# Publications

Myers SS. Global Environmental Change: The Threat to Human Health in Worldwatch Report 181. Worldwatch Institute; 2009. Publisher's VersionAbstract

Over the past two-to-three hundred years, humanity’s ecological footprint has ballooned to such an extent that we are now fundamentally altering the planet. We have transformed the Earth’s land surface and altered the function of its ecosystems, and we are triggering the rapid loss of both terrestrial and marine life. We are also profoundly changing our planet’s climate. It is increasingly apparent that the breadth and depth of the changes we are wreaking on the environment are imperiling not only many of the other species with which we share the ecological stage, but the health and wellbeing of our own species as well. Global climate change threatens human health in numerous and profound ways. Large segments of the population will experience more heat waves, altered exposure to infectious disease, and more-frequent natural disasters. Most significantly, climatic disruption threatens the adequacy of the core “building blocks” of health for large populations around the globe: sufficient food and nutrition, safe water for drinking and sanitation, fresh air to breathe, and secure homes to live in. As climate change dismantles these central elements of healthy societies, people with fewer resources will be forced to migrate in large numbers to lands where they may not be welcome. A likely result of all of these processes will be increased civic instability and strife.

Kahane R, Hodgkin T, Jaenicke H, Hoogendoorn C, Hermann M, Keatinge JDH, d'Arros Hughes J, Padulosi S, Looney N. Agrobiodiversity for Food Security, Health and Income. Agron Sustain Dev [Internet]. 2013;33 :671-693. Publisher's VersionAbstract

By the year 2050, agriculture will have to provide the food and nutrition requirements of some 9 billion peo- ple. Moreover, to maintain that level of productivity indef- initely it must do so using environmentally sustainable production systems. This task will be profoundly compli- cated by the effects of climate change, increasing compe- tition for water resources and loss of productive lands. Agricultural production methods will also need to recog- nize and accommodate ongoing rural to urban migration and address a host of economic, ecological and social concerns about the ‘high inputs/high outputs’ model of present-day industrial agriculture. At the same time, there is a need to confront the unacceptable levels of continuing food and nutrition insecurity, greatest in the emerging economy countries of Africa and Asia where poverty, rapid population growth and climate change present additional challenges and where agriculture is practiced primarily by small-scale farmers. Within this context, we here review science-based evidence arguing that diversification with greater use of highly valuable but presently under- valorised crops and species should be an essential element of any model for sustainable smallholder agriculture. The major points of these development opportunity crops are presented in four sections: agricultural farming systems, health and nutrition, environmental sustainability and pros- perity of the populations. For each section, these crops and their associated indigenous knowledge are reported to bring benefits and services when integrated with food systems. In this paper, we conclude that not only a change in policy is needed to influence behaviours and practices but also strong leadership able to synergize the various initiatives and implement an action plan.

Brown ME, Grace K, Shively G, Johnson KB, Carroll M. Using Satellite Remote Sensing and Household Survey Data to Assess Human Health and Nutrition Response to Environmental Change. Popul Environ [Internet]. 2014. Publisher's VersionAbstract

Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis.

Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, Chaytor S, Colbourn T, Collins M, Cooper A, et al. Health and Climate Change: Policy Responses to Protect Public Health. The Lancet Comissions; 2015. Publisher's VersionAbstract

The 2015 Lancet Commission on Health and Climate Change has been formed to map out the impacts of climate change, and the necessary policy responses, in order to ensure the highest attainable standards of health for populations worldwide. This Commission is multi- disciplinary and international in nature, with strong collaboration between academic centres in Europe and China.

The central finding from the Commission’s work is that tackling climate change could be the greatest global health opportunity of the 21st century. The key messages from the Commission are summarised below, accompanied by ten underlying recommendations to accelerate action in the next 5 years.

Machovina B. The Role of Agriculture and Food Consumption in Tropical Conservation. Department of Biology, Florida International University [Internet]. 2015. Publisher's VersionAbstract

