Non-communicable Disease

Particulate Air Pollution ProtectionWarmer temperatures associated with climate change increase the formation of tropospheric ozone, a main constituent of smog and contributor to cardiorespiratory disease, and are associated with longer pollen seasons and increased pollen production, intensifying allergic respiratory diseases such as asthma. Particulate air pollution is driving increases in cardiovascular diseases and associated mortality. We are also currently experiencing a global epidemic of over-nutrition characterized by excessive intake of the wrong foods – largely driven by inadequate access to fruits, vegetables, fish, and nuts and seeds – resulting in unprecedented rates of obesity, diabetes, and heart disease. 

Learning Objectives

  • L1: Explain global trends in the burden of non-communicable diseases.
  • L2: Understand the impact of environmental exposures in air and water on non-communicable diseases.
  • L3: Identify the key stakeholders and partners with whom to prioritize public health and ecosystem problems in the context of non-communicable diseases.


Smith KR, Woodward A, Lemke B, Otto M, Chang CJ, Mance AA, Balmes J, Kjellstrom T. The last Summer Olympics? Climate change, health, and work outdoors. The Lancet [Internet]. 2016;388 (10045) :642-644. Publisher's VersionAbstract

Climate change threatens human health in many ways, through heat waves, extreme weather events, and shifts in disease vectors, as well as economic and social stresses on populations living in or trying to escape areas affected by seawater intrusion, drought, lower agricultural productivity, and floods.1 In the short term, most of these impacts could be substantially ameliorated by actions to reduce background disease risks and other known causes of vulnerability. The world beyond 2050 poses increasingly difficult challenges, not only because of the inherent uncertainties in long-term predictions, but because the extent and speed of change might exceed society's ability to adapt.

Bell ML, Goldberg R, Hogrefe C, Kinney P, Knowlton K, Lynn B, Rosenthal J, Rosenzweig C, Patz JA. Climate change, ambient ozone, and health in 50 U.S. cities. Climatic Change [Internet]. 2007;82 :61-76. Publisher's VersionAbstract

We investigated how climate change could affect ambient ozone concentrations and the subsequent human health impacts. Hourly concentrations were estimated for 50 eastern US cities for five representative summers each in the 1990s and 2050s, reflecting current and projected future climates, respectively. Estimates of future concentrations were based on the IPCC A2 scenario using global climate, regional climate, and regional air quality models. This work does not explore the effects of future changes in anthropogenic emissions, but isolates the impact of altered climate on ozone and health. The cities' ozone levels are estimated to increase under predicted future climatic conditions, with the largest increases in cities with present-day high pollution. On average across the 50 cities, the summertime daily 1-h maximum increased 4.8 ppb, with the largest increase at 9.6 ppb. The average number of days/summer exceeding the 8-h regulatory standard increased 68%. Elevated ozone levels correspond to approximately a 0.11% to 0.27% increase in daily total mortality. While actual future ozone concentrations depend on climate and other influences such as changes in emissions of anthropogenic precursors, the results presented here indicate that with other factors constant, climate change could detrimentally affect air quality and thereby harm human health.

Raudsepp-Hearne C, Peterson GD, Tengöö M, Bennett EM, Holland T, Benessaiah K, MacDonald GK, Pfeifer L. Untangling the environmentalist's paradox: Why is human well-being increasing as ecosystem services degrade?. Bioscience [Internet]. 2010;60 :576-589. Publisher's VersionAbstract

Environmentalists have argued that ecological degradation will lead to declines in the well-being of people dependent on ecosystem services. The Millennium Ecosystem Assessment paradoxically found that human well-being has increased despite large global declines in most ecosystem services. We assess four explanations of these divergent trends: (1) We have measured well-being incorrectly; (2) well-being is dependent on food services, which are increasing, and not on other services that are declining; (3) technology has decoupled well-being from nature; (4) time lags may lead to future declines in well-being. Our findings discount the first hypothesis, but elements of the remaining three appear plausible. Although ecologists have convincingly documented ecological decline, science does not adequately understand the implications of this decline for human well-being. Untangling how human well-being has increased as ecosystem conditions decline is critical to guiding future management of ecosystem services; we propose four research areas to help achieve this goal.

Kunii O, Kanagawa S, iwao Yajima, Hisamatsu Y, Yamamura S, Amagai T, Ismail ITS. The 1997 Haze Disaster in Indonesia: Its Air Quality and Health Effects. Archives of Environmental Health [Internet]. 2002;57 :16. Publisher's VersionAbstract

In this study, the authors assessed air quality and health effects of the 1997 haze disaster in Indonesia. The authors measured carbon monoxide, carbon dioxide, sulfur dioxide, nitrogen dioxide, ozone, particulate matter with diameters less than or equal to 10 microm, inorganic ions, and polycyclic aromatic hydrocarbons. The authors also interviewed 543 people and conducted lung-function tests and determined spirometric values for these individuals. Concentrations of carbon monoxide and particulate matter with diameters less than or equal to 10 microm reached "very unhealthy" and "hazardous" levels, as defined by the Pollution Standards Index. Concentrations of the polycyclic aromatic hydrocarbons were 6-14 times higher than levels in the unaffected area. More than 90% of the respondents had respiratory symptoms, and elderly individuals suffered a serious deterioration of overall health. In multivariate analysis, the authors determined that gender, history of asthma, and frequency of wearing a mask were associated with severity of respiratory problems. The results of our study demonstrate the need for special care of the elderly and for care of those with a history of asthma. In addition, the use of a proper mask may afford protection.

Smith KR, Ezzati M. How environmental health risks change with development: The epidemiologic and environmental risk transitions revisited. Annual Review of Environment and Resources [Internet]. 2005;30 :291-333. Publisher's VersionAbstract

Transition frameworks are used to envision the important changes that occur during economic development from poor to middle-income or rich countries. We explain the derivation of and use data from the Global Burden of Disease (GBD) and Comparative Risk Assessment (CRA) projects of the World Health Organization (WHO) to explore the classic epidemiologic transition framework, which describes the changes in causes of illness and death during economic development. We provide the first full empirical test of the environmental risk transition framework, which describes the shift in environmental risks during development from household, community, and global risk factors. We find that the simplistic conclusions commonly drawn about the epidemiologic transition, in particular the increase in chronic diseases with development, are not supported by current data; in contrast, the conceptual framework of the environmental risk transition is broadly supported in a cross-sectional analysis. We also describe important kinds of environmental health risks and diseases that are not well estimated using current methods.

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