A review of the consequences of global climate change on human health.

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A Review of the Consequences of Global Climate Change on Human Health a

b

c

Ki-Hyun Kim , Ehsanul Kabir & Shamin Ara Jahan a

Department of Civil and Environmental Engineering, Hanyang University, Seoul, Korea b

Department of Farm, Power & Machinery, Bangladesh Agricultural University, Mymensingh, Bangladesh c

BRAC Clinic, Mymensingh, Bangladesh Published online: 16 Sep 2014.

To cite this article: Ki-Hyun Kim, Ehsanul Kabir & Shamin Ara Jahan (2014) A Review of the Consequences of Global Climate Change on Human Health, Journal of Environmental Science and Health, Part C: Environmental Carcinogenesis and Ecotoxicology Reviews, 32:3, 299-318, DOI: 10.1080/10590501.2014.941279 To link to this article: http://dx.doi.org/10.1080/10590501.2014.941279

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Journal of Environmental Science and Health, Part C, 32:299–318, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 1059-0501 print / 1532-4095 online DOI: 10.1080/10590501.2014.941279

A Review of the Consequences of Global Climate Change on Human Health Ki-Hyun Kim,1 Ehsanul Kabir,2 and Shamin Ara Jahan3 1 Department of Civil and Environmental Engineering, Hanyang University, Seoul, Korea 2 Department of Farm, Power & Machinery, Bangladesh Agricultural University, Mymensingh, Bangladesh 3 BRAC Clinic, Mymensingh, Bangladesh

The impact of climate change has been significant enough to endanger human health both directly and indirectly via heat stress, degraded air quality, rising sea levels, food and water security, extreme weather events (e.g., floods, droughts, earthquakes, volcano eruptions, tsunamis, hurricanes, etc.), vulnerable shelter, and population migration. The deterioration of environmental conditions may facilitate the transmission of diarrhea, vector-borne and infectious diseases, cardiovascular and respiratory illnesses, malnutrition, etc. Indirect effects of climate change such as mental health problems due to stress, loss of homes, economic instability, and forced migration are also unignorably important. Children, the elderly, and communities living in poverty are among the most vulnerable of the harmful effects due to climate change. In this article, we have reviewed the scientific evidence for the human health impact of climate change and analyzed the various diseases in association with changes in the atmospheric environment and climate conditions. Keywords: disease

climate change; health impacts; air quality; infectious; non-infectious

1. INTRODUCTION The Intergovernmental Panel on Climate Change (IPCC) states that “Climate change is a change in the state of the climate that can be identified (e.g., by using statistical tests) by changes in the mean and/or the variability of its properties and that persists for an extended period typically decades or longer” [1].

Address correspondence to Ki-Hyun Kim, Department of Civil and Environmental Engineering, Hanyang University, 222 Wangsimni-Ro, Seoul 133-791, Korea. E-mail: [email protected] or [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/lesc.

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The United Nations Framework Convention on Climate Change also defines climate change as “a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods” [1]. Factors that cause significant changes to the earth’s incoming and outgoing energy balance can lead to climate change [2]. Because many types of natural phenomena (such as volcanic eruption, variations in ocean currents, or atmospheric circulation) are involved in the alteration of solar radiation, they can be represented as the major natural components controlling the climate system [3]. However, most of those components are so episodic as to exert only relatively short-term effects on climate [2]. In contrast, increases in global average air (and ocean) temperatures, widespread melting of snow and ice, and rising global average sea level have been observed as the apparent consequence of climate change over the past few decades (Figure 1) [1]. The potential risks and side effects of climate change are projected to rise substantially due to human vulnerability to changes induced by rising heat waves and the associated extreme weather events (flash floods, droughts, heat waves, earthquakes, volcano eruptions, tsunamis, tropical cyclones, etc.) [4, 5]. Among the many changes, deterioration of atmospheric environment is of priori significance, as such alterations can ultimately cause diverse illness and diseases, for example, cardiovascular mortality and respiratory illnesses, vector borne diseases, nutritional diseases (due to food insufficiency), transmission of infectious diseases, and diarrhea (due to poor sanitation) [6, 7]. According to the World Health Organization (WHO), many prevalent human diseases (e.g., respiratory illnesses and cardiovascular disease) are linked to climate fluctuations due to heat waves and altered transmissions of infectious diseases [8]. Parasites that originate in tropical regions may migrate to temperate regions with the spreading of warmer zones [9]. As a result, diseases such as malaria can spread into a broader area. It is also predicted that asthma will increase around the world as allergens of asthma become more common [9]. The impact of climate change on human health will vary greatly depending on many variables including the behavior, age, gender, race, and economic status of individuals. Moreover, such variables can also be expanded to include region, the sensitivity of populations, the extent and length of exposure to climate change, and society’s ability to adapt to change [10]. People living in small islands and coastal regions, megacities, and mountainous and polar regions are particularly prone to such degrading environmental conditions [11]. Likewise, children living in poor countries, the elderly, and those with infirmities or pre-existing medical conditions will be affected most sensitively by these alterations [6, 12]. According to a health report of the US National Assessment on Climate Change, climate change may increase the risk of exposure to air pollutants


