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Environment, Society, Climate and Health: Analysis, Understanding and Prediction Mark L. Wilson

Environment, Society, Climate and Health: Analysis, Understanding and Prediction Mark L. Wilson Department of Epidemiology and Global Health Program School of Public Health The University of Michigan Colloquium on Climate and Health NCAR Boulder, Colorado 23 July, 2004. Outline.

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Environment, Society, Climate and Health: Analysis, Understanding and Prediction Mark L. Wilson

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  1. Environment, Society, Climate and Health: • Analysis, Understanding and Prediction • Mark L. Wilson • Department of Epidemiology • and • Global Health Program • School of Public Health • The University of Michigan • Colloquium on Climate and Health • NCAR • Boulder, Colorado • 23 July, 2004

  2. Outline • Introduction: Infectious Disease Epidemiology • Patterns of Environmental Influences • Climate as an Environmental Driver • Examples from our research • Discussion of examples from your research/interests

  3. Climate Variability vs. Climate Change • Climate Change: - persistent change or trend in mean atmospheric conditions - current changes unprecedented in human history • Climate Variability: - day-to-day (weather) or relatively short term (seasonal) changes in atmospheric conditions - effects on disease patterns most easily analyzed, and used in forecasts

  4. Classical Epidemiological Triad Environment Agent Host

  5. Environment* (biophysical, psycho-social, etc.) Agent (diverse exposures, including non-contagious ) Host (animal, plant, ultimately human) *CLIMATE is an Environmental Influence

  6. Environment Agent Host

  7. Environment longevity & infectivity outside host nutrition hygiene host distribution, abundance, infection treatment housing e.g. cholera hantaviral disease hookworm schistosomiasis e.g. TB, HIV/AIDS, diarrheal diseases, acute respiratory infections Agent Host tissue tropisms, pathogenicity, immune response, host specificity e.g. rabies, Lyme disease, malaria, cryptosporidiosi. Examples Involving Infectious Diseases

  8. Environment Altered hygiene Improved irrigation Redesigned housing Better nutrition Agent Host But for ALL diseases, complex interactions occur...

  9. Environment Agent transport to new areas New antibiotics, pesticides Labor actions affecting toxin exposure Agent Host

  10. Exposure probability, host immunity, support networks, availability of supportive care Environment Agent Host

  11. Examples of Environmental and Epidemiological Data • Climate patterns – variability… perhaps change… • Land Use / Land Cover patterns • Human case data (specific or syndromic) • Vector abundance and pathogen infection • Reservoir abundance / infection prevalence • Environmental use and exposures • Economic development, human demography, migration … more Each of these is historicallychanging in time and space

  12. Social and Economic Policies Institutions (including medical care) Living Conditions Social Relationships Individual Risk Factors Genetic/Constitutional Factors Pathophysiologic pathways Physical Environment Individual/Population Health Environmental Determinants of Human Disease Modified from Kaplan, 2002

  13. Social and Economic Policies Institutions (including medical care) Living Conditions Social Relationships Individual Risk Factors Genetic/Constitutional Factors Pathophysiologic pathways Individual/Population Health Research Challenge – Analyze and understand interactions! Climate?

  14. What is climate change? Climate variability? High Unchanging Average, Unchanging Extremes Average Trend Environmental Variable (solid line) Actual Measure (dashed line) Low Time

  15. High Unchanging Average, Increasing Extremes Average Trend Environmental Variable (solid line) Actual Measure (dashed line) Low Time

  16. High Increasing Average, Unchanging Extremes Environmental Variable Average Trend (solid line) Actual Measure (dashed line) Low Time

  17. High Increasing Average, GreaterExtremes Environmental Variable Average Trend (solid line) Actual Measure (dashed line) Low Time

  18. High IncreasingRate of Increasing Average, Unchanging Extremes Environmental Variable Average Trend (solid line) Actual Measure (dashed line) Low Time

  19. High IncreasingRate of Increasing Average, GreaterExtremes Environmental Variable Average Trend (solid line) Actual Measure (dashed line) Low Time

  20. Each of these climate change patterns may have different impacts on particular disease risks. Effects will depend on the ecology of transmission and the etiology and expression of disease.