A growing human population, shifting human dietary habits, and climate change are negatively affecting global ecosystems on a massive scale. Expanding agricultural areas to feed a growing population drives extensive habitat loss, and climate change compounds stresses on both food security and ecosystems. Understanding the negative effects of human diet and climate change on agricultural and natural ecosystems provides a context within which potential technological and behavioral solutions can be proposed to help maximize conservation. The purpose of this research was to (1) examine the potential effects of climate change on the suitability of areas for commercial banana plantations in Latin America in the 2050s and how shifts in growing areas could affect protected areas; (2) test the ability of small unmanned aerial vehicles (UAVs) to map productivity of banana plantations as a potential tool for increasing yields and decreasing future plantation expansions; (3) project the effects on biodiversity of increasing rates of animal product consumption in developing megadiverse countries; and (4) estimate the capacity of global pasture biomass production and Fischer-Tropsch hydrocarbon synthesis (IGCC-FT) processing to meet electricity, gasoline and diesel needs. The results indicate that (1) the overall extent of areas suitable for conventional banana cultivation is predicted to decrease by 19% by 2050 because of a hotter and drier climate, but all current banana exporting countries are predicted to maintain some suitable areas with no effects on protected areas; (2) Spatial patterns of NDVI and ENDVI were significantly positively correlated with several metrics of fruit yield and quality, indicating that UAV systems can be used in banana plantations to map spatial patterns of fruit yield; (3) Livestock production is the single largest driver of habitat loss, and both livestock and feedstock production are increasing in developing biodiverse tropical countries. Reducing global animal product consumption should therefore be at the forefront of strategies aimed at reducing biodiversity loss; (4) Removing livestock from global pasture lands and instead utilizing the biomass production could produce enough energy to meet 100% of the electricity, gasoline, and diesel needs of over 40 countries with extensive grassland ecosystems, primarily in tropical developing countries.

Myers SS, Zanobetti A, Kloog I, Huygers P, Leakey ADB, Bloom AJ, Carlisle E, Dietterich LH, Fitzgerald G, Hasewaga T, et al. Increasing CO2 Threatens Human Nutrition. Nature. 2014;510 :139-143.Abstract

Dietary deficiencies of zinc and iron are a substantial global public health problem. An estimated two billion people suffer these deficiencies, causing a loss of 63 million life-years annually. Most of these people depend on C3 grains and legumes as their primary dietary source of zinc and iron. Here we report that C3 grains and legumes have lower concentrations of zinc and iron when grown under field conditions at the elevated atmospheric CO2 concentration predicted for the middle of this century. C3 crops other than legumes also have lower concentrations of protein, whereas C4 crops seem to be less affected. Differences between cultivars of a single crop suggest that breeding for decreased sensitivity to atmospheric CO2 concentration could partly address these new challenges to global health.

Macdiarmid JI. Is a Healthy Diet an Environmentally Sustainable Diet?. Proceedings of the Nutrition Society [Internet]. 2012. Publisher's VersionAbstract

The concept of a healthy and environmentally sustainable diet is not new, but with increasing concern about future global food security and climate change there is a renewed interest in this topic. Dietary intakes in UK accounts for approximately 20–30% of total annual greenhouse gas emissions (GHGE), with the greatest contributions coming from high intakes of meat and dairy products. Dietary proposals to help mitigate climate change (i.e. reduce GHGE) have focused on reducing consumption of meat and dairy products, but this must be considered in the context of the whole diet, alongside any possible nutritional consequences for health. Bringing together health and environmental impact of the diet raises the question of whether a healthy diet can also be an environmentally sustainable diet. While recent research showed that it is possible to achieve a realistic diet that meets dietary requirement for health and has lower GHGE, it cannot be assumed that a healthy diet will always have lower GHGE. With different combinations of food it is possible to consume a diet that meets dietary requirements for health, but has high GHGE. It is important to understand what constitutes a sustainable diet, but this then needs to be communicated effectively to try and change well-established dietary intakes of the population. Studies show that understanding of sustainable diets is poor and there are many misconceptions (e.g. the overestimation of the protein requirements for a healthy diet), which could contribute to the barriers towards changing dietary intakes.

Hales S, Kovats S, Lloyd S, Campbell-Lendrum D ed. Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. World Health Organization; 2014. Publisher's VersionAbstract

WHO releases a quantitative assessment of the health impacts of climate change. This constitutes an update and a further development of the assessment that was first published by WHO for the year 2000, now with a wider range of health impacts, and projections for future years.

The assessment takes into account a subset of the possible health impacts, and assumes continued economic growth and health progress. Even under these conditions, it concludes that climate change is expected to cause approximately 250 000 additional deaths per year between 2030 and 2050; 38 000 due to heat exposure in elderly people, 48 000 due to diarrhoea, 60 000 due to malaria, and 95 000 due to childhood undernutrition. Results indicate that the burden of disease from climate change in the future will continue to fall mainly on children in developing countries, but that other population groups will be increasingly affected.