Consequences of Global Climate Change

Figure 1: Observed changes in (a) global average surface temperature; (b) global average sea level; and (c) Northern Hemisphere snow cover (smoothed curves are used to represent decadal averaged values with yearly values in circles) (Source: [64]).

through alteration of weather, anthropogenic emissions, and biogenic emissions, while inducing changes in the distribution and types of airborne allergens [13]. In light of the immense latent danger of climate change, this review was organized to collect and describe the growing evidence regarding its human health impacts with altering environmental conditions. In this context, the aim of this review is to analyze the basic features of diverse human diseases in association with climate change and air quality degradation.

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2. IMPACT OF CLIMATE CHANGE AND CONSEQUENTIAL ALTERNATION OF POLLUTANT CYCLING Climate change is expected to alter the concentration and distribution of pollutants in the atmosphere to lead to significant public health consequences [14]. The possible impact of such consequences has been established from many previous studies [1, 15]. Its impact can be reflected on mortality directly via imminent threats (such as floods, droughts, earthquakes, volcano eruptions, tsunamis, cyclones, etc.) and indirectly via slow but steady changes (e.g., water and air pollution). In addition, the frequency and severity of heat waves is also increasing continuously. As a result, the risk of illness and death by dehydration, heart attack, stroke, and respiratory disease is increasing. The WHO estimates that more than 150,000 deaths and 5.5 million disability-adjusted life years can be attributed to climate change as of 2000 [16]. However, these statistics from 2000, while still remaining as the most recent estimate, are based on only five outcomes: direct temperature effects, diarrhea, malnutrition, flood-related injury, and malaria. There is a line of evidence that supports a close linkage between climate change and air pollution. Moreover, many of the traditional air pollutants and greenhouse gases share not only common sources but may also interact physically and chemically in the atmosphere. Consequently, their interactions can cause a variety of environmental impacts on the local, regional, and global scales. Continued global warming is expected to exacerbate air quality problems by increasing the frequency, duration, and intensity of conditions conducive to the determination of air quality. For instance, elevated temperatures can generally facilitate the formation of ozone [17]. However, the impact of climate change on the regional ozone levels can be complicated by the interactions between temperature, water vapor levels, and air circulation patterns [18]. Although ozone concentrations are projected to increase in many regions on the globe, the tropospheric ozone is subject to photocatalytic degradation in the presence of increased atmospheric water vapor. It was estimated that climate change could reduce the global ozone by 0.5–1.0 ppb over the continents and 1–2 ppb over the oceans in 2030 [19, 20]. Nevertheless, ozone smog forms when pollution from vehicles, factories, and other sources reacts with sunlight and heat [21]. Increasing temperatures can speed up this process with the enhanced production of smog. Ground-level ozone is formed when certain air pollutants (such as NOx and volatile organic compounds) are exposed to each other under sunlight [22]. As this ozone can reduce lung function and inflame airways, it can increase respiratory symptoms and aggravate asthma or other lung diseases [23]. Climate change has the potential to induce shifts in precipitation patterns and thereby affecting the fate and behavior of airborne particulate matter (PM) [17, 24]. Hence, the formation of secondary PM can be catalyzed by the



