and health communities should work together in formulating links between atmosphere, weather and health.
A long-term research agenda would cover five main areas: heat-related morbidity and mortality; weather-related natural disasters; air pollution; water- and food-borne diseases; and vector- and rodent-borne diseases.
4. The Role of the Health Sector
Science has underestimated the rate at which climate change is occurring, as well as the sensitivity of biological systems to small changes in temperature. A doubling of carbon dioxide levels will expand the area and extend the season in which diseases like malaria can be transmitted. Warmer winters have already extended the geographic range for Lyme disease and encephalitis. Based on the precautionary principle, the public health response should incorporate three levels of solutions: 1) surveillance, monitoring and response capability; 2) better health early warning systems; and 3) policy related to environment and energy.
The health sector can also contribute to a reduction in greenhouse gas emissions. Emissions reductions involve a three-part strategy: 1) recognizing impact, 2) identifying and estimating the costs and benefits of corrective action, and 3) implementing a continuous improvement strategy. In one grouping of health care facilities, fuel use was reduced by 20-55% and electricity use by 12-40% between October 1998 and September 1999.
The role of professional and public education is in informing, persuading, and ultimately changing behaviour. A key challenge is to compete for both public and professional attention in an audience that is increasingly saturated and fragmented. The tone of the message is also a factor: communication based on fear, risk and lack of control does not provoke a good reaction. Health professionals will ultimately bear the responsibility for communication on climate change and health, even if they are already overburdened.
5. Collaborative and Coordinated Approaches
Public health is currently rethinking old assumptions to identify elements of successful collaboration between the health and environmental sectors. Successful collaboration is an ongoing balance between competing interests, driven by the need for pragmatism, the desire for perfection, the challenge of reconciling immediacy and importance, and the need to keep in mind why a project is being pursued and with whom. The best consultation programs are more than what is needed but less than what is desired. Effective collaboration means sharing problems and challenges as well as successes.