Paul R. Epstein

Climate Change and Extreme Weather Events; Implications for Food Production, Plant Diseases, and Pests

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Human health effects of a changing global nitrogen cycle

Changes to the global nitrogen cycle affect human health well beyond the associated benefits of increased food production. Many intensively fertilized crops become animal feed, helping to create disparities in world food distribution and leading to unbalanced diets, even in wealthy nations. Excessive air- and water-borne nitrogen are linked to respiratory ailments, cardiac disease, and several cancers. Ecological feedbacks to excess nitrogen can inhibit crop growth, increase allergenic pollen production, and potentially affect the dynamics of several vector-borne diseases, including West Nile virus, malaria, and cholera. These and other examples suggest that our increasing production and use of fixed nitrogen poses a growing public health risk.

Climate Variability and Change in the United States: Potential Impacts on Water- and Foodborne Diseases Caused by Microbiologic Agents

Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

Climate change and emerging infectious diseases.

The ranges of infectious diseases and vectors are changing in altitude, along with shifts in plant communities and the retreat of alpine glaciers. Additionally, extreme weather events create conditions conducive to clusters of insect-, rodent- and water-borne diseases. Accelerating climate change carries profound threats for public health and society.

Biological and physical signs of climate change: focus on mosquito-borne diseases

The Intergovernmental Panel on Climate Change concluded that there is “discernible evidence” that humans—through accelerating changes in multiple forcing factors—have begun to alter the earths climate regime. Such conclusions are based primarily upon so-called “fingerprint” studies, namely the warming pattern in the midtroposphere in the Southern Hemisphere, the disproportionate rise in nighttime and winter temperatures, and the statistical increase in extreme weather events in many nations. All three aspects of climate change and climate variability have biological implications. Detection of climate change has also drawn upon data from glacial records that indicate a general retreat of tropical summit glaciers. Here the authors examine biological (plant and insect) data, glacial findings, and temperature records taken at high-elevation, mountainous regions. It is concluded that, at high elevations, the overall trends regarding glaciers, plants, insect range, and shifting isotherms show remarkable intern...

Full cost accounting for the life cycle of coal.

Each stage in the life cycle of coal—extraction, transport, processing, and combustion—generates a waste stream and carries multiple hazards for health and the environment. These costs are external to the coal industry and are thus often considered “externalities.” We estimate that the life cycle effects of coal and the waste stream generated are costing the U.S. public a third to over one‐half of a trillion dollars annually. Many of these so‐called externalities are, moreover, cumulative. Accounting for the damages conservatively doubles to triples the price of electricity from coal per kWh generated, making wind, solar, and other forms of nonfossil fuel power generation, along with investments in efficiency and electricity conservation methods, economically competitive. We focus on Appalachia, though coal is mined in other regions of the United States and is burned throughout the world.

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

West Nile virus and the climate

West Nile virus is transmitted by urban-dwelling mosquitoes to birds and other animals, with occasional “spillover” to humans. While the means by which West Nile virus was introduced into the Americas in 1999 remain unknown, the climatic conditions that amplify diseases that cycle among urban mosquitoes, birds, and humans are warm winters and spring droughts. This information can be useful in generating early warning systems and mobilizing timely and the most environmentally friendly public health interventions. The extreme weather conditions accompanying long-term climate change may also be contributing to the spread of West Nile virus in the United States and Europe.

The Impact of Climate Change on Child Health

Human activity has contributed to climate change. The relationship between climate and child health has not been well investigated. This review discusses the role of climate change on child health and suggests 3 ways in which this relationship may manifest. First, environmental changes associated with anthropogenic greenhouse gases can lead to respiratory diseases, sunburn, melanoma, and immunosuppression. Second, climate change may directly cause heat stroke, drowning, gastrointestinal diseases, and psychosocial maldevelopment. Third, ecologic alterations triggered by climate change can increase rates of malnutrition, allergies and exposure to mycotoxins, vector-borne diseases (malaria, dengue, encephalitides, Lyme disease), and emerging infectious diseases. Further climate change is likely, given global industrial and political realities. Proactive and preventive physician action, research focused on the differential effects of climate change on subpopulations including children, and policy advocacy on the individual and federal levels could contain climate change and inform appropriate prevention and response.

Deaths and injuries caused by land mines in Mozambique

Land mines in Mozambique are still causing death and injuries years after the initial dispute. Since 1980, 3400 people have had an amputation because of land mine injuries. However, there are no direct estimates of the number of deaths or casualties which are not treated in hospitals. In March, 1994, a medical team assembled by Physicians for Human Rights (PHR) conducted household surveys in the province of Manica and in the sub-district of Metuchira, province of Sofala. The object was to assess the frequency and severity of injuries and mortality caused by land mines in the civilian population. We found ratios of 8.1 and 16.7 casualties per 1000 living people in Manica and Metuchira, respectively. The prevalence of amputees was 3.2 per 1000 in Manica, and 2.3 in Metuchira. These figures are several folds higher than suggested by hospital data. The case fatality rate was 48%. Most of the victims were civilians (68%) and were injured by antipersonnel mines (81%). 16% of victims were women, and 7% were under 15 years of age. Our results suggest that the impact of land mines is substantially higher than originally thought.