in situ gas phase reactions [17]. Inhaling fine particles can lead to a broad range of adverse health effects, including premature mortality, aggravation of cardiovascular and respiratory disease, development of chronic lung disease, exacerbation of asthma, and decreased lung function growth in children [25]. As climate change affects synoptic-scale weather patterns, it can also lead to the alteration of the regional distribution of air pollutants [26]. Changes in climate conditions play an important role with regards to the cycling of persistent organic pollutants (POPs) by altering the emission rates from primary and secondary sources, gas-particle partitioning, reaction rates (photolysis, biodegradation, oxidation), air-surface exchanges (volatilization), major hydroxyl radical formations, etc. [27]. The environmental fate and behavior of POPs are thus affected, as the fundamental mechanisms of solvent switching and solvent depletion are altered with the enhanced degradation rate of contaminant [28, 29]. Increasing temperatures may also force plants to participate in air quality degradation via enhanced production of pollen [30]. For instance, climate change may facilitate the spread of ragweed, an invasive plant with very allergenic pollen [2, 6]. Furthermore, with the expansion of dry areas, wildfire risks may go up, which would further worsen air quality through the elevation of soot levels [31].

3. TYPES OF HUMAN DISEASES IN ASSOCIATION WITH CLIMATE CHANGE Changes in temperature, precipitation patterns, and extreme climatic events could ultimately lead to the spread of diverse human diseases [32]. As rising temperatures can increase the concentrations of unhealthy air pollutants, smog, pollen pollution, and wildfire smoke, all these can bring about diverse symptoms such as eye irritation, headache, nasal stuffiness, wheezing, skin irritation, coughing, and chest pain [33]. Figure 2 summarizes the global burden of climate change attribute diseases. Especially, young children, the elderly, and those with respiratory problems (such as asthma, emphysema, and bronchitis), are especially vulnerable to the effects of climate change [34]. In the next section, diverse human diseases associated with climate change are reviewed.

3.1. Climate Change and Infectious Disease 3.1.1. Vector-borne diseases Climate change can exert an influence on transmission cycles and the occurrence of vector-borne diseases (VBD) (e.g., malaria, schistosomiasis, onchocerciasis, trypanosomiasis, filariasis, leishmaniasis, plague, Rift Valley fever, etc.). VBD is mainly transmitted by the bite of infected arthropod species

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K.-H. Kim, E. Kabir, and S. A. Jahan Climate impacts


Extreme weather (floods, cyclones, tsunamis, etc.)

Heat waves

Air pollution

Droughts

Respiratory diseases and allergic illnesses

Deaths and injuries

Deaths

Infectious and water-borne diseases outbreaks

Cardiovascular diseases

Stress disorder

M alnutrition and under-nutrition

Vector-borne diseases

Stress disorder

Figure 2: Major known and probable health risks from climate change.

such as mosquitoes, ticks, triatomine bugs, sandflies, and blackflies [6]. Because arthropod vectors are cold-blooded (ectothermic), the biology and ecology of vectors and intermediate hosts are affected by a number of factors (temporal and spatial changes in temperature, precipitation, and humidity). Changes in survival and the reproduction rates of vectors in turn can influence habitat suitability, distribution, abundance, intensity, and temporal patterns of vector activity (particularly biting rates) [35]. Plasmodium falciparum malaria epidemics and Rift Valley fever were observed in Kenya from 1997–1998 due to a short-term increase in temperature and rainfall as an effect of El Nino [36, 37]. VBD is found to be transmitted mainly by mosquito species. As adult female mosquitoes digest blood faster and feed more frequently, they can increase transmission intensity in warmer climates [38]. In addition, mosquito larvae take a relatively short time to mature at high temperatures. Hence, more offspring can be produced during the transmission period [39]. At the same time with rising temperature, malaria parasites and viruses can complete extrinsic incubation within the female mosquito in a short time [40]. The transmission rate of dengue was also found to increase as observed ´ from 2◦ C rise in temperature in northern India [41]. In Mexico, Colón-Gonzalez and colleagues [42] found significant weather influences on dengue incidences. This was because rising temperatures shortened the extrinsic incubation period of the virus as well as the development time and the gonotrophic cycle of the mosquito, resulting in an increased likelihood of dengue transmission [43]. As a result of increases in heat, precipitation, and humidity, nearly 4000 cases of imported and locally transmitted dengue fever were reported in the United