  21. Each exposure type should be considered in context of: • PERSON (age, behavior, gender, SES, etc.) • TIME (year, season, adjacent periods, etc.) • PLACE (geographic location, habitat, proximity, etc.) • Most Epidemiological studies only superficially consider this for environmental (climatic) exposures: • PERSON most often involves standard descriptors that do not include "social" characteristics or other environmental exposures (e.g. climatic). • TIMEis rarely dynamic, considers only recent past, and climate pattern over long periods not always available. • PLACE often ignored or not carefully evaluated (e.g. spatial autocorrelation, climate patterns in regions may be important ).

  22. Environment and Exposure Direct Exposure Indirect Exposure Environmental Exposures Source Source Vehicle Humans Humans Solar UV EM Radiation Tetanus Stream pollutants Air Particulates Legionella Anthroponotic Infections Humans Humans Vehicle Vehicle Humans Humans STDs Measles Hepatitis B Malaria Dengue Roundworm Zoonotic Infections Animals Animals Vehicle Vehicle Animals Animals Humans Lyme Disease Hantaviral Disease Most arboviral diseases Anthrax Ebola (?) CJD Humans

  23. Direct Exposure Indirect Exposure Source Source Vehicle Humans Humans Solar UV EM Radiation Tetanus Stream pollutants Air Particulates Legionella Environment and Exposure Where might Climate Impact? Environmental Exposures

  24. Direct Exposure Indirect Exposure Humans Humans Vehicle Vehicle Humans Humans STDs Measles Hepatitis B Malaria Dengue Roundworm Environment and Exposure Where might Climate Impact? Anthroponotic Infections

  25. Direct Exposure Indirect Exposure Animals Animals Vehicle Vehicle Animals Animals Humans Lyme Disease Hantaviral Disease Most arboviral diseases Anthrax Ebola (?) CJD Humans Environment and Exposure Where might Climate Impact? Zoonotic Infections

  26. Elements of Climate and Health Heat-related mortality Extreme Events Air Pollution Vector-borne Diseases Water-borne Diseases Agricultural Production Maximum Temperature Minimum Temperature Mean Temperature Rainfall Amount Rainfall Frequency Rainfall Rate

  27. More sensitive • Which are more sensitive???? • Less sensitive • What about less sensitive??? Low High Sensitivity Sensitivity Lowest Moderate What diseases are climate sensitive?

  28. More sensitive • heat stress • effects of storms • air pollution effects • asthma • vector-borne diseases • water-borne diseases • food-borne diseases • Less sensitive • sexually transmitted diseases • violence • most cancers • atherosclerosis • tuberculosis • myocardial infarction Low High Sensitivity Sensitivity Lowest Moderate What diseases are climate sensitive?

  29. Sexually transmitted Disease Heat stress Effects of Storms Water-borne disease More Complex Food-borne disease Asthma Atherosclerosis Vector-borne Disease Cancer (not skin) Myocardial Infarction Violence More Climate Sensitive

  30. Discussion… • From YOUR EXPERIENCES or INTERESTS: • What diseases might have a climate link and what climate variables might impact on which diseases? • WHY? What are the biological or social pathways? • How would these be investigated/researched? • What additional information would you seek? • How would you integrate this into OTHER determinants of risk? • Could you forecast risk based on these analyses alone? • What other factors should be considered and why?

  31. Importance of temporally and spatially extensive data in analyzing and interpreting role of climate: • Climate change occurring over long time period • Climate variability change not easy to recognize without long-term observations • Time-space changes in disease patterns require accurate and consistent surveillance (often non-existent, especially in developing countries) • Inference of climate-disease links limited without carefully considering time-space patterns

  32. a b c d Interpreting Spatial Patterns of Risk • Area of risk • Size of areas • Location and pattern • Inter-area distances • Connectivity among locations

  33. Pattern of disease … or knowledge, SES, exposure, etc... T1 T2 T3 How can extensive time-space datasets help?

  34. How can extensive time-space datasets help?

  35. Abundance / Prevalence Time How can extensive temporal datasets help?

  36. Inter-annual Fluctuations Establishment and Colonization Abundance / Prevalence Dispersal, Invasion, Extinction, Reinvasion Time How can extensive temporal datasets help?

  37. Habitat Fragmentation Distance from Source Climate variable Change in Suitable Habitat How can extensive spatial datasets help? High Abundance or Infection Low Environmental Index Low High

  38. Some Sources of Data • Meteorological Stations (climate, weather) • Satellite – climate, vegetation, soil moisture, etc • Census: population, age, sex, location, etc… • Passive or active surveillance of human cases • Surveillance of vector, reservoir abundance • more...

  39. Knowing is not enough; we must apply.Willing is not enough; we must do.(Goethe)

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