Hedlund C, Blomstedt Y, Schumann B. Association of climatic factors with infectious diseases in the Arctic and subarctic region--a systematic review. Glob Health Action [Internet]. 2014;7 :24161. Publisher's VersionAbstract

Avnery S, Mauzerall DL, Fiore AM. Increasing global agricultural production by reducing ozone damages via methane emission controls and ozone-resistant cultivar selection. Glob Chang Biol [Internet]. 2013;19 (4) :1285-1299. Full ArticleAbstract

Meeting the projected 50% increase in global grain demand by 2030 without further environmental degradation poses a major challenge for agricultural production. Because surface ozone (O3) has a significant negative impact on crop yields, one way to increase future production is to reduce O3-induced agricultural losses. We present two strategies whereby O3 damage to crops may be reduced. We first examine the potential benefits of an O3 mitigation strategy motivated by climate change goals: gradual emission reductions of methane (CH4), an important greenhouse gas and tropospheric O3 precursor that has not yet been targeted for O3 pollution abatement. Our second strategy focuses on adapting crops to O3 exposure by selecting cultivars with demonstrated O3 resistance. We find that the CH4reductions considered would increase global production of soybean, maize, and wheat by 23–102 Mt in 2030 – the equivalent of a ∼2–8% increase in year 2000 production worth $3.5–15 billion worldwide (USD2000), increasing the cost effectiveness of this CH4 mitigation policy. Choosing crop varieties with O3 resistance (relative to median-sensitivity cultivars) could improve global agricultural production in 2030 by over 140 Mt, the equivalent of a 12% increase in 2000 production worth ∼$22 billion. Benefits are dominated by improvements for wheat in South Asia, where O3-induced crop losses would otherwise be severe. Combining the two strategies generates benefits that are less than fully additive, given the nature of O3effects on crops. Our results demonstrate the significant potential to sustainably improve global agricultural production by decreasing O3-induced reductions in crop yields.

Naish S, Dale P, Mackenzie JS, McBride J, Mengersen K, Tong S. Climate change and dengue: a critical and systematic review of quantitative modelling approaches. BMC Infectious Diseases [Internet]. 2014;14 (167). Publisher's VersionAbstract

### Background

Many studies have found associations between climatic conditions and dengue transmission. However, there is a debate about the future impacts of climate change on dengue transmission. This paper reviewed epidemiological evidence on the relationship between climate and dengue with a focus on quantitative methods for assessing the potential impacts of climate change on global dengue transmission.

### Methods

A literature search was conducted in October 2012, using the electronic databases PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search focused on peer-reviewed journal articles published in English from January 1991 through October 2012.

### Results

Sixteen studies met the inclusion criteria and most studies showed that the transmission of dengue is highly sensitive to climatic conditions, especially temperature, rainfall and relative humidity. Studies on the potential impacts of climate change on dengue indicate increased climatic suitability for transmission and an expansion of the geographic regions at risk during this century. A variety of quantitative modelling approaches were used in the studies. Several key methodological issues and current knowledge gaps were identified through this review.

### Conclusions

It is important to assemble spatio-temporal patterns of dengue transmission compatible with long-term data on climate and other socio-ecological changes and this would advance projections of dengue risks associated with climate change.

Zhang Y, Bi P, Hiller JE. Climate change and disability-adjusted life years. J Environ Health [Internet]. 2007;70 (3) :32-6. Publisher's VersionAbstract

The authors conducted a systematic review of the studies of disability-adjusted life years (DALYs) lost because of climate change. The review considered both methodological issues and research results. It found that little is known about DALYs lost because of climate change, except for results based on limited information presented in the World Health Organization (WHO) global-burden-of-disease study in 2002. The measurement of DALYs attributable to climate change presents additional difficulties over measurement of DALYs attributable to other causes. Further studies linking DALYs and climate change should be conducted in various populations and in different ecological regions, including developing countries.

Volker S, Baumeister H, Classen T, Hornberg C, Kistemann T. Evidence for the temperature-mitigating capacity of urban blue space - a health geographic perspective. Erdkunde [Internet]. 2013;67 (4) :355-371. Publisher's VersionAbstract

Climate change is regarded as one of the greatest challenges to cities in the future. Some proposals focus on incorporating urban green space to counter the rise in temperature and ensuing public health hazards. Urban blue spaces, defined as all surface waters within a city, are regarded as a possible factor for temperature mitigation, but effects have not been quantified and so remain underrepresented in research, recommendations for action and planning. A systematic review was conducted of studies quantifying the temperature-mitigating effects of urban blue compared to other urban sites (n=27). The studies included in the review measured air temperatures at various types of urban blue space such as ponds, lakes or rivers and compared them with reference sites at defined distances or to urban reference sites in the same city. The meta-analysis suggested that a cooling effect of 2.5 K (CI 95% 1.9-3.2 K, p<0.01) during the warmest months on northern hemisphere (between May and October) can be attributed to urban blue sites when including remote sensing data. However, research on the air temperature effects of urban blue space remains sparse compared to attributable to urban blue space are limited by surrounding environmental conditions like microclimate, urban development, wind velocity, wind turbulence, wind direction, temperature and humidity. Future research is needed to help planners use urban blue space efficiently as a temperature-mitigating and health protecting and promoting factor. The temperature-mitigating capacity of urban blue can potentially reduce heat stress in urban areas. To create healthy environments in the cities of the future, a better understanding of health affecting aspects of urban blue is needed to initiate public health action.