States between 1995 and 2005 [44]. However, several other factors (such as changes in land use, population density, and human behavior) can also influence the occurrence pattern of VBD as well as the extent of its infection [35].


3.1.2. Diarrhoeal diseases Climate change is expected to increase the global burden of diarrheal disease, which is responsible for the majority of childhood deaths globally [45]. Previous studies confirmed an array of climatic factors as the cause of diarrheal disease (including temperature, rainfall, and relative humidity) [46–48]. After a flood-event, rates of diarrhoeal disease (including cholera) may increase, especially in areas with poor sanitation facilities [49, 50]. Indeed, even without flooding, heavy rainfall may increase rates of diarrhoeal disease due to the overflow of latrines or sewage systems [47, 51]. On the other hand, drought conditions can reduce the availability of fresh water, increasing the frequency of diarrhoeal and other diseases associated with poor hygiene [52]. High temperatures are also a risk factor of increased rates of diarrhoeal diseases including salmonella and cholera [53]. In 1997, a great number of patients with diarrhea and dehydration were admitted to hospitals in Lima, Peru, with ab˜ event [54]. A time series analysis normal temperatures rise during an El Nino of daily admission data from the hospital confirmed 8% increase due to diarrhea per 1◦ C increase in temperature [55]. 3.1.3. Cholera Cholera is highly contagious and dose-dependent, while being ingested via contaminated water and food (especially seafood) [56]. Vibrio cholerae, the causative agent of cholera, was identified to be associated with plankton and copepods for its survival, multiplication, and transmission [57]. For instance, at a salinity of 15% and temperatures from 25◦ to 30◦ C, attachment of V. ´ cholerae to copepods was reported [58]. Fernandez and colleagues [59] analyzed data from three cholera epidemics in Lusaka, Zambia from 2003 to 2006. They concluded that the increase in cholera cases is controlled by rising temperatures. They found the 5.2% increase in cholera cases during an epidemic at 1◦ C increase in temperature (six weeks before the beginning of the outbreak). Scientists from the International Vaccine Institute in Seoul, Korea analyzed disease and weather data from cholera-endemic areas of Zanzibar, Tanzania from 2002 to 2008; a cholera outbreak occurred imminently in the month if an increase in the average minimum temperature (one degree Celsius) and an increase in rainfall (200 mm) were recorded in a previous month [60]. Explanation for cholera outbreaks in coastal areas of Bangladesh has also been sought in terms of the rise of sea surface temperature and abundance of plankton (as an environmental reservoir of the cholera pathogen) [61]. Magny and Colwell [56] proposed a possible linkage between cholera bacterium, sea surface temperature, and phytoplankton. As surface temperatures

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increased, the abundance of phytoplankton brought about a large population of zooplankton, which served as a reservoir for cholera bacteria, a waterborne disease [62]. Droughts can promote the growth of cholera vibrios by increasing salinity in local waters, which in turn helps Vibrio cholerae attach to copepods. Ultimately, floods help distribute the bacteria more widely [63]. Climate change-driven storms, flooding, and heavy rainfall may also lead to the spread of cholera in more physical ways by breaking down sanitation, sewage treatment plants, water treatment systems, etc.

3.2. Climate Change and Non-infectious Disease 3.2.1. Effect of heat waves The World Meteorological Organization [64] defines a heat wave as “when the daily maximum temperature of more than five consecutive days exceeds the average maximum temperature by 5◦ C (9 F), the normal period being 1961–1990.” Rising temperature is indeed the most robust among all the phenomena induced by global warming. Apart from discomfort, rising temperatures can also raise the number of illnesses, emergency room visits, and even deaths [65]. Due to the magnifying effect of paved surfaces and the lack of tree cover, city dwellers can be frequently put under heat-related risks [9]. Hence, illnesses are projected to increase with enhanced frequency and growing intensity of heat waves. The human body follows two natural mechanisms to cool off: (i) evaporation of sweat from the skin and (ii) increasing skin blood flow [7]. However, these processes may put strain on the heart and lungs. As a result, excessive heat can cause a host of adverse health effects including heat cramps, heat edema (swelling), heat syncope (fainting), heat exhaustion, and life-threatening heat stroke [12]. Additionally, a number of chronic medical conditions can increase heat stress and associated illnesses: obesity, vascular disease, multiple sclerosis, hyperthyroidism, diabetes, breathing problems, skin diseases, and psychiatric problems [7]. A number of indirect effects of increasing temperatures may be listed to include social isolation and the use of drugs to treat depression, high blood pressure, or insomnia [66]. Its impacts can also be extended to add eye diseases like cataracts, dry eyes, pterygium, and vernal keratoconjunctivitis, and skin diseases [67]. A deadly heat wave in Europe claimed around 70,000 lives in 2003 [68] and 56,000 in Russia in 2010 [69]. In the United States, an average of 400 deaths per year was estimated as the direct consequence of heat, while approximately 1800 died from illnesses were indirectly worsened by rising heat, including heat exhaustion, heat stroke, and cardiovascular disease [9].



3.2.2. Respiratory diseases Increases in temperature (and ozone concentration levels) can lead to an increase in the burden of diverse diseases ranging from airway injury and inflammation to acute decrease in lung function [70]. Inhaled ozone causes an inflammatory response, manifested by increased airway permeability and bronchial hyperactivity, which can lead to increasing incidences of asthma and other cardiovascular respiratory diseases [71, 72]. In England and Wales, more than 2000 excess deaths were reported more than 10 hot summer days (from August 4–13, 2003) due to the devastating heatwave of that year [73]. Approximately one-fourth to one-third of those deaths have been attributed to the effects of increased particulate air pollutants and ozone, which spiked in concentration with the soaring temperatures [74]. Ozone has been identified as a powerful oxidant to cause structural airway and lung tissue damage as well as severe symptoms of asthma, which is often accompanied by such phenomena as an increase in respiratory hospital admissions and deaths in both Europe and the United States [75, 76]. According to a previous study, ozone exposure raises the risk of death from respiratory causes because long-term, low-level exposure can exert lethal effects [77]. In another study, Bloomer and colleagues [78] examined 3-million valid simultaneous measurements of temperature and ozone. The overall result was that for roughly every degree of warming (◦ F) in the observed data, there was a corresponding increase of ozone pollution by 1.2 parts per billion (ppb) [78]. Like the case of ozone, warmer air temperatures can influence the regional distribution of aeroallergens. Allergenic pollens tend to grow more profusely in a warmer climate, spreading respiratory disorders such as asthma, emphysema, chronic bronchitis, and allergy problems [79]. Changes in the climate can also affect a number of pulmonary diseases like chronic obstructive pulmonary disease, pneumothorax, and respiratory infections in children [79]. There are also indications of a relationship between air pollution and tuberculosis. Further, there is a line of evidence suggesting that dust storms in deserts (as well as high altitude areas) can cause respiratory problems for people in distant areas [80]. Recent research presented scientific evidence that the risk of premature death among respiratory patients is up to six times higher than in the rest of the population with the rise of every one Celsius degree in temperature [81].