Augustin J, Franzke N, Augustin M, Kappas M. Does climate change affect the incidence of skin and allergic diseases in Germany?. J Dtsch Dermatol Ges [Internet]. 2008;6 (8) :632-8. Publisher's VersionAbstract

BACKGROUND: Skin diseases have great socio-economic importance in Germany due to their high and in some cases still-increasing prevalence. Little attention has yet been paid to the influence of the change in climate on these diseases. OBJECTIVE: Clarify the evidence of the effects of climate change on the prevalence of skin diseases and allergies in Germany. METHODS: First, a theoretical model of the possible mechanisms and influence factors of climate and weather was created for different disease groups (skin malignancies, allergies, skin infections). Then, a systematic online and manual literature search was made for model-derived key words.The relevant publications were selected and evaluated according to a priori criteria. RESULTS: From a total of n = 31,221 hits, n = 320 publications remained for evaluation.Changes in the following parameters can be regarded as essential climatologic factors influencing the prevalence of skin and allergic diseases: temperature, UV radiation, precipitation/humidity, cloudiness, and general weather conditions.There were only a few original articles addressed to this topic. Most of them address recurring phenomena (especially levels of airborne pollen), UV radiation or ozone (and the ozone hole). Quantitative statements, prognosis models and climate scenarios have not yet been published for Germany with respect to skin diseases. CONCLUSION: Only few scientific articles on the relationship between climate changes and the prevalence of skin diseases have been published. They do not allow a reliable statement on future developments. The outlook for changes in prevalence requires further clarification using published climate models.

Bouzid M, Hooper L, Hunter PR. The effectiveness of public health interventions to reduce the health impact of climate change: a systematic review of systematic reviews. PLoS One [Internet]. 2013;8 (4) :e62041. Publisher's VersionAbstract

BACKGROUND: Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases. METHODS AND FINDINGS: For each disease, we performed a systematic search with no restriction on date or language of publication on Medline, Web of Knowledge, Cochrane CENTRAL and SCOPUS up to December 2010 to identify systematic reviews of public health interventions. We retrieved some 3176 records of which 85 full papers were assessed and 33 included in the review. The included papers investigated the effect of public health interventions on various outcome measures. All interventions were GRADE assessed to determine the strength of evidence. In addition we developed a systematic review quality score. The interventions included environmental interventions to control vectors, chemoprophylaxis, immunization, household and community water treatment, greening cities and community advice. For most reviews, GRADE showed low quality of evidence because of poor study design and high heterogeneity. Also for some key areas such as floods, droughts and other weather extremes, there are no adequate systematic reviews of potential public health interventions. CONCLUSION: In conclusion, we found the evidence base to be mostly weak for environmental interventions that could have the most value in a warmer world. Nevertheless, such interventions should not be dismissed. Future research on public health interventions for climate change adaptation needs to be concerned about quality in study design and should address the gap for floods, droughts and other extreme weather events that pose a risk to health.

Burkart K, Khan MMH, Schneider A, Breitner S, Langner M, Krämer A, Endlicher W. The effects of season and meteorology on human mortality in tropical climates: a systematic review. Trans R Soc Trop Med Hyg [Internet]. 2014;108 (7) :393-401. Publisher's VersionAbstract

Research in the field of atmospheric science and epidemiology has long recognized the health effects of seasonal and meteorological conditions. However, little scientific knowledge exists to date about the impacts of atmospheric parameters on human mortality in tropical regions. Working within the scope of this systematic review, this investigation conducted a literature search using different databases; original research articles were chosen according to pre-defined inclusion and exclusion criteria. Both seasonal and meteorological effects were considered. The findings suggest that high amounts of rainfall and increasing temperatures cause a seasonal excess in infectious disease mortality and are therefore relevant in regions and populations in which such diseases are prevalent. On the contrary, moderately low and very high temperatures exercise an adverse effect on cardio-respiratory mortality and shape the mortality pattern in areas and sub-groups in which these diseases are dominant. Atmospheric effects were subject to population-specific factors such as age and socio-economic status and differed between urban and rural areas. The consequences of climate change as well as environmental, epidemiological and social change (e.g., emerging non-communicable diseases, ageing of the population, urbanization) suggest a growing relevance of heat-related excess mortality in tropical regions.

Brown LH, Buettner PG, Canyon DV. The energy burden and environmental impact of health services. Am J Public Health [Internet]. 2012;102 (12) :e76-82. Publisher's VersionAbstract

OBJECTIVES: We reviewed the English-language literature on the energy burden and environmental impact of health services. METHODS: We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions. RESULTS: We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. CONCLUSIONS: Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.