3.2.3. Cardiovascular health Because of climate change, the risk of cardiovascular disease rises both directly and indirectly via air pollution and changes in dietary options [82]. The physiological reactions to increased heat exposure include a number of symptoms (such as increased core body temperature and heart rate, shift of

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blood flow from central organs to skin, and greater sweating and associated dehydration), if sufficient quantities of liquid are not provided [83]. Extreme cold and extreme heat can increase hospital admissions for chest pain, stroke, cardiac dysrhythmia (irregular heart beat), and other cardiovascular diseases [84]. Increased ozone formation (due to temperature rise) is suspected to cause heart attacks by damaging pulmonary gas exchange processes with enhanced heart stress [85]. As droughts can also facilitate the rise of PM levels in the atmosphere, it may help the development such symptoms as systematic inflammation, compromised heart function, deep venous thrombosis, pulmonary embolisms, and blood vessel dysfunction [86]. As a result of extreme weather events, growth in stress and anxiety levels can also lead to heart attacks, sudden cardiac death, and stress-related cardiomyopathy (heart disease) [87]. Liao and colleagues [88] stated that the number of deaths from cardiovascular diseases would increase by 0.23% with an increment of temperature by 1%. Hajat and associates [89] reported the combined effects of cardiovascular diseases due both to heat exposure and air pollution during hot seasons in megacities ˜ Paulo, and London). (e.g., Delhi, Sao

3.2.4. Mental health The impact on mental health induced by extreme weather conditions (like hurricanes, tornados, floods, fires, drought, tsunamis, etc.) is expected to be reflected by anxiety, post-traumatic stress, depression, etc. [90, 91]. These mental effects can persist over extended periods because of the loss of homes, livelihoods, and communities. Even in the absence of direct physical impacts, the perception and fear of climate change may threaten mental health to a great extent [92]. Nevertheless, such impact may differ according to the type, suddenness, and scale of the catastrophe, while being distinguished in the context of the social, historical, and cultural factors [93]. About 63% of Hurricane Katrina evacuees were reported to suffer from either moderate or severe symptoms of post-traumatic stress disorder [94]. As such, most psychosocial effects of climate change are likely to proceed gradually and cumulatively. Droughts are predicted to become more frequent and severe in many subtropical regions of the world due to climate change, and they are subsequently expected to cause hunger, anxiety, and depression with the reduction of agricultural productivities [95]. Consequently, suicide rates, especially of farmers, are reported to rise noticeably with droughts [96]. Heat waves that can engender increased interpersonal violence, anxiety, depression, and reduced work capacity (apart from sickening) can also lead to the deaths of those who are unable to find the means to remain cool [97]. Social isolation is another aspect of heat stress, as some people may not venture outdoors during hot days, which may promote the further depression. A study conducted in Adelaide, Australia


also pointed an increased incidence of hospital admissions with mental health diagnoses during heat waves [98].


3.2.5. Cancer Climate change is also suspected to exert a potential impact on cancer both directly and indirectly in the form of mitigation strategies. Most importantly, increased exposure to suspected carcinogenic toxic chemicals is likely to increase due to heavy rainfall and volatilization of chemicals due to increased temperature [99]. Melting glaciers and ice sheets can also release cancercausing pollutants into the oceans and air [100]. By damaging the stratospheric ozone layer, climate change may dramatically raise the chance of UV exposure, which can increase the dangers of skin cancer [101, 102]. Increased UV radiation can also impact the human immune system and alter the body’s ability to remove the earliest mutant cells that initiate the cancer process. It is however yet unclear whether these changes would be beneficial or detrimental [103]. Moreover, a decline in air quality with the rise of air pollutant level may also increase the risk of lung cancer [104]. As weather patterns become more erratic with climate change, liver cancer (through aflatoxin contamination) has been suspected to become an increasing problem [105]. Nevertheless, climate change is also expected to increase heavy precipitation and flooding events. Such conditions, if occurring, may also affect the potential for leakage of toxic contaminents from storage facilities or their runoff into water from land containing toxic pollutants. Some of these chemicals are known carcinogens with their ultimate impact of bringing about greater incidences of cancer [106].

4. PRE-EMPTIVE POLICIES AND PLANNED ADAPTIVE STRATEGIES As shown in Table 1, there are diverse diseases that are tightly linked to climate change across various regions on the globe. According to the WHO, “Global warming that has occurred since the 1970s caused over 140 000 excess deaths annually by the year 2004” [8]. Many of the major killers such as diarrhoeal diseases, malnutrition, malaria, and dengue are highly climate-sensitive and are expected to worsen with time. Table 2 summarizes some examples of death toll data as the direct or indirect consequences of climate change. Although climate change poses many kinds of risks to human health and ecosystems, it may also bring some limited beneficial effects like fewer cold-related deaths, increased food supply (by enhanced agricultural productivity and land), etc. [107]. The ideal goals of climate policy should thus be set to reduce its risks, while taking advantage of its opportunities. Because adapting to the potential effects of climate change is a complex and ongoing process, it indeed requires action taken by individuals, communities, governments, and international agencies. In order to make proper decisions, policymakers should be able to provide timely and useful information about

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K.-H. Kim, E. Kabir, and S. A. Jahan Table 1: Global Burden of Climate Change Attribute Disease (Source: [108]) Total DisabilityAdjusted Life Years /Million Population Malnutrition Diarrhea Malaria Floods Total


Region African region Eastern Mediterranean region Latin American and Caribbean region South-East Asian region Western Pacific regiona Developed countriesb World

616 313

414 291

860 112

4 52

1894 768

3072 1587

0

17

3

72

92

188

1918

640

0

14

2572

1703

0

89

43

37

169

111

0

0

0

8

8

8.90

2847

1460

1018

192

5517

920

aWithout bAnd

developed countries. Cuba.

the possible consequences of climate change and available adaptation options. Efforts should also be directed toward accurate assessments to cope with the potential consequences of climate change to seek for the maximum opportunities to reduce the risks. Table 2: The Death Toll as the Direct or Indirect Consequences of Climate Change

Order 1 2 3 4 5 6 7

8 9 10 11 12 13

Cause of Death

Number of Deaths

Heat wave

600 70,000 56,000 760 560,000 3076 2828

Drought Flood

Cyclone Tsunamis Diarrhoeal disease Malnutrition and undernutrition Malaria

4723 138,366 230,000 2.2 million

Location

Period

United States 1995 Europe 2003 Russia 2010 England 2013 East Africa 2011–2012 India, Bangladesh 2004 2011 Philippines, Thailand, Cambodia, Myanmar, Malaysia, Vietnam, Southeast Europe 2013 Myanmar 2008 Indonesia 2004 Global Each year

References [109] [68] [69] [110] [111] [49] [50]

[51] [112] [113] [8]

3.5 million

Global

Each year

[8]

1 million

Global

Each year

[8]



The challenge for decision-makers is complicated by the fact that climate change is only one of the many delicate factors that can influence human health and ecosystems, while being affected by a variety of social, political, economic, environmental, technological, and demographic factors [66]. Because of deep involvement in multiple sectors and resources including agriculture, forestry, water resources, air quality, ecosystems and biodiversity, and cultural resources, climate change may force many types of conflicts between stakeholders representing the interests of different sectors [16]. To effectively allocate scarce human and financial resources, policymakers must contend different situations to control multiple social objectives (e.g., elimination of poverty, support for agriculture, promotion of economic growth, and protection of cultural resources) and competing stakeholder desires. For this reason, the IPCC suggested that it is helpful to view climate change as part of the large challenge of sustainable development [1].

5. CONCLUSION The impact of climate change on human health is largely negative despite certain potential positive effects (e.g., lower cold-related mortality and greater crop yields in temperate zones). Its negative impacts are, however, projected to be heavily concentrated in developing low-latitude countries already experiencing a large burden of disease due to flood, drought, extreme weather events, heat wave, cyclones, etc. The consequences of climate change are thus wide enough to alter spatial and temporal distribution of vector-borne diseases, exacerbation of heat related mortality, air pollution related respiratory diseases, and water borne diseases. It has become critical to determine the scope and focus of both basic and applied research on climate change and the associated health impact at local, regional, national, and global levels. Significant research is essential to integrate climate science with health sciences. Integrating environmental, public health, and meteorological observations to realtime public health issues, along with efforts to downscale long-term climate models should be effectively and efficiently put together to accurately estimate human exposure risks and burden of disease. Such systematic efforts should also be directed to incorporate a breadth of environmental parameters as well as sociodemographic parameters such as population, income, and education.

FUNDING This study was supported by a grant from the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (MEST) (No. 2009-0093848